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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.
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Research Article
Doing the month in a Taiwanese postpartum nursing
center: An ethnographic study
Yueh-Chen Yeh, RN, MSN, PhD,
Winsome St John, RN, RM, PhD
and Lorraine Venturato, RN, RM, PhD
School of Nursing, Taipei Medical University, Taipei, Taiwan,
Population and Social Health Research Program, Griffith
Health Institute, and
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 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:
Received 12 August 2013; revision received 18 October 2013; accepted 22 October
Nursing and Health Sciences (2013), ••, ••–••
© 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
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.
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.
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).
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.
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
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.
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.
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
Table 2. Demographic characteristics of the participants
25–29 3 11
30–34 17 63
35–39 7 26
Junior College 4 15
University 14 52
Masters 6 22
PhD 3 11
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
Vegetables and fruit are good for my health, you know . . . I chose vegetables such as
cauliflower, grapes, strawberries, and apples
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
After washing, using a hair dryer is a good way to do [it]
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
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
As for the taboo not to go out, . . . I was tightly bundled to prevent exposure to the wind
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
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!
4 Y-C. Yeh et al.
© 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
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.
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.
6 Y-C. Yeh et al.
© 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
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
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.
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.
The authors thank the new mothers who participated in
this project. Without them, this work would not have been
Study design: Y-CY, WS, LV.
Data collection: Y-CY.
Data analysis and manuscript writing: Y-CY, WS, LV.
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... The majority of studies used more than one data collection method (30/39) and adopted an inductive approach to data collection (33/39). While most studies described participant groups that were key stakeholders, only two studies used the term key informants (Hunter, 2010;Yeh et al., 2014). Regardless of the method used, the majority of studies used field notes or memoing to record observation and nonverbal communication (33/39). ...
... Nine studies stipulated the position of the researcher on the insider-outsider continuum (Allen et al., 2015;Flacking & Dykes, 2013;Hugill et al., 2013;Miltenburg et al., 2018;Mondy et al., 2016;O'Boyle, 2013O'Boyle, , 2014Spendlove, 2018;Yeh et al., 2014). In five of these studies the researcher was described as an insider (Miltenburg et al., 2018;O'Boyle, 2013O'Boyle, , 2014Spendlove, 2018;Yeh et al., 2014), in three as an outsider (Allen et al., 2015;Flacking & Dykes, 2013;Mondy et al., 2016), and one study commented that the team included insiders and outsiders (Hugill et al., 2013). ...
... Nine studies stipulated the position of the researcher on the insider-outsider continuum (Allen et al., 2015;Flacking & Dykes, 2013;Hugill et al., 2013;Miltenburg et al., 2018;Mondy et al., 2016;O'Boyle, 2013O'Boyle, , 2014Spendlove, 2018;Yeh et al., 2014). In five of these studies the researcher was described as an insider (Miltenburg et al., 2018;O'Boyle, 2013O'Boyle, , 2014Spendlove, 2018;Yeh et al., 2014), in three as an outsider (Allen et al., 2015;Flacking & Dykes, 2013;Mondy et al., 2016), and one study commented that the team included insiders and outsiders (Hugill et al., 2013). This study described the position of the researchers as follows: ...
Full-text available
While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.
... The postpartum period is a time of great vulnerability for many women [1]. Throughout the world, many culturally-specific traditional care practices for postpartum women are observed to ensure recovery and avoid health problems in later years [2]. ...
... Maternal role confidence was measured using the selfconfidence scale developed by Pharis [26]. This scale consisted of 10 items rated on a 5-point Likert scale (1)(2)(3)(4)(5), with higher scores indicating higher degrees of maternal confidence for infant care. The internal consistency reliability for this scale at four measurements in this study ranged from .718 to .912. ...
