[WHY] The art of premium postpartum care at Korea's sanhujoriwon

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Published: 06 Jan. 2024, 08:28 Updated: 07 Jan. 2024, 16:20

[WHY] The art of premium postpartum care at Korea's sanhujoriwon

A woman breastfeeds her baby [SHUTTERSTOCK]

Expectant mother Lee Na-young, 33, has her postpartum care planned to a T.

“I will be going directly to a sanhujoriwon in Gangseo District [western Seoul] from the hospital I gave birth in and will be staying there for two weeks with my newborn,” Lee said.

Sanhujoriwon are postpartum care centers, providing around-the-clock care for women as they recuperate after childbirth. They are largely seen as being unique to Korea, though their premium counterparts are popping up around K-towns in the United States and China these days.

A nurse takes care of a newborn at a postnatal room in a sanhujoriwon in Gangwon. [JOONGANG PHOTO]

In Korea, around 80 percent of new mothers admit themselves to these centers every year, according to Statistics Korea — and eagerly so. Lee said she is most looking forward to massages and three warm, healthy meals every day.

Sanhujoriwon now are up against the country’s record low birthrate. Not a cheap service, they can also cost new parents an arm and a leg, especially with fancier, private facilities going for over 25 million won ($19,000). But business at sanhujoriwon is still booming, with expectant moms scrambling to reserve their spots months before giving birth. So what exactly is sanhujoriwon and why are they such a big deal in Korea?

The Korea JoongAng Daily looked at what goes on inside these centers and their relation to the ultramodern society.

What goes on inside a sanhujoriwon

Former newscaster and TV personality Park Eun-young films her room at a sanhujoriwon in Gangnam District, southern Seoul. [SCREEN CAPTURE]

“They say sanhujoriwon is heaven, and I think I know why now,” former newscaster and TV personality Park Eun-young says in a vlog about her experience at a sanhujoriwon in Gangnam District, southern Seoul, in 2021. “I don’t have to think about anything other than getting better!”

She had just finished her lunch, which included a large lobster overlaid with cheese. She will now breastfeed her baby, and then go get a facial and a high-frequency massage.

Lee also filmed her suite and her private garden where she said she will be spending her first two weeks after childbirth. The room is estimated to have cost around 25 million won for a two-week stay at the time, according to postings on online forums for mothers, otherwise known as “mom cafes.”

Former newscaster and TV personality Park Eun-young films her lunch which includes lobster at a sanhujoriwon in Gangnam District, southern Seoul. [SCREEN CAPTURE]

Park’s case certainly isn’t the reality for all new mothers, but sans the lobster and private garden, the central idea of sanhujoriwon remains the same: Women are temporarily able to let go of all their responsibilities in order to focus on postnatal recovery.

Typical services include help with breastfeeding, baby care lessons, yoga, Pilates, massages and counseling for those experiencing postpartum depression or other mental issues.

Kim Sung-jae, 34, stayed with his wife at a postpartum center in Gangseo District in October and was overall satisfied with the experience, minus the lack of privacy and space.

A public sanhujoriwon in South Chungcheong [JOONGANG PHOTO]

“My wife is a pretty active person, but she felt a little suffocated because there wasn’t enough space to move around,” he said. “All she could do was wander the halls or walk around our room.”

Her postpartum center cost around 3 million won, which is right around the average price for a two-week stay at a postpartum center in Seoul, according to the Health Ministry.

“Meals were adequate, pretty standard for the pricing, and we learned a lot about how to care for the baby by the nurses there.

“As a guy, it was kind of a buffer period to get myself psychologically prepared for my role as a dad, and it also gave me time to get through the administrative work regarding the hospital and the baby.”

A nurse holds a newborn at a hospital in Seoul [YONHAP]

Some, on the other hand, don’t find the facilities too attractive.

You Mi-seon, 32, is due in April and will likely not be going to a postpartum center.

“I am a strong believer in mothers spending time with their newborns and want to be with my baby and take care of him or her from the point they are born, but that isn’t possible to the extent that I would like at sanhujoriwon,” she said.

A typical sanhujoriwon has separate rooms for the mother and the infant: The mother stays in a regular room, sometimes with her husband, while all the babies in the center are placed together in neonatal rooms. Nurses take care of the babies around the clock, including putting them to sleep and giving them baths. The mother is called in to breastfeed every three hours.

