After Delivery Care Of Mother For First Three Months By Ayurveda

By Dr JV Hebbar
The first three months after delivery is very important for the mother. During this period, the expanded uterus shrinks back to normal position, ligaments, muscles and tendons associated with uterus start gaining back the lost power. Mother also recovers back the mental strength, which will be a bit low in the first week after delivery.

First week care after delivery

We have learnt in detail about the care of mother in the first week after delivery.
Click to read Ayurvedic Post Natal Care – The First Week After Delivery 

The following explanation is further to the first week care.
1. Oil massage and hot water bath – should be continued for the next 2 to 3 months. Oils preferred are – Balaswagandhadi Taila, Ksheerabala taila or Bala taila. It helps to strengthen the lower back, hip area, bones, muscles and ligaments.

Can lower abdomen and gluteal region be massaged with oil after delivery?
If the delivery is normal, then there is no problem in massaging the abdominal and waist area.
If the delivery was through surgery (caesarian), then better to avoid lower abdominal area, till the suture heals completely.
Click to read: Ayurvedic post natal care based on season and place

2. Lumbar belt –
Using an abdomen belt with moderate pressure at least for 4 – 5 hours a day helps to strengthen the back, supports uterus and ligaments.

Rest – While mild walking is quite okay, rigorous work, heavy weight lifting is totally discouraged. It leaves the uterine muscles and tendons weak. Uterine prolapse during post mid life is linked to improper after delivery care of mother and rest.

In case of normal delivery – rest for at least 3 months.
In case of CS delivery – rest for at last 4-5 months.

4 important herbs for after-delivery care

Ayurvedic medicines

Ayurveda explains different Ayurvedic products based on the need of the mother. Here is a general bird view regarding a few basic Ayurvedic products. Consult your Ayurvedic doctor for suitable suggestion. Self medication will be dangerous.

In Rural India and in folklore Ayurveda practice, they make a laddu out of dry fruits, called Gondh Ki Laddu or Edible Gum Laddu.
It is administered from 2nd week till 3 – 4 months to improve strength and immunity of the nursing mother.

As a general rule, Dashamoolarishtam is advised for the initial couple of months. It helps to relieve pain and inflammation. It also boosts immunity and keeps most of the infections at bay.
Usual dose is 5 ml, mixed with 10 ml water 2 times a day after food.
Please take note that in some people with very weak and sensitive stomach, Dasamoolaristam may cause gastritis / piles or fistula. If it is causing gastritis, use Dasamularishta only once per day, 5 ml, mixed with half a cup of lukewarm water, in the morning, after food for 2 months time.

Jeerakarishtam is advised especially for mothers during winter and rainy season. It helps to keep the body warm due to its hot nature. It also helps induce normal lactation.
Usual dose is 5 -10 ml, mixed with 10 ml water 2 times a day after food.

Shatavari Gulam is usually advised to achieve overall hormonal balance. It also helps to improve lactation.
Usual dose is 5 – 10 grams, 2 – 3 times a day, after food.

Pulilehyam – usually administered in Kerala Ayurveda practice. It is administered starting from the third week onward for 30 – 45 days.

Balanta Kada – number 1 – 3 is often prescribed by a few doctors.
Balant Kada no. 1 is  administered soon after delivery till next 10 days
Balanta kada no.2  is administered from 11th to 20th day after delivery
Balant Kada no. 3 is administered from 21st day after delivery till next 2 – 3 weeks time.

Note: All the products are not advised together. Usually doctor chooses a permutation and combination of medicines based on symptoms in the mother.

Commonly used herbs

Musta – Nut grass – It helps to improve breast milk production and also relieves milk duct clogs. Its paste is made with water and applied over breasts to relieve inflammation and to improve lactation. If the baby has mild fever or diarrhea, a water decoction of this herb is made and administered to the mother.

Shatavari – A teaspoon of powder is mixed with a cup of milk and boiled. It is administered for a period of 5th day to 3 – 4 months to improve breast milk production. Apart from improving breast milk, it is also useful to calm the mind (useful in post partum depression). It assists in normal involution of uterus as well.

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

Diet

She can have all the warm foods and freshly made hot dishes.
Avoid ice creams and excess oily foods.

