The Compendium of Caraka 4.8: aṣṭamo 'adhyāyaḥ

Now we shall expound the anatomy chapter on the instructions for procreation.

Thus said the venerable Ātreya.

For a woman and a man whose semen, ovum, and uterus are unafflicted, who desire superior offspring, we shall teach the procedure that accomplishes that aim.

First, one should prepare both the woman and the man with unction and fomentation, cleanse them with emesis and purgation, and gradually restore them to their normal state.

Once cleansed, one should treat them with non-unctuous and unctuous enemas; and one should treat the man with ghee and milk prepared with sweet herbs, and the woman with sesame oil and black gram.

Then, from the onset of menstruation, she should remain for three nights observing celibacy, sleeping on the ground, eating food with her hands from an unbroken vessel, and not undergoing any cleansing.

Then, on the fourth day, after rubbing her with unguents and bathing her along with her head, one should dress her in white garments, and the man as well.

Then, wearing white clothes, wearing garlands, cheerful in mind, and mutually affectionate, they should copulate from the bath onwards on even days if desiring a son, and on odd days if desiring a daughter.

He should not approach her when she is lying prone or on her side.

In a prone woman, wind is forceful and compresses the vagina; in one lying on her side, if on the right side, phlegm is displaced and blocks the uterus; if on the left side, bile is compressed and burns up the ovum and semen; therefore, she should receive the seed lying supine, for thus the doṣas remain in their proper places.

When it is completed, he should sprinkle her with cold water.

There, a woman who has overeaten, is hungry, thirsty, frightened, dejected, afflicted by grief, angry, desiring another man, or excessively lustful in intercourse does not conceive an embryo, or produces defective offspring.

One should avoid a woman who is too young, too old, chronically ill, or afflicted by any other disorder.

These same faults apply to the man as well.

Therefore, the woman and the man should unite free from all faults.

Arising with joy and mutually disposed to copulation, having prepared a comfortable bed that has pleasant scents and is well-spread, having eaten agreeable and wholesome food without overeating, the man should mount with his right foot and the woman with her left foot.

There he should employ the mantra: “You are the serpent; you are life; you are the foundation everywhere; may Dhātṛ give you; may Vidhātṛ place you; be endowed with the splendor of Brahman.”

“May Brahmā, Bṛhaspati, Viṣṇu, Soma, Sūrya, and likewise the Aśvins,

Bhaga, and Mitra and Varuṇa give me a heroic son.” Having recited this, they should copulate.

If she should wish thus: “I desire a son who is large, fair, amber-eyed, vigorous, pure, and endowed with sattva,” then, beginning from the bath of purification, one should constantly give her to drink, time after time for seven days, in a silver or bronze vessel, a churned drink of fair barley mixed with honey and ghee, stirred into the milk of a white cow with a matching calf; and in the morning she should eat preparations of rice and barley mixed with curds, honey, and ghee, or with milk; likewise in the evening her shelter, bed, seat, drink, clothing, and ornaments should be fair; and evening and morning she should continually look upon a large, white, noble bull or stallion, adorned with yellow sandalwood on its limbs.

And one should attend upon her with gentle tales that are pleasing to the mind.

And she should look upon women and men of gentle appearance, speech, manners, and conduct, and upon other fair sense objects as well.

Her female companions, and likewise her husband, should constantly treat her with agreeable and beneficial things.

And they should not engage in sexual union.

Having remained according to this regimen for seven nights, on the eighth day, after bathing in water including the head together with her husband, she should put on intact, fair garments, and wear fair garlands and ornaments.

Then the officiating priest, examining a site sloping to the east or sloping to the north in the north-eastern direction of the house, smearing the sacrificial mound with cow dung and water, and sprinkling it with water, should set up the altar upon it.

To the west of it, employed by a brāhmaṇa, he should sit upon a heap of intact cloth or on a white bull's hide; employed by a kṣatriya, on a tiger skin or an ox skin; employed by a vaiśya, on a ruru-deer skin or a goat skin.

Sitting there, having kindled the fire with fuel sticks of palāśa, iṅgudī, udumbara, or madhūka, having strewn it around with kuśa grass, and having enclosed it with enclosing sticks, he should scatter parched grain and white, fragrant flowers.

Having brought forward a water vessel purified with a strainer and prepared the ghee for the oblation, he should place noble animals and others of the prescribed color all around.

Then, desiring a son, sitting to the west of the fire and to the south of the brāhmaṇa, she should hold on to him together with her husband, wishing for the desired son.

