Adele Vitale, South Korea
Adele Vitale is a Certified Birth Doula and Childbirth Educator (CBI) as well as a Dunstan Baby Language Instructor, and a Trainer for the Labour Doula and Childbirth Educator certification courses offered by Childbirth International. After completing her education as a conference interpreter and translator and spending several years in administrative management for international companies in China, she moved to Korea and found her true calling: helping couples get the birth they are hoping for, whether they live in Seoul or anywhere else in Korea. Adele currently lives in Gimhae with her Korean husband and their two daughters.
Introduction
Can you give me a little background on yourself?
I am Italian and I have been fascinated by foreign languages and cultures my entire life. After graduating high school, I spent a year in the UK to improve my English, and this is where I met my husband. He is Korean and at the time I knew nothing about the Far East, but I knew he was the one! We spent the first 12 years of our relationship long-distance, as I graduated university (I have an MA in Interpreting and Translation for Italian, English and Mandarin Chinese) and then won a scholarship to Beijing. I ended up spending five years in China working for multinational companies before I decided to move to Korea and start a family. That experience was invaluable to me when it comes to mastering negotiating skills within a Confucian culture.
How long have you lived in South Korea?
I started visiting Korea on a regular basis starting in 1999, but I only moved here officially when I got married in September 2010, so I have now been living here for 11 years.
What inspired you to become a doula?
As often happens, it was my own experience of pregnancy, birth, and the postpartum that inspired me to become a doula. I got pregnant only six months after moving to Korea, at a time when I knew nothing about the medical system in general, and the way pregnancy and birth are managed in particular. I immediately started educating myself and soon realised that living outside of the capital Seoul (which is where half of the Korean population lives) meant my options were extremely limited, especially as a foreigner who still spoke little Korean. I was incredibly lucky to find a doula who was willing to travel all the way to me -- some five hours away -- and her invaluable support inspired me to become a doula and childbirth educator myself, serving expat families living away from the capital region.
Pregnancy
What type of prenatal care do you provide for mothers during pregnancy? And is this common in South Korea?
As a doula, I make sure to understand what my clients’ goals are for their birth, and equip them with the necessary knowledge and skills to achieve them. I don’t take it for granted that my clients want any specific kind of birth, also considering they come from different cultural backgrounds, and so the prenatal care I offer is based on their needs. Mostly, I offer information and emotional support, as being pregnant away from home in a country like Korea has its own extra challenges.
As a childbirth educator, I also offer prenatal education courses, and again I strive to tailor my classes to my clients’ needs, focusing on evidence-based information and skill development. Many Korean hospitals offer classes, but these are mostly open to the pregnant person only (so partners do not get a chance to educate themselves) and tend to be very passive, lecture-style where routine hospital policy is presented as best practices. Because of the strong authority bias that is characteristic of Confucian cultures, anything a medical professional says is taken as a fact and explanations are not offered, which results in many people approaching birth with very little information and no decision-making skills. This leads to the current cesarean birth rate of almost 50%, and a lot of traumatic experiences.
Is any attention given to preparing women both physically and psychologically for birth?
Korea is one of the countries with the lowest birth rates in the world, and Koreans love babies, so pregnant people are generally cared for with much attentiveness. According to the philosophy called taegyo, pregnant people are to be surrounded by beauty at all times -- they are offered the most delicious fruits, shielded from stressful news, and encouraged to rest and take good care of themselves. While this contributes to a positive mindset leading up to birth, it can also create a dangerous belief that pregnant people are weak and defenceless, further contributing to a passive attitude when it comes to decision-making. Korean women traditionally having a smaller build also means a lot of emphasis is placed on avoiding excess weight gain, with people encouraged to walk for hours on end towards the end of pregnancy but without any education on building strength in the core and pelvic floor. In recent years, prenatal exercise classes have become more popular, but there are still lots of misconceptions about what a pregnant body can do.
Birth
What have you found to be the attitudes towards birth to be in South Korea? Relaxed? More medical-based?
Definitely medical-based. While the previous generation was mostly born at home (my own husband, who is 48, was too), with economic development, as invariably happens, birth moved to the hospital, where reliance upon technology and interventions is very heavy. Ultrasounds are performed at every prenatal visit in Korea, meaning once a month until 34 to 36 weeks, and then biweekly or weekly as the estimated due date approaches. Induction is often offered at 39 weeks, IV fluids (with restriction of food and drinks) and episiotomies are routine, and newborns are almost invariably separated from parents right after birth and formula fed in the nursery. Facilities that distance themselves from this medical model are few and far between, so most people are subject to heavily medicalised births.
Where do most women in South Korea give birth (home/hospital/birthing centre)?
