1. The ante-natal phase - which includes - diagnosis of pregnancy and care during pregnancy - garbhini-paricharya.
2. Natal phase - namely the process of delivery - from the onset of the labour pains upto delivery of the placenta - prasava kaala paricharya.
3. Post-natal phase - namely the post-partal period or looking after the new-born baby, care of t h e mother during lactation - soothika paricharya.

The first phase of garbhini-paricharya starts off with the diagnosis of pregnancy. Diagnosis of pregnancy can be based on:

1. Presumptive signs and symptoms
2. Probable signs
3. Positive signs

Our Aachaaryas have classified them as sadyogruheeta -garbha lakshanas and vyaktha-garbha-lakshanas. Sadyogruheeta- garbha-lakshanas (including presumptive and probable signs) are the set of signs and symptoms which help in the detection of pregnancy within a week of conception or even just after coition. Vyaktha-garbha-lakshanas (positive sings) are generally observed after amenorrhea i.e. these symptoms are observed after her first missed period and are symptoms which help in confirming the pregnancy.

1. Sadyogruheeta garbha lakshanas
   The signs and symptoms that can be seen immediately after conception are follows:

   Charaka lists them as "Nishteevika gowravamangasaadas-tandra apaharshow hrudaye vyatha cha trupthischa beejagrahanam cha yonyaam garbhasya sadhyonamgathesya lingam" i.e. repeated spitting, heaviness, malaise, drowsiness, horripilation, uneasiness, pain in the chest, a feeling of satisfaction, retention of the ejaculated semen in the yoni (Cha. Sam., Sha. 2/23).

   Sushrutha lists them as "Shramoglaanihi pipaasaa sakthisadanam shukrashonithayoravabandhaha sphuranam cha yonehe" i.e.fatigue, langour, excessive thirst, lassitude of the thigh’s, retention of shukra and shonitha (absence of menstrual and coital discharges) and quivering in the vagina (Sus. Sam., Sha. 3/10).

   Vaagbhatta II states "...angagrahaha, trupthirgurutwam, sphuranam shukraasraananubandanam, hrudaya spandanam thandra trudglaanihi lomaharshanam" i.e. body pain, satisfaction, heaviness, quivering, retention and combination of shukra and aarthava, palpitation, dizziness, excessive thirst, langour, horipulation are the immediate sings of pregnancy (Ash. Hru., Sha. 1/37-38). Vaagbhatta I includes nausea and excessive salivation also in the list of symptoms.

   There are various interpretation of the term "sadyogruheetha". According to some Aachaaryas these are the signs and symptoms which are seen and felt by the pregnant woman immediately after conception i.e. the moment the shukra and aarthava unite, or even just after maithuna (copulation) which results in conception. According to others they are the signs and symptoms which appear within seven days of conception. Some others say that they are the signs and symptoms before the cessation of menstruation. It is also explained as signs and symptoms of women having become recently pregnant (5).

2. Vyaktha garbhalakshana / dowhrudya lakshana
   These are the signs and symptoms observed after the growth of the embryo becomes conspicuous. Charaka explains these signs and symptoms as that of dowhrudyam or that of having two hrudayas and states that their knowledge is essential to facilitate their management. These signs and symptoms are seen during the third month of gestation. They are described by Charaka as : "Aarthavaadarshanamasya samsravanam anannaabhilasha chardihi arochakomlakaamatha cha visheshena shraddha pranayanamucchaavacheshu bhaveshu gurugaatratwam chakshusho glaanihi sthanayoho, sthanyamoshtayoho, stanamandalayoshcha kaarshynyamatyartham, shwayathuhu paadayoreeshallomaraajyudgamo yonyaaschataala twamithi garbhe paryaagate roopani bhavanthi". The vyakthagarbha lakshanas are amenorrhea, excessive salivation, dislike for food, vomiting, anorexia, craving for sour substances, alternate desires for article which are of high or low quality (beneficial/non-beneficial), heaviness of body, langour of eyes, milk secretion in breasts, blackening of lips and areola, slight odema of feet, development of romaraji (the vertical streak of hair line extending to the umblicus) and dilation of vagina (Cha. Sam., Sha. 4/16).

