text:
Caesarean section
|Caesarean section
A team of obstetricians performing a Caesarean section in a modern hospital.
A Caesarean section (also spelled various other ways; often abbreviated to C-section) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk. Many are also performed upon request for childbirths that could otherwise have been vaginal.[1][2][3] The rate has risen to 46% in China and to levels of 25% and above in many Asian, European and Latin American countries.[4] The rate has increased in the United States, to 33% of all births in 2012, up from 21% in 1996.[5] Across Europe, there are differences between countries: in Italy the Caesarean section rate is 40%, while in the Nordic countries it is 14%.[6]
Elective cesarean can be harmful to the baby and mother with bad outcomes in low risk pregnancies occurring in 8.6% of vaginal deliveries and 9.2% of C-section deliveries.[5] Professional societies have established guidelines for non-medically indicated cesarean before 39 weeks.[7]
Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby.
Elective caesarean section should not be scheduled before 39 weeks gestational age unless there is a medical indication to do so.[8] Some medical indications are below. Not all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use discretion to decide whether a Caesarean is necessary.
Complications of labor and factors impeding vaginal delivery, such as:
- prolonged labour or a failure to progress (dystocia)
- fetal distress
- cord prolapse
- uterine rupture
- increased blood pressure (hypertension) in the mother or baby after amniotic rupture
- increased heart rate (tachycardia) in the mother or baby after amniotic rupture
- placental problems (placenta praevia, placental abruption or placenta accreta)
- abnormal presentation (breech or transversepositions)
- failed labour induction
- failed instrumental delivery (by forceps or ventouse (Sometimes a trial of forceps/ventouse delivery is attempted, and if unsuccessful, it will be switched to a Caesarean section.)
- large baby weighing >4000g (macrosomia)
- umbilical cord abnormalities (vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion)
Other complications of pregnancy, pre-existing conditions and concomitant disease, such as:
- pre-eclampsia
- hypertension[9]
- previous (high risk) fetus
- HIV infection of the mother
- Sexually transmitted diseases, such as genital herpes (which can be passed on to the baby if the baby is born vaginally (but can usually be treated in with medication and do not require a Caesarean section)
- previous classical (longitudinal) Caesarean section
- previous uterine rupture
- prior problems with the healing of the perineum (from previous childbirth or Crohn's disease)
- Bicornuate uterus
- Rare cases of posthumous birth after the death of the mother
- Lack of obstetric skill - obstetricians not being skilled in performing breech births, multiple births, etc. (In most situations, women can birth vaginally under these circumstances. However, obstetricians are not always trained in proper procedures)[10]
- Improper Use of Technology (Electric Fetal Monitoring [EFM])[10][11]
Caesarean sections are in some cases performed for reasons other than medical necessity. These can vary, with a key distinction being between hospital- or doctor-centric reasons and mother-centric reasons. Critics of doctor-ordered Caesareans worry that Caesareans are in some cases performed because they are profitable for the hospital, because a quick Caesarean is more convenient for an obstetrician than a lengthy vaginal birth, or because it is easier to perform surgery at a scheduled time than to respond to nature's schedule and deliver a baby at an hour that is not predetermined.[12]
Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Hospitals should institute strict monitoring of births to comply with full term (more than 39 weeks gestation) elective C-section guidelines. In review, three hospitals following policy guidelines brought elective early deliveries down 64%, 57%, and 80%.[7] The researchers found many benefits but "no adverse effects" in the health of the mothers and babies at those hospitals.[7][13]
In this context, it is worth remembering many studies have shown operations performed out-of-hours tend to have more complications (both surgical and anaesthetic).[14] For this reason, if a Caesarean is anticipated to be likely to be needed for a woman, it may be preferable to perform this electively (or pre-emptively) during daylight operating hours, rather than wait for it to become an emergency with the increased risk of surgical and anaesthetic complications that can follow from emergency surgery.
Another contributing factor for doctor-ordered procedures may be fear of medical malpractice lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome, Mater Dei, was under media attention for carrying a record of Caesarian sections (90% over total birth), explained: "We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest she gets a C-section "[15]
Studies of United States women have indicated married white women giving birth in private hospitals are more likely to have a Caesarean section than poorer women, although they are less likely to have complications that may lead to a Caesarean section being required. The women in these studies have indicated their preference for Caesarean section is more likely to be partly due to considerations of pain and vaginal tone.[16] In contrast, a recent study in the British Medical Journal retrospectively analysed a large number of Caesarean sections in England and stratified them by social class. Their finding was Caesarean sections are not more likely in women of higher social class than in women in other classes.[17] Some have suggested, due to the comparative risks of Caesarean section with an uncomplicated vaginal delivery, patients should be discouraged or forbidden from choosing it.[18]
Some 42% of obstetricians believe the media and women are responsible for the rising Caesarean section rates.[19] A study conducted in Sweden, however, concludes that relatively few women wish to be delivered by Caesarean section.[20]
Multiple birth[edit]
A study in 2013 involving 106 participating centers in 25 countries came to the conclusion that, in a twin pregnancy of a gestational age between 32 weeks 0 days and 38 weeks 6 days, and the first twin is in cephalic presentation, planned Cesarean section does not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal disability, as compared with planned vaginal delivery.[21] In this study, 44% of the women planned for vaginal delivery still ended up having Cesarean section for unplanned reasons such as pregnancy complications. In comparison, it has been estimated that 75% of twin pregnancies in the United States were delivered by Cesarean section in 2008.[22]
Bad outcomes in low risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of C-section deliveries.[5]
The mortality rate for Caesarian sections is 13 per 100,000 and for vaginal birth 3.5 per 100,000 in the developed world.[5] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[23]
In Canada the difference in bad outcome in the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the risk.[24]
As with all types of abdominal surgeries, a Caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections.[25] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches.[25]
Women who had Caesarean sections were more likely to have problems with later pregnancies, and it is recommended that women who want larger families should not seek an elective Caesarean. The risk of placenta accreta, a potentially life-threatening condition, is 0.13% after two Caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery.[27]
Women who had just one previous Caesarean section are more likely to have problems with their second birth.[5] Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second deliveries. However, some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself.[28]
An often overlooked aspect of maternal health is the psychological risks and implications that a Cesarean birth can have. Mothers can experience increased incidence of postnatal depression, and can experience significant psychological birth trauma and ongoingbirth-related post-traumatic stress disorder after obstetric intervention during the birthing process and Cesarean section.[29][30][31][32] [33]
Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Complications from elective cesarean before 39 weeks include: newborn mortality at 37 weeks may be 2.5 times the number at 40 weeks, and was elevated compared to 38 weeks of gestation. These "early term" births were also associated with increased death during infancy, compared to those occurring at 39 to 41 weeks ("full term").[7] Researchers in one study and another review found many benefits to going full term, but "no adverse effects" in the health of the mothers or babies.[7][13]
In one recent study, neonates born before 39 weeks may experienced 2.5 times more of complications compared with those delivered at 39 to 40 weeks. Problems among babies delivered "pre-term" in this study included respiratory distress, jaundice and low blood sugar.[34] The American College of Obstetricians and Gynecologists and medical policy makers review research studies and find increased incidence of suspected or proven sepsis, RDS, Hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4 – 5 days. In the case of cesarean sections, rates of respiratory death were 14x higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2x times higher for pre-labor cesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery prior to 39 weeks.[7]
In a research study widely publicized, children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math.[35]
Other risks include:
- Wet lung: Retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor.[36]
- Potential for early delivery and complications: Preterm delivery is possible if due-date calculation is inaccurate. One study found an increased risk of complications if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks.[37]
- Higher infant mortality risk: In C-sections performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had C-sections, compared to 0.62 per 1,000 for women who delivered vaginally.[38]
|This section does not cite any references or sources. (August 2012)
There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
- The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today, as it is more prone to complications.
- The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
- An unplanned Caesarean section is performed once labour has commenced due to unexpected labor complications.
- A crash/emergent/emergency Caesarean section is performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
- A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical reasons and ideally as close to the due date as possible.
- A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
- Traditionally, other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
- A repeat Caesarean section is one that is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand, the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
Cesarean section can be performed with single or double layer suturing of the uterine incision.[39] A Cochrane review came to the result that single layer closure compared with double layer closure was associated with a statistically significant reduction in mean blood loss.[40]
Misgav Ladach method[edit]
A modified cesarean section which has been used nearly all over the world in the last 20 years. It was described by Michael Stark, the president of the New European Surgical Academy, at the time he was the director of the Misgav Ladach general hospital in Jerusalem. The method was presented during a FIGO conference in Montréal in 1994[41] and then distributed by the University of Uppsala, Sweden, in more than 100 countries. This method is based on minimalistic principles. He examined all steps in cesarean sections in use, analyzed them for their necessity and, if found necessary, for their optimal way of performance. For the abdominal incision he used the modified Joel Cohen incision and compared the longitudinal abdominal structures to strings on musical instruments. As blood vessels and muscles have lateral sway, it is possible to stretch rather than cut them. The peritoneum is opened by repeat stretching, no abdominal swabs are used, the uterus is closed in one layer with a big needle to reduce the amount of foreign body as much as possible, the peritoneal layers remain unsutured and the abdomen is closed with two layers only. Women undergoing this operation recover quickly and can look after the newborns soon after surgery. There are many publications showing the advantages over traditional cesarean section methods.[42][43][44]
Both general and regional anaesthesia(spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during Caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby.[45] Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal intubation.[46]
Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled Caesarean section.[47] Regional anaesthesia during Caesarean section is different from the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. The dermatomal level of anesthesia required for Caesarean delivery is also higher than that required for labor analgesia.[46]
General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.
