* Sandeep Pal Singh- MD Scholar * Prof. Ajay Kumar Sharma – Prof & Head
* NIA, Jaipur
The term “Neonatal” means pertaining to a child who is just born. Lot of instructions are available in classic Ayurvedic literature for the care of the neonates in the form of traditional practices. Most of the traditional practices of neonatal care appear to be based on experiences, logic and scientific justifications laid down by several Acharyas of different Ayurvedic classics. But these practices have undergone a lot of changes and twists over decades and some of them have become irrelevant in the present times. Traditional practices of neonatal care change from place to place and from time to time. Some of the traditional neonatal practices as mentioned in different Ayurvedic classics, which are being practiced throughout India, are summarised below-
- Resuscitation of Newborn (Pranapratyagamnam)
- Care of the Cord (Nabhi Nadi – Paricharya)
- Prelactal Feeds and Baby Bath (Jatkarma Sanskara & Swarna Prashana Sanskara) 4. Colostrum & Breast Feeding
- Lactagogues (Breast milk Purifiers & Promoters)
- Wet Nursing (Dhatri Gunah)
- Baby Massage (Shshuabhyangam)
- Corrilium Application (Anjana)
- (Janma Ghutti) Modified medicinal preparation for the neonate
- Ear and Nose piercing (Karna & Nasa Vedhana Sanskara)
1] Resuscitation of Newborn (Pranapratyagamnam): The newborn baby is to be resuscitated before cutting the cord. There are two types of resuscitative procedures
Following interpretations can be drawn from the verses quoted above:-
There are two types of resuscitative procedures –
ii For unconcious or asphyxiated neonate.
i) Routine Resuscitation (Vishodhanam) :-
Routine Resuscitation (Vishodhanam) is performed in following steps –
a) Cleansing the face & oral cavity with ghee and rock salt.
b) Swab soaked in Balataila to be applied on head especially on the vertex as Pichudharanam.
c) Mukhparisheka i.e. whole face including eye, ear, nose & mouth should be cleaned with water.
d) Pramarjanam i.e. tongue, lips, throat including palate should be gently cleaned with right index finger which should have nails cut, properly washed, dried and wrapped with cotton.
e) Anal & Uretheral orifices should be cleaned properly.
f) Chardnam – Ghee & rock salt should be given again for emesis to vomit out swallowed amniotic fluid.
ii) For Resuscitation of unconscious or asphyxiated neonate –
a) If neonate is asphyxiated or doesn’t cry after birth then two stones should be striken near the base of the ear.
b) Mukhparisheka i.e. hot or cold water (depending upon the season) should be sprinkled over the face.
c) Fanning should be done with blackened broken earthen pot or with winnowing basket made of Krishna Kapalika
d) After resuscitation following mantra should be spoken near the ear of neonate for his longevity “Thou is born from each of my body parts and from the heart. You are my Atma itself & named as son. Thou live for hundred years in which each year should be of hundred years. Thou attain longivity. May the nakshatras (planets), Dishas (directions), nights & days protect thee.”
2] Care of the chord (Nabhi Nadi Paricharya) :-A
After Resucitation cord care practices are adopted. Here are a few verses quoted from different Ayurvedic classics regarding chord care practices:
Following conclusions can be drawn from the verse quoted above :- Chord
care practices involve three procedures – a) Chord cutting; b) Chord tying;
c) Chord dressing.
a) Chord cutting – Cord should be measured 4 fingers (2 inches) from the neonate’s umbilicus & tied the first thread; (thread should be silken soft and soft). Then tie the second thread at 8 fingers (4 inches). Then gently hold between the two threads and cut the cord with the knife or sickle shape (Ardhadhara – Mandalagrum shastra) sharp edged instrument, which should be made up of gold, silver or iron. Instruments should be purified in fire.
b) Chord Tying – The thread used for tying the end of stump should go around the neck in such a way that stump end faces upwards thereby eliminating chances of bleeding & oozing.
c) Chord Dressing – After cord tying dressing of the cord is advised which depends upon the condition of cord. If the cord is dry then Kushtataila or Lodhrataila can be applied & if the cord is wet then Lodhradi Churna should be applied. According to Acharya Sushruta after cord cutting the child should be treated as a wounded person.
3] Prelactal feeds & Baby Bath (Jatkarma Sanskara/ Suwarna Prashana Sanskara) -Administration of prelacteal feeds before breast feeding is advised in different Ayurvedic texts and is called Jatkarma Samskara or Suwarna Prashana Samskara.
There after the neonate should be given paste of ghee, honey or ghee, honey and gold bhasma. The paste should be given by the baby’s father while chanting a mantra. This improves the life span, intellect, strength, digestion, fair complexion of the child along with enhancing the immune power. Then rock salt & ghee are given again for inducing vomiting. After the prashana, the baby should be given massage with balataila and cover the anterior fontanelle with oily tampoon. The baby is now bathed with hot or lukewarm decoction (depending upon the season) prepared from focus group of drugs and some fragrant drugs, which are easily available. The child should be wrapped with soft silken new cloth and made to sleep covered with soft cloths.
