Fighting China’s Shame and Ignorance on Postpartum Incontinence


SHANGHAI — When Chen Lijun explains the damage giving birth can do to the body, the young women in her audience gasp. Unsatisfying sex, prolapsed organs, and an inability to hold in your pee aren’t exactly the sorts of things their mothers told them about.

But, to her audience’s obvious relief, there are solutions, says Chen, a health instructor who specializes in the pelvic floor — the web of muscles that support the bladder, bowels, and uterus in women. Even though pelvic floor problems are common among mothers worldwide, millions of Chinese women remain unaware of them.

The Chinese Medical Association said in 2011 that 18.9% of adult Chinese women experience stress urinary incontinence (SUI), a leakage of urine that occurs when the abdomen is placed under strain, even by simple actions like coughing, sneezing, or laughing. But China Women’s News, a newspaper affiliated with the state-backed All-China Women’s Federation, puts the figure at nearly 50% with just one-tenth of those affected seeking treatment. In absolute terms, this would mean roughly between 93 million and 246 million Chinese women have untreated SUI.

Although postpartum incontinence is common, many new mothers are afraid or embarrassed to talk about their urinary incontinence. The event where Chen is a speaker — called “Pelvic Floor Awakening” and hosted on May 11, one day before this year’s Mother’s Day — aims to raise awareness. It is jointly organized by Yummy, an online platform for Chinese women to discuss sex, and British intimacy brand Durex. More importantly, says Yummy founder Zhao Jing, the message is “to let women know that they are not alone in this battle.”

Growing up, few Chinese women who are now in their 20s and 30s were ever told by their mothers what it is like to give birth, and how to deal with the physical and mental toll it can take. “But the younger generation is paying more attention to their feelings and needs,” says Zhao. She decided to organize the event after noticing an increase in Yummy users sharing their awkward experiences leaking urine while laughing, coughing, or running during pregnancy or afterward.

Attendants watch a video about postpartum mothers at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Fan Yiying/Sixth Tone

Attendants watch a video about postpartum mothers at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Fan Yiying

Huang Jianxuan, one of the 30 or so attendants, has had occasional incontinence since she gave birth to her son three years ago. She wasn’t sure what caused it. “I thought it was normal, as other mothers I asked were going through the same thing,” she tells Sixth Tone.

“It’s common but definitely not normal,” responds Chen, explaining that pregnancy stretches the pelvic floor muscles, which sometimes don’t return to their original positions after childbirth and can leave the bladder and other organs unsupported, potentially leading to SUI. Regular exercise, therapy, or surgery can repair the damage. The pelvic floor is a niche medical field in China, neglected by both women and medical experts, Chen says.

In some Western countries, health insurers require new mothers to undergo postpartum pelvic floor rehabilitation. In China, though, it’s mostly just top hospitals that offer such programs. When, six weeks after giving birth, Huang visited a Shanghai hospital for a postnatal examination, doctors didn’t mention checking her pelvic floor. “But even if they had, I wouldn’t have gone for it, because I was too busy taking care of my baby,” says the 29-year-old.

As China’s medical resources are stretched and doctors are preoccupied with more acute conditions, Chen believes social organizations should lead the drive for better pelvic floor care. That conviction led her to leave the state-owned hospital she had worked at for over 20 years and establish her own practice offering female pelvic floor health services in 2016.

At the event, Chen confesses to the audience that after giving birth to her second child while she was in her 30s, she went through an unspeakable period of time when her underwear was constantly wet. “I looked energetic and cheerful, but deep down inside, I was so afraid of running or jumping,” Chen says. “But then I recovered, and I wanted to help more women.”

So far, Chen’s taken on over 300 cases in her Beijing clinic, and she regularly posts on social media to raise awareness. At the same time, she believes public figures may have a greater influence.

Chen Lijun, a health instructor, gives a speech about pelvic-floor care at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Courtesy of Zhao Jing

Chen Lijun, a health instructor, gives a speech about pelvic-floor care at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Courtesy of Zhao Jing

When celebrating her third Mother’s Day on May 12, Ella Chen Chia-hwa, member of the legendary Taiwanese girl group S.H.E, shared her experiences with pelvic floor muscle disorder after giving birth. “My pad would get completely soaked, and then my pants were wet,” Chen Chia-hwa wrote on Facebook. Recently, she finally opted for surgery, she added. Her post was shared on Chinese social app Weibo, where thousands of users left comments with their own experiences.

When working in the hospital, Chen Lijun says she noticed that new mothers only sought medical advice when facing serious problems like Chen Chia-hwa’s. However, since 2016, she has witnessed a change. Many of her clients have yet to become mothers, or even have sex. “The younger generation has the sense to protect their pelvic floor before giving birth,” she says. Compared with older generations, who bear their symptoms in silence, Chen Lijun finds it “stunning” to see Chinese millennials so eager to figure out why their mothers have urinary incontinence, and why their elder sisters no longer have sex after childbirth.