Recovery period[edit]
Typically, the recovery time depends on the patient and her pain tolerance and inflammation levels. Doctors do recommend abstention from strenuous work (e.g., lifting objects over 10 lbs (4.5 kg)., running, walking up stairs, or athletics) for up to six weeks[medical citation needed] , and a waiting period of ~18 months before attempting to conceive another child.[medical citation needed]
Efforts to decrease the rate of C-section includes: emphasizing that a long latent phase of labor is not a justification, changing the start of active labor from a cervical dilation of 4 cm to 6 cm and at least 2 or 3 hours of pushing should be allowed in those who have previously and not previously had children respectively before labor arrest is considered.[5]
In the United Kingdom, in 2008, the Caesarean section rate was 24%.[48] In Ireland the rate was 26.1% in 2009.[49] The Canadian rate was 26% in 2005–2006.[50] Australia has a high Caesarean section rate, at 31% in 2007.[51] In the United States the rate of C-section is around 33% and varies from 23% to 40% depending on the state in question.[5]
In Italy the incidence of Caesarean sections is particularly high, although it varies from region to region.[15] In Campania, 60% of 2008 births reportedly occurred via Caesarean sections.[52] In the Rome region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.[53][54]
With nearly 1.3 million stays, Cesarean section was one of the most common procedures performed in U.S. hospitals in 2011. It was the second-most common procedure performed for people ages 18 to 44 years old.[55] Caesarean rates in the U.S. have risen considerably since 1996.[56] The procedure increased 60% from 1996 to 2009. In 2010, the Cesarean delivery rate was 32.8% of all births (a slight decrease from 2009's high of 32.9% of all births).[57]
China has been cited as having the highest rates of C-sections in the world at 46% as of 2008.[58]
Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery[59] but there is also research that appears to show that there is no significant difference in Caesarean rates when comparing midwife continuity care to conventional fragmented care.[60]
More emergency Caesareans—about 66%—are performed during the day rather than during the night.[61]
Changing rates[edit]
In the United States C-section rates have increased from just over 20% in 1996 to 33% in 2011.[5] This increase has not resulted in improved outcomes resulting in the position that C-sections may be done too frequently.[5]
The World Health Organization officially withdrew its previous recommendation of a 15% C-section rates in June 2010. Their official statement read, "There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them."[62]
The US National Institutes of Health says rises in rates of Caesarean sections are not, in isolation, a cause for concern, but may reflect changing reproductive patterns: "The World Health Organization has determined an "ideal rate" of all cesarean deliveries (such as 15 percent) for a population. One surgeon's opinion[who?] is that there is no consistency in this ideal rate, and artificial declarations of an ideal rate should be discouraged. Goals for achieving an optimal cesarean delivery rate should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal preferences. This opinion is based on the idea that if left unchallenged, optimal cesarean delivery rates will vary over time and across different populations according to individual and societal circumstances."[63]
The number of C-sections performed has grown, for example, a fourfold increase from 1971 to 1991 (from 4.2 per 100 births).[citation needed] This may be accredited to the improved technology in detecting prebirth distress.[citation needed] Malpractice has been looked into because of the rapid increase. Some argue the higher costs of C-section births compared to regular births make physicians quicker to recommend surgery. Usually, if a doctor makes a recommendation, people are quick to take it to heart and act upon it. The effect of relative C-section price on C-section usage should be examined.
Some have speculated that cesarean section rates have increased due to a relationship between birth weight and maternal pelvis size, positing on the basis of Darwinian-inspired logic that since the advent of successful Caesarean birth over the last 150 years, more mothers with small pelvises and babies with large birth weights have survived and contributed to these traits. However, this idea fails to take into account that historically disproportion in childbirth was caused by maternal malnutrition in childhood, in particular malformed pelvic bones due to childhood rickets. Improved maternal nutrition should have led to increased ease in vaginal birth, not an increase in cesarean sections.[64]
The mother of Bindusara (born c. 320 BCE, ruled 298 – c.272 BCE), the second Mauryan Samrat (emperor) of India, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta's teacher and adviser, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby's life.[65][66]
According to the ancient Chinese Records of the Grand Historian, Luzhong, a sixth-generation descendant of the Yellow Emperor, had six sons, all born by "cutting open the body". The sixth son Jilian founded the House of Mi that ruled the State of Chu (c. 1030–223 BCE).[67]
In the Irish mythological text the Ulster Cycle, the character Furbaide Ferbend is said to have been born by posthumous Caesarean section, after his mother was murdered by his evil aunt Medb.
The Babylonian Talmud, an ancient Jewish religious text, mentions a procedure similar to the Caesarean section. The procedure is termed yotzei dofen.[66]
Pliny the Elder theorized that Julius Caesar's name came from an ancestor who was born by Caesarean section, but the truth of this is debated (see the article on the Etymology of the name of Julius Caesar). The Ancient Roman Caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth. Caesar's mother, Aurelia, lived through childbirth and successfully gave birth to her son, ruling out the possibility the Roman ruler and general was born by Caesarean section. His first wife however died in childbirth, giving birth to a stilborn son who might have lived had a caesarean taken place.
The Catalan saint Raymond Nonnatus (1204–1240), received his surname—from the Latin non-natus ("not born")—because he was born by Caesarean section. His mother died while giving birth to him.[68]
An early account of Caesarean section in Iran is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the national legendary hero of Iran.[69][70] According to the Shahnameh, the Simurghinstructed Zal upon how to perform a Caesarean section, thus saving Rudaba and the child Rostam.[71]
Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in Siegershausen, Switzerland: Jakob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour.[72] However, there is some basis for supposing that women regularly survived the operation in Roman times.[73] For most of the time since the 16th century, the procedure had a high mortality rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. In Great Britain and Ireland, the mortality rate in 1865 was 85%. Key steps in reducing mortality were:
- Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer in 1881 is thought to be first modern CS performed.
- The introduction of uterine suturing by Max Sänger in 1882
- Modification by Hermann Johannes Pfannenstiel in 1900, see Pfannenstiel incision
- Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912)[clarification needed]
- Adherence to principles of asepsis
- Anesthesia advances
- Blood transfusion
- Antibiotics
European travelers in the Great Lakes region of Africa during the 19th century observed Caesarean sections being performed on a regular basis.[74] The expectant mother was normally anesthetized with alcohol, and herbal mixtures were used to encourage healing. From the well-developed nature of the procedures employed, European observers concluded they had been employed for some time.[74] Dr. James Barry carried out the first successful Caesarean by a European doctor in Africa in Cape Town, while posted there between 1817 and 1828.[33]
The first successful Caesarean section to be performed in America took place in what was formerly Mason County, Virginia (now Mason County, West Virginia), in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.[75]
On March 5, 2000, in Mexico, Inés Ramírez performed a Caesarean section on herself and survived, as did her son, Orlando Ruiz Ramírez.[76] She is believed to be the only woman to have performed a successful Caesarean section on herself.[citation needed]
The Roman Lex Regia (royal law), later the Lex Caesarea (imperial law), of Numa Pompilius (715–673 BCE),[77] required the child of a mother dead in childbirth to be cut from her womb.[78] This seems to have begun as a religious requirement that mothers not be buried pregnant,[79] and to have evolved into a way of saving the fetus, with Roman practice requiring a living mother to be in her tenth month of pregnancy before resorting to the procedure, reflecting the knowledge that she could not survive the delivery.[80] Speculation that the Roman Emperor Julius Caesar was born by the method now known as C-section is apparently false.[81] Although Caesarean sections were performed in Roman times, no classical source records a mother surviving such a delivery,[78][82] – the earliest recorded survival dates to the 12th century scholar and physician Maimonides (see Commentary to Mishnah Bekhorot 8:2). The term has also been explained as deriving from the verb caedere, "to cut", with children delivered this way referred to as caesones. Pliny the Elder refers to a certain Julius Caesar (an ancestor of the famous Roman statesman) as ab utero caeso, "cut from the womb" giving this as an explanation for the cognomen "Caesar" which was then carried by his descendents.[78] Nonetheless, even if the etymological hypothesis linking the cesarean section to Julius Caesar is a false etymology, it has been widely believed. For example, the Oxford English Dictionary defines Caesarean birth as "the delivery of a child by cutting through the walls of the abdomen when delivery cannot take place in the natural way, as was done in the case of Julius Caesar".[83] Merriam-Webster's Collegiate Dictionary (11th edition) leaves room for etymological uncertainty with the phrase, "from the legendary association of such a delivery with the Roman cognomen Caesar"[84]
Some link with Julius Caesar, or with Roman emperors in general, exists in other languages, as well. For example, the modern German, Norwegian, Danish, Dutch, Swedish, Turkish and Hungarian terms are respectively Kaiserschnitt, keisersnitt, kejsersnit,keizersnede, kejsarsnitt, sezeryan, and császármetszés (literally: "Emperor's cut").[85] The German term has also been imported into Japanese (帝王切開 teiōsekkai) and Korean (제왕 절개 jewang jeolgae), both literally meaning "emperor incision". Similar in western Slavic (Polish) cięcie cesarskie, (Czech)císařský řez and (Slovak) cisársky rez (literally "imperial cut"), whereas the south Slavic term is Serbian царски рез and Slovenian cárski réz, which literally means "tzar" cut. The Russian term kesarevo secheniye (Кесарево сечение késarevo sečénije) literally means Caesar's section. The Arabic term (ولادة قيصرية wilaada qaySaríyya) also means "Caesarean birth." The Hebrew term ניתוח קיסרי (nitúakh Keisári) translates literally as Caesarean surgery. In Romania and Portugal, it is usually called cesariana, meaning from (or related to) Caesar.[citation needed]
According to Shahnameh ancient Persian book, the hero Rostam was the first person who was born with this method and term رستمينه (rostamineh) is corresponded to Caesarean.[citation needed] Also, Hindu mythical monkey god Hanuman was born through a similar procedure on her mother Anjani.