Then, as she makes her wish, the officiating priest, invoking Prajāpati over her womb, should perform the optional rite for the fulfillment of her desire with this verse: “May Viṣṇu prepare the womb.”

And then, having basted the cooked sacrificial offering with ghee, he should offer three oblations into the fire according to traditional teaching.

He should give her the water vessel consecrated with mantras, saying: “Perform all your water rituals with this.”

Then, upon completion of the ritual, stepping forward first with her right foot, she should circumambulate the fire clockwise together with her husband.

Then, having had the brāhmaṇas recite blessings, first the man, and afterwards the woman, should eat the remainder of the ghee; and they should not leave any leftover uneaten.

Then the two should cohabit for eight nights, maintaining the same kind of accoutrements, and thus they will produce the desired son.

For a woman who wishes for a son who is dark, red-eyed, broad-chested, and long-armed, or one who wishes for one with black, soft, long hair, white eyes, white teeth, splendid, and self-possessed, this very same sacrificial procedure applies.

However, the equipment should differ in color.

Their other equipment should be arranged in accordance with the color of the son, just as prayed for.

A śūdra woman, however, should only pay homage to the gods, the fire, the twice-born, elders, ascetics, and perfected beings.

Whichever kind of son a woman wishes for, having heard her particular wish for a son, one should cause her to mentally traverse those respective lands.

Then, whatever kind of son resembling the people of whichever regions she wishes for, she should be told: 'Adopt the diet, lifestyle, care, and attire of the people of those respective regions.'

Thus has been explained all the procedure that brings about the fulfillment of wishes for a son.

Indeed, it is not this procedure alone that causes differentiation of complexion.

Rather, the fire element also, when dominated by the water and ether elements, produces a fair complexion; when dominated by the earth and wind elements, it produces a dark complexion; and when all elements are equal, it produces a tawny complexion.

Moreover, the factors causing differentiation of the mental temperament of those various living beings are the mental temperaments of the mother and father, what the pregnant woman constantly hears, past karma suitable to oneself, and the habitual cultivation of a particular mental temperament.

When a woman and a man, whose bodies have been prepared in accordance with the prescribed procedure, attain union, the unvitiated semen, having united with the unvitiated ovum in an uninjured genital tract and an unvitiated uterus, invariably produces an embryo.

Just as a dye endowed with full qualities produces color on a clean, properly prepared cloth the moment it falls upon it, so it is [here]; or just as milk, when curdled with curd, leaves behind its own nature through curdling and attains the state of curd, so it is with the semen.

The cause for whether the embryo developing in this manner becomes male or female has already been stated.

For just as an undamaged seed that has been sown conforms to its own nature—rice [becomes] rice-nature or barley [becomes] barley-nature—so too male and female conform to the division of causes as described.

A transformation of the two [sexes] is taught through a rite prescribed in the Vedas, when properly applied prior to [the sex] becoming manifest; for rites endowed with the perfection of place and time invariably yield the desired fruit, and similarly other [rites yield] the contrary.

Therefore, having observed that a woman has conceived, one should administer to her the virilific rite before the manifestation of the embryo['s sex].

Having taken two undamaged leaf-buds from the eastern and northern branches of a banyan tree grown in a cow-pen, together with two grains of black gram or two white mustard seeds endowed with excellence, and having thrown [them] into curd, she should drink it under [the asterism] Puṣya. In the very same manner, she should drink under Puṣya [the paste of] the others—the pastes of jīvaka, ṛṣabhaka, apāmārga, and sahacara—either together or individually as desired, processed with milk; or having thrown a wall-insect or a small fish into a handful of water, she should drink it under Puṣya. Likewise, having thrown tiny human figurines made of gold, silver, or iron, heated to the color of fire, into curd, milk, or a handful of water, she should drink it without leaving any residue under Puṣya. And under Puṣya itself, having inhaled the vapor of cooking rice paste and having placed the liquid of that very paste mixed with water on a threshold, she should herself instil it into her right nostril with a cotton swab. And whatever other virilific rite the brāhmaṇas or authoritative women should recommend, that too should be performed.

Such are the virilific rites.

Hereafter we shall explain the pregnancy-stabilizers: aindrī, brāhmī, śatavīryā, sahasravīryā, amoghā, avyathā, śivā, ariṣṭā, vāṭyapuṣpī, and viṣvaksenakāntā—wearing these herbs on the head or on the right hand, drinking milk or ghee cooked with these very [herbs], bathing with these very [herbs] under every Puṣya, and constantly anointing oneself with them.

