Pregnancy in Ayurveda
AYURVEDA has a well-documented description of caring for pregnant women, called Garbhini Paricharya. The regimen prescribes practices for each month and stage of pregnancy. These systems are, in fact, diligently followed as traditional practices in innumerable households even today. Garbhini Paricharya prescribes ahara (diet), vihara (lifestyle) and vichara (thought process) to be followed during pregnancy as these have a direct effect on the mother and the child. Of these, wholesome diet is given great importance as it aids foetal growth, maternal health and lactation after childbirth. Great care is also recommended during the first three months and after the completion of the seventh month of pregnancy.
During the first three months of pregnancy, the foetus is in a formative stage. During this stage, the embryo is nourished directly by upsnehan (percolation). Therefore, more liquid diets such as fruits with juice content, coconut water, milk are recommended. While milk and a light diet is recommended during the first month; in the second and third months, milk medicated with life-building herbs such as Vidari, Shatavari (Asparagus), Yashtimadhu (Licorice) and Brahmi are prescribed along with honey and ghee. Brahmi helps in calming the nerves and is also a good prajasthapan (sustainer of pregnancy). Garbhini Paricharya considers milk an ideal constituent of diet for pregnant women as it is a source of calcium, lactose and butter fat. Milk also has moderate amounts of protein with anabolic properties that give strength. Ayurveda is particular that pregnant women should not get constipation. While mild laxatives and enema is recommended if there is a tendency to constipation, it is found that usually, milk alone is sufficient to cope with the constipation. Towards the end of the third month, the foetus starts showing distinct development and sensory perceptions. Motor reactions start developing and heartbeat can also be heard. The fourth month sees the formation of dhatus (tissues) in the foetus. In the fifth month, blood and muscles are formed. In the sixth month, fatty tissue is formed. In the seventh month, foetal growth is complete. Foetal organs are well formed and acquire strength by the sixth and seventh months. Skin, hair and nails are also noticed at this stage. Medicated ghee is recommended as a nutritional supplement to the diet. The embryo gets its nourishment through the umbilical cord. Rice, milk, butter and ghee along with fruits and leafy vegetables are recommended. This is useful for foetal growth, for maternal health and for further lactation. As per Ayurveda, pregnancy is the time to consume nutritional food substances like urad dal and amla. From the fourth to the seventh month, medicinal supplements such as Ashwagandha, Kraunch beej and Guduchi. Aswagandha and guduchi are given to strengthen the uterine muscles and also to nourish the embryo. These also help in the prevention of intrauterine growth retardation. Fat, salt and water should be reduced in the diet from the seventh month onwards. Rice kanji with ghee is a recommended diet. Small amounts of basil can be taken as antispasmodic. Herbs such as Gokshura and Sariva, which are mild diuretics and urinary antiseptics, can also be taken. Ayurveda advises certain decoctions during pregnancy, for the growth of the foetus and for the health of the mother. Ghrita preparations (medicated ghee) like Phala Sarpis can be taken from the first month of pregnancy. Dadimadi Ghritham improves the growth of the foetus while Kalyanaka Ghritham improves mental growth. These decotions can be taken from the seventh month of pregnancy. In addition, Sukhaprasava Ghritham helps in easy delivery of the baby. These Ghrita preparations can be included as an integral part of the diet, during pregnancy. Interestingly, the suggested Ayurvedic diet correlates to modern nutrition recommended for pregnant women such as high protein, vitamins and minerals.
Diagnosis Of Pregnancy
The topic of Prasoothi Tantra itself it divided into three areas viz.
1. The antenatal phase which includes – diagnosis of pregnancy and care during pregnancy – garbhini-paricharya.
2. Natal phase – namely the process of delivery – from the onset of the labour pains upto delivery of the placenta -prasava kaala paricharya.
3. Post-natal phase – namely the post-partal period or looking after the new-born baby, care of the mother during lactation -soothika paricharya.
The first phase of garbhini-paricharya starts off with the diagnosis of pregnancy. Diagnosis of pregnancy can be based on: Presumptive signs and symptoms, Probable signs, Positive signs. They are classified them assadyogruheeta -garbha lakshanas andvyaktha-garbhalakshanas. Sadyogruheeta- garbha-lakshanas (including presumptive and probable signs) are the set of signs and symptoms which help in the detection of pregnancy within a week of conception or even just after coition.Vyaktha-garbha-lakshanas (positive sings) are generally observed after amenorrhea i.e. these symptoms are observed after her first missed period and are symptoms which help in confirming the pregnancy. Sadyogruheeta garbha lakshanas – The signs and symptoms that can be seen immediately after conception are follows:
Charaka lists them as “Nishteevika gowravamangasaadas-tandra apaharshow hrudaye vyatha cha trupthischa beejagrahanam cha yonyaam garbhasya sadhyonamgathesya lingam ” i.e. repeated spitting, heaviness, malaise, drowsiness, horripilation, uneasiness, pain in the chest, a feeling of satisfaction, retention of the ejaculated semen in the yoni (Cha. Sam., Sha. 2/23).
