Citation
La Cuarentena

Material Information

Title:
La Cuarentena an ethnographic study of Mexican immigrant families postpartum
Creator:
Waugh, Lisa Johnson
Publication Date:
Language:
English
Physical Description:
viii, 175 leaves : ; 28 cm

Subjects

Subjects / Keywords:
Puerperium ( lcsh )
Immigrant families -- Colorado ( lcsh )
Mexicans -- Social life and customs -- Colorado ( lcsh )
Immigrant families ( fast )
Mexicans -- Social life and customs ( fast )
Puerperium ( fast )
Colorado ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 168-175).
General Note:
Department of Health and Behavioral Sciences
Statement of Responsibility:
by Lisa Johnson Waugh.

Record Information

Source Institution:
|University of Colorado Denver
Holding Location:
|Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
677841540 ( OCLC )
ocn677841540
Classification:
LD1193.L566 2010d W38 ( lcc )

Full Text
LA CUARENTENA. AN ETHNOGRAPHIC STUDY OF
MEXICAN IMMIGRANT FAMILIES POSTPARTUM
by
Lisa Johnson Waugh
B.A. University of Colorado Boulder, 1981
B.S.N. University of Colorado Health Sciences Center, 1984
M.P.A. University of Colorado School of Public Affairs, 1997
A thesis submitted to the
University of Colorado Denver
In partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Health and Behavioral Sciences
2010


by Lisa Johnson Waugh
All rights reserved.


This thesis for the Doctor of Philosophy
degree by
Lisa Johnson Waugh
has been approved
by
Stephen Koester
( J,, #), &>io
Date


Waugh, Lisa Johnson (Ph.D., Health and Behavioral Sciences)
La cuarentena-. An Ethnographic Study of Mexican Immigrant Families
Postpartum.
Thesis directed by Associate Professor John Brett.
La cuarentena refers to the quarantine or cuarenta dias (forty
days) of recovery for Mexican women after the birth of a child. The
traditional customs of postpartum recovery are explored in an ethnographic
study of la cuarentena among recent immigrant families in Colorado.
Through participant observation and ethnographic interviews with forty
immigrant women and their family members, participants revealed their
contested and negotiated understandings of the period of postpartum recovery.
La cuarentena refers to traditional behaviors regarding diet, clothing, bathing,
and sexual abstinence as well as specific beliefs/ fears about recovery,
expectations of social support, and long term implications for women as they
age. As an exercise in critical ethnography, this research primarily addresses
the effects of discursive power, and how women integrate and balance sources
of authoritative knowledge during the postpartum period. While the families
in this study expressed trust and confidence in biomedicine, they also revealed
a strong preference for the generational knowledge inherent to la cuarentena
during postpartum recovery. La cuarentena is seen as a site for the
exploration of how families compromise, negotiate, and transform the
understandings they receive from both biomedicine and family traditions.
Expanding the existing literature on cross cultural birth and reproduction, this
research examines the roots of the authority behind traditional knowledge.
The practice of 40 days of rest, isolation, and purification postpartum comes
from the Old Testament (Leviticus 12:1-5), exposing the authoritative
knowledge behind la cuarentena as rooted in Biblical sources. However, far
from being passive or compliant, immigrant women show that they are
assertive agents in building new hybrid understandings that are coherent with
their lives.
This abstract accurately represents the content of the candidates
thesis. I recommend its publi
ABSTRACT
Signed
in


DEDICATION
I dedicate this thesis to the Mexican women I have worked with for seven
years, the young mothers who crossed a dangerous border and found
themselves in Colorado. They welcomed me into their homes, shared their
hopes and fears, and revealed the complexity of creating cultural identity.
IV


ACKNOWLEDGEMENTS
I would like to acknowledge the support of Dr. Ruth OBrien, who served as
grant sponsor for the NRSA Fellowship award from the National Institutes of
Nursing Research (Grant # 1F31NR010429-01A1). I also could not have
completed this project if not for the support of staff at Boulder County Public
Health, particularly Jane McKinley. Finally, heartfelt thanks to Dr. John
Brett, who encouraged me to study la cuarentena, and translate practice into
theory.
v


TABLE OF CONTENTS
Figures...........................................vii
Tables...........................................viii
Guadalupes Story...................................1
CHAPTER
1. INTRODUCTION.....................................8
2. HISTORICAL CONTEXT OF LA CUARENTENA.............17
3. METHODS AND STUDY DESIGN........................56
4. CUSTOMS AND BEHAVIORS FOR RECOVERY..............79
5. BELIEFS AND FEARS POSTPARTUM...................105
6. SOCIAL SUPPORT FOR THE NEW MOTHER..............118
7. AGING AND LA CUARENTENA........................132
8. CONCLUSIONS: STRUCTURE AND AGENCY IN LA
CUARENTENA........................................138
BIBLIOGRAPHY......................................168
vi


LIST OF FIGURES
Figure 1. Overall research design
57
Vll


LIST OF TABLES
Table 1. Inclusion and Exclusion Criteria................................63
Table 2. Demographic descriptions of families involved in the study......66
Table 3. Overview of home visits, interviews, aims and methods...........68
Table 4. Code System.....................................................75
vm


GUADALUPES STORY
The names and histories of the women who inform this study come
from el rancho, la sierra, el pueblo: Consuelo, Blanca, Rufina, Yuridia,
Guadalupe. They watched their older sisters having babies at home in
Mexico, cared for by grandmothers, mothers, aunts, and surrounded by the
bearers of tradition, las sehoras del pueblo. In the traditional ways, these
older women gave the new mother massages and bed baths, prepared special
foods, and taught them how to breastfeed and care for a newborn. They tell
how la cuarentena is forty days of rest and recovery special care that is
given to the new mother to reward her after all the hard work and pain of
birthing. Las sehoras... they feed you, give you special herbs, wrap your
belly, put you to bed. Its described as a time of honoring the new mother,
and indulging her as she prepares for motherhood. For forty days she isnt
allowed to cook or clean, and the aunts bring her the baby for nursing, and
take him away when he cries. Along with the loving care, wisdom, and idyllic
imagery of this time, las sehoras also pass on the fears of generations of
women from rural Mexico. The new mothers are told the rules:
You must cover up, or the aire (the drafts) will get in to your body -
the new mother is so open after birth, so vulnerable... you must take
special care to wrap the abdomen (fajarse) because the organs can
fall down, or even out or the stomach rises up, and thats when the
mother sometimes loses her life. Be careful, or your belly will get
1


flabby, and you know those women who have fat, sagging bellies, they
didn t wrap up right after delivery. The older women who have
swelling joints, headaches, poor vision -you know they didnt take
care during la cuarentena and they worked too hard. They suffer
now when its your time youll know... they should have been careful
during their recovery. ... they say that until youve made it through
the first forty days, you have one foot in the grave you re not safe
yet.
Guadalupes first child was bom in Mexico, with a midwife (partera)
who cared for her at home. After delivery, she maintained bed rest for 20
days only getting up to go to the adobe sweat house near her neighbors
house where every few days she would go to lay on mats and sweat out the
toxins of her pregnancy. Her mother cared for her baby while she rested,
recovered, and regained her strength. For the next 20 days, until she had
observed the full six weeks of la cuarentena, she stayed in her mothers home
- only then did she think of returning to her husbands house. The
consequences of having intercourse during la cuarentena are very serious:
.. con respeto a tener relaciones, supuestamente es eso ... para evitar
tanto sangrado. Y si la mujer tiene relaciones antes de perder el mes, puede
perder la vida. Por eso es lo que recomiendan alia.
.. about having intercourse, supposedly its about... avoiding too
much bleeding, and if the woman has intercourse before a month is out, she
can lose her life. Thats why they recommend [the separation] there [in
Mexico].
Guadalupe carefully ate a traditional diet of tortillas, dry roasted beef
(no pork), simple foods (neither hot nor cold), and lots of warm, sweet
drinks (atoles) made from cornstarch (maizena). Immediately after the birth,
2


the partera wrapped her upper abdomen (under her rib cage) with a tight
narrow binding {el cenidor) that would prevent her organs from rising up
when she walked around, having become so loose and out of place. Later she
wrapped her lower abdomen with long cotton cloths {la faja). She always
covered her head and back with a shawl, or with the hood of a sweatshirt -
even in the heat to prevent her milk from drying up, and to protect her from
drafts {el aire). If a draft were to enter through her open pores, or through her
ears, she would risk a bad cold, painful joints {rheumos), or pulsing headaches
(punzadas). So she took care to do all the right things, and she recovered
well and regained her health.
At first it seemed like her baby was fine, she nursed well and gained
weight but as the baby grew she started to develop strange twitches in her
neck, and her eyes didnt focus correctly. Guadalupes husband was
inattentive to her and the baby, he even had another woman and wouldnt
give her the money she needed to take the baby for special help. Several of
her sisters lived in the US, in Colorado so she decided to go there to see if
her baby could get better medical attention. Her sisters sent her money and
she traveled with some of the young men who help you cross the border the
coyotes, but these ones were ok she said, because her sisters knew them.
When Guadalupe successfully got to Colorado, she stayed with her
sisters for several years. Eventually she found work cleaning at a supermarket
3


at night, and moved into her own apartment. Her child qualified for free
services, and received in-home therapy for what was described to her as a
nerve problem related to trauma during birth. When she became pregnant
with her second child, she said she felt grateful that this baby would be bom in
the hospital. Her baby would be safer that way he would be healthy if he
was bom in a hospital. But she realized that she would have to go through la
cuarentena without her mother and grandmother, and she said that she felt
anxious and concerned about how she would manage. The new babys father
had disappeared, and wasnt there to help her.
The delivery went well the doctors were good, the nurses were kind,
her baby was a healthy and perfect baby boy. She felt concerned about
herself, though she had to wait too long to wrap her abdomen with the faja,
and she knew it was important to put it on immediately after delivery. The
nurses wouldnt allow it she knew they wouldnt let her put it on, her sisters
had told her so she didnt even try to wrap up tightly until later. As she was
leaving the hospital, after the nurse left the room, she hid in the bathroom and
put it on under her clothes so that she wouldnt be caught. She couldnt go all
the way from the hospital room to the car, and drive all the way home without
it she knew that would be very dangerous, so she had her sister bring a bulky
coat that would hide it well.
4


Later, at home, her sisters did all they could to help her. They brought
her food, and they helped her bathe and wrap her belly (fajarse), they even
stayed overnight for over a week, but then they needed to get back to their
own families. She needed to get up to care for her older child, and she had to
take care of herself, bathe, cook, answer the phone. She only had one month
off from work, and she couldnt afford to lose her job. When she went back to
work she would have to supplement her feeding with formula, she wouldnt
be able to keep breastfeeding full time. She looked for the special herbs she
needed, and couldnt find most of them though people visiting from Mexico
had been able to bring her some of what she needed. She felt she would
probably be okay, because this was her second child and she already knew
what to do, how to care for a baby. She said that maybe some of the things
her mother had emphasized werent so important this time she hadnt put
cotton in her ears to protect from the aire, she felt that simply covering up
with the hood of a sweatshirt would be good enough. But no one was there at
3:00 am to help her when the baby cried, and she felt so tired. She missed
home, her tears came easily. She complained of a back ache, which she didnt
have the first time because the sweat baths had helped her clear all the toxins,
and this time she felt that her body was not strong. She feared that she wasnt
producing enough breast milk to feed the baby. When she called her mother
in Mexico, she pretended that everything was ok, and she tried not to cry she
5


knew her mother would worry if she was careless about following la
cuarentena.
La cuarentena, es muy diferente aqui, pues porque alia me sentla con
confianza porque estaba mi mama. Y aca, no es algo diferente.
''La cuarentena, its very different for me here, well because there I
felt so safe because my mom was with me. Here, no its something
different.
Ultimately, how she observes la cuarentena could influence
Guadalupes diet and nutritional status, her success and persistence with
breastfeeding, how she approaches intimacy in the postpartum period, family
social support and whether she experiences isolation/ loneliness and is at risk
for depression, her process of bonding with her newborn, and how she
understands her own health and recovery (even her long term aging process).
She will engage in a process of sorting through messages from her health care
providers in the clinic, whom she trusts and respects and messages from her
mother and las senoras del pueblo who are part of her own identity, and
define her frame of reference for understanding the postpartum period. Both
sources of knowledge are legitimized by structural sources of power, and
represent institutionalized authority biomedicine in the clinic/hospital, and
family traditions based in generational knowledge, and rooted in Church
doctrine and the Bible. Sorting through the messages from these two
powerful and influential sources of authority is a challenging process for
6


Guadalupe and other young immigrant mothers. It is a selection process
which shapes their cultural identity, and which defines them as individuals. In
this research, la cuarentena is seen as a site for understanding how power
operates in the perinatal period, and how it is diffused: families describe what
la cuarentena means to them.
7


