Doing the month in a Taiwanese postpartum nursing center: An ethnographic study

Abstract

Traditionally Chinese and Taiwanese postpartum women conducted postpartum ritual practices, called “doing the month,” at home. Today, many Taiwanese women undertake this ritual in postpartum nursing centers. However, little is known about how the traditional practices are being transformed in relation to contemporary health care in Taiwan. In this ethnographic study observations were carried out in a large post-partum center attached to a major hospital in Taipei for nine months, and 27 postpartum women were interviewed. Data were analyzed using ethnographic approaches to extract codes and categories. Doing the month was reshaped by being relocated from the home to a healthcare setting. Midwives took on roles traditionally taken by family members, which had an impact on family roles and relationships. Some postpartum practices were maintained, based on traditional explanations. However, many were modified or challenged, based on explanations from contemporary scientific knowledge. Midwives need to be aware that there could be differences between their culture of care and the cultural values of the women they care for. This study informs culturally appropriate postpartum care and support for women with traditional and contemporary cultural beliefs and attitudes to doing the month in a range of healthcare contexts.

Full text

Research Article
Doing the month in a Taiwanese postpartum nursing
center: An ethnographic study
Yueh-Chen Yeh, RN, MSN, PhD,
1
Winsome St John, RN, RM, PhD
2
and Lorraine Venturato, RN, RM, PhD
3
1
School of Nursing, Taipei Medical University, Taipei, Taiwan,
2
Population and Social Health Research Program, Griffith
Health Institute, and
3
Research Centre for Clinical Practice Innovation, School of Nursing & Midwifery, Griffith
University, Gold Coast, Queensland, Australia
Abstract Traditionally Chinese and Taiwanese postpartum women conducted postpartum ritual practices, called “doing
the month,” at home. Today, many Taiwanese women undertake this ritual in postpartum nursing centers.
However, little is known about how the traditional practices are being transformed in relation to contempo-
rary health care in Taiwan. In this ethnographic study observations were carried out in a large post-partum
center attached to a major hospital in Taipei for nine months, and 27 postpartum women were interviewed.
Data were analyzed using ethnographic approaches to extract codes and categories. Doing the month was
reshaped by being relocated from the home to a healthcare setting. Midwives took on roles traditionally taken
by family members, which had an impact on family roles and relationships. Some postpartum practices were
maintained, based on traditional explanations. However, many were modified or challenged, based on expla-
nations from contemporary scientific knowledge. Midwives need to be aware that there could be differences
between their culture of care and the cultural values of the women they care for.This study informs culturally
appropriate postpartum care and support for women with traditional and contemporary cultural beliefs and
attitudes to doing the month in a range of healthcare contexts.
Key words Chinese culture, cultural values, ethnography, cross-cultural health practices postpartum care, Taiwan
childbirth.
INTRODUCTION
Childbirth is usually a time of transition and social celebra-
tion, and often initiates adjustments in cultural responsibili-
ties (Steinberg, 1996). In numerous societies, including
Chinese societies, postpartum care is influenced by both tra-
ditional beliefs and contemporary healthcare practices
(Lauderdale, 1999; Posmontier & Horowitz, 2004). “Doing
the month” is a 30-day Chinese postpartum ritual involving
physical and social prescriptions and taboos. According to
Chinese folk and classical medicine, postpartum women are
in a state of extreme yin and yang imbalance, which may
result in weakness and vulnerability (Chen, 2001). This type
of weakness is regarded as dangerous to physiological
health and makes new mothers vulnerable to “heat” or
“cold,” which may cause health problems such as dizziness,
headaches, backache, and arthralgia during the month or in
later years (Pillsbury, 1978). Furthermore, during this time,
wind and water are considered dangerous because they may
enter the body through skin pores and cause tumors, weak-
ness, and arthritis (Liu et al., 2012). Therefore, Chinese
women are advised to follow a particular diet and
healthcare practices.
