AYURVEDA POST DELIVERY CARE : SOOTIKA PARICHARYA

Post delivery care in ayurveda : A woman is reborn the time she brings a new life to earth as a mother and she rightly deserve utmost care and affection during this time of her life. Ayurveda, the ancient science of life emphasizes the importance for the care of mother at every phase of her life especially in ante natal or post natal regimen. The time period after delivery of child and expulsion of placenta is called ‘Sutikakala’ in Ayurveda and the lady is referred to as ‘Soothika’. The post partum period is (peurperium) is from the end of labor until the genital tract has returned to normal, which usually lasts for 42 days. Sutikakala (duration of puerperium)is  the  period  following  childbirth during which all body tissues revert back approximately to a pre-pregnant state.

SOOTHIKA KALA ACCORDING TO DIFFERENT CLASSICS 

Post delivery care in ayurveda:Acharya Charaka has not given any specific duration, however all other classical texts have given definite period of specific dietetics and management for a puerperal woman which can be considered as a normal duration of puerperium.  Acharya Susruta and Acharya Vaghbhata have said that after one and half month of regulated or restricted specific dietetics and mode of life the woman becomes free from the epithet of Soothika and have cited the opinion of others that the woman should be called Soothika till she does not restart her menstrual cycle. Bhavaprakasha and Yogaratnakara have given the duration of specific dietetic management only for one month yet Kashyapa have mentioned the duration of soothikakala for six months. Bhavaprakasha besides agreeing with Acharya Susruta have mentioned that after subsidence of complications and aggravation of doshas caused during labour due to dhatukshaya , the woman should give up specific mode of life after four months. Considering the above, four specific durations of soothika emerge, which are as follows:

Post delivery care in ayurveda

• One and a half months
• Reappearance of menstruation
• Six months
• Four months

Soothika kala or the Post natal care (post-natal) is a period following child birth which can be certainly co-related with Sutika paricharya explained in Ayurveda. This term is obtained from the word ‘prasuta’ (mother following delivery).A woman becomes weak or emaciated due to development of fetus and also empty bodied due to unsteadiness or languor of dhatus, labour pains and excretion of kleda (moisture) and blood. Anatomic changes occurring in reproductive organs during pregnancy reach their almost pre-pregnancy stage after about six weeks, however, in resumption of pre-pregnancy physiology i.e. ovarian and menstrual cycle great individual variations occur, as some woman restart their menstruation from the second month of delivery, while others may not get it even for a year. Considering this individual variation, authors have not given any specific time limit and rather have just said that “reappearance of menstruation”.

SOOTHIKA PARICHARYA (POST NATAL CARE)

As the soothika is under physical, mental and emotional stress during post partum period, she should be taken care of with utmost attention in order to cope up with the new challenge of the baby and herself. The digestive power, muscle mass and the strength is decreased and she is highly susceptible to diseases. Ayurveda describes different set of procedures, lifestyle and dietary regimen to be followed during this time give reassurance to the new mother to gain mental, emotional and spiritual resources needed to carry her through all the demands of family life, without feeling depleted. By following this regimen, the soothika attains all the lost things and reaches her pre pregnancy stage. Negligence of soothika paricharya would result in incurable diseases which can become fatal.

AIMS OF SOOTHIKA PARICHARYA (POST NATAL CARE)

• To reinforce the digestive and metabolic state of the body; Agnideepana and Pachana
• To replenish the body, by imparting strength ; Dhatu- paripurnata, Dhatupusti, Balya
• Vatashamana pacifying vitiated vata dosha
• Raktavardhaka; increasing the blood
• To ensure good quantity and quality of breast milk; ) Stanyavardhaka
• Garbhashayashuddhi : cleansing of the uterus
• : bringing the body to the pre pregnancy state

SUTIKA-PARICHARYA: GENERAL REGIMEN:

Sutika Paricharya comprises of three main aspects: Ahara (Diet), Vihara (Lifestyle), and Aushadi (Post natal visit and Medicines) and Ashwasana (Psychological Reassurance). Care should be taken to follow life and dietetics which pacify the vitiated vata. Acharyas have different opinions regarding dietetics and mode of life in their texts but all of those are ultimately vatashamaka (pacifying the vitiated vata dosha) and brimhana (nourishment of the body).

