Chinese medical culture has had its own tradition of postpartum care for more than 2,000 years, going back at least as far as the Chin dynasty (221-206 B.C.). Central to it is the idea of zuo yuezi, literally "sitting the month," a time of rest for the new mother during which she is fed according to a complicated regimen of health-giving foods, chosen for the special qualities they are thought to have in traditional Chinese medical practice. But the modern world has caught up with the practice of zuo yuezi; what used to be a family ritual has now become big business, from the home delivery of prepared "medicinal" food, to the provision of fully equipped care centers where mother and baby can experience a level of care that few homes are equipped to provide.
Zuo yuezi revolves around the idea that a postpartum mother is enfeebled by giving birth and can easily fall ill. To prevent this from happening and aid her recovery, traditional practice holds that she should adhere to a number of taboos, while partaking of a special diet which will help her regain her strength and vitality.
Zuo yuezi is deemed one of three prime periods for a woman to improve her health in her lifetime. The special attention to postpartum syndrome is not an alien concept to a culture familiar with Chinese herbal diet therapy. As early as puberty, women are encouraged to take Chinese medicinal herbs, to facilitate blood flow. While such a diet is also promoted for zuo yuezi, the concept of zuo yuezi extends far beyond what is eaten. Menopause is the third and last chance to improve one's health, but only zuo yuezi involves a high-profile ritual.
Women of all educational levels and from all walks of life follow at least some of the traditional rules--though the rules themselves vary from region to region. Generally speaking, they involve staying indoors to do little more than sleeping and eating for an entire month. There is a strict diet, with rules such as no cold food and no ordinary water, then there are a set of more general rules and practices such as not doing exercise, not washing one's hair and having one's belly bound. Among the promoters of this traditional practice in modern times, Chuang Shu-chi is a household name. Chuang is the first female doctor of Chinese medicine in Taiwan and also a regular MD of a university in Japan. Her book The Way of Sitting the Month is the first attempt to integrate Chinese traditional methods of postpartum care with modern medical theory and practice, and is the result of her many years of clinic experience and traditional practices.
Dietary Advice
According to Chuang's granddaughter Chang Huei-ju, who now owns a zuo yuezi-related business, her grandmother's theory is that the growth of the fetus compresses and displaces the internal organs during pregnancy. After delivery they need to return to their usual position and resiliency--failure to do so will result in sickness--and this can be either helped or hindered by the diet one has and the exercise one does. Chuang suggests a diet should follow the order: pork liver for the first week, kidneys for the second week and sesame oil chicken for the third, each of these dishes having its own special function. On top of this, all water drunk should be distilled from rice wine--Chuang thinks that ordinary water can negatively affect the metabolism.
For many households expecting a new baby and choosing to follow tradition, assembling enough bottles of Taiwanese rice wine is part of a high-profile ritual. Usually it takes three bottles of rice wine to produce a bottle of water, so the amount of wine needed is considerable, as is the time spent in heating it to boil off the alcohol. Families committed to the traditional way, however, usually care little for either the expense or trouble. But, in recent years, shortages of rice wine have occurred as the result of announced price rises for the comestible leading to hoarding--especially when Taiwan was forced by World Trade Organization regulations to start taxing rice wine, which is in fact used primarily as a cooking condiment, rather than an alcoholic beverage. At one point, the Taiwan Tobacco and Liquor Corp., the principal rice wine maker and distributor, had to resort to rationing. Given that the practice of zuo yuezi is impossible without rice wine, the company had a policy that a parturient was allowed to purchase 40 bottles of rice wine, but only when provided with both the baby's birth certificate and the mother's ID card. The current price for rice wine is NT$180 (US$6), per 600 milliliter bottle, around nine times the price in 2002.