Postpartum mothers are advised to confine themselves, rest
completely, and avoid bathing or washing their hair to
prevent contact with yin, such as cold air, wind, and water.As
a result, postpartum women are confined to the home, stay in
bed, windows are typically kept closed; and air conditioning is
avoided even in the hot, humid Taiwanese summer. In addi-
tion, postpartum women are encouraged to eat “hot” or yang
foods, such as rice wine, food cooked with ginger and sesame
oil, kidney, liver, chicken, and eggs for four weeks. “Cold” or
yin foods, such as turnips, Chinese cabbage, bamboo shoots,
and leafy green vegetables are considered to weaken a post-
partum woman’s health and should be avoided (Strand et al.,
2009; Liu et al., 2012). Postpartum women are considered to
be polluted during the 30-day postpartum period.The woman
cannot have sex with her husband during this time because it
is believed to bring misfortune (Pillsbury, 1978; Wong, 2004).
These rituals, together with restrictions on social activities
are observed to provide a new mother with time to rest,
regain strength, and learn to care for the baby (Posmontier &
Horowitz, 2004).
Correspondence address: Yueh-Chen Yeh, 250, Wuxing St., Xinyi Dist., Taipei City
110, Taiwan. Email: yuehchen@tmu.edu.tw
Received 12 August 2013; revision received 18 October 2013; accepted 22 October
2013.
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© 2013 Wiley Publishing Asia Pty Ltd. doi: 10.1111/nhs.12110

The international literature shows that in many countries
many new mothers spend relatively little time in hospital
after childbirth, but feel a need for additional support, guid-
ance, and assurance from healthcare professionals (Forster
et al., 2008; Hung et al., 2010; Martin et al., 2013). Postpar-
tum mothers’ experiences of being discharged from mater-
nity hospitals have been described as unpredictable and
stressful (Howell, 2010; Martin et al., 2013), especially for
first-time mothers (Forster et al., 2008; Ngai & Chan, 2012;
Ohashi & Asanorn, 2012). In Taiwan, childbirth fundamen-
tally changes and increases the complexity of a new moth-
er’s life, not only because of increased demands, conflict and
stress (Gaoa et al., 2013), but also because of their inexpe-
rience with following the ritual practices of doing the month
within the realities of contemporary society (Liu-Chiang,
1995; Liu et al., 2006; Hung et al., 2012). Traditional ritual
practices that contributed to social order in the past are
now being challenged and transformed in response to social
changes, such as changing family structures, women’s status,
and healthcare systems. These social changes also affect the
ritual practices of doing the month. In Taiwan, the national
healthcare system no longer provides postpartum home
visits, and other postpartum-related services are quite
limited (Hung et al., 2012). Therefore, numerous Taiwanese
women now follow doing the month in postpartum nursing
centers (PNC) after being discharged from maternity
hospitals.
Postpartum nursing centers represent themselves as pro-
viding new mothers with a feasible alternative to doing the
month at home, and are an increasingly popular choice for
affluent contemporary women (Hung et al., 2010; Chen,
2011). Many similar establishments and commercial PNCs
have sprung up not only in Taiwanese and Chinese societies,
but in also in Western countries such as Canada, Scotland,
and Australia, where there are large Chinese communities
(Cheung, 1997; Brathwaite & Williams, 2004; Chu, 2005).
New mothers are admitted to PNCs after being discharged
from maternity hospitals. Most PNCs are staffed by physi-
cians and midwives who are responsible for caring for the
baby and facilitating the mothers’ recovery, suggesting that it
is possible to combine contemporary societal values and
modern healthcare delivery practices with traditional ritual
practices (Hung et al., 2010).
The services provided by PNCs indicate the development
of a new type of health industry that differs from early post-
partum care and post-discharge postpartum care. Today, 166
PNCs are operating in Taiwan (National Statistics ROC
Taiwan, 2013).Thus, doing the month practices are now being
revived and transferred outside the family by contemporary
Taiwanese women. However, little is known about how doing
the month practices are being transformed in relation to
contemporary health care in Taiwan today.
Aim
The purpose of this study was to explore how the traditional
Chinese postpartum ritual of doing the month is being
reshaped for new mothers in a contemporary healthcare
context at a PNC in Taiwan.
METHODS
Design
An ethnographic approach was used for this study.