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Background: Many South Korean women stay in specialized postpartum care centers called Sanhujoriwon for 2 weeks after childbirth, a time which is widely recognized as a critical period for maternal role adjustment. Mothers' time within the postpartum care center offers a unique opportunity for nursing intervention to promote a successful transition to motherhood, especially for first time mothers. This study aimed to develop a maternal role adjustment program within the Sanhujoriwon based on the ecological model, and to evaluate its effects on maternal role confidence and breastfeeding success. Methods: A non-equivalent control group pretest-posttest design was used. Data were collected from 30 participants in the experimental group and 37 in the control group at four measurement times, i.e., admission day to Sanhujoriwon, discharge day from Sanhujoriwon, 4-6 weeks postpartum, and 12 weeks postpartum. The experimental group received the maternal role adjustment program, which included family education and counseling regarding breastfeeding and infant care, and encouraged rooming-in practices during their stay in the Sanhujoriwon. The data were analyzed using the IBM SPSS statistics 25.0 program using descriptive statistics, t-test, chi-square test, ANCOVA, and GEE. Results: There were significant interaction effects showing different patterns in maternal role confidence and breastfeeding success scores over the four time points. Maternal role confidence in the experimental group gradually increased over time. Maternal role confidence in the control group also increased from baseline to 4 to 6 week postpartum, but abruptly decreased at 12 week postpartum. At 12 weeks postpartum, maternal role confidence in the experimental group was significantly higher than that of the control group. In addition, breastfeeding success scores in the experimental group also gradually increased over the four time points, while those of the control group showed a gradual decline. Breastfeeding success scores were significantly higher than those of control group at both 4-6 weeks and 12 weeks postpartum. Conclusions: These results indicate that the maternal role adjustment program was effective in improving maternal role confidence and breastfeeding success among first time mothers in the postpartum care center.
... However, for Chinese women, this period is essential for engaging in postpartum confinement practices, in which the daily life of the postpartum mother is often supported by the woman's mother or mother-in-law [16]. In recent years, due to social changes and the prevalence of small families, it has become common for women to stay in postpartum care centers or hire a yuesao (maternity caregiver specializing in caring for mothers and newborns during the postpartum confinement period [16]) after giving birth [17]. It is strongly recommended to pay more attention to the impact of cultural practices on mental health. ...
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Background Stress is a risk factor for poor physical and mental health, affecting new mothers’ ability, especially those with perinatal mood and anxiety disorders, to maintain their everyday lives. Over the past 50 years, global incidences of depression and anxiety disorders have increased, reaching pandemic levels. These incidences represent major public health issues that are challenging to detect and treat. Mindfulness programs are viable for reducing stress, anxiety, and depression. The present study evaluates mindfulness intervention effects on stress, anxiety, depression, and mother–infant bonding. Methods We collected data on 102 women participating in a prenatal mindfulness program between July 2021 and March 2022; they were parallel and randomly assigned to experimental or control groups. The intervention group received an 8-week course in a prenatal mindfulness program, and the control group received usual standard prenatal care. The self-reported stress, pregnancy-related anxiety, and depression were assessed before and after the intervention and at 36 weeks of gestation. At 2 and 4 months postpartum, all participants provided self-reported their levels of stress, depression, and quality of mother-infant bonding. Results Compared to the control group, the experimental group that received the prenatal mindfulness intervention experienced reduced prenatal stress, anxiety, and depression and reduced postnatal stress and depression. Despite this, there was no significant difference between the groups in terms of the quality of mother-infant bonding. Conclusions Mindfulness prenatal programs are convenient and effective methods of decreasing stress, anxiety, and depression during the perinatal period. Based on our findings, prenatal mindfulness may play a role in mitigating mood and anxiety disorders and should be considered in future approaches to preventing psychological distress. Trial registration number This trial has been prospectively registered at (NCT04693130) and the first registration date was 12/24/2020.
... Many women believe that poor postpartum care is related to health problems they experience for the rest of their lives. Therefore, evaluation of postpartum recovery, sleep, fatigue, pain, depression, anxiety, and breastfeeding is important for women after childbirth, and appropriate postpartum care services should be provided [4,5]. ...
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Objectives: In East Asia, postpartum care has traditionally been considered important for maternal health; however, studies on this are still insufficient. Therefore, we examined the satisfaction and perceived effectiveness of herbal decoctions used in postpartum care in a city in the Republic of Korea (ROK). Methods: We analyzed anonymized secondary data obtained from a retrospective cross-sectional survey of women who had taken herbal decoctions provided by the support service for women giving birth in a local city in ROK. The questionnaire items consisted of basic information regarding childbirth, the need for the herbal decoction support service, satisfaction, and the effectiveness of the service received. Results: A total of 68 women were included in the study, and those aged 30-39 accounted for 73.13%. Of the 68 women, 79.37% visited within 3 weeks of childbirth. Women's satisfaction regarding herbal decoction support for postpartum care was 76.47%, and most women (98.53%) responded that they needed it more than twice. More than 50% of women showed improvement in puerperal wind disorders, weight gain, and delayed eliminated lochia. Conclusion: A large proportion of women who took herbal decoctions reported satisfaction and perceived effectiveness when used to treat puerperal wind disorders. Nevertheless, future well-designed clinical studies are needed to provide information on whether herbal decoctions effectively prevent and treat puerperal wind disorders.
