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Kruekaew J, Kritcharoen S. Thai Traditional Midwifery Care

Article
Thai Traditional Midwifery Care
Janpaphat Kruekaew1* Sureeporn Kritcharoen2

1
Lecturer, Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand.
2
Associate Professor, Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand.
*Corresponding author: janpaphat.k@psu.ac.th

Abstract
Thai traditional midwifery care involves knowledge of holistic health care and wisdom of Thai
ancestors. This traditional knowledge and wisdom have been preserved from generation to generation, aimed
at caring for pregnant women and their babies from the antenatal to postpartum periods in normal process.
The caring principles of the antenatal period are dietary care behavior care and Thai massage. The objectives
of this care are to prevent complications during labor and encourage a comfortable pregnancy. In terms of
the intrapartum period, the purpose of Thai traditional midwifery is to encourage pregnant women to give
birth at home and belief practice for new life. Furthermore, Thai massage is used to decrease some pain and
fatigue from the antepartum to postpartum care periods. After delivery, a series of Thai wisdom knowledge
is applied to mothers, for example, heat therapy and massage in order to keep their newborn and themselves
healthy. Heat therapy is employed since it is believed that heat would provide short-term and long-term
benefits for women’s health. Some of the benefits include eliminating lochia from the uterus and vaginal
canal, reducing pain during sexual intercourse, and reducing roughness of facial skin, slackening abdominal
surface cause by delivery and lack of moisture in the vaginal area, as well as low immunity.

Keywords: best practices; maternal and child health care; midwifery; Thai traditional midwives care

Introduction The traditional Thai philosophy is the art and

Traditional Thai medicine consists of traditional practice of healing which is based on traditional Thai
philosophy and knowledge, including specific methods knowledge passed on from generation to generation.
of practice that have used to take care of Thai citizens. Thai culture and way of life is a holistic
This tradition is congruent with Thai cultures and natural approach to health care with respect of
and ways of life based on Buddhist principles. nature and Thai wisdom.
Traditional Thai medicine uses different forms of Buddhist principles are respected religious
practices complementing each other, such as medicine, beliefs involving the five commandants of the Buddha.
massage, midwifery and pharmaceutical, Buddhist rites Buddhist prayers and meditation practices are used
and meditation, as well as other rituals based on for pregnant women to gain strength in both body
belief in supernatural power or power of the universe.1,2 and mind.3 The five commandants are as follows:

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Thai Traditional Midwifery Care Kruekaew J, Kritcharoen S.

panatibata (Do not kill animals or destroy other life), disappearing from Thai society. Nevertheless, Thai
atinatana (Do not rob other people’s possessions), traditional Midwifery wisdom is still dominant in
adultery (Do not have affairs), falsehood (Do not the contemporary period and perpetuated by close
lie), and liquor mir semashko (Do not drink alcohol), female family members who take care of pregnant
respectively. Moreover, these rules are based upon women during the antenatal, intrapartum, and
beliefs in sin and retribution. postnatal periods.
Thai massage or nuad is a form of manual The Efficacy of Thai Traditional Midwives Care
therapy applied to promote health and for relaxation. Care of the Antenatal Period
It can also be effective to cure or relieve several Midwifery and maternal and child health
symptoms of back pain, tension and headaches among care Thai wisdom and traditional midwifery practice
other benefits. Thai massage can be divided into two for antenatal mothers is concerned about foodstuffs,
categories: folk massage and royal massage. Both health care behavior and the correct position of a
massage types refer to the principles of sen sib or baby in a womb. Moreover, traditional care during
ten sib primary energy lines (sen), as well as being the antenatal period were: pregnancy diagnosis of
developed, refined, and passed on from generation proper nutrition, preparation for normal delivery,
to generation over the years. The techniques of folk and pregnancy suggestions for mothers’ and their
massage vary from different regions; however, the babies’ well-being by following approaches.
similitude among them is that hands, elbows, knees Beliefs of Dietary Precautions
and feet are employed to massage, press, bend or Limitations of certain foods are highlighted
stretch body parts, covering and applying pressure by Thai Traditional Midwives during pregnancy. If
and manipulating the body. pregnant women eat some kinds of unhealthy food,
In contrast, royal massage emphasizes they can affect the balance of their maternal body
the use of hands and fingers to apply pressure to (Thai people believe that the human body contains
acupressure points associated with ten energies. four elements: earth, water, wind and fire. When
Furthermore, Thais also produce different forms of these four elements are in equilibrium, the body
wooden massage instruments that can be used for is considered healthy.) There are several examples
self-massage and promoting health.4,5 of recommended and prohibited food for pregnant
Midwifery, maternal and child health care women. First of all, drinking more coconut juice
is one method of holistic health care preserved and can reduce vernix serosa; therefore, a baby will
passed on from one generation to another in order to have good skin. Second, eating eggs are prohibited
care for a mother and baby from the antenatal through during pregnancy since it can lead to an action
postpartum periods. The principles of Midwifery are of abortion. Furthermore, fatty food should be
compose of (1) beliefs in caring for mothers and avoided due to the fact that it could lead to have
infants, (2) care and practice with pregnant women, an abnormally large baby which causes obstruction
(3) the intrapartum care and practice, and (4) the in labor. Also, no spicy food and candies should
postpartum care. Thai Traditional Midwifery (TTM) be consumed, for a baby mouth could be infected
leds to natural childbirth; as a result, mothers and and difficult for breastfeeding, and a baby would
infants are healthy, comfortable, and they can have less hair. Interestingly, the belief of Muslim
recovery faster after delivery.3,6 Regarding Thai traditional midwifery in the southern part of Thailand
Traditional Midwifery (TTM), natural childbirth is is that a pregnant women should consume dates. In
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Kruekaew J, Kritcharoen S. Thai Traditional Midwifery Care