Sushrutha lists them as “Shramoglaanihi pipaasaa sakthisadanam shukrashonithayoravabandhahasphuranam cha yonehe” i.e.fatigue, langour, excessive thirst, lassitude of the thighs, retention ofshukraandshonitha (absence of menstrual and coital discharges) and quivering in the vagina (Sus. Sam., Sha. 3/10).
Vaagbhatta II states “…angagrahaha, hrudaya spandanam trupthirgurutwam, thandra trudglaanihi sphuranam shukraasraananubandanam, lomaharshanam” i.e. body pain, satisfaction, heaviness, quivering, retention and combination of shukra and aarthava, palpitation, dizziness, excessive thirst, langour, horipulation are the immediate sings of pregnancy (Ash. Hru., Sha. 1/37-38).
Vaagbhatta I includes nausea and excessive salivation also in the list of symptoms. There are various interpretation of the term “sadyogruheetha”.
These are the signs and symptoms which are seen and felt by the pregnant woman immediately after conception i.e. the moment the shukra andaarthava unite, or even just after maithuna (copulation) which results in conception. They can be the signs and symptoms which appear within seven days of conception. They can be the signs and symptoms before the cessation of menstruation. It is also explained as signs and symptoms of women having become recently pregnant.
Vyaktha garbhalakshana / dowhrudya lakshana These are the signs and symptoms observed after the growth of the embryo becomes conspicuous. Charaka explains these signs and symptoms as that of dowhrudyam or that of having two hrudayas and states that their knowledge is essential to facilitate their management. These signs and symptoms are seen during the third month of gestation. They are described by Charaka as : “Aarthavaadarshanamasya cha visheshena samsravanam anannaabhilasha chardihi bhaveshu arochakomlakaamatha shraddha pranayanamucchaavacheshu gurugaatratwam chakshusho glaanihi sthanayoho, sthanyamoshtayoho, stanamandalayoshcha kaarshynyamatyartham, twamithi garbhe shwayathuhu paadayoreeshallomaraajyudgamo roopani yonyaaschataala lakshanas are paryaagate bhavanthi”. The vyakthagarbha amenorrhea, excessive salivation, dislike for food, vomiting, anorexia, craving for sour substances, alternate desires for article which are of high or low quality (beneficial/nonbeneficial), heaviness of body, languor of eyes, milk secretion in breasts, blackening of lips and areola, slight edema of feet, development of romaraji (the vertical streak of hair line extending to the umblicus) and dilation of vagina (Cha. Sam., Sha. 4/16). In addition to these, Sushrutha and Bhaavamisra mention – repeated drooping of eyes, vomiting without apparent cause, aversion to good smells and excessive salivation and tiredness as symptoms (Sus. Sam., Sha. 3/11) and Bha. Pra. Poo. Gar. 3/42). Vruddha Vaagbhatta in Ashtaanga Sangraham along with the other signs and symptoms also mentions “yatha yatha cha garbho vruddhimaapnothi tatha bharahara – rasaapchaaraatcha sthriyaa balakshaya” – i.e. the increase in the weight of the embryo causes diversion for her nutrients and thus her energy also decreases (Ash. San. Sha. 2/9 and 59). Vaagbhatta in Ashtaanga Hrudaya -adds the symptoms emaciation, indigestion, burning sensation of the whole body and expression of various desires.
In Charaka Samhitha and Kaashyapa Samhitha, the signs and symptoms for each month maasaanumaasika-lakshana have also been described from the fourth upto seventh month which are as follows:
1. Fourth month – Chathurthi maasi sthiratwam apadyathe garbhaha thasamaat tada garbhini guru gaathrathwam adhikam aapadyathe visheshna” i.e. due to stability in the foetus the woman feels more weariness in the body (Cha. Sam., Sha. 4/20).
2. Fifth month – Charaka states : “Panchame maasi garbhasya, maamsa shonitopachayo bhavathi, adhikam anyebhyo maasebhyaha tasmaat tada garbhini kaar-shyamaapadyathe visheshena. During the fifth month, there is an excessive increase of flesh and blood of the foetus in comparison to the other months; due to this the pregnant woman grows excessively thin (Cha. Sam., Sha 4/21).
Kaashyapa has also mentioned a similar symptom namely “Garbhinee panchemaasi tasmaat kaarshyen yujyate” i.e. in the fifth month the pregnant woman is associated with leanness. ( Kaa. Sam., Sha. Asa.). Chakrapani Dattas commentary on Charakas lines are “Yatho garbha maamsaadi poshanenaiva ksheena ahaara rasona maathur maamsaadi samyak poshayathi” i.e The nutrition of the mother is utilised for the growth of the child during this month, hence the mother grows thin.
