CONFINEMENT & TRADITIONAL PRACTICES

Traditional postnatal care practices have been more extensively and completely designed amongst the Malays. lt has been put in high perspective and its knowledge is very widespread.

Traditional Malay prenatal treatments for easy delivery

Delivering a child is a critical stage for the mother, and thus every effort is made to ease delivery. The use of drugs and anesthetics to relieve pain during delivery tends to have a few potential side effects to the mum and baby.

Amongst the Malays, coconut oil is widely used as prenatal treatment to ease delivery. It is believed that taking a few tablespoonfuls of coconut oil daily a few weeks before delivery can facilitate labor and delivery. Daily application of a little coconut oil around the vagina opening, inside and out from the 6^th month onwards, will reduce the need for episiotomy (making slit around the vagina opening to avoid tears).

Concepts of Malay traditional postnatal care

The areas most stressed during pregnancy are the abdominal muscles, pelvic floor muscles, the back and the reproductive organs. All these need conditioning after child birth. How well the vagina returns to its normal size after child birth is linked to the muscle tone of the pelvic floor.

The pelvic floor muscles are distended during pregnancy and childbirth. Distended pelvic floor muscles will lead to a distended vagina, and thus lead to less sensation during sex. Distended vagina may sometimes make embarrassing noises, or have water dripping from it minutes after bath. There may also be urinary incontinence, painful sex, backache, or a feeling of pressure or weight in the pelvic area.

The quality and tone of the pelvic floor muscles and the ligaments that hold and support them also determine the proper placement of the abdominal organs. Thus, toning of the pelvic floor muscle is very important to the internal health of a woman.

What happens after the baby is born?

Following a vaginal delivery, all the reproductive organs will feel tender and bruised, resulting in soreness. The cervix will remain a little dilated for up to a week. Then it will thicken, shrink, and return to its original size. The vagina is swollen for a day or two. The vaginal walls and the genital area will be very sensitive during the weeks that follow delivery and will remain supple for 2-3 months.

Heat and warming treatments sooth the soreness, improve blood circulation and promote the healing process. The use of herbal bath, vaginal herbal wash and intake of herbal juice also help in the healing process, and reduce the chances of infection.

The mother’s center of gravity changes during pregnancy, forcing her to walk with a somewhat arched back. In addition, the abdominal muscles also lose tone during pregnancy. So, for a few months after childbirth the new mother may be quite vulnerable to backache. Besides, the abdomen appears distended and flabby, and the belly will remain floppy for a few weeks. Many women feel the sensation of ‘emptiness’.

Thus, there is a need to tone the weakened abdominal muscles, and this is where the abdominal wrapping or ‘bengkung’ is important. The use of ‘bengkung’ supports the back and firms the belly while the use of herbs spread on the stomach before the ‘bengkung’ is put on, is important in firming the stomach muscles.

Traditional Malay postnatal care

In Malay traditions, new mothers follow a strict 44 days confinement period or ‘pantang’ using herbs, spices and oils to enable them to heal and rejuvenate.

The wonderful effect of traditional Malay postnatal care treatments is appreciated by many of those who have practiced them. It has been proven that women who diligently follow the traditional confinement practices or ‘pantang’ will regain their pre-pregnancy figure, their health and energy levels right after the confinement period.

lf all the recommended practices are closely followed , the new mother is expected to recover almost totally after 44 days , including regaining her original body shape and weight, without having to do any exercise. A hundred percent recovery is expected after 100 days. lt is quite common to find mothers within the Malay community who remain fit even after their tenth delivery.

Postnatal care treatments are also fascinating in being able to treat women who suffer from sexual or uterus-related diseases. lt is really a treasure which should not be neglected and forgotten.

Malay confinement practices revolve around a few elements.

The use of herbs is the key feature in traditional Malay postnatal care. Different herbs may be taken internally or applied externally in the form of decoctions (fresh or dried leaves, flowers, roots or stems steeped in boiling water), extracts added to ointments or ground and made into capsules .Some herb mixture are grounded and spread on the whole body, or on selected parts such as on the abdomen to promote blood circulation and for firming, on the forehead (pilis) to dispel wind, prevent migraine and postnatal blues from lack of sleep. Rinsing the vaginal area with herbal wash cleanses, soothes, deodorizes, heals and tightens the vaginal muscles.