fact, dates are so popular that they can offer high Buddhist belief are based on sins and passion. A
nutrition and calories.7,8 Moreover, eating bananas is pregnant woman who follows Buddhist principles
prohibited since pregnant mothers could give twin will pass all obstacles and good things will come
births and face a difficult labor. Bitter melon, bitter to her life.
cucumber, and watermelon can also cause retained Thai Massage
placenta. During pregnancy, precaution food will Preparation for unchallenging labor by
provide negative effects on mothers and their fetus massage is an alternative therapy with non-
health. Also, it is believed that when a mother has pharmacologic treatments. The mechanisms of massage
each meal, they should not finish eating as the last on spasticity vary depending on each technique.
person; hence, this mother will have a difficult time Thai massage during pregnancy could start at the
in child upbringing.9 In addition, shells are forbidden; period of the seventh month or 28 weeks. If the
the perinatal after birth will be easy to get infected. massage is given before the aforementioned period,
All in all, TTM provides some strict diet in order it will cause abortion. Regarding Thai Traditional
to protect mothers and infants, and help mothers to midwives, a specific type of massage for pregnant
process easy labor. women called “Kud-thong massage” (Royal Thai
The Buddhist Principles. massage combined with folk massage) are applied
Behavioral precautions should be a concern during pregnancy. This kind of massage can soothe
for the well-being of mothers and fetuses. Belief the delivery of tension and help a baby to move
in Buddhism strongly influences a mothers health himself/herself in the womb not to press on the
behavior. In respect to the five commandments of bladder and to reduce urinary symptoms. Furthermore,
Buddhism, for example, killing animals is completely the massage can improve blood circulation, reduce
immoral during pregnancy. If a pregnant woman back pain, and stimulate lymphatic circulation which
kill animals, it is said that her baby will have bad decreases edema during pregnancy.10
behavior and a bad mind.3 Since the main rules of

Figure 1 Kud-Thong

Songklanagarind Journal of Nursing, Volume 38 No. 1 January - March 2018: 103-110 105
Thai Traditional Midwifery Care Kruekaew J, Kritcharoen S.

It can also ensure that a baby is not support in this labour process, especially her husband.
squeezed and deformed inside a womb. The massage Before labor her husband should sit behind the
should be applied two to three times per week pregnant woman, using his legs astride to her
from the seventh month onward.9 The procedure of shoulders. Thus, when some contractions are intensified,
this massage is about the right positions, a Thai the woman can hold on to his thigh muscles giving
midwife should sit beside a pregnant woman, use her strength to push. Instead of her husband, the
both hands, rock a woman’s body from side to side midwives can help her tie a piece of long cloth to
like an elephant, and then move up the medial sides the ceiling over the room. While the woman is in
of the legs around the Palm circle and the knees. labor, all windows and doors of the labour room
The Thai midwife should continue using her palms must be open wide because this symbolizes an easy
pressing on the quadriceps to the femoral triangle, birth. The woman should face to the East direction
followed by her foot compressing the adductors as during the labour since Thai people believe that
well as the hamstring area by pushing and pulling the East part is the dawn direction. Therefore, it is
like a boat pedal. After that, rub the belly gently a symbol of birth and life whereas the West side
with some coconut oil. The Thai midwife should symbolizes death.7,9,11 During the labour process, Thai
also provide some relaxing massage on the abdomen traditional midwives use specific herbs combined
in order to relieve some muscle fatigue, stiffness, with the massage around the woman’s vaginal area
spasm, and tension throughout the back area, head, to prevent the tearing of the vagina. If the placenta
neck and cervical neck.11 This special massage is is retained in the uterus more than thirty minutes,
provided for pregnant women to increase awareness take a roll of some herbal leaves, put it into her
of their mind-body connection, empower the pregnant mouth in order that the pregnant woman will vomit
women, reduce some discomfort, increase their self- and the placenta will be delivered.
awareness, and reduce anxiety before going into Thai Massage for Easy Birth
labor. Moreover, the benefits of this massage are The role of Thai traditional massage in midwives
to relax the abdomen and correct the position of includes taking care of a pregnant woman during
the baby if necessary. The protocol of Thai midwives delivery for relaxation of the abdomen to have
massage for pregnant women are as follows: 1) Hot enough energy to push during labor. Thai traditional
herbal compress or herbal steam bath is banned midwives support the mother in labor with massage
before massage during pregnancy; 2) Do not because a woman could have some excruciating pain
acupressure or blend with strength; 3) Foot massage during this stage. Thai traditional massage technique
is not allowed for pregnant women; 4) Finally, used by Thai traditional midwives is specific. Royal
massage for pregnant women should not be applied Thai massage is a type of massage often used in
before the seventh month. It can be seen that the the labor stage in order to relieve a woman’s pain
main purpose at the antenatal period is to take care until delivery. In addition to pain relief, the massage
of pregnant women and achieve ease their labor. during the labor process can enhance the emotional
state allowing the woman to grow spiritually. The
Care of the Intrapartum Period pregnant woman in ongoing labor can feel better
Birth at home, is one belief of Thai when midwives provide them with this kind of
traditional Midwifery. They contains many steps of massage so that she will feel a sense of loving,
the labour process. A woman’s family members can kindness, compassion, and equanimity.11 It can be
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Kruekaew J, Kritcharoen S. Thai Traditional Midwifery Care