3. Sixth month – Charaka states that Shashte maasi garbhasya thasmattada bala garbhini varnopachayo bhavatyadhikamanyebhyo, maasebhyaha, balavarnahaanim, aapadyathe visheshena i.e. there is a comparitive increase in the strength and complexion of the foetus during the sixth month of gestation. Therefore the lady loses her strength and complexion considerably (Cha. Sam., Sha. 4/22).
4. Seven month – Sapthame maasi garbha sarvairbhaavaihi aapyaayyathe, thasmaat tada garbhini sarvaakaaraihi klaanthathama. There is an all round development of the foetus during the seventh month of gestation. Therefore, a pregnant women becomes exceedingly deficient in all aspects of her health (Cha. Sam., Sha. 4/23). Though there has been reduction in the physical state of the mother, in the seventh month all the factors viz., flesh, blood, etc. Get reduced simultaneously (Chakrapani Dattas commentary on Cha. Sam., Sha.4/23)
5. Eighth month – During the eighth month of gestation there is cross movement of the ojas through the channels carrying nourishment from the mother to the foetus, because of the immaturity of the foetus. It is advised that one should not even mention about the eighth month to the pregnant woman because the knowledge of the danger involved in this month, would only increase her fear, which in turn will aggravate vata in her body and may lead on to dangerous consequences like premature delivery or even death of the foetus. During the eight month the ojas is not stable. If the ojas has moved to the mother the foetus will die and if it is still with the foetus then the mother’s life will be in danger. Hence our aacharyas do not consider this month fit for labour (Cha. Sam., Sha.4/24).
Ojas is defined as ojastejo dhaathunaam i.e. the essence of all the dhatus is called the ojas. The ojas is responsible for the life to be sustained and is also the source for the internal strength and resistance power.
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: a. Maasaanumasika pathya : monthwise dietary regimen and prescriptions b. Garbhasthaapaka dravyaas : Substances which are beneficial to pregnancy and c. 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 – Month wise 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, Ayurveda gives detail the month wise 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 vata (vataanulomana) – 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, 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 and shita 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 – ghrita 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 and gokshura 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, in the eighth month it would not be out of place to mention the role of vata 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 vata especially the apaana Vaayu. The functions of apaana Vaayu are “Vatavinmoothra 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 the vata and due to this reason we find that towards the last few months of delivery, all efforts are taken to keep the vata in an unvitiated state. As has been said earlier vata plays an important role in the delivery of the garbha – thus care is taken to maintain it. For this reason, basti i.e. medicated enema, is administered during the eighth month. It forms one of the panchakarmas which are the five types of eliminative therapies. Basti is broadly of two types -anuvaasana basti (unctuous enema) and aasthapana basti (corrective enema). Basti in general is the therapy of choice to eliminate vitiated vata. Anuvaasana basti or sneha basti differs from aasthaapana basti or nirooha basti by the proportion of the kashaayas (decoctions) and snehas (oils) used in preparing the enema. While anuvaasana has a lesser proportion of Kashaayas, the aasthapana has lesser quantity of sneha. Sushrutha has advised aasthaapana basti (a medicated enema with non unctuous substances like kashaaya) with decoction of badari (Zizyphus jujube) mixed with bala (Sida cardifolia), athibala (Abutilon indicum), shatapushpa (Foeniculum vulgare), palaala (pasted sesamum seeds), milk, curds, masthu (sour buttermilk), oil, salt, madanaphala (Raundia dumentorum) honey and ghrita and followed byanuvaasana basti (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 in vataanulomana (regulation of vata by its downward movement).
Month nine, the pregnant woman should be given anuvaasana basti 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 vatahara 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 the garbhopaghathakara bhaavas and help in the proper maintenance of the garbha. 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, brahmi (Bacopa monnieri), shatavari (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 the garbha (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 namely aahaara 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 undergo snehana (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 of Bhagavatam 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). Harita advises, 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 and viruddhaahara. (Yog. Rat. ksheera dosha chikitsa). The effects of the various garbhopagathakarabhaavas have been mentioned as follows: squatting or sitting in abnormal postures, control of natural urges, use of pungent hot foods and exertion would cause intrauterine death of foetus death of foetus or premature delivery or abortion. Sleeping in supine position with stretched extremities 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 of Virudhddhaahaara
Dowhrudya – 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. Ayurveda 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.
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 “yukti” 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 excessive desire for salt and raw (sour) mango the same can be substituted by rock salt (saindhava lavana) and amalaki (Phyllanthus emblica)
2. Desires for ushna tikshna 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 amalaki alone or in combination with haritaki (Terminalia chebula) and vibhitaki (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 heart (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.
