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Yaodan Wang of Wellington was shocked to receive a tub of ice cream after giving birth to her second child.
"When I gave birth to my second child, the hospital provided cold water and a small box of ice cream," Wang said. "I definitely didn't eat it. My husband ate it, so nothing went to waste."
Such experiences are common with new Chinese mothers giving birth in New Zealand who are unfamiliar with Western practices that are very different from their age-old confinement approach to recovery.
Postpartum confinement is a tradition many Chinese mothers follow for one month to aid recovery after giving birth.
The tradition - called "zuo yue zi" in Mandarin, or "sitting the month" - forces new mothers to refrain from undertaking strenuous activity such as household chores, heavy lifting and, in many cases, leaving the house for a month after childbirth.
They're also expected to avoid certain foods during this period, particularly "cold" or "damp" items believed to upset the body's balance and impede healing.
Some new Chinese mothers in New Zealand struggle to follow the prescribed set of lifestyle and dietary guidelines under the tradition as they navigate the country's Western-style health system.
Yaodan Wang, a mother of three in Wellington, followed a strict diet to aid recovery after childbirth. Photo: Supplied
Postpartum diets
Postpartum meals, or "yue zi cai", are believed to be an important part of a new mother's recovery, with ingredients selected for their nourishing and "warming" properties to aid healing and restore nutrients lost because of childbirth.
However, it can be difficult for Chinese mothers to access such dishes while recovering in a New Zealand hospital after giving birth.
Wang followed strict guidelines when selecting food to aid recovery after the birth of her three children.
"I didn't eat any seasoning or salty foods throughout the entire confinement period after my eldest daughter was born," Wang said. "I also avoided 'cold' and raw foods when I had my second daughter, since the weather was cooler. Even now, after my little [two-month-old] son was born, I heat up any fruit before eating it."
Wang struggled to find "warm" items served with meals during each of her short stays in hospital.
"The milk served was cold. The hospital had a microwave, so I asked my husband to heat it up before I drank it," she said.
"It would be ideal if the food provided by hospitals could be more aligned with Chinese dietary habits, offering lightly flavored and warm meals for mothers after childbirth."
Asian and Ethnic Health Services offers mental health and wellbeing workshops for the Asian community. Photo: Supplied
Auckland-based Lu Yan experienced similar struggles with postpartum meals.
Yan's eldest son was born in China, which allowed her access to fresh, lightly seasoned meals that were low in salt and oil and served warm.
However, she encountered a completely different postpartum environment after giving birth to her second child in New Zealand in January.
"The meals provided by New Zealand hospitals are everyday foods such as bread, oats, mashed potatoes and pasta - whatever tastes good, including cold and salty options," Yan said.
"I tried to eat hospital meals for a day but returned them in the days that followed because I didn't want them to go to waste," she said.
"My mother took over preparing postpartum meals for me [on subsequent days], while my friends would also bring suitable food to the hospital."
In addition to a dearth of traditional postpartum Chinese meals in hospital, Yan also struggled to find a skilled nanny in New Zealand.
A postpartum nanny, or "yue sao", typically cares for a new mother and baby in the first month after childbirth in China.
"I found a postpartum nanny even before giving birth to my eldest son in China," she said.
"The nanny accompanied me to hospital, returned home with me, prepared various postpartum meals throughout the entire confinement period and helped care for the baby."
Yan struggled to find an affordable and experienced postpartum nanny after her daughter was born and so asked her mother to fly to New Zealand to help.
Yan said several commercial agencies offering specialized maternal and child health meals for new mothers operated in New Zealand but charged high fees for their service.
"I contacted one of the more affordable services [for a quote], but they charged around $140 a day to prepare postpartum meals," she said. "Postpartum care in New Zealand is far more expensive than in China."
Striking a balance
Grace Ryu, group manager of Asian and Ethnic Health Services, said postpartum traditions existed in several Asian cultures, including "sanhujori" on the Korean Peninsula and "jaappa" in India.
Grace Ryu, group manager of Asian and Ethnic Health Services Photo: Supplied
However, she was concerned that language barriers and cultural differences often prevented Asian women from sharing personal or sensitive issues.
"They may be uncomfortable or unable to communicate in English," she said. "Even for mothers who may be fluent in English, there are still concerns that their cultural preferences or practices may not be understood."
Traditional Chinese medical beliefs were a case in point, she said.
"There is the concept of 'qi xue' ('vital energy and blood') that refers to two essential components in traditional Chinese medicine," she said.
"These components are weakened after giving birth, making the mother vulnerable to illness. As such, traditional postpartum practices are highly valued by many Asian women to ensure a holistic approach to restoring balance in the mother's body after giving birth.
"Due to the loss of hot 'qi', many [new mothers] avoid cold foods to restore balance and bring the hot 'qi' back to the body with hot meals."
Vartika Sharma, a senior lecturer and research fellow in the Faculty of Medical and Health Sciences at the University of Auckland, said her team conducted a research project that explored pregnancy care among ethnic women, including those from Asian, Middle Eastern, Latin American and African backgrounds.
The research found that women from ethnic groups shared several common postpartum practices.
For instance, Indian women typically observed a confinement period of nearly 40 days after childbirth to recover and heal from the process.
Sharma said many women not only followed traditional diets but also took extra precautions to avoid infections, such as staying indoors and limiting visitors.
For women observing traditional confinement practices, she said, one of the biggest challenges was finding a balance between such customs and whatever was available in their new environment.
"You're trying to do something that is such an anomaly in the New Zealand system," Sharma said. "For example, if you're expected to go for a medical appointment, but your tradition says that you really can't go out of the house.
Vartika Sharma, a senior lecturer and research fellow in the Faculty of Medical and Health Sciences at the University of Auckland Photo: Supplied
"These women have to navigate what the health system is telling them to do, but there is a contrary advice that you get from your own family and your own culture.
"It's about constantly navigating between two different systems and trying to balance between the Western health system and traditional practices."
Sharma said misunderstandings about postpartum traditions sometimes led to stereotypes about women.
"In the interviews that we did, one participant spoke about how women are treated like a princess in a very pejorative connotation," she said.
"That can make women feel quite uncomfortable because [it makes them feel like] they're doing something that they would not find other women are doing."
Sharma said New Zealand's healthcare system should strengthen "cultural safety" for ethnic women who observed traditional confinement practices after childbirth.
"We often talk about something called cultural safety, which essentially means understanding the expectations of your patient," she said.
"It's about whether the services you're providing are inclusive of their worldviews and their expectations from the healthcare system.
"How do you make sure that you're not dismissing everything that is non-Western and creating a space where women feel comfortable about who they are and [open to] having those discussions."
Sharma said maternal care services should extend beyond language support, highlighting the importance of creating an inclusive environment.
"A tailored maternal care service should go beyond just the language part of it." she said.
"It is if I walk into a room and I am being looked after by a midwife, I know that I will be heard, and I can make choices - that I would not be dismissed for who I am."
Ryu agreed, noting that Asian and Ethnic Health Services have collaborated closely with families and cultural liaisons to provide holistic care that met the unique needs of mothers within ethnic communities.
"By ensuring there is clear communication between healthcare professionals and patients around cultural practices, we can avoid misunderstandings and impacts on care," she said.