There are three kinds of medical facilities in Korea: clinics (that only have up to five ob-gyns and sometimes paediatricians), mid-size hospitals (with various departments and emergency medical care), and university hospitals (mostly for high-risk births). Most people give birth in ob-gyn clinics -- home births are very rare, and birthing centres are mostly concentrated in the Greater Seoul area, leaving those outside of that region very little choice.
What types of pain relief are available during birth?
The only option for medical pain relief in Korea is a walking epidural. This is often administered only between 4 and 8cm of dilation (no sooner, no later), in a single injection that lasts about two hours (similar to a spinal block), possibly with one or two top-ups. Depending on the facility, an anaesthesiologist may only be available during office hours, further limiting access.
What type of appointments typically follow birth, and are these in-home or out-of-home visits?
Most facilities schedule a single check-up for the birthing person about one week after birth. No in-home postpartum medical care is provided, unless a home birth with a midwife.
What ways did you support the physical healing following birth?
In my postpartum visits, I help my clients explore their goals for their postpartum recovery -- whether they are interested in starting an exercise program for instance -- and discuss issues Korean doctors tend not to focus on, such as when they expect to resume having intimate relations (and therefore contraception), and pelvic floor health. I also discuss nutrition, especially for nursing people, and mental health.
Postpartum
What’s the culture around taking newborns out in public? Do mothers typically wait a certain period for taking the baby out into public spaces?
Traditionally, Korean babies were kept at home for the first one hundred days of their life, surrounded only by the closest family members. This was done to protect them from infectious diseases, and give the new parents a chance to rest. After the first one hundred days, the baby was officially introduced to the extended family (and society) with a celebratory party. These days it’s rare for parents to wait that long before leaving the house with their babies, although the ongoing pandemic may have reverted the trend once again.
Can you share about the concept of Sanhujori?
Confinement after birth is a tradition found in many Eastern cultures, and again it’s rooted in the need to protect the new baby while at the same time giving the birthing person the opportunity to fully recover. Traditionally, it was a close relative taking care of the dyad in their own home for the first few weeks, but these days there are specialized facilities (often annexed to birthing clinics) with nurses and lactation professionals on staff, or agencies providing helpers for in-home care. Koreans believe that in the days and weeks following birth, the body is weak and “open”, hence the need to make sure the birthing person be kept warm at all times (even in summer!), and only eat warm, soft foods. Seaweed soup, rich in iron and iodine, is offered at every meal, which generated the tradition of people eating seaweed soup on their birthday. Pig feet broth is also a common meal in the postpartum period, as it can increase milk supply.
Can you share a little bit about the South Korean postnatal care centres - what type of care they provide?
As mentioned above, postnatal centres were created for people who don’t have the option of in-home care, and/or want a luxury experience (“the last vacation before facing the reality of life with a newborn”). New parents are accommodated in hotel-like rooms, with meals being served in a common area for socialization, and the day is interspersed with activities like massages, hairdressing, and classes to learn baby-related crafts. Unfortunately, not all facilities allow rooming in with baby -- many Korean babies are routinely formula fed, based on the belief that nursing would be too stressful, and rest is more important. The facilities that do offer this option will usually have lactation professionals on staff for extra support, and offer pumping supplies as needed. Also, not all centres allow non-gestational parents to have contact with their babies, as most return to work a few days after the baby’s birth, and therefore carry a risk of infection -- in some cases, especially at this time, they are not even allowed inside. Common areas are provided for the new parents to meet visitors (or each other), but without baby.
While the idea of a postpartum recovery centre where new parents are pampered and given an opportunity to rest is a great idea, the fact that most promote routine separation in the first crucial weeks, and the prohibitive costs (in excess of one thousand US dollars per week in most cases) make this a less attractive option for many, especially non-Korean speakers who have the added barrier of language.
An alternative to this system is in-home care, with trained postpartum helpers (often nurses and/or lactation professionals) who can visit the new parents during working hours or even stay overnight, to take care of the dyad and carry out household chores. This service is partially subsidised by the government for babies of Korean nationality, can be extended for up to three months, and offers parents more flexibility, although again for expats, language is an issue in most cases, as the helpers are middle-aged Korean women with limited or no English skills -- and different cultural beliefs, too.
What do you personally believe were the most important things in aiding postpartum recovery?
I believe the importance of mental health is still vastly underestimated, also (albeit not only) in the postpartum period. I often repeat that the way many of us give birth today, in isolation and often far away from home, is very new in the history of mankind, and can be detrimental to the one’s mental health. I believe more support is needed in this respect -- taking care of a newborn is exhausting, nursing can be hard to learn and painful, physical recovery takes time, but a well supported parent with a healthy mindset can tackle all this, whereas being isolated, unsupported, and surrounded by unrealistic images of “life with a newborn” that all too often create a sense of inadequacy, is a recipe for postpartum mood disorders.
