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Repost: About confinement practice

What are confinement practices?
Confinement practices are traditional postnatal practices aimed at helping a new mum recover from the rigours of pregnancy, labour and birth. Mum and baby are said to be in confinement because they are effectively "quarantined" at home. For a Malaysian-Chinese mum, the confinement period lasts for a whole month from baby's birth.  In every community, the confinement period is a time for the new mum to rest and avoid any physical work.

Traditionally, your mother or mother-in-law will take care of you during the confinement period. Many Chinese mothers who can afford it also hire a confinement nanny or confinement lady, also known as a pui yuet (Cantonese for "companion for a month"), who will see to your needs as well as your baby's. 

Mums in bigger cities and urban centres may also have the option to check into a 
confinement centre. These centres usually provide lodgings, confinement meals and have confinement ladies on hand to help.

Confinement taboos and restrictions
Some mums consider confinement to be old-fashioned and opt to not follow the more restrictive practices. Yet, many do still observe confinement as they welcome the enforced rest built into this tradition. Whatever your options, do what is comfortable and makes sense to you.

Chinese confinement restrictions include:
·         No washing your hair for the entire confinement period.
·         Avoiding exposure to "cool" elements such as cold water.
·         Low temperatures from an air-conditioner or fan must be avoided too.
·         Bathing only with specially prepared warm water that is infused with herbs.

These prohibitions are said to help ensure that your body retain as much heat as possible. It is believed this will help you avoid health problems such as rheumatism, arthritis, headaches and body pains later in life.

Chinese confinement diet
You will be required to eat a variety of dishes that will "warm" the body up. These include ginger and a traditional tonic brewed with herbs. They are believed to promote better blood circulation and strengthen the joints. The Chinese also believe that fish soups
can help boost low milk supply. 

 It is believed that "cooling" foods such as cold drinks, cucumber, cabbage and pineapple should be avoided. Also, "windy" foods such as onions and jackfruit are off limits as they are believed to cause colic in your baby. 

Similar to the Chinese, the Malays believe "cooling" elements found in foods such as cucumber, young coconut, water spinach (kangkung) and sugarcane should be avoided. "Cooling" foods are said to cause rheumatism, arthritis and weak joints in a mother's body.


How do I know if I’ll need a confinement lady?

That depends on whether you plan to observe confinement practices. If yes, how closely or rigorously do you plan to follow the age-old rules and taboos? While some mums enjoy the help and support offered by a confinement lady, others find the traditional postnatal practices that come with her too restrictive and stressful.
You also need to consider the cost of a confinement lady or helper. Mums in major city centres such as the Klang Valley report that an experienced pui yuet is being paid up to RM4,000 for the month.

With a pui yuet around, I was able to rest very well and recover from a painful episiotomy. She took over the night feeds and fed my baby with expressed breastmilk. I was a bit nervous about bathing my newborn, so she did it for the first month and showed me how. It was very good having her around, especially for a new mother like me.

I didn't follow all the rules strictly though. I have very long hair and I didn't want to wait a whole month before washing it after the birth! So, I agreed to wash my hair using the herbal bath she had prepared.

New mothers are not supposed to sleep with the air-conditioner or fan on during the confinement. But I broke this rule! To compromise, I wore long sleeves and long pants and socks to sleep.

Many Malaysian-Chinese women hire a pui yuet (literally "companion for the month" in Cantonese) to help out in the postnatal period immediately after birth. Also known as a confinement nanny or confinement lady, a pui yuet is usually an older woman experienced in caring for the special needs of a new mum and newborn baby according to the traditional confinement practices of the Chinese. Although some women find confinement nannies or confinement ladies to be old-fashioned in their approach to the do's and dont's of the postnatal period, they can be particularly helpful to a first-time mum who may not be familiar with various aspects of caring for a newborn baby.

How and where to find a pui yuet? Word of mouth is your best bet. Ask a friend, colleague or family member who has employed a pui yuet if she would use her again. Also check if the pui yuet was attentive to the baby, if she could cook well and followed instructions. This kind of recommendation ensures you are getting someone with reasonable manner and habits.

Traditionally, the pui yuet's duties include:

·         Bathing baby daily.
·         Feeding baby (once breastfeeding is well-established, you can express breastmilk so that she can take over one or more night feeds).
·         Generally caring for the baby so that the new mother can rest.
·         Cooking special confinement dishes such as traditional chicken soup which are considered extra-nutritious. In smaller households (especially if it is just you and your husband), it is not unreasonable to ask the pui yuet to cook all the regular meals.
·         Washing the baby and the new mother's clothes (or you can just toss everything into the machine).

Few confinement ladies or confinement nannies these days are expected to do other household chores, though they should always clean up the kitchen and dishes after meals. The older and more traditional ladies will be used to doing some light housework.

