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Knowledge regarding the Signs Before Labor: When a pregnancy nears term, if the fetus suddenly moves restlessly but abdominal pain is not severe, or comes and goes intermittently, or delivery occurs after one to two days or even three to five days later, this is called "Nong Tai" (False Labor/Practice Contractions). One must not rashly sit on the birthing bed; instead, one must wait quietly for the proper time. If amniotic fluid has been released but there is no lower back soreness/pain and no delivery, it is also called "Nong Tai". Therefore, there is a condition called "Li Jiang Sheng" (Delivery with Prolonged Fluid Leakage), where fluid flows for one or two days without delivery; delivery occurs only when the flow of fluid gradually decreases. If too much fluid flows out, it may lead to a dry uterus and difficult labor, which is unfavorable. In such cases, one should take Bazhen Tang (Eight-Treasure Decoction) regularly to assist Qi and Blood, ensuring safety without worry. There is another condition where sudden abdominal pain occurs one month before term, resembling imminent delivery but not resulting in birth, called "Shi Yue" (Trial Month). There are also cases where there is abdominal pain but no lower back soreness, and the pulse has not yet shown the characteristics of "Li Jing" (Pulse departing from the meridian pattern indicating imminent birth), so no delivery occurs. There are cases where there is abdominal pain but no sensation of bearing down; although the fetus turns, its position is not correct, indicating it is not the proper time for delivery. It must be understood that paroxysmal abdominal pain is the process of the fetus breaking the membranes and turning. Those with strong Qi find turning easy, while those with weak Qi find it difficult. Thin membranes break quickly, thick membranes break slowly, hence some experience abdominal pain for one to two days before delivery. Pregnant women should keep their minds at ease and follow the natural course; they must absolutely avoid using strong drugs to force labor, which could result in death. When the natural time for delivery arrives, there will inevitably be tight contractions, accompanied by urgent pain in the umbilical region, heavy soreness and pain in the lower back, a burning sensation in the eyes, urgency in the anus, etc. Once the fetal position is correct and the head reaches the birth canal, applying force to push will result in immediate delivery. However, there are also cases of mild abdominal pain, or no abdominal pain at all, with only a sensation of lower back soreness and bearing down leading to delivery; 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." It is like defecating; you cannot force it when not urgent, nor can you stop it when urgent. Although this reasoning seems vulgar, understanding it prevents disaster.

Guidance on Managing Fetal Turning: Whenever a fetus turns in the womb, the abdomen necessarily hurts. Even if several days pass without delivery, do not panic. Have someone support the woman to walk in the room, or stand leaning against an object, keeping her body and abdomen straight. If she feels slightly fatigued, use soft cushions to prop up her back, lie supine for a moment, then have her walk and stand again, allowing the fetus to turn slowly within the abdomen. Delay is harmless. It is advisable to loosen the skirt belt slightly to give the fetus enough space to turn comfortably. If the woman endures pain poorly, bending over or leaning sideways, the fetus will inevitably be crowded, confusing its path. Midwives who do not understand this principle, seeing delayed delivery, frequently test the waters (check for rupture), mistakenly injuring the fetal membranes. Wind may enter the birth canal causing swelling, or the amniotic fluid may dry up before the fetus arrives, making delivery more difficult! In such cases, instruct the parturient to eat as much as possible and regulate her breathing, or use herbs that invigorate blood and facilitate fetal descent (recipes for these are found in the Chapter on Promoting Delivery). Wait until the fetus presses against the cervix; this is the most critical point for the family. I once saw a woman who feared pain during labor, curling her body while sitting or lying, causing the fetal position to turn improperly. When the fetus reached the birth canal, it was blocked by the mother's curled body and could not exit. After a short while, it turned again, but the mother, protecting herself from pain, closed off the passage again. This happened two or three times, leaving the fetus powerless to move, resulting in dystocia. Others saw the motionless fetus and thought it was dead, but it was actually just powerless, not dead. We immediately instructed the mother to straighten her body and abdomen, move periodically, sit and stand, calm her mind and harmonize her Qi, and eat as much as possible. After the fetus paused briefly and regained strength, it turned to the birth canal and was delivered smoothly and easily.

