Three Keys to Successful Pregnancy
Since medical school, I have been fascinated with the customs of different cultures with respect to pregnancy and childbirth, having served as a health caregiver on several continents. Some customs were clearly wise; others had me questioning their value in light of their potential danger at such a delicate time.
In Zululand where women commonly had tiny pelvises due to childhood rickets and therefore high rates of cesarean sections, the wise expectant mothers would leave their kraals a month before they were due to come to the hospital for delivery. Every Thursday at sunset, they would chant rhythmically and stomp a war dance to enliven their fetuses with the bellicosity worthy of a Zulu. Living and cooking communally, the expectant mothers worked themselves into a certain mental state that culminated in war cries during labor making them oblivious to pain. Anesthesia was pointless, including during the episiotomies. The screaming was supposed to imbue their child with health and ferocity, but we found that avoiding anesthesia reduced the complication rates for both mother and child. Clearly a wise practice.
In this light, it is interesting to examine the understanding of Ayurveda as described by Charaka, editor of the world’s oldest textbook of medicine. He recounts a debate on pregnancy that occurred perhaps four to five thousand years ago between Atreya, a professor of medicine, and Bharadwaja, his questioning, rebellious student who is also a Vedic seer. Atreya begins his lesson about the delivery of the fetus, explaining what goes into making a healthy infant.
“The embryo is the product of the mother, father, the Self, the suitability of lifestyle (satmya), the nourishing plasma (rasa) and the mediating essence between the body and spirit (sattva).”
Bharadwaja is upset by the idea that a human being can be reduced to a product, a synthesis of factors, and retorts, “No! Why? Because if this were the case, the nature of the mother, father, lifestyle, the use of different foods, whether they are drunk, eaten, chewed or licked, nothing of this produces an embryo any more than the pure psyche comes from the other world to create an embryo.” Bharadwaja never reveals a better explanation, but he is clearly unhappy with the idea of human being as a formula. As a Vedic seer, he has a quantum mechanical view of the world, and hates reductionism, even though his professor says that the cosmic Self and the unifying spirit are two of the ingredients.
Their argument rages on, covering conception’s what and when, and predating our current controversies about the issues. Atreya stakes his ground to outline ways to optimize the outcome of pregnancy. Couples planning their own pregnancy should consider the words of these ancient sages only in the light of their own wisdom, common sense and advice of their doctors.
The Three Keys
The three Sanskrit words from this passage that guide us for pregnancy are satmya, rasa and sattva.
Suitability
, nourishment, and purity. Satmya (suitability) means a diet and lifestyle appropriate to the circumstances. This contrasts with western medicine’s usual approach of prescribing based on a protocol or algorithm, e.g. every woman gets vitamins and iron. Rasa is the primordial plasma that nourishes all the other tissues. Sattva is the quality of wholesomeness, silence and purity, which the text implies mediates between body and spirit. These are the key ingredients a couple can do something about, their genes being unchangeable.
Suitability
In general, in Ayurvedic medicine, patients follow a therapeutic regimen that balances the three doshas or physiological operators. In pregnancy, on the other hand, the key is suitability. In other words, choose the diet and activities that you naturally desire and that make you feel well.
Critically, suitability means foods that are easily digested. Eating what you naturally desire does not include foods you take out of habit, comfort, stress or convenience or even because you have been told they are good for you. It also does not include foods that most adolescents and adults find distasteful on their first taste and for which you must cultivate a taste, like beer.
During pregnancy, you are eating for two physiologies: yours and the fetus’s. If you feel an unusual craving, it may be from the fetus’ unique needs, which may be different from your own. This is why pregnant women should not adhere strictly to an Ayurvedic diet based either on their body type or their imbalances, but on their cravings and suitability. If you find yourself dining only on the proverbial pickles, indulge yourself to a reasonable limit, but tempered by common sense and intuition.
Nourishment
Nourishing means to favor warm, cooked, fresh foods but to avoid heavy foods that are hard to digest. Include adequate protein, remembering that heavy meat dishes and cheese are most easily digested at noon, especially in the last trimester, when it may be uncomfortable to retire after a big supper. Vegetarians should use lentils or well-cooked mung beans, reducing other beans and chickpeas that create gas.
Charaka recommends milk and clarified butter (ghee) throughout pregnancy, so it is interesting that dairy is the most assimilable form of calcium. Don’t forget you are going to be extracting enough calcium out of your own body to create a new skeleton. Take at least a couple of glasses of milk daily; low fat is fine, and preferably alone, not with meals or with sour foods as they aggravate its digestion. Milk should be boiled and taken warm. You can add a quarter teaspoon of sugar and a pinch of cardamom or a few threads of saffron. Add a pinch of nutmeg before bed. Hot milk and cooked cereal makes a good breakfast.
Nourishing also means grains, but if you take too much pasta, potatoes and bread during pregnancy, constipation and weight gain are frequent consequences. Selecting your starches to contain more fiber will help both problems: hot oatmeal with milk or granola, brown vs. white rice, whole wheat or rye vs. white bread, cream of whole wheat, millet and quinoa (rich in protein) are good choices. Avoid straining at the stool, and obey without delay any urge to pass urine or stool.
To avoid indigestion as the pregnancy advances, vegetables are best taken cooked and salads should include only young tender leaves. Avoid excessively pungent spices, chilies, garlic and onions, which are not sattvic, and which may create painful reflux when the fetus presses on the stomach.
