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Ayurvedic Bodywork in Pregnancy

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If you are an Ayurvedic masseuse or have specialized in postnatal bodywork, consider expanding your package of offerings to a value specific month by month service for your clients.  Here is the advice sourced from the Dhanwantari Institute, from some of the classical texts, with a few comments from the peanut gallery.

Because the fetus in the first three months is of very unstable, jelly like consistency and hyper-responsive to maternal experience, Ancient Ayurvedic texts tend not to advise regular massage the first three months. Some gentle oil/massage on marma points and especially the hands and feet (not deep digs however) is considered often beneficial however.  Points to avoid are similar to in accupuncture and other modalities.

Oiling in general is considered to increase warmth in the body, and mama’s pitta is up especially in the first trimester, so warm oil massage may not be best idea as full body treatment.  Use of coconut will be preferred, or more energy work such as marma therapy, polarity, acupressure, etc.  Heightened pitta continues though generally not as dramatically, with vata on the increase naturally also after the first trimester.

In any case, what mama experiences, Ayurveda believes baby experiences, so stress or intensity to maternal body can create some strain to baby’s system which is living in heightened sensitivity and delicacy at this time.  Or mild massage can be be beneficially stimulating to the marmani for mother and baby.

From 4 months to labor, massage has specific advisories also, according to the Dhanvantari Institute. In our forth month, gentle massage which benefits mama’s mind and mood helps stabilize baby’s heart, taking extra care around mother’s abdomen.   We know that just applying warm oil against the lay of the hair increases neurotransmitters in a good way.  Applying oil is a more appropriate way to speak of massage style than what most call massage for this time.

At this time oil padding over the vagina is recommended also.

In the 6th month, gentle breast massage, especially nipples, is advised with herbalized or plain coconut oil.  Why 6th month specifically, I have no idea.  Perhaps this is recommended from 6th month on; I would say so.  Modern research has found that twisting and stretching of the nipples this early does not seem to really make a difference, similarly starting so early on stretching of the perineum.  Oiling serves to promote natural elasticity and comfort however.

In the 7th month, an herbal paste on the stretching and sometimes burning tissues along with massage is valuable, and massage can be especially helpful with swelling on the feet.  Although the article does not say which herbs, I would choose demulcent and skin herbs and oils, and essential oils like myrrh, geranium, ylang ylang, chamomile, rosewood and vetiver for the skin which are seriously committed to quality, as they will be influencing baby in utero also.

Massage schools teach what therapists agree, with the strain on body mechanics of weight changes, deeper work along spine, hips and neck/shoulders feels especially good, done in well supported side-lying position.  Yet, due to softening of connective tissues from the hormone relaxin in some mothers early to mid pregnancy, deep work may need to be modified to not overstretch already easily stretched ligaments and tendons.  Again, mothers may crave and need some extra support to pregnancy discomforts, so personalized choices by therapist and mother are important.  Use of the Ayurvedic abhyanga style oil massage gives many relaxing and balancing benefits without going into excessively deep tissue work.

In the 8th and 9th month, vaginal massage and oil padding of the vaginal area is advised, and from 36 weeks/9th month a small 30 ml basti on alternate days is advised on regular basis to lubricate the tissues. The quantity of oil does not significantly increase apana vayu, but offers good preparation for birth in multiple ways. This practice is discussed by several practitioners including Vaidya Seema Datta in the UK, on Jan 13th, 2013 in the pertinatalayurveda forum.

“Tissues being softened and elastic, less resistance during the delivery results in bearable pain and many of our mums are able to deliver without any intervention with much less average delivery time” reports Seema. She advises this protocol regularly with all her expectant client at 36 weeks with olive oil or sesame oil, unless mother is post due date. Then a mix of castor and sesame is more indicated.

Once a mother has gone into early labor, another warm small oil enema of about 1/3-1/2 cup, after full body abhyanga (oil massage) is advised for natural body relaxation and easier labor.  Ayudoulas know that the mother with vaginal delivery can benefit from postpartum massage as soon as she would like.  After major abdominal delivery, application of warm oil all over her body except avoiding abdomen is still very beneficial for maternal Vata, but massage is contraindicated until the wound is sealed, mother feels ready, and doctor or midwife gives the ok for this gentle treatment.

Ysha Oakes, LMT, CPAD

Tips for Tempers

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Here’s quick tips to teach your client, and more if you have time to read the full blog.  These are good supports, and important preventives.  This first is free and she can do this while baby is falling asleep in her arms – “alternate nostril pranayama”.   More tips below are low or no cost choices also.

