"Doing the month": an exploration of postpartum practices in Chinese women

Taiwanese women's experiences of becoming a mother to a very-low-birth-weight preterm infant: a grounded theory study

BACKGROUND

Significant improvements have occurred in the survival rates of small preterm infants. As more infants survive their preterm birth, the number of parents associated with this experience has also increased. Clearly, the birth of very-low-birth-weight (VLBW) preterm infants poses considerable challenges for all mothers. These challenges are further compounded in Taiwan, where women are traditionally required to practise the cultural ritual (Zuo Yue Zi) which includes confinement to the house with a special balanced diet for the first month postnatally. Moreover, there is a deficit of information on mothers' experiences when their preterm infants are in neonatal intensive care units (NICUs).

AIMS

The aim of this study was to explore Taiwanese mothers' (n=26) parenting experiences when their preterm infants were in NICUs.

DESIGN

A qualitative research approach, grounded theory, was used to explore the mothers' lived reality of these experiences.

METHODS

In-depth interviews and participant observations were conducted to gain insight into the experience of parenting.

FINDINGS

A theoretical model was formulated from the findings delineating Taiwanese mothers' parenting experiences during their preterm infants stay in hospital. The findings indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with an unexpected crisis. The particular cultural postnatal ritual posed this group of Taiwanese mothers with an additional difficulty in establishing physical interactions. However, the Taiwanese mothers created alternative channels of contact with their hospitalised infants using emotional connections, while the physical interactions were certainly limited. Despite all the difficulties this group of Taiwanese mothers faced and resolved, they all gradually captured and embraced the parenting role. The finding of this study further indicated that the support the mothers received from the healthcare professionals and the social networks the mothers made helped to create the connections that developed between the mothers and infants, making their journey towards parenthood possible.

CONCLUSION

The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This would help Taiwanese women come to terms with becoming mothers of VLBW infants and subsequently enhance their parenting role.

A population-based survey of women's traditional postpartum behaviours in Northern China

OBJECTIVE

to describe patterns of women's postpartum behaviour in the period of 'doing the month' in a Northern rural area in China; and to determine the degree of difference between postpartum behaviour and daily behaviour.

DESIGN

a retrospective cross-sectional survey was conducted in May 2004, using a questionnaire previously developed in pilot studies.

SETTING

Laishui County, Hebei Province, China.

PARTICIPANTS

a random sample of 1813 rural women.

FINDINGS

women's traditional postpartum behaviours assessed by our postpartum behaviour questionnaire showed that most women adhered to traditional customs, drastically changing their practices in eating, sanitation, dress, activity, and household chores during the period of 'doing the month.' The analysis of variance analysis indicated that a woman's age had no effect on the change of behavioural patterns, and that a women's education had no significant effect.

CONCLUSIONS

traditional postpartum behaviours are still very popular in rural areas of Northern China. Fearful of suffering illness in later years, many women closely adhere to traditional postpartum practices.

Maternal lactation characteristics after consumption of an alcoholic soup during the postpartum 'doing-the-month' ritual

OBJECTIVE

The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and the lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum 'doing-the-month' ritual.

DESIGN

Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0.3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured.

RESULTS

Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, beta-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant.

CONCLUSION

Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.

Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study

BACKGROUND

Zuo yuezi is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of zuo yuezi from social, cultural and western medical perspectives.

METHODS

We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards.

RESULTS

Respondents reported that zuo yuezi was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. Zuo yuezi included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several zuo yuezi practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although zuo yuezi emphasises breast feeding.

CONCLUSION

Zuo yuezi is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed.

Demographic characteristics of participants in studies of risk factors, prevention, and treatment of postpartum depression

OBJECTIVES

Metaanalyses have found that sociodemographic variables are not strong predictors of postpartum depression. However, no studies have systematically examined the extent to which the samples used in published research on postpartum depression have included sufficiently diverse samples of women to merit this conclusion. The objectives o this study were to examine the demographic characteristics of participants in previously published studies and to document existing gaps in the current literature.

METHOD

We extracted age, ethnicity, relationship status, and socioeconomic status of 51 453 participants from 143 studies previously selected for systematic literature reviews.

RESULTS

Few studies reported complete demographic data; however, existing data indicate that participants were predominantly aged 25 to 35 years, white, partnered, and of mid- or high-socioeconomic status.

