Pregnancy and Postpartum Care - An Ayurvedic View

PREGNANCY

A beautiful start of an incredible journey. No words can describe its beauty and feelings.

Pregnancy occurs when an egg fertilizes with a sperm, grows inside the uterus and develops into a baby. Its duration is approximately 40 weeks (9 months 7 days\ 280 days' \ 10 moon months) from the last menstrual period. Missed periods, tender breasts, nausea and vomiting, hunger, frequent urination and other premenstrual symptoms all indicates that you may be pregnant. Consult your doctor and have a pregnancy test as soon as possible.

Once you come to know that you are pregnant, get ready for a change in lifestyle and diet. Pregnancy period is generally classified to three trimesters.

• First trimester – 1 to 3 months including conception
• Second trimester – 4 to 6 months
• Third trimester – 7th month to delivery

First Trimester

The first day of your last period to the end of week 12 is considered as the first trimester. This means that when your urine shows double lines in the stick, you are likely to be 5 or 6 weeks pregnant. A lot happens during these first three months. Almost 25% of pregnant women show up a "show" i.e. slight bleeding during their first trimester (implantation bleeding).

Conception occurs in this time. Foods that enhances the growth of zygote and which aids proper implantation should be taken during this time.

Please avoid the foods that are difficult to digest, also which are pungent, sour and salty.

Unripe Papaya (latin – carica papaya) and pineapple (latin – ananus comosus) are always a question by pregnant ladies. Unripe papaya can initiate premature uterine contraction. Certain enzymes in pineapple may cause the softening of cervix. Both are not good in early pregnancy. So it is better to be on safe side by avoiding these two food items.

Drink plenty of water (3 liters per day). Include tender coconut water, butter milk, rice gruel and fruit juices. This may help to minimize the stretch marks after delivery.

Normally, medical checkups should be done once in a month till 7 months, twice a month till 36 weeks and there after weekly once till delivery.

Folic acid, calcium and iron tablets should be taken according to doctor's prescription.

HOW MUCH FOLIC ACID DO I NEED TO TAKE DURING MY PREGNANCY?

It is recommended to have daily 5 mg folic acid supplement intake for 6 months prior to conception. It should be continued to 12 weeks of pregnancy.

This folic acid intake before and during pregnancy will help the fetus to fight against the neural tube defects including spina bifida.

The folic acid which we get through our food is referred to as folate. The major sources of folate in food includes:
Green leafy vegetables : Lamb's quarters (bathua), mustard greens (sarson), coriander (hara dhania), fenugreek leaves (methi), radish (mooli) leaves, mint (pudina) ,lettuce (salad patta) and spinach (paalak).

Vegetables: Bottle gourd (lauki), apple gourd (tinda), lady's finger (bhindi), carrot (gajar), beetroot (chukandar), bitter gourd (karela), capsicum (shimla mirch), cauliflower (phool gobhi), cauliflower (phool gobhi), asparagus (shatwar/sootmooli), cabbage (patta gobhi), broccoli (hari gobhi), french beans (been), peas (matar), corn (makai) and brussels sprouts (chhoti gobhi).

Lentils and Pulses: Bengal gram (chana), soya beans, black-eyed beans (lobhia), chickpeas (kabuli chana) and kidney beans (rajma).

Fruits: oranges (narangi/santara), muskmelon (kharbuja), pomegranate (anaar), avocado or butter fruit (makhanphal), guava (amrood), sweet lime (mausambi, kinnow) and strawberries.

Fortified breakfast cereal: Cornflakes, whole wheat flakes, oats, wheat germ and wheat bran. Whole wheat flour, whole meal bread,and whole wheat pasta.

Dry fruits and nuts: Peanuts (moongphali), walnuts (akhrot), and almonds (badaam).

Ayurveda prescribes medicine and diet plan for every month of pregnancy. Also emphasizes the factors that affect the mental faculty of the progeny. The mental faculty of parents and the sounds heard repeatedly by the mother accounts for this. So all the expecting mothers please relax and enjoy some nice music.

