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I. Methods of Midwifery

When pregnancy reaches full term, delivery occurs naturally, like a ripe melon falling from the vine. Childbirth is originally an ordinary event; as long as the midwifery methods are appropriate, mother and child will naturally be safe. Cases that develop into dystocia (difficult labor), or injure the mother or the child, are all due to not observing prenatal education in daily life, or being flustered at the time of delivery. The key point of midwifery lies in ensuring that mother and child pass through safely during labor. The methods must be thoroughly mastered, the temperament should be patient, and the actions should be agile. Patience prevents urging the pregnant woman to act too early, while agility ensures that postpartum care for mother and child is simple, rapid, and appropriate. The steps are described below:

First, labor should proceed slowly. When a pregnant woman experiences abdominal pain at full term, it may sometimes be false labor pains (Braxton Hicks contractions) and not the true time of delivery. True labor requires both abdominal pain and lower back pain to occur simultaneously. Furthermore, when the intensity increases, with each contraction becoming tighter than the previous one, this is the time when birth is imminent. Therefore, when the pregnant woman has abdominal pain, the midwife should only offer comfort and not intervene physically. Wait until the lower back pain becomes rhythmic and the amniotic sac ruptures, then wait patiently for the baby to descend. Only when the fetal vertex is slightly visible should the head be supported and gently guided down, allowing for a smooth delivery. Forcing the parturient to exert effort too early, or intervening too soon, can lead to malpresentation (abnormal fetal position), injuring the fetus.

Second, endurance is needed during labor. The parturient should endure abdominal pain; the more she can tolerate the pain, the easier the delivery. It is most taboo to fear pain and curl up in bed, as this causes stagnation of Qi and blood, hindering fetal rotation and making delivery difficult.

Third, quietness is required during labor. In the delivery room, two experienced midwives are sufficient for observation. Relatives visiting or family members gathering should be strictly avoided, as this leads to stale air and noisy environments, disturbing the parturient's mind. It is best to let the parturient endure pain, take a slight walk to promote the free flow of Qi and blood, or walk with support, or lie on her back for a moment to nourish the spirit and conserve energy. Thus, fetal delivery will encounter no difficulties.

II. Care Immediately After Birth

The first thing to note at the time of birth is the temperature of the room. In summer, although windows should not be fully opened, air circulation should be maintained to prevent stuffiness. In winter, the room should be kept warm to avoid exposure to cold drafts (overheating with coal stoves and carbon monoxide accumulation are also highly inadvisable). Generally, a warmer room is preferable because the fetus in the womb is warmer than the outside environment. For example, a baby born in summer should initially be wrapped in a single-layered cotton skirt; after bathing, change into single-layered clothing. A baby born in winter should be quickly wrapped in thick cotton before other procedures. These are the initial measures upon birth.

Care after birth involves several aspects, all requiring cautious and agile handling to avoid injury to the infant and potential complications.

First, bathing. After birth, if there are two midwives, one attends to the mother and the other to the infant. If there is only one, wrap the infant simply and set aside. After attending to the mother (which takes only a few minutes), prepare boiled water with a small amount of Boric Acid (Borax solution), mix well, and use it for bathing once the temperature is suitable (warmer water is better, but not too cold). Use clean medicinal cotton to wash the body gently; the procedure should be quick. After bathing, dry the moisture with a clean towel, then cut the umbilical cord using sterilized scissors. Some do not bathe immediately but cut the cord first; this is done either due to extreme cold or lack of time. In such cases, bathing can be delayed until the third day with heating. Bathing water may consist of decoctions of young branches of Mulberry, Locust Tree, Elm, Peach, and Willow (3-5 cun pieces, dozens of segments), mixed with a little Pig Bile (Suizhudan) for its cooling and detoxifying properties. After bathing, Talcum Powder (Huashi), Licorice Root (Gancao) powder, or Pine Pollen (Songhua) may be dusted to prevent the delicate skin from irritation due to moisture.

Second, umbilical cord management. If the infant is not bathed, fine; if bathing is necessary, the cord must be cut *after* bathing, never before. Cutting before bathing exposes the stump to water, dampness, wind, and cold, leading to disease. To manage the cord: hold the segment of the umbilical cord near the placenta with one hand, and squeeze the cord several times with the other hand to ensure placental blood flows into the umbilical vein. Then, grasp the cord about 6-7 cun away from the navel, tie it tightly with silk thread, and quickly cut it with sterilized scissors. Apply soft Alum (Kufan) powder, wrap with cloth, and sprinkle more Alum on the navel itself. Coil the remaining cord stump onto the navel, cover with gauze, and bind securely around the back. Monitor until dry. The cord usually falls off in 3-5 days (do not pull if not completely detached). At this stage, the navel is tender; wrap with soft cloth and cotton for a few days. Internally, one may apply ash from roasted coarse paper (to remove fire toxicity), fine Alum powder, or Pine Pollen. Constant monitoring is required to prevent dampness and injury, avoiding conditions such as Neonatal Tetanus (Qifeng) or Umbilical Ulceration (Qilan).

Third, squeezing milk. Newborns, regardless of gender, often have swollen breasts ("witch's milk"). The midwife should squeeze each nipple slightly during bathing to expel some milk, resolving the swelling and hardness.

Fourth, dressing. Infant clothing should be made of clean, old linen/cotton, without borders, featuring frayed edges ("wool clothes"), as they are soft and do not irritate the skin. Dressing must be done carefully to avoid injuring bones and tendons, and promptly to prevent chilling.

Fifth, cleaning the mouth. At birth, the infant may contain toxic fluids or blood clots in the mouth. The midwife should use agile techniques to remove these while the head is still emerging and before crying begins. Once crying starts, the fluid is swallowed, making removal impossible. Swallowing these toxins harms the gastrointestinal tract and causes oral diseases. Since immediate removal is often missed, wiping the mouth is necessary after dressing. Commonly, decoctions of Licorice Root (Gancao) and Honeysuckle Flower (Yinhua) are used with cotton to wipe the oral cavity. For severe heat-toxin, Coptis Decoction (Huanglian Tang) is used. Minor swallowing is acceptable. Subsequently, wipe every 3-4 hours using Boric Acid solution or Rhubarb Decoction (Dahuang Tang). Eyes must also be washed. Initially, 1-2 drops of dilute Silver Nitrate (Xiao Suansinyin) may be instilled. Thereafter, wipe the corners of the eyes and eyelids frequently with Boric Acid solution. Fluids and membranes from the birth canal entering the eyes can be toxic; attention is crucial to prevent ophthalmia and future eye diseases.

The above five points constitute the standard care for newborns. Special care for neonatal emergencies will be discussed in subsequent sections to guide immediate action.