Ethnography reveals the particularities of cultures and
rituals (Denzin, 1996; Munhall, 2007), enables cultural
knowledge to be elicited within a specific community or
setting, in this case a PNC, by observing events, listening to
conversations, and asking questions (Hammersley &
Atkinson, 2007).
Setting
The PNC selected for this study was located in Taipei City,
where traditional cultural practices and cosmopolitan values
and practices influence each other. The demography of
women living in Taipei City reflects the changing position of
women in Taiwanese society. Data were collected by the first
author over a period of nine months in a 36-bed PNC that is
affiliated with a hospital. The PNC was unfamiliar territory
for the first author, and she had no prior connection to the
staff or the PNC. This allowed her to act as a “cultural stran-
ger” (Maso, 2001) who does not make assumptions about the
social or cultural group being studied and allowed her to
maintain a professional distance.At the time of the fieldwork,
the PNC was staffed by medical, nursing, and allied health
practitioners. The ratio of midwives to babies and mothers
was 1:12–15. Daily costs and charges in the PNC were $120 to
$140 USD (=$3600–$4200 NTD), which is expensive for most
Taiwanese families.
Participants
The main criteria for participant selection was that partici-
pants had to be first-time mothers who had given birth to
healthy newborns and were seeking to maintain the tradi-
tional practices of doing the month by attending the PNC.
Additional selection criteria included the ability to speak
Chinese and willingness to participate in the study. All par-
ticipants were assured of confidentiality and given the option
of withdrawing from the study at any time. A total of 27
first-time mothers at the PNC was recruited for formal
semistructured interviews, to satisfy the principle of satura-
tion (Hammersley & Atkinson, 2007).
Data collection
Semistructured interviews and key informant interviews
were conducted to uncover the new mothers’ day-to-day
activities related to doing the month. The first author usually
conducted the one-on-one interviews in participants’ rooms,
which were quiet and private. Each interview lasted between
40 and 80 min. All interviews were audiorecorded (with
interviewees’ permission) for transcription and analysis pur-
poses. Each interview was transcribed and translated into
English by the first author. A conversation guide was pre-
pared that aimed to encourage participants to describe their
2 Y-C. Yeh et al.
© 2013 Wiley Publishing Asia Pty Ltd.

stories, experiences, and attitudes toward the ritual practices
of doing the month (Table 1). In addition, a brief demo-
graphic profile was obtained to describe the participant
group.
During the observation period, the researcher was con-
sistently present in the PNC, but followed a flexible time
schedule (Bernard, 2011). The daily activities of the PNC,
the staff, new mothers, and visitors, as well as informal con-
versations with new mothers and visitors, and the new
mothers’ educational sessions, were observed, in addition to
the formal interviews with 27 new mothers. The observa-
tions and interviews provided a systematic method for
observing, describing, documenting, and capturing the daily
activities and nuances (Leininger, 1991) related to the prac-
tice of doing the month.
Ethical considerations
This study was approved by the Griffith University Human
Research Ethics Committee (HREC) in Australia and the
participating PNC in Taiwan. Throughout the study, the
researchers fully considered participants’ human rights.
The purpose of the study was explained, and confidentiality
was assured. To protect the identity of the participants and
the agency, the agency has not been identified and data were
de-identified before reporting results.
Rigor
To enhance the trustworthiness of the findings, credibility,
dependability, and confirmability were established (Lincoln
& Guba, 1985). The first author is an experienced registered
midwife and has been an obstetrics educator for more than 10
years. The researcher’s background and experience enabled
her to build trust with participants when discussing their
daily lives related to doing the month. Credibility is achieved
by prolonged engagement and member-checking with the
participants. Furthermore, verbatim quotations are used
during presentation of findings to allow readers to judge the
veracity of the work (Lincoln & Guba, 1985).
Data analysis
Although analytical approaches followed in ethnographic
studies are often debated, the crucial consideration is that
researchers must be able to describe people and their culture
(Hammersley & Atkinson, 2007). By locating the study at a
PNC, it was possible to understand how doing the month was
performed in this context. A multistep analysis technique
developed by Creswell (2003) was used, which involves a
cyclical process of data collection and verification at every
step of the inquiry to construct a solid product. Data were
manually analyzed by underlining key words in the tran-
scripts, decreasing code phrases, shaping concepts, grouping
concepts into categories, and classifying the categories. These
steps facilitated a rigorous and transparent analysis process
(Munhall, 2007), and proved to be useful throughout the
complex processes of identifying, exploring, developing, and
enriching the interpretation of data. The researcher’s pro-
longed engagement and familiarity with the target culture
facilitated her sense of the data, allowing her to become a
storyteller about the processes of doing the month in this
PNC context.
