If a pregnant woman is taken care of as advised, she will give birth to a child who does not have any diseases - a healthy, physically strong, radiant and well nourished baby. He will be superior to all in the race.

This great science compares conception to the germination and sprouting of a seed and its transformation into a sapling. When the male and female seeds unite and the soul enters the union, it becomes an embryo (garbha). Ayurved gives importance to the quality of the seed and hence, to the development during adolescence, of both the male and the female. In addition to the female seed, the mother also provides the 'soil, nutrition and the right season' for the seed to grow. Hence, Ayurved advises special attention to be paid to the nutrition and protection of the woman to keep her (the soil) rich and clean. It further advises that a female under sixteen years of age and a male under twenty should not bear a child. The rules of sexual intercourse are also laid down. So also, those of antenatal care: the husband and other family members are advised to take care of the pregnant woman's diet and encourage activities that are dear to her and beneficial to the foetus or child growing in her body. Thus, the approach towards motherhood, that is pregnancy and childbirth, is a holistic one. Such concepts are excellent, but the question is are they practiced? In fact, it needs thorough introspection on our part to find out why this approach was abandoned.

Garbhini Vyakaran

Ayurved describes the general management of pregnancy under Garbhini Vyakaran. There are separate chapters for general management, special management, diseases in pregnancy and their treatment and so on. Rules concerning diet, activities, behavior and mental activity (ahar, vihar, achar and vichar respectively) are also laid down. The physician is cautioned and advised to be very careful about the management of pregnancy: if a vessel filled with oil right up to the brim is to be carried without spilling even a single drop, every step has to be carefully watched. The same is the case in the management of a pregnant woman. The physician should aim at protecting and nourishing both the foetus and the mother.

From the moment the pregnancy is confirmed, the woman is advised to follow certain rules. The physician steps in and starts supervision so that the pregnancy can terminate in a normal delivery at the scheduled time. Especially when she approaches full term, critical care is necessary as one of her feet is considered to be in this world and the other in the world of Yama (the god of death). Delivery is not complete unless the placenta is delivered. If the delivery is not normal, says this ancient science; the woman is likely to be affected by one or the other of a list of 64 ailments, which are described in detail in Garbhini Vyakaran.

Sometimes, even an expert can get baffled by situations arising during the course of pregnancy and the post-delivery period. Hence, the physician has to have foresight, definite convictions, expertise, experience and compassion while taking on the responsibility of a pregnant woman. He has to think of the welfare of two individuals at the same time - that of the mother and the foetus. Both are to be nourished and protected. The requirements of both are usually identical. But, if they happen to clash, the protection of the mother should be the priority.

If a couple desires to have a good progeny, both the partners should be careful about their diet, activities, behavior and emotional status before as well as after conception. One has to keep this in mind throughout the pregnancy.

General Rules from Inception of Pregnancyto Delivery

The mother-to-be should -

• Always try to be in a happy mood
• Be clean, neat and well dressed
• Wear simple clothes
• Sleep under a roof in a clean environment (not infested with insects such as mosquito's etc.)

The food she eats should be tasty, more of it should be in a liquid form, moist, nourishing, enriched with all the six rasas (tastes) and treated by deepan drugs which are known to increase appetite and digestive power.

She should always avoid -

• Excessive sex particularly during early and late pregnancy
• Overeating or fasting
• Sleeping during the day time and staying up late at night
• Tight clothes and tight belts
• Witnessing or listening to things which give rise to feelings of sorrow, anger, horror or agony
• Travelling in a vehicle on rough roads
• Squatting for a long time or sitting in an uncomfortable position or on a hard surface
• Lifting heavy things or remaining in a bending position for a long time
• Oleation massage etc. unless positively indicated
• Beholding natural urges unless in an emergency
• Dry, stale, fermented, heavy, hot or strong food, alcohol and meat (fish is allowed)
• Visiting abandoned and remote places
• Leaning into a deep well.

Garbhini Parichaya

The development of the foetus in the uterus is described under Garbhavakranti, and special regimens are prescribed for each month under Garbhini Paricharya. The general rule is to take greater care during the first three months of pregnancy and after the completion of the seventh month.

During the first trimester, stress is laid on stabilizing the pregnancy and nurturing the uterine bed through rasa and rakta dhatus. The embryo gets nourishment directly by percolation (upsnehan). Hence more jaleeya (liquid) substances such as juicy fruits, coconut water, milk, and so on are advocated.

In the first month, sipping cold milk and maintaining a light diet, and during the next two months, the intake of milk medicated with herbs like Vidari, Shatavari, Yasthimadhu, Brahmi and so on, which are jeevaneeya (life-building) and garbhasthapak (helping nidation) are advocated. Honey and ghee are also recommended.

By the end of the third month, the body parts of the foetus become differentiated, sensory perceptions and motor reactions start developing, the heart starts beating, and is said to express its desires through the mother's blood. This is the period when the woman craves for certain foods/flavours. The needs of both the foetus and the mother are identical. Hence, Ayurved recommends that her cravings be fulfilled as far as possible, if not contraindicated. Brahmi helps in calming the nerves and is also a good prajasthapan (sustainer of pregnancy).

