Ayurveda And Pregnancy
PART ONE: BEFORE CONCEIVING
Pregnancy is one of the most dynamic, challenging, and rewarding times that a woman will experience in her life. She will certainly come to face some very interesting changes that she couldn’t even perceive possible, emotionally, physically and spiritually. It is imperative during this time that she has adequate support and knowledge to sustain her well-being throughout pregnancy, childhood and beyond. The ancient wisdom of Ayurveda, based on the patterns and energy found in nature, provides a complete system of support that will guide a pregnant woman with care and confidence through this amazing time.
Within a seed, the intelligence of the entire plant resides. In a nourishing environment, a single pit of a peach grows a ten foot tree. Purusha, or pure conciousness is represented by this dormant seed, unmanifested but with endless potential. The first step of creation is referred to as prakriti, also the word used to describe an individual’s constitution that is set at birth. Mahat describes the universal intelligence that brings prakriti into manifestation. Without the impulsive moment of prakriti, where the process of creation begins, Purusha and Mahat lie dormant. This concept can be applied to the sperm and ovum coming together in the moment of conception. Within the egg lies the intelligence but without that action of the sperm meeting the egg, the egg and sperm would die off without any result. With that creative impulse, the reaction of a new life begins, with inumerous processes beginning to unfold.
Balance Upon Conception
Because the impulse of creation is such a critical moment, it is of utmost importance that both the man and woman trying to conceive undergo a deep cleansing process in order to be in a state of physical and mental purity when fertilization takes place, and to ensure that each individual’s constitution is strong. Panchakarma, translating to five actions, is a rejuvenation therapy that is recommended for strengthening the physiology and ridding the body of waste which can do harm to many levels of well-being. During this time of cleansing, the person will take adequate amounts of rest physically as well as from mental activity, and will spend much time in meditation. They will eat a very basic and easy to digest diet of mainly kitchari, split mung bean and rice soup, with vegetables. They will undergo a series of body therapies daily including massage, enemas, purgation therapy, shirodhara (a constant stream of warm sesame oil on the third eye), therapeutic vomiting, and other therapies, all varying with individual constitution and imbalance. This treatment will last anywhere from a few days to a few weeks, and is recommended to be done each year, but especially before trying to conceive. These treatments are known to transform people, rid the body of disease, regenerate cells and restore vitality at the deepest level.
PART TWO: PREGNANCY
Pregnancy and the Doshas
The pregnant woman is referred to as the garbhini in Sanskrit. Therefore, the care of the pregnant woman is stated as garbhini paricharya. There are many recommendations that she should follow during this time that are fairly consistent from woman to woman. For instance, although there are cases where a woman might need to restrict her diet based on her prakriti, constitution, or vikruti, current state of imbalance, for the most part in pregnancy, it is advised to include dravyas, or substances, that might be avoided otherwise, due to the constitutional makeup of the growing baby.
Pregnancy is a very delicate and unique situation, because it is one in which all of the doshas are being increased in the body under normal circumstances. The doshas are made up of two different elements, or mahabhutas, found in nature. The combined quality of air and ether compose vata dosha, the energy created by fire and water is pitta dosha, and it is that of water and earth that make up kapha dosha. Because pregnancy is a time of such vast and abrupt change, physically and emotionally, it is primarily vata provoking. However, because the blood volume of the pregnant woman increases to 200% by her 7th month, hormones increase as well as body temperature, pitta also increases during this time. Lastly, because of the large increase in weight in such a short period of time, fluid retention, and general slow-moving tendency, kapha is naturally higher in the body as well. It is also because of this that a woman is advised to take tridoshic diet and lifestyle, meaning things that will naturally bring harmony to all three doshic energies.
As mentioned earlier, the vata dosha is the main dosha that is aggravated during pregnancy. The doshas are further broken down into subdoshas, each governing a specific function and location in the body. All of the vata subdoshas encompass movement in the body. Apana Vata, or Apana Prana is the subdosha that is emphasized during pregnancy as its location is the colon and abdomen, and it governs all downward motion in bodily function; mentruation, delivery of the fetus, elimination, etc. Apana Prana also controls development of the organs of the growing fetus (2, pg. 50). It is because of this that Apana Prana must be balanced properly. If it is too weak or too strong, miscarriage or problems during the delivery can result.