Finally, the Roman praenomen (given name) Caeso was said to be given to children who were born via C-section. While this was probably just folk etymology made popular by Pliny the Elder, it was well known by the time the term came into common use.[86]
- The e/ae/æ variation reflects American and British English spelling differences.
- The capital-versus-lowercase variation reflects a style of lowercasing some eponymous terms (e.g., cesarean, eustachian, fallopian, mendelian, parkinsonian, parkinsonism).[87] Capital and lowercase stylings coexist in prevalent usage. Intradocument style consistency is usually advocated.
- Because of (1) the e-vs-ae digraph variation, (2) the related ae-vs-æ typographic ligature variation, (3) the capital-vs-lowercase variation (which is based on the idea of eponymous origin, whether that is historically accurate or not; see eponym > orthographic conventions), and (4) the -ean-vs--ian suffix variation, these factors cross-multiplied in a table cause this word to be one of the very few words in present-day English orthography to have many different normative spellings or orthographic stylings, which amount to 12 from the point of view of character encoding (that is, there are 12 different character strings that are all accepted as normative orthographic representations of this one word):
|C + e
|c + e
|C + ae
|c + ae
|C + æ
|c + æ
Vaginal birth after Caesarean[edit]
While vaginal births after Caesarean (VBAC) are not uncommon today, the rate of VBAC has declined to include less than 10% of births after previous Cesarean.[88][89] Although Caesarean deliveries made up only 5% of births overall in the USA until the mid-1970s, it was commonly believed that for women with previous Caesarean sections, "Once a Caesarean, always a Caesarean". A consumer-driven movement supporting VBAC changed medical practice and led to soaring rates of VBAC in the 1980s and early 1990s, but rates of VBAC dramatically dropped after the publication of a highly publicized scientific study showing worse outcomes for VBACs as compared to repeat Caesarean and the resulting medicolegal changes within obstetrics.[90] In 2010, the National Institutes of Health, U.S. Department of Health and Human Services, and American College of Obstetrics and Gynecology all released statements in support of increasing VBAC access and rates.[91][92][93][94]
In the past, Caesarean sections used a vertical incision which cut the uterine muscle fibres in an up and down direction (a classical Caesarean). Modern Caesareans typically involve a horizontal incision along the muscle fibres in the lower portion of the uterus (hence the term lower uterine segment Caesarean section). The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically, the scar for modern Caesareans is below the "bikini line".
Obstetricians and other caregivers differ on the relative merits of vaginal and Caesarean section following a Caesarean delivery; some still recommend a Caesarean routinely, while others do not. In the US, the American College of Obstetricians and Gynecologists (ACOG) modified the guidelines on vaginal birth after previous Caesarean delivery in 1999, 2004, and again in 2010.[95] In 2004, this modification to the guideline included the addition of the following recommendation:
Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.[96]
In 2010, ACOG modified these guidelines again to express more encouragement of VBAC, but maintained it should still be undertaken at facilities capable of emergency care, though patient autonomy in assuming increased levels of risk should be respected (ACOG Practice Bulletin Number 115, August 2010).
The recommendation for access to emergency care during trial of labor has, in some cases, had a major impact on the availability of VBACs to birthing mothers in the US. For example, a study of the change in frequency of VBAC deliveries in California after the change in guidelines, published in 2006, found the VBAC rate fell to 13.5% after the change, compared with 24% VBAC rate before the change.[97] The new recommendation has been interpreted by many hospitals as indicating a full surgical team must be standing by to perform a Caesarean section for the full duration of a VBAC woman's labor. Hospitals that prohibit VBACs entirely are said to have a 'VBAC ban'. In these situations, birthing mothers are forced to choose between having a repeat Caesarean section, finding an alternate hospital in which to deliver their babies or attempting delivery outside the hospital setting.[98]
Most recently, enhanced access to VBAC has been recommended based on updated scientific data on the safety of VBAC as compared to repeat Caesarean section, including the following recommendation emerging from the NIH VBAC conference panel in March 2010, "We recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor."[91] The U.S Department of Health and Human Services' Healthy People 2020 initiative includes objectives to reduce the primary cesarean rate and to increase the VBAC rate by at least 10% each.[94]
Within Judaism[edit]
There is a dispute among the poskim (Rabbinic authorities) as to whether a first-born son from a Caesarean section has the laws of a bechor.[99] Traditionally, a male child delivered by Caesarean is not eligible for the Pidyon HaBen dedication ritual.[100][101]
- ^ "Fear a factor in surgical births". The Sydney Morning Herald. 7 October 2007.
- ^ "Kiwi caesarean rate continues to rise". Stuff.co.nz. 12 September 2007. Retrieved 22 September 2011.
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- ^ Turner R (1990). "Caesarean Section Rates, Reasons for Operations Vary Between Countries". Fam Plann Perspect. (Guttmacher Institute) 22 (6): 281–2. doi:10.2307/2135690. JSTOR 2135690.
- ^ a b Savage W (2007). "The rising Caesarean section rate: a loss of obstetric skill?". J Obstet Gynaecol 27 (4): 339–46. doi:10.1080/01443610701337916. PMID 17654182.
- ^ Wei Ching T, Kanagalingam D, Hak Koon T (2003). "Rising Caesarean Section Rates–Where Do We Go From Here?". SGH Proceedings 12 (4): 208–12.
- ^ MacKenzie IZ, Cooke I, Annan B (2003). "Indications for Caesarean section in a consultant obstetric unit over three decades". J Obstet Gynaecol 23 (3): 233–8. doi:10.1080/0144361031000098316. PMID 12850849.
- ^ a b "Term Pregnancy: A Period of Heterogeneous Risk for Infant Mo... : Obstetrics & Gynecology". Retrieved 2012-07-12.
- ^ Cullinane M, Gray A, Hargraves C, Lansdown M, Martin I, Schubert M. Who operates when? – The 2003 Report of the Confidential Enquiry into Perioperative Deaths. Retrieved 2009-07-30.
- ^ a b "La clinica dei record: 9 neonati su 10 nati con il parto cesareo". Corriere della Sera. 14 January 2009. Retrieved 2009-02-05.[dead link]
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- ^ Barley K, Aylin P, Bottle A, Jarman B (2004). "Social class and elective Caesareans in the English NHS". BMJ 328 (7453): 1399. doi:10.1136/bmj.328.7453.1399. PMC 421774. PMID 15191977.
- ^ Bewley S, Cockburn J. (2002). "The unfacts of 'request' Caesarean section". BCOG 109 (6): 597–605. doi:10.1111/j.1471-0528.2002.07106.x.
- ^ Usha Kiran TS, Jayawickrama NS (2002). "Who is responsible for the rising Caesarean section rate?". J Obstet Gynaecol 22 (4): 363–5. doi:10.1080/01443610220141263. PMID 12521454.
- ^ Hildingsson I, Rådestad I, Rubertsson C, Waldenström U (2002). "Few women wish to be delivered by Caesarean section". BJOG 109 (6): 618–23. doi:10.1111/j.1471-0528.2002.01393.x. PMID 12118637.
- ^ Barrett, J. F. R.; Hannah, M. E.; Hutton, E. K.; Willan, A. R.; Allen, A. C.; Armson, B. A.; Gafni, A.; Joseph, K. S.; Mason, D.; Ohlsson, A.; Ross, S.; Sanchez, J. J.; Asztalos, E. V.; Twin Birth Study Collaborative Group (2013). "A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy". New England Journal of Medicine 369 (14): 1295–1305. doi:10.1056/NEJMoa1214939. PMID 24088091.
- ^ Lee, H. C.; Gould, J. B.; Boscardin, W. J.; El-Sayed, Y. Y.; Blumenfeld, Y. J. (2011). "Trends in Cesarean Delivery for Twin Births in the United States". Obstetrics & Gynecology 118 (5): 1095. doi:10.1097/AOG.0b013e3182318651.
- ^ "Caesarean Section". NHS Direct. Retrieved 2006-07-26.[dead link]
- ^ Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS (2007). "Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term". CMAJ 176 (4): 455–60. doi:10.1503/cmaj.060870. PMC 1800583. PMID 17296957.
- ^ a b Pai, Madhukar (2000). "Medical Interventions: Caesarean Sections as a Case Study". Economic and Political Weekly 35 (31): 2755–61.
- ^ "Why are Caesareans Done?". Gynaecworld. Retrieved 2006-07-26.
- ^ Silver RM, Landon MB, Rouse DJ, et al. (2006). "Maternal morbidity associated with multiple repeat cesarean deliveries". Obstet Gynecol 107 (6): 1226–32. doi:10.1097/01.AOG.0000219750.79480.84. PMID 16738145. (see also review by WebMD.com)
- ^ Kennare R, Tucker G, Heard A, Chan A (2007). "Risks of adverse outcomes in the next birth after a first cesarean delivery". Obstet Gynecol 109 (2 Pt 1): 270–6. doi:10.1097/01.AOG.0000250469.23047.73. PMID 17267823.
- ^ Beck, Cheryl Tatano (January–February 2004). "Birth Trauma: In the Eye of the Beholder". Nursing Research 53 (1): 28–35. doi:10.1097/00006199-200401000-00005. PMID 14726774.
- ^ Soet, Johanna E.; Brack, Gregory A.; DiIorio, Colleen (1 March 2003). "Prevalence and Predictors of Women's Experience of Psychological Trauma During Childbirth". Birth 30 (1): 36–46. doi:10.1046/j.1523-536X.2003.00215.x. PMID 12581038.