Likewise, the continuous use of all herbs prescribed in the group of life-promoters, through their various modes of use.

Thus the pregnancy-stabilizers have been explained.

These, on the other hand, are the factors that cause injury to the embryo: that is to say, in a woman who uses elevated, uneven, or hard seats; who suppresses the urges of flatus, urine, and feces; who engages in harsh, unaccustomed physical exercise; who excessively consumes sharp and hot things; or who consumes restricted food, the embryo dies inside the womb, or slips out prematurely, or becomes emaciated. Likewise, through trauma, crushing, or constantly looking into chasms, wells, and precipices, the mother's embryo falls prematurely; likewise, through traveling in excessively shaking vehicles, or through listening to excessively unpleasant things.

In a woman who constantly sleeps on her back, the cord attached to the navel encircles the embryo's neck; one who sleeps uncovered and roams at night gives birth to an insane child; one given to quarrel and strife, an epileptic; one given to sexual intercourse, a child who is deformed, shameless, or effeminate; one constantly grieving, a child who is timid, deficient, or short-lived; one who covets others' goods, a child who torments others, is envious, or effeminate; a thief, a child who is full of distress, extremely treacherous, or indolent; an intolerant woman, a child who is fierce, deceitful, or malicious; one constantly sleeping, a child who is drowsy, dull-witted, or of weak digestive fire; one constantly drinking alcohol, a child who is thirsty, of poor memory, or unsteady mind; one who mostly consumes monitor lizard meat, a child with urinary gravel, calculus, or slow urination; one who mostly consumes pork, a child with red eyes, stertorous breathing, or exceedingly coarse hair; one who constantly consumes fish, a child who blinks slowly or has fixed eyes; one who constantly consumes sweet things, a child with prameha, mute, or exceedingly obese; one who constantly consumes sour things, a child with internal hemorrhage or skin and eye diseases; one who constantly consumes salty things, a child with early wrinkles, gray hair, or baldness; one who constantly consumes pungent things, a child who is weak, with deficient semen, or childless; one who constantly consumes bitter things, a child who is emaciated, weak, or undeveloped; one who constantly consumes astringent things, a child who is dusky, has abdominal distension, or has upward movement of wind; and whatever etiology has been stated for each respective disease, a pregnant woman who constantly engages in that gives birth to an offspring full of disorders caused by that.

The defects of semen born of the father, however, are explained by the improper conducts born of the mother.

Thus the factors that cause injury to the embryo have been stated.

Therefore, a woman desiring the excellence of offspring should especially avoid unwholesome diet and lifestyle; and of good conduct, she should care for herself with wholesome diet and lifestyle.

And one should treat her diseases with medicines, diet, and care that are mostly mild, sweet, cold, pleasant, and delicate; one should not administer emesis, purgation, or head evacuation to her; one should not let blood; and at no time should one administer a non-unctuous or unctuous enema, except in an emergency disease.

Beginning from the eighth month, however, in emergency disorders that are curable by emesis and the like, treatment should be carried out with mild emesis and the like, or with [measures] producing that effect.

Like a full vessel of oil, a pregnant woman must be cared for without causing disturbance.

If due to improper conduct she sees menses in the second or third month, one should know that her embryo will not remain; for at that time the embryo has not acquired essence.

If from the fourth month onwards she sees menses on account of anger, grief, malice, envy, fear, terror, sexual intercourse, physical exercise, physical shock, suppression [of natural urges], irregular eating, sleeping, or standing, excess of hunger and thirst, or bad food, we shall explain the procedure for stabilizing the pregnancy for her.

As soon as menses is seen, one should tell her: “Lie down on a bed spread with a soft, comfortable, cool cover, with your head slightly lowered.”

