POSTPARTUM CARE IN AYURVEDA
Delivering a baby is an experience of a lifetime and it comes with a lot of changes to your body. The post-natal or post-partum period is the period that occurs immediately after childbirth. It is a critical period in a mother’s life but often neglected. Proper management and care for the mother and newborn are vital.
PHASES IN THE POSTNATAL PERIOD
- Acute Phase: – The 24hrs immediately following delivery.
- Sub–Acute Phase: – 2-6 weeks following delivery.
- Late Phase: – Can last from 6 weeks to 6 months following delivery.
ACUTE PHASE- The greatest health risk during this phase is bleeding. It is also termed ‘lochia’, which is the vaginal bleeding after giving birth that includes bloody fluid made up of blood, placental tissue, sloughed-off endometrial lining and mucous. It continues for 3-6 weeks. Lochia can be further divided into three.
They are namely ‘Lochia Rubra’ which lasts for 3-4 days after delivery and is bright red, or dark red in color, ‘Lochia Serosa’ – which lasts for 4-10 days post-delivery and is pinkish brown in color and blood flow will lighten than before and ‘Lochia alba’ is the bleeding which lasts from 10 to 28 days postpartum with a whiteish yellow color. The infant’s condition is evaluated at this stage. ‘KANGAROO CARE’ is advised during this stage i.e., skin-to-skin contact between mother and infant, it helps in establishing bonding and successful breastfeeding.
SUB–ACUTE POSTPARTUM PERIOD – During this phase hemorrhoids and constipation are common. More chances of postpartum infections which may lead to sepsis. So utmost care should be taken to prevent infections. Another important condition is urinary incontinence, more seen in women who deliver vaginally than in cesarean. So pelvic floor muscle strengthening exercises can be practiced. The major risk is ‘deep vein thrombosis’ for which anticoagulants are prescribed for those mothers who have a history of thrombotic episodes. Psychological disorders also emerge during this phase which will be explained later in this article.
LATE PHASE / DELAYED POSTPARTUM PERIOD – During this phase the muscles and other vascular tissues return to normality. The estrogen levels drop during this phase and can lead to hair loss mainly in the temple area. Postpartum thyroiditis is also common during this period.
POST PARTUM CONDITIONS – PHYSICAL CHANGES
The most common physical changes a mother undergoes include
- VAGINAL DISCHARGE – This is termed as ‘LOCHIA’ which is explained in detail earlier. It is similar to period bleeding in the initial days and then will lighten to pink and then to pale white or yellow.
- UTERINE SHRINKAGE – The uterus is expanded during pregnancy so as to accommodate the baby and once the delivery happens, the upper portion of the uterus named as fundus can be felt just below the belly button. During the initial days, it will be harder and massaging will help the uterus to contract and this helps in reducing the lochia as well. The uterus shrinks about one finger width each day.
- PERINEUM PAIN – The perineum is the extension of skin between the vagina and rectum, this can be swollen or torn during childbirth and may lead to pain for a few weeks. The ‘Episiotomy’ wound may take 3 weeks to heal and keep the area clean.
- BLOOD GLUCOSE CHANGES – There are chances of blood glucose level fluctuations. Monitor the levels regularly and if find them fluctuating consult a doctor. This is more common in women who suffer from diabetes or gestational diabetes. Keep an eye on the food intake of the mother.
- POSTPARTUM THYROIDITIS – It is the inflammation of the thyroid gland. It includes 2 phases, the ‘thyrotoxin phase’ shows anxiety, insomnia, fatigue, weight loss and irritability, and the ‘hypothyroid phase’ includes fatigue, weight gain, constipation, dry skin, and depression.
- URINARY INCONTINENCE – This is more prevalent in women who deliver vaginally, they may not be able to control urination. This risk is higher if force are used during delivery if you had a higher pre- pregnancy body mass index or breastfeeding for a longer duration.
- LIBIDO AND SEXUALITY – The decreased estrogen level is one of the major factors contributing to decreased libido. Body changes, fatigue, and fear of pregnancy can have an effect on the same.
Breast pain, constipation, and infections are other common complications during the post-partum period. Stool softeners are advised during this period.
POST PARTUM MENTAL HEALTH DISORDERS
Some of the women struggle with their mental health as they undergo transition to motherhood. The most common disorders are –
- Post-partum blues / Baby Blues – This usually occurs 3-5 days after delivery due to hormonal fluctuations. This is nothing but the mood swings experienced by the mother which do not last for more than a few weeks.