Purity (Wholesome)
Sattvic or wholesome foods by tradition mean, above all, fresh. The texts do not consider leftovers and preserved foods to be pure and wholesome, so this must apply to frozen foods as well. Guide yourself by the criteria you would hold for a fine restaurant: if they served you leftovers, frozen and canned foods, you’d probably never go back. Your kitchen should be the best restaurant in town (and not just when you are pregnant). Avoid foods with artificial coloring, preservatives and other chemical additives, which like many drugs have never been proven safe for pregnancy. Even herbs are unnecessary; your pharmacy is in your kitchen.
By tradition wholesome includes fresh, sweet fruits, which can be taken for breakfast, snacks or as fruit salad with a light supper. Include apples, pears, avocados, cherries, coconut, grapes, melons, mangos, peaches, and pears. Pomegranates are especially good, rich in iron, and their astringency is useful for nausea. Dried fruits such as figs, raisins, and dates can be eaten out of the bag or after being soaked in water for an hour. Sour fruits such as citrus and berries are included from the fourth month as they can aggravate morning sickness.
Here are a few hints from the ancient physicians for morning sickness and nausea:
- Roast cardamom seeds until they turn dark, powder them, and eat a pinch as needed throughout the day.
- Snack on dry crackers or toast. Always keep a little food in the stomach. Pregnancy is not a time for dieting and fasting.
- Throughout the day, sip tea made with a teaspoon of freshly grated ginger root boiled 5 minutes in water. Add fresh ginger root to soups and vegetables.
- If you awaken early in the morning, try sleeping the rest of the night in a semi-reclining position rather than flat. You can use extra pillows or put a board under the upper half of the mattress.
- Drink tea made from a teaspoon of fennel seeds steeped in boiling water. This tea is also good throughout pregnancy.
- If all else fails, lick salt out of your hand.
Nourishing Snacks for Pregnancy
Fried Dates: Sauté 3 or 4 dates in a little clarified butter (ghee) until the color darkens. It is nourishing, satisfies cravings and creates a nice aroma throughout the house.
Coconut balls: Fry 1/4 cup freshly grated coconut in 1 tablespoon of ghee until golden brown. Add 1/4-cup milk and 1 tsp raw sugar and cook on low heat until it thickens to the consistency of pudding. Then add a pinch of powdered cardamom, cinnamon, and nutmeg and cashews or almonds if desired.
Date beverage (Karjuradimanth): Soak overnight in 1 cup of water a handful of raisins, 2-3 dates, and one kokam (a dried plum found at Indian groceries). In the morning, take the seeds out of the dates and kokam and blend with a hand blender. Taken in the morning, this aids digestion, energy, and is cooling in summer.
Halva: Sauté cream of wheat or semolina in a little clarified butter, together with raisins, slivered almonds and brown sugar to taste.
Wholesome Behavioral Tonics for Pregnancy
Vedic medicine recognizes the importance of culturing happiness and joy for a successful pregnancy. What you ingest through the five senses should be as carefully chosen as your food. Avoid intense music, movies, television and even people. More than ever, keep the company of the wise, spending time with uplifting friends or relatives to avoid loneliness, stress, and worries. Vedic tradition suggests reading inspiring biographies of great people, listening to classical music.
I have found that when the expectant mother practices meditation, the likelihood she will look forward to another pregnancy is higher. The practice of Transcendental Meditation is effortless and not disciplined. During pregnancy especially, meditation needs to be easy.
Be structured about your daily routine, especially if you are working, and be disciplined about saying “no” to other activities during the last trimester. Get extra rest and go to bed on time. One or two easy daily walks of 20 to 40 minutes are ideal. Gentle yoga postures that do not put pressure on the abdomen are fine, including sun salutes, which add a gentle aerobic workout. Daily sesame or coconut oil massage before a warm shower is beneficial throughout pregnancy, ideally in the morning, spending extra time on the breasts in the last trimester.
From the eighth month, spend as much time at home resting as possible, for this is a delicate time when the essence of nourishment (ojas) is passed between mother and fetus. During the entire pregnancy, exercise moderation in sexual activity, but especially during the last 2-3 months and avoid sitting or sleeping in positions that put pressure on the abdomen.
The Role of the Expectant Father
If you are an expectant husband, your main job is to create joy around the two of you. Shower her with attention and affection, avoiding being away from home in the evenings if possible. Give your wife little gifts throughout the nine months, corresponding to the fetus’ development of five senses and organs of action: rattles, music boxes, mobiles for the crib, baby spoons, etc. Within reason, fulfill her desires. Help her keep the home extra tidy, and place a few cut flowers in the rooms.
Breastfeeding
The ancient physicians placed an importance on the mother learning to culture in her children a reverence for eating consciously, a quality that prevents weight and digestive problems later in life. Before the first feeding, the mother is bathed or sponged and then given an oil massage. She then holds the newborn such that it is facing east (an auspicious direction) for its first drink, and takes the infant to the right breast. You can modify these details to culture the idea of having children develop good eating habits from the first mouthful.
The text says few drops of breast milk falling into a glass of water should disperse easily; this milk is felt to aid growth and prevent disease. Check your milk after the colostrum has been replaced with true milk. Maternal dietary changes need to be made for the three common breast milk problems related to the three doshas: milk that produces gas, mucus or heat.
Enjoy this special time. Organize your life to cultivate suitability, nourishment and wholesomeness and it will naturally be a period of joy.
Jay Glaser, MD is a board certified internist in Massachusetts.
