Traditional Post-Birthing Practice May Endanger New Mothers and Children

According to a Cambodian med­ical belief—already a tradition 2,000 years ago—a woman enters a dangerous stage the moment she gives birth.

As her body switches from the “hot” state of pregnancy to a “cold” state after delivery, a woman must follow the ritual practice of aing phleung, or roasting fire, to restore balance. Otherwise, she may remain physically weak and subject to illness, unable to work as hard as she did in the past.

So for days and even weeks after giving birth, women live in virtual steam-bath conditions, exposed to high heat and wrapped in layers of clothes and blankets, in order to sweat profusely.

“This is an old tradition, and we don’t go against it,” said Chan Theary, executive director of Reproductive and Child Health Alliance, which works with Bud­dhist nuns and birth attendants throughout the country.

“But we ask women to do it in a smaller way,” and beware of de­hydration, she said.

On cool and humid days, keeping a woman warm and resting after delivery is actually healthy, said Koum Kanal, director of the National Maternal and Child Health Center. But in high heat and in ill-ventilated rooms, this can become detrimental to the mother, he said.

With the advent of Western medicine in the country, some city women now replace aing phleung with what they consider “hot” injections of antibiotics and vitamins, said Tanja Kuhlmann, a health and nutrition researcher from Germany. But in rural areas, where about 85 percent of the population lives, aing phleung remains common practice, she said.

Kuhlmann just completed a six-month study of post-birth habits in Kampot province. Her research was funded through a German cooperation project in health and nutrition.

Kuhlmann’s findings concur with the results of a year-long study by Elizabeth Hoban, a medical anthropologist from Australia, that was conducted two years ago in Banteay Meanchey province.

Although the focus of their work differed slightly, the aing phleung methods they observed in those two different areas of the country were identical, which shows how consistent and widespread this process remains today.

Kuhlmann wanted to find out whether aing phleung plays a role in the fact that women wait a few days before breast-feeding newborns. This was part of a study on food beliefs and taboos in infant nutrition in Cambodia for a mast­ers thesis at the Justus-Liebig University in Giessen, north of Frankfurt.

Hoban, who has been involved in maternity-care programs in Cambodia since the early 1990s, focused on traditions surrounding birth and the importance of yeay moab, or grandmother midwives, in rural areas. Her conclusions are described in the doctoral thesis that she presented in December 2002 to the Key Center for Wo­men’s Health in Society at the Uni­versity of Melbourne in Australia.

In her thesis, Hoban explained that Khmer practices are a mixture of Indian, Chinese, animistic and Western traditions.

“This is not surprising, considering Cambodia’s contact with both Chinese and Indian peoples, possibly as early as 3,000 BC, then the Western influence during French colonization be­tween 1863 and 1945, as well as more recently,” she said.

Cambodian traditional medicine classifies body fluids and food products as hot or cold, said Hoban. Good health means maintaining hot/cold balance in one’s body, which is helped by eating either hot or cold food, she said.

“Childbirth is a time of natural and supernatural danger, when a woman’s physiological state is altered,” said Hoban. “Childbirth depletes the woman of heat, blood and wind, placing her in a vulnerable state and subjecting her to illness due to cold, wind, magic and disease,” she said.

So immediately after delivery, a fire is lit to warm the woman now entering a “cold” state, said Kuhl­mann. If an elevated bed built for that purpose is available, a charcoal fire will be put directly under her bed. Otherwise, it will be lit next to her in the hut when it is built on the ground, or underneath her when the house is on stilts, said Kuhlmann.

During that period, women are expected to eat “hot” food to counterbalance their “cold” state, she said. Even though opinions vary as to hot and cold products, fruits are seen as cold and to be avoided during that time, said Kuhlmann. Tomatoes and cucum­bers are also cold, while onions and green peppers are hot, said Hoban.

In any case, women are encouraged to eat mainly rice soup (viewed as neutral food) loaded with salt and pepper to make them thirsty; and to drink hot tea, traditional medicine and rice wine to induce sweating, said Kuhl­mann. Women who can afford meat add pork or chicken to their rice soup, she said.

Aing phleung may include steambaths, during which wo­men inhale medicinal vapors, and massage, “which is a highly effective method of expelling blood from the post-parturient woman’s uterus,” said Hoban.

The length of aing phleung of­ten depends on a family’s means: Poorer women may have no choice but to return to the rice field within days of delivery, she said.

“Also, the practice seems to get shorter and shorter from one generation to the next,” said Kuhl­mann. “Grandmothers say they were doing it three to four weeks. Now, it’s about four days to one week,” although some women may continue the process at night for weeks afterwards, she said.

Both researchers agree that, in the Cambodian tradition, the mother’s health comes first, which is why aing phleung starts right after the baby is born.

“The problem is that there is no body contact between mother and baby, who would have the reflex to suck [breast milk] immediately if he was with his mother,” said Kuhlmann.

The baby will sometimes be put next to the mother on a wooden board to protect him from the heat; and will be taken away for his own good if the room be­comes too smoky, she said.

The newborn is fed water or, if the family is well-off, condensed milk until the mother starts breast feeding a few days after birth, Kuhlmann said.

Nutritionists stress that the first milk a mother produces right after birth, which is called col­ostrum, contains antibodies and anti-infective proteins that immunize the baby. In addition, breast feeding within an hour of delivery makes the mother’s uterus re­tract, which helps reduce bleeding and dangers of hemorrhaging.

Even though aing phleung may impede breast feeding, it is just one part of the problem, said Chan Theary. According to popular beliefs, colostrum is not good for the baby, she said. “This is one of the misconceptions we try to dispel,” said Koum Kanal.

Some elderly women insist that a woman should face the fire up close, and display with pride burn scars they got on their stomach during their own aing phleung, said Hoban. Racha discourages this practice, which may cause serious burns and blisters, Chan Theary said.

Moreover, mothers may suffocate in today’s homes if precautions are not taken, Koum Kanal said . Unlike traditional huts built with little to stop air flow, smoke can stay trapped in well-insulated houses.

So far, no scientific evidence shows that aing phleung may be harmful, Hoban said. But medical studies are needed both to look into the process, and to find ways to integrate it more within the country’s health programs, Kuhl­mann said.

As for “hot” injections of antibiotics that city and well-off women use to shorten or replace aing phleung, Chan Theary considers them unnecessary for a woman who has had a healthy delivery.

 

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