Sutika Paricharya - Strategies for safe postnatal care in Ayurveda

[Find the meaning and references behind the names: Just, Baby, New, Code, Class, India, Scholar, Unique, Delivery, Key, Care, Life, Day, Date, Delhi, Low, Return, Show, Time, Safe, Diet, Main, Kamini, Organ, Data, Under, Lack, Days, Dhiman, State, Post, Quick, Given, April, Goal, Strong, Weeks, Kala, Small, End, Early]

REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 101 Sutika Paricharya - Strategies for safe postnatal care in Ayurveda Kamini Dhiman 1 , Divyamol M D 2 1 Associate Professor, Dept. of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India. 2 Post Graduate Scholar, Dept. of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India. I NTRODUCTION Postpartum period is an important phase of transition in women’s life following childbirth. This period is also known as puerperium, starts following the expulsion of the placenta until complete physiological recovery of various organ systems when maternal physiological and anatomical changes return to the nonpregnant state [1] The postpartum period divides into three arbitrary phases, i.e., acute phase - the first 24 hours after delivery of the placenta, early – upto 7 days, and late – up to 6 weeks to 6 months. Each phase has its unique clinical considerations and challenges [2] Whole of this period is critical to the health and survival of a Address for correspondence: Dr. Divyamol M D Post Graduate Scholar, Dept. of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India. E-mail: divyadam 16@gmail.com Submission Date: 16/02/2022 Accepted Date: 19/03/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA mother and her newborn as it is the most vulnerable time during the hours and days after birth. Lack of care in this time period may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women, newborns, and children [3] About 39% of neonatal deaths occur on the first day of life in India, about 57% during the first three days and the majority of maternal deaths occur between the third trimester and the end of the first week after birth [4] The WHO guidelines on postnatal care recommend essential routine postnatal care for all mothers and their newborns, extra care for low birth weight and small babies, and early identification and referral or management of emergency conditions [4] The guidelines further recommend postnatal visits within 6 to 12 hours after birth, and follow-up visits from 3 to 6 days, at 6 weeks, and then at 6 months [5] In Ayurveda, the postnatal period is called as Sutika Kala, and the care given during this whole postpartum period is mentioned as Sutika Paricharya . A woman who has just given birth to a baby is called as Sutika (~postnatal woman) and almost all Acharyas have mentioned Paricharya (~care) for a S utika only after the expulsion of the placenta. Prasava (~labor) is a strenuous activity which causes Dhatu Kshaya A B S T R A C T Postnatal period is an important phase of transition in women’s life. It is the period after delivery of conceptus when maternal physiological and anatomical changes return to the nonpregnant state. Ayurveda has described in detail about the postnatal period and care for this period under the title Sutika Paricharya (~postnatal care). It has been mentioned in terms of Ahara (~diet), Vihara (~regimen) and Aushadha (~medicines). Main goal of Sutika Paricharya is to regain the lost strength and vitality as same as the prepregnant state by following the treatment principles like “ Garbhashaya Shuddhi etc. In this article, Ayurvedic compendia describing different components of Sutika Paricharya has been reviewed and described. Key words: Ayurveda, Postnatal Care, Puerperium, Sutika Kala, Sutika Paricharya

[Find the meaning and references behind the names: Stage, Every, Element, Bala, Dosha, Vata, Child, Body, Cases, Basic, Six, Original, Lot, Area, Till, Room, Half, Pre, Need]

