Abstract
Postpartum is a term given to explain and understand after childbirth phase. As we all know that a female undergoes many changes while being pregnant both mentally and physically. She gets emotionally attached with the baby and she nourishes her baby with a lot of care and love inside of her womb. A mother always know that giving birth to a baby is not easy, she knows that she has to bear pain equivalent to breaking many bones while giving birth to the most adorable human being she will ever meet. A mother waits for nine long months in order to see, sense, touch and presents all the love she has to give to her child. After giving birth, she realizes that this baby is going to fill a place in her heart that she never knew was empty. But in some cases these joyful emotions can be totally absent and a female can experience depression. This absence of positive emotions and depression is called as postpartum psychosis. In this article we will discuss the causes, symptoms and treatment for this kind of psychosis and also some preventive measures that must be adopted to avoid such conditions.
Introduction
Pregnancy is a beautiful gift for a woman. It alters your thinking forever; makes you realize that how much important and fragile life is and why it must be protected at all cost. Though speaking practically, things during pregnancy and after childbirth are not same for everyone. Females experience many difficulties during their prenatal time, natal time and post natal time. The complications faced by a woman in these stages collectively lead towards postpartum psychosis. This condition is not a flaw or weakness. It can simply be understood as a complication of giving birth. This is explained as an extreme mood disorder which is most common in new moms. The reasons for psychosis can be many and its severity varies from person to person. The symptoms arise from second or third day after delivery and lasts for four to six weeks or even more.
You will not believe but some new fathers also face postpartum psychosis and in case of both mother and father the condition is treatable. Ayurveda terms this puerperal condition as sutika vayadhi or sutika vayapad. Aacharya kashyap mentions that after the delivery of child till the placenta is not expelled, the woman cannot be called as sutika, in other words sutika term can be used only after expulsion of placenta. Now we are going to explain the General etiological factors and treatment for sutika vayapad
Causes
In modern the causes which are responsible for this condition includes:
- Female already having history of bipolar disorder or schizophrenia.
- Close family member like mother or sister with a history of PPS.
- Discontinuing of anti psychotic drugs during pregnancy or after delivery.
- Previously experienced with PPS after delivery.
- Age: In young mothers it is more common.
- After first pregnancy chances for its occurrence is high.
- Having a complicated delivery.
- Baby with health complications.
- Extreme stress of work or due to behavior of family members.
- Desire for a baby boy or baby girl.
- Most devastating cause involves still birth. (When baby is declared dead after delivery).
Etiological factors and causes for difficult curability of all sutika vayadhi or vayapad.
Etiological factors
Outing during night, terror or fright, sudden fall from height, jealousy, grief, fear, anger, suppression of various natural urges, day sleeping, eating even in indigestion, eating before the digestion of previous meals and certain other factors are responsible for puerperal disorders.
Causes for difficult curability
Since all the dhatus decrease and become languid or unsteady due to the development of fetus, body becomes empty due to labour pains and excretion of moisture and blood. Her digestive power, muscle mass and strength decreases; all the diseases occur apatarpana (non satiation) and purifying measures cannot be given. Hence, diseases developing during this time become difficult to cure.
Symptoms for post partum psychosis
These symptoms vary from mild to severe. Mild symptoms are termed as baby blues. They include mood swings, irritability, crying spells, difficulty sleeping, decreased concentration, appetite problems, sad mood, anxiety attacks and feeling overwhelmed. But in severe cases the symptoms can be understood as baby blues. But these symptoms are more intense and last long. As the severity increases mother is usually not able to take care of the baby and grew emotionally apart from her child. Severe symptoms include:
- Depressed mood or severe mood swings
- Emotionally growing apart from baby
- Decreased appetite or increased appetite
- Insomnia or sleeping more than usual.
- Fatigue and feeling of being tired all the time
- Sudden irritability
- Anger issues
- Fear of being an irresponsible mother
- Anxiety attacks
- Reduced capability to think and make decisions
- Recurrent thoughts of suicide
- Thought of harming your baby
- Total restlessness
In further stages of extreme psychosis the signs and symptom gets worse followed by delusion, confusion and disorientation with hallucinations.If left untreated for long, chances increase for something terrible to happen either to mother or to child. On addition this will affect the family along with husband and in laws really bad.
Post partum depression in fathers
New and young fathers are at the higher risk to developing this condition. The reason like previous history of depression, experiencing issues with partners, work pressure, stress, financially instability etc. lead male parent towards psychosis. This is also termed as paternal postpartum depression or psychosis. In such situations fathers face depressive thoughts, anxiety attacks, grew apart from mother and child, unusual sleeping patterns, poor eating habits etc. If you are a male parent and are facing such issues you should talk to your partner first and then to your health care professional. Generally men ignore such things and never shares what they are exactly feeling. This nature of men leads them towards many psychotic disorders and this is one of them. Men should understand that it is not important to be tough all the times.
In both mother and father this depression can also be understood as a type of unmada. To be more specific it is called as sutika unmada. The name sutika unmada is only given by aacharya kashyap in Sutika upkarmaniya aadhyaye 11 in khilasthana.
