Nursing and Health Sciences (2011), 13, 4752

Research Article

Negotiating Doing the month: An ethnographic study

examining the postnatal practices of two generations of
Chinese women
nhs_575

47..52

Eleanor Holroyd, rn, phd,1 Violeta Lopez, rn, phd, frcna2 and Sally Wai-Chi Chan, rn, phd3
1
Discipline of Nursing and Midwifery, School of Health Sciences, RMIT University, Melbourne, Victoria, 2Research Centre
for Nursing & Midwifery, Australian National University, Canberra, Australian Capital Territory, Australia and 3Alice Lee
Centre for Nursing Studies, National University of Singapore, Singapore

Abstract

In Chinese society, the specific set of postnatal practices called doing the month constitutes an integrated set
of postnatal behaviors that provides cultural and maternal protection and identity. This study examines the
cultural practice of doing the month by Chinese mothers for two generations of matrilineal datasets.
Ethnographic interviews were undertaken with new mothers and their mother and/or mother-in-law. Then, the
coded data were compared within matrilineal dyads, as well as within age cohorts. The new mothers highlighted a range of attitudinal and behavioral practices that was informed and enforced by the female family
members. They found highly individualized ways of negotiating traditional practices. In contrast, their mothers
and mothers-in-law testified to a custom-bound approach. Support from family members appeared to be
instrumental and was underscored by traditional notions of filial duty in the older generation of mothers. In
comparison, their daughters and daughters-in-law indicated more autonomously directed behaviors. Recommendations are made in order to provide healthcare professionals with a more-informed understanding of
Chinese postnatal belief systems.

Key words

Chinese women, culture, doing the month, ethnography, postnatal practices, qualitative.

INTRODUCTION AND LITERATURE REVIEW

The perinatal period from conception to childbirth and postpartum is segmented and defined structurally in terms of its
behavioral, social, and experiential content. Perinatal events
are phenomena in which both the behavior and feelings of
the woman, as well as those around her, are differentially
patterned, emphasized, and ritually marked (Pillsbury,
1978). This patterning of perinatal events exemplifies social
mores, social values, and cultural traditions for the mother,
child, and family. The social recognition of these transitions
assists the individual to successfully pass through the biological transition and to assume a new role. Specifically
referring to childbirth, there is the expected social return
and the fact that this transition represents legitimated deviance that enables the labels of folk illnesses to be applied
(Van Gennep, 1960: 97).
In most societies, birth and the immediate post-partum
period are considered to be a vulnerable time for the mother

Correspondence address: Eleanor Holroyd, Discipline of Nursing and Midwifery,

School of Health Sciences, RMIT University, PO Box 71, Bundoora, Melbourne,
Victoria 3083, Australia. Email: eleanor.holroyd@rmit.edu.au
Received 7 September 2010; accepted 5 January 2010.

2011 Blackwell Publishing Asia Pty Ltd.

and child (Callister, 2006) and frequently are considered to

be a time of ritual danger for the entire family or community.
In order to deal with this danger and the existential uncertainty that is associated with birth, communities tend to
produce a set of internally consistent and mutually dependent practices and beliefs that are intended to manage physiological changes and to make sense in a particular cultural
context. Such practices are used commonly to protect women
from emotional problems in the first month post-partum
(Lee et al., 1998).
In Chinese society, a specific set of postnatal practices
called doing the month (zou yue in Mandarin) constitutes
a common cultural custom (Wang et al., 2008; Strand et al.,
2009). Doing the month, both in historical and contemporary times, constitutes a popular and integrated set of postnatal behaviors for Chinese mothers that provides cultural
and maternal protection, reassurance, rituals, and identity
(Holroyd et al., 1997; 2004; Lee et al., 2004). These practices
and rituals give intimacy, as well as emotional and maternal
support, that strengthens the mothers self-esteem and provides a buffer against the stressors and difficulties that are
encountered in early motherhood. Historically, the benefits
of this practice ensured that a woman would have sufficient
rest to regain enough energy to resume and continue her
work in good health (Pillsbury, 1982).
doi: 10.1111/j.1442-2018.2011.00575.x