Kamini Dhiman et al. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 102 (~depletion of body tissues) and there by depletion of Bala (~strength) of the woman which is the need behind exclusive care for both women and infant after delivery. Paricharya is mentioned extensively in classics which includes Ahara (~diet), Aushadha (~medicines) and Vihara (~regimens). These are mentioned for a period of at least one and half month upto 6-month duration which aims at restoration of health of the postnatal woman in all aspects. By following these regimens, she attains Dhatu Paripoornatha (~replenishment of Dhatu ) and reaches her overall health status as pre-pregnancy stage. A gamut of care throughout pregnancy and the postpartum period is critically important and in India, the coverage of PNC service utilization is considerably low given the risks of postpartum complications. Ayurveda suggests systematic way of caring postpartum women ie. Sutika Paricharya which should be adapted as possible in all cases. A IMS AND O BJECTIVES To review the literature of Sutika, Sutikakala and Sutika paricharya alongwith Pathya & Apathya in Sutika paricharya and its clinical significance. M ETHODOLOGY A thorough review of literature related to Sutika paricharya in Ayurvedic compendia was performed. Chapters consolidating the concepts from both Laghutrayi, Bruhatrayi and other relevant Samhitas have been sorted and included in the manuscript. R ESULTS Sutika The word Sutika is used to describe the postnatal woman and it is derived from the basic sanskrit element ‘ Su ’ with meaning ‘to produce’ or ‘to yield’ [6] A woman who has just given birth to a child followed by expulsion of the placenta is called as Sutika. [7] Sutika Kala The postnatal phase is called as Sutika Kala. It is an area in our classics where a lot of differences of opinions are there. Its duration varies from 12 days to six months, and some opines that the re-establishment of menstrual cycle is an endpoint of Sutika Kala. Caraka has not given any specific duration. Susruta has mentioned the 1 ½ month duration of Sutika Kala and added the opinion of others that the women should be called Sutika till she does not restart her menstrual cycle following the delivery of the child [8] Acarya Vagabhata, Bhavaprakasha and Yogaratnakara have mentioned the duration of 1½ month i.e. approximately 45 days or until next menstrual cycle [9,12] Kashyapa has described Sutika kala different from all this and suggested that total six months period is required to regain Raktadi dhatu to their original status following delivery [13] In the context of Mudhagarbha (obstructed labor), a 4 month time period has described as Sutika kala for the subsidence of complications and pacifying the aggravated Doshas [14] Sutikagara Sutikagara (~accouchement room) is explained in Ayurveda, which is an aseptic room constructed specially for puerperal women. It was made compulsory in ancient days to stay for women in Sutikagara for at least 10 days [6] It is a building which would be separately constructed for every Sutika and dismantled after her discharge. This concept heightens the Ayurveda vision of one-to-one handling and personalized approach for medical care [15] Sutika Paricharya Sidhanta (Principles of Sutika Paricharya ) The treatment principles include, Ashwasana Sutika Abhyanga Deepana Pachana Garbhasaya Sodhana and Kleda Soshana Soola Prashamana Vata Anulomana Bala Vridhi Stanya Janana

[Find the meaning and references behind the names: Yusa, Fix, Mani, Head, Yoni, Rasa, Sneha, Kola, Table, General, Bath, Pana, Gana]

Kamini Dhiman et al. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 103 Brihmana Sutika Paricharya Sutika paricharya is mentioned in terms of both Samanya (General) and Visesha (special) paricharya. Samanya Sutika Paricharya (~General postnatal care) It can be mentioned in terms of Ahara, Aushadha and Vihara. Manidharana (~Wearing of amulet) The Sutika should fix Trivruta mani (~amulet) over her head. It gives psychological support to her. Sutika Snana (~Bath of postnatal women) On 10 th or 12 th day, according to the practice of family the bathing ceremony should be performed [16] Table 1: Samanya Sutika Paricharya as per different Samhitas Text Days Ahara and Aushadha Vihara Charaka Samhita [17] 5-7 day 1) Snehapana 2) Yavagupana 1) Abhyanga 2) Parishekaubhayatakala 3) Udaravestana Kramavat Aapyayan & Swasthavritta palana Sushruta [18] 2-3 days 1) Vatahara kashaya pana 2) Ushna gudodaka with pippalydi dravyas 1) Sarvadaihika balataila abhyanga 2) Parisheka with vatahara dravyas 3 or 4 -6 or 7 Days 1) Sneha yavagu/ksheera yavagu with Vidarigana dravyas 8 th day 1) Jangal mamsarasa 2) Yava, Kola, Kulatha yusha 3) Shaliodana bhojana Asthanga Hridaya [19] 2-3 days 1) Snehapana - with panchakolachurna 2) Ushna gudodaka with panchakola churna / Vatahara aushadhi toyapana 3) Peya – Purvokta dravyas 1) Yoni abhyanga & sarvadaihika abhyanga 2)Sthanika udara abhyanga - ghrita/taila 3) Udaravestana 4) Udvartana 5) Parisheka 6) Avagaha 4-7 days SnehaYavagu/ KsheeraYavagu 8-12 days Jeevaniya gana/brihmaniya gana/ Madhuravarga siddha Hriddya annapana After 12 days Mamsa rasa Asthanga Sangraha [20] 3 or 5 or 7 days 1) Snehapana with Panchakola churna with saindhava 2) Sneha ayogya-Vatahara/ laghupanchamoola kwatha pana 3) Ksheera yavagu pana-Vidaryadigana siddh 1) Sarvadaihika balataila abhyanga 2) Sthanika Udara abhyangagrita/taila 3) Udarvesthana 4) Ushnodaka parishekaubhayatha kala 8-12 days 1) Yava, Kola, Kulatha yusha