Massage after childbirth

Can lower abdomen and gluteal region be massaged with oil after delivery? 
Answer by Dr Hebbar: If the delivery is normal, then there is no problem in massaging the abdominal and waist area. If the delivery was through surgery (caesarian), then better to avoid lower abdominal area, till the suture heals completely. 

Chosing massage oil

After childbirth,
To strengthen massage with muscle, ligament and tendons – Bala Ashwagandhadi taila  is chosen.
To relieve waist pain, Mahanarayana taila is used.
To relieve stiffness, Kottamchukkadi taila or Saindhavadya taila is used.
To relieve itchiness, nalpamaradi taila, mahamarichadi taila are used.
To relieve stretch marks, usually Kumkumadi taila, Nalpamaradi taila, Eladi taila are used.

Addition by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Sutika Rogahara Kashayam – for puerperal sickness / disorders

a. Bala Koduttuvadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 13

Ingredients	Botanical Name	Method of using	Indications
Bala	Sida cordifolia	The decoction prepared with these ingredients should be served fresh early in the morning	1.Cures Puerperal fevers
Duralabha	Fagonia cretica
Parpata	Fumaria officinalis
Musta	Cyperus rotundus
Coriander	Coriandrum sativum
Green gram	Vigna radiata
Laghu Panchamula	Desmodium gangeticum Uraria picta Solanum indicum Solanum xanthocarpum Tribulus terrestris
Ginger	Zingiber officinale

b. Sahacharadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 14

Ingredients	Botanical Name	Method of using	Indications
Sahachara	Strobilanthes heynianus	The decoction prepared with these ingredients should be served with asafetida and rock salt.	1.Cures Puerperal fevers 2.Colic
Horse gram	Dolichos biflorus
Pushkaramula	Inula racemosa
Devadaru	Cedrus deodara
Haridra and Daruharidra	Curcuma longa and Berberis aristata
Amlavetasa	Garcinia pedunculata

Sutika

Sutika is the name given to a woman who has not only delivered her child but has also expelled the placenta. Master Kashyapa opines that the woman shall be called as sutika only after the expulsion of placenta. Sutika thus means puerperal woman. Though other authors have not defined the term sutika, they have explained the management of puerperium only after the expulsion of placenta. Therefore all Ayuveda opinions converge at a common opinion.

Duration of puerperium

It is called Sutika Kala. With exclusion of Master Charaka other authors have mentioned a definitive period of dietetics and regimen for puerperal woman. This shall be considered as normal puerperal duration.
Read – Ayurvedic Post Natal Care – The First Week After Delivery

Sl No	Opinion on puerperal duration	Author / treatise	Cut off puerperal duration
1	a) After following regulated specific dietetics and mode of life for a time period of 1 and half months, the woman becomes free from sutika (epithet). b) The woman shall be called as sutika until her menstrual cycle starts.	Sushruta Vagbhata I Vagbhata II	1 ½ months Or Reappearance of menstrual cycle
2	Specific dietetic management should be done for 1 month.	Kashyapa, Bhavaprakasha Yogaratnakara	1 month
3	Puerperal duration is for 6 months	Kashyapa	6 months
4	After the complications and aggravation of doshas subside, the woman shall give up specific mode of life after 4 months.	Bhavaprakasha and Yogaratnakara (after agreeing with Sushruta’s explanation of 1 ½ months)	4 months

Read – Ayurvedic Post Natal Mother Care Based On Season And Place
Summing up the above said descriptions, we can find 4 different opinions on durations of sutika i.e. –

• 1 ½ months
• Reappearance of menstrual cycle
• 6 months
• 4 months

Certain anatomical changes take place in reproductive organs during pregnancy. After delivery, these changes almost revert back to their pre-pregnancy stage after about 6 weeks. But the physiological aspects including restart of ovarian and menstrual cycle show great individual variations in reverting back to the pre-pregnancy stage. In some women the menstrual cycle may restart from the 2^nd month of delivery. In others it may take a year or two also. This might have been the reason behind the Ayurveda authors writing ‘reappearance of menstruation’ rather than mentioning specific time limit.

