Himali Nayak spent the first six weeks of motherhood lying flat in her bed as she bonded with her son, Hemir.
The home she shares with her husband in Westmead was worlds away from her upbringing in Gujarat, west India, but the 31-year-old was determined to follow the traditional practice of bed rest after birth.
Ms Nayak’s mother and father travelled from India and moved into her two-bedroom apartment to care for the new mother and baby and share all the household chores with her husband so that she could observe the cultural custom.
“My mother would not allow me to do anything in the kitchen or allow me to lift anything,” said Mrs Nayak, who moved to Australia as a newlywed in 2011.
“We all took care of Hemir. If I was alone it would be very hard [to do] everything ... I cannot put into words how grateful I am to all of them.”
Bed rest after birth is a common cultural custom among African, Indian, Chinese, Korean and Arabic women.
When Mrs Nayak’s sister Ripal gave birth in Gujarat nine months ago, her extended family and her in-laws supported her during the bed rest period. She and her baby boy Prayaan are visiting Mrs Nayak in Westmead.
A new study suggests many women from China, India, Pakistan, Bangladesh and Sri Lanka are modifying the traditional practices in their west Sydney homes.
The researchers say women should not be discouraged from observing the cultural customs, but they need to be warned that immobility increased the risk of venous thromboembolism (VTE).
VTE is the leading cause of maternal death in countries with good maternity services. Though the condition was rare, with an Australian study finding VTE occurred in 1.14 per 1000 births, women were at greatest risk in the postpartum period.
A series of interviews with 150 new mothers in western Sydney found more than half rested in bed and 85 per cent rested around the home as much as possible in the 30 days after giving birth.
As Ms Nayak lay horizontal, she bonded with her son and listened to traditional prayers on YouTube.
She was not to watch horror or violent movies, but could watch joyful Indian movies she loved and read uplifting novels.
Her mother cooked her traditional dishes of lentils, curries and sweet Halwa with cardamom, ginger and other spices.
“They say, if you eat this your baby won’t get any allergies,” she said.
The study found more than 90 per cent of the women interviewed had live-in help, usually their mother or mother-in-law, who travelled from their homes in China or the Indian subcontinent.
Having a relative live with them increased the likelihood of immobility six-fold, found the study published in Midwifery.
Almost 50 per cent of participants said they did no housework and 39 per cent did not cook during the bed rest period.
One in 10 never left home and more than one in five only left home once, with 93 per cent saying the reason they went out was to see their family doctor.
When they were asked what they spent most of the day doing, 69 per cent said "looking at the internet”, 36 per cent were watching TV and 16 per cent were caring for older children.
The strict resting practices meant mothers focused on nurturing their babies, and supported breastfeeding, said lead author and Midwife Sarah Melov at the Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital.
“It’s a lovely custom, not having to race around and do everything else,” Ms Melov said.
“Traditionally they would have a whole village looking after them.”
But with its focus on immobility, bed rest could significantly increase the risk of VTE, argued Ms Melov and co-author Associate Professor Kerry Hitos at the Westmead Institute for Maternal and Fetal Medicine.
Women who practised bed rest needed to be warned of the risk of VTE and encouraged to incorporate some activity into their day, similar to advice given on long-haul flights.
“We absolutely encourage people to practise their cultural beliefs, just with that extra information that you need to move around a bit more,” Ms Melov said.
Previous guidelines from the National Health and Medical Research Council - no longer in use - recommended minimising immobilisation to prevent VTE for women.
Healthcare professionals should be aware that their patients may be practising bed rest, and talk to them about VTE, Ms Melov said.
Almost 70 per cent of women who give birth at Westmead Hospital are born overseas and one-third overall were from China and the Indian subcontinent.
Women who had a vaginal delivery were 3.5 times more likely to practise bed rest than women who had a caesarean. The researchers suggested women who had a caesarean were likely warned of the risk of VTE after surgery by maternity staff and took precautions.
Some participants said they would have liked to have practised bed rest more intensively, but their relatives could not come to Australia. Others said they felt “cultural pressure” to conform to the bed rest practice, the researchers said.
Ms Melov said these women often modified the practice to suit their wishes. For instance, some cultures did not permit bathing, but the participants chose to shower regularly. Others ignored the directive to avoid reading or spending time online.
Husbands traditionally did not play a large role in the practices but some of the women interviewed said their partners had stepped into the traditional role of their mother or mother-in-law if their relatives could not be with them.
The practice may be confronting to some Western mothers, but Ms Melov suggested many would find the focus of relaxation and bonding very appealing during what can be a stressful time as women transition into motherhood.
“I think everyone would want to do it if they could,” she said.