June 2015


Two cultures and a baby

By Alice Pung
Two cultures and a baby

Birth of the Virgin c.1620, Simon Vouet. Photo © G Nimatallah / Getty Images

On pregnancy and birth, tradition and family

“What are you doing?” my hospital roommate asks. I’m standing by the door of our shared bathroom, towel in hand, waiting for the nurse to return with a shower cap. In antenatal classes I was told a warm shower is comforting when going into labour, but I don’t want to give birth with wet hair dripping down my back.

“No, no, no,” my roommate insists, “you must wash your hair now!” I’d only met the woman a few moments ago, through the curtained partition separating our beds, when I walked over to the bathroom as my contractions began. “Didn’t your mum teach you? You can’t wash your hair for 30 days after you have a baby, so you must do it now. This is your last time!” I smile and thank her for her advice, then slink back to my side of the room. She has a Thai accent, and I know exactly what she is talking about, but pretend not to. I also know that she will sequester herself in her heated house for at least 30 days after giving birth, refrain from washing her hair, maybe not even shower, and live on a diet of special soups and tonics.

Every pregnant woman, and new parent, receives their fair dose of unsolicited advice from well-intentioned family members and strangers. Most of it is mildly annoying, but some of it can be anxiety-inducing, particularly if you feel you have to pretend to follow that advice to alleviate the concerns of loved ones whose fears you don’t share yourself. The Chinese and South-East Asian practice of zuo yue zi, which literally means “sitting the month”, goes back thousands of years and is even mentioned in the I Ching. Hospitals in Australia make allowance for this practice, which they refer to as “cultural confinement”, by sending nurses to visit the postpartum mother, who is not allowed outside the house. There are other things a new mother is not supposed to do: drink cold drinks, squat, eat certain vegetables and fruit, stand by an open window, turn on air-conditioning or cry.

Not every mother will follow all of these rules, and they vary in different regions of Asia. Other cultures also practise postpartum confinement – South Americans, Indians and traditional Greeks, for instance – but the distinct practices of my heritage spread from the north of China to the warmer climes of South-East Asia. My family are ethnic Chinese, born in Cambodia, and I think a lot of the theory behind the customs must have got lost in translation. Much of it seems like superstitious claptrap, especially when I remember my grandmother prohibiting my pregnant aunt from watching cartoons with us because she didn’t want the unborn baby to come out “deformed” like Alvin the Chipmunk. Whenever nurses ask whether I will practise cultural confinement, I tell them definitely not.

Nonetheless, during my own pregnancy I developed a heightened awareness of the fragility of life. I was grateful when friends gave me bags of baby clothes from their own children, but I could not sort through them or look at them. Just in case. I couldn’t digest the idea of a baby shower. Just in case. Because I was so nauseous for the first three months, I was filled with feelings of catastrophic expectancy. Conceived in a refugee camp and naturally underweight all my life, I wasn’t confident that I could grow a healthy and robust baby. I kept my fears to myself, yet with every doctor and midwife visit, I also realised how seriously the medical profession took the possibility of pre- and post-natal depression. My sister, who is a doctor, told me that some suffering mothers at the hospital wouldn’t pick up their babies or feed them.

Ever since I was 20, one motherhood image has inadvertently and continually flashed through my mind: a photograph of a mother holding her baby in a strange way. The photo was from the Tuol Sleng Genocide Museum in Phnom Penh, Cambodia. Meticulous in their documentation of death, the Khmer Rouge took photos of every prisoner before they executed them. The mother holds her prostrate newborn low, almost near her waist. She stares straight at the camera, the ultimate face of detachment.

At the hospital, I collected the beyondblue booklet A Guide to Emotional Health and Wellbeing During Pregnancy and Early Parenthood, but I also wondered whether there was one for new grandparents. All the terrible things that could happen, my parents expected to happen, with the only insurance being that I stay home all the time, only venturing to and from work. “Don’t go to Little Saigon Market in Footscray,” Mum warned me. “You’ll slip over fruit scraps on the ground, fall and miscarry.”

