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1. Knowledge Regarding the State of "Seeming to Labor but Not Yet Delivering" for Pregnant Women: Whenever a pregnancy nears its term, if the fetus suddenly moves restlessly and abdominal pain is not severe, or if it comes and goes, lasting one or two days, or three to five days before delivery, this is called "Playing Fetus" (Nong Tai). One must not rashly sit on the straw mat ready for birth; one must wait quietly for the proper time. If the amniotic fluid has already broken, yet there is no lower back soreness/aching and delivery does not occur, this is also called "Playing Fetus." Therefore, there is a condition called "Dripping Fluid Birth" (Li Jiang Sheng), where fluid flows for one or two days without delivery, and delivery occurs only after the flow of fluid gradually decreases. If too much fluid flows out, it may lead to a dry uterus and difficult labor, which is undesirable. In such cases, one should take Bazhen Tang (Eight-Treasure Decoction) at regular intervals to assist Qi and Blood, so that one can await delivery without worry. There is another condition occurring a month before term, with sudden abdominal pain resembling imminent labor, yet no delivery occurs, called "Testing Month" (Shi Yue). There are also cases where the abdomen hurts but the lower back does not ache, and the pulse has not yet shown the "Departed from Meridian" sign, yet no delivery occurs. There are also cases where the abdomen hurts but the fetal head has not descended, and although the fetus turns, its body position is not correct, indicating it is not yet the proper time for delivery. One must know that intermittent abdominal pain is caused by the fetus breaking the membranes and turning. Those with strong Qi turn easily, while those with weak Qi find it harder. Thin membranes break quickly, thick membranes break slowly, hence the occurrence of delivery after one or two days of abdominal pain. All pregnant women should keep their minds at ease and wait for the natural course of events. One must absolutely avoid using force to rush delivery, lest it endanger life. When the natural time for delivery arrives, there will inevitably be intense contractions, such as urgent pain in the navel and abdomen, heavy soreness and pain in the lower back, eyes feeling like fire, urgency in the anus, etc., all appearing together. Once the fetal body is aligned and the head reaches the birth canal, exerting effort once will result in delivery. However, some deliver with only slight abdominal pain or no pain at all, feeling only lower back soreness and bearing down sensation. This is because the Kidney governs the waist, and the uterus is connected to the Kidney. The ancients said: "When the time comes, delivery happens naturally, just like defecating; one cannot urge it when not urgent, nor stop it when urgent." Although this reasoning seems common, understanding it prevents disasters.

2. Knowledge Regarding the Natural Prodromal Signs of Labor: Whenever a pregnant woman approaches labor, half a month or several days prior, the fetal abdomen must descend, and urination becomes frequent. When about to deliver, the pulse first shows the "Departed from Meridian" sign. Wiping and pinching the middle joint or proximal joint of the middle finger of the parturient woman; if a pulsation is felt, this is the time for entering the delivery room.

3. Knowledge Regarding Care and Regulation During Fetal Turning: Whenever a fetus turns in the womb, the abdomen must hurt. Even if delivery is delayed by several days, one must not panic. Have someone support her to walk in the room, or stand leaning against an object, keeping the body and abdomen straight. If she feels slightly tired, pad the back with quilts and lie supine for a moment, then have her walk and stand again. Allow the fetus to turn slowly in the abdomen; delay is harmless. Loosen the skirt belt slightly to give the fetus ample room to turn and stretch comfortably. If she endures pain poorly, bending over or leaning sideways, the fetus will be crowded and lose its way. Midwives who do not understand this principle, seeing slow labor, frequently test the waters, mistakenly rupturing the membranes, allowing wind pathogen to enter the birth canal causing swelling, or causing the amniotic fluid to dry up before the fetus arrives, making delivery even more difficult. In such cases, only urge the parturient to eat and drink despite discomfort, regulate her breathing, or use herbs that invigorate blood and facilitate lubricated delivery. (Herbal formulas for invigorating blood and facilitating delivery are found in the Chapter on Promoting Delivery.) Wait until the fetus presses against the cervix, then exert maximum effort; the fetus will follow the fluid down. This follows the principle of "when the melon is ripe, the stem falls." One must absolutely not exert effort prematurely, leading to mental fatigue and exhaustion at the critical moment, which is the most crucial point for childbirth. I have seen a woman afraid of pain during labor, curling up sitting or lying, causing the fetal origin to turn irregularly. When the fetus emerged from the sac, seeking the birth canal, it was blocked by the mother's curled body, preventing exit. After a short while, it turned again, but the mother, protecting herself from pain, closed off the passage again. Repeating this two or three times, the fetus lost strength and could not move, resulting in dystocia. Others saw the fetus motionless and assumed it was dead, but it was actually due to lack of strength, not death. Immediately instruct the mother to straighten her body and abdomen, move, sit, and stand occasionally, calm her mind and harmonize her Qi, eat and drink despite discomfort. Wait for the fetus to pause and regain strength, then turn to the birth canal again, resulting in smooth delivery.

