A Primer on Ayurveda for the Childbearing Years Part 3: Ayurveda for Pregnancy and Childbirth.

Editor's note: This is third in a series of articles about Ayurveda and women's health. Please refer to the Spring and Summer 2001 issues of Special Delivery for Parts 1 and 2 of this series, and for definitions of terms. Throughout, the author has indicated increasing or decreasing doshas using a "+" or a "-" sign, respectively, as well as using the initial of the dosha.

Pregnancy is a very special season in the life of a woman. Tremendous changes happen within-physically, mentally, emotionally, and spiritually. There is a tendency in our culture for women to ignore their pregnancy (as they try to ignore their menstrual/fertility cycles) and act as though there is nothing different about them except that there's a baby growing inside.

Ayurvedic teachings promote a proper attitude of worship toward all pregnant women. They are fulfilling the very important full-time role of bringing new life into the world. Their experiences in pregnancy directly feed into the sensory and neural organs of the developing child--so the more beautiful, loving, and uplifting the mother's experience, the healthier the child will tend to perceive the world throughout his or her life.

Wise women give themselves all the space and time possible to turn inward during their pregnancies, to listen to their bodies and their intuitions, and to tune in to the beneficial forces available to them in the physical and spiritual worlds. In this way, they give birth with grace and their children are blessed with the best possible start in the world.

Energetically, pregnancy is full of change, creativity, and expansion, so vata is normally emphasized. Metabolism warmth in the body is increased so pitta is normally increased. Additionally, the bulk of the body is increased so kapha is also normally increased. In each woman these changes are interplaying with her constitution, the baby's constitution, and her environmental influences.

The intricacy of working with pregnant women is further increased by the need to avoid any therapies and herbs that may disturb the uterus and the apana prana or downward energy. The apana prana is key to maintaining the pregnancy as well as birthing the baby. This is why it is very important to take care of imbalanced conditions before pregnancy whenever possible, because it is generally more complex to treat women during pregnancy. Prevention is emphasized for selfcare, with treatment generally reserved for experienced ayurvedic practitioners.

General Recommendations for Pregnancy Selfcare

Eat and follow a lifestyle according to current ayurvedic condition rather than strictly by constitution. This is because the baby's needs and desires start being felt more by the mother in her food preferences and energetics especially after the fifth month. Satisfy cravings while maintaining discrimination; eat fresh food; and avoid processed or leftover food, refined sugars, very spicy foods, food straight from the refrigerator or freezer, and chemical additives in foods.

Nutritional needs are increased during pregnancy--quantity as well as quality. During pregnancy a woman needs more calories, calcium, protein, and iron. Nourishing herbal infusions can help fulfill these needs. For pitta and kapha: red raspberry and/or nettles; for vata: oatstraw. The pregnant woman can drink up to a quart daily suitable for her type or one to two cups of other infusions.

To make an infusion put a big handful of herbs in quart jar, fill with boiling hot water, and let it sit four to six hours. Strain and refrigerate what isn't consumed immediately. Rewarm as needed. Organic herbs are always the best choice. Avoid herbs unsafe for pregnancy. (See page 7 for a list of Ayurvedic herbs for pregnancy.) Nutritional ayurvedic herbs and preparations that are also good include: ghee; chyvan prash VK- P+ for cold season; and shakti prana VPK-for hot season or if high P.

Eating is only the first step. Digesting is equally important. Rules for good digestion include: Eat only when your previous meal has been digested. Avoid foods you know you have difficulty digesting. Do not drink lots of liquids with your meal, especially cold drinks. Cooked, moist, soupy, and warm foods are generally easier to digest than raw. Adding digestive herbs to food may help digestion.

