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|title=Jatisutriya Sharira

|titlemode=append

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|keywords=Jatisutriya, Dhatri, obstetric care, maternal health~~, neonatal care~~, post-pregnancy regimen

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|keywords=Jatisutriya, Dhatri, obstetric care, maternal health, post-pregnancy regimen, Ayurveda, charak samhita, Indian system of medicine, [[Prenatal care (garbhini paricharya)]], maternal health,[[Garbha‎‎]], fetus, post natal care ([[Sutika Paricharya]]), [[Congenital disorders]], [[Neonatal care]], infant care, upbringing of child, alternative systems of medicine,

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|description=~~Sharira Sthana~~ Chapter ~~8. Obstetrics~~, Maternal Health and Neonatal Care

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|description= Chapter on Obstetric care, Maternal Health and Neonatal Care in Ayurveda

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

}}

<big>'''Sharira Sthana Chapter 8. Obstetrics, Maternal Health and Neonatal Care '''</big>

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~~<big>'''Abstract'''</big>~~

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<div style="text-align:justify;">The word Jati literally means birth. Hence this chapter describes aspects related to pre-conception, conception, methods of procreation and post-pregnancy. It deals with obstetrics and midwifery care, measures for good parental health and effective neonatal care. It also describes pioneering concepts such as architecture of a maternity home, attending wet nurses (and the concept of a milk bank), and well-furnished nurseries. It also prescribes measures for good upbringing of children. </div>

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~~'''Keywords''':''Jatisutriya, Dhatri,'' obstetric care, maternal health, neonatal care, post-pregnancy regimen.~~

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~~</div>~~

{{Infobox

|title = Jatisutriya Sharira

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|data1 = [[Sharira Sthana]] Chapter 8

|label2 = Preceding Chapter

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|data2 = [[Sankhya Sharira]]

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|data2 = [[Sharira Sankhya Sharira]]

|label3= Succeeding Chapter

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Rajagopala S., Gujarathi J., Deole Y. S.

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|label7 = Reviewer

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|data7 = Patwardhan K.

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|label8 = Editors

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|data8 = Bhalerao S., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s04.009 10.47468/CSNE.2020.e01.s04.009]

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}}

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<big>'''Abstract'''</big>

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~~|header3~~ =

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<div style="text-align:justify;">The word Jati literally means birth. Hence this chapter describes aspects related to pre-conception, conception, methods of procreation and post-pregnancy. It deals with obstetrics and midwifery care, measures for good parental health and effective neonatal care. It also describes pioneering concepts such as architecture of a maternity home, attending wet nurses (and the concept of a milk bank), and well-furnished nurseries. It also prescribes measures for good upbringing of children. </div>

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}}

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'''Keywords''': Jatisutriya, Dhatri, obstetric care, [[Prenatal care (garbhini paricharya)]], maternal health,[[Garbha‎‎]], fetus, post-pregnancy regimen, post natal care ([[Sutika Paricharya]]), [[Congenital disorders]], [[Neonatal care]], infant care, upbringing of child.

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</div>

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=== Introduction ===

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== Introduction ==

The [[Sharira Sthana]] and [[Chikitsa Sthana]] provide valuable insights into obstretics, midwifery and gynaecology in the Vedic ages. Since [[Ayurveda]] is holistic in its treatment of various aspects of life sciences, these sections go beyond in their treatment of these branches of medicine, prescribing ground rules for effective neonatology and improved parental health. This chapter starts with certain guidelines for purification of the parents, including spiritual practices and appropriate rules for coitus, to improve the odds of giving birth to a healthy and desired offspring. For purification, therapies such as [[Panchakarma]] are advocated. A very specific - and contentious - spiritual procedure called ''putreshti yajna'' is also explained here, with an aim towards giving birth to a son (or a child of desired gender) with all excellent qualities.

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Summarizing the eighth chapter, it deals with Obstetrics and Neonatology while also touching upon parental health and early child care, introducing certain concepts that are now considered modern best practices in the field,

</div>

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===Sanskrit text, Transliteration and English Translation===

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==Sanskrit text, Transliteration and English Translation==

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athAto jAtisUtrIyaM shArIraM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2||

</div></div>

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~~“Now I shall expound the chapter dealing with continuation of one’s own lineage, in this discourse on Sharira.” Thus said Lord Atreya [1-2]~~

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Note: ''Jati'' means birth and ''Sutra'' is which is described in short. ''Jatisutriya'' is description of different methods and procedures of birth in short.

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Now we shall expound the chapter "Jatisutriya Sharira" (Obstetrics, Maternal Health and Neonatal Care). Thus said Lord Atreya. [1-2]

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Note: ''Jati'' means birth and ''Sutra'' is which is described in short. ''Jatisutriya'' is description of different methods and procedures of birth in short. It deals with continuation of one’s own lineage in this discourse on Sharira.

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Such a couple (desiring good progeny) should first undergo purification therapies described earlier in this treatise - unction and sudation procedures followed by emesis and purgation - and gradually get back to normalcy. Once purified, the couple should undergo non-unctuous and unctuous enema. Then, the man should be administered with sweet-tasting drugs processed with ghee and milk while the woman should take sesame oil and black gram. [4]

</div>

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==== Abstinence from coitus during menstruation ====

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=== Abstinence from coitus during menstruation ===

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While menstruating, the woman should abstain from coitus for three nights, sleep on the ground, consume food with her hand from unbroken utensils, and should not clean her body by any means. On the fourth day, she should be anointed well with oil and should be given a good head bath, cleansed well, and then made to wear white coloured apparel. The man should follow similar rituals as the woman on her fourth day of menstruation. Then onwards, the two, wearing white apparels and garlands, with pleasant disposition, loving each other, should enter into acts of cohabitation - on even days if desirous of a male child, and on odd days for a female child. [5]

</div>

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==== Postures and circumstances to be avoided for coitus ====

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=== Postures and circumstances to be avoided for coitus ===

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During sexual intercourse, the woman should not be in prone posture, or lie on her sides. In the former case, ''vata dosha'' becomes stronger and inflicts the genital tract and in the latter case, lying on her right side, displaces ''kapha dosha'' into the mouth of the uterus and creates obstruction, while if she is on her left side, ''pitta dosha'' afflicts the ovum and sperm by its heat. Therefore, the woman should receive the sperm lying on her back, in this position; the doshas are in their states of normalcy. After coitus, vagina should be sprinkled with cold water.

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During sexual intercourse, the woman should not be in prone posture, or lie on her sides. In the former case, ''[[vata dosha]]'' becomes stronger and inflicts the genital tract and in the latter case, lying on her right side, displaces ''[[kapha dosha]]'' into the mouth of the uterus and creates obstruction, while if she is on her left side, ''[[pitta dosha]]'' afflicts the ovum and sperm by its heat. Therefore, the woman should receive the sperm lying on her back, in this position; the doshas are in their states of normalcy. After coitus, vagina should be sprinkled with cold water.

The woman who has overeaten, thirsty, frightened, dejected, in grief, anger or in love with a man other than her husband, or who is overpassionate (during the coital act) will fail to conceive or if conceived, will give birth to a child with some defects.

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A very young (sexually immature) girl or a very old woman, woman suffering from chronic illness or suffering with any other disorders should not procreate. This condition applies for a male partner too. Hence only a man and a woman who are free from all defects, and are of suitable age should engage in coitus. [6]

</div>

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==== Preparations before coitus ====

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=== Preparations before coitus ===

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The couple that is sufficiently aroused and fully engrossed in the sexual act, after having their favorite food (wholesome, not overeaten), should lie on bed which is well adorned with pleasant perfumes and bedecked with comfortable mattresses of one’s choice for the sexual act, man placing his right foot first and woman her left. [7]

</div>

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==== ''Mantra'' before the sexual act ====

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=== ''Mantra'' before the sexual act ===

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Then, they should recite the ''mantra'' meaning: ‘Thou art the day; Thou art the life; Thou art well established from all sides. May the supporter endow Thee; may the dispenser dispense to Thee: be Thou born with ''Brahmic'' splendor’. May Brahma, Brhaspati, Visnu, Soma, Surya and the two Ashwins, as also Bhaga, Mitra and Varuna, bless me with a heroic son.’ Having uttered this, the couple should commence the sexual act. [8]

</div>

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==== Daily rituals to be followed a week before coitus by a woman desirous of a healthy male child ====

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=== Daily rituals to be followed a week before coitus by a woman desirous of a healthy male child ===

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Her companions and husband should also entertain her with things, discussion topics, and activities that are pleasant to her, and not stressful. The couple, should, however avoid sexual contact during this period. Following this regimen for a week, on the eighth day she, along with her husband, after taking a head bath with pure (consecrated – ''abhimantritam'') water, get prepared for coitus by adorning themselves with new white apparel, garlands and ornaments. [9]

</div>

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==== Rituals at the end of the week ====

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=== Rituals at the end of the week ===

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Thus seated, he should kindle the scared fire with the twigs of ''palasha'' (Butea monosperma Kuntze), ''ingudi'' (Balanites aegyptica Delile), ''udumbara'' (Ficus racemosa Linn) or ''madhuka'' (Madhuka indica J.F.Gmel), spread the ''kusha'' (Desmostachya bipinnata Stapf.) grass around, and fix the enclosure of fire with big stalks of ''palasha'' (Butea monospermakuntze) on all four sides, and then spread the altar with parched/roasted paddy and white coloured flowers having sweet fragrance. Then, he should prepare a water pot, clean and sanctified by ''mantras'', make available adequate amount of ghee for offerings, and place auspicious objects (such as bulls or stallions) of said qualities and colors, etc. in and around the place of offering as mentioned earlier. [10]

</div>

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==== Additional rituals before cohabiting ====

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=== Additional rituals before cohabiting ===

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As regards the woman desirous of a child with sky blue complexion, red eye, broad chest and long limbs, or a woman who seeks off spring with black complexion, with black, soft and long hair, glittering white eye and teeth, radiant and self-restrained, the rituals to be followed are the same as described above. The preparations and materials required will not be of the same color but it should be made, in either case, to match the desired complexion of the child to be born, agreeable to the mother’s desire. [12]

</div>

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==== Rituals for those belonging to the "shudra" lineage ====

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=== Rituals for those belonging to the "shudra" lineage ===

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Those belonging to ''shudra'' lineage, the mere act of salutation/pray (to the God, holy fire, ''brahmanas'', teachers/elders/preceptors, and saints and seers) should suffice. [13]

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==== Advice for the mother desiring certain traits in her offspring ====

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=== Advice for the mother desiring certain traits in her offspring ===

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Thus, the section detailing rituals that couples desirous of a healthy progeny – of the attributes of their liking – has been explained. [14]

</div>

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==== Role of ''~~mahabhutas~~'' in contributing to the complexion of the offspring ====

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=== Role of ''[[mahabhuta]]s'' in contributing to the complexion of the offspring ===

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Apart from the procedures mentioned above, ''~~mahabhutas~~'' also contribute in colour and complexion of skin. It is important to note that the ''teja'' (aura) associated with ''apa'' and ''akasha ~~mahabuta~~'' are responsible for fair complexion, ''prithvi'' and ''vayu'' are responsible for black, and an equilibrium of all the five ''~~mahabhutas~~'' result in ''shyamavarna'' i.e. sky-like bluish complexion. [15]

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Apart from the procedures mentioned above, ''[[mahabhuta]]s'' also contribute in colour and complexion of skin. It is important to note that the ''[[teja]]'' (aura) associated with ''[[apa]]'' and ''[[akasha mahabhuta]]'' are responsible for fair complexion, ''[[prithvi]]'' and ''[[vayu]]'' are responsible for black, and an equilibrium of all the five ''[[mahabhuta]]s'' result in ''shyamavarna'' i.e. sky-like bluish complexion. [15]

</div>

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==== Factors determining the psychological disposition of the progeny ====

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=== Factors determining the psychological disposition of the progeny ===

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Factors determining the sex of an embryo have already been explained. Just as an undamaged seed when sown reproduces its own kind, such as the paddy seed germinates into paddy and the barley seed produces barley, so too men and women beget children possessing the natural characteristics of their parents. [18]

</div>

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==== Factors for healthy progeny ====

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=== Factors for healthy progeny ===

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</div>

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==== Measures for the preservation of the embryo ====

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=== Measures for the preservation of the embryo ===

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From this verse onwards, measures for the preservation of embryo (''garbha'') have been explained. Some of these rituals or practices require the pregnant woman to wear herbs, such as ''aindri'' (Citrulluscolocynthis Schrad – Gorakshakarkati), ''brahmi'' (Bacopamonnieri Pennel), ''satavirya'' (Cynodon doctylon Pers), ''sahasravirya'' (a variety of ''durva'' - cynodon species, also known as ''durvadwaya''), ''amogha'' (''patala'' – Stereospermumsuaveolens DC), ''avyatha'' (''guduchi'' – Tinospora cordifolia Miers), ''shiva''(''haritaki'' – Terminaliachebula Linn), ''arishta'' (katukarohini – Piccrorhizakurroa Royle ex Benth), ''vatyapushpi'' (Pitabala – Sidacordifolia Linn), and ''vishwaksenakanta'' (''priyangu'' – Callicarpa macrophylla Vahl.),on her head or her right hand. Or she may drink milk or ghee processed with the above mentioned herbs, or bathe at every occasion of ''pushyanakshatra'' with water boiled using these herbs, and she should keep these herbs readily available always. Similarly, the regular use of all of the ''jivaniya'' class of herbs (life promoter group of herbs) in the (above) prescribed manner is also beneficial. Thus, the procedures for stabilization of embryo (''garbha'') have been described in this verse. [20]

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From this verse onwards, measures for the preservation of embryo (''[[garbha]]'') have been explained. Some of these rituals or practices require the pregnant woman to wear herbs, such as ''aindri'' (Citrulluscolocynthis Schrad – Gorakshakarkati), ''brahmi'' (Bacopamonnieri Pennel), ''satavirya'' (Cynodon doctylon Pers), ''sahasravirya'' (a variety of ''durva'' - cynodon species, also known as ''durvadwaya''), ''amogha'' (''patala'' – Stereospermumsuaveolens DC), ''avyatha'' (''guduchi'' – Tinospora cordifolia Miers), ''shiva''(''haritaki'' – Terminaliachebula Linn), ''arishta'' (katukarohini – Piccrorhizakurroa Royle ex Benth), ''vatyapushpi'' (Pitabala – Sidacordifolia Linn), and ''vishwaksenakanta'' (''priyangu'' – Callicarpa macrophylla Vahl.),on her head or her right hand. Or she may drink milk or ghee processed with the above mentioned herbs, or bathe at every occasion of ''pushyanakshatra'' with water boiled using these herbs, and she should keep these herbs readily available always. Similarly, the regular use of all of the ''jivaniya'' class of herbs (life promoter group of herbs) in the (above) prescribed manner is also beneficial. Thus, the procedures for stabilization of embryo (''[[garbha]]'') have been described in this verse. [20]

