The experiences of postpartum

hospital stay and returning home

among Thai mothers in Australia
Pranee L. Rice, Charin Naksook, Lyndsey E. Watson

Objective: to describe the experience of postpartum care among Thai women in

Melbourne, Australia.

Design: ethnographic interviews and participant observation w i t h women in relation to

postpartum care and practices.

Setting: Melbourne Metropolitan Area, Victoria, Australia.

Participants: 26 Thai born w o m e n who gave birth in Australia.
Findings: the Thai women had varying views about the length of t i m e they should spend
in hospital and the care they received. Ten of the twelve women who had had a
caesarean birth stayed in hospital for six or more days, consistent w i t h the hospital
practice. However, most of those who had had a vaginal delivery opted to go home
earlier than the standard hospital practice of four days stay. This was because they were
unhappy about specific hospital practices, the hospital environment, or because there
are several Thai confinement customs, which, traditionally, a new m o t h e r must observe
in order to maintain good health and avoid future ill health and which they were not able
to follow in hospital. Nevertheless, most women were satisfied w i t h t h e i r postpartum
care. Most women were aware of the Thai cultural beliefs and practices. However, they
showed varying ways of coping w i t h the hospital e n v i r o n m e n t in relation to t h e i r varying
social situations.

Implications for practice: Thai w o m e n are diverse in t h e i r needs, perceptions and

experience of postpartum care. Therefore, it is appropriate neither to stereotype all
Thai women as requiring to follow traditional confinement practices nor to require
them to adjust to standard hospital practices. Rather an e n v i r o n m e n t of caring concern
whereby each woman's individual needs can be solicited, understood and, where
Pranee L. Rice possible, attended to as required. The challenge is in achieving this.
PhD
Senior Lecturer, School of
Public Health, La Trobe
University, Bundoora,
Victoria, Australia 3083

Charin Naksook 1978, Manderson 1981, Sieh 1981, Laden-nan 1987,

PhD
INTRODUCTION
Research Fellow, School of Rice 1993, 1994, Chang 1995, Symonds 1996,
Public Health, La Trobe Townsend & Rice 1996, Cheung 1997).
University, Bundoora,
The postpartum period is the time that most women
Victoria, Australia 3083 recover from birth and begin to take on a new role. It Despite the importance of this period, women's
is during this period that most women have mixed experience of postpartum care has not received great
Lyndsey Watson
MSc feelings, 'exciting and emotionally fraught' (Wool- attention (Shields et al. 1997, Woollett & Nicholson
Senior Research Fellow, 1997). Most writing about women's birthing experi-
Centre for the Study of
lett & Dosanjh-Matwala 1990, p. 178). More imp-
Mothers' and Children's ortantly, in many cultures, it is seen as a most ence has so far been concentrated on antenatal and
Health. La Trobe University, labour care (e.g. Reid & Mcllwaine 1980, Woollett
1463 Cardigan Street,
dangerous period and a new mother is vulnerable to
Carlton, Victoria, Australia all sorts of illnesses. Not only are the women's et al. 1983, Porter & Macintyre 1984, Lazarus &
3053 Philipson 1990, Woollett & Dosanjh-Matwala 1990,
behaviours often restricted during this period, they
(Correspondence to PLR) also want to observe certain traditional customs in Brown & Lumley 1993, Woollett et al. 1995,
Manuscript accepted Gardner et al. 1996, Holroyd et al. 1997), When
12 Hay 1998
order to avoid ill health in later years (Pillsbury

Midwlfery (1999) IS, 47-57 © 1999 Harcourt Brace& Co. L~

48 M ~

the issue of postpartum care is addressed, it tends to speakers and part of the Thai community in
represent the experience of Anglo-Celtic women Australia.
(e.g. Moss et al. 1987, Romito & Zalateo 1992, Each interview was tape-recorded. The length of
Small et al. 1992, DiMatteo et al. 1993, Stamp & the interviews varied, depending on the respondents'
Crowther 1994), except for some anthropological responses. Each interview took between three and
studies which address the postpartum experience of four hours (for all topics including childbearing,
women in several societies (Stem & Kruckman childrearing, motherhood and reproductive health).
1983, Rice & Manderson 1996). Although there Most women were interviewed once. There were,
have been some recent publications on the post- however, a number of occasions when we needed to
partum experience of migrant women, such as obtain more information. Those women were then
women from the Indian sub-continent in England visited for a second time, and in some cases a third
(Woollett & Dosanjh-Matwala 1990), Chinese time. In addition, a participant observation method
women in Scotland (Cheung 1997), and Filipino, was used to allow observation and recording of the
Turkish and Vietnamese women in Australia (Yell- women's cultural beliefs and practices and their
and et al. 1998), the experience of other groups is experiences in Australia more fully. The authors
still largely neglected. In particular, the postpartum attended a number of ceremonies and participated in
experience of Thai migrant women in a Western many activities during the fieldwork period. The
country is non-existent. interviews and participant observation were under-
In this paper the experience of Thai women taken during 1994-1995.
during the postpartum period in an Australian For each woman informed consent was obtained
setting is examined. In particular, women's percep- after the information about the research and the
tions of care and their experiences during hospital nature of the woman's participation was clearly
stay in the first few days after birth in maternity explained. Ethical approval for the study was given
hospitals are discussed. In addition, some traditional by La Trobe University Human Ethics Committee.
customs during the postpartum period and the All interviews were transcribed in the Thai
adaptations resulting from social changes in wo- language. This was to maintain the subtlety of
men's lives are described. These Thai women's meaning of the women's voices as accurately as
views, experiences and needs are acknowledged. possible. The analysis was also undertaken from the
Their perceptions and experiences of pregnancy and Thai transcripts, and only those quotations which are
birth have been presented elsewhere (Rice & presented in this paper were translated into English.
Naksook 1998). The translation retains, verbatim, what the women
said, with some syntactical corrections. The first
author translated the quotations, and these were
METHODS cross-checked by the other authors.
A thematic analysis approach was used to derive
The study comprised ethnographic interviews cover- patterns in the women's responses (Glaser & Stauss
ing a number of issues concerning reproductive 1967, Miles & Huberman 1984). The transcripts
health, including the experience of pregnancy and were examined for the women's explanations related
childbirth, with 30 Thai women in Melbourne, to the concept concerned. From these, several
Victoria. The theoretical sampling technique themes were derived.
(Strauss 1987, Minichiello et al. 1995) was used to
determine the number of women in the study. Put
simply, the recruiting was terminated when no new
FINDINGS
data emerged. The majority of the women were
recruited through the Thai Buddhist temple in
Sample characteristics
Melbourne where most Thai-born people, particu-
larly women, frequently go for social and religious The demographic characteristics of the women who
functions. Some were recruited through the authors' participated in this study have been presented in an
personal network or by a 'snowball' sampling earlier publication (Rice & Naksook 1998) and these
technique, when informants were asked to nominate are summarised here. Thirty women participated in
or contact friends or relatives who may be interested this study, however, four of these had not given birth
in participating in the study (Yoddamnem-Attig et in Australia and since their postpartum experience is
al. 1993, Minichiello et al. 1995). At the first contact not relevant to the Australian setting they have been
the women were told about the study and asked if excluded from the analysis for this paper. Therefore,
they could talk about their experiences relating to of the 26 Thai women, 15 were aged between 31 and
the study. Once the women agreed to participate, an 40 years, three were more than 40 years old. All the
interview time was arranged to suit their needs. The women were Buddhist. Twenty-three women were
women were individually interviewed in their own married and most had been so for between one and
homes. All interviews were conducted in the Thai five years. Seven were married to Anglo-Australian
language by the authors (one-third by the first author men and 10 to other English-speaking men, such as
and two-thirds by the second) who are Thai native English, New Zealand and American, who were
Thai mothers' experiences of postpartum hospital stay and return home in Australia 49