4. Knowledge Regarding the Selection of Midwives: Whenever a pregnant woman approaches labor, select an elderly midwife with experience and knowledge, along with one or two pure and cautious women to support her. If ignorant and rash women are mistakenly used for delivery, failing to distinguish between normal labor and fetal turning, and upon seeing abdominal pain, they randomly place both hands on the upper abdomen, pressing heavily on both sides to force the fetus down, avoiding transverse presentation, this is the first and most fatal error. When the abdomen first hurts, the membranes have not yet ruptured but are about to. The fetus, about to be delivered, possesses a form of sensitivity/spirit. Feeling external manipulation, the fetus does not know what is happening, becomes frightened, contracts, and dares not move, so when will the membranes rupture? Furthermore, some ignorant midwives harm people by privately puncturing the water bag with their fingers; this must be strictly guarded against. Amniotic fluid is the water within the uterus nourishing the fetus. Once the membrane ruptures, the fetus naturally descends with the fluid. If delivery is delayed beyond the expected time, it is due to weakness of the uterine origin, causing slower turning. Fear that the fluid will be exhausted and blood will come, blocking the path, leaving the fetus with no way through, causing stagnation. Use Baochan Wuyou San (Guarantee Safe Childbirth Powder) to secure the blood. If blood has been depleted, decoct Bazhen Tang (Eight-Treasure Decoction) with Motherwort (Yimucao) strongly, and drink it frequently. If Yuan Qi (Original Qi) is exhausted and fatigued, urgently decoct high-quality Ren Shen (Ginseng Root) [1 liang] and Dang Gui (Angelica Sinensis Root) [2 qian]. Drink until finished, then decoct again to assist Qi and Blood, which is most effective. Using drugs that promote delivery and consume Qi will yield no effect. Alternatively, first take Bazhen Tang to tonify Qi and Blood, then decoct strong Scallion Juice, having the midwife wash the birth canal to ensure smooth circulation of Qi up and down. Apply Butter and Talcum Powder to the vulva, then take Cansheng Wanquan Tang (Thousand-Complete Delivery Pill) is also excellent.

5. Knowledge Regarding Taboos During Labor: In the month of impending labor, pregnant women must not wash their hair or feet; those who violate this often experience difficult labor. When approaching the delivery moment, all doors, windows, boxes, cabinets, bottles, and jars should be loosened/unfastened. Also, all visiting relatives, widows, unmarried girls, mourning nuns, unclean persons, women whose menstruation has just started, or women with strong body odors, can all disturb the fetus and bring disaster; precautions and taboos must be observed. Popular superstition avoids many people knowing, believing that each additional person in the room causes delay. Although this is a folk theory, it contains truth, fearing that the parturient's mind becomes troubled, leading to difficult labor.