CONCLUSIONS

To assess the external validity of the findings, improved reporting of demographic characteristics is required in publications related to postpartum depression. Additional research is needed to understand postpartum depression among understudied populations.

Alcohol levels in Chinese lactating mothers after consumption of alcoholic diet during postpartum "doing-the-month" ritual

This study examined the effects of exposure to ethanol through cultural practices by lactating mothers. Specifically, the pharmacokinetics of alcohol in Chinese lactating mothers was investigated after they consumed chicken soup flavored with sesame oil and rice wine (CSSR), a typically prescribed diet during the postpartum "doing-the-month" period. Experimental findings were employed to estimate the potential ethanol dose to neonates and determine associated health risks. Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. The target alcohol dosage was 0.3g/kg. Milk and blood samples were collected at fixed time intervals from each subject following exposure to CSSR, and alcohol levels were determined. Acute health risks to infants were estimated by comparing the potential infant dosage to an established criterion dose. Blood alcohol level peaked at 20 min after exposure to CSSR and decreased almost linearly thereafter. Alcohol in milk reached a plateau roughly at 20-40 min after exposure to CSSR and then decreased. Alcohol pharmacokinetics among subjects varied widely. The coefficients of variation in subject alcohol concentrations were 16.5-46.2% (mean, 30.0%) for blood and 32.8-57.6% (mean, 44.4%) for milk. Mean maximal alcohol concentration in blood (30.2+/-5.0 mg/dl) was achieved at 23.5+/-7.6 min and in milk (31.6+/-10.3 mg/dl) at 31.7+/-12.7 min. Potential infant doses were 3.0-58.8 mg (mean, 13.4 mg), and the predicted time required for milk alcohol level to return to zero level was 175 min. The acute health risks for infants exposed to alcohol through their mothers' milk under the current exposure scenario are low (hazard index<0.2). Nursing infants at least 3h after ingesting a diet containing alcohol would further reduce potential health risks.

Perceived Stress and Support of the Chinese Postpartum Ritual “Doing the Month”

"Doing the month" is the traditional ritual for Chinese postpartum women. A qualitative study involving in-depth interviews with 20 Hong Kong Chinese women was conducted to examine the women's perceptions of stress and support in "doing the month." Four central themes were identified as follows: bound by the environmental constraints, difficulties in following the prescriptions of the rituals, conflicts between the parties involved, and attainment of the maternal role. The study revealed that "doing the month" is not necessarily protective and supportive of the postpartum women. It raises the critical question of how women can adapt the ritual to fit modern life. The study findings suggest that midwives and health care providers should provide culturally appropriate advice for new mothers. Suggestions are given on bridging the gap between traditional and modern postpartum practices.

Becoming a role model: the breastfeeding trajectory of Hong Kong women breastfeeding longer than 6 months

While a substantial proportion of breastfeeding women stop early in the postpartum period, some women are able to breastfeed for longer periods. The aim of this research was to explore the experience of breastfeeding with a subsample of Hong Kong women who have breastfed for longer than 6 months. Participants (n=17) were recruited from a larger infant-feeding study (n=360) conducted in tertiary-care hospitals in Hong Kong. In-depth qualitative interviews were conducted and content analysis was used to analyse the data. Data analysis revealed four themes that encompassed the women's experiences: (1) making the decision, (2) maintaining family harmony, (3) overcoming barriers, and (4) sustaining lactation. Antenatally, participants anticipated that breastfeeding would be very 'difficult' and described how the practice did not fit with the image of a professional woman in Hong Kong. Despite family opposition, frequently from their mother-in-law, and lack of societal acceptance, difficulties were overcome by what the Chinese people call hung-sum or determination. This study highlights unique cultural and social findings affecting breastfeeding women in Hong Kong which may be useful to health-care providers working with Chinese women locally and internationally.

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.

Postpartum depression and related psychosocial variables in Hong Kong Chinese women: Findings from a prospective study

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.

Transcultural nursing in Australian nursing curricula

As a result of the fact that Australia is a multicultural society with many people who come from non-English speaking backgrounds (NESB), the objective of the present study was to discuss the extent to which transcultural nursing education is incorporated into undergraduate nursing curricula. A survey was undertaken to determine the availability of nursing modules for undergraduate nursing students through Australian university websites on "transcultural nursing" or related modules. Although the inclusion of these modules into nursing education provide an opportunity for nurses to perceive and respond to different patient behaviors in multicultural societies, it is not sufficient to understand the complexity of the health care needs of a multicultural society. The survey findings suggest that many universities have not included transcultural nursing modules in their nursing curricula. To address this problem, more transcultural nursing modules need to be introduced into nursing curricula and nursing academics need to refine their attitudes about the importance of cultural aspects of patient care within nursing education.

Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers

BACKGROUND

The theory of planned behavior (TPB) has been used to explain breastfeeding behaviors in Western cultures. Theoretically-based investigations in other groups are sparse.

OBJECTIVE

To evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong.

METHOD

First-time breastfeeding mothers (N = 209) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1, 3, 6, 9, and 12 months postdelivery or until they weaned. Three predictive models were proposed: (a) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration; (b) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study (Duckett et al., 1998); and (c) a model that posited perceived control (PC) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior. LISREL was used for the structural equation modeling analyses.

RESULTS

Explained variance in PC and duration was high in all models. Overall fit of the strict TPB model was poor (GOFI = 0.85). The TPB for breastfeeding employed women and the PC-mediated models fit equally well (GOFI = 0.94; 0.95) and residuals were small (RMSR = 0.07). All hypothesized paths in the PC-mediated model were significant (p <.05); explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration.

DISCUSSION

Models were interpreted in light of the TPB, previous findings, the social context for breastfeeding in Hong Kong, and statistical model-building. Cross-cultural measurement issues and the need for prospective designs are continuing challenges in breastfeeding research.

Childbirth expectations of Chinese first-time pregnant women

BACKGROUND

This topic had not been researched previously and the information gained could have implications for midwives working with Chinese women everywhere.

AIMS

To explore the specific childbirth expectations of Hong Kong Chinese first-time pregnant women.

METHODS

This was a cross-sectional descriptive survey study and a Chinese version of the Childbirth Expectations Questionnaire was used to collect data. The sample consisted of 186 first-time pregnant women who first attended the antenatal clinic at a large public hospital in a major geographical region of Hong Kong.

RESULTS

Results showed that the Chinese pregnant women, the majority of who had not attended childbirth education classes, had high expectations of support from both their partners and midwives during labour and delivery. Conversely, expectations toward their own ability to cope with pain were relatively low. In addition, the pregnant women expressed concerns about the severity of labour pain and indicated low expectations about minimal use of medical interventions during labour.

CONCLUSIONS

This study results add to the existing literature about childbirth expectations of first-time pregnant Hong Kong Chinese women. Midwife educators should incorporate the findings into childbirth education classes to help pregnant women develop realistic and positive expectations.

Postpartum beliefs and practices among non-Western cultures

Postpartum health beliefs and practices among non-Western cultures are each distinct, but have many similarities. Two common belief systems surround 1) the importance of hot and cold, and 2) the necessity of confinement during a specific period of time after giving birth. This article describes common postpartum health beliefs among women in Guatemala, China, Jordan, Lebanon, Egypt, Palestine, India, and Mexico, and offers an exemplar from the author's experiences as a Korean woman giving birth in the United States. Cultural competence in the provision of postpartum care is essential for nurses in the healthcare world of the 21st century.

Traditional postpartum practices among Thai women

BACKGROUND

Culture is often related to notions of well-being, illness, healing and health that inform individuals in their day-to-day activities. The postpartum period is noted for traditional practices related to rest, healing and the consumption of food and drinks, but a contemporary view of these practices is needed.

AIMS

To gain an understanding of the traditional practices that Thai women follow in relation to postpartum care and the rationales underpinning such practices.

METHODS

This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand and attending their first postpartum hospital clinic appointment. A self-completion questionnaire was specially developed and pilot tested, and then administered to women attending the clinic.

DATA ANALYSIS

Descriptive statistics were used in relation to the incidence of particular behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional practices.

RESULTS

The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining 'heat'. These included 'lying by fire', food restrictions, taking hot baths and consuming hot drinks. Other activities involved not exposing the body to heat loss by keeping covered, not shampooing the hair, avoiding the wind and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Mothers and mothers-in-law were most influential in recommending these behaviours.

CONCLUSIONS

Traditional postpartum practices are still dominant in contemporary Thai culture and are perpetuated by close female family relatives. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs. Nurses need to educate women about the benefits of contemporary postpartum care and to provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.