48

Doing the month practices have been well documented

and are passed along matrilineal lines from mothers to
daughters (Pillsbury, 1978). In contemporary Hong Kong,
Chan and Levy (2004) reported that Chinese women followed traditional practices to different degrees, compared
to their mother. In a large-scale Hong Kong study, Lee et al.
(2004) found that the majority of women practised doing
the month and were supported by their mother and
mother-in-law, indicating high levels of emotional support. A
subsequent study by Barclay (1995) found that rapid industrialization and urbanization had eroded two-generational
family structures, which meant that some new mothers are no
longer able to rely on their relatives to be with them in the
weeks or months after childbirth.
However, what is not known is how the practices of doing
the month are passed down through the generations of
Hong Kong Chinese women. These practices need to be
understood in the context of the rapid social change that has
taken place in Hong Kong in the past decade. These changes
have influenced profoundly the traditional Hong Kong
Chinese households due to the increasing number of mothers
in full-time employment, access to maternity leave, and the
reliance on full-time, live-in domestic helpers.

AIM
The purpose of this study was to understand the female,
family-centered socializing experiences that shaped the practice of doing the month in two generations of Hong Kong
Chinese women. Specifically, the studys objectives were to
examine how and why each generation of women practised
doing the month, explain how the women gained this cultural knowledge, explore how each generation accounted
for the historical or contemporary social circumstances, and
understand the cultural explanations of doing the month
from the two generations of women.

METHODS
Design
The study used an exploratory qualitative research design to
gain access to the postnatal practices of two generations of
women. The theoretical basis of the study was the paradigm
of cultural models that was first developed by DAndrade
and Strauss (1992). A cultural model explains how, why, and
what people do in light of their social circumstances and
social structure. The cultural model was used to explain how
cultural messages of doing the month were shared, recognized, enacted, and transmitted to each generation of daughters. This model, as well as being internal or cognitive, can be
further informed by the dominant ideas of the society, as well
as the social circumstances of gender, generation, and social
class. The model guides what is considered to be right or
what ought to be done by these women from their own
perspectives and experiences in order to highlight the ways in
which two generations of women have gone about doing the
month.
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E. Holroyd et al.

Participants
The sampling method was based on a two-generational matrilinear chain of lineal descent. Using family dyads as the unit of
analysis, the focus was on the transmission of values; therefore,
it was deemed to be appropriate to trace the lines of descent
and matrimony to focus on the transmission of generational
knowledge. A convenience sample was recruited from the
postnatal public and private clinic in a regional hospital in
Hong Kong. The inclusion criteria were women who held
Hong Kong residency status, who were aged 1840 years,
first-time mothers, married, who had experienced a normal
spontaneous vaginal delivery, had a mother or mother-in-law
who was alive and living in Hong Kong, though not necessarily
co-habiting, and who were able to speak either Cantonese or
Mandarin.The exclusion criteria were single mothers, teenage
mothers, new immigrants, women with delivery complications
(requiring a longer stay in hospital), and women with documented mental heath issues. The final sample size of the new
mothers was determined by the saturation of the data.
However, the sample of the second-generation mothers was
determined from the paired familial nominations of the new
mothers; hence, saturation was not sought.

