Manual Expulsion Of Placenta – Ayurvedic Methods: Apara Patana

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

Placenta is a structure connected to the fetus in mother’s womb. Fetus derives oxygen and nutrients supplied to it through placenta by the mother. With this, fetus sustains life and grows properly.

Introduction

Placenta also removes waste products from baby’s blood. It is attached to wall of womb, internally. Umbilical cord arises from placenta and connects with navel of fetus.
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After delivery of child, placenta too gets expelled. It is separated from child by cutting off umbilical cord. Placenta has to be expelled naturally at delivery, if not it is going to cause trouble to woman. Later, it becomes mandatory to extract it by artificial methods.
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References- Charaka, Vagbhata, Kashyapa

We can find explanation of ‘expulsion of placenta’ given by Charaka, Vagbhata and Kashyapa.

1. Charaka, emphasizing the importance of expulsion of placenta stresses that an attendant should carefully inspect if placenta is expelled or not, following delivery of fetus.
2. Vagbhata, while describing features of ‘normal labor’ tells that delivery of fetus with ‘head-first presentation’ followed by ‘expulsion of placenta detached from mother’s heart’ is normal. He stresses that if things doesn’t go this way, it is abnormal.
3. Kashyapa tells that ‘only woman who has expelled her placenta following delivery of child is called sutika i.e. puerperal woman’. woman who has not expelled placenta is not called puerperal woman.

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Complications of placental retention

Complications arising due to non-expulsion of placenta

If placenta is not expelled following delivery, it becomes a source of many complications.
The complications of placenta retention are –

• Obstruction to excretion of feces, urine and fart
• Tympanites and distension of abdomen
• Flatulence
• Colic
• Anorexia

Treatment for retention of placenta

Vata, especially sub-type of vata located in abdomen and pelvic regions and controls functions therein, i.e. apana vata is said to be responsible for easy delivery of fetus and expulsion of placenta. This happens if vata is balanced. Retention of placenta is supposed to be caused by vitiated vata. Therefore, first strategy of treating ‘retention of placenta’ would be to suppress vitiated vata. If vata is controlled, placenta is expelled.

Apart from this, retention of placenta should be wisely addressed. This is done by external manipulations and internal medications.
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1. External Treatments for retention of placenta

A. External manipulation to expel placenta

Violent jerks

Woman who has retention of placenta should be held by supporting her back. Navel region of her abdomen should be forcefully compressed. She should be violently waggled. Alternatively, one should give violent jerks by holding both her arms. These maneuvers will help in expulsion of placenta as they create violent movements in abdomen and pelvis.
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Violent compression of pelvis

Pelvis of woman should be compressed repeatedly by an attendant. Attendant might use her heels to strike or compress pelvis of delivered woman. Use of heels would impart more pressure. Alternatively, attendant may hold woman by both her hips and give violent compression. Jerks and compression of abdomen and pelvis increase intra-abdominal pressure and propel placenta downwards to be expelled.

Vagina should be subjected to proper oleation. After oleation, attendant should induce violent jerks to her flanks. Uterus may be compressed from both sides and placenta delivered completely.
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Stimulation of palate, throat

Inside of throat and palate of woman having retention of placenta should be stimulated by touching it with braid of hair. Alternatively, tip of finger wrapped with hair shall be used to stimulate throat and palate. This produces cough instantaneously and consequentially increase intra-abdominal pressure. This helps in expulsion of placenta.
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B. External administration of medicines

a. Vaginal Fumigation

Should be done using one or other combination of herbs given below –

• Bhurjapatra (Betulis utilis) and Guggulu (Commiphora mukul)
• Slough of snake mixed with mustard oil
• Langaliki – Gloriosa superb
• Tumbi – Langenaria siceraria
• Kushta – Saussurea lappa
• Sarshapa – mustard

b. Anointment of medicines in vagina

using the combination of herbs given below –

• Paste of bitter bottle-gourd and ridged gourd, neem and slough of snake mixed with mustard oil should be used to anoint or fill vagina. This should be done after applying oil in vagina.
• Paste of jaggery and ginger
• Paste of Betula utilis, Gloriosa superb, Bottle gourd, snake’s slough, Saussurea lappa and mustard

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c. Vaginal Tampons

• Tampon soaked in oil prepared with Shatapushpa (Anethum sowa), Kushta (Saussurea lappa), Madanaphala (Randia dumetorum) and Hingu (asafetida) should be used.

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d. Medicated Enemas

Anuvasana Vasti / Unctuous enema

• Oil prepared with shatapushpa (Anethum sowa), kushta (Saussurea lappa), madanaphala (Randia dumetorum) and hingu (asafetida)
• Mustard oil prepared with paste of drumstick, black pepper, cumin seeds, Plumbago zeylanica and Ocimum gratissimum

Asthapana Vasti / cleansing enema

• Mustard, Saussurea lappa, Gloriosa superb and latex of Euphorbia neriifolia mixed in suramanda i.e. a type of fermented drink
• Paste of Anethum sowa, Acorus calamus, Saussurea lappa, long pepper and mustard mixed with oil and salt

Uttara Vasti / Vaginal-Uterine enema

• Oil prepared with mustard, Saussurea lappa, Gloriosa superb and latex of Euphorbia neriifolia
• Mustard oil prepared with Anethum sowa, mustard, cumin seeds, drumstick, Anacyclus pyrethrum, Plumbago zeylanica, asafetida, Saussurea lappa and Randia dumetorum with cow’s urine and cow’s milk

2. Oral medications for retention of placenta

• Paste of jaggery and ginger
• Paste of Saussurea lappa and root of Gloriosa superb mixed with cow’s urine or wine
• Paste of Saussurea lappa and cardamom mixed with wine
• Paste of long pepper, cardamom, jujube, vid salt, Piper retrofractum, Plumbago zeylanica and Nigella sativa
• Powder of vatsakadi group of herbs mixed with wine
• Decoction of red and white varieties of Calotropis gigantean

All these external and internal interventions may enhance myometrial contractions. With this placenta moves downwards and is expelled.
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Manual removal of placenta

When all medicines and methods of expelling placenta fail, it should be manually removed. Physician should first trim their nails. They should lubricate their hand with oil and insert it into vagina. Following umbilical cord, placenta should be extracted by hand.

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