The second major feature in traditional Malay postnatal care is the use of heat. Heat may be in the form of direct exposure to heat, the use of a heated river stone or ‘bertungku’ to help break down fats, shrink the womb and regain pre-pregnancy shape, showering with warm herbal baths to help regain energy, dispel wind and deodorize, application of warming herbal massage oils on whole body to promote blood circulation and release of water retention, and applying ‘tapel’ or firming herbal blend on abdomen to promote blood circulation to the abdominal area, and of course the intake of ‘jamu’.

The third feature is traditional Malay postnatal massage to promote blood circulation and lift the womb from sagging. Body massage is done at least 6 to 7 times during the confinement period. Massage helps to improve blood flow through the muscles, making them less constricted and tense which makes the new mother feels more relaxed. Massage also helps to burn off body fat.

Secret to Malay postnatal slimming is the wearing of traditional abdominal wrap or ‘bengkung’ everyday for 44 days , minimum 12 hours a day to tighten the abdomen and other parts of the body that sagged after childbirth, to shrink the uterus, to flatten the stomach, to promote good posture while breast feeding and to prevent overeating during confinement .

All these postnatal treatments after birth are mainly designed to tone the reproductive organs, especially the uterus, the abdominal muscles and the pelvic floor muscles. lt is believed that all the treatments and ‘pantang’ are to ensure that the new mother will remain fit physically, mentally and sexually active even after her menopause.Failing to follow all the ‘pantang’ and treatments is believed to lead to common women’s problems such as prolapsed uterus, incontinence and other gynecological diseases later in their life.

During confinement period, water has to be taken in small sips and never to be gulped. This is believed to stop the stomach from bulging. Ice water is forbidden as it is believed to distend the stomach muscles, resulting in bulging belly. All meals are to be taken in small quantities though they may be taken more frequently. This is also believed to have an effect on stomach firming. Liquid or watery and fatty or oily foods are not allowed. Intake of watery food is believed to delay the loss of retained moisture in the body while fatty and oily foods will interfere with the process of losing accumulated fat.

Going out of the house, other than going for check-ups is not encouraged. Special care is given to foot steps, paying special attention to the big toes. In Malay culture, the big toes are to be treated with care so as not to knock them on to any hard object. lt is believed that such incidences can lead to ‘bentan’, which is a situation where the body becomes very weak and may develop shivers and trembling (not due to fever).When this happens, the body will take a long time to recuperate. This may be related to the fact that in reflexology the area of the big toe controls the uterus.

Traditionally, the new mother has to keep herself warm at all times. She has to put on socks and a sweater and house slippers, especially if she has to walk on a cement floor. Intake of cold food is not allowed. Staying in an air-conditioned room is not encouraged. Intake of hot foods and herbs are encouraged.  These will enhance perspiration. Excessive perspiration is seen as a wonderful way to lose all the water that is retained by the body throughout the pregnancy.

Traditional Malay postnatal treatments after caesarian birth

The traditional treatments normally start slightly later after a caesarian birth. The intake of turmeric juice may be done in the first week for three consecutive days. Turmeric is an anti-bacterial herb which may also help to reduce the risk of infection of the caesarian cut. Tungku may be performed only on areas, such as the thighs, ankles and back, and this will help to tone the uterus and pelvic floor muscles. Herbal baths may be performed but normally it can be difficult in the early part after a caesarian birth. The use of bengkung may not be possible in the early part of caesarian, however, it should be performed in the later part, failing which may leave the abdominal muscles not toned, and in most cases will result in a flabby belly. Treatments that are performed away from the stomach, may be carried out as in vaginal birth.

Some insights into Chinese and Indian traditional postnatal practices

Chinese postnatal practices

One of the other main principles of Chinese postnatal practices is preventing “wind” from entering the body, which is said to be the cause of joint problems in later years. Hence, the notoriously peculiar practice of not allowing the women to bathe or wash their hair.

