|Year : 2018 | Volume
| Issue : 4 | Page : 217-221
Combined effect of yoga and sūtikāparicaryā in normal vaginal delivery and caesarean section: Case series
PS Sreeranjini, Anjaly Muraleedharan, Hemavathi Shivapura Krishnarajabhatt
Department of Stri Roga and Prasuti Tantra (Gynaecology and Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham, India
|Date of Submission||03-Feb-2018|
|Date of Decision||09-Aug-2020|
|Date of Acceptance||24-Jun-2021|
|Date of Web Publication||04-Jan-2022|
Dr. Hemavathi Shivapura Krishnarajabhatt
Department of Stri Roga and Prasuti Tantra (Gynaecology and Obstetrics), Amrita School of Ayurveda, Amritapuri, Amrita Vishwa Vidyapeetham
Source of Support: None, Conflict of Interest: None
Pregnancy parturition and puerperium are the most important events taking place in a woman's life. Even though as we all aware of the importance of postnatal care, it is the most ignored in present era due to busy life schedule. As mentioned in our classics the śūnya śarīratva (Empty bodied) of sūtikā (Puerperal women) due to labour pains, rakta parisravaṇa (Bleeding) and dhātu śithilatā (Unsteadiness of dhātus) causes vāta kopa which may lead to diseases that become incurable or curable with difficulty. Proper adherence to postnatal care explained by āyurveda classics will results in faster restoration of mother's health by attaining replenishment of dhāthus, steadiness of body, and proper reproductive cycle. Along with the dietetic regulations and external therapies practicing some of the yoga procedures based on physical strength with restricted time, duration, and in a proper manner will provide an additional support in strengthening the abdominal, pelvic fascia and muscles, reducing the abdominal and pelvic girth, preventing excessive weight gain by reducing the fat deposition, and also helps in maintaining emotional stability. The study was conducted in 12 patients, 6 were included in normal vaginal delivery group and 6 included in caesarean section group. Along with sūtikāparicaryā specific yoga exercises were also advised. Remarkable outcome was noticed in reducing the weight and abdominal girth.
Keywords: Āyurveda, caesarean section, normal vaginal delivery, postnatal care, sūtikā, sūtikā paricaryā, Yoga, Yoga āsanas
|How to cite this article:|
Sreeranjini P S, Muraleedharan A, Krishnarajabhatt HS. Combined effect of yoga and sūtikāparicaryā in normal vaginal delivery and caesarean section: Case series. Ancient Sci Life 2018;37:217-21
|How to cite this URL:|
Sreeranjini P S, Muraleedharan A, Krishnarajabhatt HS. Combined effect of yoga and sūtikāparicaryā in normal vaginal delivery and caesarean section: Case series. Ancient Sci Life [serial online] 2018 [cited 2022 Dec 4];37:217-21. Available from: https://www.ancientscienceoflife.org/text.asp?2018/37/4/217/334718
| Introduction|| |
An explicit description for sūtikā (Puerperal women) given by ācārya kaśyapa is, only after the expulsion of placenta until she attaining her next menstruation.
Almost all the classics have mentioned about specific dietetic rules and management protocol during this normal puerperal period. Generally, the duration of sūtikāparicaryā (Management of puerperal women) can be considered as 1 ½ months (around 45 days). Some other references in classics regarding sūtikā kāla (Duration of puerperium) as 4 to 6 months. This may be because of considering the nature of delivery. Udarapatanādi kriyās (Incision made to remove the dead fetus from the womb) were also mentioned based on complications and doṣa aggravation as in mūḍhagarbha management.
ācārya kaśyapa has given a detailed management considering nativity (deśa/videśa) and family custom (Kula sātmya). After performing proper rakṣoghna karmas (Antiseptic measures) compressing the abdomen is advised for the excretion of leftover abnormalities of the fetus (Garbha doṣa pravṛtti), followed by udara veṣtana (Wrapping of abdomen), abhyaṅga (Anointment), and svedana (Sudation) to pacify vāta. Intake of maṇḍa (Scum of boiled rice) is advised based on digestive power followed by hitāśana and snehapāna. She should be given with sneha yavāgu (Rice gruel) medicated by pippali and nāgara as alpa sneha and alavaṇa for 3 days and the same with more of sneha and lavaṇa (sasneha lavaṇottara) considering the digestive power. All these along with svasthavṛttapālana (Sanative and restorative life style) should be followed for 1 month.
In the 8 aṅga of yoga, āsana can be taken as a mode of vyāyāma (Exercise) which can be practiced daily. By this lightness of body, ability to do hard work, proper digestion, depletion of the excessive fat, stable and distinct physique etc., can be obtained. As the yoga works on physical, vital, mental, emotional, psychic and spiritual levels of a person, it can be advised to practice daily as a vyāyāma, along with already prescribed sūtikāparicaryā considering the strength of the woman. It can provide a good outcome in conditions of weight gain, increased abdominal girth and pelvic girth, loss of endurance etc.