Initiating and sustaining breastfeeding in Hong Kong: contextual influences on new mothers' experiences

The research reported in the present paper was conducted as part of a larger longitudinal infant feeding study examining the relationship between motivational and situational variables, and primaparas' infant feeding behaviors. The aim of this investigation was to identify contextual factors that influenced first-time mothers' breastfeeding practices in the immediate postpartum period. Employing an exploratory, qualitative design, data were collected through unstructured in-depth interviews with 19 primiparous mothers at one-month postpartum. Thematic analysis revealed two main themes: sociocultural and environmental influences, and lactation management. Although the participants wanted to succeed at breastfeeding, they faced many impediments in a society that was not supportive of lactating mothers. Health professionals' mixed messages, life stresses (short maternity leaves and lack of work place support for breastfeeding) and the participants' poor understanding of the physiological process of lactation presented obstacles for continued breastfeeding.

Adherence to cultural practices following childbirth in migrant Chinese women and relation to postpartum mood

Chinese women (N = 102) who had migrated to Sydney, Australia, were interviewed about traditional cultural practices they had followed in the first six weeks of the postpartum period. The majority (90.2%) of these women had adhered to some form of practice, with the most frequent being eating warm ('yang') food (78%), following confinement for one month (55%), and using warm water for washing themselves (19%). Of note was that 18% of these women felt ambivalent about following such practices, with the impression being that the adoption of such practices was more a result of family or in-law expectations than the wishes of the woman. Of the 9.8% who did not follow any form of traditional Chinese postpartum practice, only half felt ambivalent or negative about not doing so. There was no relationship between the women's mood at six weeks postpartum and how she felt about following or not following such practices. The adherence to traditional cultural practices was not related to length of time in Australia, nor to whether the woman was residing with her parents or in-laws. There was some indication that more educated women were less likely to follow cultural practices following the birth.

Chinese women's perceptions of the effectiveness of antenatal education in the preparation for motherhood

AIM OF THE STUDY

This was an exploratory descriptive study using mixed methodology to investigate Hong Kong Chinese women's perceptions of the effectiveness of antenatal education in their preparation for motherhood.

DESIGN

In the first phase, the structure and process of five antenatal classes on the topic of motherhood were observed using an observation guide. In the second phase 11 women who had attended the antenatal classes were interviewed in two focus groups, using a semi-structured interview guide.

FINDINGS

In respect to the structure of the classes women revealed that large class sizes and the didactic mode of teaching inhibited learning. While they were satisfied with the date and time of antenatal classes, and the information about self and baby care being provided, they felt unprepared for the demands of motherhood. Further themes identified from the analysis were: anticipating personal needs for antenatal preparation for motherhood, unrealistic preparation for breastfeeding problems, inadequate preparation for baby care, unfulfilled informational needs and conflicting advice from antenatal educators.

CONCLUSION

The conclusion highlights Chinese culturally specific changes needed in the content and mode of antenatal education. In addition, recommendations are made for antenatal educators to work within a framework of adult Chinese learning styles in order to meet the educational needs of Chinese women.

Hong Kong Chinese perceptions of the experience of unrelated bone marrow donation

This paper presents a qualitative perspective of the Chinese experience of unrelated bone marrow donation. A total population of 37 Chinese men and women, residing in Hong Kong who had donated bone marrow to an unrelated recipient were interviewed and asked their retrospective perceptions and experiences during the process of unrelated bone marrow donation. The majority was female (60%) and single (59.3%). The median age was 30.9 years. The main themes drawn from thematic content analysis included: association with bad and good fortune, religious concerns associated with complete bodies, barriers posed by the extended family, fulfilling personal identities linked to perceptions of altruism, reciprocity and generosity and the differences between the expectations and reality of the experience of bone marrow donation. These accounts indicate how, for Chinese populations, the act of body fluid donation cannot be isolated from the experiences of life-long immersion in the dominant social and cultural processes of the time. In addition, Confucian notions of the body, the power of body fluids to pollute, the importance of blood and bones as sources of vital energy and the process of bodily transference into the after life are highlighted. Furthermore, what is also identifiably Chinese is that donation is more of a self-fulfilling act than a social act with very little familial or social recognition being accorded in the public world. The conclusion highlights how donors entered into the decision to donate with little awareness of the long-term consequences. The process, however, was seen by the donors to be beneficial. A compelling argument is made for more educational and emotional support regarding the experience of bone marrow donation from Hong Kong's formal service providers.

"Remnants of feudalism"? Women's health and their utilization of health services in rural China

Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China.