6. Knowledge Regarding the Need for Silence During Labor: During labor, the room must not be noisy. Even in case of unexpected emergencies, shouting outside is prohibited. If the parturient is frightened and startled, fetal stagnation and Qi knotting will occur, leading to difficult labor. The Classics state: "Fright scatters the Spirit, Worry knots the Qi, Fear makes Qi timid; timidity closes the Upper Jiao; closure causes Qi to return; return causes Lower Jiao distension; thus Qi ceases to move." This Qi knotting and stagnation leads to difficult labor. If the Chi (Kidney) pulses on both wrists are absent, while other pulses are peaceful, this indicates Lower Jiao distension and Qi blockage, a pulse sign of difficult labor. Urgently use Zisu Yin (Perilla Decoction) to dissipate knots and move Qi to achieve delivery.

7. Knowledge Regarding Drinking Soup/Water During Labor: At the time of delivery, if the pregnant woman feels stifled and thirsty in the epigastrium, use half a cup of White Honey dissolved in warm water to drink. If she desires water, only clear Rice Water should be given. Honey moistens dryness and facilitates delivery; Rice Water assists Middle Qi. Some women vomit food and medicine taken during labor. If they continue to eat and take medicine after vomiting, ensuring they do not become weak or dry, they will still deliver spontaneously; there is no need to worry about the vomiting. Therefore, the parturient must not go hungry; hunger leads to deficiency of Middle Qi and lack of strength to expel the fetus. Eat small amounts of Congee made from Japonica Glutinous Rice, or drink broth from hen soup. Do not eat meat or hard foods, as they may stagnate in the Upper Jiao, preventing Qi from descending, causing not only difficult labor but also internal injury. Do not eat too full; being slightly hungry is best. Hunger causes Qi to descend; descending Qi accelerates delivery. I believe that for thirst, inability to eat, and vomiting, drinking Dushen Tang (Single Ginseng Decoction) is best and can also promote delivery.

8. Knowledge Regarding Abnormal Deliveries: Besides normal deliveries, there are eight types of abnormal deliveries: Transverse Presentation (Heng Chan), Breech/Foot First (Ni Chan), Sitting Presentation (Zuo Chan), Obstructed Presentation (Ai Chan), Oblique Presentation (Pian Chan), Posterior Occiput Presentation (Zhang Hou Chan), Prolapsed Intestine (Pan Chang Chan), and Prolapsed Umbilical Cord (Lang Qi Chan). These are caused by deficiency of Qi and Blood in the pregnant woman, or by sitting on the straw, testing waters, or pushing too early. Upon encountering these abnormalities, the parturient must lie supine, remain calm, and select an experienced midwife to manage. Treatments for each are listed below.

For Transverse Presentation (Hand presenting first), known popularly as "Seeking Salt Birth": Let the mother lie supine calmly. Apply salt to the infant's palm, then smear sesame oil on the protruding hand. The midwife gently pushes it back. If the infant's hand touches the salt, the muscles sting, causing pain and retraction. Wait for the fetus to turn and align the head, then help the mother push; the infant will emerge.

For Breech/Foot First Presentation (Foot presenting first), known as "Treading Lotus Birth": Let the mother lie supine, without fear or anxiety. Apply salt to the sole of the foot, and smear sesame oil on the protruding foot. The midwife gently pushes it back. Wait for the fetus to turn and align the head, then push to deliver. In cases of transverse or breech presentation, the lives of mother and child depend on moments. Without emergency methods, how can one claim medical sanctity? Causes include the fetus not yet turning smoothly, with limbs pushed out by maternal effort, or maternal Qi/Blood deficiency causing the fetus to lack strength to turn, resulting in limb presentation. Quickly use the salt-oil method to push back. If pushed out by force, it is easy to turn back without medication. If deficient and unable to turn, urgently decoct Niujie Tang (Rescue Reversal Decoction) to assist Qi and Blood. After pushing back for a short while, the fetus gains strength to turn, aligns the head, and delivers. Crucially, do not allow limbs to protrude for long or excessively. If hands or feet appear slightly, treat immediately with salt. If protruding too long, they become blue and hard, difficult to push back, injuring the fetus. Do not listen to wicked women suggesting cutting limbs with a knife; touching the blade disturbs the fetus internally and injures the mother. Some use needles on limbs or grasp the sole; I fear this frightens the fetus into contracting, potentially harming the mother's heart/mind. Salt application is preferable.