Understanding variations in these time durations – Therefore we can infer that ‘1 ½ months’ duration has been given in relation to anatomical changes / reverting of reproductive system. The explanation of ‘reappearance of menstruation’ probably indicates physiological changes of reproductive system. 6 months duration probably reflects the idea about reappearance of menstrual cycle. The duration of 4 months has been probably given keeping in view the obstruction of labor or other kinds of abnormal labors wherein the post-operative management for 4 months has been advised.
Read – After Delivery Care Of Mother For First Three Months By Ayurveda

Onset of menstruation

After the delivery of the baby, the ahara rasa – nutrients reach the breasts of the woman and form milk immediately. The remaining rasa gets transformed into blood. This blood circulating all through the body reaches the reproductive system (uterus) of the woman. After the woman attains replenishment of her tissues and steadiness of her body, the blood accumulated in the uterus gets discharged periodically. This is how the menstruation reappears after delivery of the child.

Management of puerperal woman

It is called Sutika Paricharya

I. General management, diet and mode of life

Almost all classics have advised the use of the below mentioned for a period of 3-7 days –

• Massage with herbal oils
• Oral administration of medicated fats along with medicines and decoctions
• Medicated meat soup – from 7^th to 12^th day

Different opinions about general management and use of herbs and formulations

1. Master Charaka’s opinion – Cha.Sha.8/48

a. Pippalyadi Churna – Powder of the below mentioned herbs should be given orally with ghee, oil, muscle fat or bone marrow after considering the tolerance and digestive capacity of the puerperal woman –

• Pippali – Piper longum
• Pippalimula – roots of Piper longum
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica
• Shringavera – Zingiber officinale

b. Abhyanga and Udara veshtana – After giving this powder, the woman’s abdomen should be given massage with medicated oil. Following this the abdomen should be wrapped with a big clean cloth. This causes compression of abdomen. When abdomen is compressed it prevents vitiation of vata.

c. Pippalyadi Yavagu – After the fats get digested, gruel made with rice and processed with Pippalyadi Churna explained above and mixed with ghee should be administered.

d. Ushnodaka Parishechana / Parisheka – Irrigation or bath / shower with hot water should be given at morning and evening before administration of fat and other fats and gruel.

e. Apyayana / Brmhana – The above said regimen should be administered for 5 or 7 nights and day. Following this brmhana therapy i.e. anabolic foods which increase muscles and energy should be gradually administered. This regimen is not suitable for women living in marshy lands since kapha is dominant in these areas. This regimen is suitable for women of ‘wild / desert like and dry’ regions.
Read – Multiple Pregnancy, Twins Ayurveda Concept – Bahvapatya, Yugma Garbha

2. Master Sushruta’s opinion – Su.Sha.10/16-18

a. Abhyanga – Firstly the woman should be massaged with Bala Taila.

b. Bhadradarvadi Kwatha – Following massage, the woman shall be prescribed with decoction prepared using Bhadradaru – Cedrus deodara and other herbs. The same decoction can be used to give irrigation. This decoction suppresses vata.

c. Pippalyadi Churna – The powder of the below mentioned ingredients should be given for oral consumption along with jaggery water if the doshas or blood is left inside i.e. some blood clots and doshas have remained in the uterus –

• Pippali – Piper longum
• Pippalimula – roots of Piper longum
• Hasti Pippali – Scindapsis officinalis
• Chitraka – Plumbago zeylanica
• Srngavera – Zingiber officinale

This should be continued until all abnormal blood i.e. lochia rubra is properly excreted.

d. Vidarigandhadi Yavagu – After this, the rice gruel prepared with herbs of Vidarigandhadi group of herbs, mixed with ghee or milk should be given for 3 days (from 3^rd or 4^th day to 6^th or 7^th day after delivery).

e. Shali and Mamsa Rasa – From 7^th or 8^th day, cooked shali rice with meat soup of wild animals processed with yava – barley, kola – Ziziphus mauritiana and Kulattha – horse gram should be given after having considered the strength and digestive power of the woman.

f. Ushnodaka Parishechana – Irrigation / shower with hot water should be given. The woman should avoid anger, exercise and coitus. According to Dalhana, the irrigation would flush off the abnormal blood from the uterus and also suppress vata. Sudation should be given after the delivery of full term fetus.