Signs of poor digestion include gas, belching, and stomach and intestinal discomforts. Ayurvedic digestive herbs safe for pregnancy include: mints; pippili; tarragon; cardamom; jasmine; cumin; cinnamon; and basil. Other digestive helps include: papaya (be aware that digestive enzymes may be pitta provoking on a long term basis). A substitute for papaya can be 1/2 teaspoon grated fresh ginger with a squeeze of lemon (or lime if you are pitta) with a pinch of salt taken ten to twenty minutes before meal time. This will stimulate one's own digestive enzymes into action, and is better than adding others artificially. To help with absorption, drink takram after meals. It is made by churning two tablespoons of unsweetened natural cows' yogurt with one cup of water and adding a pinch of salt and two pinches of cumin.

Happiness and the spiritual state of love are true nourishment for mother and the baby. Ways to increase these elements of your life are: worship, chant, meditate, pray, and contemplate the lives of great saints and other great beings; be with people who uplift you; avoid disturbing television or violent movies; have as beautiful and peaceful an environment as possible; eat only fresh whole foods.

The mate is an important part of the process--his or her time, energy, and nourishing of the mother is important to the development of the baby. Ayurveda recognizes that marital problems during pregnancy can even physically affect the baby--so nurturing the parents' relationship nurtures the baby and strengthens the safe haven it will be born into.

Ayurvedic fetal development teachings tell us that the constitution of the baby is formed by the genetic makeup of mother and father; the diet and emotions of the mother during pregnancy; environmental influences; and the samskaras or spiritual patterns that the soul brings in with it from previous incarnations.

Ayurveda teaches that the baby is physically conscious of his or her development, which is being confirmed today by the science of perinatal psychology. One important teaching is that what the mother takes in through her sense organs goes into the development of the baby's sense organs. This further emphasizes the importance of what kind of environment the woman is in during pregnancy. There were even traditional Ayurvedic ceremonies for different stages of pregnancy to "feed" the specific senses. Today we can emphasize as much as possible seeing beautiful and loving things, listening to loving and melodious sounds, touching pleasing things and being touched in loving ways, tasting wholesome tastes, and smelling fragrant odors during pregnancy.

Ayurvedic teachings believe that during the first two months only astral projection connects the baby to its current body. The fourth month is very critical--the heart starts to develop as the seat of consciousness. This leads to the baby's desires starting to express themselves through the mother's desires. After this time the mental body becomes connected to the physical body.

In the eighth month, ojas (vital fluid) moves from mother to the baby. This is the time to eat more ojas-producing foods and stay at home and rest to ensure vitality for both mother and baby. Avoid wasting energy needlessly--spend more time doing much less, letting the energy go inward. Be in nature; eat ghee, milk, dates, apricots, sesame seeds, ayurvedic tonics (ashwagunda or shatavari); chant om; be in touch with God/dess as you know Her or Him; meditate. What to avoid for guarding ojas: anger, worry, overwork, drugs or stimulants, hunger, sorrow, excessive sex, and devitalized food.

Rubbing warm sesame oil on the soles of the feet helps balance vata and also stimulates the energy points of the feet, keeping energy flowing throughout the body. A great way to unwind and to spend quiet time together is for mates to regularly give evening foot massages to each other (sesame oil may be too "hot" for pitas, almond oil might be better for them).

Sleeping in the day is not generally recommended as it can cause imbalances, especially for kapha people. Resting is beneficial at the right times and in the right amounts for personal needs.

Taking warm baths relaxes muscles when feeling tense. Tension inhibits circulation, thus inhibiting movement of both nutrition and energy. It keeps toxins locked into places rather than moving them out. Full body massage is very healthy; allowing the woman to integrate her body changes, while relaxing her and benefiting her physiologically.

Aromatherapy can be helpful also as part of tension relief--be sure to use only oils indicated safe for pregnancy! (Essential oils generally considered safe in pregnancy are tangerine, mandarin, grapefruit, geranium, Roman chamomile, rose bulgar, rose maroc, jasmine, ylang-ylang, and lavender.)

Avoid overly vigorous sex, especially at the usual times when menses would be expected or if there are any signs that the pregnancy is fragile (spotting or cramping or lots of low pressure). Sexual excesses may also use up ojas or cause doshic imbalances, especially of apana prana, which can cause many different problems of pregnancy and birth. Women are more susceptible to infections at this time too. Ayurveda traditionally encourages celibacy during pregnancy. Yoga asanas, pranayama, and meditation are ways to naturally control sexual desires through spiritual practice. The most important factors to consider if continuing an active sexual life are to do so in a loving context and with awareness of what feels comfortable and right to the woman.

