Prenatal care (garbhini paricharya)

Prenatal Care in Ayurveda (Garbhini paricharya) 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 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]

Contributors

Section/Chapter/topic	Sharira / Garbha / Prenatal care (garbhini paricharya)
Authors	Anagha S., Deole Y.S.
Reviewed by	Basisht G.
Affiliations	Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar
Correspondence email	carakasamhita@gmail.com
Date of first publication:	August 14, 2020

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. It includes:

1. Physical dimension

2. Psychological dimension

3. Spiritual dimension

4. Social dimensions

5. Diagnostic and therapeutic dimensions

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

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

Diet during pregnancy

The diet (ahara) consumed by the pregnant woman gets transformed into the nutrient fluid (rasa) which is having a threefold action:

a) Nourishing the body elements of the mother

b) Providing nourishment to the growing fetus

c) Helping the formation of breast milk. [Cha. Sa. Sharira Sthana 6/23]

Whatever the diet consumed by the pregnant woman becomes congenial to the fetus. So, diet of a pregnant woman should be designed considering the place of living, time, season and digestive capacity. [Ka. Sa. Sutra Sthana 18/24,25]

The diet prescribed for pregnant lady should satisfy the following criteria:

1. Palatable

2. More liquid in nature

3. Predominantly sweet in taste

4. Unctuous

5. Processed with appetizing drugs [Su. Sa. Sharira Sthana 10/3]

• She should always include butter, ghee and milk in her diet. [A.Hr.Sharira Sthana 1/43]

• Use of hot water, milk and meat is emphasized by Acharya Kashyapa. Milk provides nourishment and stability to the fetus. Meat provides nutrients for nourishment to the fetus and suppresses the aggravated vata. Meat soup(mamsa rasa) is considered as the best preparation for a pregnant lady. Meat treated with milk or mixed with sour articles or salt is also beneficial. [ Ka.Sa. Khila Sthana 24/6,7,11,12]

• Yogaratnakara provides a list of recommended dietary items during pregnancy as mentioned below.

• Two varieties of rice (Shali and Shashtika)

• green gram(mudga)

• wheat (godhuma)

• flour of parched rice (lajasaktu)

• butter

• ghee

• milk

• curd mixed with sugar and condiments

• honey

• sugar

• jackfruit

• banana

• fruit of gooseberry (amalaki)

• grapes (draksha)

• sour and sweet substances.

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

Table 1: Month wise dietary regimen for pregnant woman

Month Dietary regimen 1st Month • Milk frequently in desired quantity (considering the digestive power and strength)* • Sweet, cold and liquid diet** • Clarified butter extracted from the milk and medicated with Desmodium gangeticum (shaliparni) and Butea monosperma(palasha) along with water processed with gold or silver (boiled and cooled water)*** • Glycyrrhiza glabra(madhuyashti), Grewia asiatica(parushaka) and Madhuka indica(madhukapushpa) with butter and honey, sweetened milk ## 2nd month • Milk medicated with sweet (madhura)herbs* • Sweet, cold and liquid diet** • Sweetened milk with Lilium polyphyllum(kakoli )## 3rd month • Milk with honey and ghee* • Cooked rice of Shashtika variety along with milk.** • Mixture of cooked rice and pulse(krisara)## 4th month • Milk with 12 gm(one aksha) of butter.* • Cooked rice (shashtika)with curd** • dainty and pleasant food mixed with milk/ butter/ meat of wild animals** 5th Month • Ghee prepared with butter extracted from milk.* • Cooked rice (shashtika) with milk, ghee and meat of wild animals** • Rice gruel(yavagu)# • Rice cooked with milk and sweetened(payasa)## 6th Month • Ghee prepared from milk (ksheerasarpi) medicated with the herbs of madhura group* • Ghee or rice gruel medicated with Tribulus terrestris(gokshura).** • Sweetened curd## 7th month • Ghee prepared from milk (ksheerasarpi)medicated with the herbs of madhura group* • Ghee medicated with prithakparnyadi (vidarigandhadi) group of herbs** • A sweet dish called Gritakhanda.## 8th month • Rice gruel prepared with milk and mixed with ghee.* • Unctuous gruels and meat soup of wild animals.** • A kind of sweet preparation called Gritapooraka.## 9th month • Meat soup with cooked rice and fat (preferably ghee), rice gruel mixed with large quantity of fat.*** • Different types of cereals.##