Pregnancy is a Special Time
It is said in Ayurveda that the woman can completely reset her health during the childbearing year if she takes proper care during this important period. However, if she does not make adjustments in her life to prepare for the changes that lie ahead, ignoring a proper diet, keeping up to a pace she is used to before pregnancy and not taking time for adequate rest and mental relaxation, she can contract imbalances that can take much discipline to counteract. The demands of a newborn baby are many, not to mention the fact that when recovering from childbirth the woman cannot keep up with very much. A lack of sleep, breastfeeding demands and constant care of the baby will require stored energy, so it is imperative that before and during pregnancy, health concerns have previously been addressed, and proper care is taken throughout the time of childbearing. When a woman carries a child within her womb for 9 months, her body does a tremendous amount of work, and what the baby requires will be taken directly from the mother’s stores. The health of the mother-to-be must be the first priority in order to sustain her vitality over the following years.
Digestion, Shukra Dhatu, and Ojas
Digestion in Ayurveda is considered to be the root of health. In the west it is said that we are what we eat. However, in the east it is said that we are what we digest. All of the bodily nourishment and energy that sustains our physical structure as well as our emotional well-being comes from the food we consume. This is particularly important in pregnancy because the quality of the nourishment to the baby will depend completely on the mother’s intake of food, and the quality of processing in her body.
There are digestive guidelines that are given in Ayurveda that if followed ensure a strong agni, or digestive fire, therefore supporting the initial step in the process of health. These include things like eating in a pleasant environment, not overeating, taking the biggest meal at lunchtime when the agni is naturally at its peak, and waiting several hours between meals to eat until the previous meal has been digested (3, pg. 88). The quality of foods that should be emphasized to aid a strong agni will be discussed in the diet section. The significance of agni and digestion lies in the nutritive fluid. This is the digested pool of nutrients that will begin to circulate throughout and nourish the entire body.
The dhatus represent the seven structural tissues of the body. Each is formed subsequently from the nutritive fluid created by the digestive process, and is found is less quantity than its preceding dhatu. It takes about 5-7 days after the consumption of food, for each layer of dhatu to form, the first taking only this time to produce, and the last requiring about a month. The dhatus, rasa, rakta, mamsa, meda, asthi, majja, shukra/artaja represent the western concepts of plasma, red blood cells, muscle, fat, bone, bone marrow, and sperm/ovum, respectively. The shukra dhatu is the tissue layer of reproduction, however, not only is it responsible for the sperm or ovum, it also controls the reproduction of cells. This is why it holds so much importance preconception as well as in pregnancy. It is said that shukra lies within each cell of the body, with that reproductive quality within.
It is because of the successive nourishment of the dhatus that a strong agni and vibrant diet are critical. Shukra dhatu is the last of the seven-dhatu-chain to be nourished from the digested nutrition, and it is the tissue found in the least quantity in the body. If there is not enough nutrition after processing through the previous six dhatus, it will lack strength. In cases of infertility, it is the shukra dhatu in both the woman and the man that should be nourished. To ensure healthy sperm, ovum, and overall production of fetal cells, shukra dhatu must be strong and balanced, and pregnancy can then be achieved.
Ojas is explained in Ayurveda as the juice of life. It is responsible for immunity, vibrancy, strength, enthusiasm and is the foundation of life. Without enough ojas, people feel dull, lifeless, weak, fall ill frequently, and lack a zest for life. The pool of ojas is filled only after each of the seven dhatus has taken from the nutritive fluid in the digestive process. It is because of this that so much significance is placed on balanced rasa, and eating foods that will be very nourishing to the dhatus.
Ojas has a special role in pregnancy because during the eighth month, ojas is passed from the mother to the baby through the placenta. It will return to the mother, and then fluctuate back and forth throughout this month. Ojas is responsible for happiness and inspiration, so during this time, when the ojas is given to the baby for periods of time, the mother will experience waves of joy and sorrow. There is more danger to the fetus this month because the ojas is unsteady, so it is vital that extra care is taken. It is in the eighth month that is most important to surround the mother with love, avoid stress and strain, and refrain from travel (4, pg. 72).
Psychology in Pregnancy
In Ayurvedic psychology, the concept of the gunas is discussed. The gunas are three qualities, tamas, rajas and sattva. Tamas represents stillness and darkness. Rajas represents movement and stimulation. Sattva is the quality of knowledge and purity. In psychology, the gunas represent different states of mind. It is important to pay attention to the gunas in pregnancy because one should always try to move closer to a sattvic lifestyle in order to live a more pure life, and a pregnant woman should try to give her baby as much sattvic quality as possible. Different things influence the gunas, such as diet and activities, or even train of thought. It is because of this that it is not recommended for pregnant women to watch violent or ill-natured films, or focus on this sort of subject matter.
