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Importance of Postpartum Care

The postpartum stage denotes the period instantaneously after delivery till six weeks after delivery. Through this period, women experience several physiological alterations before resuming in their pre-pregnancy state. They, therefore, experience several types of troubles such as physical, emotional, psychological, and social tribulations, which may inspire them to attempt treatments (Rogers et al., 2020). Postpartum care is essential since new mothers are at great risk of serious and at times frightening health complications after delivery. Various new mothers lose lives from health complications that may be prevented by reaching postpartum care. Postpartum checkups are important for any new mother. Some women lack skilled attendants while giving birth. According to the World Health Organization (WHO), women should be observed within twenty-four hours after delivery irrespective of the place of giving birth. It is therefore significant for new mothers to be attended at least for the first 24 hours after giving birth to ensure that both the condition of the mother and the newborn are stable. There are several ethnic groups in Malaysia. Chinese, Malay and Indian comprise a greater percentage of the population in the country. Malaysian women have various postpartum exercises that they consider essential for averting upcoming disorders. Notwithstanding the alleged disparities in intra-ethnic postpartum performance, various Malaysian moms, from different backgrounds, share resemblances in their postpartum routines and practices regarding views and devotion to food restrictions, use of customary postpartum massage and customary herbs, and acknowledgment of the responsibility of elder female family associates in postnatal care.

All of these sprints are rich in traditional acquaintance and rehearses that have been in place for a long. Hence, the multiplicity of ethnicity in Malaysia has additionally improved the customs and health care of the country. One significant area of traditional medicine is involved with the delivery habit observed by women. The traditional childbirth practice is outlined as all attitudes, activities, and customs made during the prenatal, labor, birth, and post-natal phase. These exercises are collectively made and molded by the discernment and practice of society. Consequently, several customs around the domain custom explicit postnatal routines or management. This is essential to avoid ill health in advanced ages even though sometimes the instant upshots are not experienced. These postpartum rehearses or customs would warrant the mother to be cossetted for a given period of giving birth. The postpartum practices are formulated based on the perception of a particular culture to avoid complications in the future. Some of the postpartum care practices include; observing hygiene, outlined period of rest, food recommendation and limitation, particular handling for the mother, breastfeeding, and newborn care (Youn et al., 2021). Thus, in Malaysia, the Indians, Malays, and Chinese societies have multiple beliefs and perform post-delivery care.

Postpartum Care Practices in Malaysia

Maternity confinement is the traditional management for handling women who have delivered. Confinement involves the constraints put regarding diet and various practices during the period immediately after childbirth. This care is important since it enhances the healing of the mother and the restoration of energy within a given duration (Abdullah, et al, 2019). WHO recommends that postpartum care practices should start approximately an hour after birth of the placenta and the care should last at least for six weeks after delivery. Each ethnic group has a unique way of confinement. For instance, the Malay women observe a confinement period of forty-five days and some prolong the duration to eighty days. Conferring to the Malay, a midwife takes care of mothers after delivery which is essential to uphold the health of women to regain and get back to normal routine and sustain the health of the generative system of women after giving birth (Yusoff et al., 2018). Postpartum care practices guarantee that the darns during delivery are mended to prevent any other difficulties in the future (Ghaffar et al, 2021). Women who have undergone cesarean delivery are given special care equated to those who undergo natural delivery. During this period, foods that are contemplated cold and lethal such as; long beans, cucumber, pineapples, crabs, and certain types of fish are greatly forbidden. Whereas, tonic drinks and herbal paste are considered hot and women are advised to consume them.