Beginning the eighth month, begin to apply licorice ghee to vagina. Perineal massage four to five times per week will make the tissues healthy and supple, allowing them to stretch readily for the birthing of the baby. It also helps women get used to the unusual sensation of their vagina stretching to birth a baby. They can relax at that point and be less likely to tear, as well as keep from being overwhelmed with sensations or emotions during the pushing stage. It usually works best for the mate to do it for the woman, but if that's not possible she can try to stretch herself (on the toilet or lying on her side may work easier in this case).

Directions: Wash hands, then, using the licorice ghee as lubricant, insert one or two fingers along the bottom of the vagina. After a couple of inches there is a "drop-off" where the inner edge of the muscles lie. Massage the whole bottom half of this vaginal sling gently, yet firmly enough to create a definite stretching, burning sensation. Along with the massage, the woman should practice relaxing these muscles, while they are being stretched to their limit. Over a week or two there often is a noticeable change in stretchability. Continue pushing the limit of stretching and relaxing until the birth.

Traditionally, in the last month of pregnancy the woman may be given small, gentle therapeutic oil enemas to be sure that the apana prana is balanced for the work of labor. After this process she eats a predominantly vata-reducing diet, adjusted to her needs and the season. The emphasis is on preventing an imbalance of the apana prana, which can lead to malposition or uterine malfunction during labor. At least avoid holding back urine, gas, or bowel movements, getting chilled, or getting jarred to support the proper movement of the apana.

The proper caregiver is important during pregnancy, birth, and postpartum. This person should be both technically knowledgeable and openhearted. The woman must feel comfortable with this person--they will share the intimate moments of giving birth and be one of the first people the baby will relate to. If the birthing woman doesn't feel relaxed, uplifted, and trusting of this person it can impede the labor process, possibly leading to complications. Wise women pick someone familiar with many forms of healing, which can be used before resorting to drugs and surgery as solutions. Complete pregnancy care includes nutritional counseling and time to get questions answered and concerns addressed.

Exercises

Daily walks or swims are appropriate exercise, as well as yoga asanas indicated for pregnancy. Gentle stretching of the pelvis helps flexibility during labor. I recommend the book Active Birth by Janet Balaskas for exercises. Avoid too vigorous exercise, and exercise where injury is more likely, such as skiing or horseback riding. Jarring exercises can disturb the apana vayu. Never exercise to full capacity! This depletes ojas/immune and vital force, so key to building the baby's future health as well as the mother's.

The following exercises tone and strengthen the muscles of the pelvic floor, which, during pregnancy, must support the weight of the baby, as well as the uterus and bladder. They also help regulate the apana. These exercises are good for pelvic health throughout the life cycle, increasing strength, circulation, and health of tissues for greater orgasms as well as continued health through the elder years.

Ashwini Mudra 

This energy exercise helps balance vata and the apana prana energy, especially useful in pregnancy.

Directions: In a quiet place, eyes closed, inhale completely and hold the breath. Contract and release the anal sphincter rapidly and repeatedly. Hold the breath only so long as the following exhalation can be slow and controlled. Begin with three rounds of about ten pulls each. Don't bear down when holding the breath, which could strain ligaments and put downward pressure on the uterus. Don't do the breath part in a fragile pregnancy, just contract and release. Repeat daily.

Pelvic Floor Exercises (Kegels)

Once you know them practice, anywhere, anytime--even the grocery line! Do each 200 times per day, slowly or quickly, or elevator kegels, which tighten upward in levels.

Bladder-strengthening exercise: Practice tightening and releasing the muscles that control urine flow from the bladder. Do this first when urinating to find the muscles, then practice it other times.

Vaginal exercise: Practice tightening and releasing the muscles of the vagina. Tighten muscles around a finger or a penis to ensure you're using those muscles.