RESULTS
Data collection in ethnographic fieldwork requires collecting
data in natural settings from a variety of data sources such
as observation and individual interviews with new mothers,
and informal conversations with staff and visitors. Martin
(1992) argued that inclusion of multiple voices was desirable,
because different members of a culture have different opin-
ions. Demographic details of the 27 new-mother interview
participants are presented in Table 2. The new mothers were
aged between 26 and 38 years old, with a mean age of 32
years. All participants were married (
x = 34.
years) and the
majority (81%, n = 22) lived with only their husbands.
Education levels ranged from junior college to doctorate
levels. The following section outlines categories that emerged
from the interviews: dietary practices; restricted physical
activities; restricted hygiene practices; and social proscrip-
tions (Table 3). The reasons for performing doing the month
at a PNC are overviewed, because they provide an important
context for the practices.
Table 1. Interview guide for the new mothers
Semistructured questions
1. Why did you choose to practice doing the month at a
post-natal centre?
2. What has your experience of doing the month been like?
3. Do you strictly follow the practices of doing the month?
4. What do you think is the most important aspect of doing the
month?
Table 2. Demographic characteristics of the participants
N%
Age
25–29 3 11
30–34 17 63
35–39 7 26
Education
Junior College 4 15
University 14 52
Masters 6 22
PhD 3 11
Employment
Yes 17 63
No 10 37
Family unit
Living with parents-in-law 5 19
Living with husband 22 81
Doing the month postpartum care in Taiwan 3
© 2013 Wiley Publishing Asia Pty Ltd.

Reasons for performing doing the month at a
postpartum nursing center
Participants usually made the decision to perform doing the
month at a PNC after discussing it with their husbands,
friends, and family. They usually made their final decision
after consulting with both their mother and mother-in-law.
Participants had generally been brought up to believe that
adherence to this ritual was physically and psychologically
appropriate, and that it prevents them from experiencing
illnesses in the future. The participants provided the follow-
ing reasons for deciding to perform doing the month at the
PNC. (i) Participants respected the traditional ritual of doing
the month and believed that the practices nurture their physi-
cal recovery. For instance, participants stated that:“[I will be]
able to rest properly [at the PNC].” (ii) Participants sought
Table 3. Doing the month at the post-natal centre: themes
Categories Codes
Reasons for practicing doing
the month at the PNC
Have adequate rest
Can be more relaxed
The baby and mother can be cared for by midwives
Respect for the traditional ideals of doing the month
Learning childcare skills
Lack of a helper
Avoid “monitoring” by the older generation
Complexity of doing the month procedures
The variety of dishes and nutritional balance of doing the month meals at the MCC
Dietary practices Maintained
• I don’t like sesame oil chicken, but I eat it for my health
• as long as I can follow the traditional way, I just follow it
• I keep an eye on eating and take a lot of Chinese herbs
Modified
• Vegetables and fruit are good for my health, you know . . . I chose vegetables such as
cauliflower, grapes, strawberries, and apples
Challenged
• I won’t follow the taboos of doing the month entirely
• I eat the diet similar to that of normal people
• We have had good foods every day; my nutrition is good enough
Restricted hygiene practices Maintained
• I didn’t wash my hair and only cleaned it with a towel to prevent the effects in old age
• I didn’t wash my hair to satisfy the needs of the seniors [in the family], and let them feel assured
• My family asked me not to wash and bathe. I’d like to take their advice
Modified
• After washing, using a hair dryer is a good way to do [it]
Challenged
• I didn’t follow the taboos of not washing and bathing
• I felt very uncomfortable before I washed my hair
• I use boiled water to clean and it [the episiotomy wound] is healing well and not hurting
anymore
Restricted physical activities Maintained
• I went out and was exposed to winds, and now I have soreness in my neck. I did find it really
uncomfortable. I believe postpartum women should not be exposed to the wind
• The knowledge passed down by ancients is supported by reasons
Modified
• As for the taboo not to go out, . . . I was tightly bundled to prevent exposure to the wind
Challenged
• I came down to walk around three hours after delivery
• I think to lie in bed this much is not good for health
Social restriction Maintained
• I don’t feel like having sex because my [episiotomy] wound is not healed yet.