[Find the meaning and references behind the names: Desha, Residence, Shali, Nagar, Land, Shaka, Jala, Sayana, Manda, Arjuna, Place, Agni, Guda, Arid]

Kamini Dhiman et al. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 104 2) laghu annapana 5) Acchadana 6) Avagahana After 12 days 1) Jangala mamsarasa 2) Jeevaniya gana/ brihmaniya gana/ Madhura, vatahara dravyasadhita annapana Kashyapa [21] 3-5 5-7 1) Manda pana 2) Hitakar bhojana 3) Snehapana 4) Snehayukta yavagu pana-pippali, nagaralavana rahita yavagu 7-12 Snehayukta yavagu panawith lavana 12 days 1) Kulatha yusha 2) Jangala mamsarasa 3) Gritha bharjita shaka 1 month Snehana, Swedana, Ushna jala sevana Harita [22] After Prasava Kwatha pana - Lodhra, arjuna etc dravya 1 st Day Upavasa 2 nd Day 1) Guda,nagar, haritaki sevana 2) Ushna kulatha yusha sevana 3 rd Day Panchakola Yavagu pana 4 th Day Chaturjata mishrita Yavagupana 5/10/15 days Shali Shastik odana Visishta Paricharya [23] It is explained on the basis of Desha (~residence place) & gender of child. Table 2: Visesha sutika paricharya according to Desha of Sutika. Desha Ahara Vihara Anupa Desha (~marshy land) 1) Manda prayoga with agni- Swedana, Nivata Shayana balavardhaka dravya 2) Ushna dravya sevana Jangala Desha (~arid land) for 3-5 days Snehopachara Snehopachara Sadharana Desha Neither too sneha nor ruksha dravyas

[Find the meaning and references behind the names: Less, Dosa, Better, Sita, Male, Jati, Roots, Loss, Great, Development, Aimed, Turn, Shoka, Sleep, Anger, Ati, Blood, Person, Bhaya, Desa, Fear, Cold, Female, Due, Shita, Caste, Oil, Quality, Mental, Empty, Common]