There are various practices followed in the rural areas (including tribal areas), which have a rationale in Ayurveda. Some of the practices that are followed during pregnancy have a great significance. 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. 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 Ayurveda has proscribed sex during pregnancy. 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. Excessive hard work is prohibited 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 umbilical 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 giddy 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 don’t’s appear incomprehensible. 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”. 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 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 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 Ayurveda.
Therapeutics During Pregnancy – The physical and psychological disorders of a pregnant woman are no different from any other individual as the doshas and dushyas of the body remain the same. However, the principles of management differ as tikshna, katu and strong medicines would harm the foetus. Thus the choice of drugs for the disorders occurring during pregnancy should be restricted – they must be mrudu (mild), sheeta (cold) madhura (sweet) and hrudya (pleasing). But when mother’s life is in danger then she should be saved by the use, if necessary of drastic measures and pungent drugs, even if it may be harmful to the foetus (Ash. San. Sha. 2/62-63).
If the disease is acute and/or serious emetics can be given followed by the use of sweet and sour substances mixed with anulomaka drugs (carminatives). All the pacifying drugs should be mrudu, (i.e.) mild and be given along with food or drinks. In short, in the words of Charaka, the pregnant woman should be treated with all the care as when carrying a pot filled with oil. Just as the slightest oscillation of the pot causes spilling of oil, the slightest excitement to the pregnant woman can initiate complications like abortion etc. (Cha. Sam., Sha. 8/22).
The treatment in a pregnant woman depends on the month of gestation as well as the severity of the disease.
Conditions during Pregnancy and their treatment
1. Body pain and joint pain
3. Weakness (Paandu roga/anemia)
4. Nausea, vomiting, morning sickness
5. Swelling / oedema
6. Night blindness
7. Blurred vision
15. Itching in the vulva
16. Excessive vaginal discharge (white/red)
17. Burning sensation while urinating
19. Pain in the abdomen
20. Head ache
22. Kikkisa (Striae gravidarum)
These are some of the most common conditions and diseases that are encountered during various stages of pregnancy. Also the causes, treatments and preventive measures for the various conditions.
Some of the medications* which can be administered in the common ailments of pregnant women
1. Body pain/Joint pain External application of Dhanvantra taila, Sahacharadi taila, Visha garbha taila, and other Vata hara tailas is recommended.
2. Dizziness The suggested medicine is the swarasa of shatavari (Asparagus racemosa). However it is essential that the root cause of dizziness should be detected and treatment given, as it may have various causes, like paandu, general weakness or toxaemia. This is NOT meant to be used as a “manual” for treatment.
3. Paandu roga One of major disturbing conditions during pregnancy is paandu, or anemia during pregnancy. Ayurveda has recognised this condition and prescribed adequate medication, also taking care not to cause any side effects which are often seen during the administration of iron supplement in the form of ferrous sulphate and folic acid. This iron supplement does not find a good compliance with the pregnant woman as it increases the vomiting sensation and nausea and also causes constipation in many women. To avoid such reactions it is advised to take the necessary iron supplement in a form that is most suitable for her body and also in combination with other drugs which help in controlling such reactions.
Some of the combinations in practice are:
a. Lohasavam with Draksharishtam (Draksharishtam acts as a mild laxative)
b. Dhatri loha – In this preparation, there is lot of aamalaki (Phyllanthus emblica) which controls the nausea and constipation. There is also some yashtimadhu (Glycyrrihiza glabra) and guduchi (Tinospora cordifolia) which also help in alleviating the side effects c. Punarnava mandooram – Punarnava (Boheavia diffusa) acts as diuretic and hence helps to prevent any retention of urine or oedema which if often seen in pregnant woman especially at the end of the second trimester and in the third trimester.
4. Nausea and vomiting. All the classics have mentioned excessive salivation and nausea etc. morning sickness) as symptoms of normal pregnancy. Sushrutha has included pregnancy also while describing the nidaana of chardiroga (i.e). Vomiting. Madhukosha commentary says that vayu being pushed upward by foetus gets provoked and causes vomiting.
There are three specific causes for this garbhaja chardiroga
a. Vata Vaigunya
b. Dauhrida – avamaanana or non fulfillment of dauhrudya
c. Garbha nimittha or due to the foetus Power of laaja (puffed rice) with honey can be given, as it is the best among anti-emitics. However the cause for vomiting is to be checked, since vomiting may be a symptom for some other disease.