A postnatal room inside a sanhujoriwon in Seoul [YONHAP]

“I especially don’t like the idea of sleeping apart from my baby, and I want to feed my baby when he or she is actually hungry instead of subjecting the baby to the sanhujoriwon’s feeding schedule,” You added.

Opting to not stay at a sanhujoriwon shouldn’t be confused with overlooking postpartum care, You said.

“I will likely be staying for a week at the hospital where I gave birth and get a helper when I return home,” she said, adding that there are no significant differences in price compared to going to an average sanhujoriwon in Seoul. “My mother is also thinking of moving closer to our home so that she can make sure that I properly recover from childbirth.”

Postpartum care is no joke in Korea

Kim Ye-ji, 39, was shocked when a nurse in a New Zealand hospital popped a popsicle in Kim’s mouth after she gave birth to her second child there, saying that she had sweat too much during labor and that it would help her cool down. She was also served a T-bone steak for dinner and told that she could shower whenever.

“These things would never happen in Korea,” she said.

Korean postpartum care is specific and serious, including eating lots of miyeokguk (seaweed soup) to maintain healthy iron levels, staying indoors and keeping warm, and avoiding showers or any strenuous activity.

They may not all be empirically proven, but these postpartum practices go way back.

Eating seaweed soup, for instance, can be traced back to the ethnic Koreans in the post-Soviet states who saw whales feeding on seaweed after giving birth to heal their birth wounds, so they started to feed seaweed to women in postpartum as well, according to the Tang Dynasty leishu, or reference encyclopedia, “Chohakgi.” Seaweed as soup first appears in the Joseon Dynasty’s (1392-1910) academic study on females called “Joseonyeosokgo,” which states that women ate three bowls of seaweed soup with white rice after giving birth.

Miyeokguk, or seaweed soup [JOONGANG PHOTO]

Women postpartum are also traditionally put under strict house arrest for 21 days. Called sam chil il, or the three seven days, women and newborns in the Joseon Dynasty weren’t allowed to leave the house or see visitors for three weeks. As an indication of this, her family would hang straw ropes around the front door of the house. Today, the same rest period is thought of as necessary for the mother’s stretched body and muscles to return to their original state. Most importantly, she must keep warm with layers of clothes from head to toe, even during summer.

All of this is done to ultimately prevent a type of postpartum syndrome that is seemingly only recognized and treated in Korea: sanhupung.

What is sanhupung?

Sanhupung refers to a wide-ranging set of maladies experienced after birth, from fever, joint pain and body aches to psychological conditions apart from the diagnostic postpartum depression, like perinatal mood and anxiety disorder.

A 2022 qualitative study on Korean Medicine-Based Postpartum Care in Korea published in the International Journal of Environmental Research and Public Health describes sanhupung as a “cultural disease,” defined in Korean medicine as the synthesis of “various postpartum symptoms caused by improper management of the postpartum period after childbirth or miscarriage.”

Sanhupung directly translates to “postpartum cold breeze.” Many women suffering from sanhupung describe feeling a cold breeze enter their bodies, which is why Koreans are so focused on keeping the new mothers warm.

“Mothers spared no effort for [postpartum] recovery, including trying to sweat and keep their body warm, to avoid feeling the cold breeze,” reads the study, which conducted extensive interviews to observe women’s experiences of Korean medicine-based postpartum health care. “They also expressed fears about lifelong suffering without proper postpartum care. Therefore, they showed a willingness to take better care of their bodies.”

Mothers with sanhupung visit an oriental clinic for herbal remedies and treatments like acupuncture.

A tray of herbs at an oriental clinic [JOONGANG PHOTOS]

Having the terminology for the eclectic postnatal syndrome, however, doesn’t mean that Korean women are the only ones who are susceptible to it.

According to the World Health Organization (WHO) research team, a third of new mothers around the world have lasting health issues after childbirth. The study, published in Lancet Global Health and eClinicalMedicine in December, estimated that some 40 million women worldwide suffer from postnatal physical pain, urinary incontinence and depression that can persist for months or even years.

“Many postpartum conditions cause considerable suffering in women’s daily life long after birth, both emotionally and physically, and yet they are largely under-appreciated, under-recognized, and under-reported,” said Pascale Allotey, the director of sexual and reproductive health and research at the WHO, in the report.

