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Prenatal care is known as “garbhini paricharya” in Ayurveda. ‘Garbhini’ means pregnant woman and ‘paricharya’ means ideal protocol. It includes the ideal dietary and lifestyle protocol followed by a pregnant woman to attain optimum health of progeny and prevent any complications.

Prenatal care is known as “garbhini paricharya” in Ayurveda. ‘Garbhini’ means pregnant woman and ‘paricharya’ means ideal protocol. It includes the ideal dietary and lifestyle protocol followed by a pregnant woman to attain optimum health of progeny and prevent any complications.

The guidelines for prenatal care start even before conception. The couple planning to have a progeny shall follow purification procedures (panchakarma), proper diet and life style modifications as part of preconception care. The prenatal care begins from the very first day when (usually due to missed menstrual cycle). [Su. Sa. Sharira Sthana 10/3].

The guidelines for prenatal care start even before conception. The couple planning to have a progeny shall follow purification procedures (panchakarma), proper diet and life style modifications as part of preconception care. The prenatal care begins from the very first day when (usually due to missed menstrual cycle). [Su. Sa. Sharira Sthana 10/3].

The conceived woman shall be treated with special care just like a pot filled with oil. As the slightest oscillation of such a pot causes spilling of the oil, similarly the slightest exertions or excitements to the pregnant woman can initiate adverse pregnancy outcomes. [Cha. Sa.[[Sharira Sthana]] 8/22]

The conceived woman shall be treated with special care just like a pot filled with oil. As the slightest oscillation of such a pot causes spilling of the oil, similarly the slightest exertions or excitements to the pregnant woman can initiate adverse pregnancy outcomes. [Cha. Sa.[[Sharira Sthana]] 8/22]

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==General aspects of prenatal care in Ayurveda==

==General aspects of prenatal care in Ayurveda==

Fetus is dependent on mother in every aspect during intrauterine life.  So, the health of fetus is totally dependent upon the maternal health. The ultimate aim of preconception and prenatal care is healthy progeny.  

Fetus is dependent on mother in every aspect during intrauterine life.  So, the health of fetus is totally dependent upon the maternal health. The ultimate aim of preconception and prenatal care is healthy progeny.  

It includes:  

It includes:  

Apart from the general prenatal care, month-wise special care especially in the dietetics, is also advised. This monthly regimen is planned considering the intrauterine growth and developmental milestones of the fetus and nutritional requirements of mother. This makes a unique addition in prenatal care in Ayurveda.  

Apart from the general prenatal care, month-wise special care especially in the dietetics, is also advised. This monthly regimen is planned considering the intrauterine growth and developmental milestones of the fetus and nutritional requirements of mother. This makes a unique addition in prenatal care in Ayurveda.  

 

==Physical dimension of prenatal care==

==Physical dimension of prenatal care==

 

It includes both diet (ahara) and activities (vihara).

It includes both diet (ahara) and activities (vihara).

    

    

*anabolic and gratifying edibles. [Y.R. Ksheeradosha Chikitsa]

*anabolic and gratifying edibles. [Y.R. Ksheeradosha Chikitsa]

 

=== Table 1 :Month wise dietary regimen for pregnant woman===

=== Table 1 :Month wise dietary regimen for pregnant woman===

•Resistant starch acts like soluble fiber in the gastrointestinal tract, thus providing the health benefit.

•Resistant starch acts like soluble fiber in the gastrointestinal tract, thus providing the health benefit.

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Contemporary medical science gives importance to diet in terms of supplementation of essential macro and micro nutrients. In pregnant women’s diet the emphasize is given mainly in supplementation of iron, calcium, folic acid, DHA, iodine, and vitamin D.

Contemporary medical science gives importance to diet in terms of supplementation of essential macro and micro nutrients. In pregnant women’s diet the emphasize is given mainly in supplementation of iron, calcium, folic acid, DHA, iodine, and vitamin D.