Data collection and analysis

The method of data collection involved the use of ethnographic, in-depth, semistructured interviews. The ethnographic interviews were tape-recorded and included guided
and open-ended questions. The topics that were included in
the two interview guides were developed from the literature
review. Field notes were taken to contextualize the data and
to record the non-verbal interactions or emotions that were
relevant to the interpretation of the data. In addition,
demographic data were collected with regard to age, number
of children, family relationships, employment, household
income, birth type, and sex of the last child. A trilingual
(Cantonese, Mandarin, and English) research nurse was
responsible for conducting all the interviews and the training
in interview techniques was given by the principal investigator prior to the commencement of the study. In order to
evaluate the feasibility of the interview guide, the clarity of
the questions, and the length of the interview, a pilot study
was conducted by interviewing two women from each generation, independent and yet representative of the main
sample. Subsequent to the pilot study, minor changes were
made to the interview guide.
Once consent was obtained, all the women were contacted
for a face-to-face interview at a location, date, and time of their
preference. Each dyad was interviewed by beginning with the
new mother, followed by her mother or mother-in-law.All the
new mothers were interviewed from between 6 weeks and
6 months post-partum. This period allowed the new mothers
to complete the doing the month period. The interviews
were conducted in either Cantonese or Mandarin (five interviews) and lasted for ~1 h. The mothers first were asked to
remember as much as possible about their last childbirth. An
allowance was made for memory bias in interpreting the data,
an approach that is common to life history accounts.

Chinese postnatal belief practices

Following the completion of each interview, the audiotapes were transcribed verbatim and a selection of these
were translated into English, back-translated, and then the
two original English versions were compared by an independent, qualified, bilingual Chinese-English translator to
ensure the accuracy of the translation (Brislin, 1983). The
major purpose of the translations was to facilitate the analysis of significant quantities of text-based data; in particular,
to group codes and categories and to develop conceptual
maps in order to facilitate linkages in developing theory. The
transcriptions to English from the two languages enabled a
standardization of the data for analysis purposes (Brislin,
1983), although a recognized limitation of this study was the
non-use of software packages, such as ATlis TI, which would
have enabled the handling of the original language data in a
more systematic and contextual manner. The coding of the
family member datasets was undertaken independently and
then compared within matrilineal dyads, as well as within
age cohorts. A multilevel approach to the data analysis was
used, within each generation initially and then across both
generations.

Ethical approval
Ethics approval was obtained from the Survey and Behavioral Research Ethics Committee of the Chinese University
of Hong Kong.The women who met the inclusion criteria and
who were willing to participate were informed about the
objectives of the study and were assured that their privacy
and confidentiality would be maintained. Their written
informed consent was obtained. Once consent was obtained
from the new mother, she was asked to introduce her mother
or mother-in-law to the research assistant, who invited them
to participate in the study.

Reliability and validity

Sensitive interviewing ensured that preconceived ideas or
expectations about the phenomenon were examined
between the members of the research team. Feedback
about the categories that had been developed during the
data analysis was sought from the participants in order to
ensure the validity of the coding system. The reliability was
ensured by audio-taping and transcribing the interviews.
Audio-taping promoted a complete and accurate account of
the womens responses, thereby increasing the reliability
of the data by reducing the risk of selective filtering of
the data by the investigators through recall or summation. In addition, the translated data were checked by one
of the members of the research team in order to ensure
that the data accurately reflected the meaning of the
Chinese data.
Close collaboration between the members of the research
team, including the research assistant, occurred at all stages
of the research process. The analysis was undertaken independently by two researchers to ensure consistency and
agreement in the coding of the data. In addition, an audit trail
ensured an accurate record of all the decisions and processes
that were undertaken during the study.

49

RESULTS
Participants
A total of 32 interviews was conducted, including 20 new
mothers, nine mothers of new mothers, and three mothersin-law. The mean age of the new mothers, their mothers, and
the mothers-in-law were 29.5, 56.2, and 55.3 years, respectively. All the new mothers were living with their husband
and first-born baby. Among the 20 new mothers, only one was
living with her in-laws and her husbands sister. The average
monthly household income of the new mothers ranged from
$US1200 to US3000. The monthly household income of the
nine mothers of the new mothers ranged from $US1480 to
$US1500. Seventeen new mothers had completed secondary
education and three were tertiary graduates. The older generation of women had lower education levels, compared to
their daughter or daughter-in-law. The sex of the new-born
babies consisted of nine girls and 11 boys. Among the 20 new
mothers, 13 of them took 10 months of maternity leave and
seven had taken 2 months leave prelabor and then they took
8 months of leave after the birth. Six new mothers had hired
full-time helpers who were from Hong Kong or from mainland China, four being the mother of the new mothers and
two being the mother-in-law.