Surely, the mind of a pregnant woman can seem like another at times. Between aggrivation of doshas, rampant hormones and all the changes she is facing, a lot of fear, anger or depression can be experienced. The influence of emotion can be very powerful, the elevated senses of a pregnant woman can at times be overwhelming to her and her family. It is because of this that regular meditation should be practiced. In examining thoughts and emotions, it is easier to keep perspective and to label thoughts as just thatand nothing more. Thus they can be released and a great deal of pressure can subside. It is imperative that the expectant mother not dwell on emotions for long, and should seek counseling if specific issues seem to come up consistently in order to find a way to resolve them. Emotions can shed a lot of light on what is going on in the body, and by paying attention to what emotional tendency, ie., anger, sadness, etc., is prominent, measures can be taken with diet and lifestyle to counteract them. This will be discussed in more depth.
In the classical Ayurvedic texts, the gradual development of the growing baby in the womb is described. A major component to the physical formation of the fetus is the dhatus, or bodily tissues, as they hold the structure of the body.
1st Trimester: From the moment of conception to the end of the first 14 weeks or so, a tremendous amount of growth and development occur. Mainly, however, it is generalized by a state of fluid, as the embryo is in a jelly-like state until the end of the first several weeks. The rasa dhatu, or tissue of plasma, serum and lymph represent the fluids of the body and are what is mainly being developed at this time, along with the fetal growth organs. The sense organs and all the limbs emerge simultaneously.
Another important milestone that occurs in this stage of life is the beating of the heart. In Ayurveda, the heart is considered the seat of consciousness. The heart of the fetus is connected to the heart of the mother through arteries and the placenta. It is through this incredible link that feelings of the baby are said to be felt by the mother during this period. One of the most critical guidelines in pregnancy recommendations is that the mother be taken care of and given anything she desires in the third month especially in order to prevent any mental or physical suffering of the child (2, pg. 65-68). It is considered very important to pay close attention to cravings, desires, and a state of love and happiness. Any deprivation the mother feels, the baby will inevitably feel as well. The mother’s feeling of contentment and connection with the baby helps to ensure proper development of the baby’s heart (1, pg. 2).
2nd Trimester: During the fourth month, the development of the fetal dhatus continues. By 18 weeks, rakta dhatu and mamsa dhatu, red blood cells and muscle tissue, begin to rapidly form, which are given nourishment by rasa dhatu. Because of the increase in the baby’s strength, the mother may lose some vitality during this month. By the sixth month, meda dhatu, fatty tissue, as well as the upadhatus become the main focus of development. (2, pg. 69, 70). Upadhatus are the minor tissue of each dhatu, including body hair, tendons, blood vessels, skin, to name a few.
3rd Trimester: By the seventh month of gestation, the fetal growth is nearly complete. The organs are finely tuned and refined, and weight gain rapidly increases. The eighth month is one of great significance. During the eighth month, ojas is transferred from the mother to the growing baby. Ojas has no western equivalent, but is the most refined product of digestion, and is present only in small amounts in the body. It is said to be a person’s essence, vitality, immunity, and what gives a person luster and glow in the skin. It is what gives a feeling of contentment and pure consciousness (2, pg. 84). Because of this, the pregnant woman should take a lot of rest, do no traveling, and focus on proper diet and digestion in order to keep deliver healthy ojas to the baby while keeping her own ojas in adequate quantity. During the ninth month, the baby’s organs continue to refine and grow. By the last few weeks of pregnancy, the baby’s position should be head facing down and face toward the back of the mother to prepare for a journey through the birth canal.
It was mentioned previously how important agni is to process the fuel that is given to the body, but equally important is the quality of food that is consumed. The general quality of the diet should be as sattvic as possible in order to sustain purity of body and mind, as well as create ojas (2, pg. 86). Food should be warm and moist to encourage the abundance of rasa dhatu that is needed for the increase of blood during pregnancy, the production of each dhatu in the mother and fetus, as well as the preparation for lactation. Food should have prana, or life force. When food is not fresh, it is tamasic, and will introduce the quality of stagnancy into the physiology of the mother and fetus. The diet should be light in order to preserve the agni which is naturally dimmed during the many processes of pregnancy, and to enable the food to be easily digested. (4, pg 15).