In some case, postnatal depression, anxiety etc., may cause decreased milk production which in turn create a negative impact on both mother and baby. Practising prāṇāyāma (Breathing exercise) will help to relieve anxiety, anger, depression, sleeplessness etc., thereby keeping the mother in a relaxed state and promotes further lactation.
Proper administration of sūtikāparicaryā helps in dhātuvṛddhi. Several studies have been reported that pelvic floor dysfunction is more in women who had spontaneous vaginal delivery (58%), and 43% of those who underwent caesarean section. Increased prevalence of pelvic floor disfunctions have been noted in vaginally parous women in the immediate postpartum periods and at several years of postpartum. So practicing yoga and exercises focusing on pelvic and perineal region helps to reduce the complications like vaginal prolapse, abdominal distension, fat collection etc., Administering abhyaṅga along with the exercises will improve the sturdiness of body.
| Materials and Methods|| |
Selection of patients
12 patients were selected from the IP admissions of Amrita School of Āyurveda.
All these patients came here after 5 days of normal vaginal delivery, after 10 days in case of a Caesarean section were included. Patients with any postnatal complications like hypertension, infections including UTI etc., were excluded.
Specific yogāsanas were advised to practice along with the routine sūtikāparicaryā from the day of admission up to discharge (Around 15 days).
Specific yoga āsanas advised to practice daily for about 20 mnts. Initially each patient is advised to 5 rounds of specific yoga āsanas. Maximum number of rounds advised is 10.
- Pelvic tilt exercises
- Wight, abdominal and pelvic girth recorded daily.
Other interventions followed:
- All the patients received same internal medications [Table 1] and [Table 2]
- Same treatments were given for all patients.
The details of normal vaginal delivery and caesarean section before treatment are recorded in [Table 3] and [Table 4].
| Results|| |
The results are statistically analysed using Paired T-test.The P value for 1 variable (weight) in before and after treatment is obtained as P < 0.01, i.e., the study is significant at the level of 95% confidence interval.,
The analysis using P Value indicates that in both the caesarean section and normal vaginal delivery cases, there is a substantial and significant reduction in the weight of the subjects. The change in the measurement values of Pelvic girth is more significant in normal delivery subjects in comparison to the caesarean subjects. The reason for its comparatively lesser value change in the latter cases could be due to the limitations in performing the yogāsanas due to the pain caused by the lower abdominal incision, the statistically analysed details are included in [Table 5] and [Table 6].
|Table 5: Statistical analysis of caesarean section, before and after treatment|
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|Table 6: Statistical analysis of normal vaginal delivery, before and after treatment|
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| Discussion|| |
As can be inferred from the above tables, the highest value of change observed in the Abdominal girth value in the normal delivery subjects was 34cm (142-108) and the lowest being 6cms (124-118cms). In the caesarean section subjects, the highest value of change in Abdominal girth observed stood at 10cms (114-104cms) and 4cm (90-86cms) being the lowest. Thus by following the prescribed yoga exercises and the internal medications specified, the patients were observed to have attained a reduction in Abdominal girth values of an average of 12.5 cms in the normal and 6.3 cms in the caesarean section cases respectively. In the Pelvic girth values, the change observed stood at an average of 21.3cm and 10.8cm in the Normal and Caesarean section cases respectively. Finally, as far as the body weight is concerned, an average change of 4.5 kg was observed in the normal delivery subjects, with 3 patients losing 5 kgs each. In the caesarean section cases, the change in body weight attained an average of 3.3kgs with the highest loss being 6kgs. It can thus be observed that there is a marked change in the Abdominal girth, Pelvic girth and body weight values which depicts the effect of the medications and yoga exercises prescribed, details are recorded in [Table 7] and [Table 8].