• [Cha. Sa. Sharira Sthana 8/32], **[ Su.Sa. Sharira Sthana 10/4], ***[A.S. Sharira Sthana 3/3-11]

1. [Bhe.Sa.Sharira Sthana 8/6], ##[Ha. Sa. Tritiya Sthana 49/2]

Table 2: Nutritional analysis of the major components of diet for the pregnant lady: Source Properties explained in Ayurveda Nutritional benefits Milk Sweet taste(madhura), unctuous(snigdha), cold(sheeta) in potency, vitality enhancer(ojasyam),tissue growth promoting(dhatu vardhaka),alleviates vata and pitta,galactogogue (sthanyakaram) Complete food source of sugar, protein, fat, calcium, sulphur, magnesium, manganese, iodine, zinc, riboflavin, and vitamin B12, A, and K. Lactose - helps in growth and development. Proteins -casein, lactoglobulin, lactalbumin, and lactoferrin- provide immunological benefits. Milk has all amino acids to promote growth. Ghee Intellect promoting(dhee,smriti,medha), improves digestion (agnivardhana), promotes strength(balyam), cold(sheeta) in potency,alleviates vata and pitta Ghee is a complex lipid of glycerides (majorly triglycerides), free fatty acids, phospholipids, sterols, sterol esters, fat-soluble vitamins, carbonyls, hydrocarbons, and carotenoids. • Vitamin D- for the development of skeleton of young ones. • vitamin E-essential for normal pregnancy, birth, and breast milk production Butter alleviates Vata and Pitta, promote digestion, promote intellect (medhya), not producing gastric irritation(avidahi), improves taste sensation(rochanam), promotes strength and nourishment (balyam, brihmana), improves vitality (Ojovivardhanam ) • High calorie food as 100 g of butter provides almost 700 kcal. • Rich in minerals such as calcium, phosphorus, and potassium. • Good amount of sodium and small amounts of fluoride, selenium, zinc, and magnesium. • Rich in vitamin A, vitamin E, riboflavin, niacin, and pantothenic acid. • Vitamin K, folate, and vitamin B12 in small amounts. Honey alleviates Kapha and Pitta • Primarily a high-energy carbohydrate food anti-inflammatory, immune boosting property, broad spectrum antibacterial activity. • Honey sugars are easily digestible sugars Rice gruel Pacifies thirst (Trishnahara), clears bladder (Basti shodhana), pacifies vata (vataanulomana) , light for digestion(laghu) • Starch molecules, which are the source of calories in diets, prepared from rice, when heated in an aqueous or moist environment, swell and rupture and thus permits greater enzymatic digestion by the activity of enzymes such as amylases. • Resistant starch acts like soluble fiber in the gastrointestinal tract, thus providing the health benefit.

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. The World Health Organization guides use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women. However, routine use of multiple micronutrient powders during pregnancy is not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes. High food quality, together with adequate macro- and micronutrient 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.

Life style guidelines for pregnant woman

The lifestyle protocol is indicated for maternal and fetal health commonly. [A.S. Sharira Sthana 2/58] The pregnant woman desirous of a healthy progeny should avoid all non-congenial diet and activities. She should protect and uplift herself through good conduct. [Cha. Sa. Sharira Sthana 8/21] Daily bath and worshiping the rising sun are recommended.[ Ka. Sa. Sharira Sthana 5/15]. Anointment with cooling agents, musk, sandal and camphor, wearing garlands, moonlight bath and gentle massage are also recommended. [Y.R. Ksheera dosha Chikitsa] The objective of all these protocols is to preserve optimum health in views of physical, mental and spiritual aspects. Positive mental attitude of mother helps for better progeny.