3. Master Vagbhata’s opinion – A.Sam.Sha.3/38

a. Abhyanga – Massage should be given with Bala Taila.

b. Sneha Matra / Kashaya pana – Proper dose of unctuous substances / fats processed (mixed) with one of the below mentioned powders should be given for oral consumption when the woman is hungry, in a quantity which she can digest in a whole day –

Pippalyadi Churna – powder prepared with –

• Pippali – Piper longum
• Pippalimula – Roots of Piper longum
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica and
• Shunti – Zingiber officinale

Yavanyadi Churna – powder prepared with –

• Yavani –
• Upakunchika –
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica
• Pippali – Piper longum
• Maricha – Piper nigrum
• Shunti – Zingiber officinale

If the woman is unfit to take oily substances / medicated fats, she should be given with decoction of either laghu panchamula or vata suppressing herbs.

c. Abhyanga and Udara Veshtana – After the above said measures the woman should be given with abdominal massage with ghee and oil and wrapped with cloth. This helps in prevention of vitiation of vayu.

d. Vidaryadi yavagu – After the digestion of medicated fats / unctuous substances, rice gruel prepared with above mentioned herbs or Vidaryadi group of herbs or milk should be given to the woman to drink, in a quantity which she can easily digest.

e. Ushnodaka Parisheka – Irrigation / shower / bath should be given with hot water at morning and evening before administering ghee or gruel. This shall be used for 3, 5 or 7 days. Following this, light diet shall be given with soup of barley, jujube and horse gram.

f. Apyayana – After 12 days of using the above regimen, satiating and strengthening foods should be given after considering her strength and digestive capacity. Meat soup of wild animals / animals living in desert like regions should be used for this purpose. Also oil, ghee or decoction prepared with Jivaniya, Brmhaniya, Madhura and Vatahara group of herbs should also be used for giving massage, oleation, irrigation and bathing.

Vagbhata II has given similar explanation. He has added massaging the vagina and uterus region also along with body massage. Arunadatta opines that if meat preparations are used before 12 days, it would attract the grahas.

4. Master Kashyapa’s opinion – Ka.Sam.Khi.11

a. Rakshogna dravya – The puerperal woman should use antiseptic medicines and other beneficial things.

b. Nyubja shayana and Udara Pidana – Sweet spoken accoucheuse should encourage the woman immediately after delivery and make her lie down in hunch-back position. She should rub her back, press her abdomen and flanks and then compress her abdomen to expel the doshas left over after delivery. Following this, abdomen and flanks should be wrapped with clean big cloth. With this, the abdomen reaches its proper place and vayu also subsides.

c. External use of Bala Taila – The woman should sit on a small chair covered with leather bag filled with hot Bala Taila. With this her vagina and uterus becomes healthy.

d. Swedana and Snana – Sudation should be given to the vagina and uterine region with krsra – oleo prepared with Priyangu etc herbs. Following this, hot water bath and proper rest should be given to the woman.

e. Dhupana – After overcoming tiredness, the woman should be given with fumigation using Kushta – Saussurea lappa, Guggulu – Commiphora mukul and Agaru – Aquilaria agallocha mixed with ghee.

f. Manda and Yavagu and Mamsarasa – Scum of boiled rice should be given for 3 or 5 days after considering the strength and digestive power of the woman. Following this, the woman should take beneficial diet and unctuous substances i.e. oil and ghee. After digestion of fats, rice gruel devoid of salt and added with little fats and mixed with powder of Pippali – Piper longum and Nagara – Zingiber officinale should be given. After 6-7 days, rice gruel mixed with sufficient quantity of salt and fats should be served. Following this, meat soup of wild animals / animals of desert like region and soup of horse gram mixed with fats, salt and sour articles and ash gourd, radish, cucumber etc vegetables fried in ghee should be given.

The woman should use oleation, sudation and hot water for one month after delivery. Management should not be done in isolation. Traditions, diet and beneficial things as related to the family and geography should be given duly considered. Sudation is contraindicated.

