Keywords
1. Postpartum depression
2. Chinese confinement practice
3. Doing the month
4. Maternal mental health
5. Traditional postpartum practices
Introduction
Postpartum depression (PPD) is a prevalent mental health concern affecting new mothers worldwide, including in China. Traditionally, Chinese culture has embraced a postpartum practice known as “doing the month,” which is believed to provide the necessary rest and support for new mothers during the early stages of motherhood. A recent study published in Women and Birth, the journal of the Australian College of Midwives, provides a closer look at how this cultural tradition affects the incidence of PPD among Chinese women. This article elucidates the findings of this study, discussing the complexities of traditional practices amidst changing social dynamics and the implications for maternal mental health support.
Background on “Doing the Month”
The custom of “doing the month” involves postnatal confinement where new mothers are encouraged to stay indoors, abstain from certain foods, and engage in specific health practices for one month after childbirth. The intention is to aid the mother’s recovery and fend off health issues by providing an environment of rest and nourishment. For many generations, this period has also offered psychological benefits through the structure and support it provides.
The Shanghai Birth Cohort Study
The study in question, conducted as a part of the Shanghai Birth Cohort, observed 2615 postpartum women from Shanghai, China, from 2013 to 2016. Detailed data on “doing the month” practices and postnatal depression levels, measured using the Edinburgh Postnatal Depression Scale (EPDS), were collected on the 42nd day after childbirth. The study led by Ding Guodong, along with other Chinese and international researchers, sought to understand the association between traditional postpartum practices and PPD.
Key Findings
The research concluded that the estimated prevalence of PPD in the Shanghai area was 11.8% at six weeks postpartum. It was found that mothers who went outside their homes during the first month showed increased risks of PPD compared to those who remained inside. Specifically, women leaving home 1-2 times had an odds ratio (OR) of 1.9 for PPD development, which escalated to an OR of 2.5 for those venturing out six times or more.
Additionally, sleep duration appeared to significantly correlate with PPD risk. Women averaging 6 hours of sleep or less per night were more likely to suffer from PPD when compared to those who slept 8 hours, with an OR of 1.7 for six hours of sleep and an alarming OR of 3.3 for less than six hours.
A startling, yet positive, observation was related to the practice of opening house windows. Women who often opened the windows showcased decreased risks of PPD (OR = 0.6) when compared to those who never or rarely did so, and the risk was even lower (OR = 0.4) among women who always opened their windows.
Conclusions and Recommendations
The findings from the Shanghai Birth Cohort study challenge the notion that all the activities associated with “doing the month” are protective against PPD. Instead, these results suggest that some practices—such as confining oneself indoors without exposure to sunlight and fresh air—may not be as beneficial as once believed.
The study recommends the need for flexibility in applying traditional customs to modern life, emphasizing adjustments to enhance the positive effects on maternal health. The authors suggest that certain aspects of “doing the month,” such as the avoidance of strenuous activity and encouragement of rest, are beneficial and should be preserved, while others, like strict home confinement and inadequate sleep, might require rethinking.
Implications for Policy and Practice
Policymakers and healthcare providers should take note of these findings to better shape postpartum care that respects cultural practices while also aligning with contemporary health standards. Educating families and care providers about the elements of traditional practices that support or hinder maternal mental health is essential. Encouraging practices like adequate sleep, moderate fresh air exposure, and social support can be critical in preventing PPD.
Public and Personal Health Perspectives
This study illustrates the importance of integrating personal cultural traditions with modern healthcare understandings. It advocates for a personalized approach to postpartum care, acknowledging that each woman’s needs may be different and adaptations to traditional practices are sometimes necessary.
Future Research Directions
Future research could explore the specific elements of “doing the month” that contribute most significantly to mental health outcomes and how these can be adapted to suit the diverse living situations and lifestyles of contemporary mothers. Longitudinal studies may also help to ascertain the long-term effects of adherence to or divergence from traditional practices on maternal and child health.
Conclusion
The Shanghai Birth Cohort study contributes significant knowledge to the understanding of postpartum depression and the role that traditional practices play in the mental health of new mothers. While respecting cultural heritage and the potential benefits of traditional practices, it is imperative to critically evaluate each element of such customs in light of current mental health standards. This approach can lead to more comprehensive and adaptable postpartum care strategies that acknowledge the importance of tradition while ensuring the health and wellbeing of mothers and their babies.
References
1. Guodong, D., Lei, N., Vinturache, A. A., Jun, Z., Min, L., Yu, G., … & Ying, T. (2020). “Doing the month” and postpartum depression among Chinese women: A Shanghai prospective cohort study. Women and Birth, 33(2), e151-e158. DOI: 10.1016/j.wombi.2019.04.004
2. O’Hara, M. W., & McCabe, J. E. (2013). Postpartum Depression: Current Status and Future Directions. Annual Review of Clinical Psychology, 9, 379-407. DOI: 10.1146/annurev-clinpsy-050212-185612
3. Xu, Y., Herrman, H., Tsutsumi, A., & Fisher, J. (2011). Psychological and social consequences of losing a child in a natural or human-made disaster: A review of the evidence. Asia-Pacific Psychiatry, 3(4), 237-248. DOI: 10.1111/j.1758-5872.2011.00153.x
4. Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? Journal of Affective Disorders, 74(2), 139-147. DOI: 10.1016/S0165-0327(02)00012-5
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DOI: 10.1016/j.wombi.2019.04.004
Authors and Affiliations
Ding Guodong – Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Respiratory Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China.
Niu Lei – Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Vinturache Angela – Department Obstetrics & Gynecology, St. George’s Hospital, St. George’s University Hospitals NHS Foundation Trust, London, UK.
Zhang Jun – Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Lu Min – Department of Respiratory Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China.
Gao Yu – Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Pan Shuming – Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Tian Ying – Ministry of Education and Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.