Contra indications during pregnancy (garbhopaghatakara bhava)

Diet to be avoided

• Excessive heavy to digest, hot and pungent substances [Cha .Sa. Sharira Sthana 4/18] • Intoxicating substances like wine[Cha .Sa. Sharira Sthana 4/18] • Excessive use of meat[Cha.Sa. Sharira Sthana 4/18] • Dried up, stale, putrefied and wet food. [Su.Sa. Sharira Sthana 10/3] • Those diet which obstructs body channels (vishtambhi) .[A.Hr.Sharira Sthana 1/44] • Polluted and incompatible food[Y.R. Ksheeradosha Chikitsa] • 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

• Harsh or violent activities [Cha.Sa. Sharira Sthana 4/18] • Ride over vehicle running on uneven path [Cha.Sa. Sharira Sthana 4/18] • Coitus [Su.Sa. Sharira Sthana 10/3] • Exercise [Su.Sa. Sharira Sthana 10/3] • Sleeping in day time [Su.Sa.Sharira Sthana 10/3] • Awakening in night [Su.Sa. Sharira Sthana 10/3] • Squatting posture of sitting(utkatakasanam) [Su.Sa. Sharira Sthana 10/3] • Suppression of natural urges [Su.Sa. Sharira Sthana 10/3] • Prolonged stay in hot sun or near fire[A.S. Sharira Sthana 2/60] • Fasting [A.S. Sharira Sthana 2/60] • Lifting heavy weight [A.Hr. Sharira Sthana 1/44] • Eating clay[Ha. Sa. Tritiya Sthana 49]

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] The psychological and cognitive development of fetus depends on the psychological status of mother and father and the topics listened by the woman during pregnancy. [A.S. Sharira Sthana 1/66]. Various studies related to maternal mental health and its association with birth outcomes and child behavior has proven the fact that maternal mental status has a strong influence on baby. The studies related to pre-natal stress and the pregnancy outcome suggest that exposure to high levels of maternal cortisol during pregnancy can be negatively related to offspring cognitive skills. From the very first day of pregnancy, the woman is advised to remain in high spirit, pious, wearing ornaments, clean white garments and perform religious rituals, do auspicious deeds and worship deity and priest. [Su. Sa. Sharira Sthana 10/3]. 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

• Contact with dirty, disfigured, foul smelling, awful looking substances [Su.Sa. Sharira Sthana 10/3] • Listening to very much exciting stories [Su. Sa. Sharira Sthana 10/3] • Unwanted outing, visiting lonely places, haunted tree, cremation ground etc. [Su.Sa. Sharira Sthana 10/3] • Acts likely to promote anger and disgrace[Su. Sa. Sharira Sthana 10/3]

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] • For prevention of abortion, intrauterine death of fetus, premature delivery etc. a protection band (varana bandha) is also recommended which is to be done before 8th month. A special spiritual strategy called ‘matangi vidya” is recommended for such rituals by acharya Kashyapa. [Ka. Sa. Kalpa Sthana 6/80] In current clinical settings, these practices are not followed. However, the scientific studies on these practices may provide newer insights in preventive antenatal care.

=Social dimensions

The pregnant woman shall be well behaved with everyone. Respecting and treating the elders, priests etc. in good manner is recommended. [Su. Sa. Sharira Sthana 10/3], [ Ka. Sa. Sharira Sthana 5/15]. Behavior of husband and attendants: Affectionate and gentle behavior of husband and servants towards the pregnant woman helps in maintaining the healthy status of pregnancy. She should be pleased with things of her desire and those which are wholesome. [A. Hr. Sharira Sthana 1/43] Room settings: Her sleeping and sitting place should be covered with soft cushion or mattress. They should not be very high and should possess elevated upper portion for head rest to make it perfect and very comfortable. [Su. Sa. Sharira Sthana 10/3] The abode should be fumigated with fragrant drugs and it should be free from insects like mosquito etc. Vedic hymns should be recited by the people well versed in it and vocal and instrumental music should be played by the musicians. [Ka.Sa. Sharira Sthana 5/14] Effect of music on maternal psychology and fetal well being is a well explored area of research.

Diagnostics and therapeutics

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.