Ayurveda put forwards the concept of pumsavana to have healthy and desired progeny. Also Ayurveda describes certain measures for the maintenance of pregnancy. Milk or boiled with drugs like brahmi (latin – bacopa monnieri), durva (latin – cynodon dactylon), giloy (tinospora cordifolia), neem (picrorhiza kurroa cordifolia), bala (sida cordifolia) should be taken during pregnancy.

AYURVEDA MENTIONS ABOUT CERTAIN FACTORS THAT MAY AFFECT HEALTHY PREGNANCY. THIS INCLUDES:

• Resorting to seats which are uncomfortable irregular and high
• Inhibition of the urges of flatus, micturition and defecation
• Resorting to difficult and unsuitable exercises
• Intake of sharp and hot food, food in excessive quantity or in less quantity
• Injury or pressure frequently, physical assaults
• Hearing of loud noises in excess
• Habitually resorting to sexual intercourse
• Constantly given to grief and anger
• Addiction to alcohol and smoking

Avoid all the above mentioned factors. Sure, you will have a safe delivery.

Certain milk decoctions for every month are prescribed in Ayurveda for healthy mother and fetus.

1. First month – roots of bala (sida cordifolia)
2. Second month – lakhmana  (ipomoea marginata)
3. Third month – brhathi (solanum indicum) and kantakari (solanum surratense)

METHOD OF PREPARATION OF MILK DECOCTION

30 gms of drug is washed well and crushed. This is added to 150 ml of milk and 600 ml water. It is boiled well and reduced to 150 ml. This should be taken in twice daily before food. Those who are reluctant to have this can take it at least for first 10 days of the month. Bala (sida cordifolia) alone can be used to prepare the drink for every month.

Proper administration of such drinks helps to

• Increases the Hb content of blood
• Reduces the chances of miscarriage
• Fights against pregnancy infections like rubella (TORCH infections)

Milk, butter, shashtika rice should be taken in first trimester. Shastika rice is best in third month of pregnancy.

During the first trimester of your pregnancy, actually won't likely need any additional calories. Instead of the additional calories, you should focus on choosing nutritious food items that keep up your energy and for supporting your baby's development.

In charaka samhita, acharya it is mentioned about the regimens for pregnant woman. During the first month she should take milk in adequate quantity regularly. She should take wholesome food in morning and evening. During second month, milk should be given boiled with drugs having sweet taste. During third month, milk mixed with honey and ghee should be given.

• Spinach – Spinach is high in folic acid, which is crucial in allowing your babies neural tube to properly fuse in the first month after consumption.
• Lentils – Protein is important during each trimester, as it aids in the proper growth of your babies tissue and muscle.
• Lean Beef- Beef is great source of iron and as long as you do not eat it under cooked, beef is great for you and your unborn baby.
  Note : The best choice for expecting moms is organic, grass-fed, and hormone-free.
• Salmon- Calcium and vitamin D are rich in salmon and is one of the safer fish to eat during pregnancy.
• Collard Greens- Collard greens are high in iron and many pregnant women lack enough iron.
• Chicken- Chicken is high in iron which creates red blood cells and helps your body get enough oxygen.
• Yogurt- Calcium and vitamin D is rich in yogurt and it ensures your body is getting enough which prevents your baby from having to “steal” it from your bones while eating.
• Broccoli- Broccoli really contains a high amount of iron which is needed in the first trimester to form red blood cells & hemoglobin in your baby.
• Eggs- Aside from being an excellent source of protein, eggs are high in calcium and vitamin D as well, both of which are needed for your baby for proper formation of bones.
• Asparagus- Asparagus is high in vitamin D of which many women are deficient.
• Nuts- Pregnant women need an extra 60grams of protein a day beginning the first trimester of pregnancy. Avoid if you have allergy.
• Cottage Cheese- Cottage cheese contains both calcium and proteins which are good for muscle and bone development. Always have food which is properly cleaned and cooked perfectly.

Avoid food which can cause allergy (especially shrimps). This may vary from person to person. Change the diet according to your body constitution and cravings.

