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    Demand for Maternity Matrons Swells, Alongside Growing Pains

    Care for new mothers and infants meets fresh challenges as it shifts from tradition to profession.

    In a dimly lit apartment in Beijing’s suburbs, Miao Caili sings to a baby doll as she wraps it in cloth. With her professional attire and rapid, accented Mandarin, she wouldn’t seem out of place in an office. Instead, her delicately made-up face softens into a tender smile as she demonstrates different techniques for wrapping an infant to her student, Zhang Yan. Zhang is training to become a maternity matron, or yuesao, like Miao.

    Yuesao attend to new mothers and their infants during the month following childbirth, which Chinese tradition designates as a period of recovery. The practice, known as zuo yuezi, or “sitting the month,” requires new mothers to stay indoors, limit physical exertion, and focus on nutrition. The yuesao is on duty around the clock, cooking special meals for the mother; feeding, bathing, and changing the baby; and managing the emotional well-being of both parent and child.

    The maternity care profession in China has seen substantial growth over the last few years, to the extent where many urban, middle-class families now consider yuesao mandatory. For some young parents, living far from extended family networks or wanting to avoid conflict with older generations over parenting decisions make hiring yuesao an obvious choice. 

    Meanwhile, greater awareness of health issues like postpartum depression also has more women seeking out professional assistance, particularly from certified yuesao specializing in areas like nutrition or lactation. 

    As a result, the role of the maternity matron is shifting from its traditional roots — sometimes associated with superstition — to a modern health care environment, with competitive wages to match. In a profession that doesn’t require a university education, yuesao can make around 10,000 yuan ($1,465) for each appointment, typically 26 days long. High demand and decent pay are drawing more and more women to the career — and even some men, who are called yuege.

    But rapid growth has also spurred instability in the nascent industry. While yuesao can earn more than some white-collar workers, many lack access to insurance coverage or retirement funds. Fake certificates abound, and even qualified yuesao must contend with the misconception that they are nothing more than household servants. 

    Miao first started working as a yuesao 18 years ago, shortly after she moved to Beijing from Shanxi province in northern China, where she had worked for many years as a postnatal caretaker in hospital maternity wards. Back then, few people had heard of the yuesao profession. “People saw me as a diaper washer,” Miao tells Sixth Tone, “and I didn’t know what to call my job either.”

    In fact, the role is “very demanding,” Miao says, explaining that while live-in yuesao are hired to help new mothers recover and learn how to care for their babies, the attendants frequently end up mediating family disputes and other conflicts that arise in the stressful period after a baby is born. 

    Miao has come a long way since the early days of her career, when clients called her “Little Miao.” Now, at age 46, she’s reverently referred to as “Aunt Miao” and no longer works full time as a yuesao, having joined the management team of a training agency in October 2014. Two months ago, she opened her own agency to recruit, train, and place yuesao like Zhang — who booked her first appointment this month — taking advantage of the market growth anticipated since China’s two-child family planning policy took effect at the beginning of the year.

    Many of Miao’s recruits come from her hometown in Lucheng County, Shanxi province, where the decline of coal mining has left many jobless. In fact, the yuesao industry reveals the opportunity divide between rural areas like Lucheng and China’s major cities, where Miao says the market is booming. 

    Young mother Zhuang Qiyan tells Sixth Tone that only a few families around her in rural Shandong, a province in eastern China, hire yuesao. Though the going price for these attendants in her county is around 3,500 yuan, much less than in the city, professional maternity care seemed like an unnecessary expense to 27-year-old Zhuang when she gave birth to her son in 2013. “I don’t have that kind of money,” Zhuang says. “I don’t need a yuesao. I can manage by myself.”

    But for 28-year-old Zhang Zhuoer, having an experienced attendant by her side helped immensely after she had her son last year in Shenzhen, a tech hub in China’s southern province of Guangdong. The 53-year-old yuesao she hired cooked eight meals a day and helped facilitate breast-feeding of her baby every two hours. “She didn’t have a proper rest once in 24 hours,” Zhang Zhuoer — who is not related to yuesao trainee Zhang Yan — tells Sixth Tone. “Her job was full of physical labor.”

    Zhang Zhuoer had heard other mothers complain that many yuesao are rural women with minimal education and are not worth the money. But she feels that she made the right choice in hiring professional help, especially for her first child.

    “I’ve only done yuezi once, and maybe I’ll go through it once more in my life,” she says. “It didn’t cost too much [to hire a yuesao], and it made me more relaxed. Why not spend the money?”

    Of course, as demand for yuesao rises among mothers of means, clients’ expectations are also increasing. A decade ago, it was enough for a yuesao to have a sunny disposition and plenty of energy. These days, clients consider not only a yuesao candidate’s skills and experience, but also her age, references, credentials, hometown, and even her zodiac animal. 

    Having additional skill certificates can double a yuesao’s salary, which — combined with a lack of market regulation — has given rise to a side industry of private training courses charging thousands of yuan for unofficial certificates in special areas like lactation consulting.

    Lian Lanying, 42, feels that despite the modern-day emphasis on certification, the quality of training for yuesao hasn’t improved since she started in the industry 17 years ago. “When I was trained in 1999, the teacher was the obstetric nurse,” Lian recalls. “We learned from her for 10 days and then practiced at the maternity nursing center for a month without income.”

    Now, many companies will award certificates after only a week of training — and Lian herself is taking advantage of this lucrative new business opportunity. She earns up to 30,000 yuan a month working as a certified lactation consultant, training yuesao, and selling certificates.

    One of Lian’s customers, Meng Qingzhi, 49, recently bought a dietitian certificate for 580 yuan. After five years in the profession, Meng has reached the top level at the agency where she works, but she realized that younger parents don’t trust her expertise without a certificate. “I don’t know which organization issued the certificate, but it doesn’t matter. It is just a piece of paper,” Meng says.

    But certified lactation consultant Louise Roy says unqualified yuesao can cause real harm in specialized areas like hers. “Most yuesao receive training on general newborn care and formula preparation but little to none on breast-feeding, and their knowledge is often incorrect or even outright dangerous,” says Roy, who served as a postpartum nanny for many years in Australia and now works at Ferguson Women’s Health in Shanghai. 

    In fact, Roy believes that while practicing yuezi can be beneficial if it allows the mother to rest and focus on her newborn, relying too heavily on a yuesao can cost a mother vital bonding opportunities in the first month of her baby’s life. Roy also explains that many yuezi traditions are based on lifesaving practices of the past — for example, refraining from showering to prevent infection from unsanitary water — but are outdated for modern conditions. “It’s more a cultural choice than anything medically necessary,” Roy says of the yuezi practice.

    Miao agrees that some yuezi traditions are harmful, which is why she prefers to train new recruits rather than hire experienced yuesao like herself at her agency. For example, she says some older attendants will bind an infant’s legs together in the belief that it will help them grow straighter, though this can cause circulation issues.

    “It’s hard to change the opinions or habits of a yuesao who has worked for many years,” Miao says. 

    As the modern maternity care industry in China continues to expand and depart from its traditional roots, some enterprising yuesao like Meng are looking beyond the domestic market to even greener pastures. Meng has her eye on Australia, where she expects to double her salary and enjoy greater respect for her work. 

    “I heard that Chinese customers abroad treat yuesao well,” Meng says. “They don’t think of us as servants.”

    (Header image: Women hold plastic baby dolls as they prepare for a class photo at a yuesao training course in Beijing, Oct. 28, 2016. Kevin Frayer/Getty Images/VCG)