Qualitative results
Theme 1: Rites, rituals, and the establishment of a
post-partum time period
The new mothers and second-generation mothers highlighted a range of attitudinal and behavioral practices, such as
rest and seclusion, protective rituals, and emotional buffering,
all informed and enforced by the female family members.
More than half of the new mothers had practised doing the
month for > 1 month. These mothers considered 12 days
after labor as the time to commence eating tonic food,
seeing visitors, and accordingly introducing specific personal
hygiene practices. This commonality also was borne out
by their mother or mother-in-law. The practices that were
common to both generations included not bathing and/or not
washing ones hair, avoiding squatting, and not touching cold
water. Testimonies to both the practice and timing that were
provided by the new mothers are as follows:
. . . I shouldnt start eating tonic food until at least
2 weeks have passed.
Its okay to invite friends home. I can have visitors
immediately after discharge from hospital, but Ive to
wait for 12 days before I can give my friends pork feet
braised with ginger and vinegar.
Its usually after 12 days because thats the time pork
feet braised with ginger and vinegar is eaten.
I didnt wash my hair until the 14th day after childbirth.
Then, I washed my hair for the second time after 7 days.
After 1 month, I washed my hair every 4 days. Id wear a
hat when I go [sic] out during the first 2 months . . . If I
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E. Holroyd et al.

have a baby next time, I definitely wont have visitors

at home until after 1 month. Ive thought about it and I
believe that the 12 day custom has its purpose.
A contrast is provided by the second-generation mothers,
as follows:
I ate the ginger porridge for half [a] month and six meals
within 1 day. Within these six meals, two meals were
wheat noodles and I ate porridge, fish, and pork. These
foods were almost the same. There was no difference.
Chicken, ah . . . At the very beginning, I could not eat
these foods.

Theme 2: Finding ways to negotiate

customary practices
The first-time mothers tended to be more open about admitting that they modified a custom when it became uncomfortable, whereas there was little evidence of such practices by
their mothers. The suggestion was that this younger generation of mothers had more room to negotiate cultural practices than their mothers, which was borne out particularly in
relation to the hair-washing practices and taboos, as the new
mothers stated:

Other people use ginger water. I just washed my hair as

usual, every day, even though people said its necessary
to use ginger water for bathing, but sometimes I forget
and not [sic] bother at all and just use hot water instead.
Yes. A woman shouldnt touch unboiled water when
shes doing the month. Therefore, my mother boiled
ginger water for me to use in bathing and washing my
hair. She said it aids in recuperation of health during the
period of doing the month and is very important. Its
too bothersome for my mother but she insist [sic] on
doing this to avoid rheumatism.
The second-generation mothers were assisted in this practice by their mother-in-law, in contrast to their daughters, who
largely self-initiated this custom:
I was always given help as much as possible, so that I can
rest more. I was helped to relieve me from [my] workload, make my life easier, so I wont get uptight. Not
being uptight means I wont worry too much, so Id be
happier.
Most people practise this boiling water for one whole
month. My grandmother said it was like this in the past.
She was taught to do that.

If it doesnt create a very big trouble, basically Ill follow.

But, as some of them said Do not wash hair for
1 month, Ill tolerate it as much as I can. However, I
wash my hair if I cant tolerate.

My mother said squatting too long would induce prolapse of the uterus; the uterus would be loose after
delivery.

I used ginger water to wipe my head. For the first few

days, I did not wash my hair. Then, my hair had very bad
smell. I could not tolerate. I washed my hair and bathe
[sic] as usual.

Theme 4: Imperatives and punishments for breaking

the practice

I only did half of the things I was told. For example, the
custom of not washing hair in the first month after giving
birth is unbearable. Its summer now. Not washing hair
for 1 month would be torture. I washed my hair on the
10th day after giving birth.
A contrast is provided by the second generation of
mothers, as follows:
Sometimes, I felt I could not tolerate it but had to tolerate it as the people said bathing would let the wind in
and had [sic] adverse effect on my health. So, I dared not
to take a bath. I just used a cloth to clean my body.
Yes. I used ginger. I didnt bathe. I wiped my body
instead of bathing.