COMMON PROBLEMS DURING FIRST TRIMESTER & ITS MANAGEMENT

• Keep biscuits (or cream crackers) by your bed and nibble one or two before getting up from your bed in the morning.
• Have a ginger-based drink, such as ginger tea (adrak ki chai), ginger ale or a cup of hot water with a slice of fresh ginger and lemon.
• When you feel nauseous in this period you should chew one piece of fresh or dried ginger.
• Fresh coriander or mint and sniff freshly cut lemons.
• Pomegranate juice
• Tender coconut water
• Coriander water with sugar
• Water boiled with puffed rice or puffed rice gruel
• Guduchyadi panaka

Consult doctor immediately if bleeding, lower abdominal cramps and back ache occur.

URINARY RELATED PROBLEMS, LEUCORRHEA

Pressure exerted by the fetus on urinary bladder makes an increased urge for urination. Also the change in the pH of vaginal discharges may lead to leucorrhea and candidiasis like infections. Coriander water, coconut water helps in this. Proper voiding of urine also should be taken care of. Personal cleanliness should be maintained well. If infection is present vaginal area can be washed with nalpamara powder or triphala powder mixed with lukewarm water.

CONSTIPATION, PILES

Due to the increased activity of progesterone hormone, constipation occurs during pregnancy.

• Eat more fiber
• Have 2 – 3 prunes daily. Having more prunes may result in diarrhea, which is not advisable in first trimester.
• Flours and cereals with bran
• Gooseberry (amla – emblic myrobalan)
• Elephant yam (Amorphophallus paeoniifolius)
• Leafy vegetables and fruits
• Shallots (allium cepa)

Severe constipation if left unmanaged, leads to piles.

In case of Heart burn & regurgitation one must chew little coriander.

Second Trimester

"There is no better feeling than the movement of life inside you"

Yes, it's the phase where you can feel your little ones kicks and jerks. The baby's fingers and toes are well- defined in the second trimester of pregnancy -months 4, 5, and 6. Eyebrows, eyelids, nails, eyelashes, and hair are formed, and teeth and bones of the fetus become denser. At this point of pregnancy the nervous system starts to function.

It is also called as the honeymoon period of pregnancy, nausea subsides, emotions even out and sex drive returns. Now you can relax a little as the restrictions over the travels can be reduced.

You may always feel hungry. But try to avoid over sweetness especially refined sugar and packaged foods. Include all kind of food in the diet. Don't stick to a specific kind of food.

It's the time to have an appointment for your second trimester scan.

Milk decoctions prescribed for second trimester are

1. Forth month – roots of shalaparni (desmodium gangeticum)
2. Fifth month – giloy (tinospora cordifolia)
3. Sixth month – kantakari (solanum surratense\xanthocarpum)

You have to increase your daily calorie intake by 300 to 350 calories per day.

• If you don’t have enough weight, especially once you hit your second trimester (when morning sickness and food aversions subside), & if you are not getting enough of your Daily calorie (there are 12 types of foods that are really important for a healthy mother & baby. This includes protein, calcium, whole grains and legumes, vitamin C foods, green leafy and yellow vegetables and fruits, other fruits and vegetables, the right amount of fats and salty foods, water and other fluids, iron-rich foods and your prenatal vitamin supplements). If you are in this category, try to increase the Daily calorie each day, such as lean protein, whole grains & calcium-rich foods. If you still have trouble in gaining enough weight, speak with your dietician.
• On the other hand, if you gain weight too quickly or you’re likely getting more calories than you need, it may have negative effect for you and your baby including gestational diabetes, preeclampsia and preterm birth. So make some planning for a well-balanced diet (i.e. eliminate refined and processed calorie-dense but nutrient-less foods) and ensure that you're not cutting out the essential nutrients that your baby wants.

