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During labor, it is most taboo to exert force too early. The *Mai Jue* (Pulse Classic) states: "If pain is felt at midnight, delivery will surely occur by noon the next day." From this, it can be seen that delivery should occur half a day after the onset of abdominal pain. However, the difficulty of childbirth varies from person to person and time to time; some are naturally easy to deliver, others difficult; some have difficulty first then ease, others ease first then difficulty; there is no fixed rule. If during labor there is abdominal pain but no delivery, it is not dystocia (difficult childbirth), but rather the fetus has not yet exited the womb. The mother must not be afraid; even if it takes one or two days to three or five days, there is no harm. One should calm the mind and spirit, follow nature's course, endure the pain, eat and drink, sit when desired, walk when desired, sleep when desired, with preserving spiritual energy as the top priority. Do not listen to midwives urging premature exertion of force, do not seek to hasten the separation from the body yourself, and bystanders should not speak fearfully to disturb her mind. When the time comes, delivery will happen naturally. It is like using the toilet: if not urgent, it is difficult; when urgent, it is easy. Though this logic is common, knowing it prevents disaster.

Midwives' pressure generally falls into two categories: those who urge without knowing the proper timing, and those eager to finish one case to go to another, both of which can severely delay matters.

In some cases, before the proper time, the fetus attempts to exit the birth canal. If it turns to the hand and the mother exerts force, the hand may emerge first; if it turns to the foot and the mother exerts force, the foot may emerge first. Breech presentation (Heng Sheng / Dao Sheng) results from incorrect exertion of force. In reality, hands or feet should not emerge first. Therefore, if there is abdominal pain for several days without delivery, one should not panic. Nowadays, people see no delivery after half a day and claim it is dystocia, causing panic among family members who pray and make vows. Seeing this, the mother becomes anxious and fearful. Once anxiety arises, courage and energy diminish, eating becomes difficult. Not understanding that this is not dystocia but merely untimely, one should only endure pain and wait. If pitying her severe pain and wishing for immediate delivery, midwives and others forcing her to push before the time is ripe risks the lives of both mother and child. Why is reason ignored to such an extent? At this time, the midwife should judge by intuition, and the mother should assess carefully. Do not easily urge pushing. Only when umbilical abdominal pain is extreme, lower back heavy pain occurs, eyes feel fiery, anus feels urgent, amniotic fluid or blood descends, pulse shows Li Jing (Departed from Normal) characteristics, or is deep, fine, and slippery, indicating the fetus has exited the womb, should the mother exert effort, so as not to cause error. If several hours pass without progress, do not act rashly out of impatience, lest spiritual energy fatigue prematurely, leaving no strength for delivery and resulting in postpartum deficiency. Thus, near delivery, decoct Ren Shen Tang (Ginseng Decoction) strongly and drink frequently to tonify and support Yuan Qi (Original Qi).

Another issue is premature exertion of force causing the amniotic sac (Shui Yi) to rupture early. Exposure to wind causes the vulva to swell, become dry, narrow, and small, leading to difficult labor. Merely waiting a few more hours calmly is harmless. Also guard against ignorant midwives who maliciously puncture the amniotic sac with fingers.

Near delivery, bending the body while lying down is strictly forbidden. Even with severe pain, one should stand and walk around the room, or avoid standing continuously. Strictly avoid hunching the waist, as this aids the fetus in turning and finding the path. Mothers fearing pain refuse to straighten up, preferring to lie curled. This impedes fetal movement. When the fetus reaches the cervix, the mother's curled waist blocks it. Repeated turning and blocking exhausts the fetus, making it unable to move, leading to dystocia. Observers seeing immobility assume fetal death, but it is actually weakness, not death. At this stage, even good prescriptions cannot give the fetus strength. The key is to tonify the mother's Yuan Qi, calm the mind, harmonize Qi, and regulate spirit. Once fetal vitality recovers, safety is assured. Sometimes amniotic fluid breaks, but the fetus stops moving for one to three days. Besides regulating Qi and Blood, avoid fright, worry, and rage. Fright scatters Shen (Spirit); worry knots Qi; rage disrupts Qi flow, causing erratic Blood movement and fainting. Understanding this allows proper regulation and ensures safety.