• Use of amulet – The puerperal woman should tie amulet of Trivrita (Operuculina turpethum – red) over the head. It is sort of psychological support to her. Thus may protect her from harmful things.
• General care ie. mode of life and diet –

In general all Ayurveda classics have advised mardana (massage), oral administration of medicated oils/ghee and decoctions for three to seven days following delivery. Use of medicated rice gruels is recommended in diet. From seventh or twelfth day medicated meat yusha (soup) is directed.

SOOTHIKA PARICHARYA ACCORDING TO DIFFERENT AYURVEDA CLASSICS

CHARAKA SAMHITA

AHARA (DIET):

• When a post natal woman experiences hunger, she should be recommended pulverized pippali (Piper longum Linn.), chavya (Pepper chaba), chitraka (Plumbago zeylanica Linn.) and pippalimula (Piper longum radix) with ghrita(ghee) or oil and in the amount which she can assimilate easily.
• Following digestion of ghrita (ghee) , liquid gruel prepared with rice and medicated with pippali (Piper longum Linn.) etc. herbs mentioned above and blended with ghrita(ghee) should be given.
• This regimen should be followed for five or seven nights (day and nights) following which gradual administration of brimhana materials (anabolic or likely to increase flesh and energy) should be done.

VIHARA

• Abhyanga: Abdomen massage or mardana followed by abdomen wrapping appropriately with a large clean cloth.
• Udaravestana : Wrapping produces compression of abdomen, prevents occurrence of hollow space, which prohibits vitiation of vata.
• Parisheka- ubhyatakala: Bath twice daily at morning and evening with hot water before intake of food.

This schedule is not suitable for the women of anupadesha (marshy land), because in the persons of this area the kapha is dominant. This regimen is suitable for women of jangala (wild or dry) area.

Chakrapani has stated that in the morning irrigation should be given before ingestion of unctuous material and should be repeated following its digestion, following-wards rice gruel should be given

SUSHRUTA SAMHITA

AHARA

• Rice gruel prepared with the herbs of vidarigandhadi group and blended with ghrita or cow milk should be given for three days (from 3rd to 7th day following delivery.)
• From 7th or 8th day, cooked shali rice with meat yusha (soup) of wild animals cooked with kola, yava and kulattha (Dolichos biflorus Linn.) should be advised considering her digestive power and strength.

VIHARA

• Abhyanga (massage) with Bala taila (Sida cordifolia Linn)
• Hot water bath
• Dalhana has mentioned that irrigation should be done by pouring water in a stream, so that abnormal blood (accumulated in uterus) produced due to irrigation by garbha (delivery) is excreted properly and vata is also balanced.

MEDICINES

• Decoction of Bhadradaru (Berberis aristata De.) medicines useful for alleviating vata for oral management.

ASHTANGA SANGRAHA

AHARA

• If the soothika feels hunger then she should be given congenial unctuous materials blended with either powered yavani (Trachispermum amami Linn. Sprague.) or powder of panchakola (a compound of 5 herbs, viz., pippali – Piper longum Linn., pippalimula – Piper longum radix, chavya – Pepper chaba, chitraka – Plumbago zeylanica Linn., nagara – Zingiber officinale Rosoe.), chitraka (Plumbago zeylanica Linn.), chavya (Pepper chaba), sunthi (Zingiber officinale Rosoe.) and rock salt, in such a volume that she can digest in entire day.
• The women unfit for the use of oily materials should be given decoction of either laghupanchamula or herbs which will alleviate vata.
• After digestion of unctuous material, liquid rice-gruel properly prepared with either above herbs or vidaryadi group of herbs or cow milk should be given in quantity which she can digest suitably.

VIHARA

• Mardana (massage) with balataila (oil prepared with Sida cordifolia Linn.)
• Following the oral intake of oily materials or decoction, her abdomen should be massaged with ghee and oil and wrapped with a cloth to prevent vitiation of vata likely to occur due to availability of hollow space.
• Hot water bath twice daily in the morning and evening prior to use of ghee and rice gruel.

Duration of this regimen-

This is to be continued for 3, 5 or 7 nights by use of light diet with soup of yava, kola and kulatha. After 12 nights, following consideration of strength capacity, gradual satiation or reinforcing should be done by use of meat yusha (soup) of wild animals; besides, oil, ghrita or decoction cooked with brimhaniya, jivaniya, vatashamaka and madhura (sweet) taste herbs should be employed for unguent, mardana (massage), irrigation and bathing.

