E-ISSN:2456-3110

Review Article

Sutika Paricharya

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 3 April
Publisherwww.maharshicharaka.in

Sutika Paricharya - Strategies for safe postnatal care in Ayurveda

Dhiman K.1, Divyamol M.2*
DOI:

1 Kamini Dhiman, Associate Professor, Department of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India.

2* M D Divyamol, Post Graduate Scholar, Department of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India.

Postnatal period is an important phase of transition in women’s life. It is the period after delivery of conceptus when maternal physiological and anatomical changes return to the nonpregnant state. Ayurveda has described in detail about the postnatal period and care for this period under the title Sutika Paricharya (~postnatal care). It has been mentioned in terms of Ahara (~diet), Vihara (~regimen) and Aushadha (~medicines). Main goal of Sutika Paricharya is to regain the lost strength and vitality as same as the prepregnant state by following the treatment principles like “Garbhashaya Shuddhi etc. In this article, Ayurvedic compendia describing different components of Sutika Paricharya has been reviewed and described.

Keywords: Ayurveda, Postnatal Care, Puerperium, Sutika Kala, Sutika Paricharya

Corresponding Author How to Cite this Article To Browse
M D Divyamol, Post Graduate Scholar, Department of Striroga evam Prasuti Tantra, All India Institute of Ayurveda, New Delhi, , India.
Email: 		Kamini Dhiman, M D Divyamol, Sutika Paricharya - Strategies for safe postnatal care in Ayurveda. J Ayu Int Med Sci. 2022;7(3):101-106.
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https://jaims.in/jaims/article/view/1737

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-02-24 2022-02-26 2022-03-05 2022-03-12 2022-03-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Kamini Dhiman, M D Divyamoland Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Postpartum period is an important phase of transition in women’s life following childbirth. This period is also known as puerperium, starts following the expulsion of the placenta until complete physiological recovery of various organ systems when maternal physiological and anatomical changes return to the nonpregnant state.[1] The postpartum period divides into three arbitrary phases, i.e., acute phase - the first 24 hours after delivery of the placenta, early – upto 7 days, and late – up to 6 weeks to 6 months. Each phase has its unique clinical considerations and challenges.[2] Whole of this period is critical to the health and survival of a mother and her newborn as it is the most vulnerable time during the hours and days after birth. Lack of care in this time period may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women, newborns, and children.[3] About 39% of neonatal deaths occur on the first day of life in India, about 57% during the first three days and the majority of maternal deaths occur between the third trimester and the end of the first week after birth.[4] The WHO guidelines on postnatal care recommend essential routine postnatal care for all mothers and their newborns, extra care for low birth weight and small babies, and early identification and referral or management of emergency conditions.[4] The guidelines further recommend postnatal visits within 6 to 12 hours after birth, and follow-up visits from 3 to 6 days, at 6 weeks, and then at 6 months.[5]

In Ayurveda, the postnatal period is called as Sutika Kala, and the care given during this whole postpartum period is mentioned as Sutika Paricharya.  A woman who has just given birth to a baby is called as Sutika (~postnatal woman) and almost all Acharyas have mentioned Paricharya (~care) for a Sutika only after the expulsion of the placenta. Prasava (~labor) is a strenuous activity which causes Dhatu Kshaya (~depletion of body tissues) and there by depletion of Bala (~strength) of the woman which is the need behind exclusive care for both women and infant after delivery. Paricharya is mentioned extensively in classics which includes Ahara (~diet), Aushadha (~medicines) and Vihara (~regimens). These are mentioned for a period of at least one and half month upto 6-month duration which aims at

restoration of health of the postnatal woman in all aspects.  By following these regimens, she attains Dhatu Paripoornatha (~replenishment of Dhatu) and reaches her overall health status as pre-pregnancy stage.

A gamut of care throughout pregnancy and the postpartum period is critically important and in India, the coverage of PNC service utilization is considerably low given the risks of postpartum complications. Ayurveda suggests systematic way of caring postpartum women ie. Sutika Paricharya which should be adapted as possible in all cases.

Aims and Objectives

To review the literature of Sutika, Sutikakala and Sutika paricharya alongwith Pathya & Apathya in Sutika paricharya and its clinical significance.

Methodology

A thorough review of literature related to Sutika paricharya in Ayurvedic compendia was performed. Chapters consolidating the concepts from both Laghutrayi, Bruhatrayi and other relevant Samhitas have been sorted and included in the manuscript.

