Ah, the joys of becoming a mother. After nine months of nausea and fatigue, of seeing her body stretched out of shape, of laboring up and down stairs with an extra 20-pound load, a woman faces hours of birth pains. Afterward, she can finally sit back and .... start changing diapers. The real work has just begun. Time to rest? Forget it. You can always tell a new mother by the bags under her eyes. Surely, there is a better way.
For Chinese mothers, there is. It is called tso yueh-tzu (作月子), literally “doing the month.” According to a tradition that goes back two millennia, a new mother is expected to spend the first thirty days after childbirth doing little more than sleeping, eating, and getting used to her new role in life – both physically and psychologically. Her mother-in-law or other relatives bring her meals, attend to her comforts, and even help change the diapers.
The privileges given to the new mother are not surprising. After all, she has fulfilled her primary goal in Chinese society – producing descendants. Her in-laws have been hoping for this event from the time she became engaged. She and her baby now can assume an important role in the family. For many centuries, relatives have been willing to go to great lengths to provide special care during the key transition period just following birth. “The family wouldn't hesitate to invest much manpower and financial resources in ensuring the health of both the mother and the newborn, who are responsible for continuing the family line,” says Wong Ling-ling (翁玲玲), a research assistant at Academia Sinica in Taipei.
The tradition of tso yueh-tzu goes back to at least the Chin dynasty (221-206 B.C.). According to the ancient Book of Rites, Wong says, a woman of the imperial family would be moved away from her husband to a side room when her delivery date was near. During the month after the baby was born, the husband would send a messenger to visit her because he wasn't allowed to see her when she was not properly dressed. Different decorations, depending on the sex of the baby, would be hung on the door. Other customs related to childbirth were added over the centuries, including specific dietary rules and various taboos. From the Sung dynasty (960-1279), the system was roughly as it is today. It is not known, however, when the term tso yueh-tzu was first used.
The most important aspects of postpartum customs revolve around the special treatment given the new mother, especially when it comes to making sure she gets extra food and rest. A few decades ago, although married women were an important source of labor in the family, they often had last priority at mealtime. Most daughters-in-law enjoyed better food only on festivals or other special occasions. But during a woman's tso yueh-tzu, the situation was reversed. She could enjoy the very best dishes, including pork kidneys and other internal organs, usually considered expensive delicacies.
Babies join forces in the nursery at a postpartum care center, while their mothers spend time resting rather than changing diapers. The centers help urban women without strong family networks to enjoy the traditional privileges of tso yueh-tzu.
A new mother was also relieved of all family chores for a month. As a daughter-in-law, she would normally be one of the most hardworking members of the family, but during this time her mother-in-law and sisters-in-law would take over her responsibilities until man-yueh (滿月), the last day of tso yueh-tzu. All this special treatment was to ensure the health of the women who were producing descendants to carry on the family line. “It's natural, since nothing could be more important than having offspring in a society based on a strong family system,” Wong says.
Why does tso yueh-tzu last exactly one month? Wong thinks the early Chinese who developed the system considered the woman's physical needs. Up until several decades ago, few Chinese women had the advantage of an episiotomy to ease the baby's delivery. Many ended up with torn skin and no stitches. “The wound took from several weeks to a month to heal without a surgical suture,” Wong says. Also, without medical intervention, the womb needed a few weeks to contract to its original size. And it took at least two weeks to excrete the lochia. Roan Cheng-hsiung (阮正雄), an obstetrician at the Taipei Municipal Hospital for Women and Children, points out that a woman generally does not ovulate for the first month after childbirth. Her body, therefore, is in what could be considered an abnormal state.
But the psychological benefits of tso yueh-tzu were also considered. After all, a major change had taken place in the family, with a new member being added. Not only did this ensure that the family line would be carried on, but it also meant new responsibilities and a shifting of hierarchy within the family. “It gave both the woman and other family members some time to adjust to their new roles,” Wong says. It also provided an opportunity for the mother and her close relatives to develop strong emotional bonds with the new baby.
Nearly all Chinese families still follow the basic traditions of tso yueh-tzu, says Wong, who spent five weeks last year doing field research on the tradition in mainland China. Even in nuclear families that have little outside family support, which are becoming more common in Taiwan's urban areas, most new mothers spend a month resting, although they may not follow all the specific rules. Some even go to private tso yueh-tzu nursing centers, which do a fairly good business in Taipei despite the high prices they charge. Room and board, with babycare, is usually US$75 to US$100 a day. A relaxing environment, nutritious meals, and often Chinese herbal medicines are part of the stay. The baby is generally kept in a nursery while the mother rests in her own room. She can also have a facial, get her hair done, or attend such activities as exercise classes or lectures on parenting.
While the grandparents watch the family heir, the new mother gets a chance to rest and eat lots of a postpartum staple, ma-yu chi, chicken cooked in sesame oil, ginger, and plenty of rice wine. Says one mother who followed the traditional diet, "I had five meals of it each day, and no vegetables at all for the whole month."