ASHTANGA HRIDAYA

• Mardana (massage) of perineal region along with body
• Use of hot jaggery water
• Arunadutta has elucidated that if meat recipes are used before 12 days, may result in the danger of infliction by skanda etc. grahas.

KASHYAPA SAMHITA

AHARA

• As per her strength and digestive power scum of boiled rice should be given for 3 or 5 days. Then the women using beneficial diet should take orally unctuous recipes (oil, ghee etc.).
• Following digestion of this oil etc. salt free rice gruel blended with little quantity of unctuous material and pulverized pippali (Piper longum Linn.) and sunthi (Zingiber officinale Roscoe.) should be given. This should follow (following sixth or seven days) use of rice gruel blended with sufficient quantity of salt and unctuous materials, then meat yusha (soup) of wild animals and yusha (soup) of kulattha (Dolichos biflorus Linn.) blended with unctuous material, salt and sour recipes and kushmanda (Benincasa hispida Thum.), cucumber, radish etc. vegetables fried in ghrita.

VIHARA

• Post natal women should use specifically rakshoghna (antiseptic) and beneficial things.
• Detailed management should be done giving due consideration to place of residence (desha and videsha/ foreign country) and custom of family.
• The women immediately following delivery should be encouraged and made to lie down in hunch-back-position with flexed position (either in knee-chest position or in lateral position with thighs flexed over abdomen and lower legs over thigh and back protuberant). Now her back should be rubbed and pressing the abdomen, the lower portion should be massaged and compressed in order to expel the doshas remained after delivery.
• After this, abdomen and flanks should be wrapped with clean big cloth, so that abdomen reaches its proper place and vitiated vata also subsides.
• She should always sit over a small chair covered with leather-bag filled with hot Balataila (oil prepared with Sida cordifolia Linn.), with this her yoni becomes healthy.
• Svedana (sudation) in the yoni (perineal region and vagina) should be given with oil prepared with priyangu etc. herbs.
• After proper svedana (sudation), hot water bath should be given followed by rest.
• After overcoming the tiredness, fumigation with agaru (Aqalaria agallocha), guggulu (Commiphora mukul Hook ex stocks.) and kushtha (Sassurea luppa) blended with ghee should be done.
• Following delivery the women should use snehana (oleation), svedana (sudation) and hot water for a month. The management of post natal women should be with due consideration of customs as well as beneficial things or diet of the family and also place of residence.

HARITA SAMHITA

AHARA

• Following fasting for 1st day, on 2nd day in the morning Sunthi (Zingiber officinalis) and Haritaki ( Terminalia chebula) with jaggery, then in the following noon warm yusha (soup) of kulattha (Dolichos biflorus Linn.) should be given.
• Rice-gruel blended with Chaturjataka (a compound of 4 herbs, viz., tvak – Cinamonum zeylonicum, ela – Eletlaria cardamomum, tamalapatra – Cinamonum tamal , nagakeshara – Musua ferrea) or panchakola (a compound of 5 herbs, viz., pippali – Piper longum Linn., pippalimula – Piper longum radix, chavya – Pepper chaba, chitraka – Plumbago zeylanica Linn., nagara – Zingiber officinale Rosoe.), should be given on 3rd and 4th day correspondingly
• On 5th day cooked shali or shastika prescribed in diet. This regimen should continue for 10 or 15 days.

VIHARA

• Vaginal filling with oil and mardana (massage)d followed by svedana (sudation) with hot water should be done.

MEDICINES

• Following delivery the decoction of Arjuna (Terminalia arjuna), lodhra (Symplocos racemosa Roxb.), devadaru (Cedrus deodara), kadamba (Anthocephalus indicus A. Rich.) and bijaka (Pterocarpus marsupium Linn.) should be given for cleansing rakta (blood) and yoni (uterus).

The wise physician should allow the post natal women to see or meet other women on 12th day

BHAVA-PRAKASHA

AHARA

• Post natal women should use congenial diet, She should use unctuous, light, congenial diet

VIHARA

• Daily svedana (sudation) and mardana (massage) for one month with full alertness.

YOGA- RATNAKARA

• Immediately following delivery her vaginal canal should be pressed to avoid entry of air.

