Sutikagara – Accouchement Ward, Ayurveda Perspective

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

Sutika is a woman who has just delivered a child and her placenta has been removed. Some opine that sutika is a parturient woman – a woman in labor.

Ayurveda has opined that the woman shall be called as sutika for 1 and half months after the delivery of the child. There are differences of opinions regarding this period with some authors telling that the period shall be considered up to 4-6 months after delivery of the child. There is also an opinion that the woman shall be called as sutika until the next menstrual cycle (post delivery) begins.

Postpartum period or postnatal period begins immediately after childbirth as the mother’s body, including hormone levels and uterus size returns to a non-pregnant state. The terms puerperal period, puerperium or immediate postpartum period are the terms commonly used to describe the first 6 weeks following childbirth. This time period exactly matches with the Ayurveda explanation.

The woman during this time period should be given good physical and mental rest and be taken care of in the best possible way so as to enable her system to come back to non-pregnant state.

The Sutikagara – Ayurveda opines that sutika be isolated and kept in a separate ward and taken care of during the mentioned time period. This ward is called as Sutikagara – the accouchement ward. It is a construction which would be separately constructed for every sutika and dismantled after her discharge. This means to tell that the same ward shall not be reused for another sutika. This further justifies the Ayurveda vision of one-to-one handling and personalized approach for medical care. This would take into account the separate needs for every individual and at the same time would focus on providing clean, healthy and sterile conditions to every mother.

Summing up – Sutikagara is an isolated ward to take care of – a. expectant mother, b. woman who has just delivered a child or c. both.

1. The pregnant woman just before labor can be taken into the sutikagara and taken care of until the time period of sutika is completed.
2. Alternatively the woman immediately after delivery of child and placenta may be taken into the sutikagara and taken care of until discharge.
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Method of construction of Sutikagara

Right time to construct the ward – The ward shall be constructed before 9^th month of pregnancy, well in advance of the date of delivery of child. Indu, commentator of Ashtanga Sangraha opines that the ward shall be constructed after the beginning of 9^th month while the author of Ashtanga Hrdaya (Vagbhata II) opines that the construction shall be started in auspicious period.

Selection of land for construction – It shall be constructed on a land which is free from stones, sand or gravel and broken earthen pot pieces. These things should not be present in the area of construction or if they are present, they shall be removed before constructing the ward. The land shall have good appearance, taste and smell.

Direction – The construction should face either east or towards north. Master Sushruta opines that the door shall face either east or south.

Materials needed for construction – Woods of Bilva – Aegle marmelos, Tinduka – Diospyros malabarica, Inguda – Balanites aegyptiaca, Bhallataka – Semecarpus anacardium, Varuna – Crataeva nurvula or Khadira – Acacia catechu should be used for construction of the ward. Any other woods may be used after taking opinion and consent of Brahmanas or experts well versed in the knowledge of Atharvaveda.

Arrangements – The house should be –

• Well clothed
• The walls should be smeared with cow dung or lime
• Should be well covered on the top, the roof being constructed with a wooden frame
• The doors should be well fitted
• Walls and windows should be closed and protected with curtains
• Specific places should be allotted for fire, water, pestle and mortar, latrine, bathroom and kitchen and constructed according to rituals. Help of architects should be sought for while constructing specific allotments in specific regions.
• The construction should be comfortable for all seasons.
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Additional points from Sushruta Samhita (Su.Sha.10/5)

Dimensions – the ward should be 12 feet long and 6 feet wide.

Different constructions caste-wise

Beds – the beds shall be made with the same woods which are used for constructing the ward (caste-wise).

Placement of things – All the necessary things should be placed systematically in their specifically allocated places.

Raksha Dravyas – The articles having protective and antiseptic properties and also auspicious materials should be stored in the ward.

Other points to include

Jwalana – Flaming fire should be continuously kept inside the ward. (A.Sam.Sha.10/5)
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Materials and herbs to be stored in the accouchement ward

1. Essential herbs and medicinal items

2. Beverages and fermented drinks

• Maireya – kind of intoxicating drink
• Sura – spirituous liquor / wine
• Asava – spirit or spirituous liquor distilled from sugar or molasses

3. Other materials

• Two pieces of stones,
• Two pestles
• Two mortars
• Two needles made up of gold or silver
• Sharp instruments made up of iron
• Two beds made with the wood of Bilva – Aegle marmelos
• Woods of Tinduka – Diospyros malabarica and Ingudi – Balanites aegyptiaca for lighting fire
• Two winnowing baskets (Bhela)
• Any other materials advised by Brahmanas and old ladies

4. Animals

• One donkey
• One bull

5. People

a. Striyah cha bahvyo prajaataah – many multiparous women who are adorned with below mentioned qualities –

• Good hearted
• Those who have indulged themselves in selfless service
• Have strong character
• Have good experience in conducting labor
• Affectionate in nature
• Free from grief
• Have good endurance
• Capable of keeping the parturient woman happy

b. Brahmanas – possessing good knowledge of Atharva Veda

Entering into the sutikagara and staying therein

a. Firstly, Shanti i.e. pacifying oblations should be offered during maitra period –

• after the beginning of 9^th month
• on prefixed auspicious day
• when the moon is situated in highest place and has association of other beneficial planets

b. Then, the below mentioned should be made to enter the ward –

• cows
• Brahmanas along with fire and water

c. Following this, the pregnant woman should –

• offer grass, water, honey, parched paddy to the cows
• should make the Brahmanas to sit comfortably and wash their hands and feet
• should offer washed rice, flowers, nandimukha fruits and reverential salutation to the Brahmanas and then
• sip the water and take their blessings for welfare

d. Now the pregnant woman should enter the labor ward by first keeping her right foot inside the ward. She should follow the cows and Brahmanas reciting holy words. After entering the ward, she should stay there and wait for the onset of labor.

Explanation by Master Vagbhata (A.Sha.3/16)

• After salutation to the cows, Brahmanas and elders, the pregnant woman shall enter the ward during the auspicious star constellations (nakshatra) while enchanting auspicious words and hymns.
• She should be constantly in association of women having good and noble qualities.
• She should keep herself busy in auspicious virtues.
• She should always use the dietetics which facilitates proper excretion of feces, urine and fart.
• Phalavarti or suppositories should be used in case the woman suffers from constipation and retention of urine.

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