1094 LEADING ARTICLE Obstetrics BIRTH RITUALS AND THEIR ....................................................................................... PRESENT DAY OBSERVANCE The origins and performance of Hindu rites are not only somewhat complex Hindu birth customs but often also differ between castes. Here, we attempt to present some A R Gatrad, M Ray, A Sheikh common features of these rites in order to help non-Hindu healthcare profes- ................................................................................... sionals to develop a working apprecia- Marriage, pregnancy, and birth rituals tion of these practices and their significance. Manu, the legendary author of the any expectant mothers have and Shiva (The Destroyer). In Britain, Sanskrit Code of Law10 created a num- fears and anxieties about their the majority of Hindus are Vishnuvites.5 ber of sacraments or Samskaras—a word Mpregnancy. For Hindu pregnant Many Hindus believe that a person is which means ‘‘perfection’’. These are women, these general concerns may be born into a caste or acquires it by ‘‘activities that help achieve ‘purity’ as a compounded by difficulties in commu- behaviour;6 for example, a person of a result of which the personality of the nicating with healthcare professionals. lower caste by being ‘‘pious’’ can go individual is developed to the full, from It is our aim in this paper to provide higher up the caste ladder. Although no conception to the grave’’.11 Each sacra- clinicians with a basic understanding of longer officially recognised and less ment involves a prayer and often a Hindu birth customs in the hope that visible in modern India than in the past, ritual. Although only some of these such appreciation will go some way to the caste system still has a strong hold sacraments relate to the present discus- facilitating provision of culturally com- on Hindu families, and the impact of sion of birth customs, for completeness petent and sensitive care. this on customs (including birth) also and contextualising the principle, the In their excellent paper Webb and extends to those who have migrated. first 10 of these that are relevant to the Sergison1 defined cultural competence There are broadly four main castes: paediatric age group are described as an evolving process that depends on Brahmins (highest), Ksatriya (ruling (table 1). self-reflection, self-awareness, and caste), Vaisya (farmers and merchants), and sudras (the untouchables); this acceptance of differences. They further MARRIAGE AND PREGNANCY latter group usually work as servants explain that such competence is based The Hindu Marriage Act (1955) prohib- in India.7 on improving understanding as opposed ited child marriages in India, stipulating Closely linked with the caste system is to an increase in cultural knowledge. that boys could only marry after the age the belief in reincarnation—a belief that While fully concurring with their views of 18 years and girls after 15. Previously, one’s deeds in a former life determine we would argue that knowledge of early ‘‘child marriages’’ were thought by the caste that one is born into. This cultural context can be helpful in many to be a check on immorality and philosophy of Karma8 is of fundamental providing a prototype (as opposed to a corruption. The introduction of this Act importance to Hindus, as, it is ‘‘deeds’’ stereotype) of factors which may be is believed to have contributed to a fall in this world that will decide how the important in the provision of patient in maternal and infant mortality, while soul is reborn in the future. It is believed centred care. simultaneously improving the chances that this cycle of birth, death and rebirth Hinduism—one of the oldest world of the young to further their education ultimately results in attaining a state of religions dating back to around before marriage.12 purity that allows the liberated soul to 1500BC—originates from around the Garbadhana—the fetus laying cere- 2 become ‘‘at one’’ with the Divine pre- Indus Valley in what is now Pakistan. mony is performed at the consumma- sence. Scriptures were originally written in tion of marriage and involves special Sanskrit, a language in which most prayers for fulfilling parental duties to Hindus of today are no longer literate, DEMOGRAPHIC perpetuate the human race. In ancient and therefore customs over the years CONSIDERATIONS times, the bridegroom did not approach have tended to be passed on by word of The 2001 (UK) census revealed that the bride until the fourth night, but mouth. Almost 14 centuries ago, many there are over 559 000 Hindus in today this practice is only symbolically Hindus converted to Islam and 600 Britain,9 the majority (467 000) of enacted at the marriage ceremony. years ago Sikhism was founded as an whom originate from the Indian sub- Punsavana—the ‘‘male making’’ rite is ‘‘off shoot’’ of Hinduism. It