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When pregnancy nears the time of delivery, as soon as there is a sensation of movement within the abdomen, one should lie supine with the body straightened, waiting for the fetus to turn downward and for contractions to begin. At this point, gently pinch the middle phalanx (middle joint) of the parturient's middle finger; if pulsation is felt at this segment, it indicates that labor has commenced and birth is imminent. If one does not lie supine initially to wait for fetal repositioning, or if amniotic fluid flows frequently before delivery, this indicates that the membranes have ruptured prematurely. The blood and fluids may dry up first, leading to inevitable complications such as malpresentation and dystocia.

In cases of transverse presentation (Heng Sheng), where the fetus's arm presents first, instruct the mother to lie supine and straighten her body. Gently push the fetus's arm and body to correct the position. Then, massage the shoulder with the middle finger, ensuring the umbilical cord does not entangle the shoulder, so that the infant can be born.

In cases of breech presentation (Ni Sheng), where the feet present first, instruct the mother to lie supine and straighten her body. Press and push the feet to guide the fetus into a cephalic position, after which birth will proceed smoothly.

In cases of lateral presentation (Pian Sheng), where the fetal head is tilted to one side, follow the previous method: slowly push the head back to the center, and birth will occur.

If the occiput is seen deviating towards the anus, gently push it upward and toward the midline, and birth will occur.

In cases of obstructed labor (Ai Chan), where the head is centered but cannot descend, this is often due to the umbilical cord wrapping around the shoulders during fetal rotation. Use the middle finger to press on both shoulders of the fetus to release the cord from entanglement, allowing birth to proceed.

In cases of "sitting birth" (Zuo Chan), where the mother is exhausted and sits for a long time on chairs or cushions, blocking the birth canal, urgently hang towels or belts high up. Instruct the mother to hold onto them and flex her legs gently for an extended period; once the fetus aligns properly, birth will occur.

In cases of prolapsed rectum accompanying delivery (Pan Chang Sheng), where the intestine protrudes before the baby, it is difficult to retract. Take 49 seeds of Ricinus communis (Bixiazi, Castor Bean Seed), grind them into a paste, and apply to the vertex of the parturient's head. Once the intestine retracts, wash it off immediately. If wind dries the tissue preventing retraction, use a small amount of warm water used for sharpening knives to moisten the intestine, then administer a decoction of Magnetitum (Cishi, Magnetite) orally to facilitate retraction. Ensure the Magnetitum used has been verified by Fengshui practitioners for efficacy. Folk remedies using Sargassum (Shuimu Mian, Sea Grape) cause alarm, which may scatter Qi and lead to other pathologies; thus, this practice should be avoided.

If the membranes rupture but delivery fails to commence, administer Baosheng Wuyou San (Preserve Life and Ensure Safety Powder) to consolidate blood and promote natural delivery. If blood depletion has occurred, use one jin (approx. 500g) of Bazhen Tang (Eight Treasures Decoction) combined with half a jin of Leonurus japonicus (Yimucao, Motherwort Herb). Add several bowls of water, boil until cooked, and drink intermittently; survival is possible.

Generally, abdominal pain alone in pregnant women indicates pre-labor. Severe lower back pain accompanying abdominal pain indicates impending labor, as the Kidneys govern the lower back and the uterus is connected to the Kidneys.

Hua Tuo treated dystocia caused by transverse or breech presentations using two pieces of Ophichthus skin shed (Shetuo, Snake Slough), 28 cicada shells (Chanqiao, Cicada Slough), and two丸 (pills) of fetal hair (Taifa, Fetal Hair). Each was calcined to ash. Two qian (approx. 7.5g) were taken per dose, mixed with wine. After two doses, the patient rested briefly, and the infant was delivered normally. If these herbs are unavailable, instruct the parturient to lie supine and straighten her body. Prick the palms of the hands and soles of the feet of the fetus three to five times with a small needle, apply salt, and the limbs will retract. Wait for the body to rotate into a normal position for delivery. Alternatively, take 49 seeds of Malva verticillata (Shuhui Zi, Musk Mallow Seed) and three qian (approx. 11.25g) of Talcum (Huashi, Talc) with flowing water, decoct, and drink to facilitate normal delivery. Or, consume thickly ground Jingmo (Beijing Ink); the ink coating the fetus aids expulsion. Alternatively, use one old brush tip, processed, and take with natural juice of Nelumbo nucifera petiole (Oujie, Lotus Stem Node) and warm wine. Or, take three qian each of Perilla frutescens leaf (Zisu Ye, Perilla Leaf) and Angelica sinensis root (Danggui, Chinese Angelica Root), decoct with flowing water, and drink to expel the fetus.

Families of pregnant women should pre-engage a midwife (Wopo, Confinement Nurse) who possesses benevolence and insight. Show kindness to win her loyalty. Inform her beforehand: if delivery is difficult, claim labor has not started; if twins are involved, claim the placenta has not yet expelled. This prevents alarm, which scatters Qi and worsens delivery. My family has personally verified that dystocia often occurs in wealthy families who live in depression and ease. Although treatment principles state that Qi should be regulated before birth and Blood nourished after, one must not adhere rigidly to this. If the Spleen and Stomach are weak and Qi and Blood are insufficient, preventive tonification is necessary; otherwise, difficulties will arise during labor.

In cases of dystocia or extreme cold, urgently use a large oil-paper wick to slowly burn through the umbilical cord. Even if the infant is dead, warmth entering the abdomen can often revive the child. Do not cut the cord with a knife.

Case Record:
My wife experienced difficult labor in early winter. The child was stillborn, and her vital Qi was severely damaged. I used an oil-paper wick to burn the umbilical cord, borrowing its Yang Qi to supplement her. Shortly after, the infant cried, reviving him. Had I cut the cord with a knife as usual, my wife might not have survived. This child showed no symptoms of food stagnation or diarrhea in his first one or two years, demonstrating the efficacy of this method. The midwife, pleased by my past small favors, contributed her expertise and comforted the mother, ensuring safety.

The midwife also recounted: A woman gave birth while an Inspector General was passing by and summoned me. Upon examining the room, I found the woman had been frightened by the event and died before delivering. Later, when I reported to the Inspector, he sternly ordered me to act. Upon examination, the fetal position was normal, but the head was tilted. I could have manually corrected it to ensure safe delivery, but fearing his authority, I dared not intervene. I merely reported that this was destiny, beyond human control, and waited for the mother and child to die.