Near delivery, eating is essential, and noise must be avoided. Eating fills Qi and strengthens courage, preventing weakness from hunger/thirst. Avoiding noise calms Shen, preventing irritability. Stillness preserves Shen; agitation dissipates it. Food should preferably be rice congee made with hen broth. Chicken meat and other meats should be avoided. Slight hunger is best because hunger directs Qi downward, speeding delivery. Meat obstructs the Upper Jiao, preventing Qi descent, causing difficult labor. Postpartum, overeating should also be avoided to prevent disease.

If labor pains are in the abdomen but not the lower back, delivery is not imminent. Support the mother to walk upright. If she cannot walk, lean on something. Delivery has its own time, like a ripe fruit falling or a melon detaching. Do not rush, or harm may result. Loosen the skirt belt slightly during pain to give the fetus room to turn comfortably in the abdomen.

During labor, individuals involved in mourning, pollution, nuns, widows, or unclean persons must not enter the room, as this hinders delivery. Only experienced, sensible women who have given birth themselves, two or three in number, are sufficient. Superstition suggests fewer people aid delivery; each extra person delays the process. This should also be avoided.

Food is fundamental during labor. Some women cannot eat, leading to weak Jing Qi (Essence Qi) and inability to push. Before labor, purchase 4-5 qian of Ren Shen (Ginseng Radix et Rhizoma). For extreme deficiency or history of syncope during labor, use 1-2 liang. Near delivery, decoct one cup and keep ready. When it is clear the baby is coming, take this to greatly boost energy, far surpassing meat. Postpartum, do not administer Ren Shen indiscriminately. If truly deficient, combine with warming herbs like Hei Gan Jiang (Blackened Ginger Rhizome). A formula for postpartum uses 5 qian Ren Shen and 2 qian Dang Gui (Angelicae Sinensis Radix), decocted, mixed with Tong Bian (Boy's Urine), taken immediately after delivery. It tonifies all deficiencies and treats postpartum ailments. (Zhang) often uses this for extreme deficiency, restoring postpartum vitality to pre-pregnancy levels.

Postpartum, gradually introduce corn silk drink, as husk Qi can descend deficient fire. White rice porridge should be very thin, adjusted gradually. For three days, avoid meat, eggs, and sticky/hard foods. After six or seven days, if stomach strength returns, small amounts of hen, beef, or crucian carp clear soup may be given.

Emergency rescue methods near delivery: Hand-first presentation is called Heng Sheng (Transverse); foot-first is Dao Sheng (Breech). Tradition calls hand-first "Mi Yan Sheng" (Seeking Salt Birth). Salt has astringent properties. Salting meat causes pain and contraction. If the baby's hand contacts salt, pain and contraction cause it to turn and descend naturally. Treatment for hand/foot first: Lay mother supine. Apply salt to baby's palm/plantar surfaces, then sesame oil. Gently push back. The baby usually turns spontaneously. Do not leave limbs exposed long, as they may turn cyanotic and injure the baby, making reinsertion hard. Do not blindly use催产 drugs, as limb presentation is not treatable by medicine alone. Do not listen to wicked advice to amputate limbs; this causes fetal chaos and maternal injury. Dead fetuses often deliver slowly without force, sparing the mother. Why? The womb is hot; food digests internally. Even dead, if the mother is calm and eats, internal heat softens/decomposes the fetus, allowing safe expulsion despite foul odor. Thus, no force needed for dead fetuses, let alone live ones. Ignorant midwives often force delivery, killing both. This is earnestly warned. Abnormal fetuses may also deliver naturally if the mother is not panicked, provided she doesn't know. In critical moments, check face and tongue: Face reflects mother, tongue reflects fetus. Cyan face = mother injured; cyan tongue = fetus injured. Red face/cyan tongue = dead fetus/living mother. Red face/tongue = both safe. Cyan face/tongue with foaming = both endangered. (Zhang secret formula for dystocia/dead fetus/opened pelvis: Guang Hou Xue (Macaca Monkey Blood), approx. 1 qian, dissolved in wine, taken orally, induces immediate delivery.)