Labor and Birthing Care with Ayurveda

Traditionally; most births were taken care of by midwives rather than ayurvedic physicians. Because of this, many of the teachings about labor and birth are not written down in the texts (which were written by men) but passed on orally from midwife to apprentice. The physicians only dealt with the most complicated situations.

Ancient texts do talk about having special spaces for giving birth that would take into account the spiritual, as well as practical needs. When the woman was showing signs of beginning labor she would enter the birth space with special blessings and ceremony, to mark the significance of this time. She would be accompanied by birth attendants that were calm and supportive, inspiring the confidence of the birthing woman.

To awaken the apana prana for early labor an enema of dashamula tea can be used. To help keep balance of the vata energy, which is very high at this time, the woman must not become chilled. Massaging her with warm oil and giving her a warm bath, as well as feeding her broths and soups and avoiding icy cold drinks or foods can be useful for maintaining balance of vata and apana prana.

Marma points (ayurvedic energy points) can be massaged with appropriate essential oils to encourage labor and to soothe pain. (Remember that vata is involved wherever there is pain--keeping vata controlled helps control pain also.) The use of walking and massaging the pelvic area with warm sesame or castor oil will also help the baby move down in labor. All of these vata/apana soothing measures are also used to help when there is some malposition of the baby so that it can move more easily through the birth canal.

When the birth of the baby is approaching, licorice ghee is used again for perineal massage. After the climax of giving birth, the woman is kept comfortable and warm and fed vata-reducing foods such a stews and soups. The placenta is allowed to deliver most naturally and the cord is not cut until all pulsation has stopped. This allows the transfer of ojas to the baby to be complete, giving it good vital force and immunity. It can take one to two hours for pulsation of the cord to stop. Feel right next to the baby's tummy on the cord, measure eight fingers away from the baby's belly to find where to cut.

Traditionally, a special knife was used to cut the cord during a ceremony, again marking the ritual significance of the baby being severed from the mother. Antiseptic herbs or oils were used to keep the cord area free from infection until healed.

The baby is kept cozy and warm sesame oil is massaged onto the fontanelles to protect it from being overstimulated. A little hat, especially if made of silk, can help as well. Traditionally, babies were stimulated to spit up to clear their stomach of anything swallowed during labor. They were given special experiences to tune them into their vedic culture. One was feeding baby honey, ghee, and specially prepared edible gold to give the baby a type of ayurvedic immunization to the local pollens and dairy as well as to increase vitality. Other properties are also given by other substances: honey clears kapha, which is predominant in children; ghee increases the healthy fat in the brain to increase intellect, as well as nourish nerve and marrow tissues; and gold signifies wealth. A gold spoon can be used instead of gold preparation, if unavailable.

The baby is massaged with pure oil and bathed in mild herbal bath. Baby receives breastmilk as the best food. Before milk comes in babies are often traditionally fed ghee and honey, in the amount of a baby handful, just two to three times a day. Herbs can be used to enhance breast milk--shatavari, vidari, ajwain. (Ayurvedic physicians believe that it isn't honey that is a problem for babies--it's the processing of the honey that creates problems. One must get raw, unfiltered honey, not commercially processed. The teaching of ayurveda is that honey becomes mildly toxic when heated, which happens in most commercial processing.)

In this way the baby and mother have gone through the transitional time of pregnancy and childbirth with the nurturance and help of ayurveda. You'll learn more about ayurvedic postpartum care in the next installment of this series.

-- Terra Richardson practiced homebirth midwifery for thirteen years in Boulder, Colorado before retiring to focus on Wise Womanhood, offering midwifery training classes and holistic healing practice using ayurveda, flower essences, and Reiki energy healing. She coauthored Pregnant Feelings with Rahima Baldwin Dancy and wrote soon-to-be published Giving Birth to Ourselves--Contemplations for Midwives and Other Birth Companions. You can learn more about her classes and practice at http://wisewomanhood. bigstep.com or by calling 303-554-1800.