My parents cannot accept pain as part of my life. It seems to make them suffer more than it actually makes me suffer. They worry all the time, and in their old age it seems to have got worse. Their anxiety is physical and palpable: it scatters their thoughts and makes my mother break out with a nasty rash all over her limbs. From time to time, she also suffers from debilitating depression. My father still weighs around 45 kilograms. During the Khmer Rouge years, they lost everything – first their families, and then their possessions; understandably, their world has narrowed to a few concentric circles, the pivotal one in the centre being their children, the second their electrical appliance business. They have always been overprotective of us to a pathological degree. As author Helen Motro explains through her studies of Holocaust survivors:

Not all of our fathers beat their sons … Not all of our mothers froze us out as teenagers because they themselves survived by abandoning their own mothers at 15 in the camps. No, most of us had parents who loved too much, who smothered us with their care, their solicitude, their ever-present, all-enveloping anxiety.

There’s a specific brand of anxiety, called “transgenerational trauma”, that affects those with genocide-affected parents. Studies have even shown that children of Jewish Holocaust survivors have altered levels of circulating stress hormones compared to other adults of the same age. They simultaneously feel overprotected by their parents and overprotective of their parents. All grandchildren are joys to their grandparents, but this first grandchild means something more to my father, who has seen the death of so many children he knew and loved. Although he never directly mentions this feeling of loss, my father has always spoken with yearning of having “four generations under one roof”, the ultimate Chinese idea of a blessed family.

I am in a room in the physiotherapy department at the Royal Women’s Hospital in Melbourne with ten other women. We’ve all been referred by our doctors, midwives and, in some cases, social workers. We range from our late teens to our early 40s, first-time mothers, second-time mothers, Turkish, Scottish, Scandinavian, and even a mum who identifies as Gypsy. I only know this because during the introduction we were asked to say our names and explain how we got them. We are all strangers to one another but the anonymity is comforting. We don’t share personal stories, because this is not therapy.

When I had mentioned to my hospital midwife some of my worries, she enrolled me in the hospital’s antenatal mindfulness course. The five-week Mind Baby Body group-learning program is facilitated by a perinatal psychiatrist, Dr Kristine Mercuri, who explains that anxiety is the most common ailment of pregnancy. Six years ago, the hospital paid for mindfulness-trained practitioners to run programs for oncology patients. Kristine then devised a similar program for pregnant women. She had studied under Professor Jon Kabat-Zinn, the creator of the Mindfulness-Based Stress Reduction program that is used in hospitals worldwide, who defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally”.

Kabat-Zinn’s original mindfulness program is eight weeks long, requiring one to two hours’ practice per day. This program is shorter, Kristine says, because “I couldn’t ask pregnant women who are already so busy to commit to this level of practice. Yet the great thing about pregnancy is that there’s a deadline, and having this deadline focuses women’s attention. And if they are paying attention and focused, their practice will be concentrated.”

We’re all sitting on the floor, a large plastic mat spread out in front of us, holding ice cubes in our hands, as many as we can fit into each fist. Kristine advises us when to let go of them, and when to pick them up again. First, we hold the ice for 60 seconds. It’s a cold day and the ice stings my palms, but when we’re allowed to let go, my fingers feel suddenly suffused with warmth, and I exhale with relief.

Kristine draws a diagram on the whiteboard of a series of peaked hills. She explains that these represent labour contractions, with crests being the height of pain and the dips the reprieves. “Most people are scared of pain, so in between the pain they worry about the next wave and tense up,” she says, “but if you learn how to be in the present moment, you will not fear the pain.” After a 60-second reprieve, Kristine instructs us to pick up the ice again, but this time to breathe into the stinging sensations. We are encouraged to count our breath, make a low humming voice, even smile. The more aware I am of the pain – noticing that it comes in waves – the less energy I waste in fighting it.

“When you go into labour, cover the clock,” she suggests, “because you have no control over how long your labour will take.” Kristine says that birth plans were originally intended to give women back control over the medicalisation of their delivery, but they can set up unrealistic expectations. “Your bodies know what to do,” she reassures. “It’s growing a baby without your mind having to direct itself to it.”

