Siyi Chen explores the transformation of traditional postnatal care practices in China, highlighting the rise of the emerging profession known as Yuesao. This piece is part of a collection of posts from attendees at the 2024 Medical Humanities International Summer School for PhD researchers in Vadstena, Sweden, coordinated by the Centre for Medical Humanities and Bioethics at Linköping University, in collaboration with the Institute for Medical Humanities at Durham University.
Maternal and newborn care has undergone significant transformations in recent decades. During the 1980s and 1990s, grassroots movements advocating for women’s reproductive rights catalysed the rise of the doula, an individual who provides emotional, physical, and informational support for women during pregnancy, labor, and postpartum (Torres 2013; Norman and Rothman 2007). In reaction to the medicalization of childbirth, doulas form alliances with birthing women, helping them reduce excessive medical interventions and strive for bodily autonomy (Torres 2015; Ford 2021). By emphasizing holistic, non-medical forms of support, this profession has expanded to encompass areas such as end-of-life and surgical care, aiming to address the subjective experiences and needs of patients and their families often overlooked by biomedical interventions.
In Chinese society, a distinct birth doula has emerged in recent years, widely known as the Yuesao (月嫂). This occupational group consists exclusively of women, most of whom lack professional medical training. Nonetheless, they have established themselves as lay experts in postnatal care by updating family practices once considered outdated or superstitions. Unlike in Western society, where birth doulas often position themselves in opposition to modern medicine, the profession of Yuesao in China has been legitimized through the application of modern medical knowledge. By transforming the traditional post-birth practice of “Sitting the Month” (坐月子 Zuo yuezi) into professional care work, Yuesao have become the primary paid caregivers in contemporary postnatal care practices.
In my PhD project, I further explore how Yuesao engage with and, at times, challenge modern medical knowledge to produce professional authority in postnatal care practices. I argue that while Yuesao gain legitimacy through modern medical knowledge, the key to establishing their authority in postnatal care lies in the interactive and situational expertise they develop through embodied caregiving practices.
“Sitting the Month”: a traditional Chinese postpartum practice
“Sitting the Month” is a post-birth custom with a history of more than 2,000 years in China. During this month, the new mother is supposed to follow various dietary and physical prohibitions and behavioral restrictions to aid her recovery towards her pre-pregnancy condition after giving birth (Holroyd, Twinn, and Yim 2005). In pre-modern times, due to relatively poor living conditions, customs such as not being able to bathe or open windows were common. Additionally, older women in the family often served as the primary caregivers during the postnatal period, with new mothers expected to follow their guidance (Holroyd, Lopez and Chan 2011).
From the 20th century onwards, however, public health conditions have steadily improved, and modern medicine has been introduced to China. Many of the traditional practices adopted by older women, such as refraining from washing hair, brushing teeth, or opening windows, were considered superstitions. Despite that, far from being abandoned, the practice of “Sitting the Month” has persisted due to its deep cultural roots. New generations of mothers still perceive the necessity for enduring postnatal care. Consequently, many young women have begun to embrace modern medical knowledge to modify the traditional practices, fighting for control over their bodies from older generations (Zhang and Hanser 2023). This reflects a broader societal embrace of science as a hallmark of modernity, where traditional practices are reimagined.
Since China embraced a market economy in the late 20th century, the domestic service industry has significantly expanded. With the growing demand for the scientification of “Sitting the Month,” Yuesao have emerged as a new type of domestic worker to meet the emerging needs of a new generation of women. As explored in the following section, through short-term professional training programs based on modern medical knowledge, Yuesao have acquired a status as lay experts in caring for new mothers and their babies. By adapting traditional postnatal practices to meet the scientific expectations of modern families regarding “Sitting the Month,” Yuesao have taken over the role traditionally held by older family members in guiding postnatal practices.