Heat treatment, hot compress, herbal birth, body massage, body wrap, and vaginal steaming are the common postnatal care norms among the Malay people. Hot treatment is also referred to as being in the Malay community. The practice is carried out using a slab enfolded with multiple herbs. These herbs include; ginger, lemongrass, Kaduk leaves, Erythrina fusca Lour leaves, and Piper betle leaf. During this exercise, the caregiver heats the slabs or the bricks then wraps them with the herb leaves and a fragment of fabric. The piece is then placed close to the new mother. The process is mostly done when the woman is sleeping or while lying down. The Malay midwife states that the practice is essential in the removal of toxic substances in the woman’s body which is excreted through sweat (Ida et al.,2018). A hot compress is a kind of point massage applying heated items. Iron and stone are the main objects used to perform the exercise. These objects are also known as ‘Tengku’ with diverse weights. Generally, the two-kilogram object is mostly used while sometimes the weight used depends on the magnitude of the woman’s body. For instance, larger sizes of objects tend to be used on overweight women to acquire optimum impressions. In preparation for the hot compress, the ‘Tengku’ is completely heated then placed in herbal leaves, and finally wrapped in a cloth. The practice is applied in specific regions of the body such as the thighs and abdomen for about an hour (Fadzil et al., 2018). Herbal birth is also a significant practice. While some Malays believe that a mother is not approved to take a bath for the subsequent three days after delivery. However, after delivery, the woman’s body is dabbed using warm water to enhance the successful flow of blood (Jamaludin & Aloysius, 2019). Additionally, during confinement, the woman is encouraged to avoid bathing in the morning. Bathing in the morning may lead to the entry of wind into the body which may result in aching. An herbal bath requires a warm water temperature with different herbs such as Desmodium gangeticum added in it. Simultaneously, the woman is given a simple massage which facilitates relaxing the strained muscles during the delivery process (Azmi, 2019).

Traditional Confinement Practice

The entire-body massage is another significant postpartum care among the Malay community. People consider this exercise therapeutic since it entails the entire body and gets deep into the tissues. The entire body massage is carried out by well-skilled midwives. Technically the midwife determines the body part to initiate the massage. However, most of the midwives prefer starting from the head and completing with the feet. It is perceived that there is a slow flow of blood in a female's body after childbirth which can result in body aches. Hence the midwives believe that the massage enhances articulate blood flow. The masseur emphasizes the nerves and muscles of the hips, thighs, and back. Three massage sessions are normally recommended for the therapy though some women opt for more sessions (Dewi et al., 2020). The body wrap is another care routine executed during postpartum practice for the Malays. This act involves coating the mother’s abdomen with an herbal paste obtained from distinct spices and herbs. The smearing is followed by tense enfolding. The wrapping is through covering the belly region by use of a long piece of fabric. The area covered starts from below the breasts to the thighs. The piece of material used to cover the woman’s body is based on her body size. The body wrap practice is significant in restoring and deflating the mother’s belly after delivery. It also aids to regain the woman’s original body shape and posture (Leyva, 2018). The Malay people also consider vaginal steaming as a postnatal care practice that is mostly performed during the last phase of the confinement period. Vaginal steaming is also known as tangas and the steam is obtained from a mixture of different herbs. This treatment is performed while the woman is seated on a wooden chair opened at the middle of the perineum zone hence subjecting to the vapor emerging from a container of scalding water containing herbs. This exercise aims to uplift the uterus back to its initial position as well as to contract the uterus which has enlarged throughout the pregnancy period. Moreover, the act of vaginal steaming makes the body feel lighter (Farr et al, 2018). Infant care is also considered among the Malay group. For instance, the father of the baby whispers prayers to the infant’s ears. That is ‘azan is whispered to the right ear and ‘iqamat’ to the left ear of the ear. Also, according to Muslims, a sweet substance such as chewed date honey may be rubbed into the newborn’s palate. According to Malay boys undergo initiation any time from seven days old (Norhayati, et al., 2021).