   In addition to these, Sushrutha and Bhaavamisra mention - repeated drooping of eyes, vomiting without apparent cause, aversion to good smells and excessive salivation and tiredness as symptoms (Sus. Sam., Sha. 3/11) and Bha. Pra. Poo. Gar. 3/42). Vruddha Vaagbhatta in Ashtaanga Sangraham along with the other signs and symptoms also mentions - "yatha yatha cha garbho vruddhimaapnothi tatha bharahara - rasaapchaaraatcha sthriyaa balakshaya" - i.e. the increase in the weight of the embryo causes diversion for her nuterients and thus her energy also decreases (Ash. San. Sha. 2/9 and 59). Vaagbhatta in Ashtaanga Hrudaya - adds the symptoms emaciation, indigestion, burning sensation of the whole body and expression of various desires.

   In Charaka Samhitha and Kaashyapa Samhitha, the signs and symptoms for each month maasaanumaasika-lakshana have also been described from the fourth upto seventh month which are as follows:

1. Fourth month - Chathurthi maasi sthiratwam apadyathe garbhaha thasamaat tada garbhini guru gaathrathwam adhikam aapadyathe visheshna" i.e. due to stability in the foetus the woman feels more weariness in the body (Cha. Sam., Sha. 4/20).

2. Fifth month - Charaka states : "Panchame maasi garbhasya, maamsa shonitopachayo bhavathi, adhikam anyebhyo maasebhyaha tasmaat tada garbhini kaar-shyamaapadyathe visheshena. During the fifth month, there is an excessive increase of flesh and blood of the foetus in comparison to the other months; due to this the pregnant woman grows excessively thin (Cha. Sam., Sha 4/21). Kaashyapa has also mentioned a similar symptom namely "Garbhinee panchemaasi tasmaat kaarshyen yujyate" i.e. in the fifth month the pregnant woman is associated with leanness. (Kaa. Sam., Sha. Asa.). Chakrapani Datta’s commentary on Charaka’s lines are "Yatho garbha maamsaadi poshanenaiva ksheena ahaara rasona maathur maamsaadi samyak poshayathi" i.e The nutrition of the mother is utilised for the growth of the child during this month, hence the mother grows thin.

3. Sixth month - Charaka states that Shashte maasi garbhasya bala varnopachayo bhavatyadhikamanyebhyo, maasebhyaha, thasmattada garbhini balavarnahaanim, aapadyathe visheshena i.e. there is a comparitive increase in the strength and complexion of the foetus during the sixth month of gestation. Therefore the lady loses her strength and complexion considerably (Cha. Sam., Sha. 4/22).

4. Seven month - Sapthame maasi garbha sarvairbhaavaihi aapyaayyathe, thasmaat tada garbhini sarvaakaaraihi klaanthathama. There is an all round development of the foetus during the seventh month of gestation. Therefore, a pregnant women becomes exceedingly deficient in all aspects of her health (Cha. Sam., Sha. 4/23). Though there has been reduction in the physical state of the mother, in the seventh month all the factors viz., flesh, blood, etc. Get reduced simultaneously (Chakrapani Datta’s commentary on Cha. Sam., Sha. 4/23)

5. Eighth month - During the eighth month of gestation there is cross movement of the ojas through the channels carrying nourishment from the mother to the foetus, because of the immaturity of the foetus. It is advised that one should not even mention about the eighth month to the pregnant woman because the knowledge of the danger involved in this month, would only increase her fear, which in turn will aggravate vaatha in her body and may lead on to dangerous consequences like pre-mature delivery or even death of the foetus. During the eight month the ojas is not stable. If the ojas has moved to the mother the foetus will die and if it is still with the foetus then the mother’s life will be in danger. Hence our aacharyas do not consider this month fit for labour (Cha. Sam., Sha. 4/24).

• Ojas is defined as ojastejo dhaathunaam i.e. the essence of all the dhaathus is called the ojas. The ojas is responsibe for the life to be sustained and is also the source for the internal strength and resistance power.