Many in the audience at the event are unmarried and childless, too. Yao Weili joined Yummy two years ago. The state-owned enterprise employee pays attention to her body. She works out regularly and is familiar with Kegel — a pelvic floor-strengthening exercise that Chen explains at the event. Though Yao, 39, is single and has no immediate plans for motherhood, she decided to attend the event to get more firsthand information. “When I was little, I heard my grandma complaining about her leaking urine to my mother and aunts,” she tells Sixth Tone. But when she wanted to know more, they just stopped the conversation or shut the door.

Most of Yao’s friends are married and have at least one child. They often talk about how labor has damaged their bodies and how frustrated they are with their sex lives. “If sex is a meal, then the pelvic floor is like the ingredients,” Chen says. A damaged pelvic floor can decrease sensation in the vagina, making sex less satisfying and orgasm more difficult to achieve. Chen says about 70% of her clients and patients have low sexual desire, sexual arousal disorder, or a lack of orgasm, yet only 3% would see a doctor for such issues. “This is even worse after women have children,” she says.

Postpartum sex lives are a recent focus for Yummy, too. Early this year, it released an online “training camp” to help new mothers recover from childbirth. “We decided to step into this area after witnessing the huge demand,” Zhao says. “We want women to know that they can get back to enjoying sex after following these exercises.”

Zhao Jing, founder of Yummy, gives a speech at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Courtesy of Zhao Jing

Zhao Jing, founder of Yummy, gives a speech at the event, “Pelvic Floor Awakening,” held in Shanghai, May 11, 2019. Courtesy of Zhao Jing

Launched in 2015, Yummy now has over 2 million users in China. In 2018, Zhao was honored to have made the BBC’s list of “100 inspiring and influential women from around the world.” But she was even more thrilled when China Daily, the state-controlled English-language news outlet, shared the news on social media: “I felt the authorities had approved of me and my work and that women pleasing themselves and exploring sex wouldn’t need to be kept under the table anymore.”

As China now encourages couples to have more than one child, Chen says it’s high time to make women aware of how to take care of their pelvic floor. “It’s very likely women will wet themselves more often when they are older if they don’t exercise their pelvic floor muscles after each birth,” she says.

Huang, the mother of a 3-year-old, is thinking about having a second child in a few years. But first, she is determined to go see a doctor and regain control of her bladder. “I always told myself that it would all pass, but it didn’t,” she says after the event. “I’ve realized that whether a mother or not, women should put themselves first and take care of their bodies, rather than just building their lives around the kids.”

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Chinese Relationship Guru to Women: Put Motherhood On Hold


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Do not get pregnant too soon – that is the message of China’s most popular relationship advisor to women on Weibo. The post became an instant hit, igniting online discussions of becoming a mom directly after marriage.

Chinese best-selling author Lu Qi (陆琪), also known as one of the most popular relationship advisors on Sina Weibo, advises Chinese women on his Weibo account not to have children too quickly after getting married. The post resonated with millions of female Weibo users since it was published on May 10.

In the post, titled “Do Not Become a Mother Too Young” (不要太早当妈), Lu Qi writes about how a young girl from rural China had to give up her dream of studying at the China Academy of Art because she got pregnant. She could have become an artist and live the life of her dreams, but instead, she got married young and had a child at 18 years old. She remained in the small rural town with its narrow-minded community, raising the baby instead of going to university. Lu also illustrates how the dreams of a myriad of other young Chinese women were crushed after being forced by their husbands and parents to have kids.

“So many places to explore, so many dreams to pursue.”

Lu Qi shared his thoughts with his 21 million followers on Weibo: “I always believe that it’s irresponsible for a woman to have a child unprepared, no matter whether it’s an accident or persuasion. A mother’s love is a woman’s nature, and some people make use of this ‘nature’ to limit and change women – and they usually get what they want, which is horrible.”

Lu Qi adds that he hopes that all girls will understand that motherhood is not about carrying on the family line, or something that parents or husband urge you to do, and also not something that happens by accident. Having and raising a child will change your life for good. Once you are a mother, you have to be responsible and are limited to do what you can do with your life. There are so many places to explore in the world and so many dreams to pursue – why not achieve these goals when you are still young and then having a child when you and your husband are both ready?

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Relationship guru Lu Qi’s Weibo post ‘do not become a mother too young’ has been viewed over 66 million times.

The hashtag #不要太早当妈# (‘do not become a mother too young’) has been viewed over 66 million times on Weibo in the past few days. An ongoing poll shows that 78% Weibo users support the idea of waiting a while before having babies.

Weibo user ‘Small Fox’ cannot agree more with Lu Qi. She replied on his post: “I would have preferred having babies later in life, but my husband and parents-in-law pushed me very hard to become pregnant as soon as possible. I really regretted my decision as all the efforts I’ve made on my career were in vain. I’m not even sure if I’m able to go back to work after my kid goes to kindergarten, and I don’t know what I can do.”

“I feel like I’m not living for myself.”

“I believe I have the right to say something here, as I’ve already had two kids at age 24,” Weibo user ‘Xiaoshan Niuniu’ writes. She confesses that she would have rather waited a while to have kids if she could choose again: “I feel like I’m not living for myself since I gave birth to my kids. It makes me so sad, especially when my husband leaves the kids alone with me so that he can go out and have fun with his friends. Both husband and wife need to shoulder the responsibility for bringing up the children. However, the society holds the view that the wife is supposed to take care of both the kids and the husband. We also have our own goals and dreams!”