- ^ Creedy, Debra K; Shochet, Ian M; Horsfall, Jan (1 June 2000). "Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors". Birth 27 (2): 104–111. doi:10.1046/j.1523-536x.2000.00104.x. PMID 11251488.
- ^ Olde E, van der Hart O, Kleber R, van Son M (January 2006). "Post-traumatic stress following childbirth: a review". Clin Psychol Rev 26 (1): 1–16. doi:10.1016/j.cpr.2005.07.002. PMID 16176853.
- ^ a b Pain, Stephanie (6 March 2008). "The 'male' military surgeon who wasn't". NewScientist.com. Retrieved 16 March 2008.
- ^ "Neonatal Outcomes After Demonstrated Fetal Lung Maturity Bef... : Obstetrics & Gynecology". Retrieved 2012-07-12.
- ^ "Academic Achievement Varies With Gestational Age Among Children Born at Term". Retrieved 2012-07-12.
- ^ G Cassady, (1971), "Effect of cesarean section on neonatal body water spaces", New England Journal of Medicine
- ^ Study: Early Repeat C-Sections Puts Babies At Risk. Npr.org (8 January 2009). Retrieved on 2011-07-26.
- ^ "High infant mortality rate seen with elective c-section". Reuters Health - September 2006. Medicineonline.com. 14 September 2006. Retrieved 2011-07-26.
- ^ Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). "Evaluation of combinations of procedures in cesarean section". International Journal of Gynecology & Obstetrics 48 (3): 273. doi:10.1016/0020-7292(94)02306-J.
- ^ Dodd, J. M.; Anderson, E. R.; Gates, S. (2008). "Surgical techniques for uterine incision and uterine closure at the time of caesarean section". In Dodd, Jodie M. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD004732.pub2.
- ^ Stark M. Technique of cesarean section: Misgav Ladach method. In: Popkin DR, Peddle LJ (eds): Women's Health Today. Perspectives on current research and clinical practice. Proceedings of the XIV World Congress of Gynaecology and Obstetrics, Montreal. Parthenon Publishing group, New York, 81–5
- ^ Nabhan AF. Long-term outcomes of two different surgical techniques for cesarean. Int J Gynaecol Obstet. 2008;100(1):69-75.
- ^ Messalli EM, Cobellis L, Pierno G. Cesarean section according to Stark. Minerva Ginecol. 2001;53(5):367-71.
- ^ Hudić I, Bujold E, Fatušić Z, Skokić F, Latifagić A, Kapidžić M, Fatušić J. The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics. Arch Gynecol Obstet. 2012;286(5):1141-6
- ^ Hawkins JL, Koonin LM, Palmer SK, Gibbs CP (1997). "Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990". Anesthesiology 86 (2): 277–84. doi:10.1097/00000542-199702000-00002. PMID 9054245.
- ^ a b Afolabi BB, Lesi FE, Merah NA (2006). "Regional versus general anaesthesia for Caesarean section". In Afolabi, Bosede B. Cochrane Database Syst Rev (4): CD004350. doi:10.1002/14651858.CD004350.pub2. PMID 17054201.
- ^ Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA (2005). "Obstetric anesthesia workforce survey: twenty-year update". Anesthesiology 103 (3): 645–53. doi:10.1097/00000542-200509000-00030. PMID 16129992.
- ^ "Focus on: caesarean section - NHS Institute for Innovation and Improvement". Institute.nhs.uk. 8 October 2009.
- ^ "Caesarean Section Rates Royal College of Physicians of Ireland:". Rcpi.ie.
- ^ "C-section rate in Canada continues upward trend". Canada.com. 26 July 2007.
- ^ "To push or not to push? It's a woman's right to decide". The Sydney Morning Herald. 2 January 2011.
- ^ "Sagliocco denuncia boom di parti cesarei in Campania". Pupia.tv. 31 January 2009. Retrieved 2009-02-05.[dead link]
- ^ http://www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf
- ^ "Cesarei, alla Mater Dei il record". Tgcom.mediaset.it. 14 January 2009. Retrieved 2009-02-05.[dead link]
- ^ Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1].
- ^ "Births: Preliminary Data for 2007". National Center for Health Statistics. Retrieved 2006-11-23.
- ^ http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf
- ^ "China's C-Section Rate Highest Worldwide, WHO Study Says,"Medical News Today, 15 January 2010>
- ^ Homer CS, Davis GK, Brodie PM, et al. (2001). "Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care". BJOG 108 (1): 16–22. doi:10.1016/S0306-5456(00)00022-X. PMID 11212998.
- ^ Hodnett ED; Hodnett, Ellen (2000). "Continuity of caregivers for care during pregnancy and childbirth". In Hodnett, Ellen. Cochrane Database Syst Rev (2): CD000062. doi:10.1002/14651858.CD000062. PMID 10796108.
Hodnett ED; Henderson, Sonja (2008). "WITHDRAWN: Continuity of caregivers for care during pregnancy and childbirth". In Henderson, Sonja. Cochrane Database Syst Rev (4): CD000062. doi:10.1002/14651858.CD000062.pub2. PMID 18843605.
- ^ Goldstick O, Weissman A, Drugan A (2003). "The circadian rhythm of "urgent" operative deliveries". Isr Med Assoc J 5 (8): 564–6. PMID 12929294.
- ^ "Should there be a limit on Caesareans?". BBC News. 30 June 2010.
- ^ NIH (2006). "State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request". Obstet Gynecol 107 (6): 1386–97. doi:10.1097/00006250-200606000-00027. PMID 16738168.
- ^ Walsh, Joseph A. (2008). "Evolution and the Cesarean Section Rate". The American Biology Teacher 70 (7): 401–404. doi:10.1662/0002-7685(2008)70[401:ETCSR]2.0.CO;2. ISSN 0002-7685.
- ^ Wilhelm Geiger (1908). The Dīpavaṃsa and Mahāvaṃsa and their historical development in Ceylon. Ethel M. Coomaraswamy. H. C. Cottle, Government Printer, Ceylon. p. 40. OCLC 559688590.
- ^ a b Lurie, Samuel (2005). "The changing motives of cesarean section: from the ancient world to the twenty-first century". Archives of Gynecology and Obstetrics (Springer) 271 (4): 281–285. doi:10.1007/s00404-005-0724-4. PMID 15856269.
- ^ Sima Qian. "楚世家 (House of Chu)". Records of the Grand Historian (in Chinese). Retrieved 3 December 2011.
- ^ "St. Raymond Nonnatus". Catholic Online. Retrieved 2006-07-26.
- ^ Shahbazi, A. Shapur. "RUDABA". Encyclopedia Iranica. Retrieved 2009-07-19.
- ^ TORPIN R, VAFAIE I. The birth of Rustam. An early account of cesarean section in Iran. Am J Obstet Gynecol. 1961 Jan;81:185-9.
- ^ WIKIPEDIA Rostam
- ^ Conner, Clifford D., A People's History Of Science : : Miners, Midwives, And "low Mechanicks", pg 3
- ^ Boss, J (1961). "THE ANTIQUITY OF CAESAREAN SECTION WITH MATERNAL SURVIVAL: THE JEWISH TRADITION". Medical history 5 (2): 117–31. doi:10.1017/S0025727300026089. PMC 1034600. PMID 16562221.
- ^ a b "Cesarean Section – A Brief History: Part 2". U.S. National Institutes of Health. 25 June 2009. Retrieved 2010-11-27.
- ^ "Woman's Ills". Time Magazine. 18 June 1951. Retrieved 2009-04-01.
- ^ P, A (1 June 2004). "True grit: the mum who delivered her own baby". SMH. Retrieved 22 September 2012.
- ^ Segen, J. C. (1992). The Dictionary of Modern Medicine: A Sourcebook of Currently Used Medical Expressions, Jargon and Technical Terms. Taylor & Francis. p. 102. ISBN 1850703213. Retrieved 2012-12-07.
- ^ a b c "Caesarean section?: etymology and early history", South African Journal of Obstetrics and Gynaecology, August 2009 by Pieter W.J. van Dongen
- ^ "As there was a cultural taboo against burying an undelivered woman in Roman and German societies, according to Lex Caesarea..." U Högberg, E Iregren, CH Siven, "Maternal deaths in medieval sweden: an osteological and life table analysis", Journal of Biosocial Science, 1987, 19: 495–503 Cambridge University Press
- ^ University of Virginia Health System, Claude Moore Sciences Health Library, Ancient Gynecology:Caesarean Section
- ^ "Bad Medicine: Misconceptions and Misuses Revealed," by Christopher Wanjek, p. 5 (John Wiley & Sons, 2003)
- ^ "...could not survive the trauma of a Caesarean" Oxford Classical Dictionary, Third Edition, "Childbirth"
- ^ "Caesarean | Caesarian, adj. and n.". OED Online. June 2013. Oxford University Press. 13 June 2013 <http://www.oed.com/view/Entry/26016>.
- ^ Merriam-Webster (2003), Merriam-Webster's Collegiate Dictionary (11th ed ed.), Springfield, Massachusetts, USA: Merriam-Webster, ISBN 978-0-87779-809-5
- ^ For a summary (in German), of an article (also in German) that deals usefully with many of the relevant historical and linguistic questions raised here, go here [2].
- ^ Blumenfeld-Kosinski, Renate. Not of Woman Born: Representations of Caesarean Birth In Medieval and Renaissance Culture (Cornell University Press: 1991; 204 pages) ISBN 0-8014-9974-7: "Appendix: Creative Etymology: Caesarean Section from Pliny to Rousset" (pp. 143-153) presents an excellent history of the legend of caesarean births in Western culture.