Inspection (darshana)

The specific clinical features seen by direct observation in a pregnant lady are: • periodic increase in size of abdomen [A.S. Sharira Sthana 2/8] • development of linea nigra(lomaraji) [Cha. Sa. Sharira Sthana 4/16] • growth of breast [Cha. Sa. Sharira Sthana 4/16] • blackish discoloration of areola [Cha. Sa. Sharira Sthana 4/16] • milk secretion from breast [Cha. Sa. Sharira Sthana 4/16] • blackish discoloration of lips [Cha. Sa. Sharira Sthana 4/16] • corpulent cheeks. [A.S. Sharira Sthana 2/10] • edema in lower limbs. [Cha. Sa. Sharira Sthana 4/16]

Palpation(sparshana)

The growth of fetus is assessed palpation. Especially in the context of intra uterine growth restriction(IUGR) can be diagnosed by abdominal examination in view of following: • enlargement of abdominal size. (udaravruddhi)[A.S. Sharira Sthana 4/13] • fetal movements (garbhasphurana/spandana) [A.S. Sharira Sthana 4/13] • expansion of vagina. [Cha. Sa. Sharira Sthana 4/16]

Interrogation (prashna)

The symptoms of pregnancy are elicited through proper history taking. The first symptom, i.e. amenorrhea in a married woman is taken as an indicator for suspecting the pregnancy. [Cha. Sa. ShariraSthana 4/16] Symptoms related tothe gastro intestinal system are mentioned as initial symptoms of pregnancy. • Dislike/aversion for food(anannabhilasha). • Excessive salivation (asyasravanam) . • Anorexia(arochaka). • Interest in sour substances(amlakamata). • Vomiting(chardi)[Cha. Sa. ShariraSthana 4/16] Psychological symptoms like alternate desire for things with opposite qualities, aversion of previously appreciated fragrance etc.[Su. Sa. Sharira Sthana 3/15] are also observed as symptoms of pregnancy. General fatigue, excessive sleep, excessive yawning, getting unconscious accidentally are also listed among the symptoms of pregnancy. [A.S.Sharira Sthana 2/8] All these features can be assessed through simple interrogation in the clinical set up during antenatal visits.

Contemporary Approach

Systematic supervision of a woman during pregnancy is called antenatal care (ANC). Contemporary antenatal care has two main components. • Careful history taking and examination (general and obstetrical) • Advice given to the pregnant woman. The supervision should be regular and periodic in nature according to the need of the individual. The aims and objectives of the antenatal care include the screening of high-risk cases, continuing the risk assessment and preventing/detecting/ detecting the complications at the earliest stage to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother. 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 obstetrician. Table 3: Antenatal care model by WHO (2016) First trimester Contact 1 up to 12 weeks Second trimester Contact 2 20 weeks Contact 3 26 weeks Third trimester Contact 4 30 weeks Contact 5 34 weeks Contact 6 36 weeks Contact 7 38 weeks Contact 8 40 weeks

History taking and obstetrical examination: Proper personal history, family history, history of present and past illness, medical and surgical history are needed to be taken along with the obstetric and menstrual history. The obstetric history includes status of gravida, parity, number of deliveries (term, pre term), miscarriage, pregnancy termination and living issues. In menstrual history, cycle, duration, amount of blood flow, and first day of last normal menstrual period (LNMP) are to be noted. Calculation of the expected date of delivery: This is done according to Naegele’s formula by adding 9 calendar months and 7 days to the first day of LNMP.

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

Obstetrical examination

It includes both abdominal and vaginal examination. 1. Abdominal examination: a) Inspection: To note the condition of uterine ovoid, contour of uterus, undue enlargement of uterus, skin condition of abdomen, incisional scar mark on abdomen etc. b) Palpation: Height of the uterus is measured by placing the ulnar border of the left hand placed on the upper most level of fundus and an approximate duration of pregnancy is ascertained in terms of weeks of gestation. Alternatively, the symphyseal fundal height (SFH) is measured with a measuring tape. Obstetrical grips (Leopold maneuvers) are helpful to get an idea about the presentation of foetus, position of different body parts of foetus, attitude, engagement etc. c) Auscultation: Auscultation of distinct foetal heart sounds (FHS) not only helps in the diagnosis of a live baby, but its location of maximum intensity can resolve doubt about the presentation of the foetus. 2. Vaginal Examination Strict aseptic precautions should be taken during per vaginal examination during pregnancy. Any history of vaginal bleeding contra indicates the vaginal examination. The diagnosis of position and presentation of fetus may be difficult to diagnose accurately by internal examination during pregnancy when the cervix remains closed. Pelvic assessment and test for cephalopelvic disproportion are best done just after the onset of labour or just before the induction of labour. During labour, accurate information can be obtained by the palpation of presenting part through the open cervix.

