By Dr H Krishna Kumar and Hairil Fadzly Md Akir
Confinement practices are traditional post-natal practices for mothers after they deliver their baby. The mothers are said to be in confinement as there are a number of traditional rules and prohibitions involving their diet and daily routine for them to adhere to.
The confinement period may last from 30 to 44 days from the baby’s birth. Each culture has its own variation on confinement practices, with some seemingly outdated and having little scientific basis.
But the purpose is still relevant: to support new mothers, have them recuperate physically and emotionally after childbirth, and help their transition into motherhood – especially first-time mums.
Traditionally, mothers of new parents would be in charge of confinement care, with help from "confinement ladies" (pui yuet or bidan) in caring for the new mums and babies.
In the Chinese community, a pui yuet would stay with the new mother during the confinement, while among the Malay, a bidan would visit new mums to give them massages and hot compressions and apply abdominal wrappings, among other practices.
Nowadays, mothers have the option of checking themselves into confinement centres, which are growing in popularity. These places provide lodging and meals for mother and child, as well as support staff including nurses, midwives or confinement ladies, and laundry service.
Some centres may even offer confinement or baby products, and activities like parenting classes or massage sessions. However, these centres may have certain policies on matters like allowing fathers to stay at the centre, while others may only let dads visit during fixed hours.
The policy on breastfeeding may also vary. Most centres usually support breastfeeding, but there are some that don’t discourage formula feeding.
Lack of regulation
The regulation of confinement centres has always been a grey area. In 2016, a statement by then-Deputy Minister of Women, Family and Community Development Datin Paduka Chew Mei Fun instructed confinement centres with no medical facilities to register with the Social Welfare Department (under the Care Centre Act 1993).
But there’s not much that the government can do against "bad" confinement centres, as there is no specific section on such centres in the law. They are also not covered by the Private Healthcare Facilities and Services Act 1998. Hence, they’re not bound to any standard or minimum requirements.
As of now, most of these centres are merely recognised as businesses, like hotels and spas, not a medical facility. Thus, if any issue or problem arises during mother’s and baby’s stay at these centres, they’re usually resolved in private between the centre and the family.
There’s no dedicated avenue for a mother or family to raise any issue in case of a dispute. The lack of a medical expert (i.e. gynaecologist or paediatrician) in most these centres to detect and diagnose signs of complication in the mother or child is also worrying.
To address this, lawmakers have to work towards drafting new laws or amend existing one to regulate confinement centres, to protect mothers and babies from unwanted incidents.
In the meantime, mothers who are looking for confinement care can opt for the post-natal care package provided for free by the Traditional and Complementary Unit at several public hospitals. The Health Ministry also provides post-natal care home visits by nurses.
A nurse from the nearest health or community clinic will visit a mother’s house on certain days after birth (Day 1-4, 6, 8, 10, 15 and 20) to monitor the health status of the mother and child. Mothers have to be registered with the public hospital or clinic before delivery to utilise these services.
There’s also the MamaCare programme by the National Population and Family Development Board (known by its Malay acronym LPPKN), which trains elderly women and single mothers from low-income households in holistic postnatal care services.
Upon completion of the programme, they receive a Certificate of Professional Massage Practice, which is recognised by the government. They can also improve their skill and knowledge at a diploma level through the same programme, with accreditation from the Department of Skill Development.
It’s fine for mothers to follow confinement practices, as long as they don’t cause bodily harm and all nutritional requirements are fulfilled. Refer to a doctor if there’s any doubt about any practice, or if someone experiences shortness of breath, rapid breathing, chest pains or coughing blood during confinement – these are among the symptoms of a pulmonary embolism.
When choosing to stay at a confinement centre, do comprehensive research, make sure the staff is certified and experienced, and carefully review the contract before committing to a centre.