Therapeutic Effects of the Traditional “Doing the Month” Practices on Postpartum Depression in China

Our patient was offered biological treatment in addition to counseling and education for the management of her psychiatric symptoms. She and her family declined the proposed pharmacologic treatment after learning about the potential adverse effects of anxiolytics and antidepressants. Most psychotropic medications are category L3 (moderately safe) or category L4 (possibly hazardous) during lactation, thus indicating that more human data are needed and that these medications pose potential risks to the fetus (5). Although most drugs are considered effective and safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs (6). Growing data support the use of antidepressants during pregnancy and lactation, suggesting no associated toxicity to infants, with no observable physical or behavioral problems (7). However, there have been no studies on the long-term developmental effects of using these medications during lactation.

In most cases of mild to moderate depression with little disability, supportive psychotherapy and education may be used as the major treatment. In our case, the patient opted for behavioral and interpersonal therapy, as offered by family and friends, by practicing the traditional Chinese custom of “doing the month.” In modern medicine, childbirth is a physiologic process that, for the most part, does not require additional health care, whereas in traditional Chinese medicine, childbirth is associated with a dramatic transformation of female energy and body. According to the cosmic dual principle (8), the first month after childbirth is crucial to bring yin and yang, unbalanced by the pregnancy and delivery, back to a balanced state and to resume normality. Consequently, during this time new mothers are confined to their homes, where they follow specific rules to control their emotions, diet, and physical activity while family members care for the needs of the new mother, her baby, and the household. Many generations of Chinese women have been brought up to believe that adherence to this ritual is physiologically and psychologically beneficial and that its absence is harmful and may have short- and long-term adverse health effects. Thus, it is not surprising that modern Chinese women, as in our case example, continue to follow the traditional practices, regardless of their educational attainment or where they live. Despite the dramatic changes in social environment and the rapid advancements in modern medicine, many new mothers still adhere to traditional medicine and cultural societal norms.

China is lagging behind countries in Europe and North America in the recognition and treatment of perinatal psychiatric disorders. Poor education among women, fear related to seeing a psychotherapist, and reluctance to take psychotropic medication are the most common barriers that hinder proper identification and management of postpartum depression in Chinese women. Furthermore, most clinical sites in China still lack the screening tools and management options to address women’s mental health in the postpartum period. There is an unmet need for qualified staff who are knowledgeable about the illness and its management and are able to provide adequate and targeted treatment options to patients after weighing the risks and benefits.

A commonly cited anthropological study has suggested that the prevalence of postpartum depression is low in China because of the enriched postpartum social network provided by the family members (9). The intimacy and enriched emotional and material support made possible through these indigenous practices and rituals may strengthen a mother’s self-esteem and provide emotional support, acting as a buffer against the stress and hardship encountered by women in early motherhood (10).