• I never consider myself unclean. I want no sex life during the doing the month simply because I
don’t want it
Challenged
• There was no restriction for visiting. I like my friends visiting I want to talk to them
• I feel bored when I stay here alone
• Here [the center] is like a camp it’s rather fun!
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© 2013 Wiley Publishing Asia Pty Ltd.

to learn childcare skills. (iii) Participants wished to avoid
intergenerational conflicts about how to perform doing the
month, particularly in relation to hygiene practices. They
also mentioned that performing doing the month at a PNC
“saves trouble,” and is “more comfortable and involves fewer
restrictions.” (iv) Participants were unfamiliar with complex
doing the month procedures, as reflected in the statement:
“[I] don’t know how to prepare doing the month meals.” (v)
Participants favored the ability to make their own decisions.
(vi) Many had limited support at home. It was clear that most
of the participants had been working and lived in nuclear
families, which meant that they lacked the necessary family
support to perform doing the month.
Dietary practices: yang foods
Dietary practices at the PNC were generally performed in
accordance with contemporary nutritional principles, which
were introduced by a nutritionist during an educational
program. Several foods traditionally eaten during doing the
month were provided. One new mother mentioned she took
advantage of foods offered at the PNC that were consistent
with traditional practices, and indicated that she felt optimis-
tic about the effect on her wellbeing:
I know I cannot eat something cold. I have sesame oil
chicken and liver..., I believe doing the month well
would help adjust my physical constitution.
At the PNC, most traditional dietary practices related to
the concept of well-balanced nutrition and yang foods were
maintained, because the postpartum women asserted that
they needed nutrient-rich foods to maintain their health and
to produce breast milk for their babies. Several new mothers
believed that it was appropriate to eat high-quality food that
contains large amounts of protein, iron, and lipid-soluble
vitamins, including meats, fish, chicken, and internal organ
such as pig’s liver in their diet.
Dietary practices: yin food
Traditionally, postpartum women were advised to avoid yin
foods, such as vegetables and fruit. Most of the new mothers
at the PNC prescribed to food taboos in similar ways.
Although some vegetables and fruit were considered “cold”
in nature, the women generally believed that vegetables and
fruit were needed to ensure a balanced diet that included a
comprehensive range of nutrients. They believed that it was
acceptable to select “neutral” vegetables and fruit and to
avoid vegetables and fruit that were “cold.” For example, one
woman knew that she was supposed to avoid eating “cold”
and “raw” foods. She preferred to select her food based on
this knowledge, and she combined the traditional require-
ments with contemporary nutritional concepts:
Vegetables and fruit are good for my health, you know
. . . like a balanced diet. So I chose vegetables and fruit
that are ‘neutral’ such as cauliflower, grapes, strawber-
ries, and apples.
Several new mothers preferred to follow the professional
healthcare staff’s instructions related to nutrition, which were
mainly constructed in accordance with contemporary nutri-
tional principles and evidence.
Restricted physical activities
All new mothers in this study maintained the traditional
practices of not performing household duties, and most
rested in bed the majority of the time. A major reason pro-
vided for being at the PNC was to avoid the physical exertion
of household duties and to gain sufficient rest, regain energy,
and maintain good health. One woman stated:
If I practiced doing the month at home, I would surely do
something [housework] and walk around. As a result, it
would be even harder for me to have good rest. To
practice doing the month here makes it easier for me to
focus on myself . . . I hope to take advantage of doing the
month to take good care of myself.
Most of the new mothers adhered to the ancient taboo
against going out socially because of the belief that they were
in a weakened condition after childbirth, and the majority of
the new mothers never participated in outdoor activities.