Manual rescue techniques: If cervix is open and head is visible but stuck, likely due to cord around shoulder (Ai Chan). Lay mother supine, gently push fetus up, press shoulder with middle finger to free cord, align fetus, then push. If birth canal misaligned due to early pushing, fetus leans against leg sides, head stuck. What appears as a crown is actually the forehead (Pian Chan). Lay supine, push up, align forehead with hand, then push. If occiput presses against anus (HT Hou), wrap hand in cotton, push head from side of anus to align, then push, or use knee to support mother. These difficulties stem from curled posture and early pushing. Only experienced midwives should attempt these maneuvers.

When baby emerges, hold mother's chest with both hands; mother holds abdomen tightly to help placenta descend. If placenta is delayed, do not panic. Smoke dried grass paper near nose to induce expulsion. If further delayed, cut cord quickly, wash baby, tie cord securely with soft cloth, then cut. Cord is brittle; improper cutting risks blood reflux into uterus, causing distension and heart attack. Skilled midwives can manually remove placenta easily. For retained placenta, apply warm black cow dung wrapped in cloth to abdomen to expel it.

For newborn asphyxia (Hui Yin Men Qi Sheng), tradition says calling father's name or patting buttocks helps. Reason: a membrane blocks air passage. Patting breaks it, allowing cry. If ineffective, use a woman with light touch to pierce gently with silver hairpin. Alternatively, wrap warmly, immerse placenta in hot water (add heat in winter). Internal heat buildup breaks membrane, restoring breathing.

For prolapsed intestine (Pan Chang Sheng), where intestine protrudes before delivery: Use clean basin with warm water (hot in winter), add sesame oil for lubrication. Wait for baby and placenta to deliver. Mother inhales upward. Midwife applies oil to hands, gently retracts intestine. Spraying vinegar water to startle/retract is dangerous and should be avoided. Prolapsed bladder (Niao Bao) after delivery treated similarly. Caused by early pushing disturbing internal organs. Take organ-stabilizing tonics after reduction.

Xue Lizhai stated: When feeling uterine movement, lie supine upright. Wait for fetus to turn down. Pain begins. Pinch middle phalanx of middle finger; if pulsation occurs at proximal interphalangeal joint, labor is imminent. Frequent water leakage before labor indicates ruptured membranes, drying blood/fluid, risking malpresentation. If membranes rupture but no delivery, use Bao Sheng Wu You San to secure blood. If blood depleted, Ba Zhen Tang plus Yi Mu Cao (Leonurus Herba) strong decoction, drink frequently. Abdominal pain only = not labor. Lower back pain included = impending labor. Kidney governs waist, uterus connects to kidney. For irregular pregnancy, tell midwife "not yet in labor." For twins, mention "placenta," avoiding shock which scatters Qi. Dystocia often stems from depression. Wealthy/easy-living families need care. While theory says regulate Qi prenatally and tonify Blood postnatally, do not rigidly adhere. If Spleen/Stomach weak, Qi/Blood insufficient, pre-adjustment is needed.

"Dong Chan" (Cold Labor): Winter cold coagulates menstrual blood, hindering descent. Most harmful. In winter, keep lower body warm with wool, avoid cold surfaces. Keep room warm with stoves. Mother faces fire, keeping lower abdomen, legs, knees warm. Heat moves blood, aiding delivery.

"Re Chan" (Hot Labor): Summer mothers need moderate warmth/coolness. Too cold increases illness. Too many people create stifling heat, causing心烦 (Vexation), boiling Blood, leading to Yu Mao (Depression/Fainting) symptoms.