</div>

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==== Factors that could damage or destroy the embryo ====

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=== Factors that could damage or destroy the embryo ===

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In summary, a pregnant woman indulging in unhealthy dietary and lifestyle activities that could cause certain diseases would increase the risk of her off spring getting afflicted with similar (or more virulent) disorders. From the father’s side, defects in semen could occur due to above mentioned factors for mother. Hence, a woman desirous of a child with excellent qualities should abstain from all forms of addictions as well as unhealthy dietary and lifestyle activities. [21]

</div>

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==== Treating pregnant women afflicted with ailments ====

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=== Treating pregnant women afflicted with ailments ===

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Any ailment or disease afflicting a pregnant woman should be treated very delicately, by means of medicaments and diet that are mainly soft, palatable, cooling, pleasant and mild. She should not be subjected to emetics, purgatives, or ''nasya'' (errhines), or to practices such as bloodletting. She should not be, at any time, administered corrective and unctuous enema, except in very serious emergency situations. In her final trimester, the pregnant woman, if in emergency conditions wherein emesis is urgently required, should only be treated by means of very mild emetics etc., or by its substitutes. A pregnant woman should be handled like a pot brimful of oil, which can spill on irritation i.e., very delicately. [22]

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Any ailment or disease afflicting a pregnant woman should be treated very delicately, by means of medicaments and diet that are mainly soft, palatable, cooling, pleasant and mild. She should not be subjected to emetics, purgatives, or ''[[nasya]]'' (errhines), or to practices such as bloodletting. She should not be, at any time, administered corrective and unctuous enema, except in very serious emergency situations. In her final trimester, the pregnant woman, if in emergency conditions wherein emesis is urgently required, should only be treated by means of very mild emetics etc., or by its substitutes. A pregnant woman should be handled like a pot brimful of oil, which can spill on irritation i.e., very delicately. [22]

</div>

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==== Occurrences of bleeding during pregnancy ====

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=== Occurrences of bleeding during pregnancy ===

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If the pregnant woman, in her second trimester or later, as a consequence of excessive anger, grief, intolerance, envy, fear, sex, exercise, agitation, suppression of body urges, faulty eating, faulty lying down and standing habits, excessive hunger and thirst or as the result of malnutrition, starts to bleed, then the following course of treatment should be adopted to safeguard the conception from any mishap:

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• As soon as the blood discharge is noticed, the patient should be instructed to lie down on a soft and comfortable couch with her head placed slightly lower than the rest of ~~herbody~~.

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• As soon as the blood discharge is noticed, the patient should be instructed to lie down on a soft and comfortable couch with her head placed slightly lower than the rest of her body.

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• The physician should then place a cotton swab, immersed in medicated ghee prepared with yashtimadhu (Glycyrrhiza glabraLinn) and then kept in cold water, near or in the vaginal passage. She should also be annointed with ~~shatadhautaor~~ sahasradhauta ghrita (ghee washed a hundred or a thousand times with water or medicated decoctions) on or below the navel region. Similarly, she could also be sprinkled with cold milk or decoction of madhuka and nyagrodhadi class of (Ficusbengalensis Linn) herbs on or below her navel region, or she should take bath in tub of cold water. Cloth pieces soaked in the juice of ksheerivriksha (latex-yielding trees) class of herbs, or a cotton swab soaked in milk and ghee processed with leaf-buds of nyagrodhadi (Ficusbengalensis Linn) class of drugs should be inserted into her vagina. She should also consume ghee made up of milk in a quantity of aksha (about 10-12 ml) and treated with the same drugs as mentioned above. She should be offered a concoction made up of stamens of kamala (Nelumbo nucifera Gaertn.), utpala (Nymphaea alba Linn), and kumuda (a variety of Nymphaea species), mixed with honey and sugar linctus. She should eat singhataka (Trapabispinosa Roxb. – chestnut), pushkarabeeja (lotus seeds –Nelumbonucifera Gaertn.) and kasheruka (Scirpusgrossus Linn. f.). She may be given goat’s milk boiled with gandhapriyangu (Callicarpamacrophylla Vahl.), nilotpala (blue variety of Nymphaeaalba Linn), shaluka (rhizome of lotus), fruits of udumbara (Ficusracemosa Linn.) and leaf-buds of nyagrodha (Ficusbengalensis Linn). She should eat soft, fragrant and cooked shali rice of red variety (Orizasativa Linn.), added with honey and sugar along with milk boiled with roots of bala (Sidacordifolia Linn.), atibala (Abutilonindicum Linn.), shali, sashtika (both varieties of Orizasativa Linn.) ikshu (sugarcane- Saccharumofficinarum Linn.), and kakoli. Or she should eat the above rice along with the soup made of meat that is well-seasoned with ghee, of lava (Common Quail), kapinjala (Grey Partridge), kuranga (Roe deer), sambara (Indian Sambar), shasha (Rabbit), harina (Black Buck), ena (Antelope) orkalapuchchaka (Black tailed Deer), while sitting comfortably in a cool and well ventilated place. She should be protected from anger, grief, overexertion, activities that are sexual or intensely physical in nature, and should be entertained with pleasing and comforting stories. By following these methods, the embryo (garbha) is saved from abortion. [24]

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• The physician should then place a cotton swab, immersed in medicated ghee prepared with yashtimadhu (Glycyrrhiza glabraLinn) and then kept in cold water, near or in the vaginal passage. She should also be annointed with shatadhauta or sahasradhauta ghrita (ghee washed a hundred or a thousand times with water or medicated decoctions) on or below the navel region. Similarly, she could also be sprinkled with cold milk or decoction of madhuka and nyagrodhadi class of (Ficusbengalensis Linn) herbs on or below her navel region, or she should take bath in tub of cold water. Cloth pieces soaked in the juice of ksheerivriksha (latex-yielding trees) class of herbs, or a cotton swab soaked in milk and ghee processed with leaf-buds of nyagrodhadi (Ficusbengalensis Linn) class of drugs should be inserted into her vagina. She should also consume ghee made up of milk in a quantity of aksha (about 10-12 ml) and treated with the same drugs as mentioned above. She should be offered a concoction made up of stamens of kamala (Nelumbo nucifera Gaertn.), utpala (Nymphaea alba Linn), and kumuda (a variety of Nymphaea species), mixed with honey and sugar linctus. She should eat singhataka (Trapabispinosa Roxb. – chestnut), pushkarabeeja (lotus seeds –Nelumbonucifera Gaertn.) and kasheruka (Scirpusgrossus Linn. f.). She may be given goat’s milk boiled with gandhapriyangu (Callicarpamacrophylla Vahl.), nilotpala (blue variety of Nymphaeaalba Linn), shaluka (rhizome of lotus), fruits of udumbara (Ficusracemosa Linn.) and leaf-buds of nyagrodha (Ficusbengalensis Linn). She should eat soft, fragrant and cooked shali rice of red variety (Orizasativa Linn.), added with honey and sugar along with milk boiled with roots of bala (Sidacordifolia Linn.), atibala (Abutilonindicum Linn.), shali, sashtika (both varieties of Orizasativa Linn.) ikshu (sugarcane- Saccharumofficinarum Linn.), and kakoli. Or she should eat the above rice along with the soup made of meat that is well-seasoned with ghee, of lava (Common Quail), kapinjala (Grey Partridge), kuranga (Roe deer), sambara (Indian Sambar), shasha (Rabbit), harina (Black Buck), ena (Antelope) orkalapuchchaka (Black tailed Deer), while sitting comfortably in a cool and well ventilated place. She should be protected from anger, grief, overexertion, activities that are sexual or intensely physical in nature, and should be entertained with pleasing and comforting stories. By following these methods, the embryo ([[garbha]]) is saved from abortion. [24]

</div>

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If a pregnant woman with a large and well-formed foetus starts experiencing bleeding or other forms of uterine discharge as ~~aresult~~ of indulgence in hot and pungent food articles, the foetus will cease growing. Such a foetus will stay for a long time in the mother’s womb and this condition is referred to as Upavistaka (or prolonged gestation).

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If a pregnant woman with a large and well-formed foetus starts experiencing bleeding or other forms of uterine discharge as a result of indulgence in hot and pungent food articles, the foetus will cease growing. Such a foetus will stay for a long time in the mother’s womb and this condition is referred to as Upavistaka (or prolonged gestation).

Similarly, in a pregnant woman who suffers from malnutrition due to overindulgence in rituals requiring fasting, or who avoids unctuous articles and indulges in vata-provoking dietary or lifestyle activities, foetus will not develop due to it getting weaned away from nutrition, and such foetus will remain in the womb for a long period of time without developing. This condition is called Nagodara (elephantine gestation). [26]

</div>

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==== Specific Therapeutic courses for the management of Intrauterine Growth Retardation ====

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=== Specific Therapeutic courses for the management of Intrauterine Growth Retardation ===

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Now (we) shall expound the specific therapeutic courses of treatment recommended for the management of ''upavistaka'' (intrauterine growth retardation because of decreased nutrient transfer) and nagodara (IUGR because of malnourishment). Ghee and milk which have been medicated with ''bhautika'' (drugs having anti-evil spirits / germs action), ''jivaniya'' (life-promoting), ''brimhaniya'' (bulk promoting), ''madhura'' (sweet) and ''vatahara'' (''vata'' alleviating) drugs help stimulate the development of the fetus. Immature or undeveloped fetus (i.e. poultry eggs) with milk also acts as an effective growth stimulant for the fetus. Ample use of medicated ghee also serves to nourish the mother and her fetus. These therapeutic courses should be supplemented with walking, moving in carriages (that do not jerk a lot), physical cleansing and engaging in mild exercises and other forms of physical activities. [27]

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Now (we) shall expound the specific therapeutic courses of treatment recommended for the management of ''upavistaka'' (intrauterine growth retardation because of decreased nutrient transfer) and nagodara (IUGR because of malnourishment). Ghee and milk which have been medicated with ''bhautika'' (drugs having anti-evil spirits / germs action), ''jivaniya'' (life-promoting), ''brimhaniya'' (bulk promoting), ''madhura'' (sweet) and ''vatahara'' (''[[vata]]'' alleviating) drugs help stimulate the development of the fetus. Immature or undeveloped fetus (i.e. poultry eggs) with milk also acts as an effective growth stimulant for the fetus. Ample use of medicated ghee also serves to nourish the mother and her fetus. These therapeutic courses should be supplemented with walking, moving in carriages (that do not jerk a lot), physical cleansing and engaging in mild exercises and other forms of physical activities. [27]

</div>

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If the fetal development has stalled or is slowed (for various reasons), then the pregnant woman should be advised to take ''shali'' rice (cooked Oriza sativa Linn.) which is soft, sweet and cool, with meat juices (seasoned with ghee), of one or more of the following animals- the hawk, fish, ''gayal'', peacock, rooster, or partridge - or with gruel of ''masha'' (Phaseolusradiates Linn - black gram) or with the soup of radish, with plenty of ghee. She also should be massaged with lukewarm oil (''tila taila''-gingilly oil) over her abdomen, pelvic region, groin, thigh, waist, sides and back. [28]

</div>

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==== Constipation during third trimester ====

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=== Constipation during third trimester ===

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</div>

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==== Symptoms of intra-uterine death ====

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=== Symptoms of intra-uterine death ===

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−

If the fetus dies in the womb as a result of excessive increase of ''~~doshas~~'' caused due to over-indulgence in pungent and hot things, or due to suppression of urges to pass flatulence, urine and bowel movement, or due to faulty eating, faulty sitting, lying down or standing or due to compression (of the womb) and injuries, or passion, grief, envy, horror, fear etc., or due to intensive/extreme physical activities, then the stomach will be still, rigid, bloated up, cold and stony-hard. This condition would be accompanied by severe pain in the stomach, but the labor pains do not set in and there is no discharge. The woman’s eyes will droop and she may feel nauseous, pain, is in agony, giddiness, and breathlessness with intense restlessness. The natural urges also will not be proper as routine. If these features are seen in a pregnant woman, then it should be construed that the fetus is dead. [30]

+

If the fetus dies in the womb as a result of excessive increase of ''[[dosha]]s'' caused due to over-indulgence in pungent and hot things, or due to suppression of urges to pass flatulence, urine and bowel movement, or due to faulty eating, faulty sitting, lying down or standing or due to compression (of the womb) and injuries, or passion, grief, envy, horror, fear etc., or due to intensive/extreme physical activities, then the stomach will be still, rigid, bloated up, cold and stony-hard. This condition would be accompanied by severe pain in the stomach, but the labor pains do not set in and there is no discharge. The woman’s eyes will droop and she may feel nauseous, pain, is in agony, giddiness, and breathlessness with intense restlessness. The natural urges also will not be proper as routine. If these features are seen in a pregnant woman, then it should be construed that the fetus is dead. [30]

</div>

−

==== Treatment of intra-uterine death ====

+

=== Treatment of intra-uterine death ===

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According to some scholars, the treatment of dead fetus (which acts like a foreign body within the womb) consists of administering medicines which are used to expel the placenta. Others suggest using mantras, prayers and spiritual offerings as explained in the Atharva Veda. Yet others believe that it should be removed by surgical means by an expert surgeon.

−

If the dead fetus is immature (i.e., in its early stages of development), then once the dead fetus is extracted, the woman should drink, to her fill, alcoholic drinks such ''assura, sidhu, arishta, madhu, madira'' and ''asava'' in order to cleanse her uterus, relieve herself from pain and also to become euphoric (i.e., overcome her grief). Then she should be given food articles that are nourishing and strength-enhancing but without fat or oil in them, such as gruels that are suitable for that moment till the excess moisture of the ''dosha'' and ''~~dhatus~~'' are absorbed. Then she should be treated with ''snehapana'' (administration of unctuous substances), enema and diets processed with medications possessing appetizing, vitalizing, bulk-promoting, sweet and ''vata''-alleviating properties. If the dead fetus is a mature one, once the dead fetus is removed, that day itself she should be treated with unction measures. [31]

+

If the dead fetus is immature (i.e., in its early stages of development), then once the dead fetus is extracted, the woman should drink, to her fill, alcoholic drinks such ''assura, sidhu, arishta, madhu, madira'' and ''asava'' in order to cleanse her uterus, relieve herself from pain and also to become euphoric (i.e., overcome her grief). Then she should be given food articles that are nourishing and strength-enhancing but without fat or oil in them, such as gruels that are suitable for that moment till the excess moisture of the ''[[dosha]]'' and ''[[dhatu]]s'' are absorbed. Then she should be treated with ''snehapana'' (administration of unctuous substances), enema and diets processed with medications possessing appetizing, vitalizing, bulk-promoting, sweet and ''[[vata]]''-alleviating properties. If the dead fetus is a mature one, once the dead fetus is removed, that day itself she should be treated with unction measures. [31]

</div>

−

==== Monthly regimen to be adopted during normal pregnancy ====

+

=== Monthly regimen to be adopted during normal pregnancy ===

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*In the fifth month of pregnancy, milk along with ghee should be given.