Most husbands now visit their wives during their postpartum confinement, but anyone outside the family is often kept away from the woman's room, known as the yueh-nei fang (月內房). In particular, pregnant women, anyone who has recently attended a funeral, and those born in the Year of the Tiger are considered unlucky for the new baby. People who are preparing to take part in any religious worship also avoid visiting or touching the new mother because her “unclean” condition might be a source of disrespect to the gods.
According to custom, the woman should not leave the room unless there is a good reason. Although few urban women stick to this rule, those living in traditional environments still do. For example, in the Penghu Islands off Taiwan's western coast, a woman would never visit another person's home during tso yueh-tzu. “She might offend the gods they worship and bring misfortune to the host,” Wong explains, “If she must go out, she wraps herself tightly in a long-sleeved dress, pants, and wears a bamboo hat.” If a woman hires someone to wash her clothes, she usually has to pay a higher rate, a custom still followed even in modern, urban areas.
Tso yueh-tzu also includes strict dietary rules, which many women still follow. According to Chuang Shu-chi (莊淑旂), a doctor of Chinese medicine and the author of The Ways of Tso Yueh-tzu, women who have just given birth should, above all, not eat what the Chinese call “cold” foods. These are foods believed to cause certain conditions, such as sore back muscles, poor circulation, and a weak bladder and uterus. They include most fruits and many vegetables, especially cabbage, bamboo shoots, and turnip. In addition, new mothers should not consume anything that is actually cold, such as ice cream or iced drinks. The best foods to eat are ones high in protein and calories. Good choices are eggs, rice, noodles, brown sugar, ginger, chicken, fish, and the internal organs of pigs. Chuang recommends emphasizing different foods each week: pork liver the first week, pork kidneys the second, and chicken the third and fourth weeks.
The most common food for the postpartum month is ma-yu chi (麻油雞), sesame-oil chicken, a dish that Chuang says dates back to the Tang dynasty (618-907). A typical recipe calls for first frying ginger in hot sesame oil in a wok, adding the chicken until it is brown, then finishing up with a good portion of rice wine.
Chuang Shu-chi, a doctor of Chinese medicine – “Giving birth is the greatest opportunity for a woman to improve her health in her life. If she misses it, there will be a big difference in her body.”
In the days when 74-year-old Chuang was bearing children, much greater effort went into preparing sesame-oil chicken. “A few months ahead of my delivery day, my mother bought twenty or so fertilized eggs,” she recalls. “After they hatched, she fed the chickens grains of rice that had been soaked in Kaoliang liquor.” Kaoliang, a clear, strong alcohol made from sorghum, is sometimes called the Chinese version of vodka. The chickens were raised specifically for tso yueh-tzu meals.
Even today, many women make sure to eat plenty of sesame-oil chicken, even if they don't like the taste. “I had five meals of it each day, and no vegetables at all for the whole month,” says Wu Shu-chen (吳淑貞), 30, a working mother with three daughters. Chou Shu-fen (周淑芬), 44, who has a son and a daughter, had a slightly different version that consisted of chicken and date-plum persimmons in a porridge made of unpolished rice. It is common for a family to use twenty or more chickens and dozens of bottles of rice wine during a woman's postpartum confinement. Husbands have been known to gain weight from sharing in the sesame-oil chicken.
The wine is used not just to cook the chicken, but also in preparing most of the food a new mother eats. It becomes a substitute for water, which is considered unhealthy during tso yueh-tzu. “I dared not drink even a drop of water because my mother had warned it would give me a big stomach,” Wu Shu-chen says. Chuang explains that water influences a woman's metabolism after childbirth and can have long-lasting side effects. “Water as well as cold drinks will make women susceptible to rheumatism when they get old,” she says. Chuang thinks the thirst for water at this time is only a psychological need, not a physical one. “Don't drink it just for a moment's happiness,” she says.
Salt is also forbidden because it can cause thirst. Many women find it hard to adjust to the bland taste, because the Chinese diet they are accustomed to is often quite salty. “I didn't like the unsalted food at first, but I got used to it,” Chou Shu-fen says. “Even now I still prefer less seasoning.” Wong Ling-ling points out that the salt taboo has gained medical grounds in recent years because it can prevent high blood pressure and swelling.
Obstetrician Roan Cheng-hsiung thinks many of the postpartum taboos could be relaxed, but he supports the idea of giving a new mother plenty of rest and good food.
Still, a woman is bound to get thirsty. The answer? Sheng-hua (生化) soup, the more the better. Most mothers are very familiar with this decoction of peach kernels, ginger, the herbs Chinese angelica and chuan-chiung (川芎) rootstalk, and, of course, rice wine. But it is valued as more than a thirst-quencher. “The soup helps the body excrete the lochia,” Chuang says. “All mothers, including Caesarean cases, should drink it right after the baby is born, and for the first seven days.” Some doctors of Western medicine agree that sheng-hua soup is beneficial. “The peach kernel helps the womb contract,” says Roan Cheng-hsiung. “So not as much blood is lost.”