SHARANGADHARA SAMHITA

• Svedana (sudation) and use of bala taila (oil prepared with Sida cordifolia Linn.) following delivery.

Specific advice on the basis of place of residence: Kashyapa has described the post natal management on the basis of residence place as follows –

• For Anupa dehsa (marshy land) – In marshy land usually diseases of vata and kapha occur. Because of supremacy of humidity in this area initially fat should not used; instead scum of boiled rice treated with appetizing and strength producing things should be given. Svedana (sudation), sleeping in air free place and use of herbs having ushna or hot potency is helpful. Chakrapani has clarified that unctuous material should be prohibited.
• For Jangala desha (wild or dry place) – For strong women, she should be given ghee or oil or any other unctuous recipe in good quantity using decoction of pippali etc. herbs (described under general management). For a weak women rice gruel should be given for 3 or 5 nights. It should follow the use of cereals blended with unctuous things in regularly increasing manner. She should often be irrigated with good quantity of hot water and should avoid anger, exercise and coitus. Kashyapa has mentioned that in such places diseases of vata and pitta frequently takes place. Since oleaginous substances are compatible in this area, that should be used in abundance
• For Sadharana desha (ordinary or neither marshy nor dry place) – Average (in use of neither to unctuous nor dry material) management is advantageous.

GENERAL PRASAVARAKSHA AND SOOTHIKA CHARYA FOLLOWED IN KERALA

In case of normal delivery, one can start the use of medicines the very next day itself.

From 2^nd to 14^th day

• Dasamoolarishta + Jeerakadyrishtam in equal proportion; 30 ml twice daily after food
• Pulilehyam / Deepyakadi choornam – 5g in lukewarm water or buttermilk;twice daily at afternoon and night before food
• Buttermilk processed with dried ginger, curry leaves, ajamoda, turmeric seasoned with rock salt can be used along with rice for food.
• Garlic (peeled) and sauted in ghee or sesame oil – 15 g before food
• Shallots (peeled) and sauted in ghee or sesame oil – 15 g before food
• After 7 days, ghee and milk should be consumed increasing the quantity gradually according to one’s power of digestion.
• For bath- regular oil of one’s choice for hair and Dhanwantaram taila for body. Dhanwantaram taila should be mixed with a pinch of turmeric powder for anointing the body and leave it for a period of 30 minutes prior bath.
• Green gram powder and black gram powder can be used to rub off the excess oil as a natural scrub for bathing.
• Water for bathing : boiled with the nalpamaradi barks

From 14^th to 28^th day

• Dasamoolarishta + Jeerakadyrishtam in equal proportion; 30 ml twice daily after food
• For bath- regular oil of one’s choice for hair and Dhanwantaram taila for body. Dhanwantaram taila should be mixed with a pinch of turmeric powder for anointing the body and leave it for a period of 30 minutes prior bath.
• Dhanwantaram decoction: 10-15ml ( lukewarm) with 10 drops Dhanwantaram 101 avartana taila and one tablet of Mahadhanwantara gutika.
• Vidaryadi ghrita – 2 tsp, once in the afternoon before food
• Include meat soup gradually in diet according to one’s power of digestion, preferably goat meat soup.

After 28^th day to next 1 month

•  Vidaryadi ghrita – 2 tsp, once in the afternoon before food
• Aswagandhadi leha- 15 g with 400mg lohasindura ; at night after food and followed by one glass of warm milk
• Avoid hot and sour food substances along with rhizomes, lentils, fried foods.
• Avoid drinking cold water
• Include plenty of fruits and vegetables in the diet.
• Abstain from strenuous activities, vigil and daysleep.

SIGNIFICANCE OF DIFFERENT PROCEDURES IN SOOTHIKA PARICHARYA

1. Abhyanga

• Improves the blood circulation through By   this   leucocytes   and macrophages reach the damaged tissue in more quantity and enhance the wound healing.
• Reduces edema and swelling, strengthens the muscles, ligaments and tendons
• Lymphatic massage relieves sore muscles.
• Strengthens  lungs, intestine and vital organs for proper functioning.
• Aids body in using fat deposition.
• Improve skin,    soothes    nerves

2. Parisheka & Avagaha

• Abnormal blood (accumulated in uterus) is excreted properly, balances vata and enhances process of involution

3. Yoni dhoopana ( hot fomentation of yoni)

• Relieves pain and inflammation of vaginal tear during labour or due to episiotomy and is useful in rapid healing. Dhupana will maintain the hygiene of the perineum. It keeps episiotomy healthy and hastens its healing process.
• The drugs used like Kusta, Agaru, Guggulu have the properties antimicrobial and antiseptic properties. Yoni dhoopana restricts entry of Vata and prevents vagina from various infections.