*In the sixth month of pregnancy, milk with ghee processed with sweet-tasting drugs should be given to drink.

−

*In the seventh month of pregnancy, she should be given the same regimen as prescribed in the sixth month. Experienced women are of the opinion that during this period, the fetus develops scalp hair and it causes burning sensation in the mother. But this view is negated by Lord Atreya, who says that due to the pressure created by the fetus, the three ''~~doshas~~'' of the mother reach the chest region and cause burning sensation in her, causing itching which, in turn, causes ''kikkisa'' (stretch-marks or striae gravidarum -linea albicantes – the white abdominal lines seen during and after pregnancy on the abdomen). To manage this condition, she should regularly be given butter medicated with sweet-tasting drugs, the quantity of which she can hold in her single palm, along with a decoction of ''kola'' (Zizyphus jujube Lam). Her breasts and abdomen should be massaged with a paste of ''chandana'' (Santalumalbum Linn.), ''mrinala'' (stalk of lotus) or powder of ''shirisha'' (Albizia lebbeck Benth), ''dhataki'' (Woodfordiafruticosa Kurz), ''sarshapa'' (Mustard – Brassicanigra Koch), and ''madhuka'' (Glycyrrhizaglabra Linn.) or paste of ''kutaja'' (Holarrhenaantidysenterica Wall.), seed of ''arjaka'' (Ocimumgratissimum Linn.), ''musta'' (Cyperusrotundus Linn.), ''haridra'' (Curcumalonga Linn.) or paste of ''nimba'' (Azadirachtaindica A. Juss), ''kola'' (Zizyphusjujuba Lam.), ''surasa'' (Ocimumsanctum Linn.) and ''manjishta'' (Rubiacordifolia Linn.) or ''triphala'' (three pungent fruits – Terminaliachebula Linn., Terminaliabelerica Roxb. and Emblicaofficinalis Gaertn.) mixed with the blood of ''prishta'' (spotted deer), massage with oil prepared with leaf of ''karavira'' (Neriumindicum Mill.) and sprinkling with water processed with ''jati'' (''Malati'' – Aganosma dichotoma K. Schum.) and ''madhuka'' (Glycyrrhizaglabra Linn.) plant. Thus, itching should be avoided to prevent stretch-mark on skin (and therefore, avoiding disfiguring the skin). If itching is too severe to tolerate then it should be overcome by an application of ''unmardana'' (anointing) and ''udgharshana'' (rubbing with pastes) procedures. During this period, she should eat sweet-tasting food that is ''vata'' alleviating in nature and is light on oil, fat and salt, and should drink less water immediately after the food.

+

*In the seventh month of pregnancy, she should be given the same regimen as prescribed in the sixth month. Experienced women are of the opinion that during this period, the fetus develops scalp hair and it causes burning sensation in the mother. But this view is negated by Lord Atreya, who says that due to the pressure created by the fetus, the three ''[[dosha]]s'' of the mother reach the chest region and cause burning sensation in her, causing itching which, in turn, causes ''kikkisa'' (stretch-marks or striae gravidarum -linea albicantes – the white abdominal lines seen during and after pregnancy on the abdomen). To manage this condition, she should regularly be given butter medicated with sweet-tasting drugs, the quantity of which she can hold in her single palm, along with a decoction of ''kola'' (Zizyphus jujube Lam). Her breasts and abdomen should be massaged with a paste of ''chandana'' (Santalumalbum Linn.), ''mrinala'' (stalk of lotus) or powder of ''shirisha'' (Albizia lebbeck Benth), ''dhataki'' (Woodfordiafruticosa Kurz), ''sarshapa'' (Mustard – Brassicanigra Koch), and ''madhuka'' (Glycyrrhizaglabra Linn.) or paste of ''kutaja'' (Holarrhenaantidysenterica Wall.), seed of ''arjaka'' (Ocimumgratissimum Linn.), ''musta'' (Cyperusrotundus Linn.), ''haridra'' (Curcumalonga Linn.) or paste of ''nimba'' (Azadirachtaindica A. Juss), ''kola'' (Zizyphusjujuba Lam.), ''surasa'' (Ocimumsanctum Linn.) and ''manjishta'' (Rubiacordifolia Linn.) or ''triphala'' (three pungent fruits – Terminaliachebula Linn., Terminaliabelerica Roxb. and Emblicaofficinalis Gaertn.) mixed with the blood of ''prishta'' (spotted deer), massage with oil prepared with leaf of ''karavira'' (Neriumindicum Mill.) and sprinkling with water processed with ''jati'' (''Malati'' – Aganosma dichotoma K. Schum.) and ''madhuka'' (Glycyrrhizaglabra Linn.) plant. Thus, itching should be avoided to prevent stretch-mark on skin (and therefore, avoiding disfiguring the skin). If itching is too severe to tolerate then it should be overcome by an application of ''unmardana'' (anointing) and ''udgharshana'' (rubbing with pastes) procedures. During this period, she should eat sweet-tasting food that is ''[[vata]]'' alleviating in nature and is light on oil, fat and salt, and should drink less water immediately after the food.

*In the eighth month, she should take gruel prepared with milk and mixed with ghee in all her meals in their appropriate times. Bhadrakapya has opposing views on this and believes that it causes ''paingalya'' (tawny discoloration of the eyes of fetus) in the fetus, and hence should not be practiced. On this point, Lord Atreya believes that while the risk of paingalya may be there, it does not indicate in any way that the above regimen should not be applied. The woman following this regimen remains free from all disorders and gives birth to a child endowed with excellent health, strength, complexion, voice and compactness of body.

*Finally, in the ninth month of pregnancy, she should be treated with unctuous enema prepared with sweet-tasting drugs. A cotton swab soaked in the same oil should be kept in her genital tract in order to lubricate the passage of the fetus.

−

If the specific dietary regimen and therapeutic measures mentioned above are followed right from the first month of pregnancy to the ninth month, the entire child-bearing region of the woman’s body – including her womb, waist, sides of pelvis, and her back - become soft at the time of delivery, ''vata'' functions in a normal way, urine and bowel movement pass smoothly, skin and nails become soft, her strength and complexion are improved and the woman delivers the child effortlessly. [32]

+

If the specific dietary regimen and therapeutic measures mentioned above are followed right from the first month of pregnancy to the ninth month, the entire child-bearing region of the woman’s body – including her womb, waist, sides of pelvis, and her back - become soft at the time of delivery, ''[[vata]]'' functions in a normal way, urine and bowel movement pass smoothly, skin and nails become soft, her strength and complexion are improved and the woman delivers the child effortlessly. [32]

</div>

−

==== Infra structure of maternity home ====

+

=== Infra structure of maternity home ===

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</div>

−

==== Requirements in the maternity home ====

+

=== Requirements in the maternity home ===

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</div>

−

==== Rituals for the expecting woman before entering the maternity home ====

+

=== Rituals for the expecting woman before entering the maternity home ===

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After furnishing the maternity home, in the beginning of the ninth month, on an auspicious day, when moon is in the auspicious ''nakshatra'' (constellation), with an auspicious ''karana'' and at an auspicious ''muhurta'' (astrological unit of time), with priests offering oblations and rites to holy fire, first of all the cow, the ''brahmana'', fire and water should be made to enter the maternity home. Then grass, water, honey and ''laja'' (parched rice) should be offered to the cows, and ''akshata'' (rice grains prepared exclusively for worship), fragrant flowers and sweet fruits (such as ''khajura'', date), which are indicative of good fortune, should be offered to the ''brahmanas''. Blessings should then be sought from the ''brahmanas'', after taking sips of water (''achamana'' is taking sips of water after chanting ''mantra''). With auspicious mantras being chanted by the priests, the expecting woman should enter the maternity home, following the cow and the ''brahmanas'' to her right side. Then she should stay there until she delivers her child. [35]

</div>

−

==== Premonitory signs and symptoms of labor ====

+

=== Premonitory signs and symptoms of labor ===

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The premonitory signs and symptoms of labor include tiredness, pallor, laxity of eyes (drooping of eyelids), feeling of getting freed from constrictions around the chest, bearing down pressure sensation in pelvis because of fetus, heaviness of lower abdomen, and pain in the groin, bladder area perineum, pelvis, belly, sides and the back, discharge from the vagina, lack of desire for food. These are typically followed by the appearance of ''garbhodaka'' (amniotic fluid) and initiation of ''aavee'' (labor pain). [36]

</div>

−

==== Commencement of ''aavee'' (labor) ====

+

=== Commencement of ''aavee'' (labor) ===

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With the commencement of ''aavee'', the parturient woman should be made to sit on a bed prepared with soft materials spread over the ground. Then, the female attendants with qualities mentioned in the preceding verses should surround her from all sides and encourage her by comforting words and touch. [37]

</div>

−

==== Issues with delivery despite labor pains ====

+

=== Issues with delivery despite labor pains ===

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−

If in spite of acute labor pains, she is not able to deliver, some advise that the woman must be instructed to get up, hold a pestle and pound grains repeatedly, taking breaks and deep breaths, and moving about periodically. Lord Atreya, however, does not consider it right. According to him, a pregnant woman should always be advised to avoid strenuous exercises and particularly during parturition, since all the body elements and humors are in a state of commotion, ''vata'', aggravated by the strain involved in the exercise of pounding, could even be fatal to the pregnant woman. Woman during this situation will be difficult to cure. Other sages advise against the pounding exercises but advocating deep breathing and moving about.

+

If in spite of acute labor pains, she is not able to deliver, some advise that the woman must be instructed to get up, hold a pestle and pound grains repeatedly, taking breaks and deep breaths, and moving about periodically. Lord Atreya, however, does not consider it right. According to him, a pregnant woman should always be advised to avoid strenuous exercises and particularly during parturition, since all the body elements and humors are in a state of commotion, ''[[vata]]'', aggravated by the strain involved in the exercise of pounding, could even be fatal to the pregnant woman. Woman during this situation will be difficult to cure. Other sages advise against the pounding exercises but advocating deep breathing and moving about.

The woman should be made to inhale the powders of ''kushta'' (Saussurea lappa C.B.Clarke.), ''ela'' (Elettaria cardamomum Maton), ''langalaki'' (Gloriosa superb Linn.), ''vacha'' (Acorus calamus Linn.), ''chitraka'' (Plumbago zeylanica Linn.), ''chirbilva'' (Pongamia pinnata Mirr.) and ''chavya'' (Piper chaba Hunter), which can be administered frequently . Similarly the fumigation done with leaves of ''bhurja'' (Betula utilis D. Don.) or pith of ''shimsapa'' (Dalbergia sissoo Roxb.) could be used for inhalation. During this period, she should be given a light massage over her waist, sides, back and legs with lukewarm oil followed by a kneading massage. With these measures the fetus descends down. [38]

</div>

−

==== Mantra to be recited when labor pain increases ====

+

=== Mantra to be recited when labor pain increases ===

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−

The attending women should instruct her thus, “Don’t strain (bear down) when there is no labor pain, because if you do, the efforts may go in vain, and moreover the off spring may be born with deformities or afflicted with diseases like ''shwasa'' (dyspnoea), ''kasa'' (cough), ''shosha'' (emaciation) or ''pleeha'' (spleenic disorders). As when there is no natural urge to sneeze, or pass flatulence, urine or bowel movements, they will not appear or if appear will be with a lot of effort, similarly if the woman strains when there is no labour pain, the foetus will not come out or if at all it comes out, it will be with great difficulty. On the other hand, just as when there is a strong urge to pass bodily wastes, one should not suppress them, not straining when there is acute labor pain will lead to difficult labour. The woman should be advised to follow the following instructions - Initially she should strain (bear down) with mild force, gradually with stronger efforts. While she is bearing down hard, the attendants should keep repeating words such as ‘She has just delivered a worthy son, fortunate son’.Such words make the woman feel happy and motivate her to continue pushing the baby out. [40]

+

The attending women should instruct her thus, “Don’t strain (bear down) when there is no labor pain, because if you do, the efforts may go in vain, and moreover the off spring may be born with deformities or afflicted with diseases like ''shwasa'' (dyspnoea), ''kasa'' (cough), ''shosha'' (emaciation) or ''pleeha'' (spleenic disorders). As when there is no natural urge to sneeze, or pass flatulence, urine or bowel movements, they will not appear or if appear will be with a lot of effort, similarly if the woman strains when there is no labour pain, the foetus will not come out or if at all it comes out, it will be with great difficulty. On the other hand, just as when there is a strong urge to pass bodily wastes, one should not suppress them, not straining when there is acute labor pain will lead to difficult labour. The woman should be advised to follow the following instructions - Initially she should strain (bear down) with mild force, gradually with stronger efforts. While she is bearing down hard, the attendants should keep repeating words such as ‘She has just delivered a worthy son, fortunate son’. Such words make the woman feel happy and motivate her to continue pushing the baby out. [40]