Training to be a Yuesao
In 2023, as part of my fieldwork, I enrolled in a postnatal care training program and trained to become a Yuesao. In the first class, the mentor provided guidance and introduced the overall curriculum for Yuesao training:
In medical terms, this (postnatal care) period is called the “puerperium,” but in our language, it’s “Sitting the Month.” What’s the puerperium? It refers to the special period after the delivery of the baby and placenta. In the past, medical focus was mainly on physical recovery, but in recent years, there’s been increasing attention on the emotional and psychological well-being of the mother. So, during this time, we not only need to pay attention to their physical condition, but it’s also important to care about their feelings. Our task is to use scientific methods to provide professional care. It’s completely different from the traditional practice. (Mentor Yang, 03/01/2023)
This program was organized by a domestic service company, with support from the local government. In such training programs, the main focus is on transforming traditional “Sitting the Month” practices through the application of modern scientific knowledge. Upon completion of the course, participants must attend and pass the nationally standardized professional skills test to receive the certification of Yuesao. This test consists of two parts: the theory section covers relevant modern medical knowledge, while the practical section involves hands-on skills, such as diaper changing and performing passive exercises for babies.
Constructing Professional Authority in Postnatal Caregiving
In accordance with the traditional Chinese custom of “Sitting the Month,” Yuesao typically work for 26 to 42 days after childbirth, with the exact service period negotiated with the clients. They primarily work in private homes or postnatal care centers, where they are required to adhere to scientific feeding standards and maintain detailed records (see image below), which are verified by managers from domestic service companies.
However, theoretical knowledge alone is not always effective in postnatal caregiving, as Yuesao often find modern medical guidelines too rigid. In The Logic of Care: Health and the Problem of Patient Choice, Annemarie Mol (2008) introduces the concept of “doctoring,” which focuses on humanizing biomedicine to address its limitations. Similarly, the caregiving practices of Yuesao can be understood as a form of “doctoring.” Rather than strictly following scientific standards, they apply contextual expertise through embodied practices.
Modern medical knowledge typically recommends feeding infants every 2–3 hours, with each feed lasting 15–20 minutes. The required daily milk volume is often calculated using the formula newborn weight (kg) x (100~150), and some new mothers shared with me that they strictly adhere to this prescribed amount of milk. In contrast, Yuesao rely more on their embodied experience and use various methods to assess whether a baby has had enough to eat. Several Yuesao I interviewed emphasized the complexity of real-world feeding. One Yuesao, Xian, explained that rigid adherence to formulas is not always practical:
After two feedings, you can tell if he’s full. For example, if he drinks 60 ml out of 100 ml and then sleeps for two hours, that’s a good sign he’s satisfied. If he only takes 40 ml and then falls asleep, that’s also enough. But if he’s still crying or wakes up shortly after feeding, it means he needs more.
Such contextual expertise often proves effective in practical caregiving and can sometimes alter mothers’ views on scientific feeding methods. Lingling, a new mother, was determined to follow a scientific approach to feeding her baby. Her Yuesao, Juan, noticed that the baby’s weight gain was sluggish, and later, signs of jaundice appeared. As Lingling’s anxiety grew, Juan took the opportunity to suggest a more flexible feeding approach. Juan’s intervention helped the baby’s weight return to a normal range. Seeing these positive changes, Lingling gradually began to trust and follow Juan’s advice. Therefore, contextual expertise becomes key to constructing Yuesao’s professional authority in postnatal caregiving.
Conclusion
Birth doulas, rooted in social movements against medicalization, often help women navigate beyond scientific norms. In China, science has become a symbol of modernity, reflected in the fact that young mothers often adopt science-based child-rearing methods (Zhu 2010). The rise of the Yuesao aligns with China’s modern transformation. Yuesao have become a unique doula, deeply rooted in the cultural and social fabric of China, playing a pivotal role in modernizing the traditional post-birth custom of “Sitting the Month.”
More to the point, while Yuesao obtain their qualifications through integrating modern scientific knowledge with traditional postpartum customs, their professional authority is grounded in their ability to draw upon the contextual, embodied expertise they have cultivated over years of hands-on experience. The prominence of Yuesao in China illustrates that transforming traditional health customs relies not merely on applying modern scientific knowledge but, more importantly, on integrating it into embodied caregiving practices.
About the author
Siyi Chen is a PhD student in sociology at Tsinghua University in China. Her PhD project examines knowledge and professional authority in the context of the professionalization of traditional Chinese postpartum confinement practices. She is also currently working on an anthropological study on everyday life during the COVID-19 pandemic in rural central China.
Reference list
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