Lab investigations

• Routine investigations : Blood: Hemoglobin, haematocrit, ABO, Rh grouping, blood glucose and VDRL. Urine: Protein, sugar and puss cells. • Special investigations : Serological tests: for rubella, hepatitis B virus and HIV. Genetic Screening: This includes maternal serum alpha-fetoprotein (MSAFP), triple test at 15-18 weeks for mother at risk of carrying a fetus with neural tube defects, down syndrome or another chromosomal anomaly. Non-invasive screening for chromosomal anomaly should be a routine to all pregnant women irrespective of their age. • Ultrasound Examinations : 1st trimester: Presence of an intra uterine gestation sac, and presence of yolk sac or fetal pole within the gestation sac confirms pregnancy.USG is the best method to estimate the gestational age dating. Booking (18-20 weeks) scan is advised for detailed fetal anatomy survey and to detect any structural abnormality including cardiac. It is also helpful in placental localization. 2nd trimester: It is more helpful in assessing the fetal growth using biometric paramrters. The parameters used are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and Femur length (FL) 3rd trimester: All the information of second trimester sonography can be obtained in third trimester. Effective fetal weight, placental maturation, amniotic fluid index etc. are also evaluated. 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.

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. ShariraSthana 3/11] Acharya Vagbhata advises unctuous enema using ghee processed with madhura group of drugs for cleaning the collected feces and then therapeutic enema(niruhabasti) is given.[A.Hr.ShariraSthana 1/34-35] Unctuous enema is continued in ninth month also. In current practice, the decoction of dashamula herbs and sesame oil processed with same herbs is used for giving evacuative enema after completion of 8th month of gestation. The dashamula group of herbs includes Aegle marmelos(bilwa), Premna Integrifolia/ Clerodendrum phlomidis(agnimantha), Gmelina arborea(gambhari), Oroxylum indicum(shyonaka), Stereospermum suaveolens(patala), Desmodium gangeticum(shalaparni), Uraria picta(prishniparni), Solanum indicum(bruhati), Solanum xanthocarpum(kantakari), Tribulus terrestris(gokshura). For unctuous enema, oil processed with the above drugs(dashamula) or oil processed with sida cordifolia(bala taila), preparations like dhanwanthara taila , mahanarayana taila , ksheerabala taila etc. are also in practice. Different practices and protocols regarding enema therapy (basti) are followed. Evacuative and unctuous enema in alternate days for a maximum of 8 days is one protocol. In another protocol, initially, one evacuative enema followed by 3-4 unctuous enema on consecutive days is given. The decision depends upon the physician’s view(yukti) as per the condition and strength of the pregnant lady. In case of severe constipation and if the patient is very weak, initial unctuous enema followed by evacuative enema is effective. This kind of enema therapy is useful for facilitating easy delivery. Research works are being conducted on both evacuative enema and unctuous enema as part of prenatal care with an objective of promoting easy delivery. Two research works were conducted on evacuative enema with 200 ml of decoction of drugs of dashamula added with powder of Adathoda vasica(vasa), Piper longum (pippali and pippalimula), Piper chaba (chavya), Plumbago zeylanica(chitraka), Zingiber officinale(nagara) and Terminalia chebula(haritaki) and mixed with 60 ml of oil processed with dashamula. This enema was given after the completion of 8th month, along with unctuous enema (matra basti) using 60 ml of oil processed with dashamula in alternate days for a duration of 6 days. These studies have reported early engagement of fetal head & timely onset of labour in 90.90% of cases as a result of the abovementioned enema(basti) procedure. , 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.

Vaginal Tampon

During the ninth month, vaginal tampon(yoni pichu) with medicated oil is advised. [ Cha. Sa. ShariraSthana 8/32]. Oil processed with sida cordifolia(bala taila), formulations like dhanwanthra taila are in current practice for vaginal tampon during ninth month of pregnancy. Filling of vagina(yoni poorana) with castor oil(erannda taila) with the same oil is beneficial in promoting the onset and progression of normal labour.