living in Australia. The other nine men included strong and still had pain on the stitches I thought
Thai, Middle-Eastern and other Asian. Women's I should stay in hospital. At least, at night time
region of birth covered all regions of Thailand, the the nurse helped to look after the baby so I could
majority were born in Northeast (10) and Central sleep well and regain my strength quickly. I
Thailand (8). Twelve women had tertiary education thought that was the best way for me because if I
and 10 had only primary level. Fourteen women came home sooner I would not have had the
were at home taking care of their family, and there chance to rest. (T 12)
were seven who were self-employed or in office
work. The majority of the women in the study (24) I stayed for six days after my caesarean birth.
had from one to three children. Most of them were That was very good because my operation wound
living with their spouse and children (20). Fifteen of was nearly healed and I felt more confident about
the women had been living in Australia for up to 5 looking after my baby. I had enough time in the
years, the rest for longer. Seventeen women had hospital to learn to breast feed him, to bath him,
experienced childbirth in an Australian hospital and to change his nappies and his clothes. At
only. There were 14 women who had had their last home I only had my husband. He and I knew
baby between one and five years prior to the study, nothing about caring for babies. (T 29)
(eight within the last year), three between six and 10
years and the rest more than 10 years ago. Most
women (16) said their English proficiency was poor,
and the rest (10) 'fair' to 'good'. Women who wished to go
There are several important themes emerging from
the interviews.
Hospital length of stay
Among the twenty-six women who had their babies Hospital policy Women mentioned the hospital's
in Australian hospitals, sixteen gave birth in public policy as the main reason for them going home
maternity hospitals, two had their babies in birth when they did. This reason was given clearly by the
centres and eight in private hospitals. two women who had their babies at birth centres:
Twelve women had had caesarean births (CS),
I stayed in hospital only one night then I came
(two elective and 10 as an emergency procedure). Of
back to rest at h o m e . . . They explained to me
these, one went home on the third day and another
that we can only stay one night at the family birth
on the fifth. The rest stayed for six days or longer.
centre because they have only four rooms there
At the time of the study the recommended length
and there are mothers who come in to give birth
of stay following a normal vaginal birth was four
all the time, so I have to rest at home. But a
days. The majority of the women who had had a
midwife came to check my body and check the
vaginal birth (l 1 out of 14) went home early, eight
baby's blood at home. In the first week she came
on the third day and three within 24 hours (of whom
everyday. I only stayed one night there for both
two had given birth in a birth centre whose policy
births. (T 11)
was discharge within 24 hours of the birth).
We asked the women about their reasons for Being told to go by hospital staffwas another reason
going home at the time specified, and these can be for going home. This reason was mostly given by
categorised as presented in the following sections. mothers who stayed for three or four days and who
probably had not understood the hospital policy:

I came home on the second day. That was so

Women who chose to stay short. I asked them why they let me stay for only
Eleven of the 13 women who stayed more than five two days. They said, 'the baby is well, the mother
days had had a CS. They described their stay in is well, there is no problem, so you can go home.'
terms of needing a good rest before going home. I really wanted to stay longer because other
They also believed that if they stayed in hospital mothers stayed for a week or so. I wanted to stay
they and their babies would be looked after by close to the doctor, but because they wanted me
hospital staff. Some mothers also believed that they to leave I left. (T 24)
should stay in hospital until they could be assured of
their own well-being, and that their baby was strong
The doctor told me to go home on the fourth day.
enough to be brought home:
I really wanted to stay longer. I couldn't trader-
I stayed in hospital for seven days because I was stand why some women went home the next day
a private patient. The doctor said I could stay as after they give birth. In the hospital the doctor
long as I liked, but I wanted to stay until I felt came to see me and check me every morning.
strong enough to go home. I thought if I came They took care of me. They also looked after my
home too early there would not be anyone, except baby.... After I got up in the morning I only had
my husband, to help at home and then I had to do a shower then took a rest . . . . I asked if I ¢0uld
everything myself. Because I was not really stay longer they said no. (T 15)
$0 Midwifery