This breath practice balances the hemispheres, calms, freshens, and brings peace and contentment.  Yoga teachers, Ayurvedics and Doulas – be sure to teach your client the gentlest form of this yogic technique at this time.  It helps so much for life force purifying, freshening, moving and balancing.

Here’s instructions for your client:

  1. check which nostril you are breathing from now.  Right is solar and heating, left is lunar and cooling.  Let’s balance first, then can do more cooling “lunar pranayama” if you know it and need it.
  2. sit comfortably upright or in whatever rocking chair is comfortable.
  3. use your free hand (right if there is a choice); thumb is used for closing one nostril, ring/little fingers for the other, when it is time.
  4. breathe in and out nice easy and full.
  5. close one nostril with thumb and breathe in the other.  Naturally full breath in.
  6. switch to close other nostril and breathe a Naturally full breath out, then in on that side.  No strain or holding.
  7. switch using thumb.  Out, then in.
  8. Switch,  Out/in.    Switch Out/In …
  9. Continue, for 10 minutes.
If temper is up, do it.  If fear or anxiety dominates, do it.  See what two times a day does.  You are sitting with your baby falling asleep in your arms anyway, right?
Often we need more tools.  Here are some insights into what an AyurDoula can do.  These involve simple changes, it does not have to be about taking something away.  I believe in the crowd out instead of take-away approach.

When we get stressed and tired, it is so easy to loose it.  How many mamas have not experienced this?!    It is common and natural to snip or even have thoughts of hurting someone – our baby! for a few moments when we feel trapped in overwhelm.   Yet consistently negative emotions are the highest risk for baby – and for mom.  They can, left to grow, become life threatening, as we all know from the news*.

“Type A” – “pitta” mamas especially – and – at the end of pitta season all of us,  which is right now creates  special call to attend to such conditions.  Overlay the astrology if you believe in it, which says especially until the 23rd of this September, there are extra influences to promote short fuses.  Here’s some tips for your clients.

Postpartum mothers are on duty 24/7, no matter what help they have.  Think about the many bodily changes – tons of invisible work Mama has to do in addition to being on call for Baby.  Do I need to elaborate on other responsibilities?  We do what we can.  And we see the need for a better way!

This is where DOOOOLAS can dooooo so much in such simple little things ways, to prevent problems.  We mother the mothers at this time with the umbrella of love, wisdom, timely guidance practical supports. – Ayudoulas are specially trained for this work.  Or call on whatever friends and family and other helpers are there, under organizing guidance of an Ayurvedic who understands the special management of this “42 Days for 42 Years” window.

Let’s start with what Ayurvedics know as Vata dosha – the air and space element metabolic functions in the body.  Yes, even with high pitta (fire/water) dominant in a mother’s constitution, vikruti (imbalance) and summer to fall seasonal exacerbations, we have to look at calming vata after birth.  It can push the pitta overlays to flare up quickly.  And vata needs warmth among other things.  How to?

Avoid energetically heat producing foods and favor the season’s coolers – succulent sweet fruits and vegetables, coconut, some pomegranate and grape is great, gently cook more coriander and cilantro into foods, and organic milk rather than yoghurt or cheese helps.  But take them room temp or warm, not cold, to prevent gas, bloating and even colic contributing influences.

Also very important – enough good fats, carbs and snacks promote much needed stability and rebuilding.  At this time of year, favor clarified butter (“ghee”) and coconut oil, for their cooling properties.  Ghee not only cools, it strengthens digestive enzyme functions, and helps carry out impurities from the cells better than butter right now.

Many common chill out measures especially pitta dominant mamas will call on – can be shifted.  Most of her chill down choices make her feel more dry, brittle, fragile, emotionally chilly, ungrounded and fearful, ie, vata exacerbated.  Minimize and replace things like