</div>

−

==== Procedure to remove placenta post-delivery ====

+

=== Procedure to remove placenta post-delivery ===

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−

Immediately after the delivery of the child, one should confirm whether the placenta has been expelled out or not. If it is not expelled, then one of the female attendants should forcefully press her abdomen from above the navel region with her right hand and holding her back with left, should give a good shake to the body of the patient. The hip region of the patient should be pressed with the heels and her buttocks should be taken by hand and strongly pressed by the attendant. Her throat should be rubbed with the braid of her hair. The genital tract should be fumigated with the leaves of ''bhurja'' (Betula utilis D. Don.), ''kachamani'' (quartz) and ''sarpanirmoka'' (slough of serpent). She should be given paste of ''kushta'' (Saussurea lappa C. B. Clarke) and ''talisa'' (Abies webbiana Lindl.) mixed with the soup of ''balwaja'' (a hemp-like plant) or strong liquor of ''maireya'' and ''sura''-like beverages for drinking, or the soup of ''kulaththa'' (Dolichos biflorus Linn. - horse gram) or decoctions of ''mandukaparni'' (Centella asiatica Urban.) and ''pippali'' (Piper longum Linn.). The paste of ''laghu ela'' (Elettaria cardamomum Moton.), ''kilima'' (Devadaru – Cedrus deodara Loud.), ''kushta'' (Saussurea lappa C.B. Clarke), ''shunthi'' (Zingiber officinale Rosc.), ''vidanga'' (Embeliaribes Burm f.), ''pippali'' (Piper longum Linn.), ''kalagaru'' (Aquilaria agallocha Roxb. – black variety), ''chavya'' (Piper chaba Junter.), ''chitraka'' (Plumbago zeylanica Roxb.) and ''upakunjika'' (Nigella sativa Linn.)and crushed pieces of the right ear of a living untamed bull, pounding it on grinding stone and keeping it for some time in one of the decoctions of ''Balwaja'' (-?-) etc.;The liquid portion of this decoction should be administered to the patient as a drink. A cotton swab soaked in the oil prepared with ''shatapushpa'' (Foeniculum vulgare Mill.), ''kushta'' (Saussurea lappa C. B. Clarke), ''Madana'' (Randia dumetorum Lam.) and ''hingu'' (Ferula narthex Boiss.) should be inserted into her vaginal passage, and with the same oil, ''anuvasana basti'' (unctuous enema) should be administered to her. The decoction of ''Balwaja''(-?-) should be mixed with apaste of ''madanaphala''(Randia duemtorum Lam.), ''devadali'' (Luffaechinata Roxb.),''ikshvaku'' (Legenaria siceraria Standl.), ''dhamargava'' (Luffa cylindrica M. Roem.), ''kutaja'' (Holarrhena antidysenterica Wall.), ''kritavedhana'' (Luffa acutangula Roxb.) and ''gajapippali'' (Scindapsus officilanlis Schott.) and administered in the form of ''asthapana basti'' (non-unctuous enema).This non-unctuous enema will lead to the expulsion of the retained placenta while passing flatulence, urine and bowel movementsby the downward movement of ''vayu''. Bodily wastes have a tendency to come out of the body naturally, but may get obstructed inside the abdomen, obstructing the ejection of the placenta too. [41]

+

Immediately after the delivery of the child, one should confirm whether the placenta has been expelled out or not. If it is not expelled, then one of the female attendants should forcefully press her abdomen from above the navel region with her right hand and holding her back with left, should give a good shake to the body of the patient. The hip region of the patient should be pressed with the heels and her buttocks should be taken by hand and strongly pressed by the attendant. Her throat should be rubbed with the braid of her hair. The genital tract should be fumigated with the leaves of ''bhurja'' (Betula utilis D. Don.), ''kachamani'' (quartz) and ''sarpanirmoka'' (slough of serpent). She should be given paste of ''kushta'' (Saussurea lappa C. B. Clarke) and ''talisa'' (Abies webbiana Lindl.) mixed with the soup of ''balwaja'' (a hemp-like plant) or strong liquor of ''maireya'' and ''sura''-like beverages for drinking, or the soup of ''kulaththa'' (Dolichos biflorus Linn. - horse gram) or decoctions of ''mandukaparni'' (Centella asiatica Urban.) and ''pippali'' (Piper longum Linn.). The paste of ''laghu ela'' (Elettaria cardamomum Moton.), ''kilima'' (Devadaru – Cedrus deodara Loud.), ''kushta'' (Saussurea lappa C.B. Clarke), ''shunthi'' (Zingiber officinale Rosc.), ''vidanga'' (Embeliaribes Burm f.), ''pippali'' (Piper longum Linn.), ''kalagaru'' (Aquilaria agallocha Roxb. – black variety), ''chavya'' (Piper chaba Junter.), ''chitraka'' (Plumbago zeylanica Roxb.) and ''upakunjika'' (Nigella sativa Linn.)and crushed pieces of the right ear of a living untamed bull, pounding it on grinding stone and keeping it for some time in one of the decoctions of ''Balwaja'' (-?-) etc.;The liquid portion of this decoction should be administered to the patient as a drink. A cotton swab soaked in the oil prepared with ''shatapushpa'' (Foeniculum vulgare Mill.), ''kushta'' (Saussurea lappa C. B. Clarke), ''Madana'' (Randia dumetorum Lam.) and ''hingu'' (Ferula narthex Boiss.) should be inserted into her vaginal passage, and with the same oil, ''anuvasana basti'' (unctuous enema) should be administered to her. The decoction of ''Balwaja''(-?-) should be mixed with apaste of ''madanaphala''(Randia duemtorum Lam.), ''devadali'' (Luffaechinata Roxb.),''ikshvaku'' (Legenaria siceraria Standl.), ''dhamargava'' (Luffa cylindrica M. Roem.), ''kutaja'' (Holarrhena antidysenterica Wall.), ''kritavedhana'' (Luffa acutangula Roxb.) and ''gajapippali'' (Scindapsus officilanlis Schott.) and administered in the form of ''asthapana [[basti]]'' (non-unctuous enema).This non-unctuous enema will lead to the expulsion of the retained placenta while passing flatulence, urine and bowel movementsby the downward movement of ''vayu''. Bodily wastes have a tendency to come out of the body naturally, but may get obstructed inside the abdomen, obstructing the ejection of the placenta too. [41]

Line 958: Line 971:

</div></div>

−

While administering the various procedures described in the preceding verse to remove the placenta from the mother’s body, certain measures should also be performed on the newly born child, such as gently striking the stones near the root of the ear, and sprinkling of cold or hot water over its face, to rejuvenate its vital breath that might have stopped due to distress. If the child is not ~~movingor~~ does not revive, it should then be fanned with a winnowing basket made of bamboo etc. till it regains consciousness (the procedures to be continued till consciousness is established). Once respiration is established and gets normalized, then he should be given a good bath and cleansed thoroughly. [42]

+

While administering the various procedures described in the preceding verse to remove the placenta from the mother’s body, certain measures should also be performed on the newly born child, such as gently striking the stones near the root of the ear, and sprinkling of cold or hot water over its face, to rejuvenate its vital breath that might have stopped due to distress. If the child is not moving or does not revive, it should then be fanned with a winnowing basket made of bamboo etc. till it regains consciousness (the procedures to be continued till consciousness is established). Once respiration is established and gets normalized, then he should be given a good bath and cleansed thoroughly. [42]

</div>

−

==== Procedure for cleaning the baby after birth ====

+

=== Procedure for cleaning the baby after birth ===

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Thereafter, the palate, lips, throat and tongue of the child should be cleaned with a clean cotton swab using a finger of the attendant, whose nails have been well manicured. After cleaning the mouth, a cotton swab well soaked in oil should be placed over the ''shirastalu'' (anterior fontanel) and then a procedure to provoke vomiting should be administered using ghee with ''saindhava'' (rock salt). [43]

</div>

−

==== Measuring the umbilical cord ====

+

=== Measuring the umbilical cord ===

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This concludes the verse on the “measurement of the cord”. [44]

</div>

−

==== Complications arising due to improper cutting of the umbilical cord ====

+

=== Complications arising due to improper cutting of the umbilical cord ===

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−

Improper cutting of the umbilical cord and administering of measures explained in the preceding verse could lead to complications such as ''ayamottundita'' (vertical swelling), ''vyayamottundita'' (horizontal swelling), ''pindalika'' (lumpy swellings or formation of a circular ring around the umblicus), ''vinamika'' (swelling in the margins with depression at centre), and ''vijrumbhika'' (swelling with constant increase in size as in umblical hernia). In case of these complications, by carefully observing the severity of the condition (mild to severe involvement of the ''~~doshas~~''), it should be treated using massages, unction, and sprinkling of ghee prepared with drugs that are non-irritants and ''vata'' and ''pitta'' pacifying. [45]

+

Improper cutting of the umbilical cord and administering of measures explained in the preceding verse could lead to complications such as ''ayamottundita'' (vertical swelling), ''vyayamottundita'' (horizontal swelling), ''pindalika'' (lumpy swellings or formation of a circular ring around the umblicus), ''vinamika'' (swelling in the margins with depression at centre), and ''vijrumbhika'' (swelling with constant increase in size as in umblical hernia). In case of these complications, by carefully observing the severity of the condition (mild to severe involvement of the ''[[dosha]]s''), it should be treated using massages, unction, and sprinkling of ghee prepared with drugs that are non-irritants and ''[[vata]]'' and ''[[pitta]]'' pacifying. [45]

</div>

−

==== Birth-rites per Vedic rituals ====

+

=== Birth-rites per Vedic rituals ===

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Thereafter, birth-rites of the child should be performed per vedic rituals, which are as follows: first of all, honey and ghee duly “consecrated” with vedic mantras (chanted by brahmanas or priests) should be anointed to the child. Breast milk should first be fed from the right breast, and should be done so after performing the rituals mentioned above. An earthen pot filled with water should be consecrated with mantras and kept near the head of the child. [46]

</div>

−

==== Measures to protect the newborn ====

+

=== Measures to protect the newborn ===

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This verse describes measures to protect the newborn. To start with, the maternity home should be surrounded by the branches of ''adani'' (-?-),''khadira'' (Acacia catechu Willd.), ''karkandhu'' (Zyzyphus nummularia W.&A.), ''pilu'' (Salvadora persica Linn.), and ''parushaka'' (Grewiaasiatica Linn.).''Sarshapa'' (Brassica nigra Linn - mustard seeds), ''atasi'' (Linum ustatissimum Linn.), and ''tandula kanakanika'' (pieces of broken rice) should be spread all over the floors in the maternity home. The sacrificial ritual of offering rice to fire should be performed every morning and evening till the naming ceremony for the child is complete. At the door-sill, a wooden pestle should be kept obliquely. A ''potli'' (bag) containing ''vacha'' (Acorus calamus Linn.), ''kushtha'' (Saussurea lappa C.B. Clarke.), ''choraka'' (Ksaumaka -?-), ''hingu'' (Ferula narthex Boiss.), ''sarshapa'' (Brassica nigra Koch.), ''atasi'' (Linum usitatissimum Linn.), ''lashuna'' (Alium sativum Linn.), ''kanakanika'' (-?-) and other drugs known to be repellents of evil spirits should be tied to the door-sill, and to the necks of the mother and the child , and should also be put into cooking utensils, water jars, bed, and on either side of the door panels. There should be a fire lighted constantly with the fire woods of ''kanakanika'' (-?-), and ''tinduka'' (Diospyros peregrine Gurke.) at the fireplace within the maternity home. The attending women (of the qualities mentioned earlier) should keep vigilance of the maternity home for ten to twelve days. The whole house should be kept busy with people who are pious, affectionate and happy, and kept engaged with gifts, encouraging blessings, praise, song, music food and drinks. In order to bestow auspicious blessings on the mother and the child, ''brahmins'' well versed in Atharva Veda should perform ritual sacrifices in the sacred fire two times a day. These are, rituals and measures that need to be put in place to protect the mother and the child. [47]

</div>

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==== Post-partum care of the mother ====

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=== Post-partum care of the mother ===

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−

After the delivery (i.e., in the post-partum period) when the new mother feels hungry and needs nourishment, suitable fatty substances like ghee, oil, and majja (muscle fat or marrow), duly mixed with the powders of pippali (Piper longum Linn.), pippalimula (root of Piper longum Linn.), chavya (Piper chaba Hunter.), chitraka (Plumbagozeylanica Linn.) and shrungabera (Zingiberofficinale Rocs.) should be given to her, according to her status of ~~appetitie~~. Once she has eaten, she should be given a good massage on her abdomen with ghee and oil and then a big clean cloth should be wrapped around her abdomen so that vayu may not find a place to cause any ailment. Once the food eaten is digested, she should take liquid gruel prepared with pippali (Piper longum Linn.) etc., mixed with unctuous substances in copious amounts. She should take a warm water bath before taking meals, though. This regimen should be continued for five to seven nights. [48]

+

After the delivery (i.e., in the post-partum period) when the new mother feels hungry and needs nourishment, suitable fatty substances like ghee, oil, and majja (muscle fat or marrow), duly mixed with the powders of pippali (Piper longum Linn.), pippalimula (root of Piper longum Linn.), chavya (Piper chaba Hunter.), chitraka (Plumbagozeylanica Linn.) and shrungabera (Zingiberofficinale Rocs.) should be given to her, according to her status of appetite. Once she has eaten, she should be given a good massage on her abdomen with ghee and oil and then a big clean cloth should be wrapped around her abdomen so that vayu may not find a place to cause any ailment. Once the food eaten is digested, she should take liquid gruel prepared with pippali (Piper longum Linn.) etc., mixed with unctuous substances in copious amounts. She should take a warm water bath before taking meals, though. This regimen should be continued for five to seven nights. [48]

</div>

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On the tenth day of delivery, the woman, along with her child, should take bath in water treated with fragrant herbs, shveta sarshapa (white variety of mustard – Brassica nigra Koch.) and lodhra (Symplocos recemosa Roxb.). They should be dressed in light, new and clean garments, while the woman should also be adorned in pure, light and variegated ornaments. The garments and ornaments should have been consecrated using Vedic rituals, and blessed by priests wearing white garments and without any physical deformities. Then the child, having been wrapped in a new garment, should be placed with his head facing the east or the north. The father of the child should pay obeisance to the Gods and Brahmins on behalf of the child and then give it two names: one denoting the nakshatra under which it was born and the other intended for social interactions. The name for social purpose should have a Ghosha (sonant) for its first letter and for its last a Antastha (semi-vowel) or usman (sibilants and aspirate), should be free of Vriddhi(diphthongs), indicative of one of the three ancestors (father, grandfather and great grandfather) and not a new created The constellar name should be identical to that of the diety of the nakshatra and should be made up of two or four (Sanskrit) syllables. [50]

</div>

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==== Assessment of life-span of the baby ====

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=== Assessment of life-span of the baby ===

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This sums up the verse on physical features used to assess the longevity of the newborn. [51]

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==== Qualities of the wet-nurse attending the newborn ====

+

=== Qualities of the wet-nurse attending the newborn ===

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This verse describes the qualities of the wet nurse attending the baby. The attending physician should ask of the parents to hire a wet nurse who belongs to the same caste as the child’s mother, who is in her youth, is submissive, free from diseases, not deficient in any limb, not given to unwholesome pursuits, not ugly, not ill- disposed, is native to the country, is not mean or does not indulge in mean acts, affectionate towards children, whose children have not died, who is a mother to a male child, who is never careless, not sleeping in beds soiled with excrement, not married to man of lower caste, skillful in attendance, hygienic and is endowed with plenty of milk in her breasts. [52]

