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When a woman is about to give birth, one must let nature take its course and avoid inducing labor. Her mind should be calmed to prevent panic. One should wait until the melon is ripe and the stem detaches naturally; the baby will then deliver itself. Therefore, when employing a midwife (Wenpo), one must select an experienced, loyal, and honest person, instructing them in advance. Upon delivery, they must ensure the mother remains calm and composed, without using methods to force labor. I have seen midwives who are hurried and impatient, fearing they might miss something, forcing the use of decoctions, pinching, or coercing the fetus downward. This often results in the head and body not being aligned while hands or feet emerge first, either transversely or breech, causing significant harm. Thus, before strong contractions begin, movement should be avoided; remember to remain still. I have also encountered deceitful women who intentionally moan or exaggerate symptoms to display their ability and seek higher rewards, causing the mother anxiety and fear, which causes even greater harm. This must be handled with extreme caution.

A pregnant woman nearing delivery should not consult fortune-tellers or spirits. If charlatans like shamans frighten her for profit, making false predictions of good or bad luck, the mother will become filled with doubt and fear. This leads to stagnation of Qi and Blood, often resulting in difficult labor, which should be strictly avoided.

During the sixth or seventh month, or eighth or ninth month of pregnancy, if the woman bends slightly, the fetus may move restlessly. Pain may come and go over two or three days, or amniotic fluid may leak, but with little lower back pain. The fetus has not left its meridian path; this is called "Playing Labor" (Nongchan). Another condition occurs one month before delivery, where sudden lower back pain appears but no delivery happens; this is called "Turning Bladder" (Zhuanbao) or "Trial Month" (Shiyue). Whether amniotic fluid is present or not does not matter; the woman should simply sit, lie, walk, or stand upright, and everything will resolve naturally. If she reaches high to fetch something and feels fetal kicks suddenly, she should just bend forward, and peace will return shortly.

Labor pains lasting two to three days, or five to seven days, are originally not true labor. They result from premature agitation, with the fetus still within the sac, so it is not difficult labor. Allow the woman to sit or lie as she wishes. Do not support her sitting up or urge her to exert effort, which would cause worry and depletion of Qi. Instead, encourage diet and nourish her with herbal tonics.

There are seven signs of impending delivery: urgent pain in the umbilical and abdominal area; heavy dragging sensation in the waist; feeling of fire in the eyes; urgency in the anus; swelling and fullness of the vaginal opening; pulsation of the tendons in the middle finger; and simultaneous discharge of amniotic fluid or blood. Only when these signs appear, indicating the fetus is leaving the sac, can effort be applied. If these symptoms are not fully present, even after one or two days, do not allow her to strain. If amniotic fluid has discharged and the fetal head is at the vaginal opening but delivery does not occur after three or four days, it is because the mother's Qi has weakened. At this time, Ginseng (Renshen) is the specific remedy. For those unable to tolerate large doses, use a large dose of Bazhen Tang (Eight-Treasure Decoction) to tonify primordial Qi and regulate diet; delivery will occur naturally when the time is right.

Reduced appetite during labor is most concerning. Immediately administer Dushen Tang (Single Ginseng Decoction) regularly to prevent exhaustion of energy. If the pubic symphysis (Jiaogu) fails to open due to Qi deficiency failing to transport, use Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) to assist natural opening; Jiawei Guixiong Tang (Modified Angelica and Ligusticum Decoction) is also effective.

Premature agitation during labor may cause bleeding before the fetus dries out and dies in the womb. There is no need for panic. Let the mother lie steadily on the bed. Do not force straining, as this only damages Shen (Spirit) and Qi. Encourage food intake to prevent Qi deficiency. I have treated many such cases, achieving ten cures out of ten. Use Tuohua Jian (Decoction for Delivering the Fetus) with 1.5–2.5g of Mangxiao (Mirabilite), decocted in water and taken hot. The dead fetus will liquefy and pass. Ancient formulas used Pingwei San (Calm the Stomach Powder) with Mangxiao to expel dead fetuses and placenta. While fast, it causes hidden damage. I have seen several patients whose placentas were expelled but who died within one or two years. Pingwei San attacks Stomach Qi, and Mangxiao is salty and cold, damaging Blood, thus harming the Zang-Fu organs secretly. Now, using Tuohua Jian is easier; its herbs are sweet and warm. Danggui (Angelica Sinensis) and Chuanxiong (Ligusticum) generate and invigorate Blood, Rougui (Cinnamon Bark) warms Blood, and adding 0.5–1g of Fuzi (Prepared Aconite Root) neutralizes the coldness of Mangxiao. Such matters require extensive clinical experience to understand the pitfalls. I once treated a twenty-four-year-old primipara who failed to deliver due to haste and improper technique. By the time I arrived, the fetus had died. Asking if there was movement in the abdomen, she said no, and the lower abdomen felt cold. Knowing the fetus was certainly dead, I wanted to use the previous prescription but worried that as a primipara, her birth canal was not yet relaxed. After consulting with the family, who agreed to follow my advice, I prescribed Shiquan Dabu Tang with doubled Renshen and Rougui. This serves two purposes: supporting the mother's energy and warming the Lower Yuan (Lower Origin), allowing the fetus to decompose naturally for safe delivery. The family agreed. After one dose, the abdomen felt warm, with no pain or urgency. I noted that while we feared abdominal pain and bearing-down sensations, their absence allowed her to endure. Fortunately, she was young and strong with healthy Spleen and Stomach, eating three bowls of rice and half a fat chicken daily. Seeing her robust Middle Jiao (Middle Burner), I continued this regimen. On the fifth day, the dead fetus passed naturally, foul-smelling and decomposed. The mother’s spirit remained unchanged, with no injury. This shows that even a dead fetus can be delivered safely if done calmly; how much more so a live fetus! Yet people refuse to remain quiet and insist on forcing things. What can be done?