Heat Treatment

For the Chinese ethnicity, the confinement is basically between thirty to fifty days. At times, it differs based on the preference of the women who have delivered similar to the Malay community. Notwithstanding the modernization, the majority of Chinese women observe firmly the thirty-day traditional postpartum period. The Chinese employ a skilled confinement lady also known as companion grandmother to handle the new mom. The confinement lady is known as ‘pei yue’ who is recruited to take care of both the mother and the newborn. Thus, handles the bathing and feeding needs and routines. Chinese women must completely abide by the practices are not permitted to go outdoors during the entire confinement period. Staying indoors is essential to protect the newborn and society from danger (Wang et al, 2019). The Chinese community also prohibits bathing since they believe that bathing causes entry of evil wind which may cause aching of the joints. The woman later bathes after several weeks. The water used to bathe is boiled and then cooled to moderately warm temperatures. Leaves and roots of bitter melons are added to the bathing water. These herbs can also be obtained from Chinese traditional medicine shops (Jamaludin & Aloysius, 2019). Moreover, the confined women are not supposed to wash their heads since they believe that this act can harm the new mother as a result of cold. Food and nutrition are also a major concern among the Chinese group during the restraint period. For instance, taking plain water is greatly restricted. Instead, the decoction of desiccated longan and red dates is selected. The Chinese community also suggested taking various herbs like ginseng soup during the period. For instance, in the Chinese community in the state of Sabah, the caregiver recommends the practice of consumption of 'lihing'. This is a sort of liquor extracted from agitated rice and cooked with chicken and ginger. This soup is consumed to remove the ‘wind’ in the body and to warm up the body of the mother after delivery (Rasnovi & Harnelly, 2019)

Regarding the Chinese community in peninsula Malaysia, the food for a woman in confinement are explicit fishes that are contemplated harmless and do not cause tickling such as pomfret, redfish, and white fish cooked with sesame oil and ginger. However, vegetables are very vital in the nutrition. Chinese culture discourages the use of vegetables during restriction since most of the vegetables are cogitated cold and cause the body to get weak and cause joint aches. Mothers are encouraged to consume plenty of rice during the confinement period for them to recuperate easily from delivery exhaustion and also to boost the production of milk. Practices of body wrap and hot compress are not normally implemented in Chinese postpartum care. Furthermore, the Chinese group emphasizes the newborn too. For instance, the Sabah people apply eucalyptus oil to the entire baby’s body after bathing it. According to Chinese society, the infant is cleaned using an assortment of herbs such as roots of bitter melon. The herbs are perceived as a measure of protecting the baby from jaundice and confined roll. The postnatal practices are therefore based on the traditional Chinese belief system facilitating the preservation of Yin and Yang in the woman after delivery so that her health is restored (Ghani & Salehudin, 2018). Many Chinese people believe that a lack of adherence to these practices can result in potentially prolonged adverse complications regarding the mother’s quality of life.

Herbal Bath

The postpartum practices among the Indian ethnic aid the mother rejuvenate the body by making it warm once more. It is perceived that the delivery period renders the body cold due to massive loss of blood (Withers, et al., 2018). Among the Indians, a midwife is not compulsory. For example, in families that cannot afford to hire a midwife, an elder member of the family takes care of the mother and the newborn. They have various similarities to those of the Malay group. In this group, confinement takes place for at least a month. After giving birth, the mother is needed to keep warm every time. Therefore, women are only allowed to clean themselves with warm water previously boiled with herbs (Khalid & Mohamed, 2020). Women are not permitted to wash their hair daily to counteract cold. However, hair washing can be done on an odd number of days until the confinement period is over. The Indians believe that the hair needs to be dried immediately after cleaning since prolonged wet hair can result in post-delivery depression.