Treatment mentioned in ayurveda for Sutika unmada
Treatment is done in the three steps
- Yuktivyapashraya Chikitsa (internal and external medications)
- Daivavyapashraya Chikitsa (spiritual remedies )
- Satvavajya Chikitsa (psychotherapy)
1. Yuktivyapashraya Chikitsa (internal and external medications)
Under this treatment shodhana and shaman therapy are included. These two therapies come under langhan chikitsa and reduces kapha dosha. In sutika unmade, shaman therapy is done as sutika is not having that much stamina (bala) in body for shodhana. In shaman chikitsa vitiated dosha are bought back to normal with dietary regimen and medicines (both internally and externally). This therapy is best for patients with low body stamina like in case of Sutika.
2. Daivavyapashraya Chikitsa (spiritual remedies)
It is understood as non pharmacological treatment which includes faith in divine powers and rituals. This includes mantra chanting, mala japa etc. Here daivya means something divine, vyapashraya is belief and chikitsa is treatment. This treatment helps in reduction of stress and eliminates negative thoughts from mind. This also assists in building confidence and calms your mind.
3. Satvavajya Chikitsa (psychotherapy)
It is a supportive therapy. Here satva means mind and avajya means to overcome. In ayurveda it is stated that kama (Lust), krodha (anger), lobha (greed), moha (desires), bhay (fear), dwesha (hate), irshya (jealousy), ego, visada (grief) results in stress anxiety and depression. This therapy helps in making mind positive and overcoming above mentioned factors. During the recovery phase females can have very emotional thoughts like fear for having more children, guilt for the lost time with baby, shame, bad effects on relationships etc.
Preventive measure for sutika to avoid depression leading to
Psychosis as per Ayurveda
It is believed that after delivery there are chances that a female body might face vitiation of vata. This vitiated vata is responsible for many diseases and also for psychosis in the postpartum phase. Our archayas had mentioned a proper regimen that has to be followed by a woman in the postpartum stage to protect her from such conditions.
All classics have advised massage, oral administration of fats with medicines and decoctions for three to seven days after delivery. Use of medicated rice gruel is prescribed in diet. From seventh to twelfth day medicated meat soup is advised.
- It is said that massage with bala taila should be followed by oral administration of decoction of some drugs like bhadradaru or devadaru (Cedrus dcodara) which are capable of suppressing the vata.
- If some blood clots are still left inside of uterus then administration of pippali, pippalimula, hastpippali, chitraka and singhbera with warm jiggery water should be given. It is to be administered for 2-3 days till lochia rubra (left blood clots) is completely excreted.
- Then rice gruel prepared with the drugs of vidarikandadi group is to be mixed with milk or ghrita and should be given for three days (from third or fourth day to sixth or seventh day after delivery).
- Then from seventh or eighth day cooked shali rice with meat soup of wild animals prepared with yava, kola and kulattha is to be given keeping in mind about her digestive power.
- Good irrigation with hot water to be done.
- After delivery of a full term fetus sudation is to be done.
- Avoidance of anger, exercise and coitus is must.
- Vagbhatta advised massage of yoni (vagina) along with body massage
- Generally maintaining hunch back position is recommended.
- On tenth or twelfth day after delivery women should take full bath. But on regular basis cleaning of genitals, nipples and changing cloths should be performed to avoid infections.
There are some special indications for Sutika on the basis of place of living (Desha)
There are three types of desha
- Anupa desha (marshy lands)
- Jangal desha (wild or dry lands)
- Sadharan desha (ordinary places)
1. Anupa desha (marshy lands)
In marshly lands usually diseases due to vata and kapha Appear. Due to dominance of moisture in these areas initially fat like ghrita or taila is not to be used. Instead scum of boiled rice with appetizing and strength producing things should be administered. Sudation, sleeping in air free area and use of ushna drugs is beneficial.
2. Jangal desha (wild or dry lands)
The strong women of this area are to be administered with ghrita or taila after delivery. For weak women rice gruel is to be used for three to five nights. She should be irrigated with good quantity of hot water.
3. Sadharan desha (ordinary places)
For the women of ordinary places, simple regimen is beneficial. Kashyapa also mentions administration of oil after delivery of baby boy and administration of ghrita after delivery of baby girl to the sutika. Only after the digestion of this ghrita or taila rice gruel prepared with appetizing drugs should be given.
Contradictions for Sutika
Use of asthapana and nasya is totally contraindicated for sutika. Use of asthapana basti increases ama dosha of puerperal woman and use of nasya results in anorexia, emaciation and body ache in sutika.
Conclusion
Due to excessive modernization many women will find sutika indications and contraindications useless. But if we go back in time these are things which were taught by our grandmothers. Following sutika regimen is not outdated or old fashioned but it’s the ultimate way to prevent you from conditions like psychosis and many others. Remember ladies! Post partum is a quest back to yourself alone in your body again. For this quest you have to be stronger and healthier. For the maintenance of strength and health a women should follow all the indications and contraindications for puerperal females.
