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Garbhini Paricharya : Care Of The Pregnant Woman

Garbhini paricharya or antenatal care is the most important aspect in the whole area of Prasuthi Tantra. This is so because all other aspects depend on this phase. The proper garbhini charya would result in the proper development of the foetus, its delivery, the health of the mother and thus her ability to withstand the strain of labour and have an eventless post-partal phase. The care of the pregnant woman reflects on the quality and health of the offspring For these reasons our aachaaryaas has given a detailed and systematic and monthwise regimen plus a list of do's and dont's to be followed in the antenatal phase.
The garbhini paricharya is broadly discussed under three topics:

  1. Maasaanumasika pathya : monthwise dietary regimen and prescriptions
  2. Garbhasthaapaka dravyaas : Substances which are beneficial to pregnancy and
  3. Garbhopaghaathakara bhaavas : Activities and substances that are harmful

This can also be listed as the various foods and activities that are prescribed and proscribed, according to their effects on the garbha.

Maasaanumaasika pathya : Monthwise dietary regimen
As there is a constant development of the embryo there would also be difference in its requirements of food and nutrition. Thus the requirements of the mother also change. Having understood this change in requirements, the Aayurvedic Aachaaryaas have given in detail the monthwise dietetic regimen.

By following these dietetic regimens prescribed, the pregnant woman, having normal development of foetus, remains healthy and delivers a child possessing good health, energy, strength, complexion and voice. The child would also be sturdy. They are recommended for the pregnant woman right from the first month upto the ninth month of pregnancy. The maasaanumaasika pathya help in:

  1. Softening of placenta (apara), pelvis, waist, sides of the chest and back
  2. Downward movement of vaatha(vathaanulomana) - this is needed for the normal expulsion of foetus during delivery.
  3. Normalisation of the urine and stool and their elimination with ease
  4. Softening of her skin and nails
  5. Promotion of strength and complexion
  6. Delivery with ease of a healthy child endowed with excellent qualities in proper time.

Recommended diet and regimen for various months

First Month
As soon as pregnancy is suspected, the mother should take non-medicated cold milk separately in desired quantity (considering her digestive power and strength) Congenial food should be taken in the morning and evening. Massage with oils should be given but rubbing of unguents should be avoided (as they would liquify the doshas) (Cha. Sam., Sha. 8/32) and (Ash. San., Sha 3/3)

Second month
In the second month, the woman should be given milk medicated with madhura drugs and liquid foods which are sweet and cold (Cha. Sam., Sha. 8/32 and Sus. Sam., Sha. 10/3).

Third month
In the third month she should take milk with honey and ghee (Cha. Sam. Sha. 8/32) and shasti (a variety of rice) cooked in milk. In the first three months of pregnancy the product of fertilization is in a fluid/jelly state and thus the woman should be given more of liquids or fluids. Also during these three months the major part of mass is formed - for this madhura andsheetha veerya substances should be given which help in the formation of the cellular mass and promote growth.

Fourth Month
Butter extracted from milk (not from curds) in the quantity of one aksha (approximately 10 grams) or milk with the same amount of better should be given (Cha. Sam., Sha. 5/32). Cooked shasti (a variety of rice) with curds, pleasant food, mixed with milk and butter and meat of wild animals (Sus. Sam., Sha. 10/3) should be given to the pregnant women during the fourth month. During the fourth month there is solidification and the development of the limbs. So there is more need of solids, and more of solid food is advised.

Fifth Month
Ghee prepared with butter extracted from milk (Ksheera sarpis) and food similar to that of the fourth month should be given except that, ghee is given (mixed with milk) instead of butter.

Sixth Month
Ksheera sarpis medicated with the drugs of madhura gana - ghrutha or rice gruel medicated with gokshura (Tribulus terrestris) should be given in the sixth month. As it is quite common to notice retention of urine, in this phase of pregnancy, madhura gana drugs andgokshura would help as diuretics.

Seventh Month
The diet given in the seventh month should be the same as in the sixth month, along with ghee medicated with pruthak parnyaadi (Vidaarigandhaadhi) group of drugs. This would help in the proper development of the foetus.