The program was originally intended to help women deal with the pressures of impending parenthood and pregnancy, but Kristine discovered that a lot of expectant mothers also wanted coping techniques to deal with giving birth.

“The present moment is the only time you can make appropriate decisions,” Kristine explains. “People who remain present under pressure will make better choices, instead of reacting automatically based on past experiences.”

In our final session, when Kristine takes the roll, one of the mothers in the group is already in the labour ward. We finish off with a “loving kindness” exercise, before we go our separate ways.

After the first trimester, the rest of my pregnancy is a surprisingly happy time. There are moments of worry, of course, like getting food poisoning and an eight-day migraine. There are moments of annoyance, such as being told off by my mother for transgressions I don’t understand, like walking faster than a geriatric shuffle or eating walnuts. But, on the whole, each day brings more and more energy and optimism. Sitting alone in my flat one afternoon, I have the unassailable feeling that things will work out, and, if not, then I am resilient enough to cope. I still feel a little like I have been carrying the “replacement” for lost relatives, but rather than a burden, it now feels a comfort.

I’d begun the Mind Baby Body program as emotional insurance against postnatal depression. What I did not expect is how the mindfulness practice suddenly comes to fruition when I go into labour.

My waters break on a Saturday evening after dinner at my parents’ house. My husband, Nick, and I return home, I pack a bag and we walk to the Royal Women’s Hospital, feeling excited anticipation. Something is happening, and when it does happen, it is not the worst pain I’ve ever had in my life. Who knew that 45 minutes holding melting ice in my hands could prepare me so well for the next five hours? In labour, you realise how finite your energy is. I don’t want to waste it by crying, so I start humming instead, louder with each increasing wave. I know I must sound ridiculous to the Thai woman in the next bed, the one who insisted that I wash my hair, but I no longer care. I now understand why monks chant, and cows moo. Someone arrives – I wonder if it is the nurse with the shower cap. “The nurse told me that I’d find a very happy singing patient in Bed 21,” the midwife says when she sees me, “and she was right.”

Our baby is born at 35 weeks, but when he is put on my chest, I don’t understand that he is premature and small. Because I am also small, he seems a perfect size for me. He’s a strange creature, looking up at me with one grey eye and two yellow eyebrows, one curiously raised. The other eye is stuck shut. Marvelling over his matted black hair and miniature nipples, I cannot believe that this little person folded inside me has come out in one piece. I am euphoric. I look at Nick, battle-weary, still holding my hand. Like an Olympic runner I’ve been fully concentrating on getting through the task, but patient Nick had to wait out the protracted minutes and hours as a spectator.

When the nurse takes our baby upstairs to the Newborn Intensive and Special Care (NISC) unit, my midwife Ellen gets me a sandwich and helps me into the shower afterwards. Just like my mum 34 years ago, when she gave birth to me, I cannot believe the kindness of the hospital staff. As a new mother, I am luckier, though – the nurses are looking after my baby in intensive care, I can eat the hospital food and keep it down (Mum couldn’t stomach Western food at first), and, most importantly, I can speak English. My mother once told me that when I was born and she was left alone in the room with me, I wouldn’t stop crying. Her milk hadn’t come in yet and she had no idea what to do, so she fed me Nescafé with sweetened condensed milk from a plastic spoon.

In the Victorian public hospital system, if the mother is healthy and fit, she will go home after one night’s stay. Ellen takes me to my room and tells me to rest, that a nurse will check on me soon. When the nurse comes, she hands me a card with our baby’s bed number. She says that if I can’t breastfeed him, I should still be waking up every two to three hours to hand-express milk for him. A physiotherapist comes with some handouts about pelvic floor and abdominal exercises, and advises me to begin them as soon as I can. Then a pharmacist comes with a sheet of medications and vitamins I should take. A final nurse comes and tells me about wound care, and about correct sleeping techniques for the baby to prevent cot death.

“What if you have a patient who can’t read?” I ask her, taking the handouts she gives me.