5. Sopha (Oedema/Swelling) This is another common condition.
The treatment here is two fold – oral medication :
Decoction of roots of varshabhu (Boheavia diffusa) mixed with paste of devadaaru (Cedrus deodara) and moorva (Mardensia tenacissima) or only devadaaru with honey can be given. External application – Sudation/fomentation with hot water should be done. A paste of chandana (Santalum album), madhuka (Glycyrrhiza glabra), usheeram (Vetiveria zizanioides), naaga puspha, tila (Sesamum indicum), ajasringa, manjishta (Rubia cordifolia), root of ravi and Punarnava (Boehavia diffusa), is beneficial
6. Night blindness Flowers of agasthi (Agathi grandiflora) can be given. Nutritive food also should be given.
7. Blurred vision This generally occurs as a secondary symptom in conditions of paandu, so it can be cured by treating paandu.Some “Loha” preparation should be given.
8. Worms Vidanga (Emblica ribes) in the dose of 3 grams with honey is suggested Pregnant women are prone to have worm infestation because they have dowhrudya which often results in the desire for mud, ash etc.
9. Piles Untreated constipation may also be one of the causes for piles in pregnant woman. Preparation likeAbhayarishtam and Dantyaarishtam are advised. If constipation is the cause then it should be rectified. Siddha vaidyas advise Nathai odu bhasma or Nathai kari lehyam (The preparations of snail shell and snail flesh)
10. Constipation: Constipation is another common condition during pregnancy. If the constipation is mild, draksha (Vites vinifera) and dry rose buds can be given. If the constipation occurs due to Udavarta during the eighth month of pregnancy and is not relieved either by use of anuvasana basthi(oils medicated with the drugs of madhurangana) or by intake of substances which are unctuous and vatahara, then it should be considered as incurable. Nirooha basti is given as a next step of treatment. Constipation may be caused due to the iron supplement. So while administering any loha preparation, we have to augment it with drugs or preparations which would prevent constipation.
Udavarta is a variety of vata roga where in the vayu (flatus), faeces and urine have an upward movement (unlike the normal movement which is downward s0, this is due to downwards), this is due to pratiloma (moving in the opposite direction) of vata. This is generally caused due to vega dhaarana (control of urges)
11. Diarrhoea: Diarrhoea or athisaara can be due to a number of reasons. This can be due to the use of incompatible foods, eating before the digestion of the previous meal, over eating, indigestion, vega dhaarana (control of urges), consumption of hard or solid substances (eg. seeds, uncooked pulses and grains), excessives tharpana(satiation) and langhana(emaciation), eating uncooked roots and tubers, polluted water, water, heavy andabhishyandhi dravyas, and also hunger, grief or fear. In conditions of aama, pachana drugs (like Ashta choornam) should be given (Kas. Sam., Khi 10).
A decoction of bilwa (Aegle marmalos), mustha (Cyperus rotundus), dhaanyaka (Corriandum sativum)and jeeraka (Cuminum cinimum)can be used.
12. Fever. This is the most troublesome diseases in a pregnant woman. The foetus is also affected due to transfer of heat of fever from the mother to the foetus. Fever may be due to – excessive hunger, exertions, abhyanga, massage, dryness, heat, retention of normal faeces, improper use of snehana, swedana and agni karma psychological strain, climbing on mountains and smell of grass and flowers (pollen). Before the fourth month, the lady is advised a fast for one day (fasting is contraindicated in pregnancy as a general rule, but during jwara (fever) it can be advised for a day), followed by liquid diet (rice gruel) free from fat and salt. After the doshas have subsided, cereals with soups should be prescribed, advised meat soups and milk. Pungent diet and drinks, exercise and sudation should be avoided. No medicine need be given. During and after the fourth month medicines should be given only after considering the month of pregnancy and the doshas involved and their degree of vitiation. Lekhana karma and other such measures which make the body light should be done after considering properly – the complications of the disease, stamina and tolerance of the woman and the month of gestation. A decoction of mustha (Cyperus rotundus), parpataka (Mollungo pentaphylla), chandana (Santalum album) and shunti (Zingiber Officinallis) can be given.
For details on Aama
14. Jaundice: For treating jaundice the juice of bhuamalaki (Phyllanthus nirun) with honey and sugar can be given or guduchi (Tinosposa cordifolia), katuki (Pipcorrhiza kurrpa), chirata (Swertia chirata) and daruharidra (Berberis aristata) are given in the form of decoction.
15. Measles A decoction of nimba(Melia azadirachta), dhaanyaka (corriandrum sativum), guduchi (Tinosposa cordifolia) andpatola (Trichosanthus dioica) should be given.
16. Itching in the Vulva : A paste of haridra (Curcuma longa), nimba (Azadirachta Indica) and chandanam can be applied twice daily.
17. Excessive vaginal discharge Some amount of discharge (Both as mucous and bleeding)is normal during pregnancy but when it is recurrent and excessive, medical advice is to be taken immediately. The case for the discharge should be properly investigated and required treatment should be given. The flowers of silk cotton tree (Bombax malabaricum) should be fried in ghee and taken with sugar early in the morning. 18. Burning sensation during micturition Gokshuradi choornam with warm water, or just the decoction of gokshura be should given.
