Postnatal 'confinement': Does it work? How does it help mothers recover after giving birth?
Did you know that Malaysia has one of the lowest rates of postpartum depression in the world at just 4 per cent? While the prevalence varies according to different studies, it's comparatively low given that 10 to 15 per cent of postpartum mothers suffer from postpartum depression worldwide.
In conjunction with Postpartum Depression Month this May, we decide to uncover the factors behind this startling statistic. We had a chat with author and International Country Coordinator for Malaysia of Postpartum Support International Valerie Lynn on the proven benefits of traditional postpartum care.
With more than a decade of experience in the modernisation of traditional postnatal recovery practices, Lynn shares her two cents on whether age-old confinement customs hold any weight, along with what never to say to someone who is experiencing postpartum depression:
When does postpartum depression typically occur?
We’re finding that it can start during pregnancy—there isn't an average anymore. What I find here in the USA is that postpartum depression is monitored via a two-question questionnaire sheet—it’s rudimentary. It can start from the first week up to two years after giving birth. In USA, 30 to 50 per cent still experience postpartum mood disorder which includes anxiety, panic attacks, obsessive compulsive disorder (OCD) and more.
I myself have experienced anxiety and OCD during my postpartum period four months after I gave birth to my son in 2007. I self-diagnosed because the postpartum depression rate is so low in Malaysia; I remember it was during Mother’s Day 2008, I read articles from US and realised I was experiencing it—I had thoughts of accidentally hurting my son and falling down the stairs, and I came from a clean mental health history.
It can last a lot longer than people think—30 to 50 per cent experience it after a year and 50 per cent after three years. There is no average length of time. If you had it previously, you have a higher risk (30 per cent chance) of it recurring. Only 50 per cent of mothers are officially diagnosed. Here in USA, there are a million of women every year who are diagnosed, and these aren’t inclusive of existing cases.
How widespread is postpartum depression? Is there a common factor, whether age group or geographical location?
Every statistic isn’t 100% accurate. The reason why Malaysia's postpartum depression rate is so low is because most mothers undergo a postnatal recovery plan from day one—it is supervised and detailed, from body care to postnatal dos and don’ts. I’ve been involved with this for a while now and when I notice Malaysians write about postpartum depression in Malaysia, it’s inaccurate because they use global statistics to reference their work. One in seven people have it but that’s probably based on statistics from the US.
It’s every widespread in every culture but it’s dependent on many factors, from the home environment to stress to hormones. I’ve gotten contacts from Malaysian mums and even expatriate mothers—there’s nothing that seems to be common, perhaps a high-stress situation like a non-supportive family structure or lacking control in taking care of the baby.
There are even first-time mothers hailing from kampungs who lack that support and help—although I would say that postnatal support in villages are better than those in urban spots. I get contacted by mothers in different Southeast Asian countries, from Korea to Vietnam, so I would say that postpartum depression doesn’t discriminate.
Even in age groups, there isn’t a standard. In Hollywood here, people get postpartum depression too. We simply don’t understand the impact of motherhood.
What do you think has attributed to this low rate here in Malaysia?
I would say because of the holistic protocol and the deeply-rooted heritage in Malaysia as well. Malaysia has a natural global competitive advantage because postpartum recovery is part and parcel of the culture. I teach at the Malaysian consulate at New York and I’ve been in the field and studied it for more than 15 years now.
Malaysia’s postpartum recovery practices are preventative and help with hormonal rebalancing. It’s all about the healing window of opportunity during the first six weeks after childbirth. It’s the time when mothers shouldn't do anything to impede or weaken that process.
The structured practices and guidelines i.e. the body care, diet dos and don’ts, precautions (from not washing hair to avoid swimming and the use of air conditioning)—all these help facilitate the active process of the revision of the effects of pregnancy. It supports the healing window of opportunity because it’s a crucial time that your body is overworking for you. Most postnatal diets are different across cultures, but the guidelines are similar.
What does this postnatal recovery plan entail?
What I like is that it’s a structured postnatal recovery plan that is implemented within the first six weeks, rather than a loose set of guidelines. Some of the traditional practices are getting challenged now, such as not washing hair or bathing during the “confinement” period—but there are alternatives like herbal sponge bath instead of a shower.
When you’re pregnant, your body is in a ‘hot stage’ as you’re an incubator for your baby, and when you give birth, your body is in a ‘cold stage’ and it makes you more susceptible to illness. It’s far worse to be in a ‘cold’ stage than it is to be in a ‘hot stage’, hence why you shouldn’t douse your body with water as you may get a chill.
Now, these practices are getting fine-tuned i.e. herbal baths with the door closed so you don’t get the cool air in. There is some truth to it based on Eastern beliefs (that are currently being questioned). It’s been advocated to prevent ‘shocking’ the body as it will interrupt the healing process—which explains why it's important to do things gently especially during sponge baths.
When you shock the body through ‘cold’ things like eating certain foods and using the AC, it’s going to be a start-stop healing process for your body, from your metabolism to the digestive system. Your metabolism revs up seven times higher to get rid of the fluids (which causes postpartum swelling), hence simple steps like blow-drying your hair is important to be done in the bathroom with the door closed.
You’ll also have to wear shoes or socks that cover your feet, and to cover the big toe as it’s an important acupressure point. When I speak to mothers in Malaysia or in Southeast Asia, I always tell them that there is some truth to whatever their mums and aunties tell them. I’ve interviewed hundreds of people, from Malaysians to Thai, and mothers who’ve had multiple kids—and every single time, they tell me that when they follow and commit to the practices, they go through a faster recovery time than when they don’t.
What are the telling signs of postpartum depression and how can family members help?
When the person is not eating, not sleeping well, losing interest in the child, having anxiety and intrusive thoughts—although, you wouldn’t know if someone is having intrusive thoughts unless they are sharing it with you.
The people around the person should look out for extreme behaviour—don’t brush it off or not believe in the mother or tell her to get over it or get mad at her. Don’t compare the mothers with other mums. Every pregnancy is different.
I always tell mums that if they’re worried, reach out to someone whom they can talk to and trust their maternal instincts. For fathers, don’t distant yourself from the mothers. One of the most common things I get from mothers who contact me is that no one believes them. People tell them to ‘suck it up’ and ‘get over it’. If a mother confides in you, don’t talk her out of what she’s feeling. Don’t invalidate her experience and tell her that ‘it can’t be right’ when she’s sharing your feelings with you.
What advice can you give to help mothers/new parents especially during this pandemic?
Put a postnatal recovery plan in action, and look to virtual guides to self-massages. The roles of family members are equally as important. I have women telling me about the stresses they feel as a new mum i.e. “My mother-in-law wants me to breastfeed and I can’t” etc. It’s important for family members to understand how the new mothers want to take care of her own baby and to respect that. Dads need to be more involved too, especially during the confinement period.
A few resources for mothers to contact to include Postpartum Support International (PSI) and ibu Family Resources Group. Mothers connect with mothers—so reach out to online mother groups, whether on Facebook or Instagram.