is therefore continent, with a sizable community performed during the third month of unsurprising that not only have original coming from East Africa. This East pregnancy, in the belief that the ‘‘deity’’ Hindu customs been diluted over the African Hindu group is somewhat aty- governing the sex of the fetus is years but that the practises of other pical in that it has undergone migration activated and a male ‘‘issue’’ assured. religious customs found within South twice in a relatively short timeframe— Sons are preferred because of the Asia have intertwined with remnants of first from India to East Africa and then carriage of the family name and the Hindu teachings. However we have not on to Britain. In Britain, areas such as hope that the son will light the funeral encountered any consanguineous mar- Harrow, Leicester, and Brent have sig- pyre of his parents. Manu says: ‘‘A man riages among Hindus in the UK, a nificant Hindu communities making up is perfect when he consists of three: practice common among Muslims the 14–19% of the overall population (Office himself, his wife, and his son’’.13 In fact, world over.3 for National Statistics, 2003). Although there is still a belief among many that in Hindus believe in a ‘‘transcendent’’ generally religious, allegiance to reli- the next world/birth, the happiness of a God who may be worshipped in a gious customs will vary according to the father depends on having a continuous variety of ways through different sym- extent of ‘‘acculturation’’ (whereby line of sons.14 Furthermore, birth of a bolic manifestations (for example, sta- migrants take on some of the character- girl, particularly in India, may generate tues). The three supreme Hindu deities istics of the host community), and also parental anxieties because of the heavy forming the Hindu Trinity4 are: Brahma on whether the family roots were in financial burden resulting from the (The Creator), Vishnu (The Preserver), urban or rural India. giving of dowries. www.archdischild.com LEADING ARTICLE 1095 Table 1 Hindu sacraments (Samskaras) relevant to children before breast feeding is commenced. We are aware of this practice in some Hindu Name Procedure Time when carried out families in Britain. The custom of not breast feeding the baby for the first two Grabadhana Sacrament of impregnation Before pregnancy Punsavana Second/third month of pregnancy Second/third month of pregnancy days is still rife in India, but in our Simantonnayana Fifth to eighth month of pregnancy Fifth to eighth month of pregnancy experience this is not the case in Britain. Jatakarma At birth At birth Certain foods are believed by many Namakarana Naming the baby 10–12 days after birth South Asians, including Hindus, to have Nisramana First outing of the child Third/fourth month Annaprassana Weaning of the child Sixth month either a ‘‘cooling’’ or a ‘‘heating’’ effect Chuda Karma Cutting of hair Occasionally at birth on the functions of various organs of the Usually between first and third year body, such as mood, personality, and Karnavedha Piercing of ears Third to fifth year physical wellbeing.17 Health profes- Upanayana Investiture of sacred thread From eighth year, denoting the beginning of manhood sionals would therefore do well to be aware of the concept of ‘‘hot’’ and ‘‘cold’’ foods, both during pregnancy and the puerperium. For example, when the mother is breast feeding, if a baby Simmanantannaya—also known as ‘‘former’’ confinement. It is believed by has a cold or a fever, in the former case Valaiakappu in some parts of India some that a child born in this month she may avoid ‘‘cold’’ foods and the involves the wearing of red or green could die on the eighth day, in the converse when the baby has a raised glass bangles from the seventh month of eighth month, the eighth year, or the temperature. This concept is quite gestation. The sound of these bangles is eighteenth year! Some Hindus therefore divorced from the actual temperature believed to reach the womb and comfort consider the number ‘‘eight’’ unlucky. of food or the intensity of taste of spices. the fetus. Traditionally, these are In India, when a male is born a Thali High protein, acid, and salty foods are removed after birth and given to the (a flat bronze utensil akin to a large considered ‘‘hot’’, whereas ‘‘cold foods’’ midwife. Historically it is of interest to tray) is beaten with a stick by friends are often sweet. Lentils, millet, auber- note that in this sacrament the mother and relatives. In the case of a girl, a fan, gines, and grapes are examples of ‘‘hot’’ is allowed to fulfil her last wishes, such used for winnowing, is beaten. foods, and cereals, potatoes, milk, and as any craving for certain foods, as she is Jatakarma—this ceremony welcomes white sugar are examples of ‘‘cold’’ now thought to be entering a hazardous the child into the family. The father foods.