SPECIAL DIET IN

• Forth month – shastika rice with curd. If your digestive power is good you can have non veg too. Milk should be given along with butter in 12 gms dose.
• Fifth month – shastika rice, meat, milk, ghee. Ghee is particularly important.
• Sixth month – ghee prepared with gokshura juice (tribulus terrestris) along with rice gruel. Ghee taken out directly from milk and boiled with drugs having sweet taste can be given

CONTRAINDICATIONS IN SECOND TRIMESTER

• Weight lifting and strenuous exertion
• Lying in supine and prone position (lying on left side is always better)
• Depression, anger, fear
• Fasting
• Foods that increases the body heat, pungent
• Excess sweet (causes gestational diabetes, obesity)
• Excess salt (causes gestational hypertension, may affect the health of babys hair)
• Excess sour (causes skin and eye diseases)

COMMON PROBLEMS DURING SECOND TRIMESTER & ITS MANAGEMENT

• Back ache: Pressure exerted by the increased body weight and your raised fundal height causes back pain. Some may experience back pain extending from lumbar region to the leg (sciatica). This is because of the force exerted on sciatic nerve by your fetus. His sudden movement may trigger this. Sit straight. Lie on your left side. Place a pillow in between your legs while sleeping. Avoid the use of heels during pregnancy.
• Breast tenderness: Your body is preparing to feed your little one. Use clean loose and cotton inners.
• Gum bleeding: Hormonal changes make your gums soft and it may bleed. Gargle lukewarm water boiled with thriphala.
• Nasal bleeding: Place a cool cotton ball on nose.
• Increased vaginal discharge and urination continue as in first trimester.
• Increased hair growth is noted. Unwanted hairs can be removed by daily scrubbing it with turmeric.
• Headache: Decrease your mental tensions. Relax by practicing yoga and meditation. Apply rasnadi choorna over the forehead either using lemon juice or lukewarm water.
• Leg pain with swelling: Drink plenty of water. Take enough rest. Reduce salt intake. Consult doctor if condition persists.
• Anemia: A pregnant lady requires at least 10 gm% Hb. Iron tablets should be taken as per doctor’s advice.
• Pre eclampsia: Hypertension, swollen legs, presence of albumin in urine indicates pre eclampsia of pregnancy. Milk decoctions, maha dhanwantharam tablet is found to be useful. Ghee prepared with gokshura juice (tribulus terrestris) is good in this.

ABHYANGA AND YOGA IN PREGNANCY

Daily bath with oil massage will ease your pregnancy. Abhyanga with dhanwantharam thailam is advisable. You can select your oil after consulting with an Ayurveda physician.

Yoga therapy not only eases your pregnancy period but also helps you to have a safe and normal delivery. Practice yoga with proper guidance from your doctor. Some of the yoga asanas practiced during pregnancy is

• Thaalasanam
• Sukhasanam
• Vajrasanam
• Anantha shayanasanam
• Namaskara asanam
• Hastha utthanasanam

Third Trimester

Welcome to the third trimester! False contractions like Braxton Hicks contractions usually start about now. They feel like an intermittent tightening in your abdomen. Third trimester includes weeks 29 to 40. The end of your pregnancy is nearby. Wait a bit. . Your baby is arriving soon. It is okay to have tiredness and sure, you are so excited to have your little one.

Continue taking your prenatal vitamins. Stay active unless you're experiencing swelling or pain. Do Kegel exercises and work out for strengthening your pelvic floor muscles. An extra of 500 calories per day is needed for your body at this phase of pregnancy. To enhance this calorific value have a diet high in fruits, vegetables, low-fat forms of protein, and fiber.

You may have sleepless nights. Please don't resort to sedative pills. Get the help of your partner and get your foot soles massaged.

Massage your nipples with butter to avoid cracked nipples.

MILK DECOCTIONS USED ARE

1. Seventh month – barley with bran
2. Eighth month – roots of murva (Latin name- Marsdenia tenacissima )
3. Ninth month – shatavari (asparagus racemosus)

FOODS AND AMNIOTIC FLUID

• Golden melon (cucumis melo)
• Passion fruit (passiflora edulis)
• Tender coconut water
• Water melon, strawberries, tomato

THIRD TRIMESTER DIET CHART

• Magnesium rich foods - Nuts, whole grains, avocado, dark green leafy vegetables
• Protein rich foods - Milk, eggs, yogurt, tofu
• Calcium rich foods - Watercress, broccoli, cheese
• Folic acid rich foods - Beans, lentils,Brussels sprouts
• Iron rich foods - Beans, Breads and pastas, red meat

During seventh month pregnant mother should be made to drink 12 gms of butter boiled with sweet drugs along with kola (zizyphus jujube) decotion.