Then, having soaked a tampon in licorice and ghee kept in extremely cool water, one should place it near her genital organ. Likewise, one should smear [her body] all over below the navel with ghee washed a hundred or a thousand times; and one should sprinkle her all over below the navel with very cold cow's milk, or licorice water, or a decoction of nyagrodha and the rest; or one should immerse her in very cold water; or make her hold cloths saturated with the fresh juice of latex-bearing trees and astringent trees; or make her hold a tampon of milk and ghee processed with the sprouts of nyagrodha and the rest; and one should make her ingest a dose equal to an akṣa of this very [preparation], or make her ingest pure milk-ghee alone; and one should give her the filaments of the padma, utpala, and kumuda mixed with honey and sugar for licking; śṛṅgāṭaka, puṣkarabīja, and kaśeruka for eating; or make her drink gandhapriyaṅgu, asitotpala, śālūka, unripened fruit of udumbara, and shoots of nyagrodha with goat's milk; and one should feed her boiled rice of red śāli that is soft, fragrant, and cool, accompanied by milk boiled with balā, atibalā, śāli, ṣaṣṭika, sugarcane root, and kākolī, together with honey and sugar; or one should feed her—seated in a comfortable, cool, breezy place—with the meat juice of lāva, kapiñjala, kuraṅga, śambara, hare, deer, eṇa, or kālapucchaka, properly prepared with ghee; and one should protect her from anger, grief, exertion, sexual intercourse, and physical exercise; and one should attend on her with gentle, pleasing conversations. In this manner her pregnancy is preserved.

For her, however, who has an appearance of menses owing to the association of āma, that usually causes injury to the embryo, because the treatments for the two are mutually opposed.

In a pregnant woman whose embryo is large and has acquired essence, if an appearance of menses or other vaginal discharge occurs due to the use of hot and sharp [things], her embryo does not attain growth because of the discharge; it remains [in the womb] excessively beyond time; some designate that as upaviṣṭaka.

Moreover, in one devoted to fasting and vow-observances, consuming bad food, averse to unctuous substances, and indulging in factors stated to provoke vāta, the embryo does not attain growth because of drying up; it too remains [in the womb] excessively beyond time and becomes motionless; that, however, they designate as nāgodara.

We shall explain the specific treatment for both of those women: the use of ghees and milks processed with elemental, vitalizing, nourishing, sweet, and vāta-alleviating [drugs], as well as [the meat of] young embryos, causes embryonic growth; likewise, feeding her who has a plentiful supply of food with these very processed ghees and the like, and repeatedly attending [to her] with carriage rides, conveyance, gentle rubbing down, and yawning.

In her whose embryo has fallen asleep and does not move, one should feed her soft, sweet, cool boiled rice of red śāli with ghee-rich meat juice of any of hawk, fish, gavaya, peacock, rooster, or francolin partridge, or with māṣa soup with abundant ghee, or with radish soup.

And one should repeatedly attend to her regions of the abdomen, urinary bladder, groins, thighs, waist, flanks, and back with an oil massage using slightly warm [oil].

In her who has upward movement of wind with constipation in the eighth month, and one considers it not curable by unctuous enema, one should then prepare a non-unctuous enema for her to pacify that disorder.

For upward movement of wind, if neglected, would suddenly destroy the pregnant woman together with the embryo, or [destroy] the embryo.

There, having extracted the juice of the roots of vīraṇa, śāli, ṣaṣṭika, kuśa, kāśa, ikṣuvālikā, vetasa, and parivyādha, and of bhūtīka, anantā, kāśmarya, parūṣaka, madhuka, and mṛdvīkā, with milk and half water, one should administer a non-unctuous enema combined with the paste of priyāla, pulp of bibhītaka, and sesame, slightly salted and not overly hot.

And when her constipation is relieved, her limbs sprinkled with comfortable water, and she has eaten food that imparts stability and is non-burning, one should administer an unctuous enema to her in the evening with oil processed with sweet drugs.

One should treat her with non-unctuous and unctuous enemas while she is lying prone.

In her whose embryo dies inside the abdomen due to excessive accumulation of doṣas, or excessive consumption of sharp and hot [substances], or suppression of the urges of flatus, urine, and feces, or uneven sitting, lying down, or standing, compression, or trauma, or anger, grief, envy, fear, terror, and the like, or other reckless actions: her abdomen becomes motionless, stiff, distended, cold, and as if an internal stone; the embryo is motionless; excessive piercing pain arises, yet labor pains do not appear; the vagina does not discharge; her eyes are sunken; she faints, suffers pain, becomes dizzy, pants, has abundant restlessness, and natural urges do not appear in her properly. A woman with such characteristics one should know to have a dead embryo.

Some say the measure to expel that foreign body of the embryo is the expulsion of the placenta; some say it is mantras and the like prescribed in the Atharvaveda; some say it is extraction by a surgeon of observed competence.