“Well, then you’d have real difficulty,” she acknowledges, “but we do have some translators.”

The staff at the hospital are kind, helpful and, as I can see, often stretched to their limit with the endless rotation of birthing patients. I am in very good shape, so am discharged from the hospital two days later. I walk home from the hospital with Nick, feeling a little sorry to leave, my bag heavy with printed instructions.

Our baby stays in the NISC for another week. He is in a humidicrib, and two days after his birth he has a feeding tube put in his nose because his blood glucose level is low. I wake up at six in the morning and visit him until 11 at night. I am there so he can have a feed every three hours, and I also hold him against my chest so we can bond. It feels a lot like falling in love, but without the agitation or self-doubt. For that one week I am lucky enough to do nothing but be with my baby. I’m also lucky enough to be able to return home and sleep through the night, while he is in the expert hands of the nurses. I walk home, grateful for our public health system and happy to be a taxpayer. Tax away, I think, if this is the kind of treatment every mother and child gets.

After the birth of a baby, a mother home from hospital usually has to entertain visitors, disrupting both her and the baby’s sleep, and his feeds. But only two people at a time are allowed in the NISC unit. My parents are regular visitors. My mother brings me food at the hospital every morning before she catches a train to work. She is comforted by the sterile ward, the room with six baby beds and the rotating nurses, the humidicrib. Nothing like this existed in the Cambodia she grew up in.

As I have to walk to and from the hospital early in the morning and late at night, my parents must resign themselves to accept it. I realise that they are likely getting some degree of tacit opprobrium from our small community and relatives. How could they let a daughter out of the house in the cold? How could they let her walk home from the hospital after giving birth?

When Kate Middleton brought baby George out to the front steps of the hospital to show the world, the tone of Chinese and Taiwanese media’s coverage of the event was not of excitement, but grave alarm. Chinese medical “experts” on the news weighed in on what possible harm she could cause herself and her child, being outdoors so soon.

My mother does not mention a word about me “sitting the month”. Instead, she keeps bringing me food: pig’s trotter soup with ginger, chicken soup with goji berries and ginseng, braised eggs, salmon, and litres and litres of PhysiCAL milk. All these things, she says, are to help me recover and produce more breastmilk, but when I ask how they work, she just mutters something about warming the blood.

“Remember not to read anything during this time,” she repeatedly warns. “You could damage your eyes.” I don’t tell her about all the instructional booklets and brochures the hospital has given me. “Don’t move too much or squat,” she instructs, “because you’ll become incontinent later in life.” I don’t tell her about the physiotherapist who encouraged pelvic floor exercises immediately. Whenever my mother sees me at the hospital, I am in a big red chair with my baby on my chest, either feeding him or warming him like a human heat pod. This sedentary existence pleases her immensely.

In hospital our baby was buffered by nurses, doctors, midwives and a sanitised environment; when he comes home a week later both Nick and I fall ill with colds, which we cannot help but pass on to him. Fortunately, it does not weaken his sucking reflex. I am in our bedroom nursing our baby when my mother suddenly barges in. “You can’t just lie there all day feeding him. Your face is all shrunken and drained!” She demands that I pull the baby off the breast, get out of bed and immediately eat the soup she has brought. I tell her I’ve already had Weet-Bix for breakfast, and she yells at me for that, loud enough to startle the baby so that he unlatches from me. “You never listen to me,” she scolds. “You’ll make your baby sick and then you’ll be sorry! And why is the heater turned up so high? You’ll suffocate him!” Her tirade goes on and on. Annoyed, I growl at her to stop hassling me. My mother is a series of contradictions: she wants me to stay warm but now we’re too life-threateningly warm; she was happy to see me feed the baby in the hospital but now she wants him exclusively weaned on the bottle; and she wants me to eat grains but not breakfast cereal!

“It’s just a cold,” I tell her. “We’ll get over it.”

When my mother leaves I keep feeding the baby in our heated room, but after I finish I eat her soup.