Payment usually consists of three parts:

·         The deposit (usually a fifth or a quarter of her full fee) as you need to "book" her while you are still pregnant. The more experienced and in-demand the confinement nanny, the earlier you have to book her (many women do so in their first trimester).
·         The fee which you will pay once the confinement period is up. It can vary depending on your area. Fees are probably highest in the Klang Valley and during the Lunar New Year.
·         The ang pau (also called lai tse) is supposed to be a token sum given at the end of the month as a gesture of appreciation. Some may leave the amount up to your discretion; others state upfront how much they expect.

If you do not wish to observe the traditional restrictions of the confinement period, then you don't have to. Even if your confinement nanny nags you, it is your choice whether to wash your hair, drink cold milk, go out and see your friends, have cold showers or indeed, run naked in your garden at midnight under the full moon! Remember she is there to help you through this stressful time. You are paying her and this makes you the boss!

The postnatal period can be stressful, particularly if you have had a 
caesarean section or an episiotomy, so concentrate on keeping yourself happy and comfortable. Her happiness is secondary.
It is certainly worth helping your confinement lady (pui yuet) to settle in quickly and comfortably. This is the best way to ensure that she gets what she needs to provide the best care for you and your newborn.

Only you can determine the living arrangement that will work for you and your family in this immediate postnatal period. However, in general, a confinement lady will expect to have her own bedroom with a bed and at least a ceiling or standing fan if it is not an air-conditioned room. If you only have a mattress or roll-out bedding, do let her know in advance.

You can then place your baby’s 
cot or a travel cot in your confinement lady’s room so your baby can sleep with her if and when it suits you. This is a common arrangement your confinement lady will be used to.

If you have set up a nursery for your baby, your confinement lady can sleep there as long as she has a small corner or area to put her personal toiletries. 

Your confinement lady will need a separate bathroom. It is acceptable to ask her to share with other family members or with
your maid if you don’t have a guest bathroom. This is where she will likely handwash her own clothes (using the household’s laundry detergent). One BabyCenter mum says her confinement lady asked to use the washing machine, although this is not common. Either way, she will need access to the drying area.

As for food, your confinement lady will cook for herself and your family, besides whipping up some (hopefully) delicious 
confinement dishes and special meals for you. You will be expected to provide all the groceries and ingredients.

Apart from these basics, many mums do go the extra mile to help their confinement lady feel at home. Suggestions from BabyCenter mums include:
·         subscribing temporarily to Chinese magazines or newspapers to provide fresh reading material during her downtime (many of the older confinement ladies are dialect or Mandarin speakers);
·         inviting her to watch TV (with you or separately, depending on your own preference for privacy);
·         inviting her to take a morning or evening walk with you and baby (only an option for mums who are not too strict about their confinement do’s and dont’s!);
·         letting her know if you would prefer not to observe more traditional confinement practices or food taboos.

Confinement ladies are used to moving from
home to home, staying for four to eight weeks with each family. It does not seem like a very long time, but it will certainly be an intense and busy time in your household. You will still be recovering from labour and birth. You will be trying to get to know your new baby. You may still be grappling with breastfeeding. An experienced confinement lady who can hit the ground running will be invaluable, so it is indeed well worth the effort to make sure she has all she needs.

There are various things you can do to help both you and her adjust to your expanded household. Some ideas:
·         Many confinement nannies do not speak or are not literate in English. If you don't regularly buy Chinese newspapers, subscribe to one for the month so she won't feel so isolated.
·         If you don't feel like going out, ask a few close friends to come and see the baby so you won't feel so isolated.
·         As long as baby is safe, warm and fed, it won't hurt to let her do a few things her way.

Confinement lady: top 3 pros & cons
Pros of having a confinement lady
·         Experience. Although most confinement ladies have no formal training, they are the de facto older aunt and grandaunt who have taken care of countless babies. Many new mothers learn the babycare basics from them.

·         Reassurance. First-time mums who may not be confident in their own ability to care for their baby during this initial period often find it helpful to have someone in the house to rely on.

·         You can rest. Putting your feet up or taking a nap is much easier knowing that baby is in good hands. And you won't have to worry about cooking, either.

Cons of having a confinement lady
·         Lack of breastfeeding support. A confinement nanny is not necessarily informed about the benefits of breastfeeding or the latest research on babycare. Brush up on breastfeeding basics and if you face any difficulties, contact your doctor, a breastfeeding counsellor or a qualified lactation consultant.

·         Different ways of doing things. You may not agree with the way the confinement nanny does certain things (one new mum and her pui yuet clashed over what clothes the baby should wear!) and as a new mother, may not have the confidence to put your foot down. It may be useful to enlist your husband as an ally or have your husband speak to her.

·         She is still a stranger in your house. If you find that you really cannot get on with your confinement lady, and she is causing more stress than she is helping you, then you may want to consider terminating her services.


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Repost: 产后怎样痩身


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Repost: Useful Link for Ultrasound Antenatal

quote from http://www.ultrasoundpaedia.com/normal-2ndtrimester/
BPD and Head Circumference

fetal HeadThe correct plane for the measurement of the head circumference (HC) and bi-parietal diameter (BPD)must include the cavum septum pellucidum, thallamus and choroid plexus in the atrium of the lateral ventricles.