As the sūtikā is having śūnya śarīratva due to dhātu śithilatā and rakta parisravaṇa during labour, vāta vṛddhi occurs which may lead to several diseases that can cause bad impact over mother's health in the future life. Classics have advised internal administration of pañcakola phāṇṭa or maṇḍa pāna etc., initially f or āma nirharaṇa and to correct the weekened digestive fire. ācārya suśruta have mentioned use of pañcakola along with uṣṇa guḍodaka will helps in proper excretion of remaing accumulated doṣas including rakta. Considering the digestive power administration of yavāgu and yūṣa prepared by specific drugs added with sneha and lavaṇa is also advised; which helps in vāta śamana, dhātu puṣṭi and stanya vṛddhi. Daśamūla is reported to exhibit anti-inflammatory properties and antibacterial activity against enteric pathogens. The major constituents of daśamūlāriṣṭa like Vilwa, syonāka, aṃśumati, guḍūci are known for their free radical scavenging antiinflammatory and immune modulatory activities. Its beneficial effects in dhātukṣaya/daurbalya (weakness of body tissues) and as garbhāśayaśodhaka (cleanser of uterus), dīpana pācana properties may have contributed to its beneficial effects in postpartum period. Apart from the dīpana pācana and garbhāśayaśodhaka properties of jīrakāriṣṭa, it will improve the lactation. Puli leha helps to control bleeding after delivery, promotes involution of uterus, and improve digestion. The rasāyana and balya properties of thengin pookkuladi leha helps to imoprove the general health of the puerperal women, reduces the stress and anxiety after delivery, helps to improve lactation and controls the pain. kūśmāṇḍa avaleha improves the strength, provides immunity and promotes the lactation. It controls the bleeding, corrects aneamia and improve appetite.
External therapies like abhyaṅga, uṣṇodaka upacāra etc., helps to provide physical stability by overcoming dhātu śithilatā and maintaining normalcy of vāta doṣa. Daśamūla kaṣāya dhārā will reduce the pain immediately by passifying vāta. The effect of kumārī and haridrā on episiotomy wound healing can be explained on the basis of their pharmacological properties. Uṣṇavīrya property of haridrā alleviates vāta and kapha and tikta rasa alleviates pitta. Its vātaśamaka property reduces the pain at the site of wound. Tikta rasa is responsible for rakta stambhana which is helpful for vraṇa ropaṇa., In modern point of view, the main chemical constituent of haridrā is curcumin act as anti-inflammatory by inhibiting the activities of lipo oxygenase and cyclo oxygenase as well as the enzyme nitric oxide synthetase. Curcuminoids which are powerfull antioxidant phyto nutrients prevents oxidative damage of DNA and found to scavenge free radicals. Haridrā is having antibacterial activity against gram positive nad gram negative bacterias. kumārī possess madhura rasa which provides dhātupoṣaṇa and thus helpful for wound healing and regeneration of skin. Tikta rasa dries up pūya and strengthen tvaca. Its śītavīrya alleviates pitta and provides cooling effect in burning sensation and all these properties helps in vraṇa ropaṇa. In modern point of view, Aloe vera is a good source of vitamin C, tryptophan and phenyl alanine, having local anti-inflammatory activity. Organic compounds such as emodin, Aloe emodin and alovin all are broken down by the Kolbe reaction to form salicylates which have both analgesic and anti-inflammatory properties and inhibit the production of prostaglandin. Yaṣṭimadhu possesses madhura rasa, śītavīrya, alleviates vāta and pitta and vraṇa ropaṇa and dāhaśamana are its importand actions. It is having anti- inflammatory, anti-pyretic properties, and it is good blood purifier. ācārya suśruta mentioned the use of yaṣṭimadhu specifically in surgical wounds.
All the prescribed yogāsana will help to increase the flexibility in the hip joints, tones and massages the entire abdominal and pelvic region including liver, pancreas, spleen, urogenital system etc., pādahastāsana and paścimottānāsana massages and tones digestive organs, alleviates flatulence, constipation, and indigestion, which also helps to improve the metabolism.
Paścimottānāsana and śaśāṅkāsana helps in relieving digestive disorders and constipation. Regularises the forthcoming menstrual cycles. Acts as a stress reliever, and removes anxiety, anger irritability etc. Supports proper involution of uterus.
Practising pelvic tilt exercises helps in stretching the abdominal muscles, helps to remove excess fat deposition in the abdominal and pelvic area, and stimulates circulation to the nerves and muscles of the spine.
Prāṇāyāma practice provides good relief from anxiety, anger, depression etc.; helps to improve blood circulation with freshly oxygenated blood; strengthens the immune system; and improves the lactation by keeping the mother in a relaxed state by releasing more of oxytocin and endorphins in mothers body.
As the episiotomy wound will heal within 5 to 10 days there will not be any complication while practicing yoga postures for restricted time duration. Statistically, in both normal and caesarean deliveries the significance level obtained was almost same. So yoga can be included along with sūtikāparicaryā to get a better outcome.
| Conclusion|| |
The sūtikāparicaryā explained in our classics have proven effect in maintaining the physical health of the mother. The dhātu śithilatā in sūtikā if not corrected properly may leads to diseases having bad impacts over general health. The prescribed internal medications and external therapies provides well support in maintaining the general health and also in improving the dhātupuṣṭi. Practising specific yogāsana along with the usual sūtikāparicaryā will helps in faster restoration of mothers health, as the yoga works on physical, vital, mental, emotional, psychic, and spiritual aspects of the person. So considering the busy life schedule of present era, it is very important to highlight the need of sūtikāparicaryā along with yoga for a better outcome.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]