Interestingly, one mother said that the hospital staff In the ward, there were four mothers there. When
asked her how long she wished to stay at the one baby cried the rest cried too, they cried like a
hospital, but quickly mentioned that the maximum choir, so I felt very uncomfortable and could not
stay was three days. This annoyed her because she sleep at night. I think the three days in hospital I
felt that she was not welcome to stay in hospital and, could only sleep about two hours. It was so
therefore, decided that she wanted to go home right tortured because I could not sleep w e l l . . .
away: Sometimes when I nearly went to sleep, the
woman in the next bed would snore very loudly
They asked me how many days I wanted to stay
and her baby would cry, so I just could not get to
and asked me if I had any concerns about birth.
sleep at all. (T 25)
As soon as I said 'nothing', they quickly said,
'maximum is three days only, if you can go home Being lonely in hospital was also a reason for
then you go home on the third day'. I was wanting to leave hospital early. Women mentioned
annoyed so I said to her ' i f it is possible I want to that there was no one that they could talk with in
go home now', but they said I had to stay at least hospital. Their husband or other family members
three days. (T 25) could only come at certain times due to other
commitments:

Family encouragement Several mothers went I asked to go home earlier than what they told me
home early because their family encouraged them because I wanted to be at home with the family. I
and could support them. One mother said her felt that in hospital, even though hospital staff
husband asked if she wanted to go home on the were helpful, it was lonely. I felt so lonely, there
third day and when she was prompted by her was no one to talk to, only staying with my baby.
mother-in-law, she decided to leave hospital on that (T 09)
day:
I wanted to go home early but the doctor told me
My husband asked me if I wanted to go home to stay. He said I could stay there, why should I
and then [the baby's] Nana told me to come home want to go home. But I felt so lonely there. I
too. She said come home and have better food at stayed there myself and waited for my husband to
home, so I felt like going home too. When I was visit me. Sometimes I cried because it was so
in the hospital, I did not know anyone there. I lonely and empty, no friend.., could not watch
was told that when I went home a hospital TV either because I could not understand it, I just
midwife would come to look after me at home stared at it. (T 14)
anyway. So I told the hospital that I wanted to go
home on the third day. (T 01) Two mothers mentioned bad feelings about the
hospital as their main reason for going home early,
Two women also mentioned the feeling of not In Thailand, as in most Southeast Asian countries,
imposing on other family members as a reason for hospitals are still associated in the minds of many
wanting to go home earlier. This feeling was very people with death and, hence, ghosts, particularly
strong among women who had a caesarean birth and those who come from rural areas. Owing to this
whose family members were working: association, women could not rest in hospital and
The doctor did not really want me to go home but they felt that they should not stay long in hospital, as
I thought I had stayed too long already because one mother explained:
my sister was looking after me and she had to I stayed there alone, there was no one to talk
take leave to care for me. I thought when her with. At night I was scared of ghosts because at
leave was up, it would be very difficult for her to night time it was very quiet so I really felt scared
come to see me and help me at the hospital. So of ghosts there. You know, in hospital there are
I thought if I went home then it would make always some dead people there, so I was scared
things easier for her even though I felt somewhat of ghosts. I wanted to be with other people, even
worried about the baby. If there was some if they would walk in and out I wouldn't mind. I
problems whom could I talk to? (T 07) did not want to sleep in hospital, I could not sleep
there. I had to come home to sleep. (T 18)

Dissatisfaction with hospital environment Being Hospital food was mentioned as one reason for them
disturbed and, hence, being unable to rest was to go home early. Many Thai mothers said that they
another reason given for going home early. Because could not eat food provided in hospital, partly
most women were public patients, they had to share because they did not like the taste of the food
a room with several other mothers. One mother said: provided, it was rather tasteless:

This child cried and that child cried, then the staff I did not like hospital food at all so I did not eat
came in to change beds, when this one came in, it. I asked my sister to pack some noodles for me.
another one went out and everyone kept walking I wanted to leave hospital as soon as possible, I
in and out, so I could not sleep at all. (T 01) did not want to stay there at all. They served food
Thai mothers' experiences of postpartum hospital stay and return home in Australia 51