Hilmar Arevalo, who is from Venezuela and came to Taiwan in 1991, is one of the many practitioners of zuo yuezi. She married a Taiwanese husband and has had four children. She followed almost all the traditions such as no hairwashing and remaining at home for 30 days. Her mother-in-law helped her carry out the custom for the first two births. For the following births she used a home delivery service for the special diet. Of the traditional food, she says, "the first time I thought it was weird and I didn't like the taste. But after that I got used to it. Now I always tell friends they should try to follow these rules. I've even sent Chinese medicine to my sisters. But they didn't like the taste." Back in her own country, people don't have any special postpartum practices.
No matter how crazy such customs may seem to those beyond the reach of Chinese culture, many in Taiwan think that not following such practices is the cause of what they see as the rapid aging of foreign women and their tendency to get out of shape.
The Problems of Tradition
However, as Arevalo found, trying to continue with tradition can be difficult in modern society. The preparation of special food and the new mother's immobility might not have been a problem in the days of extended families either living together or at least living close by. But with the huge migration to the cities in the last few decades and the arrival in Taiwan of the nuclear family, there can frequently be a lack of available manpower. As a result a number of businesses have sprung up to fill the gap. For example Chang Huei-ju's company Kuang-holing offers a postpartum diet service based on Chuang's theories.
"We first published books to promote grandmother's theories in 1989," Chang says. " Many people contacted us with questions, and we then started a diet service via home delivery."
Kuang-holing provides hot meals to customers every day and has developed a series of products such as zuo yuezi water, a substitute for water made from boiling off rice wine. The service reduces the degree to which a new mother is dependent on the aid of other family members. Demand has driven continual expansion of the operation. "In 2001, we set up three kitchens across the country. Last year we built a new headquarters," Chang says. An expansion to China is said on the way. Kuang-holing's success has spawned a number of imitators.
In the past mothers or mothers-in-law have been the principal caregivers to parturients during zuo yuezi. Conflicting views about what zuo yuezi involves can often, in such circumstances, lead to family tensions. And of course, sometimes other family members simply aren't around to help out. One way around this is to use a professional postpartum care center. Use of these is expanding but the cost--between NT$ 3,000 (US$ 92) to NT$ 6,000 (US$ 185) per day--puts them beyond the reach of all but the well-off.
Postpartum care centers are legally regulated according to the national Nursing Law. They are not medical institutes and use of them is not covered by national health insurance, which only covers three days of hospitalization for a normal birth and five or six days for a caesarean birth. Those who choose to stay at postpartum care centers must do so at their own expense. The service provided by such centers includes accommodation, care for the newborn, medical checkups and a doctor on standby, five meals a day, and courses on child rearing and the philosophy of naming. Traditional customs such as cutting the hair of a newborn baby or arranging boxes of cakes to be handed out at the ceremony of the baby's first month can be arranged at a customer's request.
Spectacular Growth
In 1994, there was only one such center in Taiwan; by the end of 2005, there were a total of 39, of which 19 were affiliated with hospitals and clinics, while 20 were independent establishments. Nearly half of these care centers are located in Taipei city. There were three registered postpartum care centers in Taipei in 2000 with 21 registered medical staff, but by 2006 that number had increased to 17 with 569 medical personnel.
Zuo yuezi requires a strict and highly specialized diet. Kuang-holing specializes in providing such foods. (Photo by Chang Su-ching)
Eyeing the growing market demand for postpartum care, WeGoGo, located in Taipei's Neihu district, opened last year. It seeks to provide customers with quality care in a setting akin to a luxury hotel. Although only open for a year, it has outperformed competitors. "In the beginning, our customers could book a room two months ahead of the due day. Now they have to book six months in advance. Otherwise they'll be on the waiting list," says Han Chih-wei, manager of WeGoGo.
Han says the nature of WeGoGo is something between medical centers and home. "We have medical facilities and stationed doctors, but we don't give treatment." Guests entering the two-story facilities of WeGoGo must wear masks and change into slippers to be allowed in. Newborn babies are taken care of at an asepsis room when mothers leave them there. Fathers can stay overnight or see their babies via the Internet when away.
"The longest we have had a customer is two months. That mother studied in Germany and came back for zuo yuezi, hoping to improve her health with proper care. We also have had customers coming back from the United States and South Korea," Liao says. "Actually we have found that many families have only one child and become more willing to spend for zuo yuezi," Han says.