Itching occurs in seventh month due to increased blood supply and due to the disturbance to normal bile flow. To ease this symptom,

• Anoint the body with the paste of chandana (santalum album), powder of sirisha (albizia lebbeck), sarshapa (brassica nigra) or madhuka (glycyrriza glabra)
• Paste of nimba (azadirachta indica)
• Surasa (ocimum sanctum), manjistha (rubia cordifoila) is also useful
• Thriphala choorna can also be used
• Bath should be using water boiled with leaves of karavira (nerium indicum), malathi (aganosma dichotoma) or madhuka (glycyrriza glabra)

If you feel itched, please don't scratch, it may injure the skin and disfigure it. If it is intolerable, gentle kneading and friction massage can be done.

During eighth month, she should regularly take milk and gruel added with ghee. By doing this, the mother herself will keep good health and give birth to a child endowed with excellence of health, strength, complexion and compactness which will make him the best even among the children of the entire clan.

During ninth month, she should be given anuvasana basthi (unctuous enema). Cotton swabs soaked in dhanwantharam thailam should be kept in vagina for the oleation of the uterus and genital tract. This helps in the downward movement of vata and helps in delivery with ease of desirable and healthy child endowed with excellent qualities in proper time.

You can include pineapple in your diet which may help to induce the labor.

SEXUAL INTERCOURSE AND PREGNANCY

The pregnant women who are having normal pregnancy (without much complication) can have sex until their fluid leaks or the labor pain begins. If you are not sure about your complications, be free to ask your practitioner. Sexual intercourse in pregnancy will not affect the baby as the fetus is covered in amniotic sac. Also the strong uterine muscles protect the baby. A thick mucus plug seals the cervix and guard against infection. During intercourse, the penis doesn't reach the baby as it doesn't go beyond the vagina.

Most women have an uncontrollable sex drive during the second trimester. Don't feel ashamed. It's natural. It's not you; your hormones and increased blood supply to cervix and vagina are the real culprits. Sex in second trimester is safe. But Ayurveda restricts over indulgence in sexual intercourse.

Sex in third trimester is safe more over sperms can induce labor. Hormonal changes during orgasm may help to stimulate your uterine contractions. Having orgasm can trigger the release of oxytocin. Oxytocin is the hormone that helps your contractions. Semen may help to soften, or ripen your cervix & can make it ready to open when labor starts.

You should avoid sexual intercourse in the following circumstances:

Bleeding or spotting after sex: those who have noticed bleeding or spotting after sexual intercourse should probably avoid intercourse. Also consult your healthcare provider to determine the cause as soon as possible.

Placenta previa: it is one of the main pregnancy complications. Here the placenta either totally or partially covers the cervix. Those who are diagnosed with placenta previa should avoid sexual intercourse, as it could cause serious problems.

When your fluid leaks towards labor, you should abstain from sexual intercourse, as the fetus is no longer protected by the membranes.

POSTPARTUM CARE

The first six weeks after childbirth is referred to as the postpartum period. This is really exciting and enjoying time, but it is also painful and hectic for a new mother to adjust to her new surroundings. Bonding with your baby happens in these weeks and make sure you never miss your postpartum checkups with your physician.

It is equally important to take care of new mothers like a newborn. Of course, the mom is also a newly born in every sense. Her body strength as well as her mental strength should be taken as prior importance.

BABY BLUES VS. POSTPARTUM DEPRESSION

During pregnancy, the mother might have dreamt of many events like the sex of the child, its complexion and so on. Also she may have expected a normal delivery, but might have ended in emergency c – section. Sometimes she had complication with her delivery. She has to struggle a lot to cope up with the new situation. This may lead to depression. This is known as baby blues or postpartum depression. It may extend to two weeks after delivery. This is mainly due to changes in the hormonal level in the body. 70 – 80% of women tend to experience mood swings & negative feelings after delivery. Symptoms of depression may vary from person to person. Sometimes there won't be any symptoms at all. Some of them are:

• unexplained crying
• irritability
• insomnia
• sadness
• mood changes
• restlessness

Your nights become sleepless. Your days become hectic. Your baby is sucking out all your energy. Also you have to get back to your work as soon as possible. Here are some tips that may help you to a great extent.