Results

Sutika: The word Sutika is used to describe the postnatal woman and it is derived from the basic sanskrit element ‘Su’ with meaning ‘to produce’ or ‘to yield’.[6] A woman who has just given birth to a child followed by expulsion of the placenta is called as Sutika.[7]

Sutika Kala: The postnatal phase is called as Sutika Kala. It is an area in our classics where a lot of differences of opinions are there. Its duration varies from 12 days to six months, and some opines that the re-establishment of menstrual cycle is an endpoint of Sutika Kala. Caraka has not given any specific duration. Susruta has mentioned the 1 ½ month duration of Sutika Kala and added the opinion of others that the women should be called Sutika till she does not restart her menstrual cycle following the delivery of the child.[8] Acarya Vagabhata, Bhavaprakasha and Yogaratnakara have mentioned the duration of 1½ month i.e. approximately 45 days or until next menstrual cycle.[9,12] Kashyapa has described Sutika kala different from all this and suggested


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that total six months period is required to regain Raktadi dhatu to their original status following delivery.[13] In the context of Mudhagarbha (obstructed labor), a 4 month time period has described as Sutika kala for the subsidence of complications and pacifying the aggravated Doshas [14]

Sutikagara: Sutikagara (~accouchement room) is explained in Ayurveda, which is an aseptic room constructed specially for puerperal women. It was made compulsory in ancient days to stay for women in Sutikagara for at least 10 days.[6] It is a building which would be separately constructed for every Sutika and dismantled after her discharge. This concept heightens the Ayurveda vision of one-to-one handling and personalized approach for medical care.[15]

Sutika Paricharya Sidhanta (Principles of Sutika Paricharya)
The treatment principles include,

Ashwasana

Sutika Abhyanga

Deepana

Pachana

Garbhasaya Sodhana and Kleda Soshana

Soola Prashamana

Vata Anulomana

Bala Vridhi

Stanya Janana

Brihmana

Sutika Paricharya: Sutika paricharya is mentioned in terms of both Samanya (General) and Visesha (special) paricharya.

Samanya Sutika Paricharya (~General postnatal care)
It can be mentioned in terms of Ahara, Aushadha and Vihara.

Manidharana (~Wearing of amulet)

The Sutika should fix Trivruta mani (~amulet) over her head. It gives psychological support to her.

Sutika Snana (~Bath of postnatal women)
On 10th or 12th day, according to the practice of family the bathing ceremony should be performed.[16]

Table 1: Samanya Sutika Paricharya as per different Samhitas

Text Days Ahara  and Aushadha Vihara
Charaka Samhita[17] 5-7day 1)Snehapana 2)Yavagupana 1) Abhyanga 2)Parisheka- ubhayatakala 3) Udaravestana
Kramavat Aapyayan & Swasthavritta palana
Sushruta[18] 2-3 days 1)Vatahara kashaya pana2)Ushna gudodaka with pippalydi dravyas 1)Sarvadaihika balataila abhyanga2)Parisheka with vatahara dravyas
3 or 4 -6 or 7 Days 1)Sneha yavagu/ksheera yavagu with Vidarigana dravyas
8th day 1)Jangal mamsarasa 2)Yava,Kola,Kulatha yusha 3)Shaliodana bhojana
Asthanga Hridaya[19] 2-3days 1)Snehapana-with panchakolachurna 2)Ushna gudodaka with panchakola churna/Vatahara aushadhi toyapana 3)Peya – Purvokta dravyas 1)Yoni abhyanga & sarvadaihika abhyanga 2)Sthanika udara abhyanga-ghrita/taila 3)Udaravestana 4)Udvartana 5)Parisheka 6)Avagaha
4-7days SnehaYavagu/KsheeraYavagu
8-12days Jeevaniya gana/brihmaniya gana/Madhuravarga siddha Hriddya annapana
After 12 days Mamsa rasa
Asthanga Sangraha[20]   3 or 5 or 7 days 1)Snehapana with Panchakola churna with saindhava 2)Sneha ayogya-Vatahara/ laghupanchamoola kwatha pana 3)Ksheera yavagu pana-Vidaryadigana siddh 1)Sarvadaihika balataila abhyanga 2)Sthanika Udara abhyanga-grita/taila 3)Udarvesthana 4)Ushnodaka parisheka-ubhayatha kala 5)Acchadana 6)Avagahana
8-12 days 1)Yava,Kola,Kulatha yusha 2)laghu annapana
After 12 days 1) Jangala mamsarasa 2) Jeevaniya gana/brihmaniya gana/Madhura,vatahara dravyasadhita annapana
Kashyapa[21] 3-5 5-7 1)Manda pana 2)Hitakar bhojana 3)Snehapana 4)Snehayukta yavagu pana-pippali,nagara-lavana rahita yavagu  
7-12 Snehayukta yavagu pana-with lavana  
12 days 1)Kulatha yusha 2)Jangala mamsarasa 3)Gritha bharjita shaka  
1 month Snehana,Swedana,Ushna jala sevana  
Harita[22] After Prasava Kwatha pana-Lodhra,arjuna etc.dravya  
1st Day Upavasa  
2nd Day 1) Guda,nagar,haritaki sevana 2) Ushna kulatha yusha sevana  
3rd Day Panchakola Yavagu pana  
4th Day Chaturjata mishrita Yavagupana  
5/10/15 days Shali Shastik odana  

