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The causes of difficult labor during pregnancy are various. In some cases, one month before the expected delivery date, sudden severe abdominal pain occurs, resembling labor but failing to deliver; this is called "Shi Yue" (Trial Month). In other cases, abdominal pain occurs near the due date, intermittent in nature, lasting for one or two days, or three or four days; this is called "Nong Tai" (Playing Fetus). In some instances, amniotic fluid leaks out in small amounts, known as "Shi Shui" (Trial Water); although there is umbilical abdominal pain, there is no lower back pain, and these are not signs of imminent delivery. If abdominal pain radiates to the lower back, it indicates that delivery is imminent.

Below the lower abdomen and above the vaginal opening of a woman, there is a prominent bone structure with joint connections. It remains closed before delivery and separates upon the onset of labor; this is referred to as "Jiao Gu" (Crossing Bone).

In cases of transverse presentation, where an arm emerges first, it is because the fetus has shifted to one side within the maternal womb, and the tendons have not yet turned correctly, causing internal obstruction that prevents smooth descent. In cases of breech presentation, where both feet emerge first, it is necessarily due to a narrow space in the maternal fatty membranes, preventing the fetus from turning and causing it to descend directly. These conditions often result from physical exertion, strain, or injury that damages the fetus, causing the fetus to press against the heart and fail to descend. In such scenarios, the fetal hands will likely clutch the mother's heart area, often leading to the death of both mother and child. Medication must be administered to reach the Heart meridian to relax the fetal hands, allowing for delivery. This is because the fetal grip is strongest when holding objects; once the medicinal qi arrives, the fetal hands naturally soften and release.

When a fetus dies in the womb, the abdomen is typically distended with pain accompanied by coldness, with no fetal movement perceived. The complexion appears sallow like earth, and the tongue turns black. Therefore, diagnostic tests state: if the face is black but the tongue is not, the mother is dead and the fetus is alive; if the tongue is black but the face is not, the mother is alive and the fetus is dead. This refers to the aforementioned principle.

In some cases, before the actual time of confinement, slight abdominal pain may occur while the amniotic sac remains intact, leading to premature expulsion; this is fortunately rare. However, if the amniotic fluid leaks out completely and lochia is exhausted, the fetus cannot be born. If no method is employed to assist delivery, both mother and child cannot be preserved.

If the placenta fails to expel after delivery, it should not be regarded as a minor issue and ignored. There are many cases where the retained placenta ascends to the heart, leading to death.

There is also a condition called "Pan Chang Sheng" (Intestine Protrusion at Birth), where the maternal intestines prolapse first during labor, followed by the birth of the infant.

The verse states: The pulse of a woman about to give birth deviates from the regular pattern (Li Jing Mai / Departed Pulse); a deep, fine, and slippery pulse is also associated with this stage. Pain felt at midnight suggests imminent separation and birth; by noon the next day, birth is certain. Additionally, pulses that are irregular in size or rhythm, resembling the Sparrow Pecking or House Leaking pulses, accompanied by lower back pain, abdominal pain, and visual disturbances, indicate that delivery is imminent and are not pathological conditions.