MAKING CONFINEMENT CENTRES SAFER FOR MOTHERS, BABIES

By Soon Li Wei

This is the first of two articles looking into the concerns surrounding the lack of regulation of confinement centres.

KUALA LUMPUR (Bernama) – First-time parents Adrian and Shirley (not their real names) were delighted when their baby son was born in 2017.  

Like many other new mothers, Shirley decided to stay at a confinement centre here for 30 days after her delivery so that she could recuperate while a nanny helped to look after the baby.

Unfortunately, it turned out to be a disastrous experience for Adrian, 36, and Shirley, 35, as the nanny at the confinement centre did not live up to their expectations. 

According to Shirley, the confinement nanny did not appear to support breastfeeding and would insist on feeding her baby formula milk.

“I said no to formula milk but she (nanny) would forcefully push the bottle into my son’s mouth. I sensed something was wrong as my son would refuse to drink. I pleaded with her to stop but she kept telling me my son was hungry and that my breast milk was not enough for him.

“She finally stopped force-feeding my son when I yelled at her,” Shirley told Bernama when interviewed recently. 

Shirley, who left the confinement centre after 14 days, said she could not lodge a complaint against the nanny as there is no proper channel for clients of confinement centres to do so.  

She said there is a need for the government to regulate confinement centres so that action can be taken against them if their practices are found to be inappropriate.

“Both the customer and centre must be protected in terms of their rights, health and safety,” she added.

Melanie (not her real name), 43, also had a nasty experience with her pui yuet (confinement lady in Chinese) who she hired after she delivered her third child three years ago.

The nanny, who was supposed to take care of Melanie and the baby in their home for 30 days, charged RM4,000 and, as per Chinese tradition, also requested an ang pow of RM200.

“But the whole thing was a damp squib. My baby became sick with a running and blocked nose. He also had a cold and fever… the germs were transmitted to him by the confinement lady as I caught her coughing and sneezing while handling my baby. She, however, denied she was sick.

"Plus, she also practised bad hygiene and never sterilised the feeding bottles. Neither did she wash her hands after using the toilet,” the mother-of-four said, adding that she replaced the nanny with a new one after about 15 days. 

REGULATING CONFINEMENT CENTRES

(photograph for illustrative purposes) --fotoBERNAMA (2021) ALL RIGHTS RESERVED

The term confinement refers to the traditional postnatal practices that are observed after childbirth for 30 to 40 days. Mothers have the option of hiring a nanny or pui yuet to take care of them and their newborn baby in the comfort of their own homes or checking into a confinement centre.

The latter option is growing in popularity with many such centres having opened in the Klang Valley and other towns in recent years.

According to Obstetrical and Gynaecological Society of Malaysia past president Dr H Krishna Kumar, there are concerns regarding the legality of these confinement centres, as well as the lack of regulation as the government has yet to come up with specific guidelines and regulations for such centres.

As of now, he said, most of these centres are merely recognised as “business entities”.  In short, they operate like a hotel or spa, and not as a medical facility. 

To open a confinement centre, all one needs is a company registered under the Companies Commission of Malaysia and a licence to operate from the local authority concerned.

Since the confinement centres are not covered by the Private Healthcare Facilities and Services Act 1998, they are not bound to any standard or minimum requirements, he added. 

"The lack of medical experts such as a gynaecologist or paediatrician in most of these centres to detect and diagnose signs of complication in the mother or child is worrying. 

"If any issue or problem arises, it is usually resolved privately between the centre and the family," he told Bernama, adding that there is also no dedicated avenue for the mother or her family to raise any issue in case of a dispute. 

(photograph for illustrative purposes) --fotoBERNAMA (2021) ALL RIGHTS RESERVED

Dr Krishna Kumar said it is time for Malaysian lawmakers to work towards drafting a new law or amend existing ones to regulate confinement centres in order to protect mothers and babies from unwanted incidents. 

"The regulation of confinement centres has always been a grey area and there is not much they (government) can do against 'bad' confinement centres as there is no specific section on (the regulation of) such centres in the law,” he said.

Dr Krishna Kumar advised mothers seeking the services of a confinement centre to do comprehensive research first before making a decision.

"Make sure the staff is certified and experienced, and carefully review the contract before committing to a centre," he said. 

He said since confinement centres do not have uniform policies, it would be wise to look into what each centre offers. 

"Do note centres that operate in private residential houses as they may not be an ideal choice as they may not fulfil certain requirements to operate as a healthcare facility," he added. 

CONFINEMENT PRACTICES 

Dr Patricia Lim Su-Lyn. -- Photo courtesy of KPJ Tawakkal Service Hospital

Elaborating on confinement practices, consultant obstetrician and gynaecologist at KPJ Tawakkal Service Hospital Dr Patricia Lim Su-Lyn said confinement is a traditional postnatal practice for mothers to rest and recover physically and mentally from childbirth, with the confinement period lasting from 30 to 44 days. 

"During the nine months of pregnancy, a woman’s body undergoes changes to carry her baby to full term. (After delivery) the body requires time to regain its strength, and postnatal care after childbirth is important.

"It is also a time for bonding with her baby and breastfeeding. In addition, it takes about six weeks for the wounds to heal and the womb to return to its original size, as well as for the body’s other systems to return to normal,” she explained. 

Dr Lim said it is a common practice for new mothers to hire a confinement lady to look after them and their baby at home or check into a confinement centre where they can recuperate and have their baby taken care of.

"Confinement should be done in a place where the mother is comfortable, be it her own home or her mother's home. She should also have privacy so that she can breastfeed her baby as well as rest,” she said. 

She said the mother can seek assistance to prepare and cook her meals as well as to wash the diapers and perform housework although it is not wrong for the mother to carry out these tasks herself if she does not have any help at home.

(photograph for illustrative purposes) --fotoBERNAMA (2021) ALL RIGHTS RESERVED

"The most important thing is for the mother and her baby to feel supported because after delivery the effect of hormones on the postnatal mother is still in play and sometimes with a newborn baby it is natural to feel overwhelmed and stressed, especially with lack of sleep and a constantly crying baby around," she said. 

She said good nutrition would help to improve wound healing and energy levels and also increase the supply of breast milk so that the mother can breastfeed on demand. 

"Other practices such as massaging and wearing a corset can help to relax sore muscles that have been used during pregnancy and delivery and also to create support for the muscles that may have weakened during pregnancy. 

"Warm baths with herbs added into the water can, perhaps, help to soothe the body as well as the muscles… it will also help the mother to relax which aids in the production of breast milk," she added. 

Edited by Rema Nambiar

BERNAMA