seen that this massage can reduce some pain from elements since all mothers’ bodies are imbalanced
uterine contraction, as well as increase pushing, after delivery. The external and internal organs
mobility and a range of motions to joints nerve need to be recovered. Thai traditional postnatal
muscles, and ligament balancing.11,12 The pressure practices are specific and relevant to each region
on the quadriceps to the femoral triangle plays an of Thailand. Traditional postpartum practices are
important role in this method. Also, feet could be still appropriate in contemporary Thai culture. The
used to compress the adductors and the hamstring care systems after delivery are various in each part
area by pushing and pulling like boat pedaling. of Thailand; the use of heat therapy is still used.
Then, place pillows under a woman’s neck and However. a hot stone called Kon-sau, which is the
between her knees, so that she can be comfortable. traditional heat therapy in the South of Thailand
Next, with palms, press up and down on both legs is applied to a place around a mother’s abdominal
in the areas of the muscles in order to reduce the area.7,8 Next, herbal bath and intake of hot herbal
spinal attachments by starting rocking from the waist drink are the heat therapy found in the North
slowly. Frequently, thumbs would be employed to East part of Thailand.14 In terms of the Central
press up and down from the iliac spine out to the region of Thailand, a portable steam-room with
hip, and then repeat the steps again. In conclusion, special herbs, sitting over charcoal, body massage,
it is beneficial for babies if pregnant women can herbal ball compression and hot salt pressure are
give a birth naturally. Although going through the all heat therapy used for mothers after birth.15
labor is a difficult moment for the pregnant women, There are different practices after delivery helping
they can pass this obstacle by coping with their the mother to recover her balance and health.16
pain.11,13 Wisdom knowledge practices in Thai
traditional midwives of postpartum care
Care of the Postpartum Period ​Thai traditional midwifery practices at the
Thai cultures and ways of life are related postnatal period are often related to various kinds
to notions of well-being and health of postpartum of heat therapy. Heat therapy (Yu-Fai or Ue Fai)
mothers in their daily life activities. Mothers’ is applied at the postpartum period to revitalize a
health and long life after birth are a concern in mother’s health after pregnancy and delivery. Yu-Fai
the postpartum period. Regaining heat therapy is can help early sub-involution of a mother’s uterus,
the knowledge of Thai traditional postpartum wisdom remove some lochia, stimulate blood circulation,
for Thai postpartum mothers. A postpartum mother deodorize amniotic fluid, as well as drive a body to
must be taken care of after birth, to have a warm get rid of impurities.3,9,15,17
body, relieve some pain and fatigue because of her In addition, heat therapy can be used in
tiredness after birth.3 According to Thai Traditional combination with some special massage for
Medicine, a human body is composed of four elements: postpartum mothers. This heat therapy should be
earth, water, wind and fire (The four elements). applied for seven days after delivery in order to keep
If the four elements of the body are balanced, a mother’s body warm, shivering is an easy way
a body will be healthy. Therefore, taking care to affect a mother’s long-term health.2,3,9 In fact, if
of mothers to go back to a normal balance at the hot therapy is not administered, bad smells from
the postpartum period is very essential. They can the female organ, pain during sexual intercourse,
become sick if there are any imbalances of four roughness of facial skin, slacken abdominal surface

