INTRODUCTION
When I was growing up in Los Angeles, a kid of Taiwanese immigrants, I felt lost straddling two dichotomous cultures. On the one hand, I struggled to become as Americanized as quickly as I could, mostly to fend off the racism I encountered at my elementary school. In first grade, I was enrolled in English as a second language program. My desire to assimilate was so urgent that by the second grade, I was catapulted into the gifted and talented program. I was wild and experimental, a “spirited child” who needed to express herself. However, at home in our Chinese household, my parents expected quiet subservience and reverence for tradition.
After my moon cycles began, my mother would declare axioms in reference to my behavior that, as an American teenager, I thought were ludicrous. “Don’t walk around with your hair wet on your period or you’ll get headaches!” she would yell after me. “Cover your stomach. You’ll get cramps!” she’d say, scrutinizing the open midriff between my cropped top and mini skirt. It was not until two decades later, after I had submerged myself in the study of East Asian medicine and had personally experienced its compelling ability to heal, that I accepted the wisdom of these traditional practices.
It was less than five years after I had become a doctor of Chinese medicine that I gave birth to my first son. I had been a weak child who grew into a sickly adult, burnt out from too many late nights and substance abuse. Holistic medicine had taught me ways to temper fatigue, pain, and migraines, to name a few body discomforts. But they were still too frequent for someone in their 20’s who should have been at the height of her vitality. Here was my chance to reset my health pattern, as if I too, in a way, can be rebirthed.
WHAT IS ZUÒ YUÈ ZI (坐月子)
TCM (traditional Chinese medicine) teaches that the month following a birth is a “golden opportunity” that can change a woman’s constitution, depending on how she takes care of herself. Zuò Yuè Zi (坐月子), or “ sitting the month” is a 2000 year old wellness protocol for restoring health in postpartum women. It begins immediately after the delivery of a baby and lasts one lunar cycle, up to 45 days. According to TCM, women who follow these specific rules can correct years of abuse to their bodies, and restore mental and physical wellbeing. Conversely, we are warned, if a woman takes on too much during this time, the results can be detrimental, resulting in menstrual pain, prolapses, and mental imbalance.
The rules for Zuò Yuè Zi can feel too constraining for a woman of today. As a holistic doctor of TCM in the Bay Area, I pare down these rules of confinement to their essence so that even modern women can reap its benefits without feeling deprived.
THE GUIDELINES
Here are the quintessential guidelines for following Zuò Yuè Zi:
1. The cardinal rule of Zuò Yuê Zi is to stay indoors and keep warm.
The period immediately after giving birth is a vulnerable time for mother and baby. After giving birth, incorporate heat to warm and nourish the mother and baby. Turn up the thermostat in the house so that the pair can comfortably practice skin to skin contact, facilitating bonding and increasing milk supply.
During this time, new mothers and newborns are especially susceptible to the external world of pathogens, cold / wind invasion, and noise pollution. The traditional rule dictates staying indoors for a minimum of one lunar cycle, or 4 weeks. This rule is nearly impossible to follow in the modern age, given the need for obstetrician and pediatrician visits. However, keeping this suggestion in mind, new mothers should be mindful of the onslaught of the external environment. Should she need to venture outside, make sure she is bundled and the back of her neck is covered. An acupuncture point called “Du 20” is located in this area. This is an entry point where pathogenic factors are said to invade the body.
2. Warm the lower abdomen and back.
Moxibustion, or the heating of the herb Artemisia Vulgaris, is known as traditional “mother warming.” Moxa, as it is also known, applied on the lower abdomen, helps to close off the cervix, heal and lift the pelvic floor and support the shrinking of the uterus back to its pre-pregnancy size. This is important because the lower abdomen holds “Dan Tien”, or the Sea of Qi and Vitality. The lower lumbar and sacral area of the back is where “Ming Men”, the Life Gate, holds the “Essence” of life. Warming these areas with this special herb that penetrates deeply into the interior of the body builds back much of the Qi and Blood lost during childbirth. If moxa is not available, alternative heat sources can be used. This includes hot water bottles, heating pads, rice packs, or infrared saunas.