They stayed inside the PNC for the entire month, believing
that the ancestors’ prescriptions were sensible, and that the
ritual would ensure their future health. Physical activities
were therefore limited, despite current scientific knowledge
demonstrating the importance of physical activity and
encouragement from the PNC to partake in postpartum exer-
cise classes.
Restricted hygiene practices
Traditionally, new mothers are not encouraged to wash their
hair or take baths for 30 days. However, several participants
washed and bathed at the PNC, even though they knew that
bathing and washing were not culturally permitted during
this period. They neglected to follow these restricted hygiene
practices because of personal preferences and a sense that
not washing was dirty. One woman mentioned that:
If I did not wash, I would feel dirty and sticky with breast
milk. I think I should keep clean, because I need to hold
my baby and breastfeed.
Rigid adherence to the prohibition in washing and bathing
was difficult from a hygiene and comfort perspective.
Although some of the new mothers did not bathe or wash
their hair during the doing the month period, most chal-
lenged or modified these practices, arguing that contempo-
rary facilities and scientific knowledge inform contemporary
hygiene and comfort practices. In an interesting interaction
with technology that was not available to previous genera-
tions, some new mothers washed their hair and then imme-
diately used a radiant hair dryer. One woman clarified that:
The taboo of not washing hair originated from rural
ancient China, where there was a poor living standard
Doing the month postpartum care in Taiwan 5
© 2013 Wiley Publishing Asia Pty Ltd.

. . . I washed my hair and dried it with a hair dryer
straight away. It is not necessary to follow the taboo
[restricted washing] strictly.
A participant indicated that she had trouble adhering to
the rules and felt extremely uncomfortable without washing
and bathing. She believed that she needed to maintain con-
temporary standards of hygiene:
I believe I would feel terrible if I didn’t bathe, and I
wouldn’t like to practice doing the month with such
discomfort. Because I have spent money on doing the
month, I would surely hope to do it in my way.
Although some new mothers challenged the restriction
against washing and bathing, others maintained the tradi-
tional restricted hygiene practices. One participant believed
that washing her hair could lead to harmful effects in later
life. She stated:
I didn’t wash my hair and bathe; I only cleaned myself
with a towel. I have learned that after delivery skin pores
will open up and I try to do what I can. I am not young
so I need to keep an eye on some taboos.
Social proscriptions
The PNC’s policies promoted restricted visiting hours, based
on the rationale that having many visitors could increase the
risk of illness for mothers and babies. During the fieldwork
period, visiting hours were restricted after 10 pm. Some new
mothers indicated that they would have preferred greater
visiting hour limitations to improve infection control, and
one participant mentioned that she felt reassured that her
baby was protected in the communal nursery:
Before coming to the center, I didn’t know that the baby
should only be in contact with its father and mother,
while others should be isolated and see it through the
glass. However, it is good because it can protect the baby
from any infection . . . I find the policy is good for the
baby.
In addition to maintaining the taboo of limiting visitors, all
participants abstained from sexual intercourse during doing
the month. Several reasons were provided for adhering to
this restriction. Some participants mentioned that they “felt
weakened,” “needed rest,” that their “wounds had not
healed,” and that they “did not want to risk infection.” All
participants mentioned that they would wait until after their
postpartum check-up before resuming sexual intercourse to
ensure that their health was maximized. This attitude was
expressed by one participant:
I don’t feel like having sex because my [episiotomy]
wound is not healed yet. I heard from the nurse that I
need to wait until the lochia stops and after the postpar-
tum check-up. It is fair enough. No sex for forty-two or
fifty-six days.
Although all of the new mothers abstained from sexual
intercourse and limited visitors during doing the month, the
reasons provided for abstaining were not the traditional ones,
such as to avoid misfortune, but were related to health, infec-
tion control, and physiological reasons.
DISCUSSION
Demographic information
Although the participants of this study were predominantly
middle-class women, their participation in doing the month
indicates that these women still conceptually adhered to tra-
ditional cultural beliefs and practices. The results from this
study suggest that doing the month practices may still be
widely observed in Taiwanese society, and thus confirm the
findings of similar studies that have been conducted in
Western countries that have substantial Chinese communi-
ties, such as America, Scotland, and Australia (Cheung, 1997;
Chu, 2005; Chen, 2011).