CHAPTER 1
INTRODUCTION
Theoretical Assumptions
One disciplinary perspective of medical anthropology is the study of
how health is culturally constructed how concepts of wellness and disease
are shaped by cultural context. Nancy Scheper-Hughes writes:
Rather than simply the study of alternative medical systems and
practices, medical anthropology becomes a much more radical
undertaking: the way in which all knowledge relating to the body,
health and illness is culturally constructed, negotiated, and
renegotiated in a dynamic process through time and space. (Scheper-
Hughes, 1996)
Critical ethnography, as a theoretical framework and methodological
approach, studies how power influences a given cultural context. From a
critical perspective, ethnography can reveal how power and coercion operate
to shape the lives of those living in poverty:
Critical medical anthropology... understands health issues in light of
the larger political and economic forces that pattern interpersonal
relationships, shape social behavior, generate social meanings, and
condition collective experience. (Singer, 1990)
This research considers the historical forces that influence immigrant women
and their families as they observe la cuarentena, focusing primarily on how
those forces of power become transformed into sources of authoritative
knowledge (Jordan, 1983). The women in this study inhabit a complex
8


social order, and are embedded in layers of power relationships: as young
mothers, as women, as immigrants, and as participants in a global economic
system, they confront gendered, ethnic, generational, socioeconomic and
political power systems which profoundly shape their lives and their personal
experience. As young women beginning their adult lives in a new place, they
balance tensions between the traditions of their families and western
biomedicine (the advice and information they receive from the clinic). In the
context of birth, recovery, and parenting, they respond to two very powerful
sources of knowledge that hold absolute authority: tradition and biomedicine.
For this study, the most relevant literature in anthropology stems from
the seminal work of Brigitte Jordan, who has been called the midwife to the
anthropology of childbirth (Robert Hahn quoted in Davis-Floyd, 1996, p.
111). Jordan, who wrote Birth in Four Cultures (1983), inspired a growing
body of cross-cultural research on birth and reproduction. Many of these
studies challenge the privileging of science and biomedicine over traditional
birthing practices. Their central theoretical concern is the study of
authoritative knowledge as rooted in scientific rationalism, and linked to
institutional systems of medical power, coercion and authority. Authoritative
knowledge in this sense is part of a western cultural hegemony which
privileges modem/ biomedical ways of understanding health and the body.
This work has been extremely influential in framing and shaping midwifery
9


practice and training throughout the world, and has legitimized traditional
birthing methods and indigenous ways of knowing birth and recovery (Davis-
Floyd & Sargent, 1997).
However, the literature tends to minimize the coercive and power-
laden influence of traditional beliefs and practices. Traditional beliefs, fears,
customs, and behaviors are also rooted in sources of authoritative knowledge,
legitimized by the social structures of church, family, and community. These
are the hierarchies of age, gender, and spiritual or religious authority which
legitimize traditional knowledge. These forms of generational knowledge
perpetuate customs, belief systems, and expectations about birth and recovery.
From these sources of authority, women acquire learned behaviors that are
distinct from a natural or embodied knowledge about birth and recovery.
In their work on critical ethnography, Simon and Dippo (1986) describe how
power is embedded in these structural forces:
Power operates not just on people but through them. Power relations
are those that structure how everyday life will be lived; that structure
how forms are produced and reproduced to limit and constrain, as well
as contest and redefine what one is able to be (Gramsci 1971). Within
ones social stock of knowledge, what is legitimated and available in
the way of particular practices in the domains of body, language, and
activity is not arbitrary. A critical ethnography must contend with the
task of understanding, materially and historically, this nonarbitrary
specificity, (p. 197)
This research examines la cuarentena as a site of contested power relations.
10


The lives of immigrant families from Mexico are fundamentally
shaped by structural forces in a global context. From the perspective of
political economy, many immigrant families are in the US because of a
capitalist economic system that exploits inexpensive (predominantly illegal)
immigrant labor, and determines their economic opportunities. But it is not
only their life circumstances that are affected by the disparity of economic
opportunity power differences between the economies of the US and
Mexico infiltrate all areas of their lives. Economic power becomes associated
with social and cultural legitimacy what is considered right, true or
healthy is that which is associated with the more powerful knowledge
system. Brigitte Jordan writes that the constitution of authoritative
knowledge is an ongoing social process that both builds and reflects power
relationships (cited in Davis-Floyd 1997, p. 56). From the perspective of
critical ethnography, these are considered to be discursive forms of power,
which influence knowledge, social discourse, and ultimately shared
perceptions of health and wellness. For immigrant families, understandings of
the body, beliefs and fears about birth and recovery, and health related
decisions are influenced by sources of knowledge, power and coercion that
inform and shape their perceptions and beliefs. These coercive influences are
both modem (biomedicine) and traditional (generational knowledge).
11


In my work as a public health nurse, caring for Mexican immigrant
families over the past seven years, I have observed many families during the
postpartum period. During la cuarentena women are experiencing an
important life transition, and they are profoundly affected by the social
influences of their families and the care they receive at the clinic. But at the
same time, their responses are often unique and authentically individual.
They are actively engaged in creating their own hybrid forms of cultural
understandings. I watched them as they argued, laughed, schemed, and
organized their way through these six weeks, and how they ultimately came to
terms with different ways of understanding la cuarentena and all of its
implications. They engage in an active, creative process of resisting and
integrating messages from both tradition and modernity sorting through
messages from both their mothers and their doctors. They choose who to
listen to and who to ignore, at times they hide their traditional practices when
they go to the clinic, and sometimes secretly scoff at their mothers fears.
They acknowledge a range of ideas, and sort, compromise, negotiate, and
create new understandings: they make choices.
This research focuses on several key observations about structure and
agency during the postpartum period. These observations are supported by
the empirical evidence from the interviews, and are documented in the
12


findings detailed in subsequent chapters. These points are expanded and
explored further in the discussion and conclusions.
Overview of key points/organizing themes
Structural forms of power shape not only the life circumstances of
immigrant families, but their ways of knowing and understanding
health, the body, birth and recovery. La cuarentena is seen as a site
for the critical study of how both macroeconomic and discursive forms
of power operate to influence health behaviors for immigrant families
during the postpartum period.
In the context of biomedicine, immigrant customs tend to be trivialized
and poorly understood, even though they have been documented as
potentially impacting health behaviors and ultimately health outcomes
(see review of the Social Science literature). The descriptive parts of
this research serve to clarify the customs of la cuarentena and reveal
the underlying fears and beliefs which influence families health
behaviors during this time. La cuarentena is seen as a site for the
descriptive study of how culture and tradition influence health
behaviors and health choices for new mothers.
Many of the women who observe la cuarentena identify more strongly
with sources of traditional knowledge during the postpartum period.
While they rely on biomedicine during acute care situations (like labor
13


and delivery), and rely on biomedicine for the care of their newborns,
many report that it is the traditional customs that more effectively help
the new mothers short term and long term recovery. During la
cuarentena many women are profoundly influenced by the fears and
beliefs that are passed on by their mothers and grandmothers, and
these beliefs are imposed on them by generational authority that
enforces acquired behaviors /learned information based in historical
tradition. La cuarentena is seen as a site for the exploration of the
(positive and negative) coercive influences inherent in generational or
traditional knowledge.
As young women balancing sources of authoritative knowledge during
the postpartum period, many young mothers create new
understandings, and new ways of interpreting both tradition and
biomedicine. Families also forge out innovative divisions of labor that
often defy traditional gender role expectations, and traditional
definitions of morality or propriety. La cuarentena is seen as a site for
the study of agency and resistance: women actively participate in both
creating and reproducing cultural norms.
14


Structure of the Dissertation
The research questions guiding the study are as follows:
How does observance of la cuarentena shape families behaviors,
beliefs and social roles during the postpartum period?
How is authoritative knowledge understood by immigrant women and
their families, and how do they negotiate between tradition and
biomedicine during la cuarentena?
This thesis is organized generally into three parts.
Background: First, in Chapter 2 la cuarentena is considered in the context of
historical, literary, and scholarly sources. References to la cuarentena are
widely spread through popular and academic literature, but it is important to
emphasize that while la cuarentena is referred to in a variety of source
material, documentation is scattered and incomplete. The literature review
presented here is the only known comprehensive examination of references to
la cuarentena, from sources as disparate as the Bible, Garcia Marquez One
Hundred Years of Solitude, and the American Journal of Maternal Child
Health. This study relies heavily on research which addresses issues of
authoritative knowledge in childbirth and reproduction, and because that work
is so relevant to this research, the literature in this genre is addressed in some
depth. The theoretical framework of critical ethnography, and its relevance to
this research, is also discussed at length.
Findings: The study methodology is reviewed in chapter 3, with specifics
15


about how the study was designed, how the data were collected, analyzed,
interpreted, and documented. Subsequent chapters present the ethnographic
findings of this research, with descriptive data and analysis of the practices
and customs of la cuarentena, and extensive quotes from women as they
describe la cuarentena and what it means to them. The chapters address
various parts of la cuarentena, beginning in chapter 4 with the customs and
behaviors typical to la cuarentena, and moving on in chapter 5 to the
underlying beliefs and fears which guide and shape behavioral choices.
Chapter 6 focuses on the social support from family, and what women have to
say about family support during la cuarentena. In chapter 7, the voices of
older women report their understandings of how observing la cuarentena
affects long term issues of aging.
Discussion: Finally, the study conclusions are presented in Chapter 8, which
reviews the theoretical framework of the study, and addresses the relationship
between the ethnographic results and theoretical issues. The chapter
concludes with suggestions for further research.
16


CHAPTER 2
HISTORICAL CONTEXT OF LA CUARENTENA
Colonial influence and la cuarentena
The tradition of forty days of postpartum seclusion has roots in Judeo-
Christian birth practices and is specified in the Bible as part of Judaic law. In
Leviticus 12:1-5, the Old Testament prescribes forty days of seclusion and
purification after the birth of a son (for a daughter the time was doubled):
The Lord said to Moses, Say to the people of Israel, if a woman
conceives and bears a male child, then she shall be unclean seven
days: as at the time of her menstruation, she shall be unclean. ...
Then she shall continue for thirty three days in the blood of her
purifying; she shall not touch any hallowed thing, nor come into the
sanctuary, until the days of her purifying are completed. ... This is the
law for her who bears a child... and the priest shall make atonement
for her and she shall be clean. Leviticus 12:1-2.
The symbolism of the number forty in the Bible is pervasive it is considered
to be the number of days required for fasting, trial, and seclusion. The Great
Flood (Genesis 7:17) continued for 40 days and 40 nights; Moses waited for
40 days on Mt. Sinai for the Ten Commandments (Exodus 24:18)', the
Israelites wandered for 40 years in the desert (Exodus 16-34). The importance
of the ritualistic 40 days of cleansing also appears in the New Testament
{Matthew 4: 1-11, Mark 1: 12-13, Luke 4: 1-13), where it is written that Jesus
17


fasted for 40 days and 40 nights in the desert after his baptism and before
beginning his ministry. The emphasis on 40 days of fasting and purification is
also symbolized in the 40 weekdays in Lent, ending at Easter. In other
historical texts, specific references to la cuarentena trace it to the Virgin
Marys period of seclusion after the birth of Christ (Foster 1960, quoted in
Mull, 1981), referring specifically to a traditional period of abstinence and
purification for forty days.
Post partum seclusion in Latin America is considered to be primarily
influenced by colonial beliefs and practices, and is traced to medieval birthing
rituals:
A period of postpartum seclusion seems to have been observed
throughout Western Europe among Christian women... The so-called
lying in period involved approximately four to six weeks of
confinement in the home or other domestic setting, which
corresponded to the duration of the lochial flow from the uterus after
childbirth. It seems to have been motivated not only by a concern to
seclude the recently delivered mother and relieve her of regular
household duties, but also to protect the newborn infant. A regulation
from Douai [an Abbey of Benedictine monks] in 1293 invokes
banishment for any woman who does not complete the full lying in
period... The lying in period ended for Christian women with the
ceremony of churching (also called purification) which ... generated
its own liturgy. This rite [was] the only one specifically for women.
(Dictionary of the Middle Ages, p. Ill)
It is significant that this emphasis on the forty days of seclusion and recovery
was historically sanctified by the canon of the Catholic Church. Given the
influence of the Catholicism on family life in Latin America, it eventually
18


became ingrained in family tradition and less associated with church practices.
Many contemporary Mexican couples refer to the instructions given by the
priests in pre-marital sessions which refer to the importance of abstinence
during la cuarentena, but in general families tend to regard the customs of la
cuarentena as folk wisdom, home remedies, folklore from their grandmothers,
and just the way it has always been done. While young couples may not
recognize the roots of the tradition in the scriptural authority of the Catholic
Church, it is important to emphasize that historically and structurally these
practices are influenced by the authoritative knowledge of the most powerful
institutions in Latin America.
Indigenous influences on la cuarentena
Both colonial and indigenous traditions have been incorporated into
the family customs of la cuarentena in Mexico. While the colonial features of
this time tend to focus on seclusion, isolation, and abstinence, both indigenous
and colonial aspects of postpartum recovery are traced to the importance of
maintaining a hot and cold balance in the body (Rubel, 1984). Hot/ cold
concepts of health are inherent to various indigenous traditions in Latin
America, and are also rooted in colonial beliefs of humoral theories of health
care (Purnell 1998, Spector, 2000). The origin of the hot/cold distinctions
were debated widely in medical anthropology (Rubel, 1984), and ultimately
many trace the origins of these practices to colonial forces. Without more
19


reliable pre-colonial sources, it is difficult to distinguish between colonial and
precolonial beliefs, but specific indigenous groups rely heavily on the concept
of a hot and cold balance. In her study of Mayan birthing practices in the
Yucatan in Mexico, Brigitte Jordan reports that following childbirth, the
Mayan mother and infant are considered hot and must remain secluded in
the house to protect them from cold/ wind (or a/re) (1983). Other
indigenous postpartum practices that have become inherent to la cuarentena
for many families include special bathing practices. Indigenous families in
central and south Mexico historically relied on the use of the temazcal, which
is an adobe sweat house, where steam vapor is scented by a variety of
medicinal plants. Sylvia Bortin documents that this is an ancient
Mesoamerican practice, possibly of Mayan origin (1993). Laura Resau also
observed these practices in Oaxaca, where Mixtec women reported that la
cuarentena is traditionally seen as a vulnerable time: women feel that their
bodies are open to coldness entering and causing immediate or future illness.
Women take protective measures to remove coldness from their raw bodies
and restore heat by following special diets, dressing warmly, and cooking the
body taking hot herbal water baths (barns de cocimiento) or steam baths
(banos de temazcal) (Resau 2002). These studies suggest that the practices
of la cuarentena have both colonial and indigenous aspects, but the literature
20


on the historical and cultural roots of la cuarentena is diffuse and incomplete,
and this is an area worthy of further study.
Popular literature
La cuarentena is also widely referred to in contemporary Latin
American and Chicano literature, showing the centrality of these practices in
the cultural frame of family life. One of numerous literary references to la
cuarentena can be found in Gabriel Garcia Marquez One Hundred Years of
Solitude, where the matriarch of the famous Buendia family, Ursula, had
barely completed her recovery of forty days when the gypsies returned... or
Ursula habia cumplido apenas su reposo de la cuarentena cuando volvieron
los gitanos (1967, p. 41). This type of reference to la cuarentena as a
familiar feature of family life is repeated in Isabel Allendes Stories of Eva
Luna, Julia Alvarez How the Garcia Girls Lost Their Accents, and Mario
Vargas Llosas La Fiesta del Chivo. As popular literary texts which reveal the
social fabric of life in Latin America, these are important indicators of the
pervasive and deeply held understanding of la cuarentena as a culturally
marked transition, where church, community, family and gendered
expectations shape a collective understanding of the postpartum period.
While none of these fictional accounts focuses exclusively on the cultural
features of la cuarentena, they address (perhaps more effectively than many
academic studies) the gendered and generational power dynamics that shape
21