Medicated water for bath

The cold decoction of pulp of Aegle marmelos(bilva), Gossipiumherbaceum(karpasa), petals of rose(patali),pounded leaves of Azadirachtaindica (pichumanda), Clerodendrumphlomidis(agnimantha),Nardostachysjatamansi(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.ShariraSthana 1/68] 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. Month Drugs* 1st month Madhuca longifolia(madhuka), seeds of Tectona grandis (sakabeeja), Pueraria tuberosa. (Willd.) DC. (payasya), Cedrus deodara (devadaru) 2nd month Ficus rumphii Blume (ashmantaka), Sesamum indicum (black tila), Rubia cordifolia (tamravalli), Asparagus recemosus(shatavari) 3rd month Dendrophthoe falcata (Vrukshadani), Pueraria tuberosa. (Willd.) DC.(payasya), Callicarpa macrophylla Yahl. (priyangu), Nymphaea alba Linn (utpala), Hemidesmus indicus (shariba) 4th month Cynodon dactylon (durva), Hemidesmus indicus (shariba), Pluchea lanceolata Oliver & Hiern (rasna), Clerodendrum Serratum (bharangi), Glycyrrhiza glabra Linn. (yastimadhu) 5th month Solanum Indicum Linn. (bruhati) , Solanum Xanthocarpum (kantakari), Gmelina arborea (kasmari), stem bark and leaf buds of latex yielding trees,ghee 6th month Uraria picta (prishniparni), Sida cordifolia (bala), Acorus Calamus Herb (vacha), Moringa oleifera (shigru), Tribulus terrestris (shwadamshtra), Glycyrrhiza glabra Linn. (madhuparnika) 7th month Trapa bispinosa Roxb. (Shringaaka), Nelumbo nucifera Gaertn(bias), Vitis vinifera (draksha), Scirpus grossus Linn. (kaseru), Madhuca longifolia(madhuka),sugar 8th month Feronia linonia (Linn.)(kapitha), Aegle marmelos L.(bilwa), Solanum Indicum Linn. (brihati), Trichosanthes Dioica.(patola), Saccharum Officinarum Linn. (ikshu), Solanum xanthocarpum(nidigdhika). 9th month Hemidesmus indicus (shariba), Pueraria tuberosa. (Willd.) DC.(payasya), Glycyrrhiza glabra Linn. (madhuyashti) 10th month Zingiber officinale(Shundhi)+ Pueraria tuberosa. (Willd.) DC.(payasya)/ Zingiber officinale (shundhi)+ Glycyrrhiza glabra Linn (madhuyashti)+ Cedrus deodara devadaru/ only Pueraria tuberosa. (Willd.) DC.(payasya)

• [ Su Sa Sharira Sthana 10/ 58-65]

Some single drugs in the form of milk decoction (ksheera kashaya)in each month of pregnancy are widely prescribed by Ayurveda practitioners, mainly in southern part of India. Month Drug 1st month Sida cordfolia(bala) 2nd month Ipomea sepiaria(lakshmana) 3rd month Solanum Indicum Linn. (bruhati) and Solanum xanthocarpum (kantakari) 4th month Desmodium gangeticum(shalaparni) 5th month Tinospora cordifolia(guduchi) 6th month Solanum xanthocarpum (kantakari) 7th month Hordeum vulgare(yavaka) 8th month Marsedenia tenacissima (morata) 9th month Asparagus racemosus(shatavari)

Therapeutic measures to be avoided

• Excessive nourishment(santarpana) and excessive emaciation(apatarpana) [Su.Sa.ShariraSthana 10/3] • Untimely use of oleation(snehana) [Su.Sa.ShariraSthana 10/3] • Blood-letting[Su.Sa.ShariraSthana 10/3] • Repeated excessive massage with oil and unguents. [Su.Sa. Sharira Sthana 10/3] • All types of cleansing therapies like Panchakarma(shodhana procedures) [A.Hr.ShariraSthana 1/44] • Sudation(swedana) and cauterization with alkali(Kshara karma)[Y.R. Ksheeradosha Chikitsa]