Once the foreign body of the embryo is removed, one should first make the woman with an unformed embryo drink any of surā, sīdhu, ariṣṭa, madhu, madirā, or āsava according to her strength, for cleansing the womb-cavity, for forgetting the pain, and for cheering [her]; after this, one should treat her with gruels and the like, or with foods appropriate for that time, which are nourishing, protect strength, and are uncombined with unctuous substances, for just the time it takes to dry up the moisture of the doṣas and tissues.

After this, one should treat her with unctuous draughts, enemas, and diet regimens designated as appetizer, vitalizer, bulk-promoter, sweet, and vāta-alleviating.

In the case of a woman whose foreign body of the embryo was fully mature, however, once the foreign body of the embryo is expelled, unctuous therapy should begin on that very day.

Hereafter, we shall instruct the regimen month by month for an embryo developing without disorder: / If she suspects she has conceived, in the first month she should repeatedly drink unboiled, measured, cold milk at appropriate times, and eat only wholesome food morning and evening; in the second month, milk prepared with sweet herbs; in the third month, milk combined with honey and ghee; in the fourth month, she should take milk-butter in the measure of an akṣa; in the fifth month, milk-ghee; in the sixth month, milk-ghee prepared with sweet herbs; and the same in the seventh month.

In this matter, women say that the hair growing on the embryo causes burning sensations in the mother; the venerable Ātreya says that this is not so: rather, due to compression by the embryo, vāta, pitta, and phlegm reach the chest and produce burning sensations; from that, itching arises; and rooted in itching, the appearance of stretch marks occurs.

In that case, one should repeatedly give her butter prepared with sweet herbs in the measure of a pāṇitala with jujube-water for drinking at appropriate times; one should rub her breasts and abdomen with pastes of sandalwood and lotus-stalk, or with powders of śirīṣa, dhātakī, mustard, and madhuka, or with pastes of kuṭaja, seeds of ārjaka, mustā, and turmeric, or with pastes of neem, jujube, surasā, and mañjiṣṭhā, or with triphalā mixed with the blood of spotted deer, blackbuck, or hare; massage should be with oil prepared with oleander leaves; affusion should be with water prepared with mālatī and madhuka; and when itching arises, she should avoid scratching to prevent laceration and disfigurement of the skin; but when the itching is unbearable, relief should be obtained by gentle rubbing and friction; and she should eat sweet food that alleviates vāta, in small quantity, without unctuous substances and salt, followed by a small drink of water.

In the eighth month, she should repeatedly drink milk-gruel containing ghee at appropriate times; Bhadrakāpya says that this is not so, for an affliction of tawny-eyedness would come upon her embryo; the venerable Punarvasu Ātreya says: 'Let there be an affliction of tawny-eyedness here, but this is certainly not something to be left undone; for doing thus, she, free from disease, gives birth to an offspring endowed with the excellence of health, strength, complexion, voice, and compactness, foremost even among kin.'

In the ninth month, however, one should give her an unctuous enema with oil prepared with sweet herbs.

And from this very oil one should introduce a tampon into the vagina to lubricate the pathway of the embryonic seat. By this procedure, prescribed beginning with the first month and up to the ninth month, the pregnant woman's uterus, abdomen, pelvis, flanks, and back become soft at the time of delivery; her vāta moves downward; her urine and feces, becoming normal, pass through their path with ease; her skin and nails attain softness; both strength and complexion increase; and she gives birth with ease, at the proper time, to a desired, healthy son endowed with perfections.

And prior to the ninth month, one should have a maternity home built in a place free from bones, gravel, and potsherds, on ground of commendable appearance, taste, and smell, facing east or facing north, made of the woods of vilva, tinduka, iṅguda, bhallātaka, varuṇa, or khadira; or of whatever other woods the brāhmaṇas versed in the Atharvaveda commend; endowed with excellence of thatch, plastering, covering, and doors; furnished with a fireplace, water, mortar, latrine, bathing area, and kitchen in accordance with the principles of architecture; and comfortable in every season.

Therein, ghee, oil, honey, rock salt, sauvarcala salt, black salt, viḍ salt, viḍaṅga, kuṣṭha, kilima, dried ginger, pippalī, pippalī-root, hastipippalī, maṇḍūkaparṇī, cardamom, lāṅgalī, vacā, cavya, citraka, cirabilva, asafoetida, mustard, garlic, kataka, kaṇa, kaṇikā, nīpa, flax, balvaja grass, birch bark, kulattha, maireya, surā, and āsava should be kept ready; likewise two stones, two wooden pestles, two mortars, a donkey and a bull, two sharp needles of gold and silver, instruments of sharp iron, two couches made of vilva wood, tinduka and iṅguda woods for kindling fire, many women who have given birth many times, endowed with affection, constantly devoted, of auspicious conduct, skilled in care, loving by nature, devoid of depression, able to endure hardship, and agreeable, and brāhmaṇas versed in the Atharvaveda; and whatever else is considered suitable there, and whatever else the brāhmaṇas and elder women say, that should be done.