the families of Mexico and Latin America. The thematic traditions of Latin
American literature address the beliefs and fears inherent to magical realism,
the power of the family (familismo), gendered power relationships
(machismo), and the power of the church and they effectively expose the
power dynamics of family life that become particularly pronounced and
relevant to women at times of essential life transitions (like la cuarentena).
Ethnographic literature
La cuarentena is also referred to in several seminal ethnographic
works, such as George Fosters (1967) ethnography of Tzintzuntzan in
Michoacan (based on fieldwork he did in 1948). In this work he refers to how
la cuarentena affects baptismal practices, stating that:
Since baptism normally occurs before expiration of the forty day
period during which a new mother is not supposed to leave her home,
she is unable to attend the baptism of her child; even if the act is
delayed beyond the cuarentena she does not go to the church (p. 77).
Dorothy Mull (1981) refers to Fosters 1948 ethnographic description of a
form of empacho caused by the failure to abstain from intercourse during la
cuarentena (p. 9). Mull documents her clinical experience with Mexican
immigrant patients post partum who presented with symptoms of empacho
de hombre,\ Empacho is commonly understood to be a form of blocked
intestine disease thought to be caused when the intestines are plugged up by
something indigestible such as chewing gum or unbaked dough (p. 8);
22


symptoms include abdominal fullness and distension. This type of empacho is
related to sexual behavior:
empacho that comes from a man... was thought to be caused when sexual
intercourse occurs too soon after childbirth (p. 8).
The work of Margarita Melville (1980), and Margarita Kay (1982) are
cited in almost every contemporary article that refers to la cuarentena, since
they were among the first to publish reviews of these practices as a significant
feature of post partum recovery. In Melvilles work, the forty days is
referred to as la dieta, a commonly used phrase that is often used
interchangeably with la cuarentena, but tends to emphasize the dietary
restrictions post partum. Melville (1980) focuses on outlining the diet based
on hot and cold foods, but she also mentions the concept of aire:
Currents of air are always thought to be dangerous but especially so
after delivery. Air can harm the eyes causing punzadas, which may
lead to blindness. It may harm the ears as well. If it is necessary for
the mother to leave the house before the prescribed time is over, she
must be very careful to cover her head with a cloth that conforms to
the shape of the head and thus completely protects it. She must always
keep her feet covered, for air can enter through the feet. The shoulders
must be covered or a breast infection may develop, (p. 60)
Melvilles book, called Twice a Minority, Mexican American Women,
provides useful descriptive information about cultural practices among
Mexican American families, but her work is limited to descriptive detail.
23


Kay (1982) sets out a comparative framework for the study of
childbirth and edits a volume of ethnographies addressing birthing practices
in various cultural settings. She develops a framework for the study of birth
as a system (p. 1). Typical of this era in anthropology, this framework looks
for a universal model of birthing the framework clearly intends to study
variations in birthing practices, but results in some astonishing
generalizations/ assumptions about cultural universals. During the modernist
era in anthropology ethnographers tended to look for commonalities cross
culturally without careful consideration of their structural and historical
context:
The puerperum seems to last six weeks or forty days for all women
delivering their first babies. It is begun by the immediate postpartum
period, which lasts for three days in cultures predominantly Christian,
and four days in Indian societies; the respective magic numbers for
each... These worldwide traditions are described in Soranus and in the
Bible, in the Book of Leviticus... (Kay 1982, p.2)
Similarly, Gwen Stem describes birthing and postpartum recovery as a
period which is everywhere a candidate for consensual shaping and
patterning (1983), and then goes on to assume universal categories of
behavior. She has identified six elements that are generally present in the
structuring of the post partum period in a variety of cultural settings,
providing a framework for studies of cultural (re) production post partum:
Cultural recognition of a distinct postpartum period, during
24


which normal duties of the mother are interrupted
Protective measures designed to reflect the vulnerability of the
new mother
Social seclusion
Mandated rest
Assistance with tasks, mostly from other women
Social recognition of the new status for the mother through
rituals, gifts, or other means.
While these frameworks were initially seen as useful tools for studying cross
cultural similarities and differences in the post partum period, the
ethnographic literature soon moved on to more contemporary (post-modern,
post-structuralist) theoretical perspectives which acknowledged that cultural
practices are a dynamic, contested, and negotiated process of individual and
group difference, and are based in relations of power and authority. The more
recent ethnographic literature on birth and birthing practices in cross cultural
settings addresses the sources of authoritative knowledge which influence
birth and recovery. This work is considered in subsequent sections.
In the general ethnographic literature there are several references to la
cuarentena as part of a broader context. For example, Elena Padilla (1958)
mentions la cuarentena in the context of her study of family and kinship
patterns among Puerto Rican immigrants in New York City. In a more recent
ethnographic review of this same cultural context, Ana Zentella (1997) refers
to the importance of la cuarentena for families in her study of bilingualism in
the Puerto Rican immigrant community in New York City. Most references
25


in the ethnographic literature, whether referring to Mexican Americans (Kay
1982, Melville 1980, Clark 2001), Hispanics (Zepeda 1982) Mexican
immigrants (Niska, 1998), families in Mexico (Resau 2002, Bortin 1993),
immigrants from Puerto Rico (Padilla 1958, Zentalla 1997) or generally Latin
American post partum practices (Argote, 2005), suggest that whether or not a
particular family chooses to comply with some or many of the customs of la
cuarentena, these traditional practices are familiar and well-known,
influencing and informing families post partum beliefs, behaviors, social
roles and expectations.
Nursing and Public Health literature
While assumptions about post partum recovery are clearly deeply held
within the cultural frame of Latin American families, they are unfamiliar to
(and often unheard of) among health care providers of other ethnicities, and
professionals from various backgrounds who work with Mexican immigrant
families during the perinatal period. The literature which is accessed by
nurses, doctors, health educators, and other public health professionals has a
number of important references to la cuarentena and postpartum cultural
practices in general, but they tend to be problem oriented, focusing on specific
issues of postpartum recovery, rather than being comprehensive or focused
studies of la cuarentena itself. There are two key studies in the nursing
literature which focus specifically on the practices of la cuarentena (Niska
26


1998, Clark 2001); they are outlined below. A number of other studies refer
to la cuarentena in the context of research regarding postpartum social
support, postpartum depression, feeding and nutrition, parental role
responsibility, physical inactivity, and abstinence. These are also cited below.
There are few estimates of the prevalence of the practices of la
cuarentena in the literature. In her review of la cuarentena among Mexican
American families in Hidalgo County Texas, Kathleen Niska estimated that
approximately 80% of families practiced parts of la cuarentena, based on
interviews with 25 families (Niska, 1998), Marlene Zepeda also found that
approximately 80% of Hispanic women surveyed in southern California
reported observing la cuarentena, based on a survey of 30 women (1982).
Kathleen Niska (1998, 1999, 2001) used an ethnographic approach to
understand the perspective of Mexican American first time parents regarding
family health. This research (which led to a series of published articles)
clearly describes the practices of la cuarentena, using them as examples of
characteristic health related decisions, dealt with through the family system.
In her work, which studied 25 Mexican American families in Hidalgo County,
Texas from 1994-1998, Niska focused primarily on testing a model of the
family as an adaptive system, referring to families as organized
wholes... where adaptational processes of support, nurturing, and socialization
operate within the family to facilitate family integration (2001, p. 323). She
27


refers to la cuarentena as an example of this adaptational response during the
period of postpartum recovery. Her account is by far the most thorough and
detailed regarding the traditional practices associated with diet, clothing, the
division of labor between husband and wife in terms of household
responsibilities and infant care. Her study emphasized that A thorough
understanding of la cuarentena will assist nurses to enhance adaptation to
parenthood for Mexican American parents,(1998, p. 329) and that /a
cuarentena provides intergenerational cohesion with affective patterning of
belonging to a continuous family tradition (1998, p. 336). Like most of the
literature in Nursing and Public Health, it is oriented toward practice
implications and emphasizes the coherence and continuity of these practices
rather than the complexity and conflict inherent to cultural (re)production,
and/or individual differences.
One of the more significant studies of social support during la
cuarentena comes from Lauren Clark (2001), where she identifies several
distinct types of social support offered during the post partum period. In her
93 interviews with 26 Mexican women living in the US, Clark identified four
categories of social support suggested by the interview data, including support
that was characterized as a) Supportive, b) Apathetic or uninvolved, c)
Antagonistic, or d) Disconnected, to describe the type of relationship between
women who were cut off from family members due to barriers of distance
28


instead of choice (p. 1306). Clark reveals the complexity behind a cultural
value placed on la familia and social support which includes instrumental
help, emotional support, and the perception that others can be counted on to
be there for them. (p. 1313). In her analysis Clark recognizes
disconnections in social support for immigrant women with the lowest levels
of acculturation and poorest English language skills, and failed support for
women who encountered aggravation and antagonism from family and friends
who they believed should have offered support instead (p. 1313). Clark
provides a nuanced account of how social support varies among families
depending on economic resources, social class, geographical proximity, and
other structural factors affecting the lives of immigrant families.
Clark (2001) describes la cuarentena as a time when ideally dense
social support is provided by la familia, the close network of family that
supports a womans rest and recovery post partum. She suggests that
successful social support during this time possibly provides a protective effect
against post partum depression. Lucy Martinez-Schallmoser (2005) also
refers to la cuarentena as providing valuable social support to Latina women
during a time of vulnerability to postpartum depression. In her study she
states that extraordinary care, thoughtfulness, assistance with housework and
childcare, and individual attention are traditionally provided to postpartum
Mexican American women during the cuarentena''' (p. 331), and she cites
29


findings showing that women who reported a high need for postpartum social
support (meaning that they didnt have support during this time) were at
increased risk for experiencing postpartum depression. In an earlier study of
the health outcomes from a Chicago-based neighborhood health project in the
1980s (The Latina Mother-Infant Project), Gwen Stem (1985) reveals
findings which showed that ...observance of the cuarentena correlated
significantly with having a positive emotional response to the pregnancy and
to having less postpartum depression or blues (p. 237).
Several studies outline the dietary restrictions during la cuarentena,
which include observance of a liquid or soft diet. Women customarily avoid
foods associated with heat, cold, acidity, gas, heaviness, spicy-ness, or
greasiness. Interview data in a number of studies shows that women tend to
favor nutritious drinks, including atoles (commeal or oatmeal based drinks) as
well as soups and broths. These are traditionally associated with increased
milk production. A number of foods are associated with indigestion or
digestive problems. Many foods are avoided because of a belief they might
cause colic in the newborn (Niska 2001, Zepeda 1982, Clark 2001).
In her study of feeding practices among Puerto Rican families in New
York, Barbara Higgins (2000) observes that la cuarentena positively
influences breastfeeding practices among women who observe the traditional
forty days of post partum recovery. There have also been studies in the
30


Journal of Human Lactation that mention la cuarentena as a significant factor
in the establishment of successful breastfeeding practices, due to the positive
social support from experienced women relatives (Skeel 1988, Moreland
2000).
Kathleen Niska (2001) emphasizes the importance of la cuarentena in
cultivating parental responsibility and role change, integrating young parents
into the parental role with a great deal of family guidance and support. Niska
focuses on role reversal in the division of labor between a woman and her
husband, with the husband taking on many of the household tasks in order to
allow the new mother time for rest and recuperation. Others, however, have
observed that women more reliably turn to their mothers (rather than
husbands) during la cuarentena for advice and practical assistance (Clark,
2001). This maternal support provides intergenerational care that can
socialize the young mother into the parenting role and allow her to bond
carefully with the new infant as she learns the role of caregiver from older
women in the family.
In a study of Latina women post partum, Edith Kieffer (2002)
addresses the high incidence of obesity, impaired glucose tolerance, and Type
2 diabetes among Latina women of childbearing age. She refers to la
cuarentena as a social barrier to physical activity after pregnancy, because at
its most extreme la cuarentena dictates bed rest for women as long as possible
31