High food quality, together with adequate macro- and micro nutrient intake in pregnancy, is crucial for the health status of the mother and child. Most conditions that occur in adulthood originate in fetal life. Moreover, some epigenetic events, modified by diet impact more than one generation.<ref>Danielewicz H, Myszczyszyn G, Dębińska A, Myszkal A, Boznański A, Hirnle L. Diet in pregnancy-more than food. Eur J Pediatr. 2017;176(12):1573-1579. doi:10.1007/s00431-017-3026-5</ref>

High food quality, together with adequate macro- and micro nutrient intake in pregnancy, is crucial for the health status of the mother and child. Most conditions that occur in adulthood originate in fetal life. Moreover, some epigenetic events, modified by diet impact more than one generation.<ref>Danielewicz H, Myszczyszyn G, Dębińska A, Myszkal A, Boznański A, Hirnle L. Diet in pregnancy-more than food. Eur J Pediatr. 2017;176(12):1573-1579. doi:10.1007/s00431-017-3026-5</ref>

 

===Life style guidelines for pregnant woman===

===Life style guidelines for pregnant woman===

 

The lifestyle protocol is indicated for maternal and fetal health commonly. [A.S. Sharira Sthana 2/58]

The lifestyle protocol is indicated for maternal and fetal health commonly. [A.S. Sharira Sthana 2/58]

*Pulses, edibles producing burning sensation (in abdomen), heavy or sour substances, edible tuber called surana, hot milk, garlic and onion.[Ha. Sa. Tritiya Sthana 49]  

*Pulses, edibles producing burning sensation (in abdomen), heavy or sour substances, edible tuber called surana, hot milk, garlic and onion.[Ha. Sa. Tritiya Sthana 49]  

 

===Activities to be avoided===

===Activities to be avoided===

 

*Harsh or violent activities [Cha.Sa. [[Sharira Sthana]] 4/18]

*Harsh or violent activities [Cha.Sa. [[Sharira Sthana]] 4/18]

*Eating clay[Ha. Sa. Tritiya Sthana 49]

*Eating clay[Ha. Sa. Tritiya Sthana 49]

 

==Psychological and Spiritual dimensions of prenatal care==

==Psychological and Spiritual dimensions of prenatal care==

Maintaining a pleasant status of mind is very essential throughout the period of pregnancy as well as during post-natal period. Even while describing the treatment of intra uterine growth restriction, the importance of mental health of pregnant woman is emphasized. It is advised to make the pregnant lady happy continuously through all possible means. [A.S. Sharira Sthana 4/25]

Maintaining a pleasant status of mind is very essential throughout the period of pregnancy as well as during post-natal period. Even while describing the treatment of intra uterine growth restriction, the importance of mental health of pregnant woman is emphasized. It is advised to make the pregnant lady happy continuously through all possible means. [A.S. Sharira Sthana 4/25]

She should use meritorious, auspicious, clean, new and intact (unbroken) garments and ornaments possessing masculine names. [ Ka. Sa. Sharira Sthana 5/12]

She should use meritorious, auspicious, clean, new and intact (unbroken) garments and ornaments possessing masculine names. [ Ka. Sa. Sharira Sthana 5/12]

 

===Activities to be avoided for preservation of mental health===

===Activities to be avoided for preservation of mental health===

 

*Contact with dirty, disfigured, foul smelling, awful looking substances [Su.Sa. Sharira Sthana 10/3]

*Contact with dirty, disfigured, foul smelling, awful looking substances [Su.Sa. Sharira Sthana 10/3]

*Acts likely to promote anger and disgrace[Su. Sa. Sharira Sthana 10/3]

*Acts likely to promote anger and disgrace[Su. Sa. Sharira Sthana 10/3]

 

===Amulet for pregnant woman===

===Amulet for pregnant woman===

 

*The pregnant woman is advised to wear amulet made of Operculina turpethum (trivrit ) in her waist during pregnancy. After delivery she is advised to wear it over her head. [Ka.Sa. Khila Sthana 10/181]

*The pregnant woman is advised to wear amulet made of Operculina turpethum (trivrit ) in her waist during pregnancy. After delivery she is advised to wear it over her head. [Ka.Sa. Khila Sthana 10/181]

Effect of music on maternal psychology and fetal well being is a well explored area of research.<ref>Corbijn van Willenswaard K, Lynn F, McNeill J, et al. Music interventions to reduce stress and anxiety in pregnancy: a systematic review and meta-analysis. BMC Psychiatry. 2017;17(1):271. Published 2017 Jul 27. doi:10.1186/s12888-017-1432-x</ref> <ref>García González J, Ventura Miranda MI, RequenaMullor M, Parron Carreño T, Alarcón Rodriguez R. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018;31(8):1058-1065. doi:10.1080/14767058.2017.1306511</ref> <ref>Liu YH, Lee CS, Yu CH, Chen CH. Effects of music listening on stress, anxiety, and sleep quality for sleep-disturbed pregnant women. Women Health. 2016;56(3):296-311. doi:10.1080/03630242.2015.1088116 </ref>