- ^ Elsevier (2007). Dorland's Illustrated Medical Dictionary (31st ed.). Philadelphia: Elsevier. ISBN 978-1-4160-2364-7.
- ^ "Cesarean births, repeat (percent) - Health Indicators Warehouse". Healthindicators.gov.
- ^ "Rates for Total Cesarean Section, Primary Cesarean Section and Vaginal Birth After Cesarean Section (VBAC), United States, 1989–2006." Childbirth Connection, 2008. Retrieved 25 September 2008.
- ^ McMahon, M. J.; Luther, E. R.; Bowes Jr, W. A.; Olshan, A. F. (1996). "Comparison of a Trial of Labor with an Elective Second Cesarean Section". New England Journal of Medicine 335 (10): 689–695. doi:10.1056/NEJM199609053351001. PMID 8703167.
- ^ a b "NIH Vaginal Birth After Cesarean (VBAC) Conference - Panel Statement". Consensus.nih.gov. Retrieved 2013-05-16.
- ^ "Vaginal Birth After Cesarean: New Insights: Structured Abstract". Ahrq.gov. 16 September 2010.
- ^ [3][dead link]
- ^ a b "Maternal, Infant, and Child Health - Healthy People". Healthypeople.gov. 13 September 2012.
- ^ American College of Obstetricians and Gynecologists (ACOG). "Guideline on Vaginal birth after previous cesarean delivery". guideline.gov. Retrieved 2008-02-09.
- ^ American College of Obstetricians and Gynecologists (ACOG). "Guideline on Vaginal birth after previous cesarean delivery: Major Recommendations". guideline.gov. Retrieved 2008-02-09.
- ^ Zweifler J, Garza A, Hughes S, Stanich MA, Hierholzer A, Lau M (2006). "Vaginal birth after cesarean in California: before and after a change in guidelines". Ann Fam Med 4 (3): 228–34. doi:10.1370/afm.544. PMC 1479438. PMID 16735524.
- ^ Rita Rubin (24 August 2005). "Battle lines drawn over C-sections". USA Today. Retrieved 2008-02-09.
- ^ See Chok Yaakov 470:2; Kaf ha-Chayim 470:3; http://www.torah.org/advanced/weekly-halacha/5758/pesach.html
- ^ "Pidyon HaBen - Definition of Pidyon HaBen (Redemption of the Firstborn)". Judaism.about.com. 19 October 2012.
- ^ "Kohanim forever from the sources, who is a cohen, the blessing of the Cohanim,. Mitvah of the cohen, Halacha, Temple service groups, pidyon - redemption of the firstborn". Cohen-levi.org.
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Yoga Sutras of Patanjali
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|Hindu scriptures
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The Yoga Sūtras of Patañjali are 196 Indian sūtras (aphorisms) that constitute the foundational text of yoga. In medieval times, yoga was cast as one of the six orthodox āstika schools of Hindu philosophy. According to the late Yogatattva Upanishad, yoga is divided into four forms — Mantrayoga, Layayoga, Hathayoga and Rājayoga[1] — the last of which is the highest (or royal) practice.[2][3]
Although the Yoga Sutras have become the most important text of yoga, the opinion of many scholars is that Patañjali was not the creator of yoga, which existed well before him, but merely a great expounder.[4]
- 1 Compilation and dating
- 2 Contents
- 3 Philosophical roots and influences
- 4 Commentaries
- 5 Non-dharmic contemporary response
- 6 Interpretations
- 7 See also
- 8 Notes
- 9 References
- 10 Sources
- 11 Further reading
- 12 External links
Compilation and dating[edit]
Various authorities attribute the compilation of the sutras to Patañjali. The surviving manuscripts of the work also attribute the work to this author. However, the author is just a name; it is much later that various hagiographical life stories arose. Patañjali was not the first to write about yoga; for example, there is much written about it in the Mokṣadharma section of the epic Mahābhārata. However, Patañjali's work became the most famous work on the subject among orthodox Brahmans.[5] The members of the Jaina faith had their own, different literature on yoga.[6]
Much confusion has been caused by the late medieval traditions of conflating Patañjali, the author of the grammatical Mahābhāṣya with the author of the same name who wrote the Yoga Sūtras. Even a superficial reading of the two works in Sanskrit shows them to be completely different in language, style and subject matter. Furthermore, before the time of Bhoja (11th century), Sanskrit authors did not conflate the authors, and treated them quite separately. Furthermore (see below) modern scholarship shows that these two authors are separated in time by about six hundred years. A third Patañjali is sometimes also invented, an author on medicine, in order to fill out the meaning of Bhoja's verse that said a single Patañjali cured speech through grammar, the mind through yoga, and the body through medicine. However, no major work of medicine by a Patañjali is known to Sanskrit literature.[7]
The most recent assessment of Patañjali's date, developed in the context of the first critical edition ever made of the Yoga Sūtras and bhāṣya based on a study of the surviving original Sanskrit manuscripts of the work, is that of Philipp A. Maas.[8] Maas's detailed evaluation of the historical evidence and past scholarship on the subject, including the opinions of the majority of Sanskrit authors who wrote in the first millennium CE, is that Patañjali's work was composed in 400 CE plus or minus 25 years. Patañjali's composition was entitled Pātañjalayogaśāstra ("The Treatise on Yoga according to Patañjali") and consisted of both Sūtras and Bhāṣya. In other words, the earliest commentry on the sūtras, the Bhāṣya that has commonly been ascribed to some unknown later author Vyāsa (the editor) was in fact Patañjali's own work. These research findings dramatically change our historical understanding of the yoga tradition, since they allow us to take the Bhāṣya as Patañjali's very own explanation of the meaning of his somewhat cryptic sūtras.
In the Yoga Sutras, Patañjali prescribes adherence to eight "limbs" or steps (the sum of which constitute "Ashtanga Yoga", the title of the second chapter) to quiet one's mind and achieve kaivalya. The Yoga Sutras form the theoretical and philosophical basis of Rāja Yoga, and are considered to be the most organized and complete definition of that discipline. The Sutras not only provide yoga with a thorough and consistent philosophical basis, they also clarify many important esoteric concepts which are common to all traditions of Indian thought, such as karma.
Structure of the text[edit]
Patañjali divided his Yoga Sutras into four chapters or books (Sanskrit pada), containing in all 196 aphorisms, divided as follows:[9][10][11]
- Samadhi Pada[9][10][11] (51 sutras). Samadhi refers to a blissful state where the yogi is absorbed into the One. Samadhi is the main technique the yogin learns by which to dive into the depths of the mind to achieve Kaivalya. The author describes yoga and then the nature and the means to attaining samādhi. This chapter contains the famous definitional verse: "Yogaś citta-vritti-nirodhaḥ" ("Yoga is the restraint of mental modifications").[12]
- Sadhana Pada[9][10][11] (55 sutras). Sadhana is the Sanskrit word for "practice" or "discipline". Here the author outlines two forms of Yoga: Kriya Yoga (Action Yoga) and Ashtanga Yoga (Eightfold or Eightlimbed Yoga).
- Kriya yoga, sometimes called Karma Yoga, is also expounded in Chapter 3 of the Bhagavad Gita, where Arjuna is encouraged by Krishna to act without attachment to the results or fruit of action and activity. It is the yoga of selfless action and service.
- Ashtanga Yoga describes the eight limbs that together constitute Rāja Yoga.
- Vibhuti Pada[9][10][11] (56 sutras). Vibhuti is the Sanskrit word for "power" or "manifestation". 'Supra-normal powers' (Sanskrit: siddhi) are acquired by the practice of yoga. The temptation of these powers should be avoided and the attention should be fixed only on liberation.
- Kaivalya Pada[9][10][11] (34 sutras). Kaivalya literally means "isolation", but as used in the Sutras stands for emancipation, liberation and used interchangeably with moksha (liberation), which is the goal of yoga. The Kaivalya Pada describes the process of liberation and the reality of the transcendental ego.
The eight limbs of Yoga[edit]
Ashtanga yoga consists of the following limbs: The first five are called external aids to Yoga (bahiranga sadhana)
- Yama refers to the five abstentions: how we relate to the external world. (The five vows of Jainism are identical to these).
- Ahimsa: non-violence, inflicting no injury or harm to others or even to one's own self, it goes as far as nonviolence in thought, word and deed.
- Satya: non-illusion; truth in word and thought.
- Asteya: non-covetousness, to the extent that one should not even desire something that is his own; non-stealing.
- Brahmacharya: abstinence, particularly in the case of sexual activity. Also, responsible behavior with respect to our goal of moving toward the truth. It suggests that we should form relationships that foster our understanding of the highest truths. "Practicing brahmacharya means that we use our sexual energy to regenerate our connection to our spiritual self. It also means that we don't use this energy in any way that might harm others."[13]
- Aparigraha: non-possessiveness; non-hoarding
- Niyama refers to the five observances: how we relate to ourselves, the inner world.
- Shaucha: cleanliness of body and mind.
- Santosha: satisfaction; satisfied with what one has.
- Tapas: austerity and associated observances for body discipline and thereby mental control.
- Svādhyāya: study of the Vedic scriptures to know about God and the soul, which leads to introspection on a greater awakening to the soul and God within,
- Ishvarapranidhana: surrender to (or worship of) God.
- Asana: Discipline of the body: rules and postures to keep it disease-free and for preserving vital energy. Correct postures are a physical aid to meditation, for they control the limbs and nervous system and prevent them from producing disturbances.
- Pranayama: control of life force energies. Beneficial to health, steadies the body and is highly conducive to the concentration of the mind.