(though usually not for the full 40 days). She states that women she
interviewed saw la cuarentena as limiting, but not precluding, physical
activity during this time. Expectations for la cuarentena include staying in
the home for as long as possible, which is isolating and lonely for many young
women who are accustomed to more physical activity and social interaction.
Sexual abstinence is referred to by some authors as the most
commonly recognized, defining feature of la cuarentena (Vera Gamboa 1998,
Luengas-Aguirrel999, Bertrand, 1991). In a review of the Spanish language
literature, several articles referred to the abstinence feature of la cuarentena as
a site of conflict and struggle for couples. Luengas-Aguirre refers to patterns
of domestic violence among families of the Sierra Norte (in Puebla), when
men refuse to respect the sexual prohibitions of la cuarentena, and force
women to have intercourse before they are fully healed from delivery (1999).
Vera Gamboa of the Universidad Autonoma de Yucatan writes extensively on
the sexuality of women in the Yucatan, referring to la cuarentena as a symbol
of respect for women, and reporting that only one third of women resume
sexual relations during la cuarentena, with most women waiting until up to
three months post partum. Bertrand (1991) explores the sexual practices
among the Quiche of Guatemala and reports that abstinence during la
cuarentena is so essential to community values that it is an assumed and
inherent feature of this time of recovery. Bertrand also observed that la
32


cuarentena was an important feature in the promotion of birth spacing among
the Quiche-Maya.
While la cuarentena is referred to in literary sources from the Bible to
popular fiction, from ethnographies to professional and research journals, very
few of the references address la cuarentena in depth or study it as a unique
and complex cultural frame. With several notable exceptions, these sources
fail to acknowledge that la cuarentena is inevitably a site of conflict as well as
social support, disagreement as well as cultural coherence, and struggle as
well as joy among families. It is the intention of this study to address some of
these deficits in the literature, complementing the existing studies with a
nuanced assessment of how young immigrant families cope with competing
cultural frames during la cuarentena.
Definition of Authoritative Knowledge
A collection of feminist (critical) anthropologists who were influenced
by post structuralist theory have studied and analyzed birth and reproduction
across cultures as a bio-social process (McElroy, 1990), and they set the
precedent and framework for further analysis of the social construction of
womens experiences during pregnancy, birth and recovery (Jordan 1993,
Rapp 1997, Davis-Floyd 1996, Sargent 1996, Ginsburg 1991, Martin 1992).
This literature calls on Foucauldian and post structuralist understandings to
study conflicting sources of knowledge (intuitive knowledge, embodied
33


knowledge, traditional knowledge, rational knowledge, technomedical
knowledge), contributing to a fuller understanding of how authoritative
knowledge influences womens understandings and behaviors in the perinatal
period. I will argue that this literature is limited by its persistent focus on the
hegemony of technomedical knowledge, and that it lacks adequate exploration
of the indigenous, ethnic and traditional forces of power and coercion which
shape womens experiences of birth and recovery.
The cross cultural study of birth and birthing practices draws
extensively from a seminal work by Brigitte Jordan, Birth in Four Cultures
(first published in 1977), where Jordan cultivated an understanding of
alternative knowledge systems regarding childbirth and birthing practices.
She defines authoritative knowledge carefully in Davis-Floyd and Sargents
collection of essays on authoritative knowledge in childbirth (1997):
For any particular domain several knowledge systems exist, some of
which, by consensus, come to carry more weight than others, either
because they explain the state of the world better for the purposes at
hand (efficacy) or because they are associated with a stronger power
base (structural superiority), and usually both. In many situations,
equally legitimate parallel knowledge systems exist and people move
easily between them, utilizing them sequentially or in parallel fashion
for particular purposes. But frequently, one kind of knowledge gains
ascendance and legitimacy. A consequence of the legitimation of one
kind of knowing as authoritative is the devaluation, often the
dismissal, of all other kinds of knowing... The constitution of
authoritative knowledge is an ongoing social process that both builds
and reflects power relationships within a community of practice... It
does this in such a way that all participants come to see the current
social order as a natural order, i.e., the way things (obviously)
34


are...Authoritative knowledge is persuasive because it seems natural,
reasonable, and consensually constructed. .. .Generally, however,
people not only accept authoritative knowledge, but are actively and
unselfconsciously engaged in its routine production and reproduction.
(p. 152)
Foucault and Authoritative Knowledge
It is important to link this definition to the intellectual history of the
study of authoritative knowledge in the social sciences. Jordan briefly
acknowledges the relevance of the work of Bourdieu in exposing how folk
knowledge is devalued in a class structured society (p. 56). But it is many of
Jordans colleagues (who produced numerous subsequent studies of birthing
and authoritative knowledge) who acknowledge the importance of Foucault in
framing an understanding of how systems of knowledge are linked to power
and authority (e.g. Rayna Rapp, Carole Browner, Robbie Davis-Floyd,
Carolyn Sargent). In his review of Foucaults contributions to the
understanding of authoritative knowledge, Bruce Knauft writes:
For Foucault, Western knowledge is not a means of enlightenment but
a basis for classificatory imposition that has broad historical structure.
In the modem era, this epistemic power has had the invidious effect of
dividing types of people and institutionalizing subordination and
stigma through the projection and classification of difference. Because
these categorical understandings have been basic to modem Western
knowledge integral to its episteme they are deeply internalized and
subjectified. Indeed, these conditions of knowledge are central to the
way we constitute ourselves as subjects... (these become) the axioms
of knowledge upon which subordination are based. (1996, p. 142)
35


Foucault referred to his work as the archaeology of knowledge (also
the genealogy of knowledge), because he studied the origins and evolution of
ideas and how understandings changed over time particularly
understandings of difference. Lydia Fillingham provides an accessible
overview of Foucauldian ideas (1993), and explains that he addressed the
evolution of how social categories were constructed culturally over time;
concepts of madness/ sanity, illness/ health, and deviance/ normality
ultimately reveal how social control is used to enforce conformity and
reinforce existing social norms. Deviance from normality is punished first
by the social institutions that have developed to uphold the social order (the
prison, the hospital, the school) but also by the members of the social group
themselves who internalize an understanding of normality and self-regulate
in order to comply with existing social expectations. This concept is central to
Foucault, and involves the internalization of normalizing judgment.
Individuals self-regulate because of the fear of authoritative repercussions,
even without knowing that authority is watching at any particular moment;
it is the authority of the social order that invades individual conscience and
enforces conformity (Fillingham, 1993).
Foucault argues that it is through language-as-social-structure that
these understandings are developed, and power relationships are established -
particularly through the opposition of subject/ object. Foucault refers to the
36


historical evolution of medical science and thought, and studies how the
human body has become the object of study, and the object of the medical
gaze (Foucault, 1975). For example, the language of medicine defines
illness, and this sets up a power differential between the doctor (subject) and
the patient (object), putting the doctor in a position of authority and in the
position not only to define the experience of the patient, but to determine how
the body will be treated. Foucault applied these same principles to the study
of madness, criminal behavior, and sexual deviance (Foucault, 1975),
and his influence on our understanding of the social world was profound. He
not only clarified the dynamics of the relationship of language to power, he
transformed social analysis and argued for moving beyond existing dualities
to a more nuanced understanding of difference and the Other. Because
contemporary critical theory assumes so much from Foucault and the scholars
who followed, it is important to acknowledge his influence in a study of
authoritative knowledge and cultural (re)production. This study will not
attempt any formal Foucauldian analysis but recognizes the profound
importance of Foucauldian scholarship in shaping critical theory.
Overview of Authoritative Knowledge in childbirth and reproduction
The relevant body of literature considered here includes cross cultural
research on birth and reproduction in Anthropology, Nursing, and Midwifery
(Jordan 1977, Kay 1982, MacCormack 1982, Kitzinger 1982, Sargent 1990,
37


Browner 1990, Rapp 1995, Ginsburg, 1995, Davis-Floyd 1997). Brigitte
Jordan and her colleagues have focused on a critique of the authoritative
knowledge of biomedicine, which is seen as privileged:
A central concern ... has been the privileged status of biomedicine as a
realm of knowledge which is separate from other cultural or social
domains, and which is perceived as objectively valid... Cultural
analyses of biomedicine aim to contextualize biomedicine and reveal
its historical, theoretical, and culturally constructed foundations.
(Sargent, 1996 p. 214)
In her introduction to a collection of essays on Childbirth and Authoritative
Knowledge work which has been a significant contribution to the field, and
published in various journals Robbie Davis-Floyd and Carolyn Sargent
summarize the defining issues for this area of research:
1) conflicts and tensions in systems of authoritative knowledge
2) the language of birth
3) the intense subjectivity and reflexivity of studying a process that so
directly concerns women as a gender
4) the multiple voices and divisive agendas within feminism
concerning issues of the female body and the non/ primacy of its
reproductive role
5) the agency and self conscious choices of birthing women and birth
practitioners
6) the multiplicities of discourse, ideology, and treatment with which
birthing women in many cultures must now cope.
7) The ideological and cultural factors that work to channel womens
choices along hegemonically approved routes
8) The politics of birth as cultural representation and expression.
(1997 p. 16-17)
38


This is hardly a comprehensive list, but outlines the breadth and ambitions of
a body of literature which holds authoritative knowledge as its central point
of inquiry. Jordan and her colleagues/ successors have focused primary on:
(l)the relationship between the hierarchical distribution of knowledge
about birth and reliance on technological intervention in labor and
delivery; (2) the relative valuation of biomedical and alternative
ways of knowing about birth; (3) the relationship between the
expression of authoritative knowledge and authority positions in
particular, the implications of the distribution of power among
pregnant women and those who assist them. (Sargent, 1996 p. 214)
There are a number of studies focused on the local clinical aspects of
midwifery during labor and delivery, and these ethnographic studies document
variations in how birth and recovery are managed in different cultural settings,
contrasting traditional practices with the imposed technologies of science and
biomedicine (there are many, but for example see Shiela Kitzinger 1994, and
Sesia 1996). There are also a number of studies that focus on feminist
concerns regarding the politics of reproduction (for example, see Ginsburg &
Rapp 2001). Many (most) studies in this genre identify the various types of
knowledge as rational, scientific, techno-centered, traditional, intuitive, and
embodied knowledge, and study the privileging of science over other ways
of knowing birth. They focus on helping women resist further biomedical
intrusion and to create new community based and woman centered models of
birth (Davis-Floyd 1996 p. 117). These studies have provided an important
39


contrast to the assumptions of biomedical practice, and have succeeded in
promoting basic reforms in midwifery practice and in obstetrical settings
which serve culturally diverse clients. Based in critical theory, and engaged in
critical medical anthropology, they have played an important role in
transforming medical practice. In diverse cultural contexts around the globe,
this literature has affirmed the inherent wisdom of traditional birthing
practices, and legitimized traditional ways of knowing birth.
This was (and continues to be) an important focus for research, but it is
also important to examine sources of discursive power that are generated from
outside the biomedical model, and which also serve to influence womens
understandings in the perinatal period. There are acquired understandings and
learned behaviors that shape womens traditional responses to birthing, and
they are no more natural than techno-medical science. It can be argued that
womens innate, natural or centered understanding of birth is culturally
produced, socially defined, historically influenced, and part of a socially
acquired and gendered identity. Many in this group of scholars have gone on
to study other forms of biotechnical intrusion into the birthing process, such
as infertility treatments, in-vitro fertilization, genetic counseling, and the high
tech care of the Neonatal Intensive Care Units but underlying assumptions
about the authority behind traditional knowledge have apparently been
inadequately examined.
40


There are uneven levels of scholarly rigor in this literature, and while
the majority of these studies impress me as being theoretical informed and
methodologically sound, others are less so. For example, Hays (1996) writes
in Medical Anthropology Quarterly:
In my ideal world authoritative knowledge in the birthplace resides in
the inner knowing of the birthing mother, provided that she is in touch
with herself, is motivated to stay healthy, and will give her best to the
process of bringing in new life. When she is unable to do this her
caregivers should first try to help her work through her anxieties and
fears, which may be impeding her ability to connect with herself, and
then, only as a last resort, use their own intuitive knowledge,
experience, and technology to assist her to birth her infant. There is
ample evidence that this new model of care in the birthplace has the
best chance for a successful outcome ... fostering intuition, self
reliance, and self trust in all the participants (p. 294).
There is a tendency in this literature to demonize rationality rather than
studying it as a structural determinant, or a discourse of power the literature
favors intuitive knowing on the part of birthing women, practitioners, and
the researchers themselves. They become advocates for a particular intuitive
and embodied perspective, and fail to provide insight into the forces of
power that prevent women from approaching birth and recovery with
authenticity. The work loses credibility when it assumes personal agency in
the form of intuition rather than first acknowledging the ways in which
women are influenced by a variety of structural determinants. It is only after a
careful analysis of structural constraints that an exploration of personal agency
41


gains clarity, and it is only then that the exercise of critical ethnography can
credibly go on to study the ways that women assert resistance.
This is a diverse, extensive and varied body of cross disciplinary
research, and there are many strengths as well as limitations to this body of
work. I have not found studies which specifically address issues of
authoritative knowledge during postpartum recovery, particularly in the
context of Mexican immigrant families. Numerous studies have focused on
pregnancy and prenatal care (e.g. Browner, 1985), labor & delivery (e.g.
Davis-Floyd, 1997), and breastfeeding (e.g. Dettwyler, 1988); but there are
fewer ethnographic studies of cultural practices during post partum recovery.
There are no known comprehensive ethnographic studies of the Mexican
immigrant cultural context post partum {la cuarentena).
Most significantly, the study of authoritative knowledge in the
literature inadequately addresses traditional knowledge as a central structural
determinant of womens behaviors in the perinatal period. Science and
biomedicine are seen as supported by structural forces of oppression and
dominance, but traditional beliefs sanctified by elders, spiritual leaders, the
church, community/ social pressures are not studied structurally as sources of
coercion, or competitive sources of authoritative knowledge. The literature
favors personal agency in the form of intuition and embodied knowledge
over the study of how oppression operates through not only modem but also
42


historically gendered, class based, traditional, and religion-centered
hegemonies. This study engages in an ongoing tradition of inquiry in critical
medical anthropology, but hopes to make a significant contribution to deficits
in the existing literature.
Ethnographic Traditions
LeCompte and Schensul (1999) define ethnography as an approach to
learning about the social and cultural life of communities; an approach which
is scientific, investigative, and uses the researcher as the primary tool of data
collection. Characteristic of this tradition is long term engagement with the
community, intensive interviewing, and participant observation. In
ethnography, listening to and observing families over time leads to
relationships of trust and cooperation that allow for intimate family customs to
be revealed. The advantage of the ethnographic approach is the depth of
insight that can be gained from intensive study of a small and purposive
selection of informants. Ethnography relies on the analysis of linguistic and
nonverbal cues that are revealed through social interaction, and through the
relationship that is established between informant and researcher (Bernard,
1998). Agar (1996) refers to the product of ethnography as knowledge you
construct to show how acts in the context of one world can be understood as
coherent from the point of view of another world (p. 33). It is the intent of
this ethnography to document the voices and traditional practices of Mexican
43


immigrant families postpartum, so that they reveal their own experiences of
recovery and transition.
Agar contrasts conventional ethnography with critical ethnography:
The growth of capitalism on the world stage has bred a concern with
power, and power is the missing ingredient in traditional ethnography.
Ethnography always dealt with context and meaning and these
concerns (continue)... But the last fifteen years have taught us to ask
another question what systems of power hold those contexts and
meanings in place? (p. 26)
Ethnography has followed a long and tortured history from its
association with colonial interests in the 19th century, to the tangle of
reflexivity advanced by post modem theory in the late 20th century. The
contemporary critique of ethnography from within anthropology has been
fascinating and important, and has firmly established the limitations of
ethnographic methods. This critique recognizes that ethnography is capable
of only presenting provisional (as opposed to definitive) interpretations, and
provisional (as opposed to final) readings of events, or presentations of
encounters (Crapanzano, 1986). This critique has exposed the ethnographers
lack of authority in translating cultural difference, since as outsider the
ethnographer is always marginal, compromised, suspect, and bound to a
western discourse which is far removed from the indigenous discourse of the
events occurrence (Crapanzano 1986 p. 76).
44


