The cost of ignoring ancient systems

The aggressive campaign to wean women away from traditional practices in obstetrics and gynaecology has cost us dear in terms of ensuring women's health. Dr. P.L.T. GIRIJA advocates a return to Ayurveda.

IN obstetrics and gynaecology, what has happened to Indian women is shocking, to say the least. Not relying on Indian systems of medicine has cost the Indian woman and the nation dear, in terms of ensuring women's health. This degeneration is striking when viewed from the point of view of Ayurveda.

Take, for instance, obstetrics. A birth is today viewed as an event wrought with complications, warranting surgical and hi-tech intervention. Induced labour and caesarian sections have become routine procedures at every maternity centre. Private nursing homes in semi-urban and rural areas are classic examples.

In one case, a private nursing home at Mancherial, Adilabad district, Andhra Pradesh, has given the following statistics. For 1999, the number of caesarian deliveries accounted for 70 per cent of the total number of deliveries. In September the same year, the percentage of women who were subjected to Caesarian- section was an all time high - 91.3 per cent.

This is by no means an isolated or a freak case. This high rate of Caesarian procedures is often motivated by monetary considerations. However, unnecessary surgical intervention is also due to a total lack of obstetric knowledge and skill.

To quote a standard text book on obstetrics: "As yet, no method of induction is both certain and safe. This is not surprising since only some of the factors which provoke spontaneous labour are known, so that it is impossible to set the stage as nature would have it set ... it raises the question whether things might not have been better left alone from the first ... whether natural delivery might have occurred had we not meddled in the first place".

Unfortunately, the reason for performing a caesarian with increasing impunity is attributed only to improved medical facilities. Thus the practices of episiotomy (cutting just below the opening of the birth canal, which helps in birth), Caesarian- sections and hysterectomy (removal of the uterus) have all come to stay as routine, advanced medical practices.

Obstetric care in Ayurveda is in striking contrast to this. Ayurveda ensures a safe and natural delivery by helping the factors which "provoke spontaneous labour". This is achieved by a regulated diet and regimen during the pregnancy, administration of herbal decoctions and medicinal preparations needed for each month, a regular application of oil on the mother-to-be and application of medicinal oil enemas in the ninth month to make more supple the birth canal, placenta, pelvis, waist, sides of the chest and back.

Ayurveda explains that the Apana Vayu, the Vayu that moves downwards from the hip region, is responsible for childbirth. Therefore, these measures help in the smooth flow of Apana Vayu and ensure a hazard-free and safe childbirth. During pregnancy, common problems like abdominal pain, cramps, fever, diarrhoea, oedema, anaemia, back pain, cold and cough are cured by administring Ayurvedic medicines. In the Susrutha Samhita, various manipulations are suggested to deal with abnormal foetal presentations so as to ensure a normal delivery. In spite of all these, if the situation warrants, surgical intervention is recommended in an obstructed labour.

With the advent of modern medicine, and with its emphasis on institutional care for a delivery, the situation is fast changing. Modern obstetrics no longer aims at allowing or aiding nature to take its course. Since the factors that give rise to spontaneous labour are not fully known to Western medicine, it is also not in a position to prepare the pregnant woman for a natural and risk-free delivery. The high rate of Caesarian deliveries seems inevitable in view of the fact that according to Western medicine, a typical pregnancy can last only upto 40 weeks. However, most obstetricians do not wait beyond 36 to 38 weeks. Pregnancies which continue beyond the specified date, are sure to face the knife.

Ayurvedic texts say that a pregnancy can last anywhere between nine and 12 months (Sushruta Samhita). Even though a 12-month pregnancy is a rare phenomenon, 11-month pregnancies were not uncommon for mothers of the older generation who were lucky enough to escape institutional deliveries. Hence, there is no need to panic and rush a mother-to-be to hospital unless it is an emergency. It is precisely here that modern medicine ought to apply its "scientific rigour" and arrive at this truth sooner than later.The next major predicament a modern doctor faces is medication. What drug can be prescribed fora pregnant woman in an ailment? There is no single drug in the modern allopathic pharmacopea which can be safely used during pregnancy. Both the doctor and the patient are left with little option except to take whatever is available.