A week later, the rest of our relatives come to visit. Nick’s family make the five and a half hour drive from Corryong to marvel over the little miracle and are content holding him, but my family dispense endless advice. I shouldn’t go out, now that I’m safely ensconced in our flat. My father instructs Nick to make sure I eat enough, because he says Asian women are weaker (which chagrins me, but amuses my husband). My eldest aunty makes me a fig, goji berry and white fungi soup. Aunty Kieu brings us pork dumplings, and Aunty Ly makes me a sweet potato pudding. Aunty Sim tells me to eat peanuts to increase milk production. I am barely alone, but never have to “entertain” family; instead they hold the baby so I can eat all the food they have brought. They bottle-feed the baby so I can rest. My mother comes over every day bearing soups infused with Chinese medical herbs.

Although postnatal depression is a debilitating and real condition, I wonder how much of the baby blues can be attributed to an unexpected detrimental change in circumstances. Reading Naomi Wolf’s Misconceptions, I imagine a poor young Anglo-Australian mum at home looking at Miranda Kerr’s postnatal abdominals in Woman’s Day, in between having to breastfeed her baby (sometimes above a new C-section wound), cook, clean and deal with visitors who want to wake the baby up to look at the colour of his eyes. When everyone leaves, she feels neglected and isolated in her house, with only a bag of hospital booklets to guide her until the next visit from the maternal and child health nurse, booklets advising her to breastfeed and exercise immediately.

In contrast, through their visits, food and endless advice, my family make sure I understand that I am equally important as the baby, if not more so: to be his primary care-giver I have to be in optimal health. I realise that my family have inherited a great lore of nutritional wisdom that they often can’t explain, knowledge I once dismissed as quackery. When I have a cold or sore throat, I know to boil Lo Han Guo (siraitia grosvenorii) in water to make a tea. I know about the inherent “heating” and “cooling” properties of some foods. And we were putting goji berries and red dates in our soups before they became “superfoods”. When I had a severe asthma attack at my uncle’s house and had left my Ventolin at home, he gave me a bag of herbs to inhale, which miraculously cleared my lungs. During the Pol Pot years, when my father was surviving the killing fields, his acupuncture skills – used with thick copper electrical wires he found on the side of the road – cured village chiefs with stomach aches, and children whose limbs flopped listlessly to their sides after being tied for too long in punishment. I can’t believe that I was once afraid that they’d impose their ways onto my modern motherhood and my modern baby.

Yet what happens to all the new Asian mothers who do not have their parents around, or whose parents are still overseas? Getting statistics for the number of women practising confinement in Australia is similar to trying to work out how many people celebrate Greek Orthodox Easter or practise Bikram yoga. For Chinese in mainland China, Taiwan and South-East Asia, however, it’s a cultural norm, and confinement nannies can be hired to cook special meals for the new mum, take care of the newborn, even do the housework and laundry. Mothers can even check into confinement clinics where they spend the month recuperating. Top clinics can charge up to $US500 per day. In Australia, such services are harder to come by, although individual older women might advertise their services as confinement nannies in the local ethnic newspapers, and Chinese medical practitioners can prepare special herbs for postpartum mothers.

The only Australian company I can find that offers a more holistic care model is Confinement Care in Sydney, run by the husband-and-wife team of Eric Cheng and Anni Chien. Anni is a qualified and registered Chinese-medicine practitioner specialising in pregnancy care, while Eric is an educator.

They set up Confinement Care after witnessing the pregnancies of their friends who were receiving good support through the conventional public and private health care system. “But when these couples started thinking about their postnatal plans, those who grew up in families with strong Chinese heritage suddenly realised that information was not so clear-cut, and often confusing,” Eric explains. After growing increasingly frustrated over some of the “poorly informed postnatal practices that mothers were putting themselves in”, Eric and Anni developed a service that provides new mothers with acupuncture, meal plans, advice and even herbal sachets for soups and baths. Yes, baths.