</div>

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==== Qualities of an ideal breast ====

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=== Qualities of an ideal breast ===

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These are the features of ideal breasts: they should be neither be very high nor very loose and sagging, neither very lean nor massive. They should have proportionate nipples and be easy to suck. [53]

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==== Qualities of the ideal breastmilk ====

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=== Qualities of the ideal breastmilk ===

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−

The breast milk which does not fit the above description is to considered vitiated and unfit for the child’s consumption. Milk that assumes a darkish or reddish hue, astringent in after-taste, clear, of no marked smell, dry, watery, frothy and light in texture or form, and is not satisfying causes emaciation, gives rise to vatika disorders, and thus, should be considered vata-vitiated. Milk that looks blackish, bluish, yellow, or coppery, has an after-taste which is sour or pungent, which smells like a corpse or like blood, and which is very warm is pitta-vitiated and could cause pittaja disorders. Finally, the milk that is very white, very sweet with a saltish after-taste, that has odour like ghee, oil, flesh-marrow or bone-marrow, is viscid, thready and sinks in water without mixing, gives rise to disorders of kapha and should be considered as kapha-vitiated milk. [55]

+

The breast milk which does not fit the above description is to considered vitiated and unfit for the child’s consumption. Milk that assumes a darkish or reddish hue, astringent in after-taste, clear, of no marked smell, dry, watery, frothy and light in texture or form, and is not satisfying causes emaciation, gives rise to vatika disorders, and thus, should be considered [[vata]]-vitiated. Milk that looks blackish, bluish, yellow, or coppery, has an after-taste which is sour or pungent, which smells like a corpse or like blood, and which is very warm is pitta-vitiated and could cause pittaja disorders. Finally, the milk that is very white, very sweet with a saltish after-taste, that has odour like ghee, oil, flesh-marrow or bone-marrow, is viscid, thready and sinks in water without mixing, gives rise to disorders of [[kapha]] and should be considered as [[kapha]]-vitiated milk. [55]

</div>

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−

If any of the three varieties of vitiated milks described in the preceding verse is in advertently consumed by the child, after ascertaining the specific features of the milk or the symptoms that are associated with a dosha affliction, emetics, purgatives and unctuous and non-unctuous enema specific to that afflicted dosha should be administered. The dietetic guidelines to a woman with vitiated milk are as follows: her food and drink should consist mainly of barley, wheat, sali and shashtika rice, mudga (Phaseolus mungo Linn. - green gram), harenuka (Lathyrus ashaca Linn.), sura, sauviraka, maireya and medaka varieties of wines, lashuna (Alium sativum Linn.) and karanja (Pongamia pinnata Merr.). The milk should be examined at frequent intervals for specific features and the appropriate corrective measures should be adopted. The decoctions of patha (Cissmpelos pareira Linn.), shunthi (Zingiberofficinale Rosc.), devadaru (Cedrusdeodara Loud.), musta (Cyperusrotundus Linn.), murva (Clemaistrilobaheyne ex Roth), guduchi (Tinosporacordifolia Miers.), indrayava (Holarrhenaantidysentrica wall.), kiratatikta (SwertiachirataBuch. -Ham.), katukarohini (Picrorhizakurroa Royle ex Benth.) and sariva (Hemidesmusindicus R. B.) are said to be beneficial. Similarly, other drugs with bitter, astringent, pungent and sweet tastes could also be administered, depending upon the nature of the disorder, dosage and season. [56]

+

If any of the three varieties of vitiated milks described in the preceding verse is in advertently consumed by the child, after ascertaining the specific features of the milk or the symptoms that are associated with a [[dosha]] affliction, emetics, purgatives and unctuous and non-unctuous enema specific to that afflicted [[dosha]] should be administered. The dietetic guidelines to a woman with vitiated milk are as follows: her food and drink should consist mainly of barley, wheat, sali and shashtika rice, mudga (Phaseolus mungo Linn. - green gram), harenuka (Lathyrus ashaca Linn.), sura, sauviraka, maireya and medaka varieties of wines, lashuna (Alium sativum Linn.) and karanja (Pongamia pinnata Merr.). The milk should be examined at frequent intervals for specific features and the appropriate corrective measures should be adopted. The decoctions of patha (Cissmpelos pareira Linn.), shunthi (Zingiberofficinale Rosc.), devadaru (Cedrusdeodara Loud.), musta (Cyperusrotundus Linn.), murva (Clemaistrilobaheyne ex Roth), guduchi (Tinosporacordifolia Miers.), indrayava (Holarrhenaantidysentrica wall.), kiratatikta (SwertiachirataBuch. -Ham.), katukarohini (Picrorhizakurroa Royle ex Benth.) and sariva (Hemidesmusindicus R. B.) are said to be beneficial. Similarly, other drugs with bitter, astringent, pungent and sweet tastes could also be administered, depending upon the nature of the disorder, dosage and season. [56]

</div>

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==== Lactation-stimulants (or galactogogues) ====

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=== Lactation-stimulants (or galactogogues) ===

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Galactogogues (lactation-stimulants) include the following food articles and habits: all wines with the exception of sidhu, vegetables, cereals and meat of domestic, marshy and aquatic origins; food articles and liquids that have predominantly sweet, sour or salty taste; herbs containing milky juices; cow’s milk; avoidance of laborious tasks, and; drinking of the decoctions of roots of virana (Vetiveria zizanoides Nash.), shashtika (a variety of shali – Oryza sativa Linn.), shali (Oryza sativa Linn.), ikshuvalika (Astercantha longifolia Nees.), darbha (Desmostachya bipinnata Stapf), kusha (Desmostachya bipinnata Stapf), kasha (Saccharum spontaneum Linn.), gundra (Saccharum sara)and Itkata (-?-)(are galactogogues). [57]

</div>

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====Procedure to be followed by the wet-nurse in order to feed the baby ====

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===Procedure to be followed by the wet-nurse in order to feed the baby ===

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When the wet nurse, having sweet, copious and pure milk, has bathed and anointed herself with fragrant pastes, dressed in white garments and adorned with herbs such as aindri (Citrullus colocynthis Schrad), brahmi (Bacopa monnieri Pennel), shatavirya (Cynodon dactylon Pers.), sahasravirya (a type of Shatavirya), amogha (Emblica officinalis Gaertn.), avyatha (Tinospora cordifolia Miers.)shiva (Terminalia chebula Linn.), vatyapushpi (Sida rhombifolia Linn.) and viswaksenakanta (Callicarpa macrophyla Vahl.), then she should take hold of the baby and, while facing east , feed the baby from the right breast first. These are prescribed duties of dhatri, or the wet nurse attending the baby. [58]

</div>

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==== Procedure of construction of nursery ====

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=== Procedure of construction of nursery ===

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This verse describes the procedure of construction of the nursery. It should be built by a skillful architect and should be sturdy, beautiful, well lighted, protected from draught, well ventilated (with air-entry from only one direction), free from pests, animals, fanged creatures, mice and moths. It should be well accessible to places of water storage, grinding, lavatory, bath and cooking, should be comfortable during all seasons, and furnished with beds, seats and spreads suited to each season. Moreover, protective measures, holy offerings, auspicious rites, and oblations should be performed and the facility should be provided with clean and experienced physicians and with a compassionate and caring staff. Thus, the ~~metod~~ of construction of a child care nursery has been described. [59]

+

This verse describes the procedure of construction of the nursery. It should be built by a skillful architect and should be sturdy, beautiful, well lighted, protected from draught, well ventilated (with air-entry from only one direction), free from pests, animals, fanged creatures, mice and moths. It should be well accessible to places of water storage, grinding, lavatory, bath and cooking, should be comfortable during all seasons, and furnished with beds, seats and spreads suited to each season. Moreover, protective measures, holy offerings, auspicious rites, and oblations should be performed and the facility should be provided with clean and experienced physicians and with a compassionate and caring staff. Thus, the method of construction of a child care nursery has been described. [59]

</div>

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</div>

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==== Measures for ensuring the child's well-being ====

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=== Measures for ensuring the child's well-being ===

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Thus all measures that promote the life of one’s progeny have been described for those who aspire to have children. By adopting these measures in the prescribed manner, one who is free from envy and ill-will attains his wishes with regard and honour. [67]

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==== Summary ====

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=== Summary ===

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</div></div>

−

Thus, to sum up this chapter, measures described here will fulfill the longing of the individual of ~~desirred~~ progeny and these are of great importance. By taking recourse to these measures in the manner prescribed, a wise man, free from envy or ill-will, is blessed (with a child) according to his wishes. [68]

+

Thus, to sum up this chapter, measures described here will fulfill the longing of the individual of desired progeny and these are of great importance. By taking recourse to these measures in the manner prescribed, a wise man, free from envy or ill-will, is blessed (with a child) according to his wishes. [68]

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Thus, ends the eight chapter of the [[Sharira Sthana]] of Agnivesha’s work as redacted by Charaka, and also marks the end of the [[Sharira Sthana]] itself. [69]

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==~~= ''~~Tattva Vimarsha~~'' /~~ Fundamental Principles===

+

== Tattva Vimarsha (Fundamental Principles) ==

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*Posture plays an important role in facilitating the union of the sperm and the ovum. Improper posture may lead to dosha prakopa, or dosha vitiation. Also, physical and mental wellbeing of both partners is essential for successful coitus and furthering one’s lineage. [6]

+

*Posture plays an important role in facilitating the union of the sperm and the ovum. Improper posture may lead to [[dosha]] prakopa, or [[dosha]] vitiation. Also, physical and mental wellbeing of both partners is essential for successful coitus and furthering one’s lineage. [6]

*Sexual intercourse, when done with happy and joyous mood results in good progeny. Entering the bed by placing the right and left leg first by male and female partners respectively needs scientific exploration. It may merely be auspicious as per rituals. [7] Healthy progeny and succession of lineage, amply supported by recitations of mantra (to invoke the Gods and bless the progeny), was the sole purpose of sexual intercourse. Pleasure and eroticism were not the prime purpose of sexual acts, per the vedic rituals documented. [8]

*For the husband to practice celibacy for the period of one week following his wife’s menstrual period is advised to ensure healthy sperm, in turn helping beget a healthy offspring. During this period specific dietetic, behavioural and psychological regimen are advised to be followed by both the partners for attaining physical and psychological well-being, which will further support conception. [9]

*The ideal time for performing the Putreshti procedure is mentioned as a week or so of cessation of menstrual flow of the female partner, so that ovulation starts. After this they may cohabit for eight nights. [11]

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*Predominance of a particular mahabhuta at the time of conception plays an important role in begetting a progeny of desired physique and complexion. [15]

+

*Predominance of a particular [[mahabhuta]] at the time of conception plays an important role in begetting a progeny of desired physique and complexion. [15]

*Psyche of the child to be born is decided by the deeds of the previous life of the individual as well as the mental disposition of the parents at the time of conception and the mental status of the mother during her pregnancy. [16]

*To beget a good progeny, healthy male and female reproductive systems, proper ovulatory cycles and potent seeds are essential. [17]

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*Upavishtaka and Nagodara, both suggestive of intrauterine growth retardation (IUGR) result due to improper nutrition to the growing foetus. [26] Proper nutrition will help correct the same. [27] Santarpana chikitsa which are vatahara are to be adopted. [28]

*Garbhini udavarta, a condition caused due to reverse movement of apana vata can have implications during child birth. [29]

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*In children, the dosha, dushya etc. causing the disease are the same as that in adults, the only difference being drug dosage. [65]

+

*In children, the [[dosha]], [[dushya]] etc. causing the disease are the same as that in adults, the only difference being drug dosage. [65]

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==~~= ''~~Vidhi Vimarsha~~'' /~~ Applied Inferences===

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== Vidhi Vimarsha (Applied Inferences) ==

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==== Ritukala – Ideal period in menstrual cycle for conception ====

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=== Ritukala – Ideal period in menstrual cycle for conception ===

−

For conception, the period after stoppage of menstruation,i.e., from the 4th day onwards to 12 days corresponding to the 16th day of the menstrual cycle is considered to be the ideal period for impregnation. During the first half of the menstrual cycle, i.e., from 1st day to 14th day, estrogen hormone is dominant, and under its influence, the cervical mucus becomes watery with a high concentration of sodium chloride. This consistency is ideal for spermatozoa to travel through the cervical canal. After ovulation on the 14th day, the formation of corpus luteum leads to the dominance of progesterone hormone, and this leads to change in a characteristic of cervical mucus from watery to viscous because of increased protein content and decrease in sodium chloride. This hampers the migration of sperm in the cervical canal. Hence the ritukala of 12 days in the first half of the cycle is justified.

+

For conception, the period after stoppage of menstruation, i.e., from the 4th day onwards to 12 days corresponding to the 16th day of the menstrual cycle is considered to be the ideal period for impregnation. During the first half of the menstrual cycle, i.e., from 1st day to 14th day, estrogen hormone is dominant, and under its influence, the cervical mucus becomes watery with a high concentration of sodium chloride. This consistency is ideal for spermatozoa to travel through the cervical canal. After ovulation on the 14th day, the formation of corpus luteum leads to the dominance of progesterone hormone, and this leads to change in a characteristic of cervical mucus from watery to viscous because of increased protein content and decrease in sodium chloride. This hampers the migration of sperm in the cervical canal. Hence the ritukala of 12 days in the first half of the cycle is justified.

[[File:gtypemucus.png]] [[File:ltypemucus.png]]

Under effect of progesterone preventing sperm penetration Cervical mucus under estrogenic effect <br>

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The possible mechanism of sex selection can be understood by knowing the swimming behavior of spermatozoa bearing X and Y chromosome in the female genital tract, as well as evidence suggesting selective penetration of spermatozoa in cervical mucus. The factors affecting the motility of sperms in genital tract are pH, temperature, viscosity, osmolarity, elements and ions. All these evidence suggest that the sex selection may depend on the female genital environment which changes throughout the cycle and hence the specific days of coitus mentioned in text may contribute to the selection of the desired offspring. The concentration of sperm in semen increases if the coitus is performed during alternate days. More the number of Y-bearing spermatozoa, more probability of procuring a male progeny<ref> Skandhan KP, Japee Jasmine: Hypothesis: Who is responsible for the sex of the offspring, Trends in Medical Research; 2011 </ref>.