The Chinese believed that a woman’s body is the weakest and most vulnerable to future ailments after childbirth, and thus a confinement period of at least 30-40 days will ensure recovery and long term health. During confinement, new mothers have to observe and endure a series of taboos, traditional rituals, and eat a strict confinement diet.

Therefore, it is almost a must to engage a ‘live-in’ confinement lady or pui yuet who is usually an experienced middle-aged mother who is knowledgeable in post natal care to take care of the new mother and baby during the confinement period. This confinement lady’s primary aim is to nurture the new mother back to good health, by providing the new mother with nutritious home-cooked meals, soups and tonics, and to take care of the newborn baby too. This will allow the new mother time to rest, recover and rejuvenate from the stresses of pregnancy and childbirth.

Chinese confinement diet is aimed at nourishing and warming the body, improving blood circulation, “expelling” toxins from the blood and promoting contraction of the uterus. New mothers are encouraged to eat small but frequent meals to prevent hunger, and thus ‘wind’ from entering her body.  But more importantly, consuming frequent meals help to ensure constant supply of breastmilk for the baby.

Confinement diet consists of warming ingredients like old ginger, sesame oil, pepper, wine and black vinegar which are used extensively in almost every confinement meal. Foods are usually steamed or lightly stir fried with minimal use of oil. Ingredients are chosen with great care, with emphasis on fresh, natural, and organic foods. Cooling foods are avoided, such as cold drinks, ‘cold’ fruits and vegetables like watermelon, pineapple, papaya, ‘kangkong’, cucumber, cabbage and beansprouts. Meanwhile, herbal soups and tonics are a main part of the diet as they nourish and rejuvenate the body. Chinese herbs such as ginseng and dong quai are vital herbs to help the body heal. Water is a no-no as it will cause water retention, hence warming drinks such as ginger & date tea and longan & date tea are prescribed. Wine such as DOM and Ginger wine is indispensable even though there are debates that nursing mothers shouldn’t have wine as the wine passes onto the mother’s milk.

Chinese confinement also comes with a list of taboos:

• New mothers are not allowed to shower and wash the hair during the confinement period of 30-40 days. The belief is the contact of cold water is said to cause the penetration of “wind” into the body, and will lead to severe body ache and future ailment.
• If the new mother insists on bathing or washing her hair, she can only use a special bath which is made from a decoction of warming herbs and spices. And the baths must be very hot, quickly taken and to be taken only in the daytime. Once she is out of the bath, she must consume wine (DOM or ginger wine) to warm her body and prevent ‘wind’ from entering her body.
• The concept of “wind” also extends to not leaving the house during the confinement, no air-condition and no fan.
• The new mother has to be wrapped up with layers of clothing and socks so as not to expose the body to “wind”.
• The new mother is prohibited from doing housework, nor carry heavy stuff, as this may cause prolapsed uterus.
• New mothers are not allowed to strain their eyes by too much reading, watching TV, and crying is a strict ‘no-no’. Otherwise, the new mothers’ eye sight will weaken considerably.
• Sexual relations with the husband is also strictly prohibited as the new mother is still healing, and to be resumed only after 100 days after childbirth.

Indian postnatal practices

Just like the Malays and Chinese, Indians strongly believed that proper confinement practices can help to prevent health problems in the years to come. The Indians’ confinement period is between 30 to 40 days.

Indian confinement practices, like in other cultures, revolve around ensuring that the uterus shrinks back to its normal size and that the internal “wounds” heal properly.

Herbal baths, using different kinds of leaves, are taken to improve blood circulation and reduce fatigue.

Omam, which is a kind of spice, is rubbed all over the body to purify and soften the skin, as well as to ‘release pain’.

Indian confinement dietary recommendations are mostly aimed at improving the production of breast milk. Green leafy vegetables, shark’s meat, garlic, black dhal pudding and boiled fenugreek seeds (halba) are among the foods believed to help produce a lot of good milk.

The Indians also have their own form of massage and herbal wraps, which are believed to help the mother regain her figure.

Confinement taboos amongst the Indians:

• No seafood if the mother is breastfeeding, as it will cause vomiting and rashes in the baby.
• No “windy” vegetables and fruits, like cabbage, eggplant or grapes.
• Control in water intake. Only boiled milk or warm water is served.