By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Woman nearing childbirth
Prajayini – a woman eager to deliver
The stage nearing to childbirth is called ‘prasava utsuka’ in Bhavaprakasha treatise. This also means ‘waiting to deliver’.
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This stage depicts a period of 1 or 2 days before labour or just beginning of first stage of labor.
This stage is recognized when woman presents below mentioned signs and symptoms –
- Laxity of abdomen / flanks
- Release of bond of hrdaya i.e. woman feels as if child to be delivered has been released from its attachment with her heart and is ready to come out
- Pain in thighs and legs
Women just about to deliver
Asanna Prasava / Upasthita Prasava – woman who is likely to deliver shortly
This is a stage of labour in continuation with previous stage. Prajayini is all about feel, anxiousness and eagerness of woman; it shows mental preparedness to deliver child. On other hand, Asanna Prasava stage is physical preparedness or signals given by body that woman would deliver child shortly.
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What they mean?
- Asana Prasava (Vagbhata) / Prajanana kalabhimata (Charaka) – First stage of labor
- Upasthita prasava (Sushruta, Bhavaprakasha) – End of first stage or beginning of second stage of labor
Signs and symptoms of first stage of labour
1. Prajanana Kalabhimata (Charaka)
- Tiredness of body
- Lack of luster of face, restless face
- Laxity / looseness of eyes
- Feeling of release of bondage with chest i.e. woman feels free in chest, as if child has freed itself from chest
- Feeling as if pelvis is slipping down, uterus coming down
- Heaviness in lower parts of body
- Pain in groin, urinary bladder, pelvis, flanks and back
- Discharges from vagina
- Loss of interest in food
- Manifestation of labour pains
- Elimination of amniotic fluid
Vagbhata and Kashyapa
2. Asanna Prasava (Vagbhata, Kashyapa)
First stage of labor is called asanna prasava by above mentioned masters.
Signs and Symptoms of end of first stage of labor
Initiation of childbirth
1. Upasthita prasava (Sushruta, Bhavaprakasha) – end of first stage or beginning of second stage of labor
- Recurrent and severe pain in back, sacral region, pelvis and all regions around
- Excessive and increased frequency of defecation and urination
- Mucoid discharges from vagina
Explanation given by all authors seem to be events happening one after other. This stage of labor extends from the onset of first stage to the end of this stage or beginning of second stage.
Names of these stages given by Charaka, Vagbhata and Kashyapa spell different but symptoms and signs explained in these stages appear to be same. We can see that few additional symptoms have been enlisted by Vagbhata and Kashyapa, looks like an improvised version of Charaka’s explanation.
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Descent of fetus
Parivartita Garbha – signs and symptoms appearing after descent of fetus
Before getting delivered, fetus descends downwards. This stage can be known when below mentioned signs and symptoms manifest –
- fetus leaves cardiac region i.e. woman feels free in heart region as fetus descends towards pelvis
- fetus enters in lower abdomen
- fetus now holds and stays in the region of neck of the urinary bladder i.e. pelvis
- There is increase in frequency and duration of labor pains
- Severe compression and tearing pain in vagina and cervix
- Discharges from vagina
Term parivartana probably refers to ‘internal rotation’ occurring in pelvis after descent of fetus and exaggerated flexion. These events refer to the second stage of labour.
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Expulsion of placenta
Apara Patana – separation and expulsion of placenta
Expulsion of placenta has been explained by all authors as an end and inevitable event occurring at the end of labour. Kashyapa explains that woman in whom placenta has not been expelled following labor is not considered as sutika i.e. puerperal.
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Other important points related to Labor
Avi, accouchement force and labor
Avi i.e. accouchement force is very much needed to push baby out of womb. According to Kashyapa, woman who is almost ready to deliver fetus will –
- have a fetus in womb which is normally situated,
- presents with dilatation of cervix of uterus and
- presence of normal uterine contractions during labor including contraction, relaxation and retraction i.e. avi, along with
- seizing pain caused due to abdominal contraction i.e. secondary force of labor is very much ready to deliver fetus i.e. grahishula
Even in presence of severe seizing pain labour doesn’t happen if normal uterine contractions are absent i.e. if avis are absent. If these contractions are delayed, fetus is put into serious trouble.
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Prasava Purva Srava, color of show
Show or bloody show is passage of small amount of blood or blood mixed mucus through vagina near end of pregnancy.
According to Kashyapa –
- If woman is about to deliver a male child, she will have scanty and unctuous show. This will resemble color of guduchi i.e. Tinospora cordifolia with very light yellowish pink color.
- If woman is about to deliver a female child, she would present with a show which resembles color of water obtained by washing flowers of palasha i.e. red in color like flowers of Butea monosperma.