‘BUYER BEWARE’ WITH DOULAS, ASIAN HEALTH EXPERTS WARN.
NO LICENSING STANDARDS FOR POSTPARTUM SERVICES
Five months ago, firsttime mother Mandy Huo chose to follow the traditional Chinese practice of “sitting the month” after childbirth and agreed to pay $ 4,000 for a postpartum doula to come to her house six days a week to cook special meals and care for her baby.
But within hours of entering her home, the doula — a middleaged woman whom Huo had spent less than an hour vetting at a coffee shop — said Huo was not producing enough breast milk and put pressure on the mother to give her baby formula milk.
“I was kind of surprised. She told me she supports a breastfed baby ( at the coffee shop),” she said. “It was very discouraging.”
The mother relented and gave her son a small amount of donor milk that was stored in the fridge. But she fired the doula later that day.
Stories like this are prompting health experts and Chinese community groups to call for regulation of the “underground” industry that caters to immigrant mothers who follow the postpartum custom known as zuo yue zi.
“This is an important cultural practice that is central to the lives of many people in this country,” said Wendy Hall, a nursing professor at the University of British Columbia. “We need to figure out ways to protect families so that they are not subject to unreasonable practices by unlicensed care providers for large amounts of money.”
Mothers have to be careful in choosing the right helper, said Queenie Choo, CEO of B.C. immigrant services agency SUCCESS. “This is buyer beware.”
Though practices vary depending on whether you’re from southern China, northern China or Taiwan, the basic rationale is the same: after giving birth, a mother needs a month to allow her body to recover and to prevent long- term illness. This means staying indoors, follow- ing a restricted diet, avoiding or limiting bathing and washing of hair, and staying away from strenuous activity.
There is no consensus on how much of this is rooted in science. Still, in cities like Vancouver and Toronto with large Asian populations, there is now said to be a thriving industry catering to these mothers. Some service providers specialize in daily home delivery of special meals, typically consisting of ginger- based soups, pork dishes — including pig’s feet — and other meals intended to make the mother stronger and help her produce breast milk.
“I believe this works. That’s why I go for this,” said Violet Chen, a Burnaby, B. C., mother who paid more than $3,000 to a company to deliver freshly made Taiwanese- style dishes during the first month after her two children were born.
Others are postpartum doulas, known as yue sao, who come to the home — some even spend the night — to help prepare meals, care for the baby, perform light housework and support the mother’s emotional needs.
“(Mothers) are very weak, they need good rest to help the body recover and readjust,” said Nelly Wu, who has been doing house visits in the Vancouver area for seven years. ( Wu spoke to the Post in Mandarin and her daughter translated).
“If she doesn’t get good help in the first month, then there could be bad health effects as she gets older.”
Some businesses advertise on Chinese- language websites. Others simply rely on referrals through word of mouth or mobile messaging forums, like WeChat. They might charge a few thousand dollars up to more than $10,000 for their services.
However, there is no certification or licensing requirements or standardized training for these service providers. Some claim qualifications from having worked in health care in Asia. Some workers, like Wu, pursue training at Canadian colleges specializing in traditional Chinese medicine. Others get their training from such non-profit organizations as Toronto’s Chinese Canadian Community Service Centre.
Simon So, the centre’s administrator, said his facility has trained more than 200 people over the past four years in its three-day program. Half the students want the training just so they can help their own family members, while others seek training so they can earn money as postpartum doulas.
“I think the demand (for postpartum services) is going up because more Chinese people coming to Canada ask for this service,” he said.
But the services can yield mixed results.
One of Hall’s graduate students, Sylvia Chang, carried out a study examining 13 immigrant women in the Vancouver area who followed traditional or modified zuo yue zi practices with support from relatives or paid helpers.
One mother who paid for the delivery of pre- packaged meals said she had to stop because the medicinal herbs made her constipated.
Another mother reported a conflict between her expectations and her doula’s way of doing things.
“From the first week to the fourth week, I hired a 24- hour postpartum doula, but I didn’t agree with her way of caring for the baby, so I switched to another postpartum doula from Guangdong.”
One mother said her doula always appeared “frantic” and “rushed,” while another mother said her doula was so focused on her assigned tasks that she failed to pick up on the mother’s emotional needs when she was depressed and suicidal.
“The women felt that the lack of regulation led to potentially corrupt services being offered for financial gain,” Chang wrote in her thesis.
Mothers reported another challenge: Certain Western medical practices, such as taking the baby in for checkups, did not always align with their zuo yue zi practices, such as staying indoors for the first month. “As a result, some mothers did not feel respected concerning their beliefs.”
Other mothers, however, said they had no problem ditching some of the more rigid edicts of zuo yue zi, even if it went against the wishes of their mothers and grandmothers.
Chang, a registered nurse who teaches prenatal classes, said she hopes her research findings will lead not only to regulation of the industry but also to greater awareness among Western health- care providers about these customs.
“If we can have awareness, it’ll be less judgmental,” she said. “It’ ll also be easier for the Chinese women to communicate to health-care providers.”
Huo, who is now able to laugh off her disappointing doula experience, said she’s learned her lesson. She advises pregnant Chinese women considering hiring a postpartum helper to make sure they get references and do thorough interviews.
“Make sure you ask a lot of questions,” she said. “If she’s not a good fit, don’t hire her.”
‘ THIS IS AN IMPORTANT CULTURAL PRACTICE’ FOR CHINESE MOTHERS.