which had lamb and I could not eat it, mostly shrink to its normal size. Yu fai must be performed
farang [Anglo/Western] food, I did not like it soon after giving birth.
anyhow.., it is so bland, tasteless. I like spicy Kao krachome is a steam bath method that Thai
food like Thai food so when I eat farang food it is women usually have to clean their bodies during the
as if I have not eaten enough food. (T 06) confinement period. Several types of herbs are
boiled with water in a big pot. The hot pot is placed
I stayed in hospital a few hours only because I on the bed. The woman sits on the bed without any
gave birth very easily. Also, I do not like farang clothes, or a minimum of clothing on and a blanket
food, so I did not like hospital food at all because covers both her and the hot pot. Kao krachome is
they only provided me with farang food. So I believed to help sweat out 'poisonous' water in the
wanted to come home to have my own food. The body so that the body may absorb 'good' water, and
doctor checked me and the baby and he said we this makes the woman have healthy and pretty skin,
both were strong enough to go home so I came particularly on her face. It also helps to protect
home on the same day that I gave birth. (T 08) against blurred vision, dizziness, headaches and
fatigue in later life. In addition, it helps to get rid of
Another reason was that most food provided was the smell of lochia, which is believed to have bad
prohibited according to Thai postpartum beliefs and odour. Similar to yu fai, kao krachome must be
practices. For example, a few mothers said they performed post delivery.
would only choose 'hot' food such as soup and
Massaging the body with a hot salt pot is another
avoid 'cold' food because it had ill effect on their traditional confinement practice in Thai culture. Sea
health. Owing to this, food provided in hospital was
salt is heated in a clay pot until it is quite hot. The
rather limited for them.
salt pot is then placed on the woman's body,
In addition, several mothers said that they could particularly on her abdomen, back, legs and arms.
not read the food menu so that they could not choose This practice is believed to 'loosen' tendon and
what they preferred to eat and ticked everything on blood vessels in the body so that the blood and
the menu. This was misinterpreted by hospital staff: 'wind' will not be obstructed. It is believed that
When I had my first child I could not read the childbirth blood is 'poisonous' and it may remain in
menu at all. When they brought the menu for me the back part of the body, particularly in the
to choose my food, I just ticked everything on the backbone. If this happens, the woman will experi-
menu. The staff said to me 'You are hungry!', I ence body aches and pains in later life.
said 'No, no, I am not hungry'. But, she said 'But Consuming traditional medicines is a common
you order a lot of food'. So I told her that 'I am practice for new mothers in Thai culture. Most kinds
sorry, I don't know what I am going to take'. I of traditional herbal medicines are brewed in alcohol
told her like this. You see they said I should tick (rice wine). Some herbal medicines must be
only what I would like to eat, but I could not read prepared in advance. It is believed that by the time
it, so I ticked everything. (T 01) a woman gives birth, the medicines will have their
full strength. These medicines are believed to be
'hot', hence, they function in a similar way to a yu
The need to observe cultural practices Lastly, fai ritual.
there were several women who said that they needed
to go home early in order to start their confinement
practices as soon as possible. Traditionally, Thai
women must observe many postpartum practices in Women's satisfaction with postpartum
order to regain good health after birth, to ensure care during hospital stay
good health in old age, and also to ensure the Women were asked about their general satisfaction
survival of their newborn baby. There are several with care provided during their hospital stay. The
traditional customs that women must observe in the majority of women said that they were satisfied with
postpartum period. For example yu fai, is a ritual the care they received:
where a woman who has just given birth lies on a
wooden bed over a warm fire for 30 days of When I was in the hospital here I received all the
confinement period. While roasting she must keep help I needed. As a Thai person I felt kreang jai
her body warm, by wrapping the body in a blanket, [considerate] and didn't want to ask for m o r e
wearing a long sleeved top and sarong, or wrapping help.., but they came to see me all the time.
a piece of cloth around her head and ears. This ritual They tried to help, for example, with breast
has been known as the 'mother roasting' ritual, a feeding. Whether it [the problem] was big or
common practice in a number of Southeast Asian small they helped, both doctors and nursing staff,
cultures (see also Manderson 1981, Rice 1994, especially the nursing staff, f r 07)
Townsend & Rice 1996) and is vital to the well-
being of a new mother. It helps to restore 'heat' lost The midwife stayed by me most of the time.
in childbirth, to flush out retained blood and Whatever I wanted she got it for me, even though
placenta from the uterus, and to make the uterus she didn't really understand what I said. My
S2 Midwifery

English wasn't good but she seemed to be able to they have to ask for it. In Thailand they always
understand me . . . . She did her job very well. serve hot water. You don't have to ask. (T 15)
(T 04)
Women also mentioned their lack o f proficiency in
Women who gave birth in private hospitals tended to English, which made conununication with their
be more satisfied with the care provided than those caregivers difficult as a reason for dissatisfaction
who gave birth in public hospitals. One woman with their postpartum care. Many Thai mothers in
mentioned that the staff did take into account her this study had very limited English and they had to
cultural practices. One incident that she could rely on their Anglo-Celtic husband during hospital
vividly recall was that a midwife asked if she stay. Since most husbands were working during the
wished to have warm water to drink rather than icy day, the women could only get help from their
cold water as soon as she was moved to her room. husbands during visiting hours in late afternoon or
She was surprised to learn that some hospital staff evening. They found this frustrating when they
had some knowledge about her cultural practices needed to ask for something or when the hospital
and was very happy to be asked as such. It also staff came to talk to them and they could not really
made her decide that she would return to that understand. One woman who received assistance
hospital for her next birth. from an interpreter said it was an uncomfortable
However, there were several women who experience for her:
believed that they were not looked after well enough
When I first met my interpreter, she said, 'I am
by hospital staff during their hospital stay:
your interpreter', and I said hello to her. Do you
It was not very good when I stayed in the hospital know what happened then? She didn't stay with
after birth. The hospital staff were bad. So were me! She just went away to talk to other
the doctors, they didn't come to see me. I only interpreters. I felt very disappointed. Instead o f
saw the midwives who some day came and some asking me what I wanted to say, or telling me
day didn't come . . . . By the time they taught me how I could find her when I needed her, she just
how to breast feed my baby it was the discharge ignored me. She made me feel that I meant
day, I had to go home. (T 25) nothing. I didn't like her personality. (T 04)

One criticism was about the rooming-in policy

adopted by matemity hospitals in Australia. A few
women believed that because they were encouraged Postpartum practices upon returning
to look after their baby that they could not have home
adequate rest whilst in hospital. This practice
Not all women in this study could observe
conflicts with the Thai traditional confinement
postpartum practices upon returning home, although
practice which requires a new mother to rest as
they felt that they needed to observe some Thai
much as possible for 30 days:
traditional rituals in order to avoid ill health and to
They left the baby with me all the time. I wanted be able to return to their 'normal' stage. The
to rest but I couldn't because my baby kept opportunity or chance o f following Thai traditional
crying. They told me to feed her even though I practices was more obvious among mothers who had
hadn't had any milk yet, so I had to do it. My their mother, mother-in-law or sisters with them in
back really hurt and yet I had to carry my baby. I Australia. One mother said that her mother-in-law
wanted to put her in bed with me but the staff arranged confinement practices for her. Her mother-
didn't allow that, so I had to carry her and put her in-law prepared the kao la'achome ritual for her after
in her cot. It was so painful . . . like being she came out o f hospital. She boiled a pot o f herbs
tortured. (T 05) and put it in a shower. The woman then sat on a
small stool inside a shower, and the shower screen
One aspect o f postpartum care that women were and the bathroom door were closed to trap the heat
dissatisfied with was the lack o f opportunity to inside. In her case, the shower screen and bathroom
follow confinement practices in hospital. As stated, were adapted to function as kao Io'achome in
many Thai women wished to observe some Thai Thailand:
confinement customs as soon as possible, but these
customs were not catered for in the hospital. Some Kao krachome is to get rid o f all the poisonous
women said that even a simple thing such as a hot water and wind in the body because the body
drink which could be easily prepared to suit Thai sweats. Here, I did kao krachome but I used a
confinement practices was not provided: shower room instead. I stayed in there and closed
the bathroom door and did not turn on the steam
Although the services and medical equipment suction so the room is hot with steam from the
here are much better, but when it comes to food hot pot. So it is the same as kao lo'achome. My
and drinks I don't think it is very good. For mother-in-law prepared it for me. She even
example, Asian women don't take cold drinks carded a lot o f herbs from Thailand for me
after birth, when they want to drink hot water t o o . . . I did this for three weeks. It was only
Thai mothers' experiences of postpartum hospital stay and return home in Australia $'t