19. Convulsion (aakshepa) Convulsions may occur as a complication of garbhajanya vishamayatha. She should be given internally, a mixture of lime juice, bida lavana (rock salk) and saindhava lavana or a decoction of agnimantha (Premna latifolia) and varuna (Crataeva nurvala). It can also be treated according to the doshic predominance In the later stages of pregnancy ghrita seka (sprinkling with ghee) is advised. The seka can be hot or cold according to the condition of the disease.
20. Pain in the abdomen Pain in the abdomen may be to various reasons, the actual cause should be detected and treatment given. The decoction of yashtimadhu (Glycyrrhiza glabra), shunti (Zingiber officinale) and devadaaru (Cedrum deodara) can be given to give relief. If the pain is due to accumulation of gas, then she is given garlic boiled in milk or Hingwashtaka choornam or Lavana Bhaskaram. She can also use more of asafoetida in her diet to avoid accumulation of gas.
21. Headache A paste of dhaanyaka (Corriandrum sativum) in milk is applied externally Here also the causative factors should be detected and avoided.
22. Insomnia Buffalo’s milk can be given and externally abhyanga over the head can be done.
23. Kikkisa (Striae gravidarum) Stiriae gravidarum is defined as the lines which appear on the abdominal skin, especially around the umblicus due to the stretching of the skin caused by the growing foetus. The growing foetus displaces all the doshas upwards and reaching the chest region produces burning and itching sensations. The result of this itching are the linear lines on the abdomen. Internally she can be frequently given butter treated with the madhura gana drugs, in the dose of 10 ml (approximately). Externally, the paste of chandana (Santallum album) and ushira (Vetiveria zizanioides) or the paste of kutaja bark (Holarrhena antidysentrica), seeds of arjaka (Orthosiplion pallidus), musta (Cyprus rotundus) and haridra (Curcuma longa) can be applied. Irrigation of the abdomen and breasts should be done with decoction of patola (Trichosanthes dioica), nimba (Azadirachta indica), manjishta (Rubia cordifolia) andsurasa (Occmim sanctum). One should avoid scratching to avoid disfigurement of the stretching skin. If the itching becomes irresistable then the powders of kutaja, arjaka mustha, haridra, patola, nimba manjishta, surasa etc. should be rubbed or paste of chandana should applied will suppress itching sensation due to its coolness.
It is interesting to note that rural and tribal people are not only competent enough in diagnosis and care during pregnancy but are equally good in the management of diseases and conditions during pregnancy. A comprehensive list of conditions encountered during the various stages of pregnancy and their treatment have been given earlier. All the conditions (barring a few) are managed by them with locally available drugs. While most of their practices are healthy and should be encouraged, some are irrational and risky and should be discouraged. Some others are interesting and need further study. Oil massage and hot water bath is advised for body pain in Tamil Nadu, Kerala and Karnataka. The report from Uttar Pradesh advises fomentation with hot water boiled with ajamoda (Apium graveolens). In Gujarat it is reported that warm water with leaves of shigru (Moringa olifera) is more useful. Dizziness and nausea are managed by oral administration of powder of dhanyaka Corriandrum sativum) with sugar in Uttar Pradesh and Tamil Nadu. Similarly juice of tulasi(Ocimum Sanctum) is also used with sugar. Lemon juice is widely used in Tamil Nadu and Karnataka. Some people in Tamil Nadu also take ginger in the form of chutney. Weakness and anemic conditions are managed by intake of powder of badam (almonds) with milk. Ghee, milk, fruits and nourishing food is also advised. Decoction of cardamom seeds and aniseeds, chutneys and pickles made of ginger, mint leaf and leaves of tiruvatchi (Bauhinia Tomentosa) were also given. Siddha Vaidyas prescribed the chutney made of tiruvatchi leaves in conditions where the pitta is vitiated and also when there is nausea and anorexia. Barley water and tender leaves of tadphal tree (Borassus flabelifer) with palm jaggery is advised for oedema in Tamil Nadu. Both of them are mutrala (diuretics) and help to reduce the fluid retention. For conditions like night blindness and blurred vision there were no significant responses. In conditions of worm infestation the woman is given a decoction of jyothismathi (Cordiospermum lelicacabum), in Tamil Nadu and Karnataka. Piles was treated by intake of flesh of snails in Tamil Nadu. Siddha vaidyas widely used preparations of the flesh of snail and the shell of snails. The general advise for relief from constipation is to include green and leafy vegetables and fruits like plantains. While in parts of Kerala and Tamil Nadu oral dehydration is resorted to in diarrhoea, in Tamil Nadu it was also reported that milk boiled with garlic (in the form of lasuna ksheera paakam) is given. Also butter milk rice is given and chillies and greens are avoided. Lasuna ksheera paka acts as a good aama pachana/ and agni deepana drug. The practice of avoiding chillies and leafy vegetables is good. Decoctions of Trikatu (Gingiber offcinale, Piper longum and Piper