Eight Month
Before we list out the diet and regimen for the eighth month it would not be out of place to mention the role of vaatha in the process of delivery and how important it is to maintain it. We see that the regimen and diet prescribed are of the nature of controlling vaatha especially the apaana Vaayu. The functions of apaana Vaayu are "Vaathavinmoothra shukraartava garbha nishkramanaadikriyaaha" i.e. the expulsion of gas, faeces, urine,shukra (semen),aartava (menstrual discharge) and the delivery of the foetus (Ash. San. Sut. 20/4). Hence to have normal delivery it is very important that we maintain thevaatha and due to this reason we find that towards the last few months of delivery, all efforts are taken to keep thevaatha in an unvitiated state.

As has been said earliervaatha plays an important role in the delivery of the garbha - thus care is taken to maintain it. For this reason,basthi i.e. medicated enema, is administered during the eighth month. It forms one of thepanchakarmas which are the five types of eliminative therapies. Basthi is broadly of two types -anuvaasana basthi (unctuous enema) and aasthapana basthi (corrective enema). Basthi in general is the therapy of choice to eliminatevitiated vaatha. Anuvaasana basthi or sneha basthi differs from aasthaapana basthi ornirooha basthi by the proportion of thekashaayas (decoctions) and snehas (oils) used in preparing the enema. While anuvaasana has a lesser proportion ofKashaayas, theaasthapana has lesser quantity ofsneha.

Sushrutha has advisedaasthaapana basthi (a medicated enema with non unctuous substances like kashaaya) with decoction of badari (Zizyphus jujube) mixed withbala (Sida cardifolia), athibala (Abutilon indicum),shatapushpa (Foeniculum vulgare), palaala (pasted sesamum seeds), milk, curds, masthu (sour buttermilk), oil, salt,madanaphala (Raundia dumentorum) honey and ghrutha and followed byanuvaasana basthi (a medicated - unctuous enema) with oils medicated with milk and decoction of drugs of madhura group. These would help in clearing the retained faeces and invaathaanulomana (regulation of vaatha by its downward movement).

Ninth Month
The pregnant woman should be given anuvaasana basthi with oil prepared with the drugs of madhura group, and also vaginal tampons (pichu) with the same oil for lubrication of garbhaashaya (uterus) and prasava maarga (birth canal). Daily bath with cold decoctions of vaathahara drugs are also advised. Meat soups with cooked rice and fat or rice gruel mixed with good quantity of fat should be given as diet.

Garbhasthaapaka aushadhi - Substances beneficial for maintenance of pregnancy
Garbha sthaapaka dravyas counter act the effect of thegarbhopaghathakara bhaavas and help in the proper maintenance of thegarbha. They can also be used in the treatment and prevention of abortion. These are to be used as a routine as they are beneficial for the maintenance of proper health, growth and development of the mother and foetus.

Some of the garbhasthaapaka aushadhis are aindri, braahmi (Bacopa monnieri), shathaavari (Asparagus racemosus), doorva (Cynodon dactylon), etc. These should be taken orally as preparations in milk and ghee. A bath with cold decoction of these drugs should be given during pushya nakshatra. These should be kept in close contact with the mother and can be used as amulets around the right arm and on the head. Drugs of the jeevaneeya gana can also be used in a similar way.

Garbhopghaatha kara bhaavas - Activities harmful to the foetus
Garbhopghaatha kara bhaavas are the aahaara and vihaara which are harmful to thegarbha (foetus). These may cause some congenital defects in the child and are not conducive to the birth of a healthy child, with all the good qualities These can be grouped under two different headings namelyaahaara and vihaara.

Aaahaara (food) to be avoided during pregnancy
The pregnant woman should avoid use of intoxicating substances like wine, meat (in excess), ushna (hot),teekshna (sharp)katu (pungent), guru and vishtambhi (hard and heavy to digest) foods (Cha. Sam., Sha. 4/18), (Sus. Sam., Sha. 3.12), (Ash. Hru., Sha 1/44-47).

