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Behind the Science: Postpartum care in China and Canada

Authors: Alex Lukey, Arrthy Thayaparan and Negin Nia (blog coordinators) | Interviewing: Kejia Wang, BSc, University of Pennsylvania, MA, University of British Columbia

For the next post in our Behind the Science series, we speak to Kejia Wang on her masters work at the University of British Columbia and career journey. In our discussion, Wang takes us through her work in women’s health research, and defines what postpartum confinement care is in China and how that differs from western systems of care. 

How did you become interested in women's health research?

I earned my undergraduate degree in the United States, where I was a bioengineering major. After that, I came to UBC to do a master's in English, specifically rhetoric. My focus at UBC were rhetoric and Science and Technology Studies. Combining the two topics allowed me to make use of my existing knowledge from STEM while learning more about how scientific ideas are debated and disseminated in the public sphere.

After coming to UBC, I met Professor Judy Segal, who became my supervisor and mentor. She is an expert on the rhetoric of health and medicine. In Judy's classes, we talked a lot about women's health research. As a woman myself, I am interested in how women's health is talked about and understood, and wanted to study women's health from an intercultural and multidisciplinary lens.

How did you decide to make the leap from bioengineering to english?

It was very interesting! I was always interested in both science and english as a child. I went into science thinking that was what I wanted to do. But after a few years of working in science, I realized that I preferred talking about science rather than actually doing science. I want to be that person who can take an engineer's work and explain to the lay public what it actually means. I am interested in the perception of scientific (or pseudoscientific and science-adjacent) ideas by the public and how different communities use these ideas to improve their lives.

How did that journey lead you to where you currently are in your career?

The engineering degree gave me a solid STEM foundation. The rhetoric at UBC gave me the foundation to understand how STEM and STEM-adjacent ideas are talked about in a public sphere. Now I'm doing work at the Resident Doctors of BC, where I am able to combine my abilities.  

So now I'm looking at both in considering policy. How do we take the data and concerns that people have and use that to draft policies that make sense from the scientific perspective, but also benefit the patient and the provider?

Regarding your thesis work, could you explain what you did in simple terms?

When I started my master's at UBC, I decided to do a thesis. We settled on postpartum care in China, because it ticked a lot of boxes in terms of what I was interested in. 

I was interested in confinement because it's sort of a peripheral health practice. As a practice and framework for postpartum care, it has not been validated by a randomized clinical trial (RCT), generally considered to be the gold standard of health research in the West. But since it's still ubiquitous in Asia, it's very much in the public consciousness. So I wanted to look at what it does, why it may be important to Chinese women as well as the Chinese nation. Which, from​​ my research, has a vested interest in supporting this practice to support a particular conceptualization of motherhood. The "ideal Chinese woman," so to speak. I was also interested in how this Chinese practice might inform a more global and holistic perspective on what is good for our health and wellness. 

For those that don’t know, could you describe what postpartum confinement is?

The Chinese practice of postpartum confinement is an umbrella term for several different practices that Chinese women do right in the period after they give birth, usually for about one month. 

There is a whole spectrum of possible practices, some more and some less popular, that women choose from. Usually, a woman will pick about three or four different practices with the advice and suggestions of her family and health care providers. 

Some of these practices include consuming specialized meals intended to restore her vitality or avoiding certain environmental triggers. This can include anything, such as washing your hair to the overuse of electronic gadgets. In some cases, there are movement restrictions, such as not leaving the house for the first few days or longer.  There is also the sense that the woman is supposed to be taken care of by others, either by the family and partner or by peripheral health professionals, such as a doula, postpartum nanny, or workers at postpartum centers. 

What are some common misconceptions of postpartum confinement?

A big one is that since the English term calls it ‘confinement,’ there is a sense that women are locked up in their houses. This obviously sounds oppressive and knowing Chinese practices, like the one-child policy, you may think that is true. 

In some cases, there is an element of coercion to it if the family members or centre has too much power dictating what the women should or shouldn't do. Generally speaking though, the woman has a lot of power in choosing what she wants to do. All these things are still woman-centred and these practices are supposed to help the woman recover. 

What do you think is the most important impact of your research?

I think one finding that I wasn't expecting was the Chinese state's investment in these practices and women's health. In a way, that seems to run counter to how people might usually conceptualize the Chinese government. You hear about things like the one-child policy or the forced IUDs. That is considered to be quite invasive. 

The state, in supporting this practice, positions itself more benevolently. This practice is framed as something that helps the woman recover, and even become a better woman. You are expected to not only recover the vitality and health that you had before, but there are these messages that encourage you to become an even more successful worker in your field, mother, and contributing female citizen. 

Another thing was that I came to understand the practice of postpartum care in China as filling a niche for what the western medicine model is not providing to women who are going through childbirth and the postpartum. Western medicine provides many guarantees around health outcomes measured by quantitative parameters. But there are other measures of wellness and health, such as bonding with the infant and bonding with the family, and a return to the "normal" that is also very valued. So that's why I think the practice has the reach and support that it has. 

The other thing to add to what’s interesting is the western model seems to be more infant-centred in the postpartum. While the Chinese model is very much mother-centred, which really shifts the whole paradigm around which practices are prioritized.

Based on your work, what would you like to see adopted in the healthcare system? 

So from a different culture's, and dare I say EDI (equity, diversity and inclusion) point of view, especially in a city as ethnically diverse as Vancouver, it would be very helpful if a Chinese Canadian mother giving birth would have these kinds of support from her home culture. 

Obviously, this is not unique to Chinese people. If it's possible to have that kind of support, not in the sense that you would be offered the full Chinese postpartum experience in Canada, but if there is more familiarity with these ways of thinking and providing care. 

The other thing, which is much more difficult, is for the health system to start considering other parameters in the outcomes when we talk about improving patient outcomes. This would mean incorporating other indicators, such as the time required for the mother’s general fitness level to return to her pre-childbirth baseline. 

Why do you think we need to focus on women's health in research?

If we have a very child-focused postpartum system, that means that the mother's health is likely being overlooked. This is unfortunate, because the postpartum is a very important moment in a woman's life - she is adjusting to her new role as a mother physically and mentally, both at home and in broader society. I think it's important and good for there to be more attention brought to the mother during this developmental period in her life.