• Relax and have some rest. Take rest as much as possible. You should feed your baby in every 3 hours. Have enough sleep. If you had c – section, rest more.
• Ask for help when needed. You should ask for help when needed. Your beloved ones can understand you and they are ready for you. Ask help, please don’t hesitate.
• Have a well-balanced diet. Have a healthy diet that helps you to heal. Try to increase the use of vegetables, fruits, whole grains and protein.
• Exercise. Discuss with your doctor before starting exercises. You may need a little more time to exercise if you had a c – section. Start with light warming ups.
• Drink enough water to stay hydrated. Less intake of water can lead to urinary infections. Having more quantity of water can cause inflammation due to the raised levels of hormones in the body.
• Abdominal bandaging (vibandha bandage) should be done. This not only helps to reduce the tummy but also alleviates the aggravated vata and reduces back pain. Abdomen should be bandaged with a cloth of 15 cm wide and should be bandaged including the lower tummy. It is to be removed after 5 to 6 hours. Ladies who undergo caesarian section can also do this. But start only after 2 weeks.
• Oil massage bath is also recommended during this time. Dhanwantharam thailam can be used. Balaswagandhadi Taila, Ksheerabala taila or Bala taila can also be used. Those who had caesarian section can also use dhanwantharam tailm in combination with panda thailam. Adding turmeric to the oil enhances glowing skin and also removes unwanted hair developed during pregnancy. Hot water bath is advised. It doesn’t mean than you should have boiling water. Heat should be balanced to your tolerance level. This should be continued atleast for 7\14 days.
• Water for bathing can be boiled with nalparamara choornam, castor leaves (ricinus communis), ixora coccinea leaves or bhandika (clerodendrum infortunatum). Water should be boiled on the previous day and again boil it before use.

DIET IN POSTPARTUM

Avoid non vegetarian diet for first 12 days after delivery. Having meat initially can cause digestive problems. Later small fishes, mutton soup can be included in the diet according to hunger. Tuna and mackerel fish even though helps to increase breast milk but can cause stomach pain. So it is better to avoid it.

Include vegetables, fruits, fiber rich food, and tender coconut water to ease the difficulties of constipation.

Include ragi, wheat, green gram in your diet rather other processed food stuffs.

COMMON AYURVEDA MEDICINES GIVEN IN POSTPARTUM

• Panchakola choornam
• Dasamoolarishtam
• Jeerakadyarishtam
• Indukantham kashaya
• Dhanwanthram kashaya
• Kurunji kuzhambu (linctus made of strobilanthes kunthiana)
• Ulli lehyam (linctus made of shallots)
• Leaf porridge – leaves of biophytum sensitivum, cotton plant (gossypium), azima tetracantha, etc.
• Fenugreek porridge
• Turmeric porridge

The first three months after delivery is really very crucial for the mother. It is in this period, the body changes back to pre-pregnancy. The expanded uterus shrinks back & regains the normal position. The muscles, ligaments and tendons associated with uterus start to gain back the lost power.

AIMS OF POSTNATAL CARE (SUTIKA PARICHARYA)

• To restore the agni. (Digestive fire)
• Normalize the vata, which may vitiated after the delivery
• Optimize the quality of breast milk.
• To avoid exertion.
• To prevent the complaints during Sutika kala such as UTI, Backache, Loss of appetite, Thirst, Anxiety, Anger, Disturbed sleep, Depression, etc.

Musta – Nut grass – It helps to improve breast milk production and also relieves milk duct clogs. Musta paste is made by grinding in water. This is applied over the breasts helping to relieve inflammation and to improve lactation. A decoction of musta is made and administered to the mother, If the baby has mild fever or diarrhea.

Shatavari – shatavari is powdered and boiled in milk. It is consumed for 3 – 4 months to improve breast milk production. Apart from improving breast milk, it is also useful in post-partum depression. It helps in normal involution of uterus (changes back to pre-pregnancy state) as well.

Yashtimadhu (Mulethi, Licorice) and fennel are the other two herbs used for improving lactation.