“Postpartum syndrome is prevalent all around the world, and Koreans aren’t the only ones who are concerned with keeping their bodies warm to prevent it,” Seo Joo-hee, specialist in neuropsychiatry of Korean medicine at the National Medical Center, said. “It is medically meaningful, however, that Korea has recognized this for a long time and has come out with various preventative measures for it.” And Sanhujoriwon is a part of that effort.

Sanhujoriwon in modern society

A scene in the movie "Kim Ji-young: Born 1982" featuring a mother working while taking care of her child. [TVING]

Sanhujoriwon arose as the importance of postpartum care continued into modern society but family forms changed.

Fewer young couples throughout the 1990s opted to live with the husband’s family, and nuclear families mushroomed. In this new, smaller family unit, women after birth no longer had the help of extended families to carry out proper postpartum care.

The rate of women using sanhujoriwon rose from 75.1 percent in 2018 to 81.2 percent in 2021, according to Statistics Korea. Those who carried out their postpartum care with the help of extended family, however, dropped from 22.2 percent in 2018 to 15.2 percent in 2021.

More women today are working as well, but because they don’t have the luxury of taking extensive leaves, sanhujoriwon, which promise a quicker postnatal recovery, became more attractive.

“I’m hoping to quickly recuperate at the sanhujoriwon and then bounce back to work a month and a half later,” expectant mother Lee said.

Sanhujoriwon also used to play a significant role in social networking among new mothers before Covid-19 hit. Called sanhujoriwon alumni, the mothers who stayed at the same center during the same period often forged close relationships, sharing information about postpartum and child care. Since the pandemic, however, the centers have doubled down on isolative care and new parents describe this network, currently, as “virtually nondescript.”

A scene from the 2020 drama "Birthcare Center" featuring new moms who have become friends at a sanhujoriwon [TVN]

Contributor to the plummeting birthrate?

“It’s a factor that makes us feel more hesitant,” said a 32-year-old female surnamed Kim from Gyeonggi, saying how she feels like she would have to go to a sanhujoriwon if she ever does give birth, despite how expensive they are.

“Nearly everyone goes to sanhujoriwon, and public ones are so hard to get into.”

The average cost to receive two weeks of care at either a public or private sanhujoriwon was 3.07 million won last year, according to data from the Health Ministry. This was up 27.4 percent from 2017. In Seoul, where the average was the highest, prices surged from 3.2 million to 4.1 million over the same period.

The average monthly wage of a white-collar employee in 2021 was 5.63 million won at a large conglomerate and 2.66 million won at small- and medium-sized companies, not accounting for income tax, according to Statistics Korea in February 2023.

Public facilities are cheaper, averaging 1.7 million won for two-week stays, whereas private ones cost some 3.09 million won, according to the Health Ministry early last year. But there are only 19 public postpartum centers in the entire country and just two in Seoul.

Korea meanwhile has the world’s lowest birthrate as of 2022, at 0.78.

Reading into these concerns, the Seoul Metropolitan Government began handing out 1-million-won postpartum care vouchers per baby, to all new parents regardless of their income, starting September last year.

The vouchers can be used to pay for sanhujoriwon or other postpartum care services, exercise classes and medicine.

“As a woman's lifelong health depends on how she takes care of her body and mind after giving birth, Seoul plans to support all mothers and help them quickly recover their health,” the city said in an August press release.

Future of sanhujoriwon

A scene from the 2020 drama "Birthcare Center" featuring a new mother looking at her baby inside a postnatal room [TVN]

The number of postpartum centers in Korea has decreased over the years, from 598 facilities in 2017 to 475 facilities in 2022, likely due to the falling birthrate, according to the Health Ministry.

Experts say that the demand for sanhujoriwon will likely persist, however, citing the older ages at which women are getting pregnant. The average age of a woman’s first pregnancy in Korea was 32.3 years old, according to the OECD in 2022. This is older than women in the United States, who were 27.1 years old on average, and 30.7 years old in Japan.

“As the new mothers are getting older, her parents who could have aided her are also older, so it becomes even more difficult to get help within the family,” Seo from the National Medical Center said. “Also, many married couples only have one kid, so they may feel that they want to get proper postpartum care from professionals, despite the cost.”

BY LEE JIAN [lee.jian@joongang.co.kr]

korea joongAng daily

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[WHY] The art of premium postpartum care at Korea's sanhujoriwon

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