Conduct a literature search to locate a journal article related to the health or health care practices of Chinese people. Present a summary of the journal article, and examine how the information presented may impact your nursing practice. Please provide a copy of the journal article (or hyperlink) if possible.

400 words 

Guodong, D., Tian, Y., Yu, J., & Angela, V. (2018). Cultural postpartum practices of ‘doing the month’ in china. Perspectives in Public Health, 138(3), 147-149. doi:http://dx.doi.org/10.1177/1757913918763285

Current topiCs & opinions

Copyright © Royal Society for Public Health 2018 May 2018 Vol 138 no 3 l Perspectives in Public Health 147
SAGE Publications
ISSN 1757-9139 DOI: 10.1177/1757913918763285

Current topiCs &
opinions

For over 2000 years, Chinese women have practiced the traditional
postpartum ritual called ‘doing the month’, during which new mothers
follow specific regulations for one month following delivery. In this article,
Guodong Ding and Ying Tian of Shanghai Jiao Tong University School of
Medicine, Jing Yu of Shanghai Jiao Tong University Affiliated Sixth
People’s Hospital, and Angela Vinturache of the Department of Obstetrics
& Gynaecology, John Radcliffe Hospital, Oxford, discuss the need for
greater understanding of this traditional practice in order to provide
appropriate medical treatment and unite traditional and modern
postpartum health.

pregnancy and childbirth are significant
life events marked by the adherence to
traditional customs in many cultures.
such ancestral beliefs and customary
practices are also present in Chinese
culture, providing an important context
for understanding the childbirth practices
of Chinese women. For over 2000 years,
many generations of Chinese women
have practiced the traditional childbirth
ritual called ‘doing the month’, also
referred to as ‘zuoyuezi’.1 Despite
modern society abandoning countless
traditions due to either disconnection or
perceived irrelevance to the westernised
world, this specific postpartum practice
has survived. since ‘zuoyuezi’ is still
passed from generation to generation,
integrated into
almost every aspect
of living, this
traditional practice
needs to be
understood and
considered when

dealing with postpartum women in order
to provide culturally appropriate advice,
respect diversity, avoid conflicts, and
bridge the gap between traditional and
modern postpartum health.

the traditional custom of ‘doing the
month’ stipulates that women should be
confined to their own home for one full
month after giving birth to their baby.
During the month of postpartum
convalescence, the new mothers follow
specific regulations to control their
physical activity, diet, and emotions.2 in
modern medicine, childbirth is a
physiologic process that, for most part,
does not require additional healthcare,
while in traditional Chinese medicine,
childbirth is associated with dramatic
transformation of female energy and
body. According to the dual principle of
yin and yang in traditional Chinese
medicine, pregnancy and childbirth are
considered to exhaust women’s yang,
leaving women in a transient functional
imbalance status of having relatively
more yin, much like illness.3 Yin originally
meant ‘shady’ and is related to the
phenomenon of cold, winter, and
darkness; it symbolises femininity,

internality, inferiority,
and negativity. Yang
is translated as
‘sunny’ and is
associated with
heat, summer, and
brightness; it

symbolises masculinity, externality,
superiority, and positivity. the first
postpartum month is believed to be a
crucial time to bring yin and yang back to
a balanced state and resume normality.
As such, major ancestral practices
promote maternal rest, preferably in bed;
discouraging domestic duties and
activities outside home; avoiding bathing,
washing hair, and brushing teeth; and
refraining from intake of ‘cold’ food for
the first month postpartum.4 of note, in
the context of traditional medicine, ‘cold’
and ‘hot’ suggest the inherent nature
rather than the temperature of food. this
specific set of practices is regarded as
not only curative but also preventative.

Although many of the practices and
rituals of ‘doing the month’ have been
disproved by science or common sense,
many Chinese women follow the
ancestral rituals because they are part of
their culture and traditional principles that
guide everyday life. new mothers spend
most of the time convalescing in bed,
avoiding domestic duties and routines,
including watching tV and reading
books, because such activities are
believed to be associated with diseases
in later life, such as chronic back pain,
joint pain, and poor eyesight.5
Confinement to the house with the
windows closed and avoiding contact
with the ‘cold’ (wind and water) are
required to maintain body warmth
because during childbirth, new mothers
lose blood, which is considered to be
‘hot’ in nature. new mothers wear
additional clothing, in particular hats and
socks; and daily personal care, such as
bathing, washing hair, and brushing teeth,
is also restricted in order to prevent the
body from being exposed to the ‘cold’.
regarding dietary restrictions, new
mothers avoid consuming ‘cold’ food
and replenish their body with ‘hot’ food.
Common ‘cold’ food that is restricted
includes fruit and raw vegetables (e.g.