However, taking all of these layers of historical and theoretical
complexity into consideration, ethnography still emerges as an effective and
meaningful process for uncovering cultural difference, giving voice to
marginalized groups, and exposing how power operates in specific cultural
contexts. In this study I chose critical ethnography as the theoretical
framework and methodology for exploring la cuarentena grounding critical
analysis in the careful observation of the lived experience of immigrant
women and their families. Bruce Knauft writes that critical ethnography is
enriched by the salutary commitment to carefully observe and document the
lived experiences and expressions of common people (p. 285). Rather than
an abstract analysis of power relationships, ethnography can excavate the
specific, local, and contested understandings which are embedded in systems
of power relations. This is critical theory woven into the empirical detail of
ethnographic research, and provides us with case examples and quotes from
participants who can speak for themselves and describe their own experience.
Brett (2002) writes that a key assumption in ethnographic research is that
people, individually and collectively, have some understanding of the issues
they confront and that appropriate methods can elicit that understanding (p.
333). It is the intent of this study to rely on immigrant women to explain their
customs and beliefs during the postpartum period and to document and
translate those explanations in the context of a broader theoretical framework.
45


As it is most commonly used in medical anthropology, the perspective of
critical ethnography gives the researcher a framework within which to study
the relations of power that influence health behaviors. In critical ethnography,
critical concerns are inherent to the methodology, and it is this tangle of
critical theory and ethnographic methods which has given depth to this
research and expanded it beyond the limitations of pure description.
Critical medical ethnography
Critical medical anthropologists have embraced contemporary social
theory and have applied the principles of critical theory to scholarship
which is relevant to health and health care: Paul Farmers (1992, 1999, 2005)
studies of AIDS in Haiti, Nancy Scheper-Hughes (1992) study of infant
mortality in Brazil, Philippe Bourgois (1996) study of drug addiction in the
barrio in New York City, and Margaret Locks (2002) study of organ
transplants in Japan are several of the most influential studies in critical
medical anthropology. These scholars have defined the project of critical
ethnography as studying the embodied effects of power (cited below), and
they have set a precedent for the analysis of how power operates to influence
perceptions of the body, experiences of health and illness, and the physical
manifestations of social power on and in the body (Singer 1990, Singer and
Baer, 1990).
46


Contemporary social theory argues that we learn about the body
through socially defined cues and messages, and that we integrate and
negotiate varied understandings of health and illness through a complex
interplay of structural influences and personal agency. Critical ethnography
proposes that cultural traditions (like la cuarentena) should be traced to/
connected to systems of language, knowledge and power that shape
understandings, influence behaviors, and that limit and/or expand the capacity
for personal choices.
Contemporary scholarship in anthropology proposes that the defining
contributions of critical ethnographic research are a) to expose how power
operates in specific contexts to perpetuate existing inequalities, and b) to
expose/ explore examples of sites of resistance to structures of power in those
contexts. Critical ethnography builds on the foundation laid by post-
structuralism by arguing that the study of difference will reveal relations of
power and coercion, and the process by which oppression operates... it is the
study of how power operates and how knowledge is shaped in the local,
specific details of a particular time, place and cultural context. The research
process involves the analysis of how systems of language, knowledge and
power influence particular situations that are grounded in the lives/ lived
experience of real people. The research relies on careful documentation of
empirical data, based on interviews, participant observation, and giving
47


voice to participants to speak for themselves. The analysis then involves
using a historical perspective to contextualize the ethnographically visible
in the deeper structures that generate or perpetuate poverty and inequality
(Farmer 2004, p. 323). While the analysis tends to focus on forces of coercion
and structural sources of authority, there is also an exploration of sites of
resistance an emphasis on personal agency, and the many examples of
personal acts of resistance against coercion or control. William Dressier
(2001) refers to this as the relationship between structure and construction,
and argues that the promise of medical anthropology lies in its ability to create
a third moment (in the tradition of Bourdieu) a synthesis of structuralist
and constructionist perspectives that studies how individuals are situated
within and constrained by social structures and how those individuals
construct an understanding of and impose meaning on the world around them
(p.455).
Scholars invariably address structure and agency, the two parts of this
process, in unequal ways depending on their focus of study. For example,
Paul Farmer tends to focus on historical and structural forces which affect the
incidence of HIV/AIDS infection and treatment. He writes that a thorough
understanding of the epidemics of AIDS and tuberculosis in Haiti or
elsewhere in the postcolonial world requires a thorough knowledge of history
48


and political economy (2004, p.305). He goes on to refer to the importance
of:
linking the interpretive project of modem anthropology to a historical
understanding of the large scale social and economic structures in
which affliction is embedded. The emergence and persistence of
these epidemics in Haiti, where they are the leading causes of young
adult death, is rooted in the enduring effects of European expansion in
the New World and in the slavery and racism with which it was
associated. An.. .anthropology of these and other plagues moves us
beyond noting, for example, their strong association with poverty and
social inequalities to an understanding of how such inequalities are
embodied as differential risk for infection (p. 305) (my emphasis).
In contrast, Donna Goldstein (2003) focuses on personal agency, and
exposes humor as a site of resistance in the lives of the women she studied in
the favelas (shantytowns) in Rio de Janeiro. Goldstein focuses on how
women subvert authoritative influences through dark humor, and leam to cope
with the effects of hardship, poverty and deprivation:
This book, then, at its core, is about power relations and how they are
experienced by the poor. Humor emerged as one of the organizing
themes but not the central focus of this study because it is where a
particular kind of communication and meaning-making takes
place.. .Humor is one of the fugitive forms of insubordination (p. 5).
From her perspective, ethnographic detail could reveal how power was
experienced and diffused in the local life of Rios favelas. It becomes a study
of how the historical affects the physical how historical processes end
up affecting the physical experiences of womens lives:
49


Here, despite their heavy and direct impact, these state and global
processes often seem detached and oddly indirect; they appear most of
the time as vague, burdensome shadows, becoming solid and real
only through the routine and visceral engagements with the embodied
effects of power, humiliating encounters with police, standing in line
at the emergency room with a deathly sick child, visiting a friends
relative in prison... the contemptuous gaze of a police officer, or the
dismissive gesture of a well-meaning but overworked doctor (p.2)
(my emphasis).
These studies, focusing on the embodied effects of power inform our
understanding of structure/ agency and coercion/ resistance. Central to this
type of research is an analysis of class, race, ethnicity, and gender the
analytical lenses of contemporary social theory. Studied together, they are the
social forces which shape the lives of those who live in poverty, and form the
basis of any social analysis in critical ethnography. But these tools of social
analysis ultimately lead us to the need for a more nuanced analysis as well -
the study of the less overt, more hidden and insidious forms of power which
shape perceptions and understandings through the control of knowledge.
In a published commentary on Farmers theories of structural
violence, Phillippe Bourgois and Nancy Scheper-Hughes (2004) make an
argument for critical ethnography to include an analysis of more subtle forms
of discursive power:
Most of anthropologys traditional subjects survive precariously as
second- and third-generation rural-urban migrants in urban
shantytowns or as the land-poor, physically ailing post-slave peasants
that Docte Paul (Farmer) treats in his clinic. Structural violence
consequently, is a crucial concept for understanding their life
50


experience, but its relationship to other forms of violence and power,
including discursive power, must be clarified lest our analysis become
too linear and deterministic. .. .We need to specify empirically and to
theorize more broadly the way everyday life is shaped by the historical
processes and contemporary politics of global political economy as
well as by local discourse and culture. To be useful ethnography must
be attuned to the local... This requires an embodied carnal
ethnography.. .by anthropologists who model themselves after the
barefoot doctor but remain true to the requirements of a barefoot
anthropology (Scheper-Hughes 1995). (p. 318) (my emphasis)
In other words, it is not enough to ground our analysis in political economy -
not even enough to rely primarily on the lenses of class, race, ethnicity and
gender we are encouraged to take our critical ethnographic analysis yet one
step further: To expose the various ways in which discursive forms of power
shape how the body is experienced and imagined.
La cuarentena as a site for the practice of engaged critical ethnography
La cuarentena is seen as a site for the critical study of how both
macroeconomic (structural) and discursive forces of power operate to
influence health behaviors for immigrant families during the
postpartum period.
La cuarentena is seen as a site for the descriptive study of the
postpartum period, documenting the beliefs and practices of family
traditions during recovery.
La cuarentena is seen as a site for the exploration of the authority
behind traditional knowledge.
51


La cuarentena is seen as a site for the study of agency and resistance:
women actively participate in creating culture.
This study examines la cuarentena as an example of how cultural
(re)production works. Seen as an exercise in practice (as influenced by
Bourdieu), it is an exploration of how structural inequalities are manifest in
the post partum period:
Bourdieu stressed that structured inequalities play out ubiquitously in
the most mundane and habitual aspects of daily life the division of
labor, the physical structure of the house, the rules of etiquette and
speech, the daily schedule and monthly calendar, the rules of marriage,
and so on. The unequal effects of these practices in the social world
were as ingrained, persistent, and difficult as they were important to
expose. Practice ... was thus dedicated to the critical illumination of
the unequal results of structural orientation as they played out in the
lived time and symbolic space of concrete social action. (Knauft 1996,
P- H3)
In the basic social science literature, cultural reproduction is defined as the
transmission of existing cultural values and norms from person to person/
generation to generation and involves the perpetuation of and performance of
learned patterns/ customs. In contrast, cultural production is defined as the
ways that individuals as social agents resist existing structural constraints to
impose meaning on their own experience, constructing explanations and
systems of meaning, and creating new understandings. It is important to
acknowledge the depth of meaning held in these terms, as they have been
shaped by the scholarship of several decades of social scientists, but it is
52


beyond the scope of this study to effectively address their full complement of
meanings. In terms of cultural reproduction, some of the varied historical/
scholarly influences have been:
a) the structuralist emphasis on language and semiotics, which saw
language as the underlying structural system that determined all
social and cultural understandings (Fillingham, 1993).
b) the Marxist emphasis on cultural reproduction as inextricably linked
to the reproduction of class structure and class identity. Marxist use of
the term relates primarily to social class and the structure of material
life:
...reproduction as the activities and relationships involved in
the perpetuation of social systems... the perpetual processes of
production-circulation- consumption- production that account
for the ability of social systems to endure over time (Browner
1996, p. 221).
c) Bourdieus emphasis on understanding social reproduction in terms
of competition for various forms of capital (economic, social, cultural,
and symbolic capital), exchanges which are dependent on class
distinctions and the reproduction of class based understandings. From
this perspective, social actors are seen as learning/ revealing their
social class through their habitus, their feel for how to behave
socially which they learn from their cultural milieu. They perform
their class identities, and as representatives of their social classes are in
53


conflict and competition for material, cultural, social and symbolic
resources (Harker, 1990).
d) Gramscis emphasis on hegemony, and the process by which the
dominant classes enlist the complicity of subaltern groups by defining
and shaping their understanding of the world in certain ways (Crehan,
2002). The significance of Gramscian theory is reviewed further in
Chapter 8, in the final discussion.
During la cuarentena cultural reproduction involves a multiplicity of
forces that collide (and collude) to guide the new mother in the post partum
period. These opposing forces operate through language, the reproduction of
class identity, the acquisition/ loss of various forms of capital (particularly
social capital), subtle understandings related to habitus, and the powerful
authoritative discourse(s) of tradition and biomedicine.
How individuals respond to / resist these opposing forces of
structural authority is considered a process of cultural production. In terms
of cultural production, this study attempts to capture the fragmentary,
evolving and negotiated understandings of women who are in the process of
building their identities, beliefs, and understandings post partum. They are
engaged in defining their maternal role and identity in a shifting and
multifaceted cultural environment. The study is influenced by a post-
54


structuralist emphasis on cultural (re)production as a shifting and contested
process of constructing collective identity. (Knauft 1996, p. 44)
In this study, I begin from an assumption of la cuarentena (and post
partum recovery) as both naturally and culturally produced (McElroy, 1990),
and build a critical analysis of la cuarentena as a process of cultural (re)
production which is influenced by authoritative knowledge. The dynamics
which shape la cuarentena are both unique and universal, and ultimately
create a shared but individually defined understanding of post partum
recovery within the context of Mexican immigrant experience in this time and
place.
55


CHAPTER 3
METHODS AND STUDY DESIGN
Research questions and Specific Aims
The research questions guiding the study are as follows:
How does observance of la cuarentena shape families behaviors,
beliefs and social roles during the postpartum period?
How is authoritative knowledge understood by immigrant women and
their families, and how do they negotiate between tradition and
biomedicine during la cuarentena?
Four specific aims address these research questions:
Aim 1: To document and describe the behaviors associated with la
cuarentena among Mexican immigrant women, specifically those behaviors
related to social support, clothing, diet, bathing, and sexual practices.
Aim 2: To explore the underlying beliefs and values that motivate the
behaviors of la cuarentena.
Aim 3: To study how the customs of la cuarentena provide the new
mother with essential social support, and shape the acquisition of the maternal
role and responsibilities.
Aim 4: To study the construction of authoritative knowledge and how
women creatively produce unique understandings, integrating traditional
understandings with biomedicine during la cuarentena.
The following figure displays the overall design of the research, which
is an examination of two primary research questions using ethnographic
methods, including participant observation and repeated in-depth interviews
with a select group of study participants. Analysis involved ongoing
56


identification (through documented field notes) of common themes and
domains which relate to the research questions. Findings are divided in two
parts: one product of this research is a conceptual model / poster which
describes the common practices of la cuarentena\ a second and more
theoretically oriented critique of la cuarentena addresses the role of
authoritative knowledge postpartum.
3
a
3
3
a.
5'
CTQ
c/i
P
3
Cl
<
O
2.
3
o
p
o'
3
3'
-1
<
C)
3?
P
3
a.
3
o'
p
3
Figure 1: Overall research design
57