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Visishta Paricharya[23]

It is explained on the basis of Desha (~residence place) & gender of child.

Table 2: Visesha sutika paricharya according to Desha of Sutika.

Desha Ahara Vihara
Anupa Desha (~marshy land) 1) Manda prayoga with agni-balavardhaka dravya  2) Ushna dravya sevana Swedana, Nivata Shayana
Jangala Desha (~arid land) for 3-5 days  Snehopachara Snehopachara
Sadharana Desha  Neither too sneha nor ruksha dravyas

Table 3: Visesha Sutika Paricharya according to sex of child

Days Gender of child Advice
5-7 days Male 1)Tailapana 2)Deepaniya aushadhi samsakrita yavagupana
Female 1) Ghritapana 2)Deepaniya aushadhi samsakrita yavagupana
Later In both sex Mandadi prayoga

Sutika paricharya for Videsha Jati (~foreigners)

Women of Mleccha caste and other foreigners should use blood, meat soups, eatable roots, rhizomes, and fruits during this period.

Pathya (~wholesome practices) and Apathya (~unwholesome practices) in Sutika Paricharya

In Sutika Kala, vitiation of Vata is common. Even less consumption of Vatala diet in a very little quantity may create many problems. So, Pathya and Apathya of the Sutika should be understood.

Pathya[24]

1. Sutika should use hitakarakaahara (~wholesome diet) & vihara (~wholesome regimens).

2. Sutika should have bath with warm water.

3. Adequate sleep should be followed.

4. For drinking, boiled water should be used.

5. Abhyanga (~oil massage) should be done with lukewarm oils and Parishek (~pouring of medicated water), Avagahana (~sitz bath) etc. should always perform with lukewarm water.

6. Udaravesthana (~bandaging of abdomen) should be done.

7. Diet must contain Garbhashayashodaka (~cleansing uterus), Sthanyavardhaka (~promoting lactation), Stanyajanana (~galactagogue), Vataharadravya (~drugs which alleviating vata dosa).

Apathya[24] 

1. Shita Ahara (~cold food items), vihara (~cold regimens).

2. Maithuna (~ sexual intercourse).

3. Physical and mental Stress.

4. Ati Vyayama (~strenuous activities).

5. Shoka (~sadness), Bhaya (~fear), Krodha (~anger).

6. Atapasevana (~Excessive exposure to sunlight) and Divaswapna (~Daysleep).

7. Panchkarma (~elimination therapy) is contra indicated in sutika.

Discussion

Childbirth care during and for the time following this period is an area of great concern nowadays. Interest for giving quality care during this period is increasing. People turn towards traditional practices during this period. In Ayurveda, a detailed description regarding the same in a systematic way is mentioned. Sutika is considered as Shoonya sharira (~empty body) as she becomes weak due to development of fetus, loss of strength of body tissues, excretion of Kleda (~moisture) and Rakta (~blood) during the delivery process etc. For regaining the lost vitality and strength, special care should be provided for Sutika. This suggests the use of Samanya and Visesha paricharya during postnatal period as per requirement. Samanya paricharya is aimed at providing a universal and unique care for all postnatal females but Visesha paricharya is somewhat more focused on person-oriented approach. This special care has been mentioned in terms of residence place (~desa) and sex of the child and which is applicable for those who are more socially stable and having chances to follow this. The main components of Sutika Paricharya are diet (~Ahara), regimen (~Vihara) and medicines (~Aushadha).


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Conclusion

Sutika Paricharya in Ayurveda is designed in a way that, it causes the Punar -Naveekarana (~replenishment) of the stree (~woman) and would prepare her for the next delivery also. At the same time, it gives importance to the Sishu Arogya (health of the baby) also. For better health attainment after delivery every postnatal woman should be encouraged to follow Sutika Paricharya as per Ayurveda classics.

Reference

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