Theme 3: Burdensome nature of the practice

Although the younger women were influenced by what their
mother had done or said in order to reinforce customary
practices, there was much dissonance, as evidenced by testimonies by the new mothers about the burdensome nature
and efficacy of certain practices. For example:
They always say Use ginger water to take bath. I only
use warm water and not [sic] bother with ginger. Too
much of a bother.
2011 Blackwell Publishing Asia Pty Ltd.

Avoidance imperatives featured strongly in these first-time

mothers testimonies and served as a potent reinforcement of
what could happen in later life by not following certain guidelines. These imperatives were largely conveyed by older relatives and influential others:
My father-in-law and mother told me not to expose
myself to the wind. I suspect whether my headache is
because Id done something against their advice. If so, I
deserve the headache.
Yes. Relax tendon, stimulate the circulation of blood, get
rid of the wind, warm the stomach. Ginger and Chinese
wine have many advantages. It can get rid of the wind
and keep the stomach warm. But, I did not follow this
. . . drink wine.
People said it reduces wind in the head and pain in the
bones. Im not sure about it. Ill know in the future. But,
I think thats true because many people said so.
They always tell me to sleep. Cook the chicken in wine
and eat the sweet ginger vinegar. They did not allow me
to wash my hair.They did not allow me to go out in order
to avoid the wind. Always like these. Mm . . .
The usual practice is to wash hair 1 month after childbirth. I washed my hair only after 10 days. I washed my
hair earlier than that. I was told the reason for not

Chinese postnatal belief practices

washing hair is to prevent wind from entering the

body, and you will be punished by frequent headaches
later.
A contrast is provided by the second generation of
mothers, as follows:
Its for the sake of health. If wind gets into the body,
the woman will develop rheumatism.

DISCUSSION
The importance of a set time period for doing the month
was related to the conceptualization of lochia as bad blood
having the power to contaminate and the importance of
waiting to maximize the benefit to the good blood. What is
emphasized by timing is a ritualized importance, which, in
turn, provides comfort in times of change while offering
maternal protection. For the women of both generations, the
adherence to specific times allowed for a recuperative
period in which care was expected, activities were limited,
and needs were taken care of by the female relatives. A
period of 40 days post-partum is common in many cultures
and coincides with the length of various religious observances. The timing was seen to be linked to the Chinese
astrological calendar (30 days) or 100 days (3 month cycle),
both of which, in turn, have further associations with fertility
cycles. The establishment of a set time period ensured that a
woman was free from other obligations and so promoted an
optimal state in which to care for her baby. For these women,
what was important was that the period of time for observances was conceptualized as finite and that permission was
granted for them to recuperate.
What was as important was the adherence to some semblance of custom, despite the women themselves finding
highly individualized ways to negotiate traditional practices.
Pressure from significant others acted as a potent reinforcement of traditional practice and was heightened in a period
of vulnerability, such as pregnancy, in Chinese society. This
finding concurs with that of Matthey et al. (2002), who
reported that the adherence to such practices stems from
family expectations and not personal preferences. Of note
was the limited memory recall by the new mothers of their
mothers postnatal practices. However, the fear of unfavorable outcomes, such as arthritis, by not following specific
practices was passed on by their mothers and did appear to
act as a motivator to sustain certain traditional postnatal
practices.
The older women testified to a more duty-bound approach,
in contrast to their daughters, who stressed youth, modernity,
autonomy, and spontaneity. In such a system, aid was seen to
flow from the natal mothers to their daughters within a
network of embedded kin relationships. Of interest is that
these younger women chose to draw on knowledge from
their mother postnatally, as opposed to their mother-in-law.
Clearly, the cultural meaning and functional attributes of
the Chinese family have changed between these two generations. Support from the family appeared to be seen as less
obligatory and more instrumental for the younger mothers,
with the traditional notion of filial duty being severely