This model illustrates that the studys research question and specific aims
were addressed through the use of participant observation during home visits,
and a series of focused interviews. Participant observation provided a
contextual lens which informed the interpretation of interview data. Three
interviews were designed to roughly address the four aims in sequence, with
allowances for overlapping themes but with the intent to divide the interviews
generally by topic area. Specific details about the interview process are
included below (Table 3). After the first interview, preliminary analysis of the
recorded data allowed for the testing of emerging findings. These findings
influenced the questions asked during subsequent interviews and allowed me
to clarify any points that I had not clearly understood. Data management and
analysis proceeded as outlined below, and the findings were subjected to a
confirmation and verification process, which involved discussing the findings
with bicultural key informants and experts from various backgrounds. The
assessment of responses to sources of authoritative knowledge is the
theoretically oriented concern of this research, and the findings / conclusions
reflect this primary focus.
Participant Observation
In my work as a public health nurse, doing home visits with recent
immigrant families over the course of seven years, I informally witnessed the
ways that families responded to the cultural frame of la cuarentena. In my
58


work, I visited with each family over the course of a three year period,
developing close and long-term relationships with approximately 75 families.
Over time, I could see that la cuarentena often influenced how families
organized and understood the postpartum period. Many families planned their
lives around the forty days of recovery, not just the logistics of visits and
family support, but also the ways that they understood the body, physical and
emotional recovery, and transition to motherhood. I observed as they
navigated their way through these six weeks, and I was impressed with how
they ultimately came to terms (individually and collectively as families) with
different ways of understanding the importance of la cuarentena and all of its
implications. As a clinician, my role was clear and there was no mechanism
for me to study, document or formalize my very informal observations of
immigrant families during this important time. With the opportunity to
perform more structured research, I welcomed the chance to transform my
role from nurse to researcher, and while I carried my previous knowledge and
observations with me, I carefully put aside my years as clinician and focused
on becoming an ethnographer.
In the context of this study I had a series of two or three interviews
with each of the women who were the primary study participants. Including
their family members who also participated in interviews, the number of
participants in the study totaled 40 individuals. The depth of familiarity I had
59


with the study participants was much less than I had had previously with my
clients, who knew me well over the course of several years. At times I felt
that while the conversations I had with study participants were carefully
structured, recorded, transcribed and analyzed, they were often less
meaningful, less intimate, somewhat more superficial than the unrecorded,
undocumented, informal conversations I had with my clients. I did my best to
let my experience with families in the past inform my understandings, without
undermining the formal data collection process. To the study participants I
was a researcher, not a nurse and the distinction between these two roles
was very clear. The study was designed to be a robust and systematic
exploration of la cuarentena, and ethnography (unlike clinical practice)
provides a formal methodology for documenting cultural practices, as well as
studying them within the framework of critical theory. As much as possible, I
have tried to make the roles of clinician and researcher complementary rather
than conflicting, and have gone to some effort to keep these roles separate and
distinct. But because ethnographic research depends on the researcher as the
primary tool of data collection, I have tried to be transparent and deliberate as
I transitioned from nurse to researcher, while still integrating the observations
and understandings from each of these roles.
60


Recruitment of participants
Selection of study participants is central to the ethnographic approach.
Participants, or interviewees are people who are knowledgeable about the
studys area of interest, and can explain events or behaviors that the observer
has witnessed. They help the researcher understand what is happening and
why (Patton 2002). The women in the study elaborated on their own
experiences during la cuarentena, and interviews focused on addressing how
women and their families individually understood and expressed their
understandings of postpartum recovery. The study also used key informants
who are bicultural, or cultural experts (such as bicultural case workers) to
provide additional insights and perspectives. Key informant interviews were
used to identify, confirm and clarify the core behaviors and beliefs that are
relevant to the observance of la cuarentena.
Approximately twenty extended families participated in the study as
interviewees (40 individuals, including the new mother, her caregiver and/or
partner, and the bicultural experts/ key informants). The decision to recruit
this number of families is based primarly on the following: the size of similar
ethnographic studies reported in the literature (Niska, Clark, Zepeda) which
base their findings on interviews with 25-30 individuals; a careful assessment
of having reached saturation, and finding repetition of responses; and the
number of interviews that was realistic within the project timeframe.
61


Families were chosen who consented to discuss their knowledge,
beliefs and customs in a series of formal interviews, as well as allowing the
researcher to informally observe them in their homes during home visits. The
primary interviewees were women who have come to the US from Mexico
within the last two years, who were pregnant at the time of the first interview,
and who were planning to observe la cuarentena after the birth of their child.
Other interviewees included the partner/ husband/ father of the child, and the
maternal caregiver (which varied it was the mother, mother in law, sister, or
other female family member).
Eligibility criteria for participation were intended to minimize the
confounding influence of acculturation on the beliefs and attitudes of recent
immigrants (Table 1). Inclusion was based on womens recent arrival in order
to minimize the effects of memory loss and distance from her culture of
origin. Women who expressed no knowledge of or interest in observing la
cuarentena were excluded from the study. In this sense the sample included
only relevant informants, chosen for their traditional practices and
perspectives. In the course of the recruitment process it was observed that this
arbitrary length of time (2 years in the US) was not relevant to womens
investment in the traditional practices of la cuarentena. There were a
significant number of women who expressed interest in participating in the
study, and who had been in the US for up to 10 years, having their third or
62


fourth child, who were engaged in practicing la cuarentena as carefully as
possible. Because of this the exclusion criteria was relaxed somewhat, and
while a core group of five families were studied according to the original
criteria, other families were included and interviewed who had been in the US
for longer periods of time. Adult women above the age of 18 were the focus
of the study, and no children or teens were included in the sample.
Table 1. Inclusion/ Exclusion Criteria
Eligibility Criteria for key informant interviews Exclusion Criteria for key informant interviews
1. women aged 18-40 2. reported Mexican ethnicity 3. pregnant at first interview 4. both primiparous and multiparous mothers will be included 5. arrival in US within last two years 6. Spanish speaking 1. no knowledge of or interest in the customs of la cuarentena 2. child(ren) deceased/ not living with mother 3. any child in critical care after delivery, precluding enactment of la cuarentena 4. English speaking 5. multiple visits/ stays in the US that cumulatively exceed 2 yrs duration
Potential informants were identified by prenatal care providers at a
community health center, Clinica Campesina in Boulder County, based on
information and training given to the providers by the investigator. Clincia
Campesina is a publicly supported non-profit agency which reported in its
development literature in 2008 that 65% of its clients are Spanish speaking;
98% live at or below 200% of the poverty level, and 69% identify as Mexican/
Latino/ Hispanic. Administrators at the clinic provided logistical support for
63


this study and prenatal providers were extremely helpful in identifying study
participants.
Prenatal care coordinators at the clinic were oriented to the purpose of
the study, the inclusion and exclusion criteria were explained, and they were
provided with materials in Spanish for use in explaining the study to potential
participants. If a potential interviewee expressed interest in participating, she
was asked to sign a preliminary form confirming her interest and providing
her contact information. The researcher then followed up with a phone call or
meeting, describing and clarifying the expectations for informants, and
explaining that not only the woman, but her husband and caregiver would be
asked to provide informed consent. They were assured of confidentiality, and
the identities of participants were protected by the use of first names only in
verbal communications and on all written materials. This protocol was
approved by the University of Colorado Human Subjects Review Committee
(#2008-115).
The families that participated in this study lived in Boulder County, in
the cities of Boulder or Longmont, Colorado. All were immigrant families
who had been in the US for anywhere from 6 months to 8 years. The mean
age of young mothers was 28 years, the mean age of the older generation of
maternal caregivers was 60 years. The young mothers had a mean educational
level of 9th grade, some had been through college and several had only
64


attended school through the first or third grade. The older generation of
maternal caregivers also ranged from having no formal schooling to
completion of high school, the mean educational level for the older women
was through the 6th grade. All of the families had at least partial employment,
though several families experienced temporary unemployment during their
time of participation in the study. Because they were recruited from programs
with eligibility requirements of income levels at or below 200% of the poverty
threshold, 100% of the families participating had incomes at these 2008 levels
(less than $20,000 for a family of 3-4). None were agricultural workers, all
were employed in the service sector (restaurants, hotels, automobile repair) or
construction. All of the families spoke Spanish as their primary language at
home, and during the interview process though several of the new mothers
and their partners were trying to learn English and were actively involved in
language lessons. Most of the participants (78%) identified themselves as
coming from a rural area, even though several of them had moved to large
cities early in their lives. Only 22% identified themselves as being from or
growing up in urban settings.
65


Table 2. Demographic description of families involved in the study
Demographic Indicators Sample description: n = 40
New mothers: 23
Female caregivers: 5
Male partners: 7
Bicultural expert key informants: 5
Maternal characteristics
First time mothers 5
Previous births 18
Mean maternal age 28 years
Mean maternal years of education 9 years (9th grade)
In US less than 2 years 5
In US more than 2 years 18
Household characteristics
Mean at 200% of 2008 poverty 100%
threshold:
Family characteristics
Spanish speaking only 100%
From urban area in Mexico 22%
From rural area in Mexico 78%
Data collection
All interviewing, data collection, transcription, and preliminary
translations were performed by me, the principal investigator. A bilingual
colleague was asked to provide translation assistance, and verify linguistic
details. Families were interviewed in Spanish in their homes, or in the home
in which they stayed for la cuarentena (sometimes this was the home of the
maternal caregiver). Details of the home environment were documented in
field notes as they were relevant to understanding the social and cultural
context of family life.
66


The interviews and participant observation began during the prenatal
period and continued through the customary forty days of recovery (Table 3).
Information was collected during three to four visits to the home. The first
visit was often very informal, though sometimes the introductory visit and the
first interview were combined. The following visits involved recorded
interviews. Information was carefully documented in field notes, as outlined
below, and the visits which focused on formal interviews also involved time
before and after the interview for informal interaction with the family and
participant observation. Ultimately it was very important to be flexible about
the sequence, content and structure of the interviews, as I needed to time the
interviews when family members were available, and accommodate their
individual circumstances and priorities. It also became apparent that some
families were excellent informants and invited extended study, while others
were less forthcoming, and our interaction was limited. The strength of
ethnographic research lies in having a clear and well-defined research plan
that can be modified to accommodate what is learned in the field.
67