- Pratyahara: withdrawal of senses from their external objects.
The last three levels are called internal aids to Yoga (antaranga sadhana)
- Dharana: concentration of the Chitta upon a physical object, such as a flame of a lamp, the midpoint of the eyebrows, or the image of a deity.
- Dhyana: steadfast meditation. Undisturbed flow of thought around the object of meditation (pratyayaikatanata). The act of meditation and the object of meditation remain distinct and separate.
- Samadhi: oneness with the object of meditation. There is no distinction between act of meditation and the object of meditation. Samadhi is of two kinds:
- Samprajnata Samadhi conscious samadhi. The mind remains concentrated (ekagra) on the object of meditation, therefore the consciousness of the object of meditation persists. Mental modifications arise only in respect of this object of meditation.
This state is of four kinds:
- Savitarka: the citta is concentrated upon a gross object of meditation such as a flame of a lamp, the tip of the nose, or the image of a deity.
- Savichara: the citta is concentrated upon a subtle object of meditation, such as the tanmatras
- Sananda Samadhi: the citta is concentrated upon a still subtler object of meditation, like the senses.
- Sasmita: the citta is concentrated upon the ego-substance with which the self is generally identified.
- Asamprajnata Samadhi superconscious. The citta and the object of meditation are fused together. The consciousness of the object of meditation is transcended. All mental modifications are checked (niruddha), although latent impressions may continue.
- Samprajnata Samadhi conscious samadhi. The mind remains concentrated (ekagra) on the object of meditation, therefore the consciousness of the object of meditation persists. Mental modifications arise only in respect of this object of meditation.
Combined simultaneous practice of Dhāraṇā, Dhyana and Samādhi is referred to as Samyama and is considered a tool of achieving various perfections, or Siddhis. But as stated above, siddhis are but distractions from Kaivalaya and are to be discouraged. Siddhis are but maya, or illusion. The purpose of using samadhi is not to gain siddhis but to achieve Kaivalya.
According to I. K. Taimni,[note 1][14] the cumulative and collective mastery of the eight limbs aids one in performing Samadhi efficiently. Samadhi then becomes the main tool used by the yogi to descend through the various layers of consciousness towards the very center of consciousness. Mastery of the eight limbs is only the prerequisite to begin the descent through consciousness to its center (bhindu or laya center). The descent through consciousness involves mastery of samskaras and overcoming the kleshas, and constitutes an effort of will perhaps greater than mastery of the eight limbs. It is through the descent of consciousness to its center, and passage through this center by dharma mega samadhi that the Atman is realized and Kaivalya is achieved. Kaivalya is related to "isolation" not because a relative being becomes isolated from all other relative beings, but because consciousness becomes its essential nature: the wholeness and fullness of the Absolute, of which there is only one. There is no other next to the Absolute; hence it is isolated. This state is the fullness, completeness, and total freedom of being (svatantra). In this state Atman is Brahman. Thus, the eight "limbs" are the means to samadhi, and samadhi is the means to the end which is Kaivalya.
Philosophical roots and influences[edit]
The Yoga Sutras are built on a foundation of Samkhya philosophy, an orthodox (Astika) and Atheistic Hindu system of dualism, and are generally seen as the practice while Samkhya is the theory. The influence of Samkhya is so pervasive in the Sutras that the historian Surendranath Dasgupta went so far as to deny independent categorization to Patañjali's system, preferring to refer to it as Patanjala Samkhya, similar to the position taken by the Jain writer Haribhadra in his commentary on Yoga.[15] Patañjali's Yoga Sutras accept the Samkhya's division of the world and phenomena into twenty-five tattvas or principles, of which one is Purusha meaning Self or consciousness, the others being Prakriti (primal nature), Buddhi (intellect or will), Ahamkara (ego), Manas (mind), five buddhindriyas (sensory capabilities), five karmendriyas (action-capabilities) and ten elements.[16][17] The second part of the Sutras, the Sadhana, also summarizes the Samkhya perspectives about all seen activity lying within the realm of the three Gunas of Sattva (illumination), Rajas (passion) and Tamas (lethargy).[18]
The Yoga Sutras diverge from early Samkhya by the addition of the principle of Isvara or God, as exemplified by Sutra 1.23 - "Iśvara pranidhãnãt vã", which is interpreted to mean that surrender to God is one way to liberation.[16][19] Isvara is defined here as "a distinct Consciousness, untouched by afflictions, actions, fruitions or their residue".[20] In the sutras, it is suggested that devotion to Isvara, represented by the mystical syllable Om may be the most efficient method of achieving the goal of Yoga.[21] This syllable Om is a central element of Hinduism, appearing in all the Upanishads, including the earliest Chandogya and Brihadaranyaka Upanishads, and expounded upon in the Mandukya Upanishad.[22]
Another divergence from Samkhya is that while the Samkhya holds that knowledge is the means to liberation, Patañjali's Yoga insists on the methods of concentration and active striving. The aim of Yoga is to free the individual from the clutches of matter, and considers intellectual knowledge alone to be inadequate for the purpose – which is different from the position taken by Samkhya.[16]
However, the essential similarities between the Samkhya and Patañjali's system remained even after the addition of the Isvara principle,[23] with Max Müller noting that "the two philosophies were in popular parlance distinguished from each other as Samkhya with and Samkhya without a Lord...."[24] The Bhagavad Gita, one of the chief scriptures of Hinduism, is considered to be based on this synthetic Samkhya-Yoga system.[25][26]
Samkhya and Yoga are thought to be two of the many schools of philosophy that originated over the centuries that had common mystical roots derived from the early Vedic and Indus-Saraswati periods. The orthodox Hindu philosophies of Samkhya, Yoga, Vedanta, as well as the non-orthodox Nastika systems of Jainism and Buddhism can all be seen as representing one stream of spiritual activity in Ancient India, in contrast to the Bhakti traditions and Vedic ritualism which were also prevalent at the same time. The Vedanta-Sramana traditions, Idol worship and Vedic rituals can be identified with the Jnana marga, Bhakti marga and the Karma marga respectively that are outlined in the Bhagavad Gita.
The Yoga sutras incorporated the teachings of many other Indian philosophical systems prevalent at the time. In Vyasa's commentary to the Yogasutras, (Yogabhashya) and Vacaspati Misra's subcommentary it is stated that the samadhi techniques are directly borrowed from the Buddhists' (Jhana) with the addition of the mystical and divine interpretations of mental absorption.[27] Karel Werner writes that "Patanjali's system is unthinkable without Buddhism. As far as its terminology goes there is much in the Yoga Sutras that reminds us of Buddhist formulations from the Pāli Canon and even more so from the Sarvāstivāda Abhidharma and from Sautrāntika."[28] Robert Thurman writes that Patañjali was influenced by the success of the Buddhist monastic system to formulate his own matrix for the version of thought he considered orthodox.[29] However, it is also to be noted that the Yoga Sutra, especially the fourth segment of Kaivalya Pada, contains several polemical verses critical of Buddhism, particularly the Vijñānavāda school of Vasubandhu.[30]
The five yamas or the constraints of the Yoga Sutras of Patañjali bear an uncanny resemblance to the five major vows of Jainism, indicating influence of Jainism.[31][32][33] Three other teachings closely associated with Jainism also make an appearance in Yoga: the doctrine of "colors" in karma (lesya); the Telos of isolation (kevala in Jainism and Kaivalyam in Yoga); and the practice of non-violence (ahimsa), though non-violence (ahimsa) made its first appearance in Indian philosophy-cum-religion in the Hindu texts known as the Upanishads [the Chāndogya Upaniṣad, dated to the 8th or 7th century BCE, one of the oldest Upanishads, has the earliest evidence for the use of the word Ahimsa in the sense familiar in Hinduism (a code of conduct). It bars violence against "all creatures" (sarvabhuta) and the practitioner of Ahimsa is said to escape from the cycle of metempsychosis/reincarnation (CU 8.15.1).[34] It also names Ahinsa as one of five essential virtues].[35]
Traditional commentary: Yogabhashya[edit]
The Yogabhashya is a commentary on the Yoga Sutras of Patañjali which has been attributed in the discourse of the tradition to Vyasa. The Yogabhashya states that 'yoga' in the Yoga Sutra has the meaning of 'samadhi'. Shankara in his commentary, the Vivarana, confirms the interpretation of yogah samadhih (YBh. I.1): 'yoga' in Patañjali's sutra has the meaning of 'rest'.[36] The interpretation of the word 'yoga' as union is the result of later, external influences that include the bhakti movement, Vedanta and Kashmiri Sivaism. But "Svaroopa-pratishthaa" (last sutra of last chapter in Patañjali's Yoga-Sutra), i.e., "resting in one's real identity" is the ultimate goal of Yoga, and it can also be expressed as "union with one's real identity, after putting to rest all movements in the mind", because 'Yoga' literally means 'Union'.
Ganganath Jha (1907) rendered a version of the Yoga Sutras with the Yogabhashya attributed to Vyasa into English in its entirety.[37] This version of Jha's also include notes drawn from Vācaspati Miśra's Tattvavaiśāradī amongst other important texts in the Yoga commentarial tradition. Even though Vyasa is credited with the Yogabhashya, many hold its authorship to Vyasa impossible, particularly if Vyasa's immortality is not considered.
Other commentaries[edit]
Countless commentaries on the Yoga Sutras are available today. A popular yoga internet site says " For those who are serious about practicing the profound teachings of the Yoga Sutra, it is recommended to have several translations and commentaries at hand. "[38] A list of 22 Classical commentaries can be found among the listings of essential Yoga texts (mantra.org).[39] This list doesn't include modern, contemporary works.