For Sitting Presentation (Breech/Rump presenting first), known as "Sitting Rump Birth": Let the mother lie supine, apply oil and push back as before. Wait for the fetus to turn and align, then push out. Alternatively, tie a towel firmly at a high point, let the mother hold it, gently flex and extend legs to open the path, resulting in smooth delivery.

For Obstructed Presentation (Cervix and opening correct, vertex showing but not descending): This is usually due to the umbilical cord entangling the shoulder, popularly called "Backpack Birth." Let the mother lie supine; the midwife gently pushes the fetus upward, uses the middle finger to press the shoulder, feels for the cord, removes it, aligns the fetus, and one push results in delivery.

For Oblique Presentation (Birth canal not aligned, pushed by maternal effort, head obliquely against the introitus): Laypeople think the vertex is showing, but it is actually the forehead. Let the mother lie supine, gently push the fetus up, align the head with hand, and one push results in delivery.

For Posterior Occiput Presentation (Occiput bone presses against the mother's anus, preventing descent): Have the midwife wrap hands in warmed cotton clothing, gently push the head from beside the anus to align it, then push to deliver. Alternatively, have the mother brace her knees.

For Prolapsed Intestine (Intestine presents first): People are terrified, but it is harmless. Let the mother lie supine calmly. Quickly prepare a clean basin with warm water, adding slightly more heat in winter. Add sesame oil for lubrication. Wait for the fetus and placenta to deliver. The midwife, with hands oiled, slowly pushes the intestine back. Have the mother clench her buttocks tightly; the intestine will retract. Some use vinegar mixed with cold water sprayed on the face to induce retraction. There is also Shenyin Dan (Miraculous Response Pill) paste. However, spraying/pasting may cause errors. Blowing Rhizoma Typhonii (Zaojiao) powder into the nose induces sneezing, which retracts the intestine naturally. If the intestine dries from wind exposure, use a little whetstone water, warmed over fire, to moisten it, then drink a cup of Magnetite (Cishi) decoction; the intestine will retract. If the bladder prolapses after the fetus/placenta, use the same method. All these prolapses of intestine/bladder are due to chronic Qi deficiency, straining, premature pushing disturbing the viscera, weakness of the Lower Yuan, and laxity of the "key" (sphincters/support). To prevent recurrence, when not pregnant, take Dihuang Wan (Rehmannia Pill) added with Fructus Schisandrae (Wuweizi) and Cortex Cinnamomi (Rougui) [1 liang each] to secure the Lower Yuan. When pregnant, take Hulian Wan (Coptis Pill) added with Ren Shen (Ginseng) to tonify Qi, and Sanbu Wan (Three Tonics Pill) to cool blood. Do not lightly use slippery/thinning fetus agents. At eight months, take Bazhen Tang added with Fructus Chebulae (Hezi), Herba Siegesbeckiae (Qumai), Pericarpium Papaveris (Suke), and honey for over ten doses. My opinion is to pre-administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for lifting earlier, to avoid issues at labor. This is safer and less complex than Hulian, Sanbu, or Suke.

For Prolapsed Umbilical Cord (Placenta/Cord presents first): Normally, the head turns to the birth canal for normal delivery. If lacking strength to turn, the foot steps on the placenta/cord first. Urgently have the midwife arrange and push it back. Wait for breath to stabilize, then顺势 push from below. Do not delay pushing back; prolonged delay causes the cord to fall again, making it hard to manage.

9. Knowledge Regarding Twin Delivery: When a pregnant woman labors, if one fetus is delivered and another appears, it is twins. Only the midwife knows this; she should only say she is retrieving the placenta, speaking of the second birth only after the first is born, to avoid frightening the mother and causing complications.

10. Knowledge Regarding Awaiting Placental Delivery: When the baby emerges, two people should hold the mother's chest, and the mother should clutch her abdomen tightly, aiding placental descent. If the placenta is delayed, do not panic. Burn paper and smoke the nose to induce expulsion. If still delayed, cut the umbilical cord immediately, wash the baby, and tie the cord with soft cloth. The cord is fragile; tying must be light yet secure before cutting. If not cut, blood may reflux into the uterus, causing distension and failure to descend, attacking the heart and causing injury. Experienced midwives can remove the placenta manually with fingers (method see chapter on Retained Placenta).