General guide Lines for treatment of diseases during pregnancy

• The diseases of pregnant woman should be treated with use of soft(mrudu), sweet(madhura), cold(sheeta), pleasing and gentle drugs, dietetics and behavior. [Cha. Sa. Sharira Sthana 8/22] • Even though the purification procedures are contra indicated in pregnancy, in case of acute or serious conditions,emetics can be given followed by use of sweet and sour edibles mixed with carminative drugs. [Su.Sa. Sharira Sthana 10/67] • Cleansing and nutritive enema (asthapana and anuvasanabasti) should not be used frequently,but if the disease is acute, moderate use of these can be done. [Cha. Sa. ShariraSthana 8/22] • After eight months, diseases curable by purification measures like emesis etc. can be treated with gentle form of those therapies or procedures giving similar benefits. Strong emetics are contraindicated. Instead of strong oral purgatives, suppositories can be used.[Cha. Sa. Sharira Sthana 8/22] • But, in case of very serious conditions, for saving the life of pregnant woman, the drastic measures and pungent drugs may be used even if those are harmful to the fetus.[ A.S. Sharira Sthana 2/63]

Benefits of prenatal care in Ayurveda

• By the practice of prenatal care including monthly regimen, the entire body, especially the reproductive tract, placenta, fetal membrane(garbhadharini), abdominal area, sacral region, flanks and back become soft. Vayu moves into its right path and direction, urine, feces and placenta are excreted or expelled easily by their respective passages. Woman gains strength and complexion and she deliver 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

• 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. • A systematic review on existing antenatal care models in different countries reveals that most of the models report fewer than half the characteristics associated with quality maternity care. • A multi-center operational study has demonstrated the feasibility and effectiveness of Ayurvedic interventions for ante natal care in primary health care level settings. Total 1174 patients completed the full course of Ayrvedic interventions in the form of tablets for antenatal care in PHC set up. Significant results were found in improvement of haemoglobin percentage, relief in symptoms like vomiting and edema. 85.46% women underwent normal delivery. The 90.22 % babies were observed with optimum birth weight. The study could improve the awareness in public regarding the integrated approaches in antenatal care and promote the institutional delivery among the rural population. • Research works are being conducted in different institutes of Ayurveda on the effect of rejuvenation therapy(rasayana)as a means of providing micronutrients during pregnancy in different trimesters. A randomized controlled clinical trial in managing the first trimester pregnancy with rejuvenation therapy(rasayana), nasal instillation of medicine (nasya) and micronized progesterone, showed better outcome as compared to the control group with micronized progesterone therapy orally. The treated group was administered combination of herbs like Tinospora cordifolia(guduchi), Embilica officinalis(amalaki), Leptadenia reticulate(jeevanti), Asperagus recemosus(shatavari), Sida cordifolia(bala), Terminalia arjuna(arjuna), Vitis vinifera(draksha) in granule form in a dose of 10 gms twice a day with cold milk. Nasal instillation of milk processed with leaf bud of Ficus bengalensis(vatashunga), 4 drops in either right or left nostril for 3 consecutive days, just after the pregnancy test is positive, was also done. Better results were reported in subjective parameters like associated symptoms during pregnancy like vomiting, giddiness, abdominal pain, constipation, and heaviness in breast and USG parameters like gestational sac, crown rump length and nuchal thickness.

• The drugs like Asperagus racemosus(shatavari), Sida cordifolia(bala), Terminalia arjuna(arjuna) when administrated as medicated milk in enema form(per rectal) or oral route had shown appreciable result in the treatment of intra uterine growth restriction as well as oligohydramnios. The outcome of the studies reveals that per rectal route of administration of the above drugs in the form of medicated milk has better effect than the oral administration. 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.