... Postpartum women may often experience weakness and vulnerability and thus require special care [2,9,41]. Therefore, a Sanhujoriwon's environment, systems, and services are designed to prioritise rest for mothers [42] to facilitate their postpartum recovery [17]. ...
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Abstract Background In South Korea, commercial postpartum care centres, known as Sanhujoriwons, have emerged as important institutions aiding mothers’ physical recovery after childbirth. Although previous studies have measured mothers’ satisfaction level with Sanhujoriwons, this study applies Bronfenbrenner’s ecological model to identify the factors influencing first-time mothers’ satisfaction with Sanhujoriwons. Methods This descriptive correlational study involved 212 first-time mothers admitted to Sanhujoriwons for two weeks with their new-borns (healthy babies weighing at least 2.5 kg) after giving birth after 37 weeks of pregnancy. Data were collected using a self-report questionnaire at five postpartum care centres in the metropolitan area of South Korea from October to December 2021, on the day of the mothers’ discharge. This study considered ecological factors such as perceived health status, postpartum depression, childcare stress, maternal identity at the individual level; partnership with Sanhujoriwon staff at the microsystem level; and the Sanhujoriwons’ education support system at the exo-system level. The data were analysed using descriptive statistics, t-test, one-way ANOVA, correlation analysis, and hierarchical regression analysis using the SPSS 25.0 Win program. Results The mean score of satisfaction with Sanhujoriwons was 59.67 ± 10.14 out of 70, indicating a high level of satisfaction. The hierarchical regression analysis showed that satisfaction with Sanhujoriwons was significantly affected by the perceived health status (β = 0.19, p
... The purpose of this postpartum rehabilitation program (PPR) is to manage the delivered women's health in a more evidence-based manner during 'doing the month' period. However, little information is available in the literature to determine whether these maternal centers would benefit the health of women after delivery [8,12]. Some studies have shown that a high-quality 'doing the month' experience positively impacted maternal parenting quality [4,[14][15][16] and exercises can be effective in reducing the symptoms of postpartum depression [14,17], while some restrictions of 'doing the month' practices might negatively impact the mental health of postpartum women [18,19]. ...
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Background: The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. Methods: The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50). Conclusion: Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.
... The environment had allowed room for negotiating strict TCPs, which new mothers traditionally had to follow without questioning. This finding concurred with previous studies that reported a rising trend of husbands and confinement nannies being the main caregivers during confinement ( Holroyd et al., 2011 ;Yeh et al., 2014 ). However, the lack of support from mothers/mothers-in-law may potentially cause confusion and uncertainty amongst mothers regarding complex TCPs, highlighting the fact that participants who did not live with their mothers/mothers-in-law were less familiar with TCPs than those who did. ...
Objective Modern Singaporean mothers still embrace traditional confinement practices after childbirth, which often marks a significant milestone in maternal experiences. However, limited studies have explored in-depth the collective confinement experiences of mothers in Singapore. This study hence aimed to explore the postpartum confinement experiences of first-time mothers from the three major ethnic groups in Singapore, namely Chinese, Malay, and Indian. Design A descriptive qualitative study was conducted. Purposive sampling was adopted to recruit participants. Individual semi-structured face-to-face/telephone interviews were used to collect data, which were analysed using thematic analysis. Setting and participants Sixteen first-time mothers were recruited from two obstetric clinics in a tertiary hospital in Singapore. Findings Five themes emerged: “Specific diets adopted and avoided for different purposes”, “Complexity of various traditional confinement practices (TCPs) adopted”, “Reasons for adopting TCPs”, “Reasons for modifying TCPs”, and “Postpartum challenges”. Key conclusions Our study provided unique insights about Singapore's Chinese, Malay and Indian first-time mothers’ postpartum confinement experiences. While confinement practices were still observed, many mothers no longer subscribed to guidelines followed by previous generations and were modifying or forgoing practices they deemed impractical. Mothers faced challenges adapting to new motherhood and often felt restrained or stressed by confinement practices. Implications for practice Healthcare professionals should take the lead to educate mothers and their families on harmful traditional confinement practices and their misconceptions. Future studies could explore alternative methods of postpartum check-up to improve first-time mothers’ confinement experiences, and focus specifically on lower-income families to explore their unique confinement experiences. Keywords confinement experiences first-time mothers post partum Singapore ethnic groups
... The rapid cultural and economic changes, and greater access to higher education, have led some urban women to question traditional practices such as doing the month and to modify traditional postpartum care (Liu et al., 2014). Traditional rituals that contribute to social order are being challenged and transformed in response to contemporary social changes in family structures, women's status, and health-care systems (Yeh et al., 2014). Yet the ancient Confucian philosophy is still present in contemporary China, reflected in filial piety and the central role of education to be a good Confucian scholar and member of society (Hwang, 2011). ...
