Category: Care of the Mother

The forty-day confinement period

The first six weeks are a critical period for a new mother’s recovery, and she is confined to her room through its duration. In Chinese culture, it is called sitting the month and in urdu it is known as chhilla and in some states it is called Japa. All my patients have complained about this confinement period. After the first two weeks of sitting holed up in one room, a woman starts to lose her mind. There is a baby sucking at her breast pretty much 24/7, the milk and sweat makes her sticky, she is perpetually oily, her food is bland, and she hasn’t felt fresh air on her body in weeks. I, for one, was dying to step out of the max security prison my home had become after my delivery. In fact, the forty-day sabbatical is so extreme in some cases that there was a woman who was not allowed to even talk to her husband in that period. She was literally sentenced to solitary confinement by her mother-in-law. Years later, when her friend had delivered, instead of congratulating her on the new baby, she ended up sobbing in front of her recalling how tormented she had been.

There are plenty of parenting websites and blogs saying that you can take a stroll in the park two weeks after delivery to get some fresh air.

New moms are often reluctant to comply with this advice because the explanations given by the nanis and dadis for the sabbatical are quite creative and not so scientific. They say things like you’ll get affected by the evil eye (nazar lagna) or cold air will enter your bones (haddiyon main hawa utarna). For want of logic in their justification, let's not discredit their suggestion just yet. Similar advice, and might I add reasoning, are seen in every other culture that has been around for more than 1000 years (such as the Mediterranean, Chinese and Latina). And as for the Americans, they have a heritage that is barely 300 years old. So, who do we listen to?

We have at some point experienced that our immunity is much lower in pregnancy. We are more prone to colds and need way more rest to get better. It is because the developing foetus is a foreign body and the immune system has to mount a reaction against it to eliminate it. However, this is our little baby and the body knows it must preserve it. So, while the embryo is getting implanted, there are changes in the uterus which allow the pregnancy to progress unharmed by the body’s immune attack. Your immunity is, in fact, lowered to favour the accommodation and development of the foetus. This state of lower immunity continues after delivery too. The process of birthing and shrinking of the uterus causes more stress to the body and a woman takes anywhere from three months to a year to completely get back to her pre-pregnancy immune levels.

One of my friends told me that she used to go to work daily and was thriving during her pregnancy. Apart from the occasional cold and heartburn, she never had any issue. She was confused about the hype around low immunity after delivery and wondered why she couldn't go out like she did while she was carrying.

I am glad she asked.

After the birth of the child, the body works overtime to repair and restore the body’s normalcy. Some women’s bodies take the slow and steady path to recovery. While in others, the immune system which was suppressed during pregnancy takes a sharp U-turn bringing the body at the crossroads of suppressed immunity of pregnancy and the normal immunity of the non-pregnant state. This is known as the Immune Reactivation Syndrome. Each woman’s body gets back on track differently, and you could be anywhere between the two extremes.

In Immune reactivation syndrome, the immunity follows a rather drastic recovery course and goes into an overdrive. In order to protect your body’s reactivity from going into a frenzy on coming in contact with every virus and bacteria, it is strongly advised that you sit it out in your room and be looked after. Taking a walk in the park daily is out of the question. Maybe a short visit to the hospital for a check-up is okay. I hope that in the coming years, this important aspect of maternal care will come into the limelight and new mothers will get home visits rather than be asked to come to the hospital.

In my experience as a family physician, I have seen women not follow the confinement period and complain about recurring colds and knee pain even after their kids start going to school. Why is the cold virus so persistently affecting them and why are their knees always paining? Most doctors tell them it’s because they don’t have enough vitamin D and the calcium levels are low. (I have seen plenty of male patients working in IT firms who never step out in the sun and have very low vitamin D levels. Yet, their knees are not crying for help! In fact, most of us urban people are calcium and vitamin D deficient. That seems to be the new normal.)

One of my patients complained how she has never felt well again after delivery. This woman was at the peak of her health in her pregnancy. She glowed, she worked, and she multitasked. Yet, delivering the baby seemed to have knocked the wind out of her sails. She felt that she never fully recovered from child birth even after her daughter’s second birthday. If this woman was so functional in her low immunity state during pregnancy, why was she so deflated after her child was born? Yup, you guessed it. She went out every other day and did not stay at home protected.

Women who have not observed postpartum confinement did not see any medical reason in parenting books and websites to support the practice. They thought it was an unnecessary restriction passed down through generations. Maybe a by-product of restrictive patriarchy, they reasoned. There was no scientific reason behind ‘bones catching a cold’, yet they complained of pain in their bones.

So, what is actually happening in the female body with Immune Reactivation Syndrome? When the woman’s immune system is reversing, her circulation is flooded with a different kind of white blood cells. The profile of the immune hormones produced by these cells also changes rather drastically.

Keeping a woman with lowered immunity in the familiar confines of home for a mandatory forty days makes a lot of sense. It’s like your body is turned inside out and anything and everything coming in contact with it has the potential to spark an exaggerated response. Innocuous viruses you would encounter in the outside world which wouldn’t even cause a sneeze have the capacity to sow the seeds of future reactivity to their harmful effects. The disease could manifest years later as an autoimmune disease. It is not always certain what triggers the initial immune attack in autoimmunity, but it is very clear that both the environment and genes play a role. Every disease is multifactorial. Protection of a woman in the first forty days could be one of the steps towards preventing something as ignored as vague joint pains or perhaps even a full-fledged autoimmune diseases in the future. And as for the mothers who did step out during their confinement, please don’t go into a frenzy saying you are doomed. We are mothers. We are way more resilient than we are given credit for.