ii Copyright (2010) By Prangthip Thasanoh iii DEDICATION This dissertation is dedicated to all the women who experience the hardship of transitioning to motherhood. iv ACKNOWLEDGMENTS Journeying from a rural family to study in a big city might be very hard without support along the way. I would like to express my gratitude to my parents Samaan and Prapaporn Thasanoh who, while in poverty, dedicated their personal happiness to raise and educate four kids. They taught me to give knowledge higher value than money and other material things. Growing up with industrious parents inspired me to try my best at school and to never stop learning. I am also thankful for two older sisters Chommanee Loboon and Naraporn Weruwanarak who promised me to take care of our parents while I am away. They are the backups who have allowed me to achieve my life goal without worries about having to leave my elderly parents behind in Thailand. I am deeply thankful for the Thai government, especially the Ministry of Public Health who, as second parents, gave me the scholarships for studying to get my bachelor‟s degree in nursing, gave me a job in a nursing college right after graduation, allowed me to leave work for higher educational degree, and provided the financial support for my doctoral program. I would like to thank all my directors, teachers, mentors, colleagues, and friends in Boromarajonani College of Nursing, Sappasithiprasong and Sappasithiprasong Medical Center in Ubon Ratchathani, Thailand, for being such a great support group to me in my endeavors and working harder to cover my workload in my absence. I cannot name them all here, but would like to specifically recognize Puntipa Kaewmataya, Malee Seethong, Pimonpan Chareansee, Udomwan Wansee, Yaowarate and Manop Praphasanont, Petmanee Viriyasuebphong, Rungrungsri Vibulchai, Jaroonsre Meenongwah, Pattaya Kaewsarn, Navapon Kaenbubpha, and Sadee Saithong Hamilton. v Living in a foreign culture where people are using a different language from the one I grew up in is challenging, especially when the purpose of the stay is to get a doctoral degree. I am really grateful to faculty and staff of the School of Nursing at the University of California, San Francisco, for giving me a chance to study here and for supporting me in the academic and personal dimensions of life. I will never forget how difficult it was writing the qualifying papers and the conducting dissertation research. Those missions would have been impossible without support I received from my advisers and committees for the qualifying examination and dissertation. I would like to give special thanks my advisers Dr. Holly Powell Kennedy and Dr. Catherine A. Chesla, who also served as a chair in dissertation committee and qualifying examination committee, respectively. They taught me how to organize my life, open my mind to any possibility, think deeper, keep working, and move forward. I would also like to recognize Dr. Christine Kennedy and Dr. Jaremiah Mock, who served on my committees, and to who I am grateful for helping me to think out of the box. Finally, I would like to express my appreciation to another of my dissertation committee members, Dr. Susanha Yimyam from Faculty of Nursing, Chiang Mai University, Thailand, for the feedback she gave me on the Thai transcript, sending me inspiring poems, and supporting information valuable to my study of Thai mothers. Finally, I would like to thank the Century Club for awarding me financial support during a year of conducting the dissertation. Some special help comes when you are in need and the memory of this will always touch my heart. I am thankful for UCSF‟s Thai alumni Dr. Supaporn Wannasuntad, who found me a room to live in close to school, and Dr. Wanwadee Neamsakul, who explained to me how to complete my class assignments. I will always remember my cohort, Dr. Katherine vi Aldrich, who added me to her group for working on an assignment in my first quarter in school. Her kindness meant a lot to me, who at the time, did not communicate well in English. She helped me to overcome feeling like I was an “unwanted group member.” I also appreciate the help from all of my formal and informal editors, including Dr. Barbara Burgel, Jenny Lui, Tara Valcarcel, Drew Yamamoto, Jim Grout, Robert Sparacino, Kent Hamilton, and Thomas Elter. Having someone waiting to edit a paper allows me to keep writing with more confidence. My success owes much to the director of Student Affairs, Jeff Kilmer, and my friend, Dr. Therese Jung Doan. Jeff found me at a point when I was extremely down in my first year at UCSF. He talked to me, gave me a hand, hired a tutor for me, and taught me how to be nice to myself. We have had the opportunity to get together for walking, talking, eating, swimming, watching movies, and drinking coffee many times since that first meeting. He is always available when I call to ask for his help or time. Jung Doan is not only my cohort and editor, but she was also a parent to me. In Fall 2005, I asked her for help on a day my world was blue. I was lacking confidence to study here, doubting that I might not be able to qualify to be a UC student. It was difficult to open my mouth and explain to her how much I needed her help. When she said “YES” and we agreed to study together, I felt like my real life as a student had just started. While I was stuck in the mud of writing this dissertation in Spring 2010, Jung offered me a room in her house to stay and do nothing but write. She provided basic needs for me including food and always asked “how can I help you.” I lastly would like to thank the people in the study setting, including the 16 participants and other mothers with whom I participated in this study, the directors of Sirindhorn Hosptial and the Sirindhorn Public Health Office, the nurses and health care vii providers in Sirindhorn Hospital and all eight Primary Care Units, and the landlady of where I stayed in the remote community where my study was conducted. I will never forget the incredible experience of learning how families took care of postpartum women in their unique way. Without a map drawn by the landlady, I might have been unable to easily access the remotest Primary Care Unit. Additionally, without the cooperation of the health care providers in each unit, I might not have been able to communicate with many of the participants. Prangthip Thasanoh August, 2010 x Table of Contents Title Page………………………………………………………………………………………i Copyright……………………………………………………………………………………...ii Acknowledgements…………………………………………………………………………...iv Abstract……………………………………………………………………………………...viii Table of Contents……………………………………………………………………………...x Chapter One: The Study Problem and Significance ................................................................. 1 Problem Statement and Significance .................................................................................... 2 Purpose .................................................................................................................................. 3 Chapter Two: Theoretical Framwork and Review of the Literature ......................................... 4 Conceptual and Theoretical Framework ................................................................................... 4 Review of the Literature ........................................................................................................... 7 Background and Significance ............................................................................................... 9 Isan Family Development and Dietary Practices ................................................................ 10 Biomedicine Postpartum Nutrition Recommendations ...................................................... 11 Nutritional Situation in Northeast Thailand ........................................................................ 13 Traditional Postpartum Nutritional Practices among Asian Societies ................................ 15 Beliefs Supporting Postpartum Practices ............................................................................ 16 Postpartum Eating Behaviors in Celected Asian Countries ................................................ 22 Factors Affecting Women‟s Health in the Postpartum Period ........................................... 31 Biological Study of Traditional Food ................................................................................. 35 Family Dynamics in Postpartum Practices ......................................................................... 37 Synthesis and Discussion ........................................................................................................ 45 Chapter Three: Research Method and Design ........................................................................ 49 Interpretive Phenomenology ............................................................................................... 49 Hermeneutic Philosophy ..................................................................................................... 50 Research Design ................................................................................................................. 53 Pilot study sesearch. ............................................................................................ 54 Research setting. ................................................................................................. 54 Sampling and recruitment. .................................................................................. 54 Data collection. ..................................................................................................