The taboo on water goes beyond its use for drinking. Women such as Wu Shu-chen who strictly follow the tso yueh-tzu tradition neither bathe nor wash their hair for the entire month. Many women no longer adhere to this rule, but most sti II try to have fewer baths and shampoos. If a woman avoids getting wet, it is reasoned, she is at less risk of getting an infection or catching a cold. Even water to wash the hands must be boiled in advance. Drafts are also considered dangerous, and most women avoid standing near open windows or in front of a fan or air conditioner. Long-sleeved dresses, long pants, and socks are recommended as well, even in hot weather.
Many women insist that following tso yueh-tzu customs brings long-term health benefits. “Giving birth is the greatest opportunity for a woman to improve her health in her life,” Chuang Shu-chi says. “If she misses it, there will be a big difference in her body. I've seen many Western women over forty who have loose breasts and skin like bark. It's because they didn't follow tso yueh-tzu.” Women who have miscarriages or abortions are no exception. “It's like picking fruit before it's ripe. It does great harm to the body,” she says. “It needs even more than a month.”
Chuang would rather young women pay more attention to postpartum rules than have to deal with physical problems later in life. “Many elderly female patients come to me with gynecological problems,” she says. “I can say 100 percent were the result of a poor tso yueh-tzu.” Ailments that come about because of poor postpartum conditions are called yueh-nei feng (月內風) and generally include bone problems, susceptibility to colds, and headaches. Chuang says they can last for the rest of a woman's life unless remedied by having another child, followed by a proper tso yueh-tzu. Western-trained Roan Cheng-hsiung, however, doesn't agree. “Some bone problems, for example, are due to a loss of calcium and can be improved anytime after childbirth,” he says. Besides, he adds, many health problems are natural results of aging, having nothing to do with childbirth.
Roan, however, does not consider tso yueh-tzu merely an old wives' tale. It is part of the long-standing system of Chinese medicine. And some of the taboos that sound ridiculous today no doubt made more sense in earlier times, when childbed fever, postpartum hemorrhage, and eclampsia were the leading causes of death for women. Vegetables and fruits, for example, might be contaminated by dung fertilizers. And an open wound could easily be infected by bathing in unclean river or well water.
Researcher Wong Ling-ling says tso yueh-tzu is also a time of adjustment – “Even if it does the woman no good physically, the psychological comfort is great.”
“From the perspective of preventing an ascending infection, [which could spread to the kidneys], I'm all for tso yueh-tzu,” Roan says. He believes it supplies a woman with good nutrition and also creates conditions for the womb to rest and contract. Roan also allows his patients to have sesame-oil chicken because it is easy for the body to assimilate. During metabolization, the sesame oil is transformed into prostaglandin, which helps the uterus contract. Also, the ginger promotes blood circulation. “It's fine as long as not much wine is added because alcohol impedes the uterus from contracting,” Roan says. “It's better to use water.”
But many of the other customs, Roan says, could be updated. In today's more sanitary environment, baths should not present a danger. And wet hair can be quickly dried with a blow dryer. Roan also maintains that there is nothing wrong with eating fruits and vegetables, as well as the many other foods often forbidden after childbirth. “Many Western hospitals offer ice cream right after childbirth,” he says. “It's a good source of the calories that a woman needs.” The point is not whether the food is cold, but that the woman doesn't get a cold, he says.
There is evidence, however, that tso yueh-tzu offers important emotional benefits. Studies show a connection between tso yueh-tzu customs and the low occurrence of postpartum depression in Chinese society. One reason: family members are still the major source of help for women after childbirth. In one survey of 326 women who had children, 90 percent had help from either their mother, mother-in-law, or husband during their postpartum confinement. “The stress of the fatigue from taking care of the baby. and all the attention given to the baby rather than the mother can be relieved through tso yueh-tzu in Chinese society,” Wong Ling-ling says. “Even if it does the woman no good physically, the psychological comfort is great.”
Not all women, especially some with higher education. worry about following the rules of tso yueh-tzu. Some simply make an effort to eat nutritious foods and in general to take care of themselves. Others follow tradition, but only to please their mother or mother-in-law.
But there are many more women like Wu Shu-chen and Chou Shu-fen, who believe strongly in the advantages of tso yueh-tzu. “It was wonderful. I did nothing but eat and sleep,” Wu says. “After that month, I didn't feel a bit of change in my body due to childbirth. Now my weight is exactly the same as when I was single.” Chou Shu-fen, who gained fourteen kilograms, feels she is healthier because of it. “Before, I had been skinny because of a bad stomach,” she says, “but I got rid of it thanks to my tso yueh-tzu.” Both of them agree that the trouble and the time they took was worth the effort.