Untimely and Delayed Labor As Per Ayurveda (Garbha Sangha – Akala Prasava)

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

Delayed Labor (Garbha Sangha)

Garbha Sangha means obstruction to normal labor or delayed labor. Garbha = fetus, Sangha = obstruction. Garbha Sangha denotes obstruction of the fetus in the womb, attachment of fetus within the uterus or cessation in the progress of labour.

We do not find the description of causes, pathogenesis or symptoms of delayed labor in Ayurveda. But Master Sushruta and Vagbhata have described treatment of the same in brief. Similarly, the term Garbhasanga has not been used in Yogaratnakara or Bhavaprakasha treatises but certain herbs for the treatment of delayed labour have been mentioned in these texts.
Read – Garbhasana – Fetus In Womb Pose, Right Method, Benefits

Imbalance of Vata, the main culprit in causation of delayed labour – Since vata in general and apana vata specifically is responsible for normal delivery of fetus, imbalance of vata may be considered to be contributory for delayed labour. Vitiated vata located in shukra – semen / sperm is also said to cause delay in labour. Treatment of garbha sangha therefore mainly involves balancing the vata.
Read – How To Balance Vata Dosha? Line Of Treatment And Reasoning

Treatment of Garbha Sangha – delayed labour

1. External Treatment

a. Fumigation of vaginal canal

It is done with one of the below mentioned –

• Krshna sarpa nirmoka – shed skin of black snake
• Pinditaka – Randia dumetorum

b. Anointment of medicines in the vaginal canal

Anointment of ground roots of Potaki – Basella rubra – with sesame oil inside the vaginal canal makes delivery of the child easy.

c. Anointment of medicines over the umbilicus

Anointment of Krshna and Vacha – Acorus calamus should be ground with water and mixed with castor oil. This paste should be applied over the umbilicus.

d. Amulet / bands

Root of one of the below mentioned herbs shall be tied as amulet over the arms or legs of the woman –

• Hiranyapushpi – Asparagus adscendens
• Suvarchala – Cleome viscosa
• Vishalya – Tridax procumbens / Gloriosa superb?

Root of one of the below mentioned herbs knotted in a thread measuring to the length of the woman should be tied as a band to the waist of the woman –

• Ikshu – Saccharum officinarum
• Tala – Borassus flabellifer
• Pratyakpushpa – Achyranthes aspera
• Paribhadra – Erythrina indica
• Kakajhanga – Peristrophe bicalyculata

e. Gomurdha Sthapana – placement over labor ward

Skeleton of cow’s head should be placed over the labor ward.
Read – Monthly Development Of Fetus – Ayurvedic perspective

2. Internal Treatment

Equal quantities of powders of roots of Matulunga – Citrus medica and Licorice should be given mixed with ghee to consume. This will help in easy delivery.

3. Use of Mantras – sacred hymns

The below mentioned hymns will help in relieving obstruction of fetus, help in treating delayed labor and also to enable easy delivery –

‘May amrta, soma, chitrabanu, bhamini and ucchaisrava live in your house and protect you. O woman! This nectar obtained by churning the sea shall expel your small fetus. May agni – fire, vayu – air, surya – sun, indra – lord Indra and samudra – sea / ocean give you solace’.

An oblation reciting the hymn – ‘All the ties and special bonds are released, the rays have been emitted by the Sun, the fetus is now free from all the fears, now do not delay, do not delay…!’ should be performed.

By reciting the Chyavanamantra the water should be treated and sanctified for 7 times. This water should be given to pregnant woman for drinking. Following this, the woman should be shown Ubhayatrimshaka Yantra. In this, the numbers are written in a box of 3×3 = 9 boxes. The total of these numbers comes to 30 when we calculate it from any side. The box looks as below mentioned –

Five grains of un-husked rice should be washed with water and treated with this mantra –

‘Yakshini named Surasa lives in south of Himalaya. Hearing the noise of her nupura – anklet, O pregnant woman, you shall be free from Shalya – the foreign body in the form of fetuses’. The enchanted rice should be strewn over the woman. With this, she delivers the fetus immediately.