Eric explains that the practice of not washing for 30 days after giving birth originated in Northern China, where winters were harsh and washing was conducted in riversides and near communal wells, in an era plagued with water-borne diseases such as cholera. “Washing in these environments contradicts Chinese medical advice, as it creates moments of vulnerability for pathogens to attack the body,” Eric explains. “At some point in time, this guidance was removed from its context and adapted as a blanket rule. But obviously, we are not exposed to waterborne viruses in our tap water, and we do not experience sudden fluctuations in temperature as we bath and shower in enclosed and heated bathrooms. Given these reasons, this ‘rule’ should not apply to mothers in Australia.” Eric mentions that there are other superstitious practices that draw on people’s fear of non-compliance, some purely based on the way similar words sound in certain dialects.

But these rituals distract from the real rationale for confinement. “When we talk about postnatal ‘confinement’,” Eric explains, “we are referring to a time that is intentionally set aside for three purposes: to rest and recover from pregnancy and the birthing process, to build a healthy body to begin the motherhood journey, and to create ample opportunities for mother and baby to bond. It is somewhat unfortunate that translators have appointed unglorifying terms like ‘confinement’, ‘sitting month’, or even ‘doing the month’, leading people to think the focus is on restriction and non-movement, and that it is to be endured.

“Clinically, women who do not have a good recovery often suffer postnatal issues like severe fatigue, lower back pain, insomnia and hair loss. These can often last for months or even years after the pregnancy.”

Indeed, this diagnosis accords with the World Health Organization’s observations that the puerperium – the six weeks following birth – is a critical period, as most maternal and infant deaths occur during this time.

Eric also mentions the importance of “reassuring anxious new grandparents”, something Western health care fails to address because of different familial structures. “If intergenerational conflict does arise over confinement approaches, the new father should step in to protect the mother’s wellbeing, and help remove the unsaid expectation that the daughter or daughter-in-law has to sacrifice her personal needs for the sake of harmony with the older generation.”

In becoming a mother, I’ve found I’ve also become a different daughter. My parents’ overwhelming anxious love was once a burden, and as a young adult I was either fighting or fleeing it. As a young mother, I have been unexpectedly freed from worry: the more my parents fret over our baby, the more I am able to choose to be a calm parent, to understand that this is not an innate temperament, but a feeling of safety derived from secure and comfortable circumstances. It is a gift.

When we take our baby to visit his great-grandparents, my 83-year-old grandmother tells me to drink wine with every meal. “It warms the qi,” she says. “If you can afford it, buy the wine with the most alcohol content.” When she gave birth to her eight children, she had to make do with homemade rice wine. “It was cheaper.” She also notices our baby has a milky-white tongue, and suggests that I give him a cloth to bite on as a remedy. “Ma, they don’t do peasanty things like that any more!” scoffs my mum to her own mother.

My grandma tells me that when she had her children, a tin of formula was $9. My grandfather made $10 a day as a cook. He gave a dollar to each kid at the end of the day, and the parents each kept one for themselves. So of course they could not afford formula milk. Instead, my grandmother bought Nestlé sweetened condensed milk and diluted it with water. “A milk bottle with a teat was $20,” she tells me, “so I got a Coke bottle and poked a hole through the lid!” She is delighted by her own ingenuity. I come to understand that my forebears were not silly and superstitious: illiteracy and poverty robbed them of proper nutrition, and they were all just doing their best to make the next generation better and stronger. Having two cultures with very different approaches to childbirth and motherhood has made me more relaxed, knowing that there is no right way to do things.

In my grandparents’ house, I look at my baby’s father, who is kind, calm and fearless, and hope that our child will have enough of his genes to cancel out my history of fear. I look at my grandma and 95-year-old grandpa, who came to Cambodia as starving peasants from China and ended up in Australia in their twilight years, surviving together through 60 years of marriage, delighting over our son. And I look at my own mother, proudly bottle-feeding the baby with formula milk that she never would have been able to have as a baby herself. We are four generations under one roof again.

Alice Pung

Alice Pung is a writer, lawyer and teacher. She is the author of Unpolished Gem, Her Father’s Daughter, Laurinda and Writers on Writers: Alice Pung on John Marsden.

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