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Sutika Paricharya: Ayurvedic Postpartum Care

All of life requires a Mother. Without her, there would be no creation and no continuation of human life. She demonstrates the magic of pure love and the potential for psycho-biological relatedness. Yet, she rarely receives the protection and support required during her birthing years. Across the world, women face hardships during this time of life which is representative of the loss of connection, and the lack of understanding regarding the depth of meaning inherent in her profound role (Richardson, 2001; Dansana & Kadam, 2019). Traditional medical systems have highly developed, scientific, time tested, wholistic practices surrounding pregnancy, childbirth, and baby and mother care postpartum. They take into consideration the delicate nature of birth, labour, and of life - the need for care in sustaining and preserving it, the multifactorial issues that can arise within it, and the way to go about protecting this sacred gift (Kim-Godwin, 2003).

This paper will focus on the postpartum needs and protocols that support the mothers return to health and wellbeing after giving birth, as offered and documented in the Ayurvedic Medical texts. First written down an estimated 5000 years ago, and continually practised to the current day, Ayurvedic Medicine - loosely translated as “The Science or Knowledge of Life,” holds a depth of knowledge for the treatment of women throughout the lifespan that has yet to be paralleled. In the Western medical system, the intimate understanding of this right of passage for women had been all but ignored, at the peril of women's mental, physical, social, and spiritual expense. Postpartum depression, infant and maternal mortality, perinatal imbalances leading to dis-ease states, mental health issues, and more, plague this population. Women the world over would derive great benefit from the postpartum practices that, when instituted, have sustained women, babies, and families, for thousands of years. Fortunately, undertaking Ayurvedic postpartum care is accessible to anyone, with some preparation, support and knowledge.

Ashtanga Ayurveda - The Eight Limbs of Ayurveda, according to the Sushruta Samhita - one of the key Ayurvedic texts written by Vidya (Doctor) Sushruta, are as follows: 1. Shalya Tantra - Surgery; Shalakya Tantra - Ear, Nose, Throat and Eyes; Kaya Chikitsa - General Medicine; Bhuta Vidhya - Psychiatry; Koumara Bhritya - Pediatrics/Gynacology; Agada Tantra - Toxicology; Rasayana Tantra - Geriatrics; and Vajikarana Tantra - Reproductive Therapy. Koumara Bhritya covers all aspects of perinatal care relating to fetal development, birth and newborn care as well as the mother’s care leading up to conception, pregnancy, and post-delivery. A women’s postpartum period is considered to start upon delivery of the placenta. The new mother who has just given birth is called a sutika, and sutika paricharya is the term for the care given during the postpartum period as a whole. The postpartum period is called the sutika kala. (Kamini Dhiman, 2022). Although the health and wellbeing of the mother and the child are intricately linked, and there are very specific perinatal protocols pertaining to the life of the fetus and newborn (Caraka, 2018), this paper will focus on the health needs of the mother and the relation to baby from the mothers perspective.

The birth of a child and the following experience of crossing into motherhood, while maintaining health and wellbeing, begins before conception and is carried through the whole process like a thread. Preconception, the mother (and father) prepare themselves for three to four months (Pillai, 2021), through cleansing, removal of vitiated doshas (imbalances), and appropriate ahara (food) and dravyas (herbs), so that the mother (and father) enter into conception in the most ideal way. From the beginning, through these protocols, ideally, the mother is entering into the process from a state which is imbued with vitality, strength, and psycho-biological wellbeing. With practices and rituals to elicit a son or daughter, to influence their child's character, as well as spiritual support in the form of mantras and prayers, the pregnancy begins. Some supports recommended to keep the mother and child well during the pregnancy include herbs such as bala, satvari, grahmi, and guduci, as well as a soft, sweet, pleasant and tender diet and regime, which is mild in nature. It is suggested that certain habits be avoided that could negatively impact the pregnancy, birth, or the health of the baby or mother such as: Continuously sleeping on the back; sleeping in the open air; excessive intercourse; grief; anger; sleeping constantly; addictions (to wine, to overconsumption of one of the six tastes); panchakarma; and too much negativity in thoughts and behaviours (Caraka, 2018). Any need for breastcare in preparation for breastfeeding should be attended to prenatally as well so that measures can be taken to avoid possible issues with feeding once the baby arrives, for example, daily oiling of the nipples to avoid dryness and cracking, and care of retracted nipples (Pillai, 2021). Each month of pregnancy brings with it specific needs which are attended to through specific recommendations which emphasise nourishment with milk, ghee and medicines (dravyas), depending on the developmental phase of the feotus and the state of the mother (Caraka, 2018). “A pregnant woman is to be treated very cautiously as if one is walking with a pot full of oil in hand without letting a drop to fall” (Caraka, 2018, p.478). In the ninth month, it is recommended that the mother begins to gather her delivery needs, female birth attendants of kind and resourceful demeanour, as well as the postpartum items that will be required such as ghee, salt, honey, appropriate herbs, medicines, and herbal wine (Caraka, 2018). It is also recommended that the expectant mother undertake daily abhyanga, yoni oil application, showers with medicated water, and oil vasti (Pillai, 2021). Indications that the delivery is approaching include: “Exhaustion of the limbs; feeling of depression in the face; looseness in eyes; feeling in the chest as if a knot is being untied; feeling as if something is coming down from the pelvis; heaviness in the lower part of the body; pain in the groin, region of the bladder, pelvis, sides of the chest and back; onset of show from the genital tract; and loss of appetite” (Caraka, 2018, p. 492). During a mothers labouring, Caraka (2018), stresses the importance of the mother being surrounded by her female birthing attendants, given a soft bed, and being spoken to in a calm and encouraging manner throughout her labour. She is “anointed with warm oil to her waist, sides of the chest, back and thighs, and they should be gently massaged’ (Caraka, 2018, p. 494).