Ayurvedic Aids for Discomforts of Pregnancy

Morning sickness:

shatavari: roast ghee in an iron pan with cardamom and date sugar to increase digestion: pippili with ghee or milk

Anemia:

punanarva mandura tablets, brahmi ghee

Constipation:

one cup hot spiced cow's milk with one teaspoon ghee before bed (use spices according to your doshas); or, a little amalaki is okay, especially if high pitta or rata and pitta provoked

Hyperacidity with a coated tongue:

figs or small pinch amalaki

Heartburn, allergies:

coriander, shatavari, pinch of amalaki

Ayurvedic tonics:

chyvan prash (cold season) or shakti prana (hot season or P+), one teaspoon daily on empty stomach; fifteen minutes later have one cup warm milk (if not lactose intolerant)

For more on the discomforts of pregnancy:

Wisewoman Herbal for the Childbearing Year by Susun Weed for Western herbal helps

The Yoga of Herbs by Lad and Frawley to check herbs according to dosha

Commonly Used Ayurvedic Herbs for Pregnancy and Labor

Amalaki (amla) tonic: rejuvenative, alterative (use only a pinch in pregnancy)PV-K+

Ashoka: prevent miscarriage, gynecological problems, antitoxic (constipates) P-VK+

Ashwagunda: tonic, rejuvenative, aphrodisiac, nervine VK-P+

Bala: nutritive, rejuvenative, easier to digest

Bamboo manna or Vamsa rochana: for too much dryness, emaciation, bleeding PV-K+

Brahmi: rejuvenative, blood purifier, fortifies immune system, good for kidneys VP

Cardamon: digestant

Castor oil: externally on hips for apana prana in labor or internally to purge to begin labor

Cumin/coriander/fennel tea: digestant (fennel not for early or fragile pregnancy)

Ghee: carrier substance for herbs, tonic to pitta, increases agni and ojas V-PK neutral (don't mix in equal proportions with honey; not for high toxins, diarrhea, or parasites)

Guduchi: diuretic, liver tonic and stimulant P-

Licorice ghee: for perineal massage, also for cervical dysplasia (topical)

Lotus: nurturing tonic, aphrodisiac, astringent, nervine PV-K+

Pippili: stimulant (use only small amount in pregnancy), expectorant, aphrodisiac VK-P+

Punanarva: diuretic, diaphoretic, laxative, rejuvenative PK-V+

Shatavari: nutritive tonic, demulcent, emmenagogue, rejuvenative, build milk PV-K+

Vidari: nutritive tonic, demulcent, emmenagogue, rejuvenative PV-K+

Ayurvedic Herbs to Avoid in Pregnancy

When in doubt, don't take it. Check with an experienced herbalist or ayurvedic practitioner whenever possible before using any herbs in pregnancy, even if they seem to be totally unrelated to your uterus. Anything in excess should be avoided. Anything that imbalances your doshas should be avoided. Anything that stimulates menses (emmenagogues) or uterine contractions (oxytocics) should be avoided. Anything that is toxic should be avoided. Strongly hormonal herbs may throw off a normal balance don't take them except in specially indicated situations. Antihistamines, laxatives, and diuretics may also be dangerous during pregnancy.

If your pregnancy is in the first trimester or has shown any signs of fragility at any time be more cautious. Herbs to avoid during fragile or early times are noted with F/E. Some herbs may be okay if the pregnancy is firmly established, which is why you may find different lists that include different herbs.

Aloe
Berberis F/E or Vata
Bitter-scraping herbs
Dill F/E
Fennel F/E
Fenugreek
Ginger (a little fresh is okay)
Haritaki
Hing la little in food is okay)
Honey
Jatamansi
Licorice root
Mahasudarshan
Neem
Nutmeg
Trikatu
Triphala F/E
Triphala Guggulu
Tumeric
Vacha
Yogaraj Ouggulu

To order ayurvedic herbs and products call The Ayurvedic Institute at 505-291-9698; Banyan Trading Company: 800-953-6424