nigrum) and Tulsi are given in Kerala and Tamil Nadu for fever.Jaundice seems to be very common and field groups were well experienced in treating it.Bhuamalaki (Phyllanthus niruri) used in Tamil Nadu and Karnataka. Also kumari (Aloe vera) and bringaraja (Eclipta alba) are used in Orissa and Tamil Nadu. Washing with salt water, decoction of haritaki (Terminalia chebula) or plain hot water is advised for itching in the vulva in Kerala and Tamil Nadu. In Orissa it is advised to apply ghee locally. For excessive vaginal discharge a decoction of ani seeds and tender coconut was advised in Tamil Nadu. The woman was advised to drink barley water and decoction of gokshura (Tribulus terrestris), in conditions of burning sensation while micturition. Gokshura being mutrala (diuretic) relieves the burning sensation. Pain in the abdomen is treated by giving decoctions of dhanyaka or decoction of fresh ginger with palm jaggery. Externally castor oil or coconut oil is applied over the abdomen. In cases of head ache, a paste of tender coconut and breast milk is applied on the forehead in Kerala and Tamil Nadu. The woman is advised to take more milk (preferably buffalo’s milk) at night, apply lime juices or oil on the head, in Tamil Nadu to get relief from insomnia. Buffalo’s milk being “guru” induces sleep. Applying lime juice and oil cools then system and induces sleep.
Abortion and Miscarriage – Every pregnancy does not complete the full term and result in the birth of a baby. The pregnancy may be terminated in between due to various reasons. Termination of pregnancy within the first three months after conception is called as abortion. In next three months it is termed as miscarriage. After the sixth month it is called as premature delivery. The first signs and symptoms for an abortion or miscarriage is bleeding and severe back pain. Thus a woman should take medical advice, as soon as she has any of these symptoms. When the pregnancy gets terminated and there is bleeding, it is called as abortion. This can be caused due to a number of reasons, including the use of unwholesome food or improper regimen. If the bleeding occurs during the second or third month of pregnancy, then the pregnancy can not be stable because during this period the embryo lacks maturity. After the fourth month this may not be very critical and one can maintain the pregnancy, despite bleeding. Garbhasraava/ Garbhapaatha The expulsion of foetus upto fourth month of pregnancy is termed as garbhasraava, because the product of conception is in a fluid form. After the fifth and sixth months it is termed as garbhapaatha as by this period the foetal parts have attained some stability of have become solid. The causes for these could be many, such as excess of-anger, grief, envy, jealousy, fear, terror, cohabitation, exercise, jerk, suppression of vegas (manifested urges), improper food, sleep and posture, hunger, thirst and intake of unwholesome food. When this happens the following symptoms are manifested : pain in the uterus, sacral and groin region and over the urinary bladder along with bleeding. The cause of the pain is the vitiation of vayu and the bleeding is due to expulsion of aama-garbha and opening of orifices of arthavavaha srotases. Treatment As the Garbhopaghathakara bhaavas are ushna tikshna and saraka in guna, the general principles for treating abortion is similar to garbha sthaapaka aahaara, vihaara andaushadas. Thus the treatment given is always shitha, mrudu and sthambaka in nature.
1. Immediately after bleeding is noticed the mother should be advised to lie down in slanting position so that her head is at a lower level and the leg at a higher level, on a bed which is soft, cooling, comfortable and cooling
2. The entire body below the navel should be smeared with shathadowtha ghrutha and sahasra dowtha ghruthaand sprinkled with cold (chilled) cow’s milk, decoctions of yashti madhu (Glycyrrhiza glabra) or nyagrodha (Ficua bengalensis).
3. Cotton swab dipped in milk or ghee boiled with the sunga (bud) of nyagrodha (Ficus bengalensis).
4. A cotton swab dipped in ghee mixed with the powder of yashtimadhu (Glycyrrhiza glabra). Internally she can be given milk or ghee boiled with buds of nyagrodha (Ficus bengalensis) in a dose of one aksha (12 ml) or even plain milk ghee. Psychologically she should refrain from anger and sorrow. She should be entertained with talks which are gentle and pleasing to her mind. She should further avoid exertion exercise and cohabitation (Cha. Sam., Sha. 8/24). Conditions when the abortion should be left untreated, to proceed
a. When the bleeding has been very severe and would have caused irrepairable damage. In such cases even if the abortion is treated and stopped, there could be some damage/deformity in the foetus, caused due to the acute blood loss.
b. If the bleeding is due to the factor which also causes the formation of “aama”,
c. ** They are pippali (Piper longum), pippalimoola, cavya (Piperchaba), chitraka (Plumbago zeylanica), shunti (Zingiber officinale) Habitual Abortion Some women have a tendency for abortion and the slightest of exertion and even normal movements tend to cause abortion. In such cases, preventive medicines, aimed at treating the cases of habitual or repeated abortion can be attempted.