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==== Selection of Suitable partner for conception ====

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=== Selection of Suitable partner for conception ===

In [[Ayurveda]] classics, the preparation of procuring healthy progeny begins with the selection of a partner. For a healthy progeny with longevity and desired traits, both partners should be of reproductive age without any physical or mental disease or chronic illness. Conception in older age is associated with genetic abnormalities like Down’s syndrome and rare chromosomal abnormalities like Patau's syndrome and Edward's syndrome in the offspring. Increased maternal age may also lead to the poor outcome of pregnancy. Conception during illness may result in congenital anomalies or growth retarded fetus. Research has shown risks of low birth weight, premature labor, anemia, and pre-eclampsia are related to the biological age<ref> CM Gibbs et al, The Impact of Early Age at First Childbirth on Maternal and Infant Health, 2012, PMID:22742615 </ref>.

Ideal position for coitus and factors affecting conception:

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In the prone position, pressure on abdomen affects the natural movement of vata dosha, while the left-lateral position stimulates the enzyme secretions in the gut and leads to pitta prakopa. Therefore, a comfortable, supine position is recommended for coitus for conception, as all body humors are in their proper positions. A sprinkling of cold water or cold compresses of vulva after coitus is useful to prevent the reverse flow of semen from the female genital tract. Mental comfort, urge for sex and willingness for sex with the same partner are very important factors for the conception and formation of a healthy fetus. As neuro-endocrinal harmony is essential during the act of coitus, one should be free of urges or thoughts of hunger, thirst, passing flatulence, urination or bowel movements, and should be free from emotions like stress, anger, anxiety while having sexual intercourse.

+

In the prone position, pressure on abdomen affects the natural movement of [[vata dosha]], while the left-lateral position stimulates the enzyme secretions in the gut and leads to [[pitta]] prakopa. Therefore, a comfortable, supine position is recommended for coitus for conception, as all body humors are in their proper positions. A sprinkling of cold water or cold compresses of vulva after coitus is useful to prevent the reverse flow of semen from the female genital tract. Mental comfort, urge for sex and willingness for sex with the same partner are very important factors for the conception and formation of a healthy fetus. As neuro-endocrinal harmony is essential during the act of coitus, one should be free of urges or thoughts of hunger, thirst, passing flatulence, urination or bowel movements, and should be free from emotions like stress, anger, anxiety while having sexual intercourse.

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==== Ambiance for coitus ====

+

=== Ambiance for coitus ===

The importance of ambiance in stimulating desire in a couple to perform sex, and thus, conceive a healthy child, is expressly mentioned in this chapter. Articles or experiences pleasant to the sensory organs (such as using fragrant objects, pleasing or arousing music or sound, articles pleasant in taste or touch) in a stimulating environment play a very important role in arousal and act as aphrodisiacs, per Ayurvedic texts.

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==== Effect of chanting mantras ====

+

=== Effect of chanting mantras ===

−

Keeping the body and its ~~doshas~~ in harmony with its environment are essential to good conception, as it is with staying healthy, per Ayurvedic texts. This is consistent with the vedic concept of Yatha Pinde Tatha Brahmande (As the Body, so the Universe) – that problems occur when there is disequilibrium between the body and its surroundings.

+

Keeping the body and its [[dosha]]s in harmony with its environment are essential to good conception, as it is with staying healthy, per Ayurvedic texts. This is consistent with the vedic concept of Yatha Pinde Tatha Brahmande (As the Body, so the Universe) – that problems occur when there is disequilibrium between the body and its surroundings.

Chanting and reciting mantras have an effect on neuro-endocrinal homeostasis<ref> Claire Braboszcz, Stephanie Hahusseau, Arnaud Delorme Meditation and Neuroscience: From Basic Research to Clinical Practice, 2010, Springer Publishing </ref>. Hence chanting or reciting mantras or shlokas is recommended for maintenance of a psychosomatic balance of the body. In Vedic rituals, shloka (sacred hymns) to be chanted are said to invoke Lord Brahma, the creator of the universe and the progenitor of all the activities of the universe, Lord Brihaspati, the power behind every activity, Lord Vishnu, the preserver of the universe, Soma and Agni, the prime principles in all living beings, Ashvinau, the symbol of health and well-being in every creature, and Mitra and Varuna, the forces necessary to sustain life in the universe. Therefore, vedic scriptures, including Ayurvedic texts, emphasize on paying one’s obeisance to deities and forces of the universe, in the form of Gods, if one desires a healthy offspring.

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Chanting of mantras is known to have physical, mental and spiritual benefits. Mantra chanting form the basis of yogic meditation practices to help calm one’s mind and ease anxieties, which could have adverse effects on one’s progeny. [[Ayurveda]] science also mentions the role of the atma, along with the union of sperm and ovum, as a prerequisite, in the formation of the garbha. For the atma (of the newborn) to be of best satva and good prior karma, the ambiance and environment of the area should be spiritual, and chanting helps in creating such an environment.

+

Chanting of mantras is known to have physical, mental and spiritual benefits. Mantra chanting form the basis of yogic meditation practices to help calm one’s mind and ease anxieties, which could have adverse effects on one’s progeny. [[Ayurveda]] science also mentions the role of the [[atma]], along with the union of sperm and ovum, as a prerequisite, in the formation of the [[garbha]]. For the [[atma]] (of the newborn) to be of best satva and good prior karma, the ambiance and environment of the area should be spiritual, and chanting helps in creating such an environment.

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==== Do’s and Dont’s before coitus ====

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=== Do’s and Dont’s before coitus ===

This chapter provides a detailed list of Do’s and Don’ts that could help a couple conceive a healthy child. These rules or guidelines address various aspects of the couple’s lifestyle – including their diet, their environment – and their health. Traditional rituals and guidelines such as staying pious (and not indulging in immoral thoughts or actions) and being in the company of spiritual or virtuous individuals have been adviced, especially for the expecting mother.

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==== Preparation for putreshthi yajna and its benefits ====

+

=== Preparation for putreshthi yajna and its benefits ===

Cultures around the world, especially in the eastern countries, practice various rituals to get a healthy offspring. While these rituals and customs are considered essential, their validity from the standpoint of scientific studies have not yet been established. Cultural traditions, however, do provide some much-needed assurance during this period of anxiety and should be continued according to tradition. The physical, psychological, social and spiritual wellbeing of the couple desirous of having progeny is very important - and this is facilitated through rituals. All the regimen and rituals also favor a planned pregnancy instead of an accidental pregnancy. A planned pregnancy ensures a proper physical, psychological, financial and social status.

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==== Regimens and factors affecting desired progeny ====

+

=== Regimens and factors affecting desired progeny ===

−

For getting the desired result (i.e., a healthy progeny of the desired traits), one has to apply the factors either in the form of the same element (dravya samanya) or the elements having similar constitution and properties (guna samanya) or similar the effort (karma samanya), giving the similar to get similar output. All the above mentioned dietary, ritualistic practices, and do's and don'ts need to be of the desired dravya, guna and karma samanya to get the desired result, i.e., healthy and long living progeny with good complexion and intelligence. Whatever the mother sees, tastes, touches, feels, thinks and the way she behaves or thinks socially or spiritually has a deep impact on the future temperament and behavior of the child. A popular example of this ‘karma based garbha samskara’ is the mythological story of Abhimanyu, the warrior son of Arjuna, in the Mahabharata. Abhimanyu, even when he was a fetus in his mother (Subhadra)’s womb, learned the technique of entering the Chakravyuha (a special type of battle formation) from his maternal uncle Lord Krishna. If the mother takes dravya having predominant jala mahabhuta dravya, there will be an increase in the kapha dhatu of the fetus, giving it a fair complexion. Similarly, other mahabhuta-dominant dravyas contribute to other types of complexions in the baby.

+

For getting the desired result (i.e., a healthy progeny of the desired traits), one has to apply the factors either in the form of the same element (dravya samanya) or the elements having similar constitution and properties ([[guna]] samanya) or similar the effort (karma samanya), giving the similar to get similar output. All the above mentioned dietary, ritualistic practices, and do's and don'ts need to be of the desired dravya, [[guna]] and karma samanya to get the desired result, i.e., healthy and long living progeny with good complexion and intelligence. Whatever the mother sees, tastes, touches, feels, thinks and the way she behaves or thinks socially or spiritually has a deep impact on the future temperament and behavior of the child. A popular example of this ‘karma based garbha samskara’ is the mythological story of Abhimanyu, the warrior son of Arjuna, in the Mahabharata. Abhimanyu, even when he was a fetus in his mother (Subhadra)’s womb, learned the technique of entering the Chakravyuha (a special type of battle formation) from his maternal uncle Lord Krishna. If the mother takes dravya having predominant jala mahabhuta dravya, there will be an increase in the kapha dhatu of the fetus, giving it a fair complexion. Similarly, other [[mahabhuta]]-dominant dravyas contribute to other types of complexions in the baby.

In Korea, for prenatal development, expectant mothers are advised to do certain practices called ‘Taegyo.<ref> Lee, Yuna, Lee, Jiyoung, Korean Traditional Taegyo Prenatal Education based on Sajudang Lee’s “Taegyo Singi”, 2016, International Journal of Childbirth Education, Pg 34-37 </ref>' Expectant mothers are advised to stay calm, avoid evil thoughts, listening to soft music, reading inspiring stories aloud, staying vigilant of surroundings and prudent in speech and action. Following these practices provides a safe and healthy environment for the fetal development.

Research in Pre-natal education

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Researchers have been studying the effect of external sensory experiences on the brain activities of infants. In one instance, researchers found enhanced brain activity in infants exposed to “novel word sounds” played everyday during the third trimester.<ref> Partanen, Eino et al, Prenatal Music Exposure Induces Long-Term Neural Effects, 2013, PLoS One, doi: 10.1371/journal.pone.0078946 </ref>

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==== Effects of karma of the progeny’s prior birth ====

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=== Effects of karma of the progeny’s prior birth ===

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As explained in this chapter, with the effect of karma samanya there is garbha sanskara on the fetus inside the mother’s womb. Therefore, the birth of an individual in any race depends on the karma of the parents and the karma from the child’s previous life. According to Charaka, an individual goes through the cycle of birth and death according to Karma Siddhanta. In fact, the birth of an individual has multiple facets like poorvakarma, matrija karma, pitrija karma, garbhadhana, garbhini paricharya and much more. One should not forget the effect of, i.e., karma on the fetus, the mother, and the father. Therefore, in spite of following of all do’s and don’ts strictly, there can be bad progeny because of it's (and the parent's) karma.

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As explained in this chapter, with the effect of karma samanya there is [[garbha]] sanskara on the fetus inside the mother’s womb. Therefore, the birth of an individual in any race depends on the karma of the parents and the karma from the child’s previous life. According to Charaka, an individual goes through the cycle of birth and death according to Karma Siddhanta. In fact, the birth of an individual has multiple facets like poorvakarma, matrija karma, pitrija karma, garbhadhana, garbhini paricharya and much more. One should not forget the effect of, i.e., karma on the fetus, the mother, and the father. Therefore, in spite of following of all do’s and don’ts strictly, there can be bad progeny because of it's (and the parent's) karma.

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==== Factors for healthy progeny ====

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=== Factors for healthy progeny ===

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As explained earlier, according to yukti pramana, the formation of garbha is multidimensional and requires normalcy of all components i.e. fertile period, healthy uterus, sufficient and healthy nutrients, and most importantly, healthy gametes.

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As explained earlier, according to yukti pramana, the formation of [[garbha]] is multidimensional and requires normalcy of all components i.e. fertile period, healthy uterus, sufficient and healthy nutrients, and most importantly, healthy gametes.

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==== Maintenance of products of conception ====

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=== Maintenance of products of conception ===

Stha or tishthati means to stay or remain in position. For sustaining a pregnancy, proper nourishment with adequate hormone status is essential. As mentioned in verse 20 of this chapter, herbs such as aindra, brahmi, satavirya, etc. help nourish the fetus, while Jivaniya herbs used regularly by the mother help achieve a healthy outcome of pregnancy.

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==== Factors causing harm to the embryo ====

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=== Factors causing harm to the embryo ===

Numerous factors that may hamper sustaining the pregnancy or cause abnormalities in the progeny have been described in this chapter. These factors can be classified as dietary, lifestyle, traumatic, psychological and spiritual factors. Observance of these avoidable factors leads to growth retardation, the death of the fetus, premature birth, illness or congenital malformations to the offspring. Research seems to indicate that emotional stress to the mother can lead to prenatal or postnatal complications of various types<ref> Stephen Maret, Introduction to Prenatal Psychology, 2011, Church Gate Books ISBN: 9780578089980 </ref> . Dietary habits and lifestyle may lead to neurohormonal changes which affect pregnancy and its outcome<ref> Calvin Hobel, Jennifer Culhane, Role of Pyschosocial and Nutritional Stress on Poor Pregnancy Outcome, 2003, J.Nutr., vol 133 no. 5 1709S-1717S </ref> . Similar faulty habits by the father can also cause abnormalities of spermatozoa which in turn leads to congenital anomalies in offspring.

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==== Precaution for the treatment of disorders in pregnant females ====

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=== Precaution for the treatment of disorders in pregnant females ===

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As explained by Charaka, a pregnant woman is like a vessel full of oil and should be treated with care, meaning that all ~~doshas~~, dhatu, mala and ojas of the pregnant woman are at such a critical physiological stage that if one does not attend to her in a timely and proper way it may lead to damage to the foetus or the mother or both. Hence the disorders which may occur during pregnancy are to be treated with special care. For the antenatal mother, the diet or medications which should be used for curing any ailment should be mild and effective. Panchakarma treatment, because of its use of invasive and strong medicines, is to be avoided. Basti and abhyanga to kati are advocated in the eighth month of pregnancy, and these are comparatively safer procedures and may also help in a normal labor. During the eighth month, the fetus is sufficiently developed and viable, and even if the mother gets labor pain while undergoing treatment (mild to aggressive courses, as the need may be), the fetus can be preserved, and there are fewer chances of compromising fetal life.

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As explained by Charaka, a pregnant woman is like a vessel full of oil and should be treated with care, meaning that all [[dosha]]s, [[dhatu]], [[mala]] and [[ojas]] of the pregnant woman are at such a critical physiological stage that if one does not attend to her in a timely and proper way it may lead to damage to the foetus or the mother or both. Hence the disorders which may occur during pregnancy are to be treated with special care. For the antenatal mother, the diet or medications which should be used for curing any ailment should be mild and effective. [[Panchakarma]] treatment, because of its use of invasive and strong medicines, is to be avoided. [[Basti]] and abhyanga to kati are advocated in the eighth month of pregnancy, and these are comparatively safer procedures and may also help in a normal labor. During the eighth month, the fetus is sufficiently developed and viable, and even if the mother gets labor pain while undergoing treatment (mild to aggressive courses, as the need may be), the fetus can be preserved, and there are fewer chances of compromising fetal life.