Lok Swaasthya Paramparaas

In this section we wish to look the knowledge that exists in various communities at the local level regarding the detection of pregnancy. In 1988 the Lok Swasthya Parampara Samvardhan Samithi (LSPSS) had taken up an all India survey to look at the various practices prevalent in communities all over India on the subject of Mother and Child care (See Appendix II for details).Observations/practices quoted here are from this survey, wherever no specific reference is cited.
Signs and symptoms like amenorrhea , vomiting -morning sickness, anorexia, liking for sour foods were generally taken as signs of pregnancy. Some were even confirming pregnancy after feeling the foetal movements (quickening)- this would be a very positive symptom both according to Aayurveda and the modern system of Medicine (6). The signs and symptoms of pregnancy as reported by local communities are - amenorrhoea, vomiting lethargy, giddiness, anorexia, dizzness, tiredness, salivary secretion, enlarged abdomen, foetal movement, pigmentation around the nipples, excessive liking for sour things, secretion of milk from the breast, slight oedema of the feet, development of striations on the abdomen, increase in the size of genital organs, nausea, movement of the foetus etc.

There are other practices to detect pregnancy which are widely used in parts of Tamil Nadu. It was reported by an elderly dai, that a particular leaf (called the "vellai poonai kaachi" in Tamil) is used to detect pregnancy. The leaves are soaked overnight in the urine of the woman who is suspected to be pregnant. The leaves are checked for white spots. The presences of white spots on the leaves, confirm pregnancy. Siddha vaidyas confirm that this test is found effective but also add that this would work only if the woman is not suffering from veneral diseases. Another test reported is - a table spoonful of honey is taken at night by the woman and if in the morning she wakes up with a strong gripping pain in the lower abdomen, then the pregnancy is considered to be confirmed. Some of these practices need a closer study and examination.

Another very common and widely practised method of diagnosis of pregnancy is the use of garbha naadi. Most of the elderly dais, resort to this method of detection of pregnancy. The experienced dais can detect the garbha nadi from the 40th day.
In summarising the results of our survey, we can say that their knowledge about the detection of pregnancy is good and the local communities are able to diagnose pregnancy without any external help.

Sex determination

In the last decade, there have been modern techniques to detect the sex of the foetus which are amniocentesis and ultra sonography. ISM's have their own systematic methods to evaluate the sex of the unborn baby. In this context Charaka says : "Savyaangachestha purusharthuve sthri sthriswapna paanaashana sheela chestha savyaathagrabha na cha vruttagarbha savya produgdha sthriyameva soote putram twatho linga viparyeva vyaamishralingaa prakruthim trutheeyaam" i.e the woman who has more desire for sex, dreams or desires to eat, uses or has association with articles bearing feminine names, possesses feminine habits and behaviour, whose foetus/uterus is situated more to the left or the abdomen is not round in shape and in whom the milk secretion appears first in the left breast and whose body part parts on the left are more active will deliver a female child. The lady having opposite characters will have a male child (Cha. Sam., Sha. 2/24-25). Sushrutha says "Tatra yasyaa dakshine sthane praak payodarshanam bhavati ......... praagabhihita lakshanam cha tasyaa napunsakamithi vidyaat" the pregnant woman in whom milk secretion appears first in the right breast, whose right eye is heavy, who walks lifting her right leg first delivers a male child. (Sus. Sam., Sha. 3/32). Even today similar methods are used by rural and tribal communities to detect the sex of the foetus. Some practices recorded during the LSPSS Survey are listed below:

It is reported in Madhya Pradesh, Maharashtra and Orissa that bulging of abdomen in the right side to be indicates a male child. Similarly a female child is said to be indicated by left sided movements (West Bengal), appearance of the milk first in the left breast (Orissa) and by the left breast being bigger than the right breast (West Bengal). These beliefs are supported by Aayurveda. There are also some other methods which are worth investigating viz. conception, on a new moon day is believed to result in a female and that on full moon day a male child (Gujarat).