Dietary

  • cold temperature foods and drinks – replace with thermous of cooling but digestive and lactation supportive weak herbal teas kept in a thermos for easy access.  Fennel, cumin, coriander, fresh ginger are good helpful – 1/2 tsp of the mix to 1 quart of hot water!  Cooling grains, like basmati (not brown) rice, quinoa and oat are preferred; cooling diary – clarified butter and organic cream top milk vs other forms, and taken warm temp cools; cooling or make the most of it – iron rich – sweeteners vs honey; cooling proteins include easy to digest small legumes, or poultry for non vegetarians.
  • bland foods – add “middle of the road” enzymatic seasonings which don’t spike heat but help digestive “fires” and make the food tasty too – food needs to be appeetizing!
  • Cucumber – and salads in general – by my experience is guaranteed gas for mom and baby used raw – I’ve cooked and seasoned it to delicious satisfaction, or you should avoid these.  Try steaming asparagus or another vegetable on the “foods to favor” list in our cookbook, and serve with a lime not vinegar vinaigrette with well roasted garlic.  This will probably satisfy salad desires for now.
  • dry quick foods like toast and crackers constipate and don’t satisfy – serve flat breads with soups and lots of ghee or other suitable fat to ground and nourish.
  • high sugar low fat sweets hit fast and hard and though even this is preferred to nothing when tempers flare – give her a little to keep blood sugar up then make a sweet with lots of butterfat, coconut, cacao butter, nuts or full fat dairy – you see adding protein and fats gives startup fuel from the sugars and carbs last a little longer, then the fats give stable long burning fuel.
  • chocolate has sweet, oily and bitter taste.  Good change she needs more of all, but craving chocolate let’s look at adding more bitter taste appropriately  – turmeric, fenugreek, and maybe a little well seasoned and cooked dandelion may crowd out that craving.
  • leftovers or pre-prepared foods to save hot kitchen time are generally devoid of prana – life force – and we say, are tamasic.  This means heavy, dulling, depressive, frustrating energies prevail with these.  Use easy cook methods and make smaller portions.

Lifestyle

  • Eating out gives probably GMO and free radical producing fats and other non-rejuvenating foods, though it gives her a break from the kitchen.  Ask if you can work with her best friend to renew the food chain a little longer if that is what’s needed.  Use this budget towards a postpartum home spa treatment instead.  Three in a row can really not just safety net but reverse many in free-fall emotionally.
  • An intense, distracting movie increases the fire element – singing or story time with family at night, more sattvic (light, love and peace filled) movies, like that are best.
  • Skipping naps.  Guess what……..this is high risk emotionally.  Need help fitting it in?  Let’s talk about the many factors, and who/what might best help.
  • Spending hours talking, processing your emotions – usually means you skipped your naps, as well, and probably ate fast food.  Can your friends value their time with  you at even $5 or $10/hour in contribution to your care at this time?
  • There are many ways to think creatively and each situation needs it’s own TLC this way.  AyurDoulas are trained to apply the needed principles to whatever resources are at hand to make the most of a mother’s experience.

Moms need to feel growing stability and rejuvenation, as well as fresh qualities in their early postpartum, even though many foods and lifestyle things that give these can complicate there are many which help.  For both hot tempered impatient or blaming moods,  and fearful, depressed and anxious moods settle, we see them settle down much with simple measures.

Stability and tissue rejuvenation are among the top priorities for mothers after childbirth according to the ancient Ayurvedic medical textbooks.  We see that the psychology, the heart and mind can be saved from self or other’s blame and most efficiently addressed taking proper care of her body’s needs at this time.  Such a blessing!

* Those mothers, whose anger or negativity became so serious we heard about them  in those very sad news stories, were all on some mood medicine cocktail inappropriate for them, according to Dr. Ann Blake-Tracey, and her website, Drug Awareness.

Of course – many mothers have pushed the envelope too far or have such fatigue their genetic predispositions are giving serious conditions beyond the scope of a general article.  We can’t presume to diagnose, treat or cure in this piece or as Ayudoulas in practice, and must encourage appropriate consultation for a client’s primary health care provider.  Postpartum mood disorders can be life threatening.

These simple supports are likely to still be helpful under this greater umbrella of licensed medical care, and for some clients, their path takes them out of our hands.

Herbs for Mood – Depression and many related conditions

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Herbs for Postnatal Moods – We use several really good ones.  Front line – I often call on Tulsi with Gotu Kola or another Brahmi tea – serotonin enhancing in Nature’s user friendly bio-balancing way that can be tandemed for month or more before beginning to SLOWLY reduce other herbs, according to some experienced Ayurvedics.  Transitioning off over at least 6 months, according to Dr. Ann Blake Tracy, if on mood meds for over a year.  She does not however have Ayurveda’s toolbox, so I believe there can be more help up front while still proceeding so very cautiously.   (Good results for a few days do not mean all is well – the medicines have stored in high quantity in brain tissues and begin to download in chunks into blood).  So this is just a beginning discussion of a number of mood supportive herbs.

These 2-3 herbs are also gentle at a time we need to be gentle!  They are key manas (Mind) rasayana (rejuvenative tonic) herbs.  Yes, they are safe in pregnancy and postpartum.  Especially for Mamas, I combine them a bit of digestive (ginger, pippali, or even cardamom), with shatavari (wild asparagus root) to potentiate the manas effects (connecting to body/hormones, and enhancing to lactation anyone?) and/or ashwagandha (more root chakra and Vata grounding/pacifying, also helps lactation).  There is controversy about use of ashwagandha in pregnancy, some are big on it, others totally avoid, I take a more middle perspective, in smaller amounts and well combined.  We can discuss that again another post.