Once the baby is born, and specific Ayurvedic protocols are undertaken for the care of the newborn, and the mother has delivered the placenta, she is now considered to be in her postnatal period. With continued support to the new mother and her baby, for 10 - 12 days - day and night, from her birth attendants, she should be surrounded by praise, affection, and happiness, with sutika paricharya (postnatal Ayurvedic care) provided. When the mother’s hunger resumes post-birth, as a part of sutika paricharya, it is recommended that she is given ghee, oil, muscle fat, and bone-marrow along with Panchakola herbs (Sangwan, 2018) of powdered pippali (Piper Longum), cavya (Piper Retrofractum), citraka (Pumbago Zeylanica), and srngavera (Zingiber Officinale), in quantity according to the mothers strength. After drinking this unctuous mixture, it is recommended that she have oil and ghee applied to her abdomen which is then “wrapped tightly with a long, clean cloth” (Caraka, 2018, p. 502). Known in Ayurveda as udaraveshtana, or “abdominal tightening,” this serves to quell possible vata aggravation through lessening the now empty space in the abdomen. In addition, udaraveshtana helps to ease the relocation of displaced organs, facilitates the return of the uterus back to its proper size, acts as a back support, and assists in the toning of the stretched skin and muscles (Mahajan & Bhoyar, 2013; Sangwan, 2018). A massage with warm bala thailam, prior to drinking the post-birth unctuous herbal mixture, has also been mentioned in the literature (Sangwan, 2018). Upon digestion of the above-mentioned unctuous mixture, the sutika is then given a rice gruel prepared with pippali, taken after she is lightly sprinkled with warm water [parashika sweda via sprinkling - a passive form of bathing and sudation (Ranghuram & Manasa, 2018)] (Caraka, 2018). Alternatively, Vagbhata (2019) suggests that the new mother be given a warm bath upon digestion of the oil concoction, followed by a thin rice gruel prepared with the aforementioned medicines, with the third day onward being a thicker gruel cooked with herbs and fat. This will be dependant on the strenght of the sutika, as taking a bath may be too strenuous for some, in which case sprinkling of water may be more appropriate. The immediate post-birth regimen is continued for five to seven days, at which time she adopts a gradually nourishing regime (Caraka, 2018), with meat not being introduced before the twelfth day (Vagbhata, 2019).

In general, pathya (supportive practices) for sutika (postpartum women) are: boiled water for drinking; always warm bath water; daily snehana and swedhana [parashika - sprinkling and pouring method with warm herbal decocotion; daily abhyanga massage with bala thailum; yoni oleation; and avagahana (warm bath with decoction, sitz bath - always with warm water]; uderveshtana (belly binding) should be done with clean cloth after massage; fumigation; wholesome diet and lifestyle; and delicate care and strenthening of agni (digestive strength) (Sangwan, 2018; Kamini Dhiman, 2022; Mahajan & Bhoyar, 2013).

Attention to the place of residence should be considered, as oleation recommendations are pertaining to dry environments which have a Vata and Pitta predominance. Special consideration should be given to marshy areas which have a Kapha predominance. It has also been suggested that with delivery of a male child, oil should be given, and with the birth of a female child, ghrita should be given to the new mother. Assessing the mothers digestive strength has been recommended, with a woman of good digestive power being given oleaginous substances and the woman with weaker digestion primarily given gruel of rice for three to five nights (Sangwan, 2018).

Contraindicated behavious (apathya) include: cold food and cold inducing regimens; intercourse; physical and mental stress; sadness, fear, and anger; too much strenuous activity; over-exposure to sunlight; too much sensory stimulation; panchakarma; and too much daytime sleep (Kamini Dhiman, 2022).