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. But, ethical, legal and social controversies still exist in this field. Bioethicists are concerned about the fact that imperfections of the technology may introduce errors like off-target cuts. Even successful edits may have disastrous consequences, including irreversible damage to the health of individuals, assaults on human dignity, issues related to justice inequality, and unpredictable and unknown threats to future generations. 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

1.Reddy BS(1990): A Study on the effect of Palash patra administration in pregnancy, IPGT &RA, Jamnagar. 2. Shukla Sharma (1992): Study of Phalagrita on garbha and garbhini, Dept of PTSR,Banaras Hindu University, Varanasi. 3. Gupta Kanchan (1994): Effect of Shatavari and Madhuyashti on pregnant woman, Dept of PTSR,Banaras Hindu University, Varanasi. 4.Ramadevi (1994): Effect of Garbhapala Rasa in Garbhiniparicharya, Dept of PTSR, BRKR Govt. Ayurveda college,Hyderabad. 5. Chaturvedi Ranjana (1995) : Role of Jatamansi in GarbhiniParicharya, Dept of PTSR,Banaras Hindu University, Varanasi. 6.Dayani Sirivardhane (2000) : Role of garbhasthapaka and garbhavrudhikaraprabhava in pregnancy with special reference to atibala, Dept of PTSR, IPGT &RA, Jamnagar 7. PallaSuneela(2001): Role of Prithakaparnyadi Ghrita and Basti on Garbha and Prasava, Dept of PTSR, IPGT &RA, Jamnagar 8. Singh Seema (2003) : effect of madhuyashti on garbhavrudhi, Dept of PTSR, Banaras Hindu University, Varanasi. 9. Rana Swarup (2005): A clinical study of Kikkisa and its management with KikkisaharaGhrita and KikkisaharaLepaw.s.r. to striae gravidorum, Dept of PTSR, IPGT &RA, Jamnagar 10. Baljot Kaur (2007): A clinical study of aetiopathogenesis of mutrakrcchraw.s.r. To lower urinary tract infection in pregnancy and puerperium and their management with brhatdhatryadighanvati, Dept of PTSR, IPGT &RA, Jamnagar 11. Rathod Sushma J (2009): A comparative study of ShatavaryadiGhanvati&BrihatDhatryadiGhanvati in the management of GarbhiniMutrakricchra (UTI in pregnancy), Dept of PTSR ,IPGT &RA, Jamnagar 12. Gupta Shalini (2009): A clinical study of Gokshuradivati in the management of gestational hypertension, Dept of PTSR ,IPGT &RA, Jamnagar. 13. Yamini Tripathi (2011): A Clinical Study of Gestational Hypertension and its Management with MamsyadiVati, Dept of PTSR ,IPGT &RA, Jamnagar 14. Sunita (2011): A Clinical Study on UpaplutaYonivyapadw.s.r. to Vulvovaginitis during Pregnancy and its Management with PanchavalkaladiVarti, Dept of PTSR ,IPGT &RA, Jamnagar. 15. Amit V Rupapara (2012): A Comparative Study on the effect of PandughniVati and DhatriLauhaVati in the Management of Garbhini Pandu (Iron deficiency anaemia), Dept of PTSR ,IPGT &RA, Jamnagar. 16.. Priti Singh Verma (2013): A further study on UpaplutaYonivyapadaw.s.r. to Vulvovaginitis during pregnancy and its management with Panchavalkaladi Formulation, Dept of PTSR ,IPGT &RA, Jamnagar. 17. Parul Anil Joshi (2013): Management of Putraghni Yoni Vyapad (w. s. r. to habitual abortion) in early pregnancy with ShramaharaDashemani, Dept of PTSR ,IPGT &RA, Jamnagar. 18.Dr. Deepthi Krishna (2013)- Influence of Kalyani Raga on fetus and pregnant women, department of basic principles, Alwas Ayurveda Medical College, Moodbidri,Karnataka. 19.Patel HemantkumarGulabbhai (2014): A Clinical Study on Kikkisa with special reference to Striae Gravidarum and its Management with Kikkisahara Yoga, Dept of PTSR ,IPGT &RA, Jamnagar. 20.Prachi Sharma(2016) : A controlled clinical study for evaluation of the effect of rasayana and micronized progesterone during first trimester of pregnancy, Dept of PTSR ,IPGT &RA, Jamnagar. 21.Dr.Mauli Vaishnav(2016)- Clinical evaluation of effect of music with creative visualization on fetal growth and maternal physiology with special reference to E.C.G,Dept of PTSR, SDM Ayurveda college, Uduppi. 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.

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