Although there are many distinct diagnoses for mood issues after, or before childbirth, in Ayurveda we see a common thread during the postpartum time of high Vata, which may also push another dosha out of it’s right place and function.  We can consider support with herbal foods – a gentle benign tea – and leave the legally appropriate scope of practice in hands of licensed practitioner.

Tulsi-Gotu Kola Tea is on sale – just received the message today – with this wonderful company, Organic India .  I so honor this company – they sustainably employ thousands of families now in India in organic herb production.  They have loose leaf tulsi and brahmi (gotu kola or bacopa both work similarly and are called “Brahmi”).

I learned this from Ayurvedic practitioner of many years, Sarasvati Buhrman – she gives 4-5 drops nasya (nose drops/nasal administration of herbs) per nostril of brahmi decocted into ghee for Vata depression, varying it for Pitta and Kapha, along with 4-5 cups daily of the above tea as front line support while the rest of needed “homework” is being put into place.  I’ve worked with an older woman her family sent me East to support for a week, in severe suicidal condition under Dr Bhurman’s advice, and watched it really help, but please note that nasya is contraindicated in Pregnancy.

And severe cases MUST be under her doctor’s umbrella of support and referral.  Particularly with pitta cases involving violent impulses or thoughts which are highest risk.  There may be risk to baby or mother’s life.  They often have many issues and sources of advice, which can throw them off from prioritizing use of your support, even dietary and massage gets de-prioritized.  So this is offered as beginning discussion on long term project for education and care research perhaps.  We would want to look at the individual’s other issues in postpartum time and prioritize for it all to create their unique herbal formulation, under client’s and Doctor’s OK.  Research projects would start with much simpler parameters of course, and less potent results for many.

How does all this fit in context of a postpartum care practice?  

The following perspectives and the best possible care are especially important!  Mood support is greatly aided with the following knowledge and skills which may be much less difficult to implement than herbal formulation.   A mother’s special abhyanga (massage) given 3 days in a row absolute minimum, or 5-6 days (not spread out, in a row) as a wiser minimum for more serious cases, so helps ground the herbal effects and not just pop back out of benefits to this process.  It is a deeply significant component of postpartum care and of mood supports,  actually advised for all mamas, not just mood challenged, for 42 days daily.

Also deeply important are the rather unique even to Ayurvedic students and many western trained Ayruvedic practitioners, dietary recommendations after childbirth.  You can learn more in my basic webinars on Ayurvedic Maternal and Newborn Care.  Also useful is the e-cookbook and e-handbook for your clients, Touching Heaven, Tonic Postpartum Care/Cooking with Ayurveda.    The advanced 5 hour webinar on Safe Postpartum Herbs is also available, and will be most valuable to those with some knowledge of Ayurvedic herbology.  Those wanting to get started with potent supports right away can begin studying client and practitioner use of aromatherapy.   A 2 hour Essential Oils (More than) Basics class is also now recorded and getting really good reviews – as I must say I expected – even from experienced aromatherapists.

The early post-pregnancy time has been called “The Black Hole in Health Care” by Dr. Jeanne Watson Driscoll PhD,APRN,BC.  It is a big Y in the road, and effects easily last for decades – “42 Days for 42 Years” according to “Mother of Ayurveda” in the west, Dr. Sarita Shrestha.

I must make clear disclaimers to this post – it cannot be intended to replace the advice of your medical doctor or primary practitioner.  Information here is presented for educational purposes and  you must complete your own homework and work within your appropriate scope of practice.  For serious concerns, you may wish to also look at the reports by Dr. Ann Blake Tracy on a well researched website maintained for many years, Drugawareness.org.  She still offers phone consultations if you feel you are having adverse reactions to mood meds.  For some of the heavy social/medical industry implications – The Citizens Commission on Human Rights (CCHR) is a nonprofit mental health watchdog, responsible for helping to enact more than 150 laws protecting individuals from abusive or coercive practices.  This is not a first focus recommendation for mothers, please; there is a serious political and social conscience and service they provide for those so inclined to work in that arena.

In your service,

Ysha Bhu

Water meditation with new baby

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Water meditation with new baby – enjoy

What a wonderful way to welcome and deeply calm a newborn into at home-ness in the earth plane and human hands. This is much more than a water bath and … if it could be taught before infant massage … about 5 minutes and worth every minute.