The powder or paste of the following drugs should be used with milk in the particular months, which would help the foetus to grow properly.
1. First month : Madhuka (Glycyrrhiza glabra), shaakabeeja, payasya (Ipomoea paniculata) and suradaaru (Cedrus deodara)
2. Second month : Ashmantaka (Banuhimia malabarica),blacktila, taamra valli andshataawari (Asparagousracemosa).
3. Third month : Vrukshaadini, payasya, lata, utpala, andsaarivaa (Hemidesmus indicus)
4. Fourth month : Ananta (Gardenia floribunda), saarivaa (Hemidesmus indicus), raasna (Pluchea lanceolata), padma, madhuka (Glycyrrhiza glabra).
5. Fifth month : Bruhatidwayam, kaashmari (Gmelina arborea), stem bark and leaf buds of latex yielding trees and ghruta.
6. Sixth month : Prishniparni (Uraria picta), bala (Sida cardifolia), or vacha (Acorus calamus), shigru ( Moringa olifera)swadamshtraandmadhuparnika. (This relieves even very severe pain).
Disorders Of The Foetus – There are conditions in which, the improper diet and regimen of the mother, does not lead to garbhapaatha or garbhasraava, but becomes a chronic disorder and causes some deformity or intrauterine death at later stages of pregnancy. These are not very easily detected. Today we come across, various conditions like uterine moles, tubal pregnancies, vesicular moles and abdominal pregnancies Ayurveda has described some conditions which have very similar signs and symptoms, though there may be variance in the causes and pathogenesis that have been described. Signs and symptoms of abdominal pregnancy
Here is an excerpt from a obstetric book to show this point: If the foetus dies after reaching a size too large to be absorbed it may undergo suppuration, calcification, mummification or adipocere formation. When the gestation sac adheres to the intestines, infection to the gestation sac and suppuration may occur. Eventually the abscess ruptures and if the patient does not die from septicaemia foetal parts may be extruded through the abdominal wall or more commonly through the bladder or rectum. In some, gestation may go on to term when a spurious labour ensures and the foetus dies, the liquor gets absorbed and the abdominal enlargement decreases. Mummification and formation of a lithopeodian occasionally ensue and the calcified products of conception may be carried for years without producing symptoms.
A few of such conditions are described below :
1. Garbha Shosha Either due to non-availability of proper diet (nourishment to the foetus) or vaginal discharges (bleeding) after conception the foetus may suffer from sosha (emaciation or dryness). Such a foetus attains its proper growth or maturity after a long time and the woman delivers it after prolonged delay. According to Sushrutha, this is due to the affliction by vaayu – the foetus gets dried up, does not fill the mother’s abodomen properly and quivers very slowly. The symptoms of this condition are as follows:1. The size of the foetus is small and underdeveloped
2. The quivering of the foetus is very mild.
3. The fetal heart sounds are also very mild. Treatment iv. v. vi. The use of ruksha (dry) articles and those vitiating vata are to be avoided Bruhmaniya (anabolic) drugs, milk and meat soup should be used. Milk treated with madhuyashti (Glycyrrhiza glabra), fruit of kaashmari (Gmelina arborea) with or without sariva (Hemindesmus indicus) and mixed with sugar should be taken. Upavishtakam After the fourth month of pregnancy (i.e after the attainment of saara by the foetus. If due to the intake of pungent and hot (ushna and teekshna) aahaaras, the mother has bleeding or any other type of yonisraavam (vaginal discharge), it may lead to the improper growth of the foetus and the delay in delivery. This condition is termed as Upavishtaka
Ghritas which are generally given to treat afflictions of bhutas (semi divine beings) are prescribed to treat upavishtaka e.g. Vacha-ghrutha, guggulvaadighrutha, mahapaishachika ghrutha. Also ghrutha medicated with jeevaneeya, bruhmaaniya, madhura and vatahara drugs can be given. Milk and meat soups medicated with the above groups of drugs or just milk and meat soups can be given without medication. Naagodara/Upashushka If the woman observes fasts, eats stale food, does not take fatty or oily substances and uses other vata vitiating articles, the foetus gets dessicated and does not grow. This foetus remains in the uterus for a very long time and does not quiver. This entity is termed as nagodara.
The treatment for nagodaram is same as that of Upavishtakam. Leena garbha Due to obstruction in the srotas and due to vata the foetus becomes “lina”(clung or adhered). This foetus remains in the uterus for very long duration and gives rise to various complications. Treatment . She should be treated with mild and predominantly unctuous sudation, emesis and purgatives, because strong emetics etc. Are likely to harm the foetus. 1. Bruhmana gruels should be given and 2. The women should be kept happy.