Table 3. Overview of home visits, interviews, aims and methods
Timing Sample Interview Questions Aims Method
Intro During Introductions Establish Field notes
home visit pregnancy Obtain Informed consent relationship with
following Gather demographic information, / trust observations
Involved referral by including age, marital status, about setting,
all family prenatal education, community of origin, Gather basic family,
members provider family makeup. Where in Mexico do data behaviors
who were you come from? How many sisters
present do you have? Have you helped them with their recovery during la cuarentena?
First Pregnancy What does la cuarentena mean to Aim #1 Tape recorded
formal -3rd you? Can you describe the interview,
Interview trimester expectations of la cuarentena? Focused Open ended
How do members of your family interview on questions
Alone observe la cuarentena? behaviors Coded
with the How do you intend to observe this and interview
new time? Will someone from the family expectations transcript;
mother care for you during this time? Who for recovery Thematic
will that be? analysis
Second 2-3 weeks How have you observed the customs Aims #1 Field notes,
formal post of la cuarentena during the past 2-3 and #2 audio
Interview partum weeks? Considering each of these behaviors ... why do think theyre Focused transcript.
Involved important? Dietary restrictions: Why interview on Transcribed in
the new does it help to drink atoles? meaning Spanish.
mother Clothing: Why is it important to systems
and her tapar bien? Coded
partner if Bathing: How do banos de vapor interview
possible help in your recovery? Sexual transcript;
abstinence: Why is it important to Thematic
abstain from intercourse at this time? analysis
Third 5-7 weeks Why is it important to you to have Aim #3 Field notes,
formal post your mother/ sister/ husband here to audio
Interview partum care for you? What has helped you Focused transcript
the most? Do you feel ready to take interview on
Involves care of the baby alone? Who do you social Confirmation
the new trust when it comes to understanding support of quotes,
mother your health/ body? observations
and her Review of findings for confirmation Assessment
caregiver and comment. Verification of of sources of
findings with the family members, authoritative
who may not have been present at the interviews. knowledge
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As outlined in the preceding table, an introductory home visit involved
establishing relationships of trust and obtaining basic demographic and
background information about the family. The first formal interview (often
the second visit) focused on the behavioral expectations of la cuarentena, in
particular clothing, dietary, bathing, and sexual practices. This interview
focused on capturing the basic social and cultural rules regarding post partum
recovery. It took place during pregnancy, and focused on recording the new
mothers plans and expectations regarding la cuarentena. This is crucial,
because often the actual practices are less than the traditional expectations,
and many immigrant women make elaborate plans that they are unable to put
into practice. Economic hardship, family members who cant travel from
Mexico, a crying baby, and post partum pain can dampen the actual
experience of recovery. Expectations for this time can carry great anticipation
for a meaningful and important milestone, a culturally marked time of
passage to a new life stage. This is often reflected in how much women
grieve for la cuarentena that they could have had or would have if their
economic circumstances had been different, or if they had been in Mexico
where family could have more effectively supported their recovery. This
interview explored how the new mother anticipated la cuarentena, and how
she imagined it might be. At this point, I began to make observations about
sources of authoritative knowledge that might be influencing the new mother
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and her family. During the first interview I tried to elicit the informants
story and her personal history. Several introductory questions were asked
which invited her to reveal her history and where she came from, and which
asked her to describe her family circumstances, social class, and educational
background. This background information was combined with basic
demographic information to compile a profile of the woman that outlines her
age, ethnicity, urban/rural community of origin, educational level, religion,
and other relevant details of her life.
The second interview (third visit) was conducted post partum and was
intended to capture what the woman actually did in terms of the traditional
practices of la cuarentena, and why. This interview was designed to include
the womans partner (father of the child), and explored what underlying
beliefs were motivating her behaviors and informing her fears. Many women
expressed fears regarding their vulnerability post partum; understanding the
meaning systems behind those fears was an essential element of the study.
Understandings of the body and its recovery post partum were explored at
length.
The third interview (fourth visit) was intended to focus more
specifically on parental role acquisition and the role of the maternal caregiver
in modeling parenting practices. This interview was designed to include the
maternal care giver, and needed to be timed to coincide with the caregivers
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presence in the home. The young mother often learns the basic tasks of
parenthood (infant feeding, bonding, bathing) as well as the long term
responsibilities of parenthood (sexual responsibilities and child spacing) under
the influence of the maternal caregiver, and the intent of this interview was to
document the role of the caregiver in enhancing (or not) the acquisition of
maternal role responsibilities. As it worked out, this interview often focused
on the maternal caregivers personal experience of la cuarentena in her own
life. An unexpected and important finding in this process was the extent to
which older women attribute the aches and pains of aging to their own post-
partum recovery. These findings are explained in further detail in later
chapters, however it is important to note that while both caregiver and the new
mother often referenced learning about baby care as an essential aspect of la
cuarentena, the real focus of this interview was often diverted to the personal
experiences of the caregiver during her long-past experiences of la
cuarentena.
The fourth interview and final visit was designed to verify
observations regarding issues of authoritative knowledge, exploring the
sources of knowledge that are most trusted and which most strongly influence
the new mother. This was an exploration of how she integrated the
biomedical understandings from the hospital/ clinic with the traditional
understandings of her family and community of origin. Sometimes one or the
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other sources of authoritative knowledge is privileged it has been my
intention to explore why, under what circumstances, and according to what
priorities each woman favors biomedicine and/or tradition in the framing of
her post partum recovery. Also, this final interview gave me an opportunity to
verify and confirm that interpretations of the data were accurate. The
interviewee was given an opportunity to confirm my observations and
preliminary findings. The purpose of this visit was based on enhancing the
credibility of findings (Bernard 1998).
Data management
Various data streams have been managed separately. The data
collection was done in both Spanish and English. Formal interview transcripts
were left in Spanish and were not translated to English, and field notes were
primarily written in English. The coding process was done in a mixture of the
two languages. Data from taped interviews were transcribed and coded in
Word documents; field notes were often hand written, and most were entered
into Word documents. All interview transcripts and field notes were coded,
and emerging themes were tagged and points which required follow up or
clarification were noted in research memos. Experienced ethnographers stress
the importance of having a carefully structured protocol for recording,
organizing and coding field notes (DeWalt and DeWalt 2002, Brett et al.
2002). The protocol involves structured time immediately after visits to
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review and annotate notes, record observations, expand on details, fill in
missing words, put observations in context, and finish cryptic quotes and
notes that were hurried during the visit. The protocol also involves structured
documentation, for example organized research memos which build
observations and hypotheses over time. These protocols were very useful in
the management of extensive amounts of data in two languages. As much as
possible, I have tried to organize all of my formal and informal observations
into one accessible program filing system (the MAXQDA program file),
where my findings can be reviewed and verified. Files and data streams are
clearly labeled and accessible, albeit recorded in a sometimes unconventional
mixing of the two languages.
Data Analysis
Field notes from participant observation and all formal interview
transcripts were imported into the qualitative software package MAXQDA
(2009). The transcripts were downloaded into the MAXQDA program file,
and coding was done in a two-phase process. The software program allows
for color coding in four primary colors, so text was divided into four types:
descriptive information, interpretive detail, references to social support, and
inferences about authoritative knowledge. From there, the narrative was
further coded in terms of specific references within each of these categories.
In the first phase of coding, the focus is on discovery and comprehension
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(Bernard 1998), whereby segments of data in a field note, quote, sentence or
paragraph are labeled with one word codes that serve to identify a particular
theme. These initial codes reflect quotes using the informants original words,
and which capture the essential meaning of a concept, idea, or description
(Patton, 2002). In this process, each transcript is mined for codable phrases
until no new codes can be identified in the data. The initial phase of coding
followed this process, and the MAXQDA program has the capability to
provide support through the use of memos, and click and drag tagging of text
with specific codes. A list of codes is included in Table 4 below.
In the next stage of data analysis the coded segments are sorted into
families of related concepts. In this process the researcher begins to
identify major concepts or domains in the data, which can be linked back to
groups of statements or quotes from informants. When the data is mined for
all relevant domains, some are recognized to be similar or repetitive and these
can be combined. Others are recognized to have subtle differences, and the
process of identifying the concept domains may involve dissecting the data
more extensively. During the coding process contradictions and differences
are revealed, and disparate perspectives are coded accordingly. Similar
statements are grouped together, and contrasted with opposing groups of
statements. This process focuses on synthesizing the data to define and clarify
the essential concepts revealed by the informants. Predictable codes (based on
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a priori understanding of la cuarentena from clinical practice) were developed
that related to aire or drafts, feeling open, use of the faja, cotton in the ears,
wrapping up, etc. These codes were complemented by de novo coding that
represents new information (Patton 2002, Brett et al 2002), such as ideas
related to aging, and la cuarentena as a frame for older women to understand
the symptoms of aging. While the coding process began with the deductive
process of breaking narrative down into small coded phrases, it ended with the
inductive process of recognizing thematic commonalities and generating
observations which described typical behavioral and belief patterns.
Table 4. Code System
DESC (green highlighted text) AK (blue) INTERP (purple) SOCIAL (red) QUOTES (tagging of exceptional quotes) Definitions: (Que significa la cuarentena para ti?)
Authoritative Knowledge: agency hiding practices/ beliefs generational knowledge gender rules faith in tradition faith in biomed distrust of tradition distrust of biomed Interpretive: for recovery for vanity long term consequences open: spirit unprotected body open fear of illness: debil rheumos punzadas explaining aire imagining the body
Social Support: breastfeeding learning about baby partner support emotional support instrumental support strong maternal support no maternal support phone support Descriptive: rest abstinence herbs bathing sweat baths clothing: taparse fajarse
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Verification
In the final stage of data analysis, results were explored with selected
bicultural health care providers who have knowledge and experience of la
cuarentena from working with the immigrant community. They shared both
professional and personal perspectives on la cuarentena, and their experiences
working with families during the six weeks of postpartum recovery. One key
informant is a bicultural caseworker who is married to a woman from Mexico.
He has extensive roots in the Latino and immigrant communities, and
provided support and guidance for the study. Another is a bilingual
caseworker who is a first generation immigrant from Mexico. She provided
extensive review of the study findings, and confirmed their relevance to her
work with young families. A third key informant directs Spanish speaking
services for young parents, and came from Peru. She served a useful role in
confirming that the cultural expectations of la cuarentena are varied but
pervasive across Latin America. Another served a crucial role in the review
of findings; she is the director of Spanish speaking support groups for young
parents, and works with immigrant women in the perinatal period. The final
key informant had a valuable perspective because of her personal and
professional background she is a medical anthropologist who lived in
Mexico for the birth of her two children, and herself experienced la
cuarentena in the context of her bicultural family life. Because of her training
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in medical anthropology, she was particularly useful in the discussion of
critical ethnography as a theoretical perspective. The proposed findings and
conclusions, were shared with them, and their feedback elicited about
accuracy, clarity, and utility in terms of their understandings of the cultural
norms and expectations of la cuarentena.
One of the most useful aspects of the verification process was that it
led me from the somewhat fragmented process of thematic coding back to a
broader perspective and ultimately to a reliance on case histories and longer
quotes. The coding process was a fragmenting, analytical process while the
verification process served to re-integrate the data according to thematic areas.
Limitations
The strengths of this study lie in the researchers informed perspective
about the area of study, the structured interview schedule with repeated
contacts with interviewees and expert key informants, the organized and
comprehensive scope of the data collection, and the careful verification
process in place for confirming findings. These criteria, which are used to
judge the rigor of ethnographic research (Bernard, 1998) were carefully
considered in the study design and provided a strong, credible foundation for
the research.
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No study is without its limitations, and this study focuses on a small,
relatively homogenous sample of immigrants within a confined geographic
area. The personal stories of particular women are highlighted, and while
their stories are individual and unique, they are assumed to be typical of
immigrant experience in other areas.
The study did not focus on the prevalence of practices related to la
cuarentena there are many women who do not find the traditional practices
meaningful, and who do not identify with their mothers and grandmothers
experiences of the postpartum period. This study focuses less on whether/
how/ why women lose their traditional understandings during acculturation,
and more on how and why la cuarentena still matters to many immigrant
women who continue to engage in traditional understandings.
The most significant limitation of this study has been my own Anglo/
white ethnicity, and several of the bicultural expert key informants carefully
suggested that women might reveal more to a researcher who shared their
Latino/ Hispanic ethnic heritage. My hope is that this research can make a
contribution to the ethnographic record, which will then also be expanded and
enriched by researchers who come from more fully bicultural perspectives.
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CHAPTER 4
CUSTOMS AND BEHAVIORS FOR RECOVERY
The forty people who participated in this study come from a variety of
backgrounds, and each family observes la cuarentena in their own way -
similar to how families celebrate major holidays, each one engages to a
greater or lesser degree in the traditions and customs of their ancestors and
communities. Depending on a variety of both personal and demographic
factors, they engage more or less wholeheartedly in the expectations of the
forty days of recovery: they are influenced by family size (their own families
as well as their families of origin), the intimacy of their personal relationships,
their closeness to their community of origin, their own health and the health
histories of their families; as well as whether they come from rural or urban
settings, their level of education, income, and social class. Overall, it was
fairly unpredictable who would be likely to engage more fully in these cultural
practices, and it didnt always fall along lines associated with age, education,
or social class. There were very young women from rural areas who called
their mothers as often as they could to get advice about la cuarentena, and
older women with university educations who followed the customs with great
care and attention. Young men with tattoos and piercings told me of their
mothers lessons about la cuarentena, and older fathers of 3-4 children helped
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their wives with genuine respect for the special requirements of this time of
recovery. It was the older generation of women who most strongly carried the
wisdom of these traditions, and their voices come through as the strongest
advocates for respecting la cuarentena.
One of the consistent messages I have heard from US bom,
acculturated Latinas is that la cuarentena is dying out that young girls
dont do it anymore, that no one really believes in the old wives tales or the
folk remedies anymore. Several people told me that it was important to
document these practices before they disappeared. My experience with
immigrant families has been very different la cuarentena is a significant
event in the lives of most of the immigrant women I work with, and all of the
women who participated in this study saw la cuarentena as essential to their
recovery. In families where the first child was born in Mexico and the second
or third child is bom in the US, or for young women from traditional families
who are here alone, la cuarentena is a central and essential part of their
experience of birthing, and frames their understanding of recovery.
In the profiles below I have chosen to describe two very different
women and their experiences of la cuarentena. These two women were
particularly well informed about the expectations of recovery they knew
what to do, as well as when and how, to ensure their own safe recovery.
Whether guided by women family members during la cuarentena, or taught as
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young girls about these practices, Carmen and Violeta were not uncertain
about the customs; they were fully engaged in honoring la cuarentena, and
wholeheartedly embraced the traditional expectations of this time. They were
also very enthusiastic about telling me about their customs, and proud and
pleased to be part of a research process which would bring what they
perceived to be successful and healthy behaviors out in the open, because
they had felt the need to hide their traditions from their American friends, and
from health care providers who were trained in the biomedical model. This
chapter focuses primarily on the behaviors and practices of la cuarentena, and
the subsequent chapter addresses in greater depth the underlying beliefs that
motivate these behaviors.
In general, la cuarentena consists of certain key behaviors which fall
into several categories, and within each of the categories there is a range of
practices. These customs and practices fall into five broad categories: rest,
diet, clothing, bathing, and abstinence. To clarify how the customs take shape
in the lives of individual women, I have profiled Carmen and Violeta who
clearly articulate how they approached each of these areas.
Carmen:
Carmen was 25 years old when she crossed the border and came to the
US with her husband looking for work. She was the first member of her
immediate family to come to the US, though her husband (Luis) had a brother
81