In Chinese culture, women are expected to devote themselves to raising the children and looking after the husband regardless how successful or ambitious they are before tying the knot. In the recent decade, Chinese women increasingly fight for their rights. Female netizens express that it means a lot to them that male icon, Lu Qi, supports them in propagating his message to women: pursue your dreams, working hard for your career, and only become a mother when the time is right.

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This article was published on What’s on Weibo.

“Sitting the Month” – a Gift or Torture?


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After Mother’s Day, it is still a hot topic on China’s social media: how could Kate Middleton appear in public, high heels and all, only 10 hours after giving birth? In China, new moms are confined to their beds for weeks after giving birth. This tradition, called ‘sitting the month’, comes with many rules. Amongst them: no showering, no drinking cold water, no leaving the house.

Just like a lot of countries in the world, China celebrated Mother’s Day last weekend, on the second Sunday in May. While the whole nation was preoccupied with buying mum’s gifts, one online picture was still passionately discussed on Sina Weibo: the photo of The Duchess of Cambridge, Kate Middleton, leaving the hospital and showing up in public looking pretty and rested, only ten hour after giving birth to Princess Charlotte.

According to Chinese tradition, women are expected to rest indoors for a full month after giving birth, which is called “sitting the month” or “zuo yuezi” (坐月子) in Chinese.

Zuo yuezi” can be dated back to Western Han Dynasty (B.C. 202 – A.D.9) and was even mentioned in the 2,000-year-old Book of Changes, or I-Ching (易经). After giving birth, tradition keeps a new mother indoors for the month after the baby is born. The new mother is treated like a queen – waited on hand and foot. She doesn’t need to do anything; not taking care of the baby nor cooking for the family. Every year, millions of Chinese women submit to this practice. Women generally see it as a gift as well as a torture.

No taking showers, no brushing teeth.

During the traditional confinement period, new mothers sit around in pajamas for a month to recover from childbirth. There are a lot of rules, which many new moms are struggling with: no going outside, no stairs, no lifting, no cold drinks, no open windows, no air conditioning in summer or winter, and, inconveniently, no taking showers or brushing teeth. Even when breastfeeding, women lie on their sides instead of holding the baby.

From generation to generation, Chinese women are told if they do not undergo this confinement, they will suffer from health problems later in life. Therefore, Chinese netizens were shocked by Kate’s public appearance in her fancy high heels just ten hours after her delivery.

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One user called “Potty-mouthed Queen” posted on Sina Weibo: “I felt extremely weak and tired after I gave birth to my daughter. There’s no way I could stand and show up like Kate after 10 hours.”

Kate’s public display led to the reflection of Chinese tradition in modern society. Another user, “Lemon”, said: “I’ve been staying in bed for 10 days already and I really hate it. I can’t brush my teeth or take a shower. I’m not allowed to eat raw fruit or vegetables, or drink coffee, cold drinks or even cold water. I understand that these rules are aimed at restoring balance to the new mother’s body after childbirth, but I’ve had enough.”

“Comparing Western women with Chinese women is like comparing apples with oranges”.

Most Chinese still believe that women following the tradition of ‘sitting the month’ later will have less health problems than those who don’t. In addition, Chinese traditions still play an integral role in everyday life, as people tend to respect them and pass them on to their children: “It must make sense since the tradition has passed generation to generation,” said many users on Weibo.

Other netizens pointed out physical differences between Chinese and westerners. “It’s like comparing apples with oranges. We shouldn’t follow what western mothers do as the diet habits and geographical environments are different“, user Zhang Daidai commented on Weibo. According to her, Caucasian women eat a lot of beef and high protein food, making it unnecessary for them to ‘sit’ the month after delivering the baby. However, the user points out, they put on weight easier than most Chinese: “It’s all about the diet habits. Westerners already have more than enough calcium and protein in their body, thus, the loss of calcium and protein during labour doesn’t really affect them. On the contrary, Chinese women generally miss these nutriments in a great amount, so it’s better to endure it for a month and avoid serious health problems in the future.”

The practice of ‘sitting the month’ related to existing ideas about balancing yin and yang. If the yin and yang are balanced in the body, one will not get sick. If they are out of balance, people tend to get ill more easily.

In spite of all the arguments online, the benefits of ‘sitting the month’ are evident for many Chinese women. As one of the new mothers shared: “I was totally against the idea of confinement in childbirth. But after 30 days, I did feel like it helped me recover and the constant headache which always bothered me before delivery is now gone.

Despite the rapid speed of China’s modernization, the long-history practice of ‘sitting the month’ remains popular and treasured. Although the radiant post delivery Kate Middleton fascinated Chinese netizens, it is unlikely that Chinese new mums will step out in their high heels after giving birth any time soon.

Image sources:
The World of Chinese
Huffington Post
Baidu

This article was published on What’s on Weibo.