Special focus is given to the mothers cravings. It is said that she should be given anything she desires, within reason, and that she craves what her body and the fetus are requiring. It is also very important to remember to include all six tastes in the diet to ensure that foods containing high concentrations of each of the five elements is incorporated. For this reason, the mother should not eat simply according to her constitution. Because the baby is of a different constitutional makeup than the mother is, emphasis should be placed on a very abundant and various diet. All colors of food should be included for this reason as well (3, pg. 75-84). The diet should be vegetarian to ensure a sattvic quality, but in a vata person, extra emphasis should be placed on unctuous, warm, protein/iron-rich, and grounding foods. Ghee is one sattvic food that should be taken regularly by expectant mothers. In addition to creating ojas, ghee increases agni, (4, pg. 86). The specific food recommendations to focus on during each month of pregnancy are as follows:
1st /2nd/3rd Months: Sweet taste, lots of liquids, fresh fruits, fresh fruit juices, cold drinks, milk, and raw butter
4th / 5th Month: Add meat broth, especially from wild animals, rice, wheat, milk and raw butter
6th Month: Same as above, but include ghrita cooked with gokshura
7th/ 8th /9th Months: Boiled milk and rice (4, pg 15).
Some other foods that are sattvic and very nourishing to the fetus are dates, raisins and blanched almonds. Kitchari, grounding vegetable like yams and carrots, whole grains/breads, and warming spices are beneficial as well (2, pg. 79). It is important to satisfy hunger, but in order to sustain a healthy agni, meals should not be too large. In Ayurveda, three meals a day is the rule of thumb, not eating more often than every 4-5 hours or until the previous meal is digested. However, for pregnant women, it is advisable to eat smaller portions due to the stomach being compressed, and to eat a little more often to sustain energy.
Body Therapies During Pregnancy
Abhyanga is a gently, warm oil massage that can be done daily on self, and is done professionally by Ayurvedic body therapists. It is very important to include in the daily routine for several reasons. First of all, the strokes that are used move along lymphatic system into the drainage sites. They will remove toxins from the blood and lymph. The massage also enhances circulation and soothe the vata dosha in the form of touch, calming the mind. It is the opposite of the vata qualities, as it is warm, moist, and smooth, and heavy. It is important for a pregnant woman to feel comfortable in her own skin, and performing this massage daily is a luxurious way to take notice of your body and take appreciation of it. It is very grounding and can be very effective in bringing the mind and focus inward. The oil is lubricating to the dhatus and will nourish dry skin. Massage oils are herbalized, and vary in indication, however, for pregnant abhyanga, a vata balancing oil is most commonly recommended. Extra focus can be put on the abdomen area, where stretch marks are most prominently formed, and the oil will create elasticity and tone in the skin. (2, pg. 100) Abhyanga is as important if not more during the postpartum weeks, and will be mentioned again in part three of this paper. (3, pg. 55-58).
Shirodhara is the treatment is known as the bliss therapy, and it gives such a profound calming effect on the mind it is as though all worry fades away. This can be a very beneficial treatment for the pregnant woman who has excess worry, fear, or a restless mind. Shirodhara is performed with a warm stream of oil, dripping over the third eye, running back over the crown shakra constantly for a period of several minutes.
During the eight and ninth month, an herbal oil enema, called basti, made of cured sesame oil base should be done about once per week. This is very balancing to Apana Prana and is preparing the body for delivery, and well as lubricating the intestinal tract and ensuring a clean bowel for the end of pregnancy.
During the last month of pregnancy, perineum basti should be performed regularly. This can be done by massaging the perineum with warm oil, or by placing an new oil-soaked tampon inside the vagina each morning. This creates the same toning and elastic effect on the skin as abhyanga does on the rest of the body. When the perineal tissue is nourished it the will stretch more effectively during labor, with less tears, and will heal much more quickly. (3, pg. 59-60).
There are many Ayurvedic preparations that are helpful to the proper development of the fetus for a normal pregnancy and delivery. However, most of the recommended formulas are not available in the United States, and it is difficult in most areas of this country to find a practitioner who is familiar with Ayurvedic prenatal herbs. Many women do not need to take anything in addition to a wholesome diet, however, depending on the individual, many herbs can be very helpful. From the onset of pregnancy, ashwaganda, shatavari, and amalaki can be taken. This is the most widely recommended herbal support during pregnancy. These herbs will help to prevent anemia, high blood pressure, fatigue, low immunity and prenatal complications. Starting in the sixth month, gokshuru and jatamansi can be also be taken (4, pg. 14). These herbs are taken in the form of powder. Specific doses should be discussed with an Ayurvedic practitioner, and care should always be taken when administering any substance in pregnancy.
PART TWO: POSTPARTUM
After the baby is born, the mother has much recouperating to do. Getting to know the newborn child while trying to adapt to the demands of new motherhood can be a difficult balance. In Ayurveda, strong emphasis is placed on the 42 days, or 6 weeks after childbirth. It is one of the most significant periods of a woman’s life, and one of the most relevance to her health in following years. It is very easy, especially in western culture of independence and fast pace to fall prey to the pressure of running until we burn out. A new mother should take every measure to rest while the new baby is resting, and needs to rely heavily on the father as well as other family/community support. Cleaning, cooking and other household duties should be delegated prior to the last few weeks of pregnancy to ensure smooth transition and a feeling of ease. If the new mother does not get adequate rest, her job to take care of her baby becomes overwhelming, and she will feel fatigued and depressed.