Songklanagarind Journal of Nursing, Volume 38 No. 1 January - March 2018: 103-110 107
Thai Traditional Midwifery Care Kruekaew J, Kritcharoen S.

caused by delivery and lack of moisture in the lochia is applied to help a mother prevent metritis
vagina could occur. after delivery or cesarean to make her feel better.
It is recommended in Thai traditional Second, presses with Phlai (Zingiber montanum) is
midwifery practices that postpartum mothers a way to help relieve muscles from stress during
should have hot water, banana blossom, hot herbal birth. In addition, Khamin Chan (Curcuma longa)
drinks, ginger and peppers due to the fact that is useful to help heal the perinea and vagina cavity.
these suggested food and drinks can increase breast Ma Grud (Citrus hystrix) is utilized to assist the
milk.2,3,7,9,11 These practices depend on each part respiratory system. Also, tamarind leaves are good
of Thailand, for instance, Hot stone compression for itching, Finally, Wan Chak Mot Luk (Curcuma
(Kon-Sau), Herbal steam bath, Herbal compress, zanthorrhiza) has an advantage for metritis sub
Heated salt-filled pot compression, and Sitting involution of the uterus to relieve the lochia. Then,
above charcoal as also used3,7-9,11,14,15,18. all of these herbs are boiled in hot water, similar to
Hot stone compression (Kon-Sau) in a those used in hot herbal compresses used in a steam
cotton towel with specific herbs is usually placed room or a close chamber. The steam and the volatile
on a body. This hot stone is laid on the top of the substances contacted with the body skin exert a
herbs wrapped up in a chunk by hand. The wrap is local effect to help a mother reduce fatigue, blood
applied with a small press on to a mother’s body, circulation to her uterus and perineal. Moreover, it
in combination with some massage. This technique is beneficial for weight loss, stimulating her breast
is performed twice a day (in the morning and the milk, and reducing her breast engorgement. In the
evening.) process, a woman should sit in a herbal steam room
Herbal steam bath or Ekgakraohm (a portable for about 20 to 30 minutes over a five-to-seven-
steam room with special herbs.) There are many day period, combined with massage after taking a
types of beneficial herbs in this heated therapy. First, herbal steam bath.11,18

Figure 2 Herbal steam bath

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Kruekaew J, Kritcharoen S. Thai Traditional Midwifery Care

Herbal compress is one means of treatment of cloth in a round chunk and placed in the pot
by using a round herbal ball of special herbs for the for postpartum care into the pot in a piece of
postpartum care. The dried herbs: Phlai (Zingiber cloth. Next, all components are applied to compress
montanum), KhaminChan (Curcuma longa), Takrai on a woman’s organs after childbirth in order to
(Cymbopogon citratus), Ma Grud (Citrus hystrix), ease pain and muscle aches, tendon, and joints. In
Ma Kham (Tamarindus indica), Som Poi (Acacia addition, this method is useful to stimulate uterine
concinna) and fresh pepper are mixed and wrapped contraction to reduce lochia and breast milk flow
in a traditional cotton based on Thai traditional frequency.14,15,18
postpartum care. The objectives of this treatment
Sitting above charcoal is a technique which
are to alleviate some pain or inflammation and is especially beneficial for perineum care. The process
induce relaxation, as well as increase energy flow of sitting above charcoal is to use heat and smoke
that is vital for health. Additionally, some massage from herb to contact a woman’s perineal and vaginal
is applied during the process of herbal compress. areas after birth. The other purposes of this method
Importantly, the special area which is necessary to are to reduce blood circulation around her pelvic and
take care of for postpartum mother is the abdomin.8,14,18 reduce lochia and heal her vaginal cavity after birth.
Heated salt-filled pot compresses is one In fact, the procedure of sitting above charcoal is
approach by putting some salt into a heated pot. usually done after the process of heated salt-filled
Then put some herbs which are wrapped in a piece pot compresses.14,15,18

Figure 3 Sitting above charcoal

Thai massage: Special care for a postpartum Conclusion

mother In conclusion, the literature reviews about
Royal massage and folk massage are two main Thai traditional midwifery are really beneficial to
types of Thai massage used after childbirth.1,2,4,6,11,13 develop midwifery care for future studies. Research
The advantages of these two techniques are to in Midwifery can be combined with Modern
reduce some pain around a woman’s legs, back, and midwifery in order to achieve a holistic approach
head, as well as reduce lochia, blow gas out of the and care of women in their antenatal, intrapartum
stomach and prevents constipation. Breast massage and postpartum periods. Finally, these techniques
can also help stimulate her breast milk.11 can be integrated in advanced midwifery by
certified, undergraduate and postgraduate students
in the future.

Songklanagarind Journal of Nursing, Volume 38 No. 1 January - March 2018: 103-110 109
Thai Traditional Midwifery Care Kruekaew J, Kritcharoen S.

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