"Raja Yoga" - a book by Swami Vivekananda provides translation and an in-depth explanation of Yoga Sutra.
Among other recent thinkers and spiritual leaders who have attempted the task, Shri Shailendra Sharma, relying on his own experience as a practitioner of Kriya yoga, translated the Sutras into Hindi and included a commentary on them.[40] Another modern yoga thinker, Ravi Shankar, taught a course in December 1994 on the Yoga Sutras of Patanjali, the substance of which was published as a new commentary.[41]
Non-dharmic contemporary response[edit]
There has recently been considerable debate in non-dharmic contexts regarding the philosophical debt that Yoga owes to the Hindu civilizational milieu that it arose in. Controversy has arisen from the claims by Christian and Muslim religious leaders that the practice of Yoga violates the core tenets of Christianity and Islam owing to its unmistakably Hindu content.[42][43][44][45][46] This was attempted to be overcome by promoting Yoga as divorced from Hindu spirituality, which in turn led to protests from Hindu and Indian groups.[47]
Although Patañjali's work does not cover the many types of Yogic practices that have become prevalent, it forms the basis for the theory of Yoga that underlies all subsequent "schools" of Yoga and their practices. In other words, all later schools of Yoga presuppose Patañjali's work.[48]
The Sutras, with commentaries, have been published by a number of successful teachers of Yoga, as well as by academicians seeking to clarify issues of textual variation. There are also other versions from a variety of sources available on the Internet. The many versions display a wide variation, particularly in translation. The text has not been submitted in its entirety to any rigorous textual analysis, and the contextual meaning of many of the Sanskrit words and phrases remains a matter of some dispute.[49]
See also[edit]
- ^ Taimni's commentary on Patañjali's Yoga Sutras
- ^ Yogatattva Upanishad, translated by K. Narayanasvami Aiyar. YTU 18(b)-19. Now I shall proceed to describe Yoga to you: Yoga is divided into many kinds on account of its actions: (viz.,) Mantra-Yoga, Laya-Yoga, Hatha-Yoga, and Raja-Yoga.
- ^ For an overview of the six orthodox schools, with detail on the grouping of schools, see: Radhakrishnan and Moore, "Contents", and pp. 453-487.
- ^ For a brief overview of the yoga school of philosophy see: Chatterjee and Datta, p. 43.
- ^ Introduction, p. xi, The Yogasūtras of Patañjali on concentration of mind. By Fernando Tola, Carmen Dragonetti, K. Dad Prithipaul. Motilal Banarsidass, 1987.
- ^ Introduction, p. xi, The Yogasūtras of Patañjali on concentration of mind. Motilal Banarsidass, 1987. By Fernando Tola, Carmen Dragonetti, K. Dad Prithipaul
- ^ Williams, R. (1998). Jaina Yoga. Delhi: Motilal Banarsidass. ISBN 978-8120807754.
- ^ Radhakrishnan and Moore attribute the text to the grammarian Patañjali, dating it as 2nd century BCE, during the Maurya Empire (322–185 BCE): see Radhakrishnan and Moore, p. 453. Scholars such as S.N. Dasgupta, (Yoga-As Philosophy and Religion Port Washington: Kennikat Press, 1924) claim this is the same Patañjali who authored the Mahabhasya, a treatise on Sanskrit grammar. For an argument about the philosophical nature of Sanskrit grammarian thought see: Lata, Bidyut (editor); Panini to Patañjali: A Grammatical March. New Delhi, 2004. Against these older views, Axel Michaels disagrees that the work was written by Patañjali, characterizing it instead as a collection of fragments and traditions of texts stemming from the 2nd or 3rd century: see Michaels, p. 267.
- ^ Maas, Philipp A. (2006). Samādhipāda: das erste Kapitel des Pātañjalayogaśāstra zum ersten Mal kritisch ediert. Aachen: Shaker. ISBN 3832249877.
- ^ a b c d e Woods 2003.
- ^ a b c d e Iyengar 2012.
- ^ a b c d e Madhvacarya 2008.
- ^ Radhakrishnan and Moore, p.454
- ^ "The Eight Limbs of Yoga, A Basic Overview". Expressionsofspirit.com. Retrieved 2012-07-29.
- ^ I.K. Taimni, The Science of Yoga: The Yoga-Sutras of Patañjali in Sanskrit , ISBN 978-81-7059-211-2
- ^ p222. A history of Indian philosophy, Volume 1 By Surendranath Dasgupta
- ^ a b c Indian Philosophy Vol 2, Sarvepalli Radhakrishnan. p314
- ^ p236. Classical Sāṃkhya: an interpretation of its history and meaning, By Gerald James Larson
- ^ Reconciling yogas: Haribhadra's collection of views on yoga. By Christopher Chapple, Haribhadrasūri, John Thomas Casey p16
- ^ Yoga sutras of Patañjali Sutra 1.23, from Light on the Yoga Sutras of Pantanjali by B.K.S Iyengar
- ^ Reconciling yogas: Haribhadra's collection of views on yoga. By Christopher Chapple, Haribhadrasūri, John Thomas Casey. p15
- ^ An outline of the religious literature of India. By John Nicol Farquhar. p. 132.
- ^ [1][dead link]
- ^ Zimmer (1951), p. 280.These two are regarded in India as twins, the two aspects of a single discipline. Sāṅkhya provides a basic theoretical exposition of human nature, enumerating and defining its elements, analyzing their manner of co-operation in a state of bondage ("bandha"), and describing their state of disentanglement or separation in release ("mokṣa"), while Yoga treats specifically of the dynamics of the process for the disentanglement, and outlines practical techniques for the gaining of release, or "isolation-integration" ("kaivalya").
- ^ Müller (1899), Chapter 7, "Yoga Philosophy," p. 104.
- ^ "Samkhya: Right Understanding – The Teachings of the Bhagavadgita – Chapter 3". Swami-krishnananda.org. Retrieved 2013-03-16.
- ^ "Bhagavad Gita, Chapter 6: Sankhya-yoga". Asitis.com. 1972-12-12. Retrieved 2013-03-16.
- ^ David, John (1914). The Yoga System of Patanjali with commentary Yogabhashya attributed to Veda Vyasa and Tattva Vaicharadi by Vacaspati Misra. Harvard University Press.
- ^ Karel Werner, The Yogi and the Mystic. Routledge 1994, page 27.
- ^ Robert Thurman, "The Central Philosophy of Tibet. Princeton University Press, 1984, page 34.
- ^ An outline of the religious literature of India, By John Nicol Farquhar p132
- ^ Christopher Chapple (2008) Yoga and the Luminous: Patanjali's Spiritual Path to Freedom New York: SUNY Press, ISBN 978-0-7914-7475-4 p. 110
- ^ Zydenbos, Robert. Jainism Today and Its Future. München: Manya Verlag, (2006) p.66
- ^ A History of Yoga By Vivian Worthington (1982) Routledge ISBN 978-0-7100-9258-8 p. 29
- ^ Tähtinen pp. 2–5; English translation: Schmidt p. 631.
- ^ Christopher Chapple (2008) Yoga and the Luminous: Patañjali's Spiritual Path to Freedom New York: SUNY Press, ISBN 978-0-7914-7475-4
- ^ Sankaracarya; Patañjali; T. S. Rukmani; Vyasa. Yogasutrabhasyavivarana of Sankara: Vivarana Text with English Translation, and Critical Notes along with Text and English Translation of Patañjali's Yogasutras and Vyasabhasya. Munshiram Manoharlal Publishers, 2001. ISBN 978-81-215-0908-4.
- ^ Ganganatha Jha (translator) (1907). The Yoga Darśana: The Sutras of Patañjali with the Bhāṣya of Vyāsa. With notes from Vācaspati Miśra's Tattvavaiśāradī, Vijnana Bhiksu's Yogavartika and Bhoja's Rajamartanda. Rajaram Tukaram Tatya: Bombay Theosophical Publication Fund. Source: [2] (accessed: January 16, 2011)
- ^ "Yoga Meditation". Swamij.com. Retrieved 2013-03-16.
- ^ "Fundamental Texts of Yoga". Mantra.org.in. Retrieved 2013-03-16.
- ^ "English translation". Shailendrasharma.org. Retrieved 2013-03-16.
- ^ "Patanjali Yoga Sutras | Patanjali Yoga | Commentary Sri Sri Ravi Shankar". The Art of Living. Retrieved 2012-07-29.
- ^ Brant, Robin (November 22, 2008). "Malaysia clerics issue yoga fatwa". BBC News.
- ^ "Why yoga is unlawful – Islam web – English". Islam web. Retrieved 2012-07-29.
- ^ "Indonesia's Fatwa Against Yoga". Time. January 29, 2009.
- ^ "Health – Should Christians Do Yoga?". Cbn.com. 2001-02-25. Retrieved 2012-07-29.
- ^ Grossman, Cathy Lynn (September 20, 2010). "Yoga poses dangers to genuine Christian faith: Theologian". USA Today.
- ^ Vitello, Paul (November 27, 2010). "Hindu Group Stirs Debate in Fight for Soul of Yoga". The New York Times.
- ^ For an overview of the scope of earlier commentaries: Complete Commentary by Sankara on the Yoga Sutras: Vivarana Sub-commentary to Vyasabhasya on the Yoga Sutras of Patanjali Tr.fr. Sanskrit, Trevor Leggett, Rev. Ed. Routledge (1990) ISBN 978-0-7103-0277-9.
- ^ Christopher Key Chapple; Reading Patañjali without Vyasa: A Critique of Four Yoga Sutra Passages, Journal of the American Academy of Religion, Vol. 62, No. 1 (Spring, 1994), pp. 85-105.