3. Stay dry
Tradition calls for keeping the body dry for one lunar month. This commandment is most likely due to the susceptibility of catching colds when the body is wet. During my confinement period, I openly defied this ancient rule out of hygienic purposes. As a compromise, I suggest washing the entire body, including the hair, less frequently and taking daily sitz baths instead. Sitz baths are healing for any tears that may have occurred during birth, takes less time and minimizes exposure to cold.
4. Nap when the baby naps, sleep when they sleep.
Sleep is essential to a woman’s recovery. Sleep deprivation can contribute to postpartum depression/psychosis and can get in the way of bonding with the baby. It is essential that a new mother take the opportunity to nap instead of staying awake to do activities when her baby is asleep during the day. The intense volatility of postpartum hormones alongside the accumulation of pregnancy fatigue and the demands of a newborn can quickly devolve into anxiety. New moms should sleep as much as they can during Zuò Yuè Zi. If she has trouble sleeping at night she can take mild soporific herbs to aid in relaxation.
5. Consume warm and warming foods.
Traditional Chinese medicine warns that cold water and iced foods can dampen one’s digestive fire. This is especially important in a new mother because coldness in the abdomen can stagnate the circulation of Blood that is important to nourish the uterus. The uterus is one of the organs in TCM that can be directly affected by cold pathogens, which can lead to stagnation, resulting in menstrual cramps and irregular cycles.
According to TCM nutrition, foods also have inherent thermal natures. During Zuò Yuè Zi only foods with warm thermal nature are to be eaten. Specific foods to tonify Blood and Kidneys (in TCM, Kidneys hold primordial energy), which are depleted during childbirth, are cooked with rice wine in dishes for easy digestion. Rice wine enhances the warming actions of food. Raw vegetables and cold drinks are strictly forbidden. Incorporate well cooked, soft, soupy, moist and creamy foods instead.
RECOMMENDED FOODS
Unless someone is familiar with Chinese ingredients, many of the traditional postpartum meals, including black chicken, pig feet and beef kidneys, may not only sound foreign but downright repugnant. The following is a list of evidence-based, easily accessible foods that support the healing of postpartum women and are more palatable to the average American diet.
Rice – Rice is the cardinal ingredient in jook or congee, which in traditional Chinese cooking, is served during periods of recovery. The thick, milky liquid of rice porridge coats the stomach to aid digestive function and calm indigestion and nausea.
Legumes, Nuts and Seeds – If your digestion can tolerate legumes, garbanzo beans, mung beans, lentils, and other beans provide excellent sources of protein and are known to support the production of breast milk. Beans, seeds and nuts are the spores of plants. In Chinese medicine there is a rule of “like for like.” Consuming seeds support the Life Force, which is lost during the process of birth. Seeds, nuts and legumes tonify the Kidneys which houses the Ming Men, or Life Gate. Just make sure you choose raw nuts, instead of roasted or salted. Soak nuts in room temperature water overnight to enhance its digestibility.
Hummus is especially beneficial as postpartum food, as it contains garbanzo beans and garlic, two ingredients that also support lactation. Black sesame seeds also feed the Kidneys and Life Force. They moisten the intestines, helping with the passing of bowel movements which can be difficult postpartum. Black sesame seeds also increase milk production.
Bone Broth – Bones simmered or cooked in a crock pot for up to 24 hours provide amino acids to increase iron. It hydrates the body and supports digestion at the same time. Bone Broth should be sipped every few hours during the postpartum period, like you would normally drink water.
Seaweed – Seaweed comes in many forms – kombu, nori, wakame, hijiki and dulse, to name a few. It is a traditional ingredient in East Asian Cuisine full of protein and iron that rebuilds depleted minerals. Seaweed is the key ingredient, along with beef, in miyeok guk, a traditional Korean postpartum soup, which is high in iodine (helps brain development), fiber (relieves constipation in postpartum) , and iron (prevents anemia).