Effect of music on maternal psychology and fetal well being is a well explored area of research.<ref>Corbijn van Willenswaard K, Lynn F, McNeill J, et al. Music interventions to reduce stress and anxiety in pregnancy: a systematic review and meta-analysis. BMC Psychiatry. 2017;17(1):271. Published 2017 Jul 27. doi:10.1186/s12888-017-1432-x</ref> <ref>García González J, Ventura Miranda MI, RequenaMullor M, Parron Carreño T, Alarcón Rodriguez R. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial. J Matern Fetal Neonatal Med. 2018;31(8):1058-1065. doi:10.1080/14767058.2017.1306511</ref> <ref>Liu YH, Lee CS, Yu CH, Chen CH. Effects of music listening on stress, anxiety, and sleep quality for sleep-disturbed pregnant women. Women Health. 2016;56(3):296-311. doi:10.1080/03630242.2015.1088116 </ref>

 

==Diagnostics and therapeutics==

==Diagnostics and therapeutics==

===Diagnosis ===

===Diagnosis ===

Diagnosis of pregnancy is explained purely based on symptoms in Ayurveda. The three-fold method is applied in antenatal examinations for pregnancy and assessment of fetal growth in uterus.

Diagnosis of pregnancy is explained purely based on symptoms in Ayurveda. The three-fold method is applied in antenatal examinations for pregnancy and assessment of fetal growth in uterus.

World Health Organization’s 2016 recommendations on antenatal care (ANC) for a positive pregnancy experience prioritize person-centered health care, well-being of women and families, and positive perinatal and maternal outcomes.  

World Health Organization’s 2016 recommendations on antenatal care (ANC) for a positive pregnancy experience prioritize person-centered health care, well-being of women and families, and positive perinatal and maternal outcomes.  

 

This model guides pregnant woman about frequency and time of contact for consultation of an obstetrician.

This model guides pregnant woman about frequency and time of contact for consultation of an obstetrician.

Examination includes general physical examination, systemic examination and obstetrical examination.

Examination includes general physical examination, systemic examination and obstetrical examination.

 

===Obstetrical examination===

===Obstetrical examination===

 

It includes both abdominal and vaginal examination.

It includes both abdominal and vaginal examination.

During labour, accurate information can be obtained by the palpation of presenting part through the open cervix.

During labour, accurate information can be obtained by the palpation of presenting part through the open cervix.

 

===Lab investigations===

===Lab investigations===

 

*'''Routine investigations :'''

*'''Routine investigations :'''

There are many biophysical tests for prenatal fetal surveillance during late pregnancy which includes ultrasonography, doppler ultra sound velocimetry, cardiotocography(CTG), non-stress test(NSS), fetal biophysical profile(BPP), vibroacoustic stimulation test, contraction stress test (CST)etc.<ref>D.C Dutta, D.C.Dutta’s Text book of Obstetrics, edited by Hiralal Konar, Jaypee brothers medical publishers, New Delhi, edition 8,Chapter 10 , page no:121</ref>

There are many biophysical tests for prenatal fetal surveillance during late pregnancy which includes ultrasonography, doppler ultra sound velocimetry, cardiotocography(CTG), non-stress test(NSS), fetal biophysical profile(BPP), vibroacoustic stimulation test, contraction stress test (CST)etc.<ref>D.C Dutta, D.C.Dutta’s Text book of Obstetrics, edited by Hiralal Konar, Jaypee brothers medical publishers, New Delhi, edition 8,Chapter 10 , page no:121</ref>

 

===Special therapies recommended during pregnancy===

===Special therapies recommended during pregnancy===

===Medicated Enema===

===Medicated Enema===

 

During the eighth month of pregnancy, evacuative enema (asthapanabasti) is advised for the elimination of retained fecal matter followed by unctuous enema (anuvasanabasti)with oil medicated with madhura group of drugs. [Su Sa. Sharira Sthana 3/11]

During the eighth month of pregnancy, evacuative enema (asthapanabasti) is advised for the elimination of retained fecal matter followed by unctuous enema (anuvasanabasti)with oil medicated with madhura group of drugs. [Su Sa. Sharira Sthana 3/11]

    

    