Untimely labour

Akala Prasava, an Ayurveda perspective

Akala Prasava means untimely labor. If the delivery happens earlier or gets delayed, it will be considered as untimely. Therefore both ‘premature labor’ and ‘delayed labor or post-maturity’ explained in modern texts are included in this discussion. Akala = untimely, Prasava = labor.

Ayurveda treatises have explained about prasava vis-à-vis labor in general, but have not classified the stages or variants of labor as such. We need to assemble the assorted explanation so as to understand the concept of prasava from an Ayurveda lens.

The normal labor is said to occur between 9^th and 12^th month according to various opinions from different authors of Ayurveda treatises. Untimely labor, as already said can either take place before its normal time – premature labor or after its normal time – delayed labor. But these concepts have not been described in clear terms in the treatises. This article is a development of the available close-in references on the basis of inference.
Read – After Delivery Care Of Mother For First Three Months By Ayurveda

I. Premature Labor

Also called Apragalbha Prasava / Viprasava.
1. Understanding premature labor by the explanation of birth of short-lived child / child having lesser body parts at birth

All masters of Ayurveda have opined that the woman should not have coitus during the first three days of the menstrual cycle. If the woman conceives by this act, there will be one or more of the below mentioned consequences –

• the child will get aborted or
• the born child will have lesser body parts or
• the child will be short lived

Birth of child with lesser body parts or a short-lived child is indirect references of premature fetus / premature labor.

2. Understanding premature labor from the perspective of explanation of the ‘fetus of 7^th month’

The expulsion of fetus up to the 6^th month of pregnancy is called as garbhapata. All authors have opined the same and also have mentioned that the fetus will be fully formed in terms of body parts in the 7^th month. But the possibilities of the delivery of the child at 7^th month have not been mentioned. On the other hand, commentators of Ashtanga Sangraha and Madhava Nidana have tried to put forth their thoughts in this perspective.
Read – Acharya Madhavakara: His Work ‘Madhava Nidana’, Legacy, Amazing Facts

a. Arunadatta’s version – The fetus attains complete development and capacity to survive in the 7^th month. There is a possibility that the child born in the 7^th month might survive. But due to untimely delivery, the child doesn’t possess longevity and other characteristics which are generally seen in a child delivered at full term. If we consider that the child delivered prematurely in the 7^th month doesn’t survive, then the mention of death of fetus born during the 8^th month would be unnecessary. This indicates that the child born in 7^th month would survive and this is one of the references for premature labor.

b. Vijayarakshita and Srikantadatta’s version – The description abortion in the 5^th and 6^th months highlights and substantiates the possibility of the child surviving when it is born in the 7^th month. Here too the birth of the child may be either normal or abnormal.
Read – Monthly Development Of Fetus – Ayurvedic perspective

• Saguna prasava – If delivery in the 7^th month is saguna i.e. normal labor without any abnormality – diseases pertaining to mother and child – then the child survives.
• Viguna prasava – If the child born in 7^th month is viguna i.e. labor with abnormality – then the child does not survive and when this happens, delivery in this month too shall be considered as garbhapata. Since the delivery in 7^th month occurs due to abnormality of doshas, it is called as viprasava – premature labor.

c. Understanding premature labor in terms of Achirajata as explained by master Charaka (Cha.Sha.4/29)

There are certain factors which are responsible for normal development of fetus. Abnormalities of these factors cause intrauterine death of fetus. Alternatively, it may end up in achirajata. Master Chakrapani clarifies that if the vitiation of dosahs is less then it ends in achirajata. Achira means early. Jata means born. Therefore, the meaning of achirajata can be taken as ‘early born’ or ‘prematurely born’. Thus, this reference helps us to understand premature labor in Ayurveda language.

d. Understanding premature labor by the explanation of complications of delivery in the 8^th month