because I have my mother-in-law that I could do I did not do anything at all because I don't have
t h i s . . . (T 09) my mother here nor do I have brothers or sisters
to help me to do that at all. (T 04)
Some women who did not have any close relatives
living with them in Australia would also try to In addition, most ingredients were not easily
observe part o f the traditional postpartum practices. obtained in Australia. Some were available at
One woman wanted to perform kao la'achome so Chinese herbal shops, but they did not know how
before she became pregnant she returned to Thai- to tell the herbalist about what they needed. Those
land and brought back a sauna tent used for loosing who had a Thai family or friends who were
weight. After giving birth, she boiled the essential knowledgeable about the names o f herbs were able
herbs and placed the pot inside the tent. She then sat to obtain essential ingredients for their confinement
in the tent until the herb water cooled down. She practices. However, most women did not have this
repeated this process for the whole confinement social support.
period. Similarly, another woman mentioned sitting Women who were married to Anglo-Australian
in a shower with hot water running in order to heat men or men o f other European backgrounds came
up her body as a means for recovery. She believed across disapproval from their husbands if they
that at least it was similar to kao hTachome and it wished to follow Thai traditional practices. One
might help to maintain good health. One mother woman could not take any traditional medicines
wanted to observe the yufid ritual, but owing to the because it contained alcohol and her husband did
unavailability o f the ingredients, she looked for an not allow her to take the medicines:
alternative option which she could do here. She said:
People said we have to take ya dong lao
At that time I wanted toyufai and at home I have (traditional medicines in alcohol) when we give
a fire place which I could light a fire like a real yu birth, but in my case, my husband did not let me
fai fire and I lay with my legs open in front o f the drink the medicines, so I did not have the chance
fire for the whole time. I think it is really good, it to take any of these medicines. (T 18)
is the same a s ),ttfai in Thailand that my mother
Among women who could not or did not wish to
has told me. Yufai is so good because it helps us
follow traditional practices, there were some inter-
not to feel cold too easily. I am susceptible to
esting patterns o f thoughts. For some, traditional
coldness, so I have to do it. When I gave birth to
practices were no longer relevant in a new living
my daughter it was in summer, but I still had the
situation. They believed that in a Western environ-
fire on to make my body hot and I also used a hot
ment, Thai ways were not necessary and nothing
water bag to place on my tummy too. (T 08)
would happen to their health owing to different
However, owing to changes in social and living living environment. They saw that most Anglo-
situations, most o f these Thai women said that they Australian women did not observe any traditional
could not follow Thai postpartum practices here. practices as in Thailand and yet they seemed to be
The women gave several reasons for this. Lack o f fine:
family support was given as the main reason for not
Soon after I gave birth they brought me icy cold
being able to follow traditional practices. Many
drink. I was surprised to see that, but then I
women mentioned that there was no one to help
thought other farang [Anglo/Western] women
prepare confinement practices such as yu fai, kao
survive childbirth even they drink cold drink, so I
lo'achome and massaging the body with a salt pot. should survive too. (T 05)
As these practices needed some extra physical
exertion in the preparation, such as carrying water,
boiling herbs with water and heating up salt in a pot, I did not follow any Thai traditional practices
women believed that they would not be able to do so here and did not feel worried about not following
owing to the cultural prohibition. Moreover, women them either because I used exercise to help
needed someone to look after their baby while they instead. At home we are not allowed to do any
took time to perform the traditional practices. exercise after birth but we mustyufai so that our
uterus will dry and get back to normal. And at
After I came home I wanted to do something like home we have mo tamyae [a traditional midwife]
yu fai, for my health. I wanted to lie down near to deliver the baby. If the perineum tears she does
the heater as often as I could, but it was not not know how to stitch it back, so yu fai is
possible because I had to walk around and nurse necessary for the wound to heal. Here we give
my baby all day and all night. If it was at home birth in hospital if we have a tear the doctor will
[in Thailand] someone in my family would look stitch it for us and the doctor tell us to have a hot
after him and bring him to me for feeding. At bath. Hot baths will help the tear to heal quickly
least in the first two weeks I could just stay warm and we won't feel the pain too long. I thought this
in my room. Here I had no one. My husband way and I was not worried aboutyufai, but I had
couldn't help me that much and he had to go to to do exercises to get my uterus back to normal. I
work. (T 29) do as farang women do here. (T 12)
54 Midwifery