- Chatterjee, Satischandra; Datta, Dhirendramohan (1984). An Introduction to Indian Philosophy (Eighth Reprint ed.). Calcutta: University of Calcutta. ISBN 978-81-291-1195-1.
- Feuerstein, George (translator) (1989), The Yoga-Sutra of Patañjali: A New Translation and Commentary, Inner Traditions, ISBN 978-0-89281-262-2
- Flood, Gavin (1996). An Introduction to Hinduism. Cambridge: Cambridge University Press. ISBN 978-0-521-43878-0.
- Iyengar, B. K. S. (2002), Light on the Yoga Sutras of Patanjali, HarperCollins UK
- Madhvacarya; Beloved, Michael (2008), Yoga Sutras of Pataņjali, Lulu.com
- Michaels, Axel (2004). Hinduism: Past and Present. Princeton, New Jersey: Princeton University Press. ISBN 978-0-691-08953-9.
- Müeller, Max (1899). Six Systems of Indian Philosophy; Samkhya and Yoga, Naya and Vaiseshika. Calcutta: Susil Gupta (India) Ltd. ISBN 978-0-7661-4296-1. Reprint edition; Originally published under the title of The Six Systems of Indian Philosophy.
- Radhakrishnan, S.; Moore, C. A. (1957). A Source Book in Indian Philosophy. Princeton, New Jersey: Princeton University Press. ISBN 978-0-691-01958-1. Princeton paperback 12th printing, 1989.
- Ranganathan, Shyam (2008). Patañjali's Yoga Sūtra: Translation, Commentary and Introduction. Delhi: Penguin Black Classics. ISBN 978-0-14-310219-9.
- Sharma, Chandradhar (1987). An Critical Survey of Indian Philosophy. Delhi: Motilal Banarsidass. ISBN 978-81-208-0365-7.
- Tubb, Gary A.; Boose, Emery R. (2006). Scholastic Sanskrit: A Manual for Students. New York, New York: Columbia University Press (published 2007). ISBN 978-0-9753734-7-7.
- Woods, James Haughton (translator) (2003), The Yoga Sutras of Patanjali, Courier Dover Publications, ISBN 978-0-486-43200-7
Further reading[edit]
- Bryant, Edwin F. (2009) The Yoga Sutras of Patanjali. New York: North Point Press. ISBN 978-0-86547-736-0
- Govindan, Marshall. Kriya Yoga Sutras of Patanjali and the Siddhas, Babaji's Kriya Yoga and Publications,2000, 2nd edition 2010, ISBN 978-1-895383-12-6
- Iyengar, B.K.S. (1993, 2002). Light on the Yoga Sūtras of Patañjali. Hammersmith, London, UK: Thorsons. ISBN 978-0-00-714516-4
- Master, E. K. The Yoga of Patañjali Kulapathi Book Trust ISBN 978-81-85943-05-3
- Swami Satyandanda Four Chapters on Freedom: Commentary on the Yoga Sutras of Patanjali ISBN 81-85787-18-2
- David Gordon White (2014). The Yoga Sutra of Patanjali: A Biography. Princeton, NJ: Princeton University Press. ISBN 978-0-691-14377-4.
- Wood, Ernest (1951). Practical Yoga, Ancient and Modern. Being a New, Independent Translation of Patañjali's Yoga Aphorisms, Interpreted in the Light of Ancient and Modern Psychological Knowledge and Practical Experience. London, UK: Rider and Company.
External links[edit]
|Wikisource has original text related to this article:
- Four Chapters on Freedom: Commentary on the Yoga Sutras of Patanjali by Sw Satyananda (Bihar School of Yoga)
- Patañjali - Yoga-Sutra: A word by word translation with grammar and comment
- The Yoga Sutras of Patañjali, translation by BonGiovanni, at sacred-texts.com
- The Yoga Sutras of Patañjali: the Book of the Spiritual Man by Patañjali, an interpretation by Charles Johnston, at Project Gutenberg
- The Yoga Sutras of Patañjali by Charles Johnston. Read Online, Flash Version at LibriPass
- Yoga sutra and related yoga texts, at sanskritdocuments.org
- Audio lectures on Yoga Sutras, by Swami Harshananda, at archive.org
- Yoga Sutras Online Program by A. G. Mohan
- Yoga Sutras of Patanjali Internet archive, multiple translations of the Yoga Sutras into English, as well as in 45+ different languages.
- Yoga Sutras of Patañjali : a Buddhist Commentary.


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— It turns out his first spoken word wasn't "mama" or "dada." So when Chandler Whitmer was asked Sunday about when he first dreamed of becoming a Division I starting quarterback, his explanation wasn't entirely surprising.
"My first word was 'ball,' " Whitmer said at the UConn football media session in advance of the season opener Thursday against UMass. "So I've probably dreamed about it since I was just a little guy. That's all I've known my entire life."
Growing up an only child in Georgia, Whitmer started playing football at 7. He started playing quarterback in the sixth grade. In a 2009 ESPNChicago.com article during his senior season at Downers Grove South High in Illinois, Whitmer listed his lofty aspirations in order:
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That's the danger of the Internet.
"Yeah," Whitmer said, laughing. "It's always out there."
UConn fans aren't expecting a national championship or a Heisman Trophy from Whitmer, but let's be blunt. The difference between a 5-7 finish and a bowl appearance last season was a quarterback. That's why UConn last fall went after the juco honorable mention All-American out of Butler Community College in El Dorado, Kan. And that's a major reason why Whitmer, eager to play immediately, accepted the scholarship offer.
After all the uncertainty and consternation at quarterback in 2011, UConn head coach Paul Pasqualoni did everybody, including himself, a favor by announcing before the start of August practice that Whitmer was No. 1.
"It feels good not to have that hanging over my head and just be able to go out and play," Whitmer said. "I think it was good, so we could get the chemistry going."
"I feel good about Chandler," Pasqualoni said. "He is right on top of his game."
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Pasqualoni said the interest in Whitmer was sparked by availability. The coaching staff wanted to get at least one and preferably two quarterbacks in for last spring's semester. They got both. Cochran completed high school early. Get them through spring ball. Get them through the playbook before preseason camp. That's the logic.


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Got these because of the price (value for money) and also because we didn't want a higher thread count. Higher thread count cotton (500+) feels more like satin than cotton, and is also too cold for winter. This is soft, snuggly, and it does get warm quickly. However the fabric is very slightly fuzzy, and as a result it attracts every bit of lint, cat hair and fiber like velcro. We made the mistake of getting it in white, which looks nice at first, but now that all the bits of fuzz from our fleece blanket are sticking to it, it doesn't look so great. If that's an issue in your house, you might want to choose another color. As for it being reversible, the striped side is much nicer than the plain side. By the way, if you use comforter clips on the corners, it keeps your comforter from sliding around inside.
i bought this duvet cover just to cover my down comforter........then to be covered by my new bed 'coverlet'..............however, this is so nice, you could easily use it alone for your bed cover. The color was almost exactly as shown online. It has a bit of a sheen, which is very nice without being glitzy. It isn't wrinkle-free, but almost! It has a nice, comfortable look. I'm very happy. AND YOU CAN'T BEAT THE PRICE........I looked everywhere.
The duvet arrived before the scheduled date, which was nice. When I pulled the duvet out, it was very soft and Ilighter than I thought it would be.. I washed it per instructions, put my comforter in and then on the bed it went. I had it for two days when I noticed a rip in the fabric. The fabric is very cheap. I am very dissapointed in this product.
My husband wakes up every morning and tells me how comfortable our bed is! This duvet cover is very soft and is nice looking and added the extra 'comfy' to our bed. I have washed a few times and the fabric has held up very well. I will be purchasing another. I am very pleased with this purchase.
I bought the green set and it was great. I then decided to get a dark red for winter but this one was out and I got another duvet that was not wrinkle resistant. It grabbed feathers, dog hair and lint. The color was great but when washed it tore. I bought another duvet from this wrinkle resistant in brown. It rocks-no more lint ect. The color is rich. Lesson learned.
I did a lot of comparison shopping and I am glad I decided on this set. I ordered a king comforter and the size I got fits perfectly in this duvet. Having a duvet is a first for me, as I have always had a regular floral type comforter. I like that I can keep the same comforter and change looks with the duvet. The white set looks very clean and inviting...like luxury hotel quailty. I definitely did not want one that would wrinkle.......way too much work to iron one.....this looks great...no wrinkles and there are a lot of buttons on the duvet to keep it in place. Very happy with this purchase.
Great sheets. I bought them for a guest room and have received nice comments.
I spent about a 100 dollars on my goose-down comforter and thought it was absurd to spend nearly the same amount for something that covers it! I looked everywhere, and even the other products on overstock aren't as good a deal as this one. some of the people reviewing said it seems "cheap," but I disagree. Very cozy and soft, and if I needed another I would definitely buy it again.
Duvet cover and pillow shams are a bit thin, but they did exit the dryer looking pretty good. For the price, they do the job in protecting my "dry clean only" duvet cover, but they are not an eye-catching decorative addition to my room.
Just received this Duvet set and I'm very happy with it. It looks so great on the bed. I ordered the brown and it's a really beautiful brown. The material is really nice quality and soft. Very happy with this purchase.
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List Price: $5.99Publisher: Rourke Educational MediaBinding: Children's Board Books Pages: 10Size: 5.25" wide x 5.25" long x 0.75" tall Weight: 0.396Language: English
Charles Reasoner lives in Woodinville, Washington with his wife and four children. He has written several children's books including Number Munch!, Color Crunch!, and the popular and successful Sliding Surprise series.
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