Kamini Dhiman et al. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 105 Table 3: Visesha Sutika Paricharya according to sex of child Days Gender of child Advice 5-7 days Male 1) Tailapana 2) Deepaniya aushadhi samsakrita yavagupana Female 1) Ghritapana 2) Deepaniya aushadhi samsakrita yavagupana Later In both sex Mandadi prayoga Sutika paricharya for Videsha Jati ( ~ foreigners) Women of Mleccha caste and other foreigners should use blood, meat soups, eatable roots, rhizomes, and fruits during this period. Pathya ( ~ wholesome practices) and Apathya ( ~ unwholesome practices) in Sutika Paricharya In Sutika Kala , vitiation of Vata is common. Even less consumption of Vatala diet in a very little quantity may create many problems. So, Pathya and Apathya of the Sutika should be understood. Pathya [24] 1 Sutika should use hitakarakaahara (~wholesome diet) & vihara (~wholesome regimens). 2 Sutika should have bath with warm water. 3 Adequate sleep should be followed. 4 For drinking, boiled water should be used. 5 Abhyanga (~oil massage) should be done with lukewarm oils and Parishek (~pouring of medicated water) , Avagahana (~sitz bath) etc. should always perform with lukewarm water. 6 Udaravesthana (~bandaging of abdomen) should be done. 7 Diet must contain Garbhashayashodaka (~cleansing uterus), Sthanyavardhaka (~promoting lactation), Stanyajanana (~galactagogue) , Vataharadravya (~drugs which alleviating vata dosa ) Apathya [24] 1 Shita Ahara (~cold food items), vihara (~cold regimens) 2 Maithuna (~ sexual intercourse). 3 Physical and mental Stress. 4 Ati Vyayama (~strenuous activities). 5 Shoka (~sadness), Bhaya (~fear) , Krodha (~anger). 6 Atapasevana (~Excessive exposure to sunlight) and Divaswapna (~Daysleep). 7. Panchkarma (~elimination therapy) is contra indicated in sutika. DISCUSSION Childbirth care during and for the time following this period is an area of great concern nowadays. Interest for giving quality care during this period is increasing. People turn towards traditional practices during this period. In Ayurveda, a detailed description regarding the same in a systematic way is mentioned. Sutika is considered as Shoonya sharira (~empty body) as she becomes weak due to development of fetus, loss of strength of body tissues, excretion of Kleda (~moisture) and Rakta (~blood) during the delivery process etc. For regaining the lost vitality and strength, special care should be provided for Sutika . This suggests the use of Samanya and Visesha paricharya during postnatal period as per requirement. Samanya paricharya is aimed at providing a universal and unique care for all postnatal females but Visesha paricharya is somewhat more focused on person-oriented approach. This special care has been mentioned in terms of residence place (~ desa ) and sex of the child and which is applicable for those who are more socially stable and having chances to follow this. The main components of Sutika Paricharya are diet (~ Ahara ), regimen (~ Vihara ) and medicines (~ Aushadha ). CONCLUSION Sutika Paricharya in Ayurveda is designed in a way that, it causes the Punar -Naveekarana (~replenishment) of the stree (~woman) and would prepare her for the next delivery also. At the same time, it gives importance to the Sishu Arogya (health of the baby) also. For better

[Find the meaning and references behind the names: Sharman, Work, Sharma, Bharati, Singh, Kashinath, Sankara, Taye, Tefera, Romano, Cite, Pandita, Ethiopia, Shastri, Int, Sci, Abhishek, Brahma, Apps, Bhu, Works, Acharya, Prasanna, Giordano, Chap, Yoga, Pandit, Sharika, Rosa, Lemo, Hari, Chauhan, Tadi, Tiwari, Belachew, Open, English, November, Nil, Gaurav, Med, Role, Hindi, Non, Srivastava, Swati, Author, Prakashan, Sarika, Mishra, Roga, Arti, Iris, Nirmala, Cacciatore, None, Khanda]