A single blind comparative study, conducted in 45 primi-gravida and primipara full term pregnancy cases, per rectal administration (matra basti) of castor oil showed better results in the augmentation of labour and shortening the first stage of labour as compared to 2.5 IU of oxytocin in 1 pint of Ringer Lactate fluid administered as per the protocol of induction.<ref>Snehal Ambalgekar, Mamatha KV, A Clinical Study in Evaluating the Efficacy of Eranda Taila for Augmentation of Labor, J Adv Res Ayur Yoga Unani Sidd Homeo 2016; 3: 5-14.</ref>

A single blind comparative study, conducted in 45 primi-gravida and primipara full term pregnancy cases, per rectal administration (matra basti) of castor oil showed better results in the augmentation of labour and shortening the first stage of labour as compared to 2.5 IU of oxytocin in 1 pint of Ringer Lactate fluid administered as per the protocol of induction.<ref>Snehal Ambalgekar, Mamatha KV, A Clinical Study in Evaluating the Efficacy of Eranda Taila for Augmentation of Labor, J Adv Res Ayur Yoga Unani Sidd Homeo 2016; 3: 5-14.</ref>

 

===Vaginal Tampon===

===Vaginal Tampon===

 

During the ninth month, vaginal tampon(yoni pichu) with medicated oil is advised. [ Cha. Sa. [[Sharira Sthana]] 8/32].

During the ninth month, vaginal tampon(yoni pichu) with medicated oil is advised. [ Cha. Sa. [[Sharira Sthana]] 8/32].

The cold decoction of pulp of Aegle marmelos(bilva), Gossipium herbaceum(karpasa), petals of rose(patali),pounded leaves of Azadirachta indica (pichumanda), Clerodendrum phlomidis(agnimantha),Nardostachys jatamansi(jatamamsi), and Ricinus communis (eranda) or water prepared with all fragrant drugs(sarvagandhodaka) should be used for bathing by the pregnant woman.[A.S. Sharira Sthana 3/14] Cold decoction of pounded leaves of drugs capable of suppressing [[vata]] is generally advised. [A.Hr. Sharira Sthana 1/68]

The cold decoction of pulp of Aegle marmelos(bilva), Gossipium herbaceum(karpasa), petals of rose(patali),pounded leaves of Azadirachta indica (pichumanda), Clerodendrum phlomidis(agnimantha),Nardostachys jatamansi(jatamamsi), and Ricinus communis (eranda) or water prepared with all fragrant drugs(sarvagandhodaka) should be used for bathing by the pregnant woman.[A.S. Sharira Sthana 3/14] Cold decoction of pounded leaves of drugs capable of suppressing [[vata]] is generally advised. [A.Hr. Sharira Sthana 1/68]

 

==='''Commonly used medicines for promotion of health of mother and fetus:'''===

==='''Commonly used medicines for promotion of health of mother and fetus:'''===

 

Some herbal formulations are mentioned as preventive medicines for habitual abortions in particular months. These are prescribed in general also for promoting the proper growth and development of the fetus. Powder or paste of the drugs can be used along with milk. Now a days, these are available in tablet/capsule form also.

Some herbal formulations are mentioned as preventive medicines for habitual abortions in particular months. These are prescribed in general also for promoting the proper growth and development of the fetus. Powder or paste of the drugs can be used along with milk. Now a days, these are available in tablet/capsule form also.

{| class="wikitable"

{| class="wikitable"

|'''9th month''' || Asparagus racemosus(shatavari)

|'''9th month''' || Asparagus racemosus(shatavari)

|}

|}

 

===Therapeutic measures to be avoided===

===Therapeutic measures to be avoided===

 

*Excessive nourishment(santarpana) and excessive emaciation(apatarpana) [Su.Sa. Sharira Sthana 10/3]

*Excessive nourishment(santarpana) and excessive emaciation(apatarpana) [Su.Sa. Sharira Sthana 10/3]

Woman gains strength and complexion and she delivers easily at proper time a desired, excellent and healthy child possessing all the qualities and long life.[Cha. Sa. [[Sharira Sthana]] 8/32]

Woman gains strength and complexion and she delivers easily at proper time a desired, excellent and healthy child possessing all the qualities and long life.[Cha. Sa. [[Sharira Sthana]] 8/32]

 

==Current Researches==

==Current Researches==

 