Is there any government-funded support after birth for new mothers and/or partners?
As soon as pregnancy is confirmed, everyone under the National Health Insurance System, non-Korean citizens included, receives a childbirth benefit of around 850 USD (1200 USD for twins) that can cover medical expenses up until two years postpartum (effective January 1st 2022, increased from around 550 USD). For babies of Korean nationality, there are also monthly subsidies for the first 6 years of life as well as a lump sum at birth and upon the first birthday, which varies by region and increases with second and subsequent children. New parents are offered discounts for bills, insurance policies, and large appliances, and daycare is also subsidized. Recently, in a further effort to increase the birth rate, parental leave was also extended, although it remains very limited in time compared to other areas of the world.
Who typically cares for the baby during the newborn stage?
As mentioned above, the majority of Korean parents use either a postpartum care center or in-home postpartum help. Traditionally, and in rural areas still to this day, elderly parents lived together with their grown-up children (usually the first son), and so the baby’s paternal grandmother would be helping with postpartum care. These days people tend to no longer live with their parents, but grandparents (on both sides) often help with childcare and recovery whenever possible.
Can you speak to the culture around newborn sleep in South Korea (particularly expectations for sleeping through the night, self soothing, etc.)?
Traditionally, Korean families co-sleep. The entire family sleeps on thick floor mattresses called yo, similar to the Japanese futon, and while many (if not most) people today have beds, floor sleeping is a very common choice for families with newborns and small children, to avoid falls and keep them warm (as the floor is heated). Due to the Korean working culture where after-work socializing is often compulsory and usually involves heavy drinking, partners often sleep in a separate room, and this arrangement is commonly maintained until children are in elementary school. Babies are not left alone to sleep in Korea -- many in-home postpartum helpers sleep with newborns to give the new parents a chance to rest, formula feeding through the night, and baby-wearing is very common. It is not unusual to see older women with babies on their back walking the neighbourhood at night trying to get a baby to fall asleep.
Breastfeeding
Do you think breastfeeding in public has been socially accepted in your country?
While nursing in public is socially acceptable in Korea, based on my personal experience and that of many clients and friends, Korean women rarely do so, mainly due to modesty. Thankfully, nursing rooms are available pretty much everywhere -- not just train stations, rest areas, airports and so on, but also large supermarkets, restaurants, and public facilities. Formula feeding is very common, but for nursing families, there is support, and nicely equipped facilities to do so.
How long do babies typically breastfeed in South Korea?
It is not common for babies to nurse past the first birthday, and daycare teachers routinely recommend toddlers are fully weaned. In the recent past, it was very different -- my husband, for instance, nursed until he was about 5 years old!
Who would a mother turn to for breastfeeding support?
Nursing parents can receive help in their birthing facilities, or alternatively there are companies nationwide with IBCLCs that pay home visits or provide help in their offices. The Japanese breast massage technique called oketani is also very common here, and this is what many Koreans look for when visiting lactation consultants, but these trained professionals can help with a variety of other lactation-related issues. Unfortunately for expats, they usually speak Korean only; a limited number of foreign lactation counselors can be found in the Greater Seoul area and nearby US military facilities, and online peer-to-peer support groups can help with general questions and emotional support.
South Korea
If you think the world could learn one thing about how South Korea approaches pregnancy, birth, & motherhood, what would it be?
I believe the emphasis on pre- and postpartum care is something that can be taken as an example. Koreans recognize that pregnancy is a unique time in a person’s life, and social expectations change accordingly. Similarly after birth, there is no rush to return to one’s previous hectic routine -- while rigid confinement is no longer observed, it is understood that the dyad needs time to get to know each other, be cared for, and recover physically and emotionally. There is no pressure to “bounce back” and “do it all;” instead, rest and good nutrition are emphasised, and while a lot could be improved in the specific ways in which support is offered, this is a powerful reminder for many of us.
What is one piece of advice you would like to give other mothers?
My advice would be to reach out and ask for help if you feel you are not coping well. No matter where you are, support is almost always available in some form or other. The pandemic has resulted in extended periods of isolation that can be detrimental to one’s mental health, and the unrealistic expectations propagated by social media can exacerbate this. We are not meant to be birthing and raising our babies in isolation! Pregnancy and the postpartum period can be very challenging times, and there is no shame in asking for help. We have been told that we need to be strong and independent, but this doesn’t mean we will not need support in one of the most vulnerable seasons of our lives -- especially those of us living away from family, in a foreign country where people speak a language we don’t understand and follow practices that we don’t recognize. It does take a village to raise a human, and the sooner you can find yours, the most enjoyable your experience will be.