In other words, because they were now living in the Some characteristics of the studied group are
country where there were no such traditional worthy of comments. First, 18 of the 26 were not
practices, there was no need to follow these married to Thai men. This large proportion is not
traditional practices. Women used a saying such surprising, since Thai women immigrating to
as, 'When you enter a town with half-closed eyes, Australia are not refugees but have come, in many
you must half-close your eyes too' (similar to the instances, as brides of Australian men. Nearly half
saying, 'When in Rome, do as the Romans do') as a of the women have been in Australia more than 5
metaphoric expression for following what people do years. Both these factors are likely to mean that
in Australia: women have had the opportunity to be exposed to
the Australian way of life. We also note the high
I did not follow any Thai ways at all, I did as
proportion that had had CS (46% compared with
farang women here do. Some people told me to
less than 20% of population in Australia at the time
be careful with this, they said when we get old we
of the study). The reason for this is not known, but is
would be ill easily.., but I was not afraid of it.
worthy of further investigation (see Small et al.
At home we have to yufai, we have to stay inside
1999, for example).
and keep our body warm for the whole month,
Although the length of their hospital stay was
but I did not do it. After I left hospital I went
determined primarily by the medical outcome of
everywhere, whenever I felt like going out, I did
their pregnancy (e.g. CS), women had different
go out. My husband told me that this is the way
views about their hospital stay. Thai mothers'
Australian women do after giving birth. (T 06)
concerns were in many ways similar to those
However, there were also women who felt anxious reported elsewhere. For example, Brown et al.
about their health as a result of not being able to (1995) have documented women's reasons for going
follow Thai traditional practices during confinement. home and reasons for staying among Australian
Many women mentioned the tendency to feel cold mothers who gave birth in 1993. They found a
easily as an indication of the consequence of not variety of reasons for going home early or staying
following traditional practices such as yu fai or kao longer in hospital given by women in the survey.
krachome: Reasons for going home early included wanting to
be with their families, being unable to sleep or
I now have problem here, I am afraid of cold
obtain good rest in hospital, and not liking being in
weather. Particularly when it rains, I would feel
the hospital. On the other hand, reasons for staying
shakingly cold... Then I thought is it because I
longer include wanting to rest and to recover from
did not yu fai as our old tradition that I feel so
their birth, to gain their confidence in caring for the
cold like t h i s . . , they say if one does not yu fai
baby and to establish breast feeding. Our findings
one would be afraid of the sky and rain
confirm many points made in Brown et al?s 1999
[susceptible to atmospheric conditions], so when
study. However, the important issue emerging from
I felt cold here I start to think this way too. (T 19)
our study, and not found in Brown et al.'s 1999
A few women said that it was difficult for their study, was the need to observe Thai traditional
uterus to shrink and their abdomen to flatten back to confinement practices, which women were unable to
its normal, prior to pregnancy size because they did do in maternity hospitals.
not observe the yu fai ritual: Women, in general, were satisfied with the
postpartum care received dunng their hospital stay.
In Thailand we have a hot shower and we light a
However, there were some aspects of postpartum
fire underne:lth the bed and then we lie on it. We
care that women were unhappy with. Of interest is
place our tummy on the hot bed so it makes our
that a number of women in this study commented on
tummy flat. When I had a baby here I did not
the rooming-in policy practised in many maternity
have anything for my tummy to place on so it
hospitals. It has been argued that a rooming-in
looks like this (big). At home, we never have this
policy may help to create and strengthen the
big tummy, it shrinks back. (T 01)
maternal-infant bond and establish breast feeding
quickly (Rice 1995). However, many mothers did
not perceive these as having the same importance.
DISCUSSION On the contrary, they believed that the policy placed
a strain on them. Since they had to actively
The study has provided an insight into Thai women's participate in looking after their baby, women felt
experiences of postpartum care as well as their that they could not rest properly, particularly at
opportunity to observe Thai traditional confinement night, and several of them opted to go home early.
practices in the first month following birth. This This is in line with what Moss et al. (1987) found in
paper is qualitative research and, therefore, the England. Mothers in their study felt that the
findings cannot represent the experience of all Thai demands from the hospital staff on their involve-
women in Melbourne, but they do provide the reader ment with their baby were too great and, hence, they
with a better and deeper understanding of the felt dissatisfied with postpartum care. The women in
subjective experience of these women. Moss's study 'preferred less involvement-doing less
Thai mothers' experiences of postpartum hospital stay and return home in Australia 55

for the baby, getting more help and having less childbirth determine a woman's anticipation of birth
contact, particularly at night' (p. 162). Brown et al. and her behaviour, as well as that of her family
(1994) have also found dissatisfaction with care members. Childbirth in Thai society also exists
among Anglo-Australian mothers who had to be within the context of Thai culture. In the past, and in
actively involved with the care of their baby because some areas nowadays, childbirth occurred mainly at
of the rooming-in policy. The findings of our study the women's homes with the assistance of a
suggest that there is a need to re-visit the rooming-in traditional birth attendant and they were instructed
policy in maternity hospitals. While early contact to observe traditional confinement practices for a
and active involvement of the mother with her baby period of one month following childbirth. In more
are seen as essential for bonding (Bowlby 1958, modem times, and particularly in Western countries,
Klaus & Kennel 1976), this may not be the case for birth takes place within a highly technological
those who wish to observe confinement practices. environment where the women have to rely on the
Different expectations owing to cultural differences expertise of scientifically-trained health profes-
may lead to misunderstandings and conflicts (Wool- sionals and they have to stay away from their
lett & Dosanjh-Matwala 1990). familiar home environment for several days (Jordan
As we have found, many Thai women still adhere 1978, Lefkarites 1992, Chu 1996, Grace 1996). This
to Thai traditional confinement practices. Traditional is particularly true for Thai women who have
confinement practices play a major role for the immigrated to Australia. Although the birth of their
women to gradually return to their normal routines babies takes place in a maternity hospital, many
as well as for their future health. They function as a of them still believe in Thai traditional customs
'rite of passage' or transition point from a 'critical surrounding birth and they will find an alternative
and dangerous' period of birth to a 'normal' life way in order to follow these practices despite
after birth (Davis-Floyd 1983). The practices allow difficulties in doing so. However, many women
women the opportunity to relinquish their family have abandoned these practices. This point is
and childcare demands so that they are able to rest, important as we cannot make the assumption that
and not feel imposed upon. The practice, as Cheung all Thai women are the same. Each woman has her
(1997) and Stem and Kruckman (1983) argue, has own unique experience and this is reflected in her
an impact on the emotional well-being of the women attitudes toward and perceptions of postpartum care.
postnatally, as well as in their future life. This is in These diverse needs have implications for birthing
great contrast with the Western model of childbirth services in Australia because not only are these Thai
which focuses on monitoring the women during women needing a variety of care, but also there are
their pregnancy and birth, and where women are many other cultural groups in a similar position.
expected to take up the maternal role as soon as the What needs to be done then? We could expect
birth is over (Woollett & Dosanjh-Matwala 1990). that the Western system should adapt to traditional
Owing to the lack of ability for Thai women to customs. The danger of this is that it runs the risk of
communicate their cultural need to rest, hospital stereotyping the cultures and being unable to cope
staff encouraged women in this study to take up with the varying adaptations that immigrant women
their maternal role as soon as possible. This caused make to their new environment. Alternatively, we
unhappiness and contributed to the decision to go could attempt to develop a better communication
home with the baby as soon as possible. system so that Thai women (and all other cultural
However, this does not mean that all Thai groups) receive comprehensive explanations of
mothers were able to observe confinement practices Western medical/maternity practices. However, the
upon returning home. Only women who had family problem with this approach is that there are not the
and social support could do so. Some women could resources or time to develop the explanations and
not do this owing to cultural differences between there is the implication that the Western system is
themselves and their Anglo/Western husbands. It fixed and preferable. We would suggest and hope for
would seem then that, for some women who have a flexible slrategy which results in better commu-
just given birth, neither the hospital nor the home nication so that cultural needs can be met and
provide a satisfactory environment for them. This is women have realistic expectations of the hospital
true in both this study of Thai women and for other environment.
groups of women independent of cultural back- To achieve this, first, Thai women's cultural
grounds (Brown et al. 1994). practices in a period following birth, particularly
As stated, many Thai women still adhered to their immediately after the event when the women are still
traditional practices, but we also found that there in the hospital, need to be acknowledged by health
were some who believed that Thai customs were no professionals and hospital staff. Some simple tasks
longer relevant owing to their changed living and such as providing hot water and culturally-appro-
social situations. In writing about childbirth, Roma- pilate food can be achieved without major disrup-
lis (1981) argues that childbirth is 'never simply a tions in hospital administration.
physiological act but rather a performance defined Second, the usual practices and policies of the
by and enacted within a cultural context' (p. 6). hospital/health service can be explained to the
Cultural ideology and expectations surrounding women ahead of time and steps taken to ensure that
56 Midwifery