Naturally, it is people with a Chinese cultural background who are most likely to use such facilities. The meals they expect to receive at a care center are usually based on Chinese medicinal herbs. WeGoGo has tried to offer a variety of meals for customers to choose from, but, Han says, around 80 percent of customers still adhere to traditional Chinese herbal diets or order home-delivery meals that follow ideas promoted by Chuang. "We are fine with that," Han says. "We also provide rice wine-evaporated water diluted with drinking water, which doctors suggest is better than 100 percent rice wine-evaporated water for a mother who is breast-feeding," Han says. "However, I have to say that some traditional food is not necessarily suitable for everyone. For example, we had a customer who insisted on having sheng-hua soup and after three weeks suffered severe bleeding. We have also seen a mother get drunk because the alcohol in the rice wine had not been fully boiled off."
East and West Meet
It is also becoming increasingly common to see Western-style medicinal facilities work with doctors practicing Chinese medicine at postpartum care centers. Lai Hui-chen, convener of the board of supervisors of the Taiwan Clinical Chinese Medicine Association, used to work at such a center, affiliated with Chung Hsing Hospital. "Basically, Chinese medicinal herbs are actually a kind of food, not a medicine or drug, and they can relieve some syndromes, such as postpartum depression," Lai says. Western medicine deals with illnesses that can be determined by some kind of physical or chemical test. But there is a range of postpartum complaints, such as sore back muscles, which are not seen as illnesses needing treatment. Here Chinese medicine can help. For a sore back, for example, Lai suggests a massage at certain acupuncture points to ease the pain.
With the increasing commercialization of zuo yuezi culture, Lai feels some myths need to be clarified. Lai says she often came across patients raising questions on whether to follow the traditional rules of zuo yuezi. "I had a number of patients complaining of having a big belly and attributing that to poor care during zuo yuezi. I always responded by getting a colleague of mine over, who drank no water during zuo yuezi but still got a big belly, to prove that there is no definite relationship between these two matters," Lai says.
From her point of view, water obtained by boiling off the alcohol in rice wine is still water. As long as the drinking water is boiled, it is OK to drink. Furthermore, if the alcohol is not fully evaporated, the baby might be harmed via breast-feeding. And some taboos no longer make sense. For example, the taboo on hair washing might have made sense when hair, usually long, had to dry naturally, often in chilly conditions, women thus risking catching cold. But now that hair can be quickly blown dry this no longer makes sense. And the taboo on exercise might have served a useful function in preventing women from returning to heavy agricultural labor too soon after childbirth, but there is hardly any risk of this in modern Taiwan, and exercise is actually needed to improve the circulation. And the benefits of a Chinese herbal diet, Lai points out, are not just limited to postpartum care.
Fossil with a Future
Zuo yuezi as a custom has an interesting status. Many, if not most Taiwanese--and Chinese--women, think of it as very important. But the vast majority of women in the world have never heard of its rituals and taboos and suffer no ill effects. If one reflects on the general ideas embodied in the custom and how these could be put into practice in pre-industrial Chinese societies, the ideas are sensible enough--get lots of rest, avoid doing anything that will make one fall ill while in a generally debilitated state, drink sterile water, eat nutritious food. The irony is that, though the ways in which this might be accomplished have been radically changed--there are, these days, surely easier ways to get sterile water than boiling off 40 bottles of rice wine, increasing prosperity is allowing more people to follow the old customs more strictly than, perhaps, ever before.
Feminists argue that this is not the only irony involved in the custom. While women might be happy to be waited on hand and foot for a month after giving birth, nevertheless the practice of zuo yuezi helps confirm their role as principally that of a provider of children to the family. Feminists argue that Taiwan remains far too steeped in backward patriarchal values for this sort of thinking to be encouraged. But no matter whether zuo yuezi is obsolete either in its methods or backward in its thinking, Taiwanese women embrace it still.
Write to Zoe Cheng at zoecheng@mail.gio.gov.tw