- Post-partum depression – It can begin any time after delivery and can last up to a year. The causes of post-partum depression are hormonal changes i.e., decreased serotonin level, situational risk, and life stresses. When a new mother is experiencing drastic changes in motivation, appetite, or mood for more than 2 weeks of childbirth it can be termed as clinical postpartum depression.
This is managed with anti-depressant medications, socializing, exercise, and good nutrition. It is important to identify the depression early so that treatment can be started at the earliest. Studies have shown when the mother is depressed the greater the delay in the infant’s development. The first year following birth is a critical time in the cognitive development of the newborn. Thus, social support to the mother is a vital factor the prevention of post-partum depression.
- Birth-related post-traumatic stress disorder- The symptoms are obsessive thoughts about the birth, panic feelings near the site where the birth occurred, feelings of numbness and detachments, nightmares, flashbacks, sadness, fearfulness, anxiety, etc.
- Post-partum psychosis – This arises within first 2-6 weeks following childbirth and the onset is quick and severe. The main symptoms are delusions and hallucinations. Physical symptoms include frantic energy, improper eating, etc., mental symptoms are memory loss, extreme confusion, etc., and behavioral symptoms are characterized by irrational statements and preoccupation with trivial things. This is a serious condition where medical intervention is needed. Doctors may prescribe mood stabilizer, antipsychotic or anti-depressant medications. So, the women in the post-partum period, need extra care, including partner and family support. The women in the post-partum period should have a balanced diet and should continue with iron and folic acid supplements.
- GET PLENTY OF REST – Your body is still healing and needs sleep.
- SEEK HELP – Socialize with friends and family.
- EAT HEALTHY- Add more whole grains, vegetables
- EXERCISE – Follow the pelvic floor strengthening exercise
- EXPECT CHANGES TO YOUR BODY
- SET ASIDE TIME TO COMMUNICATE- It is important to communicate and set aside time for loved ones.
After the baby is delivered and the placenta is expelled, the woman is referred to as Sutika. ‘Sutika Kala’ refers to the period after delivery when maternal physiological and anatomical changes return to the non-pregnant state. ‘SUTIKA PARICHARYA’ refers to post-natal care.
The post-natal care includes AHARA CHARYA, VIHARA CHARYA, OUSHADHA CHARYA, YOGASANA, some PATHYA and APATHYA etc. The principles in sutika paricharya includes taking care of the digestive fire i.e., agni deepana and pachana, nourishing regimens ie., raktadhatu poshana, regimens to increase quantity and quality of breast milk i.e., stanya vardhana, protecting the genital organs i.e., yoni sodhana, garbhasaya sodhana and koshtasodhana, and helping the mother to achieve strength physically and mentally.
I] AHARA CHARYA – DIETARY REGIMENS
Most of the ayurvedic acharyas advise fasting on the first day after delivery of the child i.e., for 24 hours. When the woman feels hungry, she shall be given ghee or til oil mixed with powder of ginger, piper longum, piper longum root, piper retrofractum and plumbago zeylanica – these are known as Panchakola churna and will help in improving digestion. It should be followed by drinking warm water mixed with jaggery or cumin seeds or ajwain seeds. This can be given for 3-5 days from delivery.
The food to be taken should be warm and easily digestible and make sure to avoid cold items such as ice-cream and refrigerated food items as they lead to indigestion. The recommended food for first 2 days is ‘Pippalyadi yavagu’ it is a gruel made with rice processed with pippalyadi churna and ghee.
From the third day onwards, she can have rava porridge, rice, rasam with ghee and medicated milk . Satavari powder can be used to process the milk as it had breast milk-enhancing properties.
From the fourth day onwards kichadi with ghee can be consumed, and Pongal can also be included in the diet. In the first week of ‘suthika kala’ the above-said food items can be administered starting with the medicated ghee mixture followed by medicated milk intake and then the porridges.
From the seventh day onwards ‘Brimhana’ or nourishing food has to be started namely ‘vidarigandhadi yavagu’- gruel prepared with vidarigandhadi group of drugs boiled in milk and ghee. the 9th day, shali and mamsa-rasa that means cooked shali rice, barley, horse-gram and meat soup can be taken depending on the digestion of the mother. Commonly used herbs include
- Musta (nut grass)- It helps in improving breast milk production and relieves milk duct clogs. If the baby is having fever or diarrhea, a water decoction of this herb is administered to the mother.