In addition to herbs, body scrub such as turmeric is applied while bathing. Indians also have food restrictions for new mothers. Similarly, food that is regarded as cold, is prohibited. These cold foods include grapes, tomatoes, mutton, eggplant, jack fruit, coconut milk, and cucumber. Nevertheless, foods like boiled fenugreek and shark meat are greatly recommended since they are alleged to rise milk production. The woman is also encouraged to take moderately warm water. Similar to the Malay routine, the Indian care practices also involve the massage procedure. The massage exercise is done daily during the postpartum care period. Oils such as mustard oil, coconut oil, and neem oil are used for the massage (Dansana & Kadam, 2019). The functions of the massage are; wound healing, energy restoration, cosmetic appearance, enhanced blood circulation, and refurbishment of sexual function. The Indian midwives also perform postnatal strapping. This is achieved by application of oil on the woman’s abdomen then fastening it with a stretched fabric to constrict the flaccid muscle. Contrary to the Malay group, Indians do not perform hot compression (Ridzuan et al., 2021). 

Women are also restricted from sexual intercourse to enhance proper and quick healing after childbirth (Kumari et al., 2022). During the postpartum care period, the midwife or the caregiver should be able to observe the mother and note any possibilities of danger. According to the Indians, some of the common postpartum danger signs are; amplified bleeding, fever, breathing complications, fits, inflammation, tender nipples, infection in the area of the wound, fetid vaginal discharge, and suicidal behaviors. In case of any of these incidences, the caregiver should change the care routine given to the mother, or at times more expertise is employed to handle the situation (Gunardi, 2021). The newborn also is passed through some practices. The expertise required to listen to the mothers and support them to avert any negative thoughts that may lead to depression.  The skilled midwife thus has a responsibility to offer emotional support to mothers with psychological concerns. In case of any incident of self-harm or suicidal thoughts the caregiver is required to maintain a close follow-up and the woman is not left alone (Azmi, 2019). For instance, immediately after birth, the baby is whispered in the name of the Hindu god. When the newborn is sixteen days old, a unique prayer is made for the baby at home. And at thirty days the newborn is taken to church and a prayer is recited for them. Massage is also done for the newborn as oil is smeared to the entire body (Hrar & Farhan, 2019). This practice is believed to be essential for the newborn’s general body growth.

Entire-Body Massage

Conclusion

The postpartum care routine has a common goal across the three ethnic groups. The practices are important since they help in; uterus contraction, attaining correct balance, and womb recovery. The care routine also aids in replenishing blood circulation, enhancing body slimming, enhancing healthy milk production, wound healing and the mother recuperates vitality. There are correspondences and disparities in the custom of postpartum care among the Malay, Chinese, and Indians. The similarities are the performs in safeguarding revival and reinstating the health of women after delivery back to non-pregnant prominence in a stated confinement phase. The fundamental feature in postpartum care that is significantly highlighted by the three ethnicities is the distress of the ‘wind’ and cold which can trigger complaints such as body aches, agitation, and dilating in the mother which would obstruct recovery. Food constraint is being witnessed in all three groups. The minor variances perceived in the model and practice between the three contests are due to the distinctive ethnicity innate from the elderly. Despite the apparent disparities in intra-ethnic postnatal rehearses, most Malaysian mothers, though from diverse backgrounds, have certain cohesion in their postpartum routines and practices. Consequently, health care benefactors should be conscious of the multi-ethnic conventional postpartum exercises and use the unities in these tries as measure of their postnatal care procedure. Steps ought to be engaged to officially incorporate these regimes into the conservative medical health care model as part of the postpartum care routine.

References

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Abdullah, B., Daud, S., Mohamad, M., & Zahid, A. Z. (2019). Postnatal confinement among Malay women: Comparing practices between two different generations. Environment-Behaviour Proceedings Journal, 4(12), 35-41.

Azmi, N. A. M. (2019). Malay traditional practices surrounding the postpartum period: a qualitative case study. Evidence Based Midwifery, 17(2), 40-46.

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Dewi, R., Yustina, I., Sudaryati, E., & Zuska, F. (2020). Postpartum Maternal Care Tradition in Manunggang Jae Village Padangsidimpuan City Indonesia. Britain International of Exact Sciences (BIoEx) Journal, 2(1), 231-239.

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Body Wrap

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