there is understanding and acknowledgement of the Cheung NF 1997 Chinese zuo yuezi (sitting in for the first
expectations that may be made regarding women. month of the postnatal period) in Scotland. Midwifery
13:55-65
For example, the development of birth plans can be
Chu C 1996 Tso Yueh-tzu (sitting the month) in contemporary
done with the help o f interpreters or bi-lingual Taiwan. In: PL Rice, L Manderson, (eds) Maternity
workers. and reproductive health in Asian societies. Harwood
Third, women's individual needs need to be Academic Press, Amsterdam.
acknowledged. Women's social and environmental Davis-Floyd RE 1983 The role of obstetrical rituals in the
resolution of cultural anomaly. Social Science and
backgrounds are important as some women may
Medicine 3 I: 175-189
wish to observe Thai cultural practices during their DiMatteo MR, Kahn KL, Berry SH 1993 Narratives of
hospital stay and upon returning home, but others birth and the postpartum: analysis of the focus group
wish to or have to abandon them. If the first two responses of new mothers. Birth 20:204-211
points are achieved in a flexible environment then Gardner MO, Cliver SP, McNeal SFet al. 1996 Ethnicity
and sources of prenatal care: findings from a National
this third will follow. For example, in the case of the
Survey. Birth 23:84-87
rooming-in practice o f many maternity hospitals, Glaser B, Strauss AL 1967 The discovery of grounded theory:
with a flexible attitude, Thai women could obtain the strategies for qualitative research. AIdine, Chicago.
rest that they require without needing to conform to Grace J .1996 Healers and modem health services: antenatal,
the hospital norms. birthing and postpartum care in rural East Lombok,
Indonesia. ln: PL Rice, L Manderson, (eds) Maternity
This brings us to our conclusion that the
and reproductive health in Asian societies. Harwood
postpartum care and experiences o f Thai women in Academic Press, Amsterdam.
our study present some unique aspects that offer a Holroyd E, Lee YK, Wong Pui-yukYetal. 1997 Hong
better understanding of the culture and social Kong Chinese women's perception of support from
circumstances o f Thai women. These are essential midwives during labour. Midwifery 13:66-72
Jordan B 1978 Birth in four cultures: a crosscultural
in providing culturally-appropriate care to Thai
investigation of childbirth in Yucaton, Holland, Sweden
women in particular, and other women o f non- and the United States. Eden Press, Montreal
English-speaking background in general. However, Klaus MH, Kennel JH 1976 Maternal-infant bonding: the
we also believe that meeting women's individual impact of early separation or loss on family development.
needs is a most important aspect if sensitive care is The C.V. Mosby Company, Saint Louis
Lademab C, 1987 Wives and midwives: childbirth and
to be achieved in Australian birthing services and
nutrition in rural Malaysia. Univesity of California Press,
elsewhere, as Small et al. (1997) argue, 'Such a Berkeley.
focus on women's individual needs would go a very Lazarus ES, Philipson EH, 1990 A longitudinal study
long way to improving all women's experiences of comparing the prenatal care of Puerto Rican and White
their maternity care (p. 15). women. Birth 17:6-11
Lefkarites MP 1992 The soeiocultural implications of
modernizing childbirth among Greek women of the
ACKNOWLEDGEMENTS
Island of Rhodes. Medical Anthropology 13:385-412
The authors wish to thank all the Thai mothers who Manderson L 1981 Roasting, smoking and dieting in response
to birth: Malay confinement in cross-cultural
participated in this study, and to Jane Yelland for her
perspectives. Social Science and Medicine 15B: 509-
kind comments in the preparation o f this paper. The 520
research described in this paper was conducted when Miles MB, Huberman AM 1984 Qualitative data analysis.
the first two authors were at the Centre for the Study Sage, Beverly Hills.
o f Mothers' and Children's Health, School o f Public Minichiello V, Aroni R, Timewell E et al. 1995 In-depth
interviewing: principles, techniques, analysis, 2nd edi-
Health, La Trobe University. The project was funded
tion. Longman, Melbourne
by the Victorian Health Promotion Foundation core Moss P, Bolland G, Foxman R et al. 1987 The hospital
funding o f the Centre and the second author was inpatient stay: the experience of first-time parents. Child:
awarded a Postdoctoral Fellowship by the Faculty o f Care, Health and Development 13: 153-167
Health Sciences in 1994-1995. Pillsbury BLK 1978 'Doing the month': confinement and
convalescence of Chinese women after childbirth. Social
Science and Medicine 12: I 1-22
REFERENCES
Porter M, Macintyre S 1984 What is, must be best: a research
Bowlby J 1958 Nature of a child's tie to his mother. note on conservative or deferential responses to antenatal
International Journal of Psychoanalysis 39:350-373 care provision. Social Science and Medicine 19: 1197-
Brown S, Lumley J 1993 Antenatal care: a case of the inverse 1200
care law? Australian Journal of Public Health 17: 95- Reid ME, MclIwaine GM 1980 Consumer opinion of a
103 hospital antenatal clinic. Social Science and Medicine
Brown S, Small R, Lumley Jet al. 1994 Missing voices: the 14A: 363-368
experiences of motherhood. Oxford University Press, Rice PL 1993 My forty days: a cross-cultural resource book
Melbourne. for health care professionals in birthing services. The
Brown S, Lumley J, Small R 1995 Reasons to stay, reasons Vietnamese Antenatal/Postnatal Support Project, Mel-
to go: Victorian women talk about early discharge. bourne
Working Paper, Centre for the Study of Mothers' and Rice PL 1994 When I had my baby here! In: Rice PL, (ed.)
Children's Health, Melbourne. Asian mothers, Australian birth. Ausmed Publication,
Chang YLC 1995 Postpartum worries: an exploration of Melbourne.
Taiwanese primiparas who participate in the Chinese Rice PL, Manderson L 1996 Maternity and reproductive
ritual of Tso-Yueh-Tzu. Maternal Child Nursing Journal health in Asian societies. Harwood Academic Press,
23:110-122 Amsterdam
Thai mothers' experiences of postpartum hospital stay and return home in Australia 57