HOME REMEDY FOR CLEANSING UTERUS

Mukkutti ( Biophytum sensitivum): leaves of mukkuti is crushed and boiled well in water and given to the delivered ladies to expel the lochia and other remains from the uterus.

MEDICINES FOR THE BABY

Apply Lakshadi keram overhead and Nalpamaradi keram over body for massage according to the prescription of a doctor and give warm water bath. The water should be boiled with Nalpamaradi powdered and filtered well through a clean cloth. These mentioned oils will provide strength to muscles and bones. These also have antiseptic and anti-allergic properties. It enhances complexion and give nourishment to skin.

Uramarunu (traditional medicine for newborn baby) – it is a Preventive and curative aid for digestive disorders in infants and children in tablet form. This is very effective in indigestion in babies. It normalizes the intestinal flora. This medicine includes drugs like garlic, asafoetida, nutmeg, rasna (alpinia galanga), yashtimadhu (glycirrhza glabra), ugragandha (trachyspermum ammi), hareerathaki (terminalia chebula), vaca (acorus calamus) etc. it should be given with breast milk.

FOR THE FIRST 15 DAYS

• Dasamoolarishtam + jeerakadyarishtam : 30 ml twice daily after food. Dasamoolarishtm should be slightly more. Otherwise there are chances of having stomach pain.
• Fenugreek porridge for breakfast
• Ulli lehyam - 1 tablespoon at night after food

NEXT 15 DAYS

• Dhanwantharam kashayam: 15 ml of kashaya mixed with 45 ml of lukewarm water twice daily before food
• Dhanwantharam gulika : twice daily with kashaya
• Kurunji kuzhampu: 1 tsp twice daily after food
• Vidaryadi lehyam, shatavari gulam etc. as directed by an Ayurveda physician.
• Some Ayurveda physicians’ opine that for the first day after delivery, she should take dry ginger powder with jaggery (heated together to form linctus), thrice a day. This will alleviate the aggravated vata and prepare the digestive fire for the upcoming medicines.
• Diabetic mothers can take accordingly to physicians’ prescription.

EXERCISES AND YOGA THERAPY IN POSTPARTUM

Delivery weakens your uterine muscles and loosens your pelvic floor. These are strengthened by exercises and yoga therapy. Start up slowly with warm ups. Slowly increase the turns. Slowly you will get back to your pre- pregnancy body. Tighten and then relax the perineal muscles. Do it again and again. Consult your doctor before starting exercise if you had caesarian.

Do pranaayama in postpartum. This will help a lot in managing the postpartum depression.

Yoga postures to be included in post -partum:

• Kegels exercise – in weakened pelvic floor
• Gomukha asana – in aching neck and shoulders
• Virabhadra asana – helps in loss of endurance
• Pelvic rocking – in weakened Abs
• Viparita karani – is a great solution for fatigue
• Pavana mukta asanam – for aggravated vata. Relives flatulence

BREASTFEEDING

Breastfeeding helps to have a magical bonding with you and your little one. It also has many health benefits for your baby. But it may not be much enjoyable to every mother. Some may have pain on feeding. This can cause stress in them. The pain can be caused due to following causes : breast engorgement, cracked or bleeding nipples, sore, oversupply or low supply of breast milk, reflux and mastitis (blocked milk ducts).

The most natural way to feed your baby is Breastfeeding.

When the baby latches your breast you should give an attention to how it does. Baby's mouth should cover a big part of the areola below the nipple, and your baby's mouth should be far back to the nipple in. When the suction hurts, break the suction (by inserting your little finger between your baby's mouth and your feeding breast) and try again. Feed after every 3 hours interval for newborns.

HOW TO INCREASE MILK SUPPLY?