The plight of the woman is even more agonising when it comes to modern practices of delivery. A high point in any routine delivery is a practice called "Episiotomy" (incision made in the tissue between the vagina and the anus). Episiotomy has been justified on the grounds that it prevents the perinium from tearing in an uncontrolled and zigzag manner; it reduces the risk of damage to the anal sphincter, protects against incontinence and heals faster. Medical research of the last 30 years has not proven any of these benefits.

On the contrary, studies reveal that this widespread and routine practice has in fact caused harm. It causes more post partum (after childbirth) pain, infection, increase in third and fourth degree vaginal laceration and a longer healing time. It results in faulty repairs of the episiotomy, localised collection of blood, a loss of blood and a formation of abcesses. Often, sutures have to be removed to drain the wound and resuturing has to be done. In short, this mutilation and reconstruction seems to be a ritual which serves no medical purpose.

The practice of episiotomy provided the modern obstetrician with reasons to sneer at and ridicule the traditional mid-wife who conducted deliveries without mutilating the birth canal. The valuable role of the mid-wife was vehemently denied. National and international agencies ganged up against her. Wherever a more tolerant attitude prevailed, demands were placed on her for "improving" her mid-wifery skills. Later, she was tolerated as a necessary evil, until such time when modern institutional care could be extended to the rural population.

India possesses a huge army of mid-wives, its numbers running into several lakhs. Even now the national average for non- institutional deliveries is still as high as 50 and 60 per cent. This percentage is far higher for some of the remote areas in India. It goes without saying that these mid-wives are the only obstetric professionals left, who can practise this branch of medicine skilfully. They are the ones who are able to manipulate abnormal presentations and ensure delivery the natural way. Indeed, it is the absence of this very important skill that has reduced childbirth to routine surgery.

With minimal resources, and with locally available material, mid- wives provided the optimum ante and post-natal care to the mother-to-be and prepared her for natural, easy and painless childbirth. They knew to manipulate and handle abnormal foetal presentations and to resuscitate and revive the baby when necessary. They performed deliveries leaving the perineum intact, in most cases, massaged and bathed the mother with medicinal oils and hot water which reduced her body pain, gave her a sense of well-being and hastened her recovery. They would massage the woman's abdomen and tie up the loose abdominal muscles and the hip region firmly, a practice which saves the new mother from many complications of Vayu, back pain for instance.

The mid-wife also performed the job of a paediatrician to the new born and prescribed regulated diet (pathyam) for the mother. In the case of a nursing mother, this diet took care of the infant's health and well-being too. Many of the procedures followed by mid-wives are based on the theory of Ayurveda and are described in Ayurvedic texts. With the overemphasis on institutional care for a delivery and the constant propaganda to stay away from traditional practices, the modern mother lost all this valuable care.

A much dreaded cause for maternal deaths is uterine bleeding after delivery or post-partum haemorrhage. The diet, regimen and medicines instructed by Ayurveda largely took care of this. Ayurveda uses a whole range of drugs like Samanga, Nyagrodha, Udumbara, Ksheera Vriksha, Sarjarasa, Gairikam, Madhuka, Sathavari and Dhataki which, with their cooling, astringent and constricting qualities along with cooling diets, arrested haemorrhage after delivery. A significant number of maternal deaths also occur due to anaemia and jaundice and it goes without saying that Ayurveda offers the best remedy for both.

In gynaecology too, Indian women have paid a heavy price. Hysterectomies have become routine. Any gynaecological complaint - irregular mensturation, heavy mensturation, pain during/before the menstrual cycle, white discharge, menopause and fibroids or cysts in the uterus can lead women only in one direction - a hysterectomy. Ayurveda provides effective cures for all these ailments. Excessive menstrual bleeding is called Pradaram in Ayurveda. This and 20 other gynaecological problems are dealt with in Ayurvedic texts with medicines, panchakarma treatment, uttara basti (cleansing of the uterus), medicinal tampons and so on. The aggressive campaign to wean women away from traditional practices has left our urban women, and, increasingly, our rural women too, in a pitiable condition. Considering all these, it must be admitted that women's health today has hit an all-time low.

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