- Shatavari – The intake of milk processed with this powder helps in improving breast milk and it is useful in managing postpartum depression.
- Yashtimadhu – LICORICE powder can also be administered. It can be mixed with ghee for intake. This helps in improving lactation.
II] VIHARA CHARAYA – Lifestyle Regimens
The vihara can be mainly classified as
- Abhyangam – After the administration of a medicated mixture of ghee the abdomen can be massaged using bala taila or ghee. This will help in reducing the vata dosha which normally gets vitiated during delivery procedures. A woman undergone caesarian should not undergo abdominal massage till the suture heals completely.
- Udara Veshtana – The abdomen should be wrapped with a big clean cloth. This causes compression of the abdomen when the abdomen is compressed it reduces vitiation of vata dosha.
- Ushnodaka Parisheka – Shower with hot water which is processed with drugs like tamarind leaves, the skin of nalpamara drug, coffee leaves, jackfruit leaves, nirgundi leaves etc., can be used. This helps in flushing off the abnormal blood form the uterus and also suppress vata.
- Nyabja Shayana and Udara pidana – make the mother lie in hunch back position. She should rub her back, press her abdomen and flanks and then compress her abdomen to expel the doshas left over after delivery.
- Swedana – Sudation can be given to the vagina and uterine region with priyang.
- Dhupana – Fumigation can be given using drugs namely kushta, guggulu and agaru mixed with ghee.
These regimens should be continued for at least one month. The puerperal woman / suthika should avoid anger, coitus, cold air and excessive exercise. Using an abdominal bandage will help to strengthen the back, supports uterus and ligaments. Rest is also an important factor.
III] OUSHADHA CHARYA – MEDICINES – For oushadha intake make sure that the mother consults an ayurvedic physician. All ayurvedic medicines are recommended after assessing the agnibala i.e., the digestion of the mother. Some of the generic medicines are
- Panchakola churnam – Which helps in regulating the digestion of mother.
- Dasamoolarishtam – It helps in relieving pain and inflammation and helps in reducing vata dosha.
- Jeerakarishtam – Mainly recommended in rainy and winter season. It helps in inducing normal lactation.
- Pulilehyam – It is administered from third week for 30 – 45 days.
- Shatavari gulam – It is advised for achieving overall hormonal balance.
- Dhanwantara kashayam – This will help in alleviating the vitiated vata dosha during delivery.
IV] YOGASANA – Start the exercises with basic stretching of the neck, arms, shoulder, knees, and ankles. Follow breathing exercises, starting with nadisudhi pranayama. Practicing meditation daily will help in managing post-partum depression.
Some of the asanas that can help in strengthening the abdominal muscles are
- Chaturanga dandasana / plank pose – It helps in weight loss and strengthens the spine and muscles around it. It improves the core strength, stability, and posture of the body
- Bhujamgasana or Cobra pose – It increases thyroid functioning, strengthens the spine, butt muscles, shoulder and lungs and improves blood circulation.
- Tadasana / Mountain pose – It activates the nerves of the body and strengthens the heart. It is good for regulating the menstrual cycle in women, cures problem related to indigestion, and strengthens arms and legs
- Trikonasana / Triangle pose – Improves flexibility of the spine and pelvic region. It relieves gastritis, indigestion, acidity, and flatulence while strengthening the ankles and the palms.
- Ushtrasana / Camel pose – It improves respiration by opening up the chest. It enhances digestion and helps in elimination by expanding the abdominal region. It relieves lower back pain, improves posture and reduces fat on the thighs.
PATHYA AND APATHYA
This can be defined as the dos and don’ts during the puerperium period.
- Pathya (Do’s) –
- Warm water shower
- Drinking warm water and consuming warm food
- Adequate sleep
- Oil massaging
- Intake of processed ghee
- Medicated fomentation
- Apathya (Don’ts) –
- Consuming cold and refrigerated foods
- Physical stress
- Mental stress
- Excessive exercise
- Anger, grief etc.,
- Day sleep
- Panchakarma (the five-cleansing procedure)
Thus, mothers need special care after giving birth to a baby. Transitioning into motherhood is a life-altering experience for every woman. Following special regimens will help the puerperal women to regain strength and to take good care of the newborn. Always try to contact a doctor when necessary. Ayurvedic medicines need to be taken under the advice of an ayurvedic physician.