4] Colostrum and Breast Feeding (Piyush and Stana Panam) :- After prelactal feed, mother’s milk should be given to baby. But before giving the feed a few drops should be discarded at every feed to purify the breast tubules.
Acharya Charaka has advised breast-feeding on the very first day but Acharya Sushruta has advised breast-feeding on third day. But before giving the breast milk breast should be slightly squeezed or milk should be drained for ensuring patency of lactiferous tubules and prevent complications like vomiting, dyspnoea, cough and fever etc. in neonate which can occur if breast milk is not discarded but it doesn’t mean that colostrum is to be discarded rather it should be encouraged in mothers as it provides strength to different parts of body in neonate along with longevity and good health.
5] Lactagogues (Breast milk purifiers and promoters): Medicines or procedures that purify breast milk should be given before giving galactogogues or along with galactogogues. These can further be classified in four groups –
a) Psychological –
Here Sushruta explains that even the thought of a women hearing of her voice or feeling of her touch, a man gets stimulated and the semen is discharged. Similarly there is a psychological impact of the child on his mother i.e. the sight or sound or even the touch of child is enough to promote lactation in mother. So there should be a feeling of affection towards child and she should avoid anger, depression etc.
b) Physical- So mother should avoid physical exertion, hunger and sexual excitement etc.
c) Diet- Diet plays a very important role in lactation as properly nourished & healthy mother can give healthy milk. So mother should be given highly Nourishing diet. There are a few dietary recommendations. So, mother should be given wheat, shali and shashtika rice, guda (Jaggery), ghee, oil, milk, green leafy vegetables, garlic, fish, onion but she should avoid excessive fatty diet along with sour, salty and astringent foods.
d) Medicine – A lot of references are available in different Ayurvedic texts for producing and enhancing mother’s milk. But they should be practiced when the above three recommendations don’t work.
6] Wet Nursing (Dhatri) – In ancient period, there were many dynasties. Wet nurse was arranged to breast feed royal and elite children. Although, there is no other substitute for mother’s milk but there are some reasons for which wet nurse should be arranged. Wet nurse is advised in special situations only where the mother has died, seriously ill or having some serious heart disease or less milk. Physiological and psychological assessment for qualifications and disqualifications should be carried out for the wet nurse.
7] Baby massage (Shishuabhyangam) – After giving bath, massage should be given with any medicated oil or Tiltaila or Balataila to the neonate. Acharya Caraka has mentioned in details regarding the importance of massage. Similarly in all Ayurvedic Samhitas a detailed description regarding importance of massage is available. In neonates massage has two benefits –
a) Regularly massageing a baby gives the opportunity to keep a check and find out any area of the body that consistently gives rise to pain, discomfort or tension.
b) During early months of life baby uncurl from their position and as they do so they stretch their muscles and joints and co-ordinate their movement. Massage in especially beneficial in this situation. The mother herself should give massage as this makes close contact of mother and child and creates affectionate relationship between them.
8] Corrilium Application (Anjanah): In Indian System of medicine two types of Anjana applications are described –
- Sauviranjana (Lead Sulphide).
- Rasanjanam (Herbal corrilium prepared from Turmeric).
The Anjana preparation is used as powder or in suppository form. Application of Rasanjana is advised once a week for secretion of netra doshas or as a daily regimen and to prevent the diseases above clavicle. It cures pain and itching sensation in the eye. It should be applied at night.
9] Janma Ghutti (Modified medicinal preparation of Lehya): Janma Ghutti available today is the modified medicinal preparation of Lehya mentioned in different Ayurvedic texts for keeping the baby healthy and to overcome some minor ailments like constipation, atulance in the baby. Acharya Kashyap has mentioned in detail about the indication of lehana in Lehadhyaya. Most of these medicinal preparations are made up of Haritaki and Soya as he main constituents as these increase digestion, tone the heart, cure constipation, kill worms, increase appetite and cure cough and maintain the balance of tridoshas. Along with above mentioned Ghuttis, medicated Ghee like Brahmi Ghrita, Kalyanakaghrita or Panchagavya Ghrita can also be used.
10] Ear and Nose piercing (Karna and Nasa Vedhana Sanskara): Although there are several references of ear piercing available in different Ayurvedic texts but the act of nose piercing is a very common traditional practice. Both of these pratices are belived to prevent the ill effects of evil spirits or protection from the omens. This ceremony is performed during 6th or 7th month of life on auspicious day after performing religious rituals. The child is seated in the lap of mother, or wet nurse. Toys like horses, elephants and sweets, eatables should be given to child to lure him and the doctor is supposed to pierce the ear by hiding it with his left hand, the anatomical orifice facing the sunlight and properly drawn so that it is easily visualized and then with the right hand a sharp needle is gently passed through it. The right ear is pierced first in male child while the left in female.
These traditional neonatal practices are being practiced throughout India and all these have scientific rationale behind them both in prevention as well as management of different type of neonatal disorders. So there is growing need to popularize these traditional neonatal practices, which are now disappearing in the piercing light of modern system of medicine.