[Support from the sutika’s birth attendants should act as a buffering and aleiviation of strain and stress to create the conditions for the above mentioned difficulties (sadness, fear, anger, physical and mental stress) that can have negative consequences for both mother and baby. Efforts should also be made to ensure that the mother (and baby) do not have to be exposed to overstimulation. This can be done through an advocating party ensuring that the care of the mother and baby are prioritized. This could include limiting of visits, release from extra demands on the mother outside of healing and newborn care, mother and baby staying home for the first 42 days, organizing postpartum help (postpartum doula, breastfeeding consultant, housekeeper, extended family members who are willing to help without expecting to be hosted, etc.) if the mother does not have a large support system, and allowing the mother and baby to rest deeply within the special energy of the new birth phase. This is especially important as this is a crucial bonding time for mother and baby and every effort should be made to not interrupt this or have the mother and baby shocked out of this time. The natural bond present at this time needs to deepen during her postpartum period. Her healing, and the upholding of a peaceful and restful atmosphere is of upmost important as she must have the conditions that allow her nervous system to be in a regulated state as she is the container for her babies nervous system during this vulnerable time. Her ability to breastfeed, to respond to baby’s cues, to experience a full and sufficient let down of her milk, and the deep bond that developes between mother and baby as well as the confidence that is being built is essential in order to carry her through the whole of her mothering role, and so much of this is relying on the sensitivity of her care and the limiting of deleterious influences.]

Due to the sensitive and delicate nature of the mother and baby during this time, it is suggested that she remain contained at home, cared for, and adhering to the postpartum vata pacifying diet and lifestyle guidance for one and a half months (Vagbhata, 2019).

“Prasava (labour) is a strenuous activity which causes dhatu kshaya (depletion of body tissues) and there by depletion of bala (strength) of the woman which is the need behind exclusive care for both women and infant after delivery.” (Kamini Dhiman, 2022).

Women are also undergoing a major transition into motherhood, and the postpartum period is one of the most vulnerable times in a woman’s life in general. Having her birth attendants surrounding her is also a medicine in that they help to educate her with breastfeeding and baby care, help her to regain her strength through facilitating sutika paricharya, and reassure her so that she gains confidence in her new role (Ranni Boes, 2014). “After delivery woman becomes weedy, also empty bodied (shoonya sharira) due to physical and mental stress and debility at the level of reproductive organs. It is essential for a mother to deepend and gain the mental, emotional and spiritual resources needed to carry her through all the demands of family life, without feeling depleted” (Mahajan & Bhoyar, 2013, p.273).

In order to replenish the dhatus, and return the sutika to her prepregnancy state, it has been recommended that the sutika paricharya consist of appropriate Ahara (food), Aushadha (medicines), and Vihara (regimens) (Kamini Dhiman, 2022). Mahajan and Bhoyar (2013) have also cited the need for Ashwasana (psychological reassurance) as an important element in sutika paricharya.

The sutika diet should be focused on vata pacification, rejuvenation (rasayanas) and strengthening (shramahara) (Sangwan, 2018), and should contain elements which work on cleansing the uterus, supporting lactation, and vata pacifying and deepana dravyas (Kamini Dhiman, 2022). As the sutika’s digestive fire (agni) has been considerably weakened, a process of rekindling the digestion will need to be undertaken. Liquidy, warm, unctuous, easy to digest meals which focus on pacifying vata (sweet, sour, salty, warm, liquidy, soft, oily) and igniting agni (digestive spices) are recommended (Mahajan & Bhoyar, 2013). In general, attention to the state of digestion (strenght of agni), elimination of feces, wound healing, and breast care, are all important aspects to consider when attending to a sutika. Following the five to seven day regime of rice gruel, herbs/medicines (dravyas), and oleation, more nourishing foods are gradually introduced. Up to fourteen days the diet remains light, nourishing, and easy to digest. After fourteen days, more vata pacifying and nourishing foods can be introduced. After twentyeight days, more nourishing foods, ghee preparations, and jam preparations can be included, depending on the digestive capability of the sutika (Pillai, 2021).

“The woman who has delivered should be nursed very carefully, for her diseases are difficult to treat because of the exhaustion caused by growth of the foetus, its birth, pain (of delivery), discharge of fluid and blood (in large quanitities)” (Vagbhata, 2019, p.379). As has been demonstrated through this examination of sutika paricharya, it is clear that a profound level of care and understanding of women’s needs postpartum has been included in the Ayurvedic medical texts, and serves to protect women’s biopsychosocial wellbeing throughout the life span. It has been said that seventyfour types of diseases can take root in the postpartum period (Sangwan, 2018), so it’s importance for the health, happiness, and wellbeing of women the world over, and thus the birthing of a new generation, can not be underestimated.

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