Dr. Jones: Every year, tens of millions of Chinese women observe a practice of staying inside for a month after giving birth. This custom is called, "Sitting the Month." Is it a strange custom? What do we recommend? This is Dr. Kirtly Jones from obstetrics and gynecology at the University of Utah Health and this is about the rituals we practice after having a baby on the Scope.
Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.
History of Childbirth
Dr. Jones: All over the world, for the hundreds of thousands of years that we have been humans, giving birth has been a very risky business. Until 100 years ago, 1 in 10 women died in childbirth. Of all the ways women met their death, giving birth was one of the most common. If they survived a difficult birth, they were often left weakened and anemic with trauma to their pelvic tissues. If their babies survived, they needed to successfully breastfeed, as there was no formula for babies. Mothers who found themselves barely alive had to also provide the milk for their babies to survive.
All over the world, there are cultural practices around this very delicate time after childbirth for the mom and the baby. In fact, we still use the word EDC, estimated date of confinement, as the term for the due date. But what is this confinement business? What do Chinese woman do? I trained in obstetrics and gynecology at the Boston Lying-In. Lying in was the term for the rest period for woman after giving birth, and many obstetrical hospitals have that phrase in their name.
The laying in period in the US was anywhere from two weeks to two months, even for healthy woman and it was their confinement. Of course, this was the luxury for woman of some financial means. Many women in the 1800s had no choice but to get up shortly after birth, and take care of the baby, all the other children, and help out on the farm. Although, most women were attended by other women in their family, or church community, and hopefully, a skilled birth attendant, they didn't have two weeks or two months to stay in bed.
Until World War I and World War II, women who gave birth in a hospital stayed in bed at the hospital for a week or so, recovering from the delivery. When hospital beds were needed for wounded soldiers, the time in the hospital was decreased from two weeks to one week, to four days, to our present 48 hours. The good news is that the frequency of a condition called Milk Leg, or blood clots in the leg from lying around that might have progressed to blood clots in the lungs, dramatically decreased when women got up out of bed after birth.
So what about those Chinese women in the practice of, quote, "sitting the month?" Women cannot go out. Family cannot come in. The guidelines are set to help women restore their energy balance to their bodies and protect their babies. Women are not allowed to bath or shower or go outside, drink cold fluid, or eat spicy foods. They cannot eat raw vegetables or fruits or drink coffee. No coffee.
All fluids have to go between room temperature or hot, and they have to bundle up and stay very warm. These practices have been noted in documents going back 2000 years. Today's affluent Chinese women can go to special confinement center, there's that word confinement again, and have all their ritual needs met for $500 a day. So we know that women are often exhausted and beat up after the birth of a child, especially the first one.
They're often exhausted, bruised, and battered down there. Their bladders don't work. And their hemorrhoids hurt. And breastfeeding every two hours doesn't help with the sleep problems. About 70 percent of women have the baby blues in the first couple weeks postpartum, and about five percent of women will develop postpartum depression. So what is good medical practice?
Postpartum Care: Recovery Timeline
The first two weeks are rocky. That's the time that moms are establishing their milk production and their feeding schedule. They need to drink a lot of fluids, and eat a balanced diet of whole grains, lots of fiber for that beat up bum, fruits, vegetables, and protein. They may continue taking their prenatal vitamins several weeks for iron replacement if they had significant blood loss, iron rich foods or iron replacement can be recommended.
Ladies need a lot of rest. But as soon as they're comfortable, after the cesarean or difficult delivery, they need to get up and walk around. This is important by, in decreasing the risk of blood clots. Family can help by taking on the cooking and cleaning responsibilities in the home for the first two weeks or maybe the first two months or maybe two years. Well, two weeks at least.
In the US women are often given an appointment to see their OB six weeks after the birth of a child. That six-week idea was made up as the time by which women should have her pelvic organs back to normal. This is a totally ridiculous plan. By six weeks, new moms have either sunk or swum on their own. If they're suffering postpartum depression, they're already well into it. If they have a bladder problem, they've been suffering for over a month. If they're not breastfeeding, they may by already pregnant because they can ovulate at four weeks. And 50 percent of women resume intercourse before their, postpartum visit.
In Europe and Great Britain, it's common for home nurse visit by a midwife, or a nurse, at about a week after discharge from the hospital. This offers support and answers questions for the new mom. A randomized trial of a midwife home visit at 10 days and three weeks, instead of a physician's six weeks visit, found women were more likely to be using contraception, more likely to be breastfeeding successfully for longer, more likely to have their babies immunized, and less likely to be depressed, if they had a home midwife visit on that schedule.
So what's the six-week postpartum visit for? We used to do a pap smear and start contraception at that visit. But now, pap smears are done every two to three years, and women should have started contraception or had a plan before they left the hospital.
Family practice docs, who do obstetrics and will also be taking care of the baby, see the mom and the baby at two weeks, a great idea. Combined group care with the pediatrician and an OB or midwife at two weeks would make a lot easier for new moms to, not only have to pile all that stuff in the cart once, but do it over and over again. So we're thinking about that here at the university and it's a great idea.
What are the cultural practices around the postpartum period in your cultural background? We certainly should celebrate the birth of a new citizen of the planet, and the woman who put her body and her life at risk to accomplish this miracle. As obstetrics practitioners, we should give up the arcane and useless rituals like the six weeks postpartum visit, and see women and their babies in a more evident space timing and do a more family friendly combination of services.
And if you can get your family to take over the cooking and cleaning for two years after the birth of a child, more power to you.
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updated: May 29, 2018
originally published: December 10, 2015
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