51

undermined, when compared to their own mothers. Within

urban Hong Kong of the 20th century, these new mothers
appeared to be less defined by the social and kin relationships; instead, there was an increased tolerance for selfinitiated activities, when compared with the accounts of their
mothers or mothers-in-law of doing the month.
In Hong Kong and, indeed, increasingly in China, a number
of factors has given rise to the increasing independence of the
younger generation of mothers. They include a smaller family
size, delayed childbirth, the rapid rise of the nuclear family,
which has been fostered by the building of new towns, the
increasing affluence of women, and the availability of lowcost domestic labor, all of which have been accelerated by
rapid and recent industrialization (Cheung & Cheung, 1995).
It can be argued that these factors foster more self-centered,
as opposed to filial-centered, decisions being made by
younger women.
Although the women could rationalize that specific
customs might not always offer protection, they were fearful
of the consequences of not adhering to, at the very least, a
minimal practice. This trend was strengthened by their natal
mothers, who took an active role in the management of their
daughters postnatal care. Also suggested is that doing the
month served to foster motherdaughter kinship ties at a
time of rapid social change, constituting a cultural identity
that is signified by motherhood. This trend suggests a shift
from the past, where the kinship obligations of daughters
drew on a Confucian-informed mother-in-law relationship.
The practice of doing the month that is integrated in
these cultural models continues in contemporary Hong
Kong. This is in spite of considerable Western influence and
modernity that are perpetuated, not only in the media, but
also by an increasing number of overseas Chinese persons
returning to Hong Kong, as well as recent reforms in education and health care (Holroyd, 2003a). The contention is that
the custom of doing the month allows protection, expression, and cultural identification at a time of personal vulnerability that is posed by childbirth.
The proposed cultural model is that emerging generations
of Chinese new mothers are highly individualized in how
they engage in certain culturally specific behaviors, while
choosing to reject behaviors. These behaviors then are given
relevance by their mothers, who draw on both the popular
circulating rhetoric and their own practices and memories of
previous times (Holroyd, 2001; 2002; 2003b). What is important is that the model for doing the month is not reproduced by the next generation of daughters, but is linked to a
complex process of understanding, life experience, and circumstances (generation and social class) that lead to the
acceptance, rejection, or modification of the practices. In the
process of transmitting the practice of doing the month
from mothers to their daughters, the goals need to concur
with the current circumstances (family type, employment,
class, education, and age) of the daughter if the practice is to
continue in the same way.
A number of primary cultural models existed to inform the
mothers and daughters practice of doing the month;
however, these then were filtered through generational
guidelines and the current social conditions and were often
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52

subject to kinship ideologies. The force and direction of these

models depended on the degree of personal relevance and
the links to the past and ongoing family socializing experiences (Holroyd, 2001).
A clear limitation of the research was the unavailability of
the second generation of mothers and the time and budget
limitations of the project. A secondary limitation was the
reliance on memory recall, although the recruitment of two
generations served to promote past recall.

CONCLUSION
The first-generation Chinese mothers who were interviewed
wanted cultural clarification and reassurance. Hong Kongs
current formal antenatal education does not prepare women
for the cultural aspects of doing the month and there is
considerable conflict and gaps between families and professional advice. This is not withstanding the fact that doing the
month remains a common practice for Chinese mothers.
Midwives and mental health nurses need more knowledge
of cultural self-protection rituals as buffers against postnatal
emotional distress. This will give credence to the ways in
which sociocultural factors influence healthcare beliefs and
behaviors. Healthcare professionals then can focus on antenatal education and specific educational interventions that
deliver culturally sensitive care.
The accommodation of cultural knowledge on doing the
month into midwifery undergraduate, postgraduate, and
refresher courses, as well as public health practice, could
serve to promote congruence with the cultural health status,
identity, and health beliefs of new mothers. Womens healthcare professionals increasingly need to facilitate the emotional and physical recovery of Chinese mothers in ways that
are in accordance with their beliefs about self-protection.
This could serve to promote both preventative and cultural
support as fundamental links to the health status of Chinese
women and family relationships.

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