Rice PL 1995 Rooming-in and cultural practices: choice or Strauss AL 1987 Qualitative analysis for social scientists.
constraint? Paper presented at the 'When Research Points Cambridge University Press, Cambridge.
to Changing Practice: What Then?' Conference, Queen Symonds PV 1996 Journey to the land of light: birth among
Elizabeth Hospital, Melboume Hmong women. In: Rice PL, Manderson L (eds.)
Rice PL, Naksook C 1998 The experience of pregnancy, Maternity and reproductive health in Asian societies.
labour and birth of Thai women in Australia. Midwifery Harwood Academic Press, Amsterdam.
14(2): 74-84 Townsend K, Rice PL 1996 A baby is born in Site 2
Romito P, Zalateo C 1992 Social history of a research project: camp: pregnancy, birth and confinement among
a study on early postpartum discharge. Social Science Cambodian refugee women. In: Rice PL, Manderson
and Medicine 34:227-235 L, (eds.) Maternity and repro-ductive health in Asian
Romalis S 1981 Childbirth: alternatives to medical control. societies. Harwood Academic Press, Amsterdam.
University of Texas Press, Austin Woollett A, Nicholson P 1997 Post-partum care and
Shields N, Reid M, Cheyne H etal. 1997 Impact of midwife- experiences of mothering-Editorial. Joumal of Repro-
managed care in the postnatal period: an exploration of ductive and Infant Psychology 15:85-89
psychosocial outcomes. Journal of Reproductive and Woollett A, Dosanjh-Matwala N 1990 Postnatal care: the
Infant Psychology 15:91 - 108 attitudes and experiences of Asian women in East
Sich D 1981 Traditional concepts and customs on pregancy, London. Midwifery 6:178-184
birth and post partum period in rural Korea. Social Woollett A, Dosanjh-Matwala N, Nicholson P e t al.
Science and Medicine 15B: 65-69 1995 A comparison of the experience of pregnancy
Small R, Lumley J, Brown S 1992 To stay or not to stay: are and childbirth of Asian and non-Asian women in
fears about shorter postnatal hospital stays justified. East London. British Journal of Psychology 68:
Midwifery 8: 170-177 65-84
Small R, Rice PL, Yelland Jet al. (1999) Mothers in a new Woollett A, Lyon L, White D 1983 The reactions of
country: the role of culture and communication in East London women to medical intervention in child-
Vietnamese, Turkish and Filipino women's experiences of birth. Journal of Reproductive and Infant Psychology
giving birth in Australia. Women & Health 28: 77-101 I: 37-46
Small R, Yelland J, Lumley J e t al. 1997 Mothers in a new Yelland J, Small R, Lumley J et al. 1998 Support, sensitivity,
country (M1NC): Vietnamese, Turkish and Filipino satisfaction: Vietnamese, Turkish and Filipino women's
women's views of maternity care. A research project experience of the postnatal stay. Midwifery 14(3): 144-
report, Centre for the Study of Mother's and Children's 154
Health, La Trobe University, Melbourne Yoddumnem-Attif B, Pituckmahaket O, Kanungsuk-
Stamp GE, Crowther CA 1994 Women's views of their kasem U 1993 The main types and steps of
postnatal care by midwives at an Adelaide Women's sampling. In: Yoddumnem-Attig B, Attig GA,
Hospital. Midwifery 10:148-156 Boonchalaksi W, et al.(eds.) Qualitative methods for
Stem G, Kruckman L 1983 Multi-disciplinary prespectives population and health research. Institute for Population
on post-partum depression: an anthropological critique. and Social Research, Mahidol University at Salaya,
Social Science and Medicine 17:1027-1041 Salaya.