*In current scenario the group antenatal care as compared to individual care offers an opportunity to increase quality of care and improve maternal and newborn outcomes. Group antenatal care holds the potential to increase healthy behaviors, promote respectful maternity care, and generate demand for services. Group ANC improves women’s health literacy on how to prevent and recognize problems, prepare for delivery, and care for their newborn.<ref>Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RMK. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth. 2017;17(1):228. Published 2017 Jul 14. doi:10.1186/s12884-017-1414-5</ref>

*In current scenario the group antenatal care as compared to individual care offers an opportunity to increase quality of care and improve maternal and newborn outcomes. Group antenatal care holds the potential to increase healthy behaviors, promote respectful maternity care, and generate demand for services. Group ANC improves women’s health literacy on how to prevent and recognize problems, prepare for delivery, and care for their newborn.<ref>Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RMK. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth. 2017;17(1):228. Published 2017 Jul 14. doi:10.1186/s12884-017-1414-5</ref>

The 450 ml of medicated milk given in the form of enema for 10 consecutive days, showed remarkably significant results in parameters of fetal biometry, estimated fetal birth weight, amniotic fluid index as compared to the control group of L-Arginine sachet(6.5g) in two divided doses for 10 days. The animal experimental study also showed promising results in maternal weight gain, maternal well being and successful delivery of the pups without any adverse effects. <ref>Suprabha .K, A clinic-experimental study of garbhakshayaw.s.r. to IUGR and its management by ShatavaryadiKsheera Basti, , Phd thesis work,2018 Dept of PTSR ,IPGT &RA, Jamnagar.</ref>

The 450 ml of medicated milk given in the form of enema for 10 consecutive days, showed remarkably significant results in parameters of fetal biometry, estimated fetal birth weight, amniotic fluid index as compared to the control group of L-Arginine sachet(6.5g) in two divided doses for 10 days. The animal experimental study also showed promising results in maternal weight gain, maternal well being and successful delivery of the pups without any adverse effects. <ref>Suprabha .K, A clinic-experimental study of garbhakshayaw.s.r. to IUGR and its management by ShatavaryadiKsheera Basti, , Phd thesis work,2018 Dept of PTSR ,IPGT &RA, Jamnagar.</ref>

 

==='''Concept of designer baby:'''===

==='''Concept of designer baby:'''===

 

The term designer baby simply means a  baby  whose genes have been chosen by the parents and doctors so that it has some particular  features. The genetic makeup of the baby has been artificially selected by genetic engineering combined with in vitro fertilization to ensure the presence or absence of some particular genes. Such genetic engineering techniques are believed to be capable of altering full range of biological traits from gender to susceptibility to disease and eventually appearance, personality and even IQ. These techniques are highly useful in cases of genetically transmitted disorders to prevent the occurrence of the particular disease in the baby by gene modification.  

The term designer baby simply means a  baby  whose genes have been chosen by the parents and doctors so that it has some particular  features. The genetic makeup of the baby has been artificially selected by genetic engineering combined with in vitro fertilization to ensure the presence or absence of some particular genes. Such genetic engineering techniques are believed to be capable of altering full range of biological traits from gender to susceptibility to disease and eventually appearance, personality and even IQ. These techniques are highly useful in cases of genetically transmitted disorders to prevent the occurrence of the particular disease in the baby by gene modification.  

Ayurveda recommends the natural and simple way of designing the baby through preconception and antenatal care. A special term “Garbha Sanskar” is given to the practices aiming to the creation of a desirable progeny based up on the guidelines from Ayurveda and other treaties related to Indian culture by modifying them through the  contemporary approach.

Ayurveda recommends the natural and simple way of designing the baby through preconception and antenatal care. A special term “Garbha Sanskar” is given to the practices aiming to the creation of a desirable progeny based up on the guidelines from Ayurveda and other treaties related to Indian culture by modifying them through the  contemporary approach.

 

==List of theses done==

==List of theses done==

 

1.Reddy BS(1990): A Study on the effect of Palash patra administration in pregnancy, IPGT &RA, Jamnagar.

1.Reddy BS(1990): A Study on the effect of Palash patra administration in pregnancy, IPGT &RA, Jamnagar.

22.Resmi V Rajagopal(2018) : Management of first trimester pregnancy with Rasayana, Nasya and micronized progesterone- A randomized controlled clinical trial, Dept of PTSR ,IPGT &RA, Jamnagar.

22.Resmi V Rajagopal(2018) : Management of first trimester pregnancy with Rasayana, Nasya and micronized progesterone- A randomized controlled clinical trial, Dept of PTSR ,IPGT &RA, Jamnagar.

 

==More information ==

==More information ==