All Ayurveda masters have described the complications of delivery in the eighth month. Delivery in the 8^th month is itself premature labor.
Read – Ayurvedic Diet And Lifestyle For Pregnant Woman

e. Understanding premature labor as caused by abnormal doshas (Ha.Sam.6^th sthana, 1/24, 25)

Master Harita tells that the delivery of the child may take place even before the completion of full term due to abnormalities of doshas, specially propelled by vayu.

f. Understanding premature labor from the perspective of abnormalities of factors influencing normal delivery (Cha.Sha.2/6)

Normalcy of the below mentioned is mandatory if a normal full-term delivery of the child should occur. They are –

• Normal shukra – semen, sperm
• Normal artava – ovum
• Normal atmakarma – deeds
• Normal ashaya – uterus
• Normal kala – time period (denotes full time pregnancy)
• Normal ahara vihara – food and lifestyle practices of the expectant mother / pregnant woman

This also means that the abnormality of either of these factors can cause premature labor.
Read – Essential Elements For Conception – Garbha Sambhava Samagri

g. Understanding premature labor from the term apaprajata (Su.Ut.38/32)

Master Sushruta tells that the disorders of apaprajata woman should be treated just like treating the disorders of any other woman. Commentator Dalhana explains the meaning of apaprajata as akalaprasuta or a woman who has delivered her child in abnormal time. This can be considered as a reference for explanation of premature labor.

i. Understanding premature labor as caused by aggravated vata (Cha.Chi.28/34, A.S.Ni.15/15)

Aggravated vayu located in the shukra i.e. semen / sperm is said to cause premature expulsion of fetus. This means to tell that when the sperm gets afflicted by aggravated vata it would cause premature labor.
Read – Child Afflicted With Putana Graha And Sheeta Putana Graha

II. Delayed Labor / post-maturity

Also called Atipragalbha Prasava / Kalatita Prasava.
a. Understanding delayed labor as caused by aggravated vata

Master Charaka and other authors have considered intrauterine stay of fetus after 10^th or 12^th month of pregnancy as abnormal. Charaka opines that the fetus is retained in the uterus for a prolonged duration due to the aggravated vata. (Charaka Sahmita, Shareera Sthana 4/25, Sushruta Samhita Shareera Sthana 3/30, Ashtanga Hrudayam Shareera Sthana 1/16)

Master Chakrapani says that the abnormality is comparatively less in the 11^th and 12^th months.

b. Understanding delayed labor as caused by obstruction of exit passage (Arunadatta, Ashtanga Hrudaya Shareera Sthana 1/16, Bhavaprakasha 70/103, Yogaratnakara StriRoga Chikitsa)

Obstruction in the exit passage (uterine cavity, vaginal canal) due to vitiated vata is the cause of prolonged stay of fetus inside the uterus. This will surely cause abnormality in labor.

Bhavaprakasha and Yogaratnakara treatises too have mentioned that the fetus does not deliver in proper time in spite of having completed full term due to the spasm of the exit passage of the fetus caused by vayu. This shall be treated by making the pregnant woman to pestle paddy in a mortar or use jerking vehicle or sit in uneven places. These procedures might initiate labor by causing increase in intra abdominal pressure or irritation.

c. Understanding delayed labor as caused by sperm afflicted by vata (Charaka Chiktisa .28/34)

The semen or sperm afflicted by vata or vayu located in the sperms may cause abnormal labor including delayed labor.
Read – Shukra Sara Purusha Lakshanas – Person With Enriched Reproductive Tissue

d. Understanding delayed labor from the explanation of Linagarbha (Sushruta Shareera 10/57)

The fetus having a prolonged intrauterine stay has been explained in the name of Linagarbha by master Sushruta. Lina = attached / adhering, Garbha = fetus. According to maste Dalhana, this abnormality is caused by the spasm caused by vayu in the exit passage of fetus. This abnormality can also cause intrauterine death of fetus. This condition too seems to be a description of post-maturity or delayed labor.

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