The effects of drug use during pregnancy on the fetus has been researched and documented. The mother as well the fetus, if subjected to certain drugs /treatment, can lead to side-effects on either or both. FDA has specified a certain list of drugs (X category) which are contraindicated during pregnancy <ref> https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/labeling/ucm093307.htm

Ix Gawade T, Ghorpade M, Effect of bala siddha taila anuvasana basti on labour pains; Ayurlog: National journal of Research in [[Ayurveda]] science’ Vol 3, Feb 2015

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</ref>. In [[Ayurveda]], the principles of antenatal treatment are given for shamana as well as shodhana, other drugs and treatment are contraindicated. In practice, for any ailments occurring during pregnancy, herbal medicines are preferred over herbo mineral medicines.

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</ref>. In [[Ayurveda]], the principles of antenatal treatment are given for shamana as well as [[shodhana]], other drugs and treatment are contraindicated. In practice, for any ailments occurring during pregnancy, herbal medicines are preferred over herbo mineral medicines.

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==== Disorders of the fetus and its treatment ====

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=== Disorders of the fetus and its treatment ===

Following are the common disorder of fetus, abortion, followed by intrauterine growth retardation and intrauterine death:

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===== Factors responsible for abortion and its treatment =====

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==== Factors responsible for abortion and its treatment ====

First-trimester abortion is seen in about 80% of total abortions. Any bleeding during the first trimester (up to 12 weeks) may either end in inevitable abortion, preterm labor and in rare cases may proceed to full term. Emotional factors like severe anger, stress, jealousy all are suspected to cause the high release of CRH (Corticotropin-releasing hormone) which may trigger uterine contractions.

Uterine bleeding from implantation site or deciduas may be triggered because of coitus, trauma, exercise and faulty regimen. Bleeding may further release prostaglandins which could trigger uterine contractions and hence abortion.

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Management of such condition is aimed at relieving uterine contractions and bleeding. Since there are vata and shonita dushti in abortion, treatment should follow the principle of vatarakta chikitsa viz. sheeta and snigdha lepa, and brimhana, vatahara, raktavardhaka diet, and drugs. Sura (alcohol-containing preparations) is mainly advised to relieve the pain and to increase the hemopoiesis.

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Management of such condition is aimed at relieving uterine contractions and bleeding. Since there are [[vata]] and shonita dushti in abortion, treatment should follow the principle of vatarakta chikitsa viz. sheeta and snigdha lepa, and [[brimhana]], vatahara, raktavardhaka diet, and drugs. Sura (alcohol-containing preparations) is mainly advised to relieve the pain and to increase the hemopoiesis.

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As explained earlier, garbhapata (abortion) due to ama dosha (during the first trimester) is very critical to treat. Treatment of ama dosha is apatarpana while that of garbha and garbhini needs santarpana, which are antagonistic and hence very tedious to treat. In practice, Madhura varga dravyas such as shatavari (Asparagus racemosus) and medicated ghee phalaghrita are used in case of threatened abortion. These promote proper nourishment and growth and stop bleeding.

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As explained earlier, garbhapata (abortion) due to ama dosha (during the first trimester) is very critical to treat. Treatment of ama dosha is apatarpana while that of [[garbha]] and garbhini needs santarpana, which are antagonistic and hence very tedious to treat. In practice, Madhura varga dravyas such as shatavari (Asparagus racemosus) and medicated ghee phalaghrita are used in case of threatened abortion. These promote proper nourishment and growth and stop bleeding.

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===== Growth retardation of fetus and its treatment =====

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==== Growth retardation of fetus and its treatment ====

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Intrauterine growth retardation of the fetus occurs due to malnourishment of mother as well as pregnancy disorders which cause vaginal discharge and bleeding. According to severity, they are categorized as garbhashosha (mentioned in Charaka Sharirsthana 2nd chapter) upavishtaka, nagodara, lina garbha (not directly mentioned but clinical features with the absence of movements of fetus suggest this condition). These conditions occur either because of improper nourishment of mother with vata and pitta dominant diet or because of decreased transfer of nutrients from mother to fetus as a consequence of fetal metabolic disorder or placental abnormality. The treatment principle applicable here is brimhana supplying nourishment to mother and fetus.

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Intrauterine growth retardation of the fetus occurs due to malnourishment of mother as well as pregnancy disorders which cause vaginal discharge and bleeding. According to severity, they are categorized as garbhashosha (mentioned in Charaka Sharirsthana 2nd chapter) upavishtaka, nagodara, lina garbha (not directly mentioned but clinical features with the absence of movements of fetus suggest this condition). These conditions occur either because of improper nourishment of mother with [[vata]] and [[pitta]] dominant diet or because of decreased transfer of nutrients from mother to fetus as a consequence of fetal metabolic disorder or placental abnormality. The treatment principle applicable here is [[brimhana]] supplying nourishment to mother and fetus.

All the dietary articles mentioned in the management have vatahara and dhatupushtikara properties, as there are vataprakopa and dhatukshya in these conditions. In the case of lina garbha, there is the absence of fetal movements, to expel such fetus, treatments which increase uterine contractions and induce labor are indicated because such fetus resembles fetus papyraceous or mummified fetus.

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Practically the herbs used in fetal growth restriction are yashtimadhu, shatavari, gambhari and preparations like phalghrita, laghumalinivasanta. These herbs and preparations are rasayana and improve dhatvagni and rasa dhatu nirmana. They also help in clearing any obstruction in the channels (srotas) which are supplying nourishment to the fetus through the mother. As mentioned in classics, ksheer basti given to the mother in severe IUGR conditions stimulates fetal growth.

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Practically the herbs used in fetal growth restriction are yashtimadhu, shatavari, gambhari and preparations like phalghrita, laghumalinivasanta. These herbs and preparations are [[rasayana]] and improve dhatvagni and [[rasa dhatu]] nirmana. They also help in clearing any obstruction in the channels (srotas) which are supplying nourishment to the fetus through the mother. As mentioned in classics, ksheer basti given to the mother in severe IUGR conditions stimulates fetal growth.

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===== Garbhini Udavarta and its management =====

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==== Garbhini Udavarta and its management ====

As a result of progesterone hormone which relaxes all the smooth muscles, there is decreased bowel and intestinal movements. Especially during the later months of pregnancy, along with progesterone, the pressure of the uterus on intestines and rectum leads to decreased peristalsis. This is observed most commonly during the 8th month. Garbhini udavarta is a similar condition with constipation and gaseous distention. This condition is to be relieved as straining for defecation may lead to hemorrhoids, bleeding hemorrhoids and leaking of membranes. Medicated enema of decoction is to be administered to clear the bowel as oral medications may aggravate uterine contractions. Enema with oil should be administered afterward for oleation of the tract, and this may further help in the formation of canal/pathway for parturition.

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The position in pregnancy to administer basti is nyubja sthithi – hunchback /flexed posture. Conventionally, the left-lateral position is used. In nyubja sthithi, the fetus moves in a ventral position relieving the pressure on colon and rectum, making it easy for basti to be administered and reach descending colon easily.

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The position in pregnancy to administer [[basti]] is nyubja sthithi – hunchback /flexed posture. Conventionally, the left-lateral position is used. In nyubja sthithi, the fetus moves in a ventral position relieving the pressure on colon and rectum, making it easy for [[basti]] to be administered and reach descending colon easily.

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===== Mrita garbha (intrauterine death) and its management =====

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==== Mrita garbha (intrauterine death) and its management ====

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All the factors which are contraindicated during pregnancy and are known to cause harm to the fetus, if continued by the mother can cause upavishtaka, nagodara, garbhashosa. If left untreated, excessive accumulation of ~~doshas~~ with maternal illness may lead to placental insufficiency and fetal disorders where it fails to metabolize nutrients and causes fetal death. The symptoms of mritagarbha (fetal death) also signify causes as antepartum hemorrhage, hypovolemia and its complications in the mother. [30]

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All the factors which are contraindicated during pregnancy and are known to cause harm to the fetus, if continued by the mother can cause upavishtaka, nagodara, garbhashosa. If left untreated, excessive accumulation of [[dosha]]s with maternal illness may lead to placental insufficiency and fetal disorders where it fails to metabolize nutrients and causes fetal death. The symptoms of mritagarbha (fetal death) also signify causes as antepartum hemorrhage, hypovolemia and its complications in the mother. [30]

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To expel the dead fetus, the treatments to be administered are to initiate uterine contractions and induce labor. If necessary surgical treatment for removal of a dead fetus is also believed to save the mother from serious complications like DIC (disseminated intravascular coagulopathy) may occur if fetal fibrin is absorbed in maternal circulation. After the removal of the dead fetus, the physician should administer sura varga (alcoholic preparations) for the relief of pain and purification of the gut and genito-urinary system and also for the sense of exhilaration. Loss of fetus in such a later stage can be very stressful for mother and anxiety, depression and other psychotic complications may arise if proper care is not taken. Once there is complete shuddhi of koshtha and garbhashaya, one should give brimhana treatment to promote tissue bulk and nutrition. As there is the removal of the kleda from all dhatus during the management and shuddhi, santarpana is very essential.

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To expel the dead fetus, the treatments to be administered are to initiate uterine contractions and induce labor. If necessary surgical treatment for removal of a dead fetus is also believed to save the mother from serious complications like DIC (disseminated intravascular coagulopathy) may occur if fetal fibrin is absorbed in maternal circulation. After the removal of the dead fetus, the physician should administer sura varga (alcoholic preparations) for the relief of pain and purification of the gut and genito-urinary system and also for the sense of exhilaration. Loss of fetus in such a later stage can be very stressful for mother and anxiety, depression and other psychotic complications may arise if proper care is not taken. Once there is complete shuddhi of koshtha and garbhashaya, one should give [[brimhana]] treatment to promote tissue bulk and nutrition. As there is the removal of the kleda from all dhatus during the management and shuddhi, santarpana is very essential.

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==== Monthly regimen during pregnancy ====

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=== Monthly regimen during pregnancy ===

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Regular intake of recommended diet and daily routine is essential for fetal growth as well as maternal well-being. Daily use of milk and milk products is an important aspect of garbhini paricharya. Milk can nourish all body tissues and is considered a wholesome diet, fulfilling the requirement of fetal as well as maternal growth. Milk is sheeta, snigdha, and madhura and increases the ojas in the body. Ojas is said to be the essence of all body tissues and revitalizes to produce new body elements. The regimen is rich in proteins as well as carbohydrates which are essential for fetal growth and development. Due care is taken while prescribing the regimen to prevent vata prakopa. Disturbance in vata balance may cause many diseases of the fetus as well as the mother. From the eighth month onwards, the preparation of birth canal for pariturition begins and also there is the descent of fetal presenting part in the pelvis. To relieve the symptoms of this pressure on pelvis and augment the formation of lower segment, to prepare cervix to become ripe and easily dilatable, basti and pichu (vaginal tampon) of oil are advised<ref> Meharban Singh – Care Of the New Born, 7thed. New Delhi. Sagar Publications, 2010. </ref>. ix Basti keeps vata dosha balanced & its gati in anulom (downward) direction, preventing the obstruction in the path of vata dosha to help the process of labor, natural and in ease.

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Regular intake of recommended diet and daily routine is essential for fetal growth as well as maternal well-being. Daily use of milk and milk products is an important aspect of garbhini paricharya. Milk can nourish all body tissues and is considered a wholesome diet, fulfilling the requirement of fetal as well as maternal growth. Milk is sheeta, snigdha, and madhura and increases the [[ojas]] in the body. [[Ojas]] is said to be the essence of all body tissues and revitalizes to produce new body elements. The regimen is rich in proteins as well as carbohydrates which are essential for fetal growth and development. Due care is taken while prescribing the regimen to prevent [[vata]] prakopa. Disturbance in [[vata]] balance may cause many diseases of the fetus as well as the mother. From the eighth month onwards, the preparation of birth canal for pariturition begins and also there is the descent of fetal presenting part in the pelvis. To relieve the symptoms of this pressure on pelvis and augment the formation of lower segment, to prepare cervix to become ripe and easily dilatable, [[basti]] and pichu (vaginal tampon) of oil are advised<ref> Meharban Singh – Care Of the New Born, 7thed. New Delhi. Sagar Publications, 2010. </ref>. ix [[Basti]] keeps [[vata dosha]] balanced & its gati in anulom (downward) direction, preventing the obstruction in the path of [[vata dosha]] to help the process of labor, natural and in ease.

Antenatal patients are prescribed Ayurvedic regimen throughout pregnancy with proper diet advice. The medicines given are shatavari, phalghrita especially during the first trimester.

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Use of a herbomineral preparation Garbhapala rasa because of its lead content is under controversy. Appropriate preparation of this herbominearal compound following Ayurvedic Formulary of India ensures proper development of the fetus and prevents bleeding and threatened abortion during the first trimester. Along with the physical development of the fetus, the spiritual and psychological development is also taken care of. Given this, the do's and don't's includes visiting scenic and places of interest, associating with likable people, eating prescribed diet, reading and listening to interesting stories are advised.

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The lifestyle, diet, exercise, synthetic drugs, food additives like artificial colors, preservatives, the onslaught of electromagnetic radiations have become an integral part of the day today life (ref:https://infoayushdarpan.wordpress.com/2017/01/18/the-role-of-masanumasik-formulations/). This affects the growth and development of the fetus. Decoctions made in the form of Ghana vati as mentioned by Ashtanga and Sushruta are used as a monthly treatment for all antenatal patients which facilitate proper nourishment and hence the growth of fetus preventing any illness. Research has shown that application of matra basti and yoni pichu of Bala ~~tssail~~ given from the first day of 9th month results in normal labor without prolongation with spontaneous onset Ref. Also, it reduces postpartum complications like a backache, lower abdominal pain, and abdominal distention.

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The lifestyle, diet, exercise, synthetic drugs, food additives like artificial colors, preservatives, the onslaught of electromagnetic radiations have become an integral part of the day today life (ref:https://infoayushdarpan.wordpress.com/2017/01/18/the-role-of-masanumasik-formulations/). This affects the growth and development of the fetus. Decoctions made in the form of Ghana vati as mentioned by Ashtanga and Sushruta are used as a monthly treatment for all antenatal patients which facilitate proper nourishment and hence the growth of fetus preventing any illness. Research has shown that application of matra [[basti]] and yoni pichu of Bala taila given from the first day of 9th month results in normal labor without prolongation with spontaneous onset Ref. Also, it reduces postpartum complications like a backache, lower abdominal pain, and abdominal distention.