5. Master Harita’s opinion – Ha.Sam.Tr.Sth.53/1-5

a. Kashaya Prayoga – Decoction prepared with the below mentioned herbs, as many as available, should be administered for purifying the blood and uterus –

• Lodhra – Symplocos racemosus
• Arjuna – Terminalia arjuna
• Kadamba – Neolamarckia cadamba
• Devadaru – Cedrus deodara
• Bijaka – Pterocarpus marsupium
• Karkandhu – Ziziphus mauritiana

b. Purana, Abhyanga, Swedana – Vaginal filling should be done with the oil. Massage followed by sudation with hot water should be given.

c. Upavasa and use of formulations –

• The woman should fast on the first day.
• On the second day, she should take mixture of ginger, Terminalia chebula and jaggery in the morning. In the noon she should consume warm soup of horse gram.
• On the third day, rice gruel mixed with panchakola should be given.
• On the fourth day, rice gruel mixed with chaturjata should be given.
• On the fifth day, shali or shashtika rice shall be prescribed in the diet.

This regimen shall be continued for 10-15 days. The woman shall be allowed to meet other women on the 12^th day.

6. Other opinions

a. The puerperal woman should use congenial diet and mode of life. She should keep away from anger, coitus, cold air and excessive exercise (Bha.Pra).

b. She should use unctuous, light, congenial diet and daily sudation and massage for 1 month (Bha.Pra).

c. Immediately after the delivery of the child the vaginal canal of the woman should be pressed so as to avoid entry of air (Y.R.).

d. Measures to protect the woman and child from the seizure of grahas or bhutas should be taken.

e. Below mentioned are contraindicated –

• Evacuative enemas – if used increases ama dosha (Cha.Si)
• Venesection – if given, causes emaciation, anorexia and bodyache
• Nasal drops / errhines – if used, it will have similar effects like that of venesection
• Purgatives
• Sudation (indicated as per Sharngdhara)

f. Brmhana dravyas – muscle bulk enhancing and energizing herbs and Manda – liquid rice gruel / thin gruels are indicated during this period.
Read – Brumhana Therapy – Nourishing Ayurvedic Treatment Principle

Benefits of proper management of puerperal woman

Due to the development of fetus the woman becomes weak or emaciated. Similarly she becomes empty bodied due to unsteadiness or languor of all tissues, labor pains and excretion of moisture and blood. With properly done above said measures, the woman attains all the lost things and reaches her pre-pregnancy stage, anatomically and physiologically.

Management of puerperal woman depending on place of living

1. Woman living in Anupa Desha – marshy land

• These regions have dominance of moisture. Diseases of vata and kapha predominance are manifested in this region.
• Fats / unctuous substances should not be used initially. Instead of this, the scum of boiled rice treated with appetizer and strengthening herbs shall be given.

2. Woman living in Jangala Desha – wild / dry / desert like place

• Oil or ghee or any unctuous substances shall be given in good quantity. Decoction prepared with Pippalyadi Churna mentioned in general management should be used as after-drink.
• Oleation in the manner explained above shall be given to strong women. To the weak women rice gruel should be given. Both these shall be used for 3-5 nights.
• Following this cereals mixed with unctuous substances shall be used in a gradually increasing manner.
• Irrigation with hot water shall be given often.
• The woman should be advised to avoid anger, exercise and coitus.

 3. Woman living in Sadharana Desha – common / normal land

This land will have qualities of both the above said lands. For woman living in this region, general or average management which comprises of not too many unctuous or too much dry therapies shall be used.
Read – Ayurvedic Diet And Lifestyle For Pregnant Woman

Management according to the sex of the child

If male child is delivered, the woman shall be given with oil. In case it is a female child, the woman shall be given with ghee to drink. After the proper digestion of fat, rice gruel prepared with appetizing herbs should be given for 5-7 days. Then, the scum of boiled rice etc should be introduced in a gradual way.

Bath to the puerperal woman

Bathing ceremony should be performed on the auspicious period of 10^th or 12^th day according to proper rituals of the family.

Diseases of the puerperal woman and their management

Some general diseases manifest during the puerperal period like fever etc. These diseases should be dealt with in the same way as they are treated in any other person.

Some specific diseases too are manifested in the puerperal woman. They are called as Sutika Rogas. They have been mentioned by Kashyapa and other masters. They need to be managed with specific treatments and medicines mentioned for them.

Click to Consult Dr Raghuram Y.S. MD (Ayu)