BPD: Measure outer table of the skull to the inner table.
HC: Measure around the outer table of the skull.

Cerebellum, cisterna magna and nuchal foldPosterior Fossa
 The correct plane for measuring the nuchal fold is to have cavum septum pellucidum (CSP) and the cerebellar hemispheres in the image.
  • The cerebellar diameter should approximately equal the weeks of gestation. (EG 19weeks=19mm)
  • Normal cisterna magna is less than 10mm.
  • A normal nuchal fold is less than 6mm (between 17-20weeks).

    Choroids and lateral ventricles

    The LATERAL VENTRICLES should be less than 10mm in diameter (best measured at the occipital horn).
    The CHOROID PLEXII should be homogeneous. Small, and sometimes multiple, choroid plexus cysts are a common finding on high resolution equipment. They are of doubtful significance as an isolated finding.

    FACE: Ensure there is symmetry with a normal inter-orbital distance.
    Coronal Nose and Lips

    NOSE & LIPS: From the 'face' image, rotate the probe to visualise the nose and lips front on.
    2 distinctly seperate nodules and in intact hypoechoic upper lip should be seen. 2 distinctly septate nostrils and an intact hypoechoic top lip.

    Abdominal CircumferenceAbdominal Circumference
    The Abdominal Circumference must include the portal section from the umbilical  vein, the stomach and a true cross section of the spine with 3 ossification centres. It should be circular in shape.

    Situs heart and stomach left sideDiaphragm
    First, confirm that the organs are correctly sited right vs left.
    An axial plane through the chest and upper abdomen shows the heart and stomach on the same side (which has been proven to be the left).
    In  a coronal plane, confirm the presence and position of heart, stomach and bladder. Also check the diaphragm.Ensure that there is no herniation of abdominal contents into the thorax.

    Transverse Kidneys Kidney longitudinal

    Confirm the presence and position of both kidneys. Be cautious not to mistake the adrenal glands which are quite large. Look for the anechoic renal pelvis. The renal pelvis TS diameter should be less than 5mm.
    The kidneys must be measured in a sagittal or coronal plane.  Utilise colour/power doppler to confirm renal arteries and help identify the kidneys in a larger patient.

    UMBILICAL CORD                                                                          

    Cord insertion and 2 umbilical arteries Male and female Gender
    Cord insertion
    Ensure the abdominal wall around the cord insertion is intact and that no bowel has herniated into the cord.
    Use power doppler to confirm the presence of 2 umbilical arteries forking around the bladder. (Be careful not to slip into a more coronal plane and mistake the iliac arteries.)
    There is an obvious penis identified at 18-20 weeks. Shown on the mouseover is the 3 parallel white stripes of the external genitalia of the female vulva.
    return to the top

    FETAL SPINE      

    Coronal Spine Spine sagittal
    Check for any scoliosis.
    Cervico-thoracic spine:Check the ribs for symmetry.
    Lumbar/sacral spine: In coronal, visualise the sacral taper and pelvic bones.
     Ensure there is a uniform, intact posterior skin edge.
    Transverse Spine
    The 3 ossification centres of the spine should be visible from neck to the lumbo-sacral junction. A smooth intact skin line should be visible throughout.
    Beware overlying cord mimicking a meningocoele.

    return to the top 


    Femur length femur measurement

    Femur  Length

    The Femur length should only be measured when the femur is horizontal (beam is perpendicular) and shadows evenly- at least from both ends.
    tibia and fibula foot perpendicular to the lower leg
    Lower limbs
    Confirm the presence and equal size of the tibia and fibula bilaterally.
    The foot should not be seen. A rounded base at the base of the leg when seen front on. If you can see the tibia, fibula and foot in one plane, suspect talipes. Rotate 90degrees to see the sole of the foot and the toes.
    The foot should be perpendicular to the tibia and fibula.

    Arms Hand ultrasound
    Upper limbs
    Similar to the leg, confirm the presence and size of length of the 3 long bones in each arm.
    The fist is often clenched. Ideally watch the hand open/close and check for 5 fingers/knuckles on each side.Check for the presence of the 5th middle phalanx.

     Return to the top


    The cervix must be measured from the internal os to the external os.
    Cervix Length
    The echogenic mucous plug is readily visible in the cervix.
    Measure the length of the cervix. It should be at least 30mm, and contain no fluid.
    Return to the top


    Placenta Placenta to Cervix measurement
    Placental bed

    • Locate the placenta (anterior V's posteror or lateral)
    • Ensure there is a myometrial rim of 3mm or more under the placenta (otherwise suspect placenta percreta/accreta).

    The placenta tip must be greater than 3cm from the internal os.

    Placental Contraction
    Uterine contraction
    Beware of uterine contractions mimicking a low lying placenta.




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