11. Knowledge Regarding Muffled Navel Birth (Asphyxia): It is normal for the newborn to cry immediately. If the baby lands silent due to muffled Qi, popular belief says calling the father's name or patting the thigh induces crying, but the mechanism is unclear. There is a membrane in the anal region blocking Qi; patting breaks it, allowing crying. If patting fails, have a nimble woman gently pierce it with the tip of a silver hairpin. If piercing is impossible, quickly wrap the baby tightly in warm cotton batting, hold close, do not cut the cord yet. Quickly soak the placenta in hot water (warm over charcoal in cold weather). Make a large oil-paper wick, light a lamp, and pass the flame back and forth over the umbilical cord. Since the cord connects to the navel, prolonged heat will internally swell and break the membrane. Once broken, the baby cries and revives, then cut the cord and bathe. Another method uses Qiai (Mugwort) wicks soaked in sesame oil, smoking the cord until charred to generate internal heat. Another method involves popping the fontanelle with a lit rush pith. All treat muffled navel birth.

12. Knowledge Regarding Stillborn at Birth: If the baby is born dead, urgently check for bubbles on the anterior roof of the mouth. Pop them with a finger, wipe blood clean with cloth. If blood enters the throat, death occurs; removing blood restores life. The white rice-like substance in the bubble, sharp as a needle tip, must also be scraped off to prevent entry into the throat.

13. Knowledge Regarding Cold Birth: In winter, cold congeals maternal blood, delaying delivery. Place stoves/fire in all parts of the room to maintain spring-like warmth. Do not remove cotton clothes from the lower body; do not sit/lie on cold surfaces. Keep the mother's back warm and the area below the navel, legs, and knees constantly warm. Heat promotes blood flow, facilitating delivery. Charcoal must be burned red outside and brought in; raw charcoal fumes may cause dizziness.

14. Knowledge Regarding Hot Birth: In midsummer, maintain appropriate temperature. Sprinkle water in the room, place basins of water, or set ice blocks far away to resolve stagnant heat. Avoid cool winds and rainy days; do not seek excessive coolness to prevent illness. Limit the number of people in the room to prevent heat oppression, maternal agitation, boiling blood, and risk of fainting/dizziness.

Niujie Tang (Rescue Reversal Decoction): Treats maternal Qi/Blood deficiency, fetal inability to turn, limb presentation.
Ren Shen (Ginseng Root) [1 liang], Dang Gui (Angelica Sinensis Root) [3 liang], Chuan Xiong (Ligusticum Chuanxiong Rhizome) [2 liang], Hong Hua (Carthamus Tinctorius Flower) [3 qian].
Decoct in water and take quickly. If still不顺 (not smooth), decoct and take again.

Sanbu Wan (Three Tonics Pill): Specifically treats Blood Heat.
Huang Qin (Scutellaria Baicalensis Root, stir-fried), Huang Lian (Coptis Chinensis Rhizome, stir-fried), Huang Bai (Phellodendron Amurense Bark, stir-fried).
Grind equal parts into powder, make pills with honey, take with plain water.

Bazhen Tang (Eight-Treasure Decoction) (See Vol 1, Pain Chapter).
Baochan Wuyou San (Guarantee Safe Childbirth Powder) (See this Vol, Prenatal Easy Delivery Formulas).
Cansheng Wanquan Tang (Thousand-Complete Delivery Pill) (See this Vol, Delivery Chapter).
Zisu Yin (Perilla Decoction) (See Vol 1, AnTai Chapter).
Shenyin Dan (Miraculous Response Pill) (See this Vol, Weisheng Chapter).
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (See Vol 1, Abilities Chapter, attached to Liuwei Dihuang Tang).
Hulian Wan (Coptis Pill) (See Vol 1, AnTai Chapter).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See Vol 1, Pain Chapter).