Traditionally, providing care for a daughter-in-law is a
mother-in-law’s social obligation to foster mother- and
daughter-in-law kinship bonds. However, 80% of new
mothers who participated in this study were living in nuclear
family units, and were no longer able to rely on their
mothers-in-law to assist them during doing the month at
home. Our findings suggest that the relationship between
mother- and daughter-in-law has become more negotiable
and is no longer consistent with the traditional rules, which
required new mothers to merely listen, and never question
the elder’s orders. Some participants indicated that the
mother-in-law’s help was sometimes unwelcome, mainly
because it is difficult to express disagreement with one’s
mother-in-law. These results are consistent with previous
studies that identified a growing trend of the new mothers’
own mothers and midwives being the key caregivers during
doing the month (Hung et al., 2010; Holroyd et al., 2011).
Dietary practices
At the PNC, traditional dietary practices prescribing well-
balanced and nutritious meals were maintained because
postpartum women felt that they needed nutrient-rich foods
to maintain health and produce breast milk for their babies.
Meats such as pig’s liver that are high in iron and lipid-
soluble vitamins, especially vitamin A (a nutrient often defi-
cient during the postpartum and lactating period) (Bodnar
et al., 2005) was regularly consumed. Several participants
consumed a variety of dishes, including beef, pork knuckles,
fish, poultry, eggs, vegetables, fruit, and milk, which is a
finding that confirms the results (Wang et al., 2008; Holroyd
et al., 2011) that Chinese postpartum women follow tradi-
tional dietary proscriptions to promote their physical
recovery following childbirth. Traditional doing the month
practices are consistent with World Health Organization
(1998) guidelines that recommend an increase of 10% to
20% of caloric intake while lactating. Participants in this
study generally preferred to base their diet on contemporary
understandings of well-balanced postpartum nutrition that
were consistent with traditional dietary practices.
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© 2013 Wiley Publishing Asia Pty Ltd.

Dietary practices regarding “yang” food for lactation
and health
Traditional dietary practices in the “yang” category have high
energy values and are rich in nutrients. The traditional rec-
ommendation is to eat meat and especially to drink gravy,
which is believed to nourish the body by warming it and
increasing breast milk production.There is a conflict between
traditional dietary practices and contemporary scientific evi-
dence related to physiology and contemporary nutritional
standards that maintain that high-fat foods increase the risk
of heart disease, obesity, and stroke (Micha & Mozaffarian,
2010). Reducing the consumption of high-fat dishes is con-
sistent with contemporary scientific knowledge and is prac-
ticed to reduce the risk of chronic diseases. Therefore, dietary
practices at the PNC have been modified according to con-
temporary scientific knowledge. The new mothers considered
proper nutrition and the consumption of high-calorie meals
vital for lactation and physical recovery. Traditional dietary
practices related to “yang” foods at the PNC have been modi-
fied based on contemporary scientific knowledge.
Dietary practices regarding “cold” foods
Traditional postpartum dietary practices advocate that cold
drinks, vegetables, fruit, and soy bean products that are con-
sidered “cold” foods, should be avoided. However, new
mothers who follow this diet may lack some nutritional ele-
ments, because the prohibition of vegetables, fruit and milk in
the traditional diet contradicts contemporary health care
knowledge. Liu et al. (2006) argued that traditional postpar-
tum diets were unlikely to provide sufficient nutrients to
meet the daily vitamin C and dietary fiber requirements for
postpartum women. Contemporary health care practices
encourage women to eat a well-balanced diet from all food
categories during this period, and our study found that
women are modifying the traditional diet to include vegeta-
bles and fruit. Their diet was generally based on contempo-
rary nutritional principles that advocate the consumption of
meat, milk, vegetables, and fruit, indicating a marked depar-
ture from the traditional diet (World Health Organization,
1998). Therefore, traditional postpartum dietary practices,
such as the avoidance of eating vegetables and fruit, were
challenged and adjusted according to contemporary scientific
knowledge.