• Feed in every 3 hours. Increased feeding increases the milk supply.
• Include vegetables fruits and legumes in the diet.
• Include moringa leaves, fenugreek, papaya, carrot, garlic, spinach, asparagus, almonds and cashew nuts.
• Avoid shrimps during lactation
• Avoid spicy and sour foods

IN AYURVEDA

• Wash the breasts using decoction made of chandana (santalum album), ushira (vetiveria zizanioides) and roots of bala (sida cordifolia)
• Moringa leaves are boiled with salt in water. Water is then strained out. Filtrate is heated with ghee. This ghee preparation taken in night will increase breast milk.
• Kashaya made from jeevanthi (holastemma adakodien) can be taken for increased laction.
• Shatika rice with milk or ghee at night is good during lactation
• Kashaya prepared with jeevanthi (holastemma adakodien), shatavari (asparagus racemosa) and ivy gourd (coccinis grandis) is also useful
• Having oat meal also helps in good lactation

WHAT TO GIVE IF MOTHER IS NOT LACTATING WELL?

• Ayurveda insists to take the baby to other lactating ladies (concept of dathri).
• Butter can be given to the baby.
• Cow’s milk or goat’s milk can be given. It should be perfectly boiled and processed with medicinal herbs.
• Equal quantity of water should be boiled with milk and is reduced to half. This can be given to the baby. Otherwise some babies may have stomach pain.

HERBS USED ARE

• Roots of shalaparni (desmodium gangeticum)
• Roots of prishniparni (pseudoarthria viscid)
• Roots of pashanabheda (aerva lanata)
• Roots of varttaki (solanum meolgena)
• Mustha – cyperus rotundus

If you notice these signs, your baby should be getting enough milk:

• Feeding of your baby will be multiple times of a day.
• Your breast feels free of pain and comfortable after breastfeeding started for the first few sucks.
• After feeding, your breast will feel soft.
• When the feed began, your breast will feel slightly elongated.
• For the first 48 hours the baby’s wetting will be 3 to 4 nappies and after that it will be frequent. When he's over five days old, he should have at least six wet nappies in a day. Baby's pee should be pale and odourless.
• Once if the baby is latched properly, you could clearly hear the sound of swallowing, when the milk starts to come in.
• Normally, the baby’s poo has mustard yellow color, when he is five days old. It is also normal to have slightly greenish yellow poo until he is 2 weeks old.
• Don’t over feed your baby. This may cause vomiting and can make the stomach upset and the baby gets irritated and tough to sleep.

PROBLEMS DURING LACTATION & ITS MANAGEMENT

The most common breastfeeding-related problems and how to avoid then are listed below:

Sore and cracked nipples. Check the position of the baby when she latches on; butter or shatadoutha gritha over your nipples after each nursing session; and let your nipples air dry after each nursing session. Also, alternate which breast you start on for each session. If the baby is positioned well and his latching is good, there will not be any clicking sound. Hold the baby closer to you as much as possible and the areola part of the nipples should be in the baby's mouth for proper feeding.

• Apply ivy gourd leaves juice with butter over the cracked nipples.
• Ixora flower processed in coconut milk can be applied.
• Paste of tulsi leaves can be applied.
• Pumpkin bud paste with salt can also be used
• Rubbing breast milk itself is good

Engorgement (overly full breasts) or blocked milk duct. Warmly massage your breasts, slightly warm compression; washing the breasts with slight warm water may help you in this situation. Laying cabbage leaves or jasmine flowers on your breasts can help relieve some of the pressure. Express out some milk in between feeds.

Mastitis or breast infection. Feverish feeling, red, hot, sore breasts with mild tenderness all indicates the chance of breast infection. Consult with your doctor. The only way to prevent mastitis is breast feeding. Express out some if you feel fullness of breast. Carelessness to fullness of breast may lead to mastitis.

Thrush. Thrush is a fungal infection. Careless oil massage & bath is the main reason to this. It may start in the breast and when the baby latches on to breasts it may spread to baby's mouth. Oils applied on the breast should be thoroughly removed before you breast feed your baby. Other reasons for thrush include cracked or sore nipples, following a diet high in sugar or yeasty foods or taking antibiotics, birth control pills or steroids. All these can throw your body's natural yeast levels out of control and lead to thrush. The symptoms of thrush include very achy or painful breasts, sore nipples, or shiny, itchy, pink, flaky or cracked nipples.

It's a truth. Pregnancy and postpartum is really hectic. But enjoy it. The best thing in the world is seeing your baby smile because of you.