From the fourth to the seventh month, drugs, which give strength to the uterine muscles and nourishment to the embryo, are advised e.g. Ashwagandha, Kraunch beej and Guduchi. They help to prevent intrauterine growth retardation (IUGR). Nourishment starts through the umbilical. cord by the kedar kulya method. The diet should be one of rice, milk, butter and gee. Fruits which are orange or yellow in color are advocated such as mangoes, apples, carrots, amalaki etc. Leafy vegetables are also advised. During the seventh month, the abdominal skin gets stretched giving rise to itching and striations, which are, called kikkis. This should be treated by taking sips of the infusion of berries or butter medicated with Manjistha, the application of the pulp of sandalwood and lotus or of a paste made of Neem, basil and Manjistha, or oil medicated with Karveer leaves or jasmine.

From the seventh month onwards, there should be less fat, less salt and less water in the diet rice kanji with a little ghee is advocated. After the completion of the seventh month, herbs, which are mild diuretics and urinary antiseptics such as Gokshuru and Sariva, are advocated. Basil in small quantities is advised; it is also anti-spasmodic.

As soon as the pregnant woman enters the ninth month, she is supposed to move to the Sootikagar (delivery area) which is specially prepared for delivery. After an asthapan basti (simple enema), she should undergo anuvasan basti (retention enema of oil boiled with some herbs) which may be repeated. Tampons soaked in the same oil are kept in the vagina to make the pelvis soft and elastic, and enhance the excretory functions of apan, vayu (urination, defecation) and expulsion of the foetus. The skin and nails become soft, and her strength and complexion are rejuvenated.

Spotting of blood during any month of pregnancy is considered to be serious and should be dealt with as advocated under Masanumasik Chikitsa, which describes the treatment month wise.

Sootikagar

The Sootikagar should be such as to meet seasonal needs. The type of land, the timber used for the building, the architectural layout of the area (the bath room, toilet, kitchen, fire place, delivery room), the type of fire wood used, the water supply and so on are described in detail. Materials such as linen, needles and instruments, essential drugs and furniture are also specified. The house should be fumigated to make it free from insects. Porous bags containing rakshoghna drugs should be suspended all around - at the entrance and at the corners - to ward off insects, bacteria and unseen evil elements (rakshoghna drugs are supposed to kill or repel them). These drugs are calamus asafoetida, garlic, Guggulu and Sarshap.

The nurse or birth attendant recommended by Ayurved, should be experienced, friendly, alert, expert, affectionate by nature, concerned and caring. The attending physician should be an expert.

Treatment Of Diseases During Pregnancy

Any disease occurring in a pregnant woman should be treated with drugs that are mild in action, compatible and safe to the foetus. Panchakarma (detoxifying procedures) should not be advocated, except basti (enema) and pichu (tampon) in the eighth and ninth months of pregnancy.

Ayurved also describes nine diseases, which are caused because of the pregnant status of the woman. These diseases are peculiar to pregnancy and are called garbhopadravas. They are: nausea, anorexia, vomiting, dryness of mouth, fever, oedema, anaemia, diarrhoea and retention of urine. Their specific treatments are also elaborately described.

As far as possible, medication should be avoided during the first three months of pregnancy. Only symptomatic treatment with very mild herbs and a suitable diet should be offered. The physician is advised to take into account the severity of the disease, the resistance power of the mother and the duration of the pregnancy, and choose the middle path so that the disease or the treatments do not result in sequelae in the mother or the foetus. For example, the use of Dashamularisht in vatic fever, cold infusion of Glycerriza lotus and Sariva in paittic fever and Guduchi vasa quash in kapha fever to bring down temperature. Similar special treatments are advised for other diseases. Drugs such as Vacha, Kumari, myrrh, are contraindicated in pregnancy and substances like garlic and asafoetida are to be used cautiously.

Different types of obstructed labor and their management with maneuvers, especially internal rotation, are also described in this section. If the physician notices that the disease is going to be dangerous to the mother, especially in the garbhopadravas, no time should be lost in terminating the pregnancy.

Even three thousand years ago, thus, Ayurved had stressed the importance of safe motherhood. It aims at excellence in the formation of the foetus, its development without anomalies, a comfortable full term delivery, and maintenance of the health of the mother. Today, with a better understanding of the physio-pathological processes and the advancement of allied sciences, we have put together a safe motherhood program for women in the form of a package namely, combating anemia, immunization of the mother, regular antenatal check up to detect any pathology in the foetus or the mother, to predict the course of delivery and, take appropriate interventions if necessary, and finally, the delivery by a trained person. But, if we really wish to bring down maternal mortality in a big way, the Ayurved approach can certainly contribute in a significant manner. Some areas where integration can be thought of are -

1. Incorporation of Do's and Don'ts in antenatal counseling;
2. Giving due importance to the psychological and emotional aspects of the pregnant woman, and her daily routine;
3. Laying stress on care by the husband and other family members;
4. Supplementing her diet with folic acid and Shatavari during the first trimester;
5. Using Ashwagandha during the second trimester to improve immunity and to prevent IUGR;
6. Giving supplements of iron and calcium with herbal preparations; and
7. Adopting the beneficial concepts of the sootikagar.

An integrated program for safe motherhood may be evolved by using these suggestions. I wish to conclude with a quotation from Maharshi Kashyap, which means: "Out of sheer love, affection and compassion, the would-be mother bears all the agony to protect the child with grace and dignity. That is really the greatness of MOTHERHOOD."

Nagral, Kumud: Concept of Safe Motherhood in Ayurved. The Journal of Family Welfare. June 1997. 43(2). P. 53-57. Location : SNDT Churchgate.

Dr. (Mrs.) Kumud Nagral is an Integrated Family Physician and Convenor of FPAI's project with the National Integrated Medical Association (NIMA), Mumbai, India.