When the fetus attempts to exit but turns slowly, maternal effort may cause hands, feet, transverse, or breech presentations. If the birth path is obstructed by the fetal head pressing against the lateral thighs, it is called "Pianchan" (Oblique Labor). If the head presses against the anus, it is called "Chenghou". If the midwife is skilled, no medicine is needed. If the midwife is incompetent, quickly help the mother lie supine on the bed, cover her with thick blankets, and have an experienced midwife gently push upward. Administer Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) internally to lift. Once lifted, reposition the fetus so the head aligns with the vaginal opening, and delivery will proceed quickly.

If the cervix is open and the fetal head is visible but not descending, it is likely the umbilical cord is entangled around the shoulders. Help the mother lie supine, gently push the fetus upward, press the shoulder lightly with fingers to release the cord, then assist delivery.

Delayed passage of the placenta indicates Qi deficiency; urgently administer Tuohua Jian. If blood enters the placenta causing distension and pain, add Mangxiao to Tuohua Jian to expel it. A skilled midwife may insert a hand along the umbilical cord, use the middle finger to push the placenta, and gently cover any blood inside, waiting patiently for expulsion. This is a good method.

Excessive early effort may rupture membranes prematurely. Exposure to wind can cause swelling, dryness, and narrowing of the vaginal opening. fumigate and wash with Ziisu (Perilla) decoction, lubricate with sesame oil and honey, and wait patiently; delivery will occur.

If intestines prolapse during labor, fill a clean basin with warm water and a little sesame oil for lubrication. When the fetus and placenta are delivered, have the mother lie slightly supine and inhale deeply to lift. The midwife, with hands lubricated in sesame oil, should gently insert the intestines. Alternatively, soak in concentrated Huangqi (Astragalus) decoction and administer Buzhong Yiqi Tang internally to restore position. If the bladder prolapses after delivery, use the same insertion method and continue Buzhong Yiqi Tang. If the midwife negligently ruptures the bladder, use Bazhen Tang with Zhu Pao (Porcine Bladder) as a guide; recovery is possible.

After delivery, if the vaginal opening remains unclose due to severe Qi and Blood deficiency, use Shiquan Dabu Tang. If the vaginal opening is abraded by a large fetus, wash with Qiai (Mugwort from Qi) and Yimucao (Motherwort) decoction.

After the placenta is delivered, with Qi and Blood depleted, sudden blackouts, dizziness, coma, locked jaw, and unconsciousness may occur. Ancients attributed this to Lochia attacking upward due to deficiency, causing "Blood Fainting" (Xueyun). However, there are two types: Blood Fainting and Qi Collapse. Mistaking Qi Collapse for Blood Fainting and using acrid-aromatic blood-invigorating and phlegm-resolving agents will lead to immediate death. Caution is essential.

In Qi Collapse, massive blood loss leads to concurrent loss of Qi, causing fainting and unconsciousness. Mild deficiency resolves quickly; severe deficiency leads to collapse and death. Observe the face: closed eyes, open mouth, flaccid hands, cold extremities, and extremely fine or floating/scattered pulses indicate Qi Collapse. Urgently administer Renshen (Ginseng), 1.5–3.5g for mild cases or 2.5–3.5g for severe, with fried rice, baked ginger, and red dates. Decoct and administer slowly. Once swallowed, life can be saved; delay is fatal. For those unable to afford Ginseng, use a large dose of Danggui Buxue Tang (Angelica Tonifies Blood Decoction) with fried rice, baked ginger, and red dates. This can also save lives.