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Sixteen women in Shanghai participated in semistructured interviews, and thematic analysis was used to interpret their responses. An overarching theme, three main themes, and 13 subthemes were identified. The overarching theme (the old ways and the new—transition into motherhood) in new China, had these main themes: (1) urban Chinese women’s transition into motherhood; (2) family’s support and struggle with tradition; and (3) modern society in the shade of the past. The transition from tradition and modernity can be a source of conflict between the generations and can negatively impact new mothers’ mental health. Loneliness, feeling misunderstood, illiteracy, parental generation’s beliefs, and health-care providers’ attitudes are all barriers to access to care.
Background Unresolved postpartum LBP may affect women’s physical and psychological health. Aim To investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP. Method Postpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values. Results In all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention. Conclusions For postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.
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Mothers with infants in the Neonatal Intensive Care Unit (NICU) are at a higher risk of postpartum depression (PPD). Risk factors of PPD include environmental factors, psychological factors and biological factors. In this review, the aim was to identify the prevalence of PPD and its associated risk factors among mothers with infants in NICU. The relationship between dietary intake in relation to traditional postpartum practices with PPD is also discussed. Findings showed that PPD among mothers with infants in NICU was prevalent, ranging between 12.1% and 68%. Factors such as preterm birth, long hospitalisation and maternal role alteration were the most associated risk factors contributing to PPD. Consumption of food based on traditional practices was found to influence maternal mental health. Therefore, a rational approach in addressing mental health issues and adhering traditional food practices is needed in order to promote a postpartum mother's safe and healthy well-being.
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to examine the changes in and relationship between perceived social support and parenting self-efficacy in the perinatal period among pregnant women in mainland China. this was a secondary analysis with data from part of an experimental study of the effects of an interpersonal-psychotherapy-oriented childbirth psychoeducation programme on maternal adaptation. A longitudinal design was employed in the present study. The study was carried out from July 2008 to May 2009 in one general hospital in Guangzhou, China. a convenience sample of 68 first-time mothers in mainland China completed measurement of social support and parenting self-efficacy during pregnancy and at six weeks and three months post partum. perceived social support and parenting self-efficacy declined during early motherhood. Parenting self-efficacy increased from six weeks post partum to three months post partum. Perceived social support positively correlated with parenting self-efficacy. culturally competent health-care intervention should be developed during early motherhood to promote perceived social support and parenting self-efficacy for the new mothers.
Literally, ethnography means writing about people, or writing an account of the way of life of a particular people. In early anthropology, what was aimed at was a descriptive account that captured a distinctive culture. Initially, ethnography was contrasted with ethnology, which was concerned with the historical and comparative analysis of cultures based on ethnographic accounts, the latter often being produced by travelers and missionaries. Over time, the term ethnology has fallen out of favor, and ethnography has come to refer to a combination of theoretical interpretation of cultures and firsthand investigation carried out by anthropologists themselves. Moreover, the term has a double meaning, referring both to a form of research and to the product of that research: ethnography as a practice produces ethnographies. And, recently, a distinction has sometimes been drawn between doing ethnography and using ethnographic methods. This has been employed by some anthropologists in an attempt to mark off their own practice from what passes for ethnographic work within sociology and other areas (Wolcott 1999).
Handbook of Obesity: Clinical Applications, Third Edition is the premier reference for physicians and researchers in the field of obesity. Written by leading scientists and clinicians, this handbook offers unparalleled depth and breadth of coverage concerning this growing global and chronic disease that affects and exacerbates comorbid conditions including diabetes and heart disease. This Third Edition is full of many revisions including: •The sections Etiology and Pathophysiology have been updated to reflect state-of-the-art advancements in the prevalence, etiology, and pathophysiology of obesity •New chapters have been added and revisions made to the subjects of genetics, molecular biology, endocrine determinants of obesity, the metabolic syndrome, and the relationship between obesity and diabetes Written by the field’s leading scientists and clinicians, Handbook of Obesity: Clinical Applications, Third Edition: •has unparalleled coverage of the full range of subjects comprising the field of obesity. •is packed with charts, diagrams, and tables that conveniently summarize key information and concepts •elucidates state-of-the-art knowledge of the definition, prevalence, etiology, and pathophysiology of obesity.