4. Hot water  bath

Hygiene is ensured by hot water bath which is very essential to prevent infection of trauma to female genital organs and infection to newborn child.

5. Udaraveshtana (Wrapping of abdomen)- Produces compression of abdomen and it avoids occurrence of hallow space, which prohibits vitiation of vata.

MODE OF ACTION OF DIET & DRUGS:

Snehapana:

The Sneha (Ghrita/ Taila / Vasa/ Majja) oleaginous substances are given to sutika  mixed with dravyas like Pippali, Pippalimoola, Chavya, Chitraka, Shrungavera, Yavani, Upakunchika. These dravyas do agnideepana & amapachana. It also avoids vataprakopa. These dravyas helps to digest the sneha and act as appetizer. Ghee Strengthen digestive system is Vata pitta shamaka, Balya, Rasayan, Agnideepak, Raktavikaranashak, & Yogavahi.

Garbhashayashodhana: Drugs like Panchakola are given with warmed jaggery water for excretion of unwanted blood from uterus. These drugs help in removal of dushtashonita or sheshadosha from uterus. It normalises the lochial discharge & does proper uterine involution.

Snehayavagu or Ksheerayavagu (Rice gruel with ghee and oil or milk)

Yavagupana in the form of manda, peya with sneha or kwatha stimulate the agni, it is easily digestible & absorbable, reduces thirst thus does the maintenance of water in the body. Milk is rich source of proteins, vitamins and calcium provides energy & maintains tissue.

 Yusha: soups prepared of Yava, Kola, Kulatha. It is semisolid, rich in protein. It aids in digestion, strengthening and nourishment

Mamsa rasa: Meat soups

Meat is an excellent source of iron, vitamins, essential amino acids and trace elements and helpful to recover maternal system from stress and strain of labour and help in galactogenesis and enhance the property of maternal milk.

Commonly prescribed drugs:

• Pippali, Pippalimula, Chavya, Chitraka, Shringavera are Ushna, Teekshna, Deepana, Pachana, Shoolagna & Kaphavatashamaka aids in digestion and pain relieving. Sunthi (Zingiber officinale Rosoe.) Increases digestive power as well as does garbhashaya shodhana to remove lochia and other retained products of conceptus.
• Kulatha (Horse gram) is an excellent source of iron, molybdenum and manganese. It has antispasmodic activity and is used in uterine disorders and anemia.

• Ervaruka (Cucumber) has 94% water content, keeps the body hydrated, regulates blood pressure, aids in digestion and acts as a diuretic. It contains magnesium, potassium, silica, vitamin A, B, C and K.
• Yava (Barley) is a good source of fibre. It contains copper, phosphorus, zinc and Vitamin E. Rice gruel prepared with Vidaryadigana act as Rasayana. Therefore the above mentioned drugs are administered during suthikakala for the wellbeing of the Suthika.
• Haritaki (Terminalia chebula) Does vatanulomana which helps to wash out the abnormal contents from uterus. Jaggery Supports digestive power as well as balances vata.
• Chaturjataka, panchakola: These drugs are digestive and possessing nice odour which will helpful improving digestive power and makes pleasant to eat by soothing mind.

Pippali

Dos & Don’ts for Soothika

Post delivery care in ayurveda PATHYA:  Follow

• Sutika should use hitakarakaahara & vihara
• Bath with warm water
• Adequate sleep
• For drinking, boiled water should be used
• Abhyanga should be done with luke warm oils & parishek, avagahana etc with always luke warm water.
• Abdominal wrapping
• Diet must contain garbhashayashodaka, sthanyavardhaka, stanyajanana, vataharadravya
• Use birth controls measures
• Pelvic floor exercise (kegel’s exercise)

Post delivery care in ayurveda APATHYA: Avoid

• Excess exercise
• Sexual intercourse
• Mental & Physical stress
• Cold water,Cold wind & Cold things
• Contraindication of Panchakarma
• Anger,Fear,Depression
• Day-sleep, exposure to sunlight