Cultural postpartum practices of
‘doing the month’ in China

763285 RSH0010.1177/1757913918763285Current topics & opinionsCurrent topics & opinions
research-article2018

this traditional practice
needs to be understood
and considered when

dealing with postpartum
women

https://doi.org/10.1177/1757913918763285

148 Perspectives in Public Health l May 2018 Vol 138 no 3

Current topiCs & opinions

cabbage, turnips, orange, and
watermelon), ice, ice cream, and duck.6
Commonly prescribed ‘hot’ food includes
eggs, chicken, pig trotter or internal
organs, ginger, and brown sugar. these
food preferences are believed to
compensate for the loss of blood at birth,
prevent sore back muscles and poor
circulation, and ensure that enough milk
is produced for infant feeding.1,4
Furthermore, new mothers should
maintain emotional stability during this
period; crying or exposure to extreme
emotions should be avoided. in addition,
refraining from sexual intercourse is
advocated because it could endanger
and bring bad luck to the family.

Despite the fact that economic and
social advances may have influenced the
manner in which the rituals are performed,
the rationale behind the traditional
practice remains the same. indeed, there
has been an increased renewal of this rite
of passage among Chinese women giving
birth and making the transition to
motherhood, with a growing movement of
‘doing the month’ from the familial domain
to the public domain.7 Yuesao (referred to
as ‘month mums’) or home health
workers are becoming increasingly
popular in China, which is similar to
postpartum doulas (birth companions)
who are now widely employed by
childrearing women in Western countries.
in addition to these services that augment
family support at home, an increasing
number of medical zuoyuezi centres have
been created, where postpartum women
can receive both modern medical care
and the benefit of traditional cultural
practices.8 the first of these centres
opened in Beijing in 1999 and in shanghai
in 2003 and are becoming increasingly
common throughout China.

several sociocultural factors may
explain this phenomenon of modern
Chinese women adhering to the traditional
postpartum practices.1,4 First and most
importantly, women are raised and
educated to believe that adherence to this
ritual is physiologically and psychologically
beneficial and that the absence of it is

harmful, with potential long-term adverse
effects on quality of life. this is based on
the traditional Chinese belief system about
health and illness causation and the
maintenance of a balance of yin and yang
in a woman’s body after childbirth. the
influence of significant others from the
family including the mother, mother-in-law,
and grandmothers may be another factor
that ensured intergenerational
perpetuation of the traditional practices.
Although some new mothers may not be
personally aware or willing to follow the
traditional practices at home, the power of
opinion from significant others may
persuade the women to at least give
some semblance of adhering to the
custom. past experiences of detrimental
effects of not following the traditional
practices from the extended family and
relatives could have a motivating force in
sustaining the customary practices. third,
modernisation and the imposition of
Western values have probably influenced
new mothers’ social expectations and
their understanding of puerperal health.
nonetheless, moving away to urban
centres and lack of family support led to
resurfacing of this tradition in a new
context of commercialisation and market
for profit, ‘doing the month’ crossing over
from a private affair into the public trade.
the traditional postpartum practices are
potent reminders of cultural beliefs
regardless of where Chinese women live.
not surprisingly, Chinese immigrant
childbearing women
continue to follow
these traditional
practices to some
extent, and the
cultural ritual is not
influenced by
maternal educational
level, acculturation, or length of time in the
host countries.9–11

industrialisation and changes in
governance of healthcare in China
encourage modern hospital and health
centre–based healthcare for childbearing
women. At the same time, there is a
re-surfacing of the ancient practices such
as ‘doing the month’ in an effort by

