PRASAVA, PRASAVA HETU AND PRASAVA KALA

PRASAVA, PRASAVA HETU AND PRASAVA KALA

• The process of childbirth has been elaborately described in Ayurveda under the term Prasava, involving physiological, psychological, and spiritual aspects.

• Classical Ayurvedic texts and modern obstetrics both discuss the causes, stages, and duration of labor, with a focus on maternal and fetal health.

DEFINITION OF PRASAVA

• The word Prasava is derived from the root “√su” (to give birth) with prefix “pra”, meaning forward or before.

• In Ayurvedic context, Prasava refers to the process of expulsion of the foetus from the uterus through the vaginal passage at the end of gestation.

📜 Classical Definition:

"योषितः प्रस्रवणं प्रसवः"
(Charaka Samhita, Sharira Sthana 8/33)
“The act of flowing out (delivery) from a woman is called Prasava.”

• It includes all the events from the onset of labor pains to the expulsion of placenta.

• It is considered a natural and physiological process governed by the balance of Vata Dosha, especially Apana Vata.

PRASAVA HETU (CAUSES OR FACTORS RESPONSIBLE FOR ONSET OF LABOR)

In Ayurveda, labor begins due to a combination of physical, biological, and karmic factors. The causes of the initiation of labor are:

🔹 Apana Vata Pravrutti (Activation of Apana Vata):

• Responsible for the downward movement and expulsion of fetus.

• Acts at the time of completion of Garbhavastha (pregnancy).
  📜 Sushruta Samhita, Sharira Sthana 10/5:

"अपानो मूत्रपुरीषशुक्रार्तवगर्भनिष्क्रमणानिलः"
“Apana Vata is responsible for expulsion of fetus, semen, urine and feces.”

🔹 Paka of Garbha (Maturation of fetus):

• Full term development leads to readiness for delivery.

🔹 Karma (Past actions of mother and fetus):

• Philosophical explanation of timing and events during labor.

🔹 Avastha of Yoni (Readiness of reproductive organs):

• The uterus, cervix, vaginal canal, and supporting structures become softened and ready for delivery.

🔹 Desire of Fetus (Jeeva Iccha):

• In some classical views, fetal consciousness contributes to the timing of delivery.

🔹 Time Factor (Kaala):

• Natural gestational period completes, leading to initiation of labor.

MODERN CORRELATION OF PRASAVA HETU (ETIOLOGY OF LABOR ONSET):

In modern obstetrics, labor is initiated by a complex interplay of maternal, fetal, hormonal, and mechanical factors:

🔹 Hormonal Factors:

• ↑ Oxytocin secretion → Uterine contractions

• ↑ Estrogen and ↓ Progesterone ratio

• Prostaglandin release → Cervical ripening and uterine activity

🔹 Fetal Signals:

• Fetal cortisol increases → Lung maturity

• Fetal hypothalamic-pituitary-adrenal axis activation

🔹 Uterine Stretch:

• Overdistension of uterus at term acts as a signal for labor

🔹 Placental Aging:

• Functional decrease in placental efficiency after term

PRASAVA KALA (STAGES OR PERIODS OF LABOR)

Ayurveda and modern science both divide labor into three primary stages:

📜 Ashtanga Hridaya Sharira Sthana 1/61:

"द्वाराणि प्रसवायाता वाता गर्भं निष्क्रमयति..."
“At the time of labor, Vata enters the reproductive channels and causes expulsion of fetus.”

🔸 1. PURVARUPA AVASTHA (Prodromal Phase/Pre-Labor signs):

• Irregular uterine contractions

• Cervical softening and effacement begins

• Nesting behavior, lightening (descent of fetus), backache, frequency of urination

🔸 2. PRATHAMA KALA (First Stage – Cervical Dilatation):

• From onset of true labor pains to full cervical dilatation (10 cm)

• Duration:
  ▪ In Primigravida: ~12–18 hours
  ▪ In Multigravida: ~6–12 hours

• Divided into:
  ▪ Latent phase: 0–6 cm dilation
  ▪ Active phase: 6–10 cm dilation

🔸 3. DVITIYA KALA (Second Stage – Fetal Expulsion):

• From full dilation to delivery of the baby

• Strong uterine contractions and bearing down efforts

• Duration:
  ▪ In Primigravida: ~30 min to 2 hours
  ▪ In Multigravida: ~15 min to 1 hour

📜 Sushruta Samhita, Sharira Sthana 10/4:

"कालो दोषाः प्रकृतिश्च बाला गार्भश्च हेतवः"
– Indicates that proper kala (time), doshas and prakriti contribute to normal delivery.

🔸 4. TRITIYA KALA (Third Stage – Placental Expulsion):

• From birth of baby to complete expulsion of placenta and membranes

• Duration: Usually within 30 minutes

• Active management helps reduce postpartum hemorrhage

MODERN STAGING OF LABOR:

• First Stage: Cervical dilation

• Second Stage: Expulsion of fetus

• Third Stage: Expulsion of placenta

• Fourth Stage (Added in modern practice): Immediate postpartum (first 1 hour) – monitoring mother for PPH, shock, etc.