Restricted hygiene practices
These results have demonstrated that rigid adherence to the
prohibition of washing and bathing was difficult to maintain
and contradicts contemporary healthcare approaches and
notions of comfort. Contemporary facilities maintain a com-
fortable environment for new mothers, indicating that doing
the month at the PNC is integrated with contemporary sci-
entific knowledge and awareness of comfort. These results
are consistent with the findings of previous studies (Chen,
2011; Holroyd et al., 2011; Liu et al., 2012) which demon-
strated that interpretations of the ritual are flexible and that
its practice now incorporates contemporary knowledge. Tra-
ditional doing the month hygiene practices have been chal-
lenged and modified according to contemporary scientific
knowledge, which has affected restrictions of hygiene
practices.
Restricted physical activities
Traditional postpartum practices encourage new mothers
to stay indoors and avoid all types of physical activity. In
modern health care, instead of restrictions, postpartum
women are encouraged to gradually reincorporate exercise
in their daily routine because it may help postpartum women
regain adequate muscle tone, increase muscle strength, and
reduce weight (Ko et al., 2013). It is also recommended for
alleviating negative physical and psychological symptoms
(Claesson et al., 2013). Traditional postpartum practices
related to limiting physical activities potentially cause health
problems such as constipation, osteoporosis, and excessive
weight gain (Bray & Bouchard, 2004). Our results indicate
that the traditional prescriptions, such as limiting physical
activities, and engaging in a few outdoor activities were com-
monly followed by new mothers, despite being challenged by
contemporary scientific evidence.
Restricted social engagement
Social restrictions that include limitations on visiting others
or entertaining visitors, as well as abstaining from sexual
activities during the postpartum period, translate as a period
of ritual impurity (Posmontier & Horowitz, 2004). This
study’s results indicate that traditional doing the month prac-
tices that require new mothers to stay indoors and abstain
from sexual activities were maintained. However, the reasons
provided for adhering to these rules have developed to incor-
porate contemporary knowledge. The participants empha-
sized that they maintained the practices to restore their
physical health and prevent episiotomy wound infection,
rather than for superstitious reasons, such as preventing mis-
fortune for their partners. These results are consistent with
previous studies (Raven et al., 2007; Holroyd et al., 2011) that
have reported that postpartum women still adhere to the
traditional prescribed behaviors to stay indoors and abstain
from sexual intercourse. Additionally, healthcare profession-
als in Taiwan typically suggest abstaining from sexual activi-
ties for approximately six weeks until the postpartum
physical check-ups are completed to ensure that the episi-
otomy wound is sufficiently healed (Nadeau, 2012). Thus, the
practice of not having sex during doing the month was
adhered to, but the rationale for it has changed.
Limitations of the study
The sample size in this study was appropriate for the nature
of qualitative study. However, the limitation of a single
setting and Chinese-speaking women in Taipei are recog-
nized. Participants in this study were healthy, highly edu-
cated, middle or upper class women, and had healthy
newborns. Therefore, the findings may not be transferable to
larger culturally diverse populations where postpartum
Doing the month postpartum care in Taiwan 7
© 2013 Wiley Publishing Asia Pty Ltd.

practices may be conducted differently. Traditionally new
mothers are isolated while they do the month, whereas
women in this study context were cared for by health profes-
sionals and could participate in group activities. Further
research could explore the differences between one-to-one
caregiving in a family setting compared with care provided by
health professionals with access to group participation.
CONCLUSIONS
Contemporary scientific knowledge and social changes have
influenced the traditional ritual practices of doing the month,
including the dietary restrictions, hygiene practices, physical
activities, and other social proscriptions. Although our par-
ticipants performed the practices at a PNC, no participant
followed all the traditional prescribed rules and restrictions.
Many participants were able to modify traditional practices
independently. Therefore, midwives should also be able to
integrate the positive aspects of doing the month in contem-
porary evidence-based healthcare practice. Additional
research is required to determine whether postpartum
nursing centers can improve parents’ childcare competence
and maternal role development.
ACKNOWLEDGMENT
The authors thank the new mothers who participated in
this project. Without them, this work would not have been
possible.
CONTRIBUTIONS
Study design: Y-CY, WS, LV.
Data collection: Y-CY.
Data analysis and manuscript writing: Y-CY, WS, LV.
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