In a matter of hours, a woman will lose around 15 pounds of weight directly from the seat of vatathe abdomen. Vata is comprised of air and space, which is exactly what is left after the baby is delivered. In addition, the vast changes that her body has undergone over the last 9 months have all come to a head with a very exhausting birthing experience. It is because of this that special attention to decrease vata in the physiology is paid. Incorporating the qualities of moisture, oiliness, warmth, heaviness, routine, and stillness will help to soothe vata and nourish the new mother.
It is recommended that postpartum abhyanga is performed daily, by a skilled Ayurvedic Postpartum Therapist. The practitioner comes to the woman’s home, and the baby can be nearby in case she needs to nurse at any point during the treatment. Much more oil is applied than a typical abhyanga for its hydrating and vata-reducing quality, and herbalized oils like Bala and Ashwaganda can help to soothe soreness and add vitality. Aggravated vata is soothed dramatically by the element of touch, so this is a very important aspect of the postpartum healing. It can get expensive to have these massages daily for the full 6 weeks, so whatever can be done will be beneficial. The massage is usually followed by warm bath and deep rest.
The agni is at is lowest at the period following labor. This is because so much energy and focus in the body was put towards getting the baby out safely and efficiently. This is a very critical time to kindle the digestive fire, being very patient in adding foods to the diet. It is very important to eat a vata-balancing diet during the postpartum period, for the well-being of mother and baby. Some symptoms of vata excess is gas (expressed in the infant as colic), disrupted sleep, fatigue and constipation.
The general quality of food to be taken in the days following delivery is soupy, warm, sweet and easily-digestable. Mostly kitchari, sweet grains, sweet vegetables, fruits, milk, ghee, oils, avocado, soaked nuts, warm cereals, warming spices, . It is important to avoid vegetables like broccoli, cauliflower, brussel sprouts, garlic, onions, chilies, peppers, greens, fermented cheeses, yeasted breads, corn, potatoes, and dry foods such as crackers, as these increase the air element. After a few weeks, some soft cheeses and white meat soups can be introduced slowly. (1, pg. 13, 14).
A very beneficial ojas-increasing energy drink that is very beneficial to lacating mothers is as follows: 10 blanched almonds, skinned, 1 cup of boiled milk, 3 dates, a pinch of cardamom, and a thread of saffron, blended.
As mentioned, agni is dramatically lessened after a woman gives birth and emphasis should be placed on rekindling that fire. One of the best ways to improve agni is to steep cumin, coriander and fennel, and drink this first thing in the morning. Warming spices in general will aid in digestion and help to make the digestive fire stronger.
Another thing to consider is that in the first days postpartum, the production of colostrum will occur followed by breast milk. The quality and quantity of breastmilk is dependent on rasa dhatu, as breast milk is an upadhatu of rasa dhatu. In addition to eating foods that build rasa dhatu, galactagogue herbs, those which support healthy milk production, can be taken as well. Shatavari is the ideal galactagogue herb for postpartum use as it has rejuvenative action, promoting vitality and strength, and supports female reproductive organs. Fenugreek is another galactagogue herb that is very beneficial in sustaining healthy milk production.
One of the best herbs taken for rejuvenation, decreasing vata dosha, and supporting a fatigued body and mind is ashwaganda. This can be taken in conjunction with shatavari. Ashwaganda will help enstill deep rest at night, as well as more energy during the day.
Containment of the Uterus
A scarf is snuggly wrapped aroung the abdomen of the postpartum mother in order to prevent excess space from being trapped within. It is done to a comfortable degree for the first week or so, and it should feel relieving to the woman to have this restraint on her belly. This is not done on a woman who has had a cesarian delivery, however, because of the exposure of the abdomen to the external environment, extra focus should be on the other vata reducing suggestions. (1, pg. 12).
In what is one of the most profound, enlightening and fulfilling experiences that a woman will undertake, Ayurveda provides a great deal of knowledge and support throughout the childbearing years. Without aiming for perfection, but with a mindset of moderation and contentment, the principles from this ancient wisdom can give much needed guidance and comfort. In whatever circumstances a pregnant woman may find herself, it is of utmost importance that she seek happiness and take care of herself in preparation for the arrival of the most amazing gift of a baby.