Then, once the ninth month has begun, on an auspicious day, when an auspicious lunar mansion is conjoined, when the lord moon is auspicious, under an auspicious astrological division, and in the maitra hour, after offering an oblation for peace, first ushering in a cow, a brāhmaṇa, fire, and water, offering grass and water and parched grain with honey to the cows, and giving unbroken grains of rice, flowers, and desired nandi-faced fruits preceded by water to the seated brāhmaṇas, saluting them, and sipping water again, one should have them pronounce blessings.

Then, following behind the cow and the brāhmaṇa with the sound of 'auspicious day', circumambulating, she should enter the maternity home.

Stationed there, she should await the time of delivery.

Her signs near the time of giving birth are indeed these: namely, exhaustion of the limbs, languor of the face, slackness of the eyes, a feeling as if the bindings of the chest are loosened, sagging of the abdomen, heaviness in the lower part, piercing pain in the groins, bladder, pelvis, abdomen, flanks, and back, discharge from the vagina, and loss of appetite for food; immediately following that, the appearance of labor pains and the pouring out of the amniotic fluid.

Upon the appearance of labor pains, however, one should arrange a bed on the ground, provided with a soft mattress.

She should sit upon it.

Then, surrounding her on all sides, women possessing the aforementioned qualities should attend upon her, comforting her with reassuring and soothing words.

If, distressed by labor pains, she does not give birth, one should say to her: 'Rise, take one or another pestle, strike this mortar filled with grain repeatedly with it, yawn repeatedly, and stroll around at intervals.' Thus advise some [authorities].

That is not so, says the venerable Ātreya.

For avoiding violent physical exercise is always advised for a pregnant woman, and especially at the time of delivery, when all bodily constituents and humors are agitated, wind stirred up by the exertion of a pestle might, finding an opening in the delicate woman, harm the vital breaths; for a pregnant woman is especially difficult to treat at that time. Therefore, the seers hold that grasping a pestle is to be avoided, but yawning and strolling are indeed to be performed.

Then one should give her the powder of kuṣṭha, elā, lāṅgalikī, vacā, citraka, cirabilva, and cavya to inhale; she should inhale it repeatedly, or the smoke of birch bark, or the smoke of śiṃśapā heartwood.

And at intervals, having anointed her waist, flanks, back, and thigh regions with slightly warm oil, one should rub [them] downward gently for comfort.

By this procedure, the fetus descends.

When one knows that the fetus, having left the cardiac region, enters her abdomen, engages the bladder neck, labor pains hurry her, and the fetus turns downward—in this state, having seated her upon a couch, one should begin to urge her to bear down.

And in her ear, an agreeable woman should whisper this mantra: / 'Earth, water, space, fire, wind, Viṣṇu, Prajāpati—

may they always protect you while pregnant and grant you expulsion of the foreign body;

give birth unexhausted, O fair-faced woman, to an unexhausted [child],

a son possessing the splendor of Kārtikeya, protected by Kārtikeya.'

And those women possessing the aforementioned qualities should instruct her: 'Do not bear down in the absence of labor pains; for she who bears down in the absence of labor pains—her effort becomes entirely futile, and her offspring becomes impaired, suffers deformity, or becomes afflicted with dyspnea, cough, consumption, or splenic disorder.'

For just as one who strives [to evacuate] the urges of sneezing, eructation, flatus, urine, and feces before their time does not attain them or attains them with difficulty, so it is with one bearing down on an unready fetus; and just as the suppression of these very [urges], such as sneezing, leads to harm, so does failing to bear down for a fetus whose time has arrived. She should be told: 'Act according to instruction.'

And acting accordingly, she should bear down gently at first, then more forcefully thereafter. And while she is bearing down, the women should make the sound: 'Delivered, delivered of an auspicious, auspicious son!'

Thus her vital breaths are replenished with joy.

And as soon as she has given birth, one should observe her: whether her placenta has come out or not.

If her placenta has not come out, then one of the women, pressing firmly above the navel with the right hand and holding [her] from behind with the left hand, should shake her thoroughly.