here, and they stayed with him for two years. When she first arrived Carmen
became pregnant but miscarried at mid-term, and this was a loss that made her
very cautious and attentive to her own health and the tenuousness of her
pregnancies. Because of the miscarriage she learned that she had some health
complications, including a bifurcated uterus, which to her meant that her
uterus was delicate and needed special care in order to support other
pregnancies. A year later she became pregnant with her first child, who was
bom by Caesarian section; this was significant to her because it meant that her
body needed to close and heal correctly after the surgery, and she believed
that the requirements of la cuarentena after a c-section were even more
important.
Carmen was raised in a rural area, in a supportive and close family
environment, and she attended school through the 9th grade. She has a close
relationship to her mother and calls her frequently from the US, though her
mother wasnt able to travel to be with her during la cuarentena. The family
does not own a business or property, and does not have the resources to apply
for a visa, nor would Carmens mother have been able to leave her
responsibilities at home in order to make the trip, because she has younger
children to care for at home. But Carmen had learned about la cuarentena as
a child, and knew from her mothers later pregnancies how to prepare herself
for the recovery. She had her mother instruct her carefully on how to
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fajarse or how to make the vendas (the long stretchy cotton cloths that
she would use to wrap her belly), and the special herbs and remedies she
would need for her baths. Her sister in law was living with her and was very
helpful in terms of cooking, but wasnt very supportive of the traditional
practices, so Carmen arranged most of it ahead of time and prepared her
husband to be her primary caregiver.
Rest: One of the most common phrases used to describe la cuarentena
is that it is Uun tiempo de reposo or a time of rest. This time of rest and
relaxation is often seen as a luxury, and depends on having a caregiver who
can tend to the new mother, and bring her food, help her with bathing, and
perform all the household chores. Carmen reported that she missed her
mother most during this time, because she felt guilty about lying around, and
if her mother were there, she would feel more entitled to rest and let things
go (household responsibilities).
L: Carmen, dime por favor que significa la cuarentena para ti.
C: Pues, mira. La cuarentena para mi es la tradicion es de estar casi la
mayorla acostada en cama...
L: iLa mayorla de la cuarentena en cama?
C: Hacer el ejercicio lo menos posible. Nada mas dedicarse uno a cuidar su
bebe... en la cama nada mas cuidando al bebe. Las primer as semanas no lo
podia es un poco mas doloroso. Luis lo banaba, lo cambiaba, y me ayudaba
a mi banarme. Aqui trata de cuidarme lo mas que pudo, con los costumbres
de alia de Mexico aunque no es lo mismo.
L: Carmen, could you tell me what la cuarentena means to you?
C: Well, look. La cuarentena for me is the tradition of being almost the
whole time lying in bed.
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L: Most of la cuarentena in bed?
C: Doing as little exercise as possible. Just dedicating yourself to the care of
your baby... in bed, just taking care of the baby. The first weeks I couldnt
even do that [care for the baby] when its more painful. Luis bathed him
[the baby], and changed him, and helped to bathe me. Here he tried to care
for me the best he could, like the customs of Mexico even though its not the
same.
Carmen reported memories of her own mother giving birth to younger
siblings, and her mother stayed in her bedroom with the shades drawn for the
whole 40 days. Carmen told about how this was her frame of reference she
remembered caring for her sister during la cuarentena, when her sister wasnt
allowed outside the house, and she stayed in her room with the baby for most
of the six weeks. The family cooked for her, and she was dependent on them
for everything. Carmen reports that if she were in Mexico, she would spend
la cuarentena at her mothers house:
C: Si estuviera en Mexico, pues horita apenas me estuviera agarrando mis
actividades nor males. Despues de un mes... estuviera apenas cocinando,
encargandome y pues al cien por ciento totalmente de mi familia. Porque ya
pues lo lavan a uno alia, pues le hacen a uno de comer. ... Yoy Luis pues
nosotros pues toda la cuarentena alii con mi mama.
C: If I were in Mexico, well just now I would be getting back to my usual
activities, after one month. I would just now be cooking carried like one
hundred percent by my family. Because there they wash/ bathe you, they
make you food to eat. Luis and I well we would spend the whole
cuarentena there with my mom.
The connections between resting and being cared for by family members are
explored further in Chapter 6, focusing on social support.
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Diet: Central to la cuarentena is la dieta, referred to as a soft diet,
with no food associated with hot or cold features. While the diet varied
greatly among families, there were two basic foods that were always
mentioned, atoles (sweet drinks made of grains, e.g. cornstarch, rice or
oatmeal) and caldo (broth). While some women were stricter with the diet, all
of the women in the study agreed that these two foods provided important
benefits for the new mother. They provided the mother with nutrients needed
for healing, and they increased her milk production. The diet was seen as
essential for the mother because her digestive system was delicate postpartum,
and also for the baby because it is generally understood that everything is
passed from mother to baby through the breast milk.
LW: iQue tomes tu durante la cuarentena?
C: Los atoles, los caldos, mas que todo caldo de polio. Casi... pues, sopa de
verdura, casi cosas caldosos. No mucha comida seca. Si come uno came,
pero casi la mayorla puros caldos.
L; i Yque tipo de came?
C: De res, casi como yo de cesarea de puerco no. Que pasan unos 22 dlas,
si comere puerco. Pero la mayorla casi de polio y de res. Y sea la came
azada o sopa de arroz, pero casi la mayorla mas caldos, caldo de polio, caldo
de polio.
L: iJe cansas de caldo de polio?
C: Si... (risas)
L: Pero sigues tomdndolo...
C: Pues, es lo que casi come uno mas. Caldo de polio.
L: iCon arroz, confideo... opuro liquido?
C: Puede ser con fideo, con arroz, varia cada dla...o el puro caldo con las
verduras.
L: Ycon sal, pero no con chile...
C: NO, con chile no, y tampoco con frijoles... No come uno frijoles como por
unos dos meses. Ni aguacate, ni chile. ...El comer asl, una dieta especial, es
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para uno mismo, y tambien para el bebe, si le esta dando uno pecho. Porque
si come uno... como... a uno le hace daho el aguacateporque al bebe le dan
colicos. O come chile uno, al bebe le dan colicos. Espor el bebe... que le
dan colicos. Tambien la dieta viene para el bebe.
L: What do you eat during la cuarentena?
C: Atoles, and chicken broth. Thats it, practically vegetable soup, and just
types of soup. Not much food that is dry. Sure you eat meat, but mostly in
soups.
L: And what type of meat?
C: Beef, but since I had a caesarian, no pork. After 22 days have passed, yes
Ill eat pork, but mostly chicken and beef. Maybe the meat is fried or in a
soup, but mostly just more chicken broth, chicken broth.
L: Do you get tired of chicken broth?
C: Yes (laughter)
L: But you keep eating it...
C: Well, thats what you eat more than anything, chicken soup.
L: With rice, or noodles, or just the broth?
C: It could be with noodles, or rice, it changes every day, or just the broth
with vegetables.
L: And with salt, but no chile...?
C: NO, not with chile, or with beans. You dont eat beans for about two
months. Or avocado, or chile. Eating like this, this special diet, is for yourself
and also for the baby, if youre breastfeeding. Because if you eat... like...
avocado, it is bad for you, and gives the baby colic. Or if you eat chile, it
gives the baby colic. Its for the baby, because they get colicky. So the
special diet is for the baby too.
Carmen described some of the more serious consequences of eating cold or
frozen foods:
C: No, cosas heladas en la cuarentena, no. Aqul a uno se le hace asl feo,
porque en el hospital le dan a uno agua con hielo. Yno... no debe uno alll en
Mexico, no. Algo frlo nada. Puro calientito. Le puede dar a uno punzadas,
un dolor de cabezapero fuerte...se siente uno como que los oldos se
revientan. Pero como le da a uno bastante sed, y hay que tomar algo, deben
de saber que no tomemos agua con hielo.
C: No things that are frozen during la cuarentena, no. Here it seems really
strange and hard for us, because they give you ice water in the hospital. And
no, youre not supposed to, there in Mexico nothing cold nothing.
Everything warm. It (ice water) can give you pulsing headaches a headache
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that is really strong. It feels like your ears are bursting. And you get so
thirsty, well you have to drink something, so they need to know that we cant
have ice water.
She also referred to the importance of having food prepared for you:
C: Cuando es cesarea, uno no debe de hacer cara a la estufa, al alumbre. No
cocinar.
L: iiEs solamente para descansar -o es porque te hace dano?
C: SI, por lo de la herida. Tarda unpoco mas, o sepuede abrir... y si se
acerca uno al alumbre. El alumbre se hace dano... eso es... no cocinar por lo
de la cesarea... Pues alia en Mexico es los cuarenta dias no cocinar... Pero
aqui lo mas quepueda uno, yyo no mas unos quince dias... cocino lo menos
que puedo.
C: When you have a c-section, you shouldnt face the stove the fire. You
shouldnt cook.
L: Is that simply to rest or is it because it does you harm?
C: Yes, its because of the wound (incision). It takes a little longer or it
could open... and if you get too close to the heat, the heat can harm you...
thats why you cant cook because of the caesarian. There in Mexico its the
whole 40 days without cooking. But here you do the best you can, and I had
only 15 days, and now I cook as little as possible.
Clothing: Covering the body during la cuarentena is described as an
essential feature of recovery. Women reported covering the entire body in
order to keep out drafts or which can enter the body when it is opened
and vulnerable after delivery. They also told of the importance of keeping
warmth in the body, and not letting it out. Wrapping the body takes two
forms the use of regular clothes (sweatshirts with hoods, winter hats, warm
socks, shawls) to cover the body carefully (even in summer), and the use of
girdles or cloths to wrap the abdomen tightly (fajarse). Carmen (like almost
every other woman in the study) wore a hoodie regularly during la
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cuarentena. This is a warm sweatshirt that zips up the front, and has a hood.
When she left the hospital to go home after her delivery, she put cotton in her
ears so that drafts could not enter there, and she wore the sweatshirt with the
hood up to cover her back and neck. She reported feeling worried that the
hospital floor was so cold, and she couldnt touch it with bare feet, so her
husband brought her warm slippers to wear. She put the faja on as soon as
she could, and kept it on for the full 40 days. Keeping the body warm and
protected after the delivery is seen as a way of avoiding serious illness:
C: Tiene que cuidarse uno cuando sale uno -pues abrigarse uno lo mas que
pueda. Mas que todo, cuidarse la espalda, porque es para la leche. Si sale
uno asl muy descubierto de a los pocos dlas se le seca uno la leche. No tiene
uno la leche. Aunque haga uno cosas o asl, entonces se le seca uno la leche.
Eso tambien es para casi la cuarentena. Es una parte para la bebe, y una
parte para uno.... Uno cubre los oldos, o se pone algodon en los oldospara
que no se entra el aire... para laspunzadas -para que no le de uno esos
entuertos dolor de huesos y todo eso. Tambien los pies descalzo, el piso
frlo le dan a uno reuma dolor de huesos y sale uno varices. Se le llama
uno eso como flebitis.
L: iCon todo hinchado?
C: Si, eso es lo frlo.
C: You have to take good care (be careful) when you go out and cover up
as much as possible. More than anything, you have to cover the back because
thats for the breast milk. If you go out without a wrap, in a few days your
milk will dry up. You wont have any milk. Even though you do whatever
else later, your milk will still dry up. (Covering up), thats also for the entire
40 days. Its partly for the baby, and partly for yourself. You cover your ears,
or put cotton in your ears so that the drafts cant get in, because of the
headaches and so that you dont get the aches and pains in your bones, and
all that. Also the feet without socks, on the cold floor it gives you aches
and pains like reumos, achey bones/ joints, and you get varicose veins. Its
called like phlebitis.
L: So everything gets swollen?
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C: Yes, thats the cold.
Like many other women, Carmen felt that wrapping the abdomen
tightly would help her extended belly contract and regain its shape and
strength. This tightening of cloths around the abdomen is referred to as
fajarse', and most commonly involves the use of a commercial girdle. But
there are various types offajas, for example traditional vendas are home-
made, and they vary from being soft, stretchy fabric to being strips of
bedsheets that are used to wrap up the lower abdomen. The cenidor is not as
common, and is a narrow strip of cloth bunched up to be more rope-like and
wrapped tightly around the upper abdomen (under the ribs). Many of the
women told me that they only use girdles now elastic or spandex girdles that
are designed to pull in the abdomen, and are sold as womens underwear. But
the concept of the faja is more than just a form-fitting girdle, and many of the
women combined vendas (long cloths) with fajas (girdles) to ensure that the
abdomen was secure and tightly held. When asked about what la cuarentena
meant to her, it was one of the first things Carmen mentioned:
C: La cuarentena, es de cuidarse uno a si mismo y dedicarse uno a cuidar su
bebe. Ypues, es de fajarse uno cuando se acaba de aliviar uno -ya sea
normal o cesarea, fajarse uno con una venda. La venda que es ancha...
L: i Y elastica o no?
C: Pues, fajarse durante casi los cuarenta dlas. Y si no es cesarea, igual
despues ponerse una venda de calzon de esas que venden en la tienda, de
eldstico. Y estar aslfajada, lo mas apretado que se pueda, le ayuda mucho a
uno... parapoderse uno moverse mejor.. o agarrar unopoco mas cosas. Le
ayude a uno para dar apoyo. Porque asl sin faja, pues no! es mas dificil, y
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camino un poco mas lento. Se agacha uno con mas esfuerza, con la faja le
ayuda a uno.
C: La cuarentena, its about taking good care of yourself, and also dedicating
yourself to caring for your baby. And well, its about wrapping the abdomen
- right after you deliver whether its a normal delivery, or c-section,
wrapping the abdomen with the venda, the kind that is wide.
L: Is it elastic or not?
C: Well, you have to wrap up for the full forty days. And if its not a c-
section, you put the venda on just the same at first, and then on top a girdle -
the kind they sell in the store, with elastic. And to be wrapped up like that, as
tight as possible, it helps you a lot... so that you can move better, and you can
reach more things. It helps by giving you support... because without the faja
- no! its more difficult, and I would walk more slowly. It holds you in
tightly, and the faja helps out.
Carmen demonstrated how she put on the faja right after her delivery she
had a long wide cotton strip of cloth which was slightly stretchy (thicker than
cheesecloth, but loosely woven and slightly wider). She folded the long strip
of cloth in three parts, and laid it on the bed. Then she laid down on top of it,
and her husband (who was her main caregiver in la cuarentena), wrapped it
around her as tightly as she could stand it, and then clasped the ends and the
layers together with safety pins. It ended up being like a wide ace bandage on
her belly, from under her ribs to her hip bones. Because of her incision, she
also had a dressing on the lower belly, and the venda held the dressing in
place. Later, when her incision was mostly healed, she held the venda in
place by putting an elastic girdle over it, and the girdle gave her even more
tight support and held her belly in. One common type of elastic girdle is a flat
strip with hook and eye clasps in front, and covers the abdomen from under
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the ribs to above the hips, so it is the same shape and size as the venda and
easily goes over it. Carmen felt that it was very important to have the faja on
from the moment of delivery, but she was told not to put it over her incision.
Her story of arguing with the nurses about this will be repeated later, but
merits reviewing in the context of her particular story of the faja:
C: Me iba a fajar pero no me dejaban (en el hospital). Dijeron que no era
recomendablepor mi herida estar fajada. El medico me dijo, yyo dije ok,
pues me la quite... pues asl es en Mexico , dije. Pero ok me la quito.
Entonces ya lo que hice fue que cuando salio el medico, y que me dejaron de
atentos, me faje otra vez. Entonces la enfermera me dijo otra vez que no era
recomendable fajarme. Bueno y otra vez la dije ok, esta bien No mas le
dije que si, pero de todos modos yo me faje. En cuando ella se fue, yo dije a
Luis fajame rapido , porque si no, no me van a dejar .. Yo no voy a poder
bajar, caminar, y subirme al camioneta.. Sera algo malpara ml con la
herida... Y ya, me faje.
C: I was going to wrap up (from the beginning) at the hospital but they
wouldnt let me. They said the faja wasnt recommended because of my
wound. The doctor told me that, and I said ok, and I took it off... thats
what we do in Mexico, I said. But ok, I took it off. Then what I did was
when the doctor left and they werent paying attention, I put it back on. Then
the nurse came in and told me again that it wasnt recommended to wear it,
and again I said ok, thats fine. I just told her that, but at any rate I wrapped
up with the faja. When she left I said to Luis help me quickly, put the faja
on, because if not, they wouldnt let me. And there was no way I was going
to walk downstairs, walk outside, and get up in the truck without the faja it
would have been really bad for me with my wound. So yes, I wore my faja.
Bathing: Carmen was one of the women who paid special attention to
baths and bathing during la cuarentena. A number of women expressed
regret that they couldnt bathe correctly during la cuarentena, but Carmen
carried through with her plans, and made sure to have everything she needed
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