Vihaaras (activities and behaviour) to be avoided during pregnancy
The pregnant woman should avoid strenuous exercise and coitus (both excessive) harsh or violent activities, travel in vehicles (on uneven road) (Cha. Sam., Sha. 4/18).Sushrutha has said that - the pregnant woman should totally give up coitus, exercise santarpana (satiation or anabolic foods and regimen), swapna viparyaya (sleeping in the day and keeping awake at night), utkataasana (squatting or the posture of sitting on the hams with the soles of feet touching the ground). She should not suppress her natural urges and she should not undergosnehana (oleation therapy) and rakthamokshana (blood letting). Her mind should be always in a pleasant state and she should neither touch nor see unpleasant things of disfigured persons (with some physical defects) scary objects, nor listen to exciting and scary stories. It is said that the mental state of the mother can influence the outcome of pregnancy as well as the child to be born. Hence one is advised to listen to scriptures - in some families the recitation (paaraayana) of suitable texts such as the Sundara Kandam (from the Ramaayana) or the tenth skanda ofBhaagavatha is performed routinely. She should not talk in high pitch and avoid thoughts which would promote her anger or fear - all these physical and mental activities would harm the foetus (Sus. Sam., Sha. 10/2).
Vaagbhatta has said that she should also avoid prolonged stay in the hot sun and peeping into pits and wells (Ash,San, Sha, 3/3). Haaritha advices, avoidance of foods which are vidaahi and constipative and vegetables like yam, garlic and onions, (Haa.Sam. 3/49). The author of Yogaratnakara has contra indicated the use of sudation, emesis,kshaara (alkalies) foods along with polluted food andviruddhaahara. (Yog. Rat. ksheera dosha chikitsa).
The effects of the variousgarbhopagathakarabhaavas have been mentioned as follows: squatting or sitting in abnormal postures, control of natural urges, use of pungent hot foods and exertion would cause intra uterine death of foetus death of foetus or premature delivery or abortion. Sleeping in supine position with stretched extremeties would cause the encircling of the umbilical cord around the neck. Indulgence (excessive)in sex would cause deformed impudent or lazy child. Over sleeping during pregnancy could result in a child who is sleepy, ignorant and has a weak agni (power of digestion). Regular use of wine or other intoxicants would result in a child with a poor memory and an unstable mind. The excessive use of any of the six rasas would cause - urinary disorder, skin and eye disorders, premature aging, infertility emaciation, weakness and disorders like flatulence and eructation respectively. (Cha, Sam., Sha. 2/61).

  • For a detailed description ofVirudhddhaahaara, the reader is referred of Section I of Chapter VIII, of Ayurvedic Principles of Food and Nutrition- LSPSS Monograph II.

One often comes across, varying and erratic likes and dislikes, in a pregnant woman irrespective of the culture or the part of the World she belongs to. These likes and dislikes are peculiar to the state of pregnancy and they vary in vary in each woman. Some of these desires are very strong. The speciality or peculiarity of these likes and dislikes are that they are very often in contrast to the usual desires of the same woman when she is not pregnant. Though these symptoms have been mentioned and described, there seems to be no understanding of its actual cause.
Aayurveda has a definite understanding of these varied desires and terms the condition as dowhrudyam. The reason for the manifestation of dowhrudyam is the presence of a second hrudaya in the foetus. As such she has two hrudayas one of her own and the other of the foetus. She is called a dowhrudini. As the foetus reaches the fifth month the chetna (i.e. consciousness) enters it and starts having its own individual desires, these along with those of the mother are manifested as a contrasting combination of likes and dislikes. This is a unique concept that explains the sudden and abnormal likes and dislikes, that pregnant women may manifest. It is said that these special desires can also help in the assessment of the sex of the child, as they are peculiar to the sex of the unborn baby.
According to our Aachaaryaas the foetus grows upto a period of four months the "chetna" or the life gets associated with the foetus and this causes the longings of the mother. These longings and desires are to be satisfied. Not doing so may cause abnormalities of the foetus like dwarfism. These desires are not always beneficial, and may prove harmful to the foetus (even when fulfilled). In such cases one should use one's "yukthi" of power of reasoning, so as to fulfill her desire and at the same time render it harmless.

Some suggestions in this regard are as follows:

  1. If there is an execessive desire for salt and raw (sour) mango the same can be substituted by rock salt (saindhava lavana) and aamalaki (Phyllanthus emblica)
  2. Desires for ushna theekshna hot/pungent foods like pickles can be fulfilled by intake of lime juice and ginger.
  3. Desire for charcoal and ash can be fulfilled by taking burnt aamalaki alone or in combination with harithaki (Terminalia chebula) and vibhithaki (Terminalia bellerica).
  4. Desire for clay, mud and brick can be replaced by gairika (red ochre) fried in ghee.