Kikkisa (striae gravidarum) which occurs on abdominal and breast area due to itching is to be treated with local application of drugs which relieves itching and burning sensation. Also, certain herbs are varnya in nature i.e. to improve color and complexion of skin. Ointments, oil, and lepa are prepared from these formulations and prescribed to mother to apply on abdominal area, thighs, and breast from the second month itself to prevent kikkisa.

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Care during 9th month of pregnancy: Instead of suitiikagara, what special care of pregnant lady is advised by Ayurvedic obstretian at home before she goes into labor should be described. What instructions are given when labor pain starts?

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==== Management of Labor ====

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=== Management of Labor ===

Instead of moving the mother after the labor pain starts, she is shifted to the delivery abode (sutikagara) at the onset of the ninth month. The entry is a ritual and done on auspicious day and timing to ensure the successful and uneventful outcome of pregnancy and parturition without any untoward complications. Symptoms and signs which signify formation of the lower segment with uterine contractions and cervical dilation indicate the onset of labor. As soon as the onset of labor is determined, the counseling and observation of mother are to be with while she is lying down.

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The intensity of increased labor pain and the onset of gripping pain in lower pelvis signifies further descent of fetus and full dilatation of the cervix. The bearing down efforts is encouraged in lying down position. Chanting also encourages the mother to bear down properly.

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The proper timing of bearing down is full dilatation and presence of intense pain (uterine contractions). The two forces, voluntary (which are maternal bearing down effort) and involuntary (uterine contractions), when combined, lead to further descent and expulsion of a fetus with birth passage properly formed after full dilatation of the cervix. Expulsion of the fetus is controlled by apana vayu located in shroni (pelvis). If there is no movement of apana vayu and the mother bears down, it causes vata prakopa and leads to vikata navajata (baby born with deformities). Secondly, whenever there is an appropriate movement of apana vayu, but the woman suppresses that urge to bear down, that too leads to vata prakopa and causes deformities in the baby, the formation of caput succedaneum and fetal distress, both occur as a result of premature bearing down efforts and absence of bearing down respectively. The consequence of premature bearing down has increased the incidence of remote complication like vaginal and uterine prolapse.

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The proper timing of bearing down is full dilatation and presence of intense pain (uterine contractions). The two forces, voluntary (which are maternal bearing down effort) and involuntary (uterine contractions), when combined, lead to further descent and expulsion of a fetus with birth passage properly formed after full dilatation of the cervix. Expulsion of the fetus is controlled by apana vayu located in shroni (pelvis). If there is no movement of apana vayu and the mother bears down, it causes [[vata]] prakopa and leads to vikata navajata (baby born with deformities). Secondly, whenever there is an appropriate movement of apana vayu, but the woman suppresses that urge to bear down, that too leads to [[vata]] prakopa and causes deformities in the baby, the formation of caput succedaneum and fetal distress, both occur as a result of premature bearing down efforts and absence of bearing down respectively. The consequence of premature bearing down has increased the incidence of remote complication like vaginal and uterine prolapse.

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After the birth of a baby, in the case of retained placenta, the therapies administered are to increase uterine contractions and increase intra-abdominal pressure for placental detachment and descent in the vagina. All these measures, along with basti, are vatahara and are vata shamaka measures for the restoration of prakrita gati of vata dosha to expel out the placenta along with stool and urine.

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After the birth of a baby, in the case of retained placenta, the therapies administered are to increase uterine contractions and increase intra-abdominal pressure for placental detachment and descent in the vagina. All these measures, along with [[basti]], are vatahara and are [[vata]] shamaka measures for the restoration of prakrita gati of [[vata dosha]] to expel out the placenta along with stool and urine.

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==== Care of the Newborn ====

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=== Care of the Newborn ===

Resuscitation of a newborn is the initial step and is called Pranapratyagaman Vidhi. There is a prescribed sequence for the clearing of mucous secretions from the oral cavity. First the palate, then the inner aspect of lips, kantha (pharynx), and the Jivha (tongue) should be cleaned. Once the secretion is cleared from the palate, it facilitates the air entry in the pharynx easily. Clearing of pharynx clears the air passage and finally clearing of tongue removes the amniotic fluid and mucous which sticks to the tongue. Nowadays, a neonatal care practice is to clear up the secretion with a suction apparatus first from the mouth and then through the nose. The reason for removing secretions from the mouth first is to prevent the aspiration of more copious oral secretions than nasal secretions. Emesis with ghee and rock salt prescribed in the past is not done. Modern practice is to do gastric suction.

Once the baby is breathing well next step is to cut the umbilical cord under aseptic conditions to prevent serious complication of stump infection. This is followed by application of oil and dry powders with antiseptic and drying property. All these measures are to prevent infection in the umbilical stump, early fall of the umbilical cord, healthy healing of the wound after the fall of the cord stump and for prevention of complications like omphalocele, etc. Lodhra, madhuka, priyamgu, suradaru, and Haridra, etc. are drugs that have kashaya and astringent properties to remove excessive moisture and prevent infection, since dry conditions favor the early separation of stump. Oil made up of the same drugs has antimicrobial and wound healing properties and prevents moisture and microbes. The wrong method of cutting of cord and improper care of the cord leads to complications.

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==== Samskara After birth ====

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=== Samskara After birth ===

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[[Ayurveda]] Acharyas follow some medicinal practices in combination with ritualistic customs. The very first feed to the baby should be applied in a ritualistic and hygienic way. Therefore, in jatakarmasamskara, the father has to take a bath before holding the baby, followed by reciting mantras softly in the ear of the baby, followed by making the baby lick gold with honey and ghee. Licking initiates swallowing movement in the newly born baby, and once such sucking and swallowing movements start, it is safe to initiate breastfeeding. Breastfeeding is recommended immediately after birth since breastmilk provides colostrum (stanya piyusha) which gives the baby ample amount of protein, cholesterol, and immunoglobins. Colostrum is said to be essential for the growth of brain and memory of the baby. Cholesterols in the colostrum have essential linoleic fatty acids and various species-specific properties that are essential for nervine and enhancement of immunity. According to the recent practice of neonatal care, breastfeeding should be initiated within 15 minutes after birth, in the case of normal labor, and within 2 hours of birth in case of cesarean section. Precautions should be taken to prevent neonatal sepsis. Are ~~ther~~ any special ayurvedic ways being used now?

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[[Ayurveda]] Acharyas follow some medicinal practices in combination with ritualistic customs. The very first feed to the baby should be applied in a ritualistic and hygienic way. Therefore, in jatakarmasamskara, the father has to take a bath before holding the baby, followed by reciting mantras softly in the ear of the baby, followed by making the baby lick gold with honey and ghee. Licking initiates swallowing movement in the newly born baby, and once such sucking and swallowing movements start, it is safe to initiate breastfeeding. Breastfeeding is recommended immediately after birth since breastmilk provides colostrum (stanya piyusha) which gives the baby ample amount of protein, cholesterol, and immunoglobins. Colostrum is said to be essential for the growth of brain and memory of the baby. Cholesterols in the colostrum have essential linoleic fatty acids and various species-specific properties that are essential for nervine and enhancement of immunity. According to the recent practice of neonatal care, breastfeeding should be initiated within 15 minutes after birth, in the case of normal labor, and within 2 hours of birth in case of cesarean section. Precautions should be taken to prevent neonatal sepsis. Are there any special ayurvedic ways being used now?

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==== Prescribed post-partum measures for women ====

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=== Prescribed post-partum measures for women ===

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Parturition and postpartum phase cause significant changes physiologically, psychologically and anatomically especially, in her hormones and the neuro-endocrinal axis. All dhatus of the mother are at a low ebb (kshaya) during labor, and therefore there is vata prakopa and agnimandya. Therefore, in the postpartum phase, a physician should administer vatahara, deepana, and brimhana upakrama and should help restore the woman’s body tissues in a systematic manner, taking care of her digestive capacity. To regain homeostasis, the regimen of diet for first ten days postpartum are prescribed.

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Parturition and postpartum phase cause significant changes physiologically, psychologically and anatomically especially, in her hormones and the neuro-endocrinal axis. All dhatus of the mother are at a low ebb (kshaya) during labor, and therefore there is [[vata]] prakopa and agnimandya. Therefore, in the postpartum phase, a physician should administer vatahara, [[deepana]], and [[brimhana]] upakrama and should help restore the woman’s body tissues in a systematic manner, taking care of her digestive capacity. To regain homeostasis, the regimen of diet for first ten days postpartum are prescribed.

The measures prescribed in these texts are for the woman after delivery to transition from the effects of labor into a state of normalcy and good health smoothly. These measures help in the involution of the uterus and pelvic cavity, contraction of the distended abdomen, and help in restoring digestion. Immediate care will help in easing the fatigue of labor too. Experienced practitioners endorse these measures clinically.

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Source: http://www.jennsutkowski.com/blog-du-moment/steam-that-yonisteam-that-yoni-for-me-or-i-mean-you

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==== Naming Ceremony ====

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=== Naming Ceremony ===

The naming ceremony is also advised to be done on the tenth day of childbirth. Although the family is free to keep a name of their choosing, guidelines for selection of the name are given here - one that is auspicious and derived through rituals, and the other for social identity.

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Naming the baby is a very important event. A person’s name always leaves a very deep impact on his/her personality and behavior. Psychologically, what one hears and reacts is very important for the mental wellbeing of the person. Therefore, one should be given a good name having an auspicious meaning and that which instills confidence in the individual. Vedic cultures have formal naming ceremonies, as do some other cultures around the world. [50]

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==== Examination of Newborn ====

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=== Examination of Newborn ===

All the morphological features of the newborn should be examined thoroughly to rule out any features of congenital anomalies and life-threatening conditions as early as possible. With the help of such findings, one can prevent further complications and consequences of these congenital issues. Therefore, on the tenth day of the child’s delivery, the physician should examine the baby thoroughly. The newborn is grossly examined at birth, but thorough examination is recommended on the tenth day because many minute observations might get missed just after birth and will become obvious by the tenth day.

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Currently, wet nurse for feeding the baby is not used unless the mother dies and close relative is available..

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Characteristics of Breast milk, the effect of a mother's diet on breast milk and its management: Shuddha stanya (pure breast milk) is necessary for the newborn. According to [[Ayurveda]] whenever the pakva ahara rasa enters the stana (breast), its madhura rasa get converted into stanya (breast milk). Therefore, whatever the mother eats converts into stanya. If the mother takes a diet that causes dosha prakopa, then such a vitiated dosha vitiates the stanya and the vitiated stanya causes disease in the newborn baby. Therefore, the mother should take balanced and healthy diet which does not vitiate ~~doshas~~.

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Characteristics of Breast milk, the effect of a mother's diet on breast milk and its management: Shuddha stanya (pure breast milk) is necessary for the newborn. According to [[Ayurveda]] whenever the pakva ahara rasa enters the stana (breast), its madhura rasa get converted into stanya (breast milk). Therefore, whatever the mother eats converts into stanya. If the mother takes a diet that causes [[dosha]] prakopa, then such a vitiated [[dosha]] vitiates the stanya and the vitiated stanya causes disease in the newborn baby. Therefore, the mother should take balanced and healthy diet which does not vitiate [[dosha]]s.

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Some of the properties of stanya afflicted with vitiated ~~doshas~~ are as follows: vitiated vata dosha has tikta, kashya rasa and therefore, the stanya afflicted with vitiated vata dosha becomes tikata and kashya (bitter). Similar samprapti (etiology) is applicable in cases of pitta and kapha dosha prakopa as well.

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Some of the properties of stanya afflicted with vitiated [[dosha]]s are as follows: vitiated [[vata dosha]] has tikta, kashya rasa and therefore, the stanya afflicted with vitiated [[vata dosha]] becomes tikata and kashya (bitter). Similar samprapti (etiology) is applicable in cases of [[pitta]] and [[kapha dosha]] prakopa as well.

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As explained earlier, stanya produced from the adya ahara rasa dhatu (from the first dhatu..) is afflicted with vitiated kapha/shleshma dosha. Shodhana treatment is key for treating stanya dushti vikara (i.e. breastmilk infections). Shodhana should be followed by the administration of tikta, katu, and kashaya rasa drugs like vachaharidradi gana or charakokta patha mahaushadi suradarvadi stanya shodhana mahakashya (Cha. Sutra Sthana).

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As explained earlier, stanya produced from the adya ahara [[rasa dhatu]] (from the first [[dhatu]]..) is afflicted with vitiated [[kapha]]/shleshma [[dosha]]. [[Shodhana]] treatment is key for treating stanya dushti vikara (i.e. breastmilk infections). [[Shodhana]] should be followed by the administration of tikta, katu, and kashaya rasa drugs like vachaharidradi gana or charakokta patha mahaushadi suradarvadi stanya shodhana mahakashya [Cha.Sa.[[Sutra Sthana]]4]

All the above-mentioned drugs and diet have been investigated and found useful with many evidence-based types of research, and are prescribed as galactagogues ref.

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The concept of examination of breast milk is not practically applied in today's era. The diet, lifestyle, and psyche of the mother affect the quality and quantity of breast milk. The characteristic and quantity of breast milk affects the growth and development of the newborn.

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==== Designing and care of the child’s room ====

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=== Designing and care of the child’s room ===

The kumaragara (or day care facility) should be prepared in such a manner as to prevent accidents and to protect the child from agantuja vyadhi (diseases due to external/extrinsic factors). In such healthy, emotionally stable and protected environment, children grow very healthy. Antimicrobial properties of all these drugs have been proven in different researches, and hence their use in newborn care and the neonatal nursery is quite evident. Till date, there is no evidence-based scientific explanation available for wearing stones and animal-based jewelry or ornaments. Most of these practices have passed down as customs or rituals since time immemorial.

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==== Toys for children ====

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=== Toys for children ===

Toys are very fundamental constituents for the proper growth and development of creative and logical thoughts in babies. Toys play a crucial role as sensory stimuli. Acharya Charaka was well aware of this aspect of child development and therefore described toys in detail. All societies and cultures have toys, and their role in child development is universally accepted.

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==== The upbringing of the child ====

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=== The upbringing of the child ===

According to Artha Shastra of Chanakya (Vishnugupta), a child till the age of five years needs a lot of care and affection, while the next ten years require inculcating him/her with discipline and education and once he/she reaches 16 years of age, he/she should be treated as a friend. Children of 16 years of age are mature, physically and sexually, and by then are ready to acquire skills of work for earning.

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=== References ===

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== Related articles ==

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[[Congenital disorders]], [[Neonatal care]], [[Garbha‎‎]], [[Prenatal care (garbhini paricharya)]], [[Sutika Paricharya]]

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== References ==

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