Sweet potatoes, carrots, beets, yams – orange and red foods like carrots and beets are rich in beta-carotene, which increases milk supply.
Gluten-free Oatmeal – choose whole pods or steel cut oats. Oatmeal creates oxytocin, a key hormone for lactation, relaxation and happiness.
Dark, leafy greens – Dark leafy green vegetables including chard, nettles, arugula, beet leaves, kale, spinach, and collard greens are potent sources of vitamin, minerals, and enzymes that contain phytoestrogens supporting lactation.
Oils and fats – Healthy fats are vital to cellular regeneration and neural metabolism. It builds a healthy immune system and supplies the body with substantive energy, balances hormones and supports brain function and mental wellbeing. The kinds of fats you eat will also influence the composition of fats in breast milk. Eat regular and substantial doses of butter, ghee and coconut oil, avocados, cold pressed extra virgin olive oil, cold pressed sesame oil, and flaxseed oil.
Barley water can be taken for 1-2 weeks and can help mothers with chronic low milk supply. Make a pot in the morning and drink throughout the day, warming each cup and sweetening it with a natural sweetener if desired. Barley water can be made with whole grain or pearl barley.
Pantry herbs – Warming herbs found in the average kitchen can be added to any meal, snack or tea to enhance depleted bodies and digestion during the postpartum recovery, including ginger, cinnamon, cumin, turmeric, and fennel.
Special TCM ingredients for postpartum recovery
Jujubes – also known as Da Zao or Chinese red dates are a classic postpartum herbal remedy used in Chinese medicine. Dates boost circulation by warming the channels, tonify Qi and Blood, and calm the Heart. They are added to almost every postpartum soup.
Goji Berries – also known as Gou Qi Zi is another classic postpartum ingredient which tonifies Qi and restores reproductive systems.
Ginger – Ginger is warm and mild and can be added to every soup, drink, meal and snack. It is a medicinal herb that heats the body, aids digestion and tonifies Qi.
Traditional TCM formulas for postpartum recovery
There are two established traditional Chinese formulas that have been used for centuries during the period of Zuò Yué Zi. I give these formulas to every postpartum woman that comes through my practice.
The first, called “Sheng Hua Tang,” is a formula made of Blood tonics like Dang Gui (Angelicae Sinensis) and Blood movers like Chuan Xiong (Ligusticum Stratum). They help assist the uterus in dislodging any remaining afterbirth and support the regeneration of blood that is lost during the birth. When taken immediately after, Sheng Hua Tang reduces uterine pain, restores uterine integrity and balances hormones.
The second formula, taken after bleeding ceases, is a well known TCM gynecological formula for women, called “Si Wu Tang.” Si Wu Tang comprises four Blood tonics. In research it has been shown to prevent postpartum depression and restore vitality in postpartum women.
If a woman remains fatigued or moody after these initial herbal formulas, I may also prescribe a supplement to address her adrenal fatigue or emotional instability.
Through my own postpartum experiences, and now, having worked with obstetric patients for 20 years, I have seen the benefits of “sitting the month first hand. A year after giving birth the first time, when I was holding a patient’s hand, she remarked how warm my palms felt. I then realized that a lifelong predicament of cold hands and feet no longer vexed me. My stamina was more sustainable than it had been when I was younger. My migraines had receded. It was obvious that the practice of Zuò Yuè Zi had indeed improved my previously fragile body.
The initial month after birth is a precious time when a new mother should be supported. Her only priorities should be bonding with and nursing her baby and recovering from childbirth. The ancient rituals of a 2000 year old practice for postpartum care should be revered and carry weight, especially as our modern lives take us further away from Nature. Sitting out the lunar month is a rare opportunity for a woman to bring herself back to an optimal state, one that can influence the remainder of her life.