women to re-connect with their roots
and maintain their cultural identity. these
two dimensions of ‘doing the month’, the
ceremonial cultural aspects and medical
opinion, have led to discussion of
controversies in the media, healthcare,
and medical scientific circles. For
instance, some studies have suggested
that the traditional postpartum practices
provide legitimate family support and
protective actions for new mothers,
relieving physical pain and reducing the
severity of symptoms, overcoming
stress, and preventing poor mental
health and depression after delivery.3,12
However, other studies indicate that the
postpartum ritual is not necessarily
curative or protective. A study conducted
in taiwan, China reported a high
prevalence of postnatal depression
(about 19%) among new mothers,
despite the fact that the vast majority of
them practiced the ritual.13 this
prevalence is even higher than those
reported in Western countries at 6.5%–
12.9%.14 Another study from rural China
reported that the traditional practices did
not decrease the risk of chronic pain for
women 5–11 years after childbirth.15
Given the inconsistencies among existing
studies and the complexities of the ritual
in contemporary society, further studies
are required to bridge the gap between
traditional practices and current evidence
about the effect of ‘doing the month’
practices upon women’s long-term

health and
wellbeing. therefore,
we emphasise the
importance of
allowing flexibility to
fit and adjust the
ritual into modern
life, to enhance the

positive effect of traditional practices and
reduce unnecessary conflict and stress.

Funding
this report was supported by the national
natural science Foundation of China
(81402645). the authors declare that they
have no actual or potential competing
financial interests.

references

1. Holroyd e, Katie FK, Chun Ls et al. ‘Doing the
month’: an exploration of postpartum practices
in Chinese women. Health Care Women Int
1997; 18: 301–313.

2. Leung sK, Arthur D and Martinson iM.
perceived stress and support of the Chinese
postpartum ritual ‘doing the month’. Health
Care Women Int 2005; 26: 212–224.

3. Chien LY, tai CJ, Ko YL et al. Adherence
to ‘doing-the-month’ practices is
associated with fewer physical and
depressive symptoms among postpartum

we emphasise the
importance of allowing

flexibility to fit and adjust
the ritual into modern life

May 2018 Vol 138 no 3 l Perspectives in Public Health 149

Current topiCs & opinions

women in taiwan. Res Nurs Health 2006; 29:
374–383.

4. Liu YQ, petrini M and Maloni JA. ‘Doing the
month’: postpartum practices in Chinese
women. Nurs Health Sci 2015; 17: 5–14.

5. Wang X, Wang Y, Zhou s et al. A population-
based survey of women’s traditional
postpartum behaviours in northern China.
Midwifery 2008; 24: 238–245.

6. Holroyd e, twinn s and Yim iW. exploring
Chinese women’s cultural beliefs and
behaviours regarding the practice of ‘doing the
month’. Women Health 2004; 40: 109–123.

7. Cheung nF, Mander r, Cheng L et al.
‘Zuoyuezi’ after caesarean in China: an interview
survey. Int J Nurs Stud 2006; 43: 193–202.

8. Callister LC. Doing the month: Chinese
postpartum practices. MCN Am J Matern
Child Nurs 2006; 31: 390.

9. Cheung nF. Chinese zuo yuezi (sitting in for
the first month of the postnatal period) in
scotland. Midwifery 1997; 13:
55–65.

10. Cheng CY and pickler rH. effects of stress
and social support on postpartum health of
Chinese mothers in the united states. Res
Nurs Health 2009; 32: 582–591.

11. Matthey s, panasetis p and Barnett B.
Adherence to cultural practices following
childbirth in migrant Chinese women and
relation to postpartum mood. Health Care
Women Int 2002; 23: 567–575.

12. raven JH, Chen Q, tolhurst rJ et al.
traditional beliefs and practices in the
postpartum period in Fujian province, China: a
qualitative study. BMC Pregnancy Childbirth
2007; 7: 8.

13. Huang YC and Mathers n. postnatal depression
– biological or cultural? A comparative study of
postnatal women in the uK and taiwan. J Adv
Nurs 2001; 33: 279–287.

14. stewart De and Vigod s. postpartum
depression. N Engl J Med 2016; 375:
2177–2186.

15. Wang X, Wang Y, Zhou s et al. Women’s
postpartum practices and chronic pain in rural
China. Matern Child Health J 2009; 13:
206–212.

http://www.jcampbell@rsph.org.uk

Reproduced with permission of copyright owner. Further reproduction
prohibited without permission.