Desires of the mother are said to have some relationship with the character of the child. For e.g. It is said that if a women desires to see a king, she will have a son who becomes prosperous etc. Indriyaarthaasthu yaan yaan saa bhokthum icchathi garbhinee, garbhaabaadha bhayaat thaamsthaan bhishagaahrutya dopayet, saa praaptadowhruda puthram janayet gunaan vitham, alabhdha dowhrudaa garbhe labhetaamani vaa bhayam yeshu yeshu indriyaartheshu dowhrude vai vimaananaa, prajaayet suthasyaarthisthasminsthathendriye. The physician (who wishes for the well being of the mother and the foetus) should satisfy all the desires of the mother related to all the five sense organs. This is so because, the lady whose dowhrudam (special desires) is fulfilled will beget a healthy child and if it is not fulfilled either she or the child would be affected . The sense organs which are not satisfied during pregnancy would result in some defect or abnormality (physical or functional) or the corresponding organ in the child (Sus. Sam., Sha. 3/16-18)

  • Hrudayam does not literally mean the organ heat (which is defined as a hollow muscular cone shaped organ). It is described as the seat of the mind, the objects of mind, sense faculties, five objects of senses, consciousness and the soul together with its qualities like happiness etc. (Cha. Sam., Sut. 30/3-4). Thus the presence of the garbha hrudaya does not merely mean the formation of the organ-heart, but the individual consciousness, its likes and dislikes which are manifested after the chetna (consciousness/life) enters it in the fourth month.

Local Practices
There are various practices followed in the rural areas (including tribal areas), which have a rationale in Aayurveda. Some of the practices that are followed during pregnancy have a great significance. A few of them which are still in practice are listed below.
It has been observed in Bangladesh that sexual intercourse is discouraged in the last few months of pregnancy - the reason given is that it may harm the foetus (7). A similar practice is observed in other areas also. Sometimes, it is reported that the sexual intercourse in late pregnancy is prohibited since "it would amount to incest, since the body of the child is already formed. As we have mentioned earlier this practice is sound and aachaaryaas have proscribed sex during pregnancy.
It is reported in Maharashtra, Uttar Pradesh, Madhya Pradesh and Tamil Nadu that the woman is allowed to do her normal daily household chores and some specify that she should not exert herself too much by carrying heavy loads or by running (8). Execessive hard work is prohibitted for pregnant woman, because over exertion may lead to abortions or other complications. Not doing any work is also not advisable as it would make the child dull and sleepy. So it is best to resort to mild house work, which would not be so strenuous and would also keep her active.

Lying on the back (supine position), carrying water from the well or peeping into pits and wells are also prohibited. These are healthy practices and have a rationale. Lying on the back or in supine position may cause the twisting of the umblical cord around the neck of the foetus, carrying water can be tiresome work and also involves risk of slipping and falling down, which are not good both for the woman and the foetus. The same reason can be given to the next practice of "not-peeping into wells and pits" the risk is more in pregnant woman as their body is a little more delicate also they may feel guiddy more easily than normal people, and so may fall into pits or wells by accident.

Food restrictions are also followed meticulously and to many a modern investigator these do's and dont's appear in-comprehensible. Among the advice on various prescriptions and proscriptions, some are listed here. One basic advice is to avoid food in large quantities or even over nourishing foods, the reason being "to avoid a large foetus resulting in a difficult delivery". This practice has been observed in Bangladesh (7) and Tamil Nadu. (8) Excess of santarpana is not advised during pregnancy, hence this is a good practice.

There are also a number of foods that are to be avoided during pregnancy. Some of them, as reported in a detailed study in Andhra Pradesh (9), are pumpkin, banana, brinjal, gongura, guava and papaya. These foods were considered too "ushna" (which may cause abortion) or very heavy to digest (straining her agni). Yet another study in Andhra Pradesh (10) found that eggs were to be avoided. This again is "guru" and in "aama" from, which may cause indigestion and formation of aama. These in turn may lead on to aamaja garbha sravam (abortion due to aama). Some are of the opinion that eggs can be given if the digestive power of the pregnant woman is good as per the dictum "Garbham aamagarbhena" which means that the foetus can be nourished by other substances having the same quality. By and large these practices are sound and are supported Aayurveda.

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