Kamini Dhiman et al. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda ISSN: 2456-3110 REVIEW ARTICLE April 2022 Journal of Ayurveda and Integrated Medical Sciences | April 2022 | Vol. 7 | Issue 3 106 health attainment after delivery every postnatal woman should be encouraged to follow Sutika Paricharya as per Ayurveda classics. REFERENCES 1 Chauhan, Gaurav. Prasanna Tadi. “Physiology, Postpartum Changes.” StatPearls , StatPearls Publishing, 21 November 2021. 2 Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. Journal of prenatal medicine. 2010 Apr;4(2):22. 3 Belachew, Tefera & Taye, Ayanos. Postnatal Care Service Utilization and Associated Factors among Mothers in Lemo Woreda, Ethiopia. Journal of Women's Health Care.2016; 5 (10) 4 Singh, Abhishek et al. “Socio -economic inequalities in the use of postnatal care in India.” PloS one 2012; 7;(5). 5 https://apps.who.int/iris/bitstream/handle/10665/97603/97 89241506649_eng.pdf. 6 Swati D, Sutika Paricharya W.S.R. To Post-Partum Care-A Samhita Based Review. International Research Journal of Ayurveda & Yoga. 2021; (4).194-200. 7 Prof.(km)P.V.Tiwari, Kashyapa Samhita text with English translation & Commentary, edition 2002, Chaukambha Bharati Academy, Varanasi, 2002. pg-576. 8 Ambikadutta shastri (editor). Sushruta Samhita, sharira sthana, chapter-10, Bharati Chaukhambha Subharti Prakashana, Varanasi 2010;p.103. 9 Shivprasad sharma, editor. Ashtangasamgraha of vridha vagbhata, Sharira sthana;chapter 3, verse 37. Varanasi, Chaukhamba Sanskrit series; 1 st edition, p. 296. 10 Hari Sadasiva Sastri, editor. Ashtangahrdaya of Vagbhata, Sharira sthana ; chapter 1, verse 100. Varanasi, Chaukhamba Surbharati Prakashan; 2018. p. 377. 11 Brahmasankar shastri, editor. Yogaratnakara, Uttarardha, Sutika Roga Chikitsa, Verse 2, Varanasi, Chaukhambha prakashan. reprint 2021.p.431. 12 Brahma sankara Mishra, editor. Bhavaprakasha, Madhyama Khanda, Striroga adhikara, chapter-69, verse-166, 2 nd ed. Chaukhamba Sanskrit series, Varanasi.2002. p.664. 13 Satyapala bhigacharya (editor), Kashyapa Samhita (Vriddha Jeevaka), Khilasthana, chap-11, 4 th ed. Chaukhambha Sanskrit Sansthan, Varanasi. 1994;p.305. 14 Brahma sankara Mishra, editor. Bhavaprakasha, Madhyama Khanda, Striroga adhikara, chapter-69, verse-167, 2 nd ed. Chaukhamba Sanskrit series, Varanasi.2002. p.664. 15 https://www.easyayurveda.com/2021/03/17/sutikagara/am p/. 16 Kashinath Shastri, Asthanga Sangraha Of Vagbhata, pub- Chaukhambha Orientalia, 9 th edition, 2005; p.376. 17 Yadavaji Trikamaji, Charaka Samhita, of Agnivesha, Chaukhambha Orientalia,5 th edition, 2001, pg-348. 18 Sushruta Samhita Of Sushruta, by-Acharya Yadavaji Trikamaji, pub-Chaukhambha Orientalia,8 th edition ,2005, pg-389. 19 Hari Sadasiva Sastri, editor. Ashtangahrdaya of Vagbhata, Sharira sthana; chapter 1. Varanasi, Chaukhamba Surbharati Prakashan; 2018. p. 376. 20 Shivprasad sharma, editor. Ashtangasamgraha of vridha vagbhata, Sharira sthana; chapter 3, verse 37. Varanasi, Chaukhamba Sanskrit series; 1 st edition, p. 295. 21 Pandit Hemaraj Sharma, Kashyapa Samhita, Chaukhambha Sanskrit Sansthan, 10 th edition,2005, pg-306. 22 Acharya Ramavalamba Shastri, Harita Samhita with Nirmala Hindi Commentary, 1 st edition, Prachya prakashana, Varanasi, 1985, pg-104. 23 Satyapala bhigacharya (editor), Kashyapa Samhita (Vriddha Jeevaka), Khilasthana, chap-11, Chaukhambha Sanskrit Sansthan, 4 th ed.2001. 24 Srivastava Sarika et. al., “Role of Shigru in M anagement of Sutika-Arti (puerperal – discomfort)” Department of Prasuti Tantra, IMS, BHU, Varanasi, 2000;p.17-18. ******************************* How to cite this article: Kamini Dhiman, Divyamol M D. Sutika Paricharya - Strategies for safe postnatal care in Ayurveda. J Ayurveda Integr Med Sci 2022;3:101-106. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Sutika Paricharya - Strategies for safe postnatal care in Ayurveda’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Vihara, Bala, Bhaya, Desha, Ahara, Ayurveda, Shoka, Aushadha, Pathya, Stanyajanana, Krodha, Prasava, Sutika, Apathya, Mudhagarbha, Maithuna, Dhatukshaya, Sutikagara, Postnatal care, Sutika kala, Sutika paricharya, Puerperium, Postpartum period, Divaswapna, Panchkarma, Ati Vyayama, Garbhashaya shuddhi, Shoonya sharira.