Selection of Midwives: When a pregnant woman approaches labor, select an elderly midwife with experience and knowledge, along with one or two pure and cautious women for support. If ignorant and rash women are mistakenly used for delivery, failing to distinguish between true labor and false labor, and upon seeing abdominal pain, they recklessly feel the pregnant woman's abdomen, pressing heavily on both sides to force the fetus downward to prevent breech presentation, this is the first cause of fatal errors. When abdominal pain first begins, the membranes have not yet ruptured but are about to. The fetus, nearing delivery, possesses a form of sensitivity. Feeling external manipulation, the fetus does not know what is happening and becomes frightened, shrinking and refusing to move; thus, when will the membranes rupture? Furthermore, some ignorant midwives harm people by privately puncturing the amniotic sac with their fingers; this must be strictly guarded against. Amniotic fluid is the water inside the uterus nourishing the fetus. If the fetus is obstructed, it naturally follows the fluid down. If delivery is delayed, it is due to weakness of the uterine power, causing slow turning. There is a risk of fluid depletion followed by bleeding, blocking the path, leaving the fetus with no way through, causing stagnation. Use Baosheng Wuyou San (Guarantee Safe and Worry-Free Powder) to secure the blood. If blood has already been depleted, decoct Bazhen Tang (Eight-Treasure Decoction) with Motherwort (Leonurus japonicus, Yimucao) strongly, and drink it frequently. If Yuan Qi (Primal Qi) is exhausted and fatigued, urgently use high-quality Ren Shen (Ginseng Radix, Renshen) 1 liang and Dang Gui (Angelica Sinensis Radix, Danggui) 2 qian, decoct and drink. Finish the dose, then decoct and drink again to boost Qi and Blood, which is most effective. Using other Qi-depleting drugs to promote delivery would be ineffective. Alternatively, first take Bazhen Tang to tonify Qi and Blood, then decoct a strong Scallion Soup, have the midwife wash the birth canal with it to ensure smooth Qi flow, apply Butter (Su You) and Talcum (Huashi) to the vulva, and subsequently take Cansheng Wanquan Tang (Perfect Delivery Promoting Decoction), which is also excellent.

Taboos During Labor: During the month of impending labor, pregnant women must not wash their hair or feet; doing so often leads to difficult labor. When approaching the time of delivery, all doors, windows, boxes, cabinets, bottles, and jars should be loosened/unfastened. All visiting relatives, widows, unmarried girls, mourners, nuns, unclean persons, women currently menstruating, or women with strong body odor, should be kept away as they can disturb the fetus and bring misfortune. These taboos are widely known. Generally, having one more person in the room causes further delay. Although this is a folk belief, it contains profound truth, fearing that maternal anxiety will lead to difficult labor.

Need for Silence During Labor: During delivery, there must be no noise in the room. Even in case of emergencies outside, shouting is prohibited. If the parturient becomes 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 cowardly; Cowardice closes the Upper Jiao; Closure causes Qi to return; Return causes Lower Jiao distension; thus Qi fails to move." This Qi knotting and failure to move leads to difficult labor. There are also cases where the parturient has absent Chi pulses (Kidney pulses) while other pulses are peaceful; this indicates Lower Jiao distension and Qi closure, a pulse sign of difficult labor. Urgently use Zisu Yin (Perilla Decoction) to dissipate knots and move Qi to achieve delivery.

Protrusion of Intestines (Pan Chang Chan): People are often shocked and afraid when intestines protrude before the baby, but it is harmless. Instruct the parturient to lie supine calmly. Quickly prepare a clean basin with warm water; in winter, make it slightly hotter. Add Sesame Oil for lubrication. Wait until the baby and placenta are delivered. The midwife should apply Sesame Oil to hands and gently insert the intestines. Instruct the parturient to clench her buttocks tightly; the intestines will naturally retract. Another method uses vinegar mixed with cold water sprayed on the face; each spray causes retraction, gradually pulling them in. There is also a method using Shenyin Dan (Miraculous Response Pill) applied externally. However, I fear these spray and paste methods may cause errors. It is better to blow Rhizoma Belamcandae Powder (Zao Jiao Mo) into the nose; sneezing will cause the intestines to retract upwards spontaneously. If intestines are dried by wind and do not retract, use a small amount of whetstone water, warmed over fire, to moisten the intestines, then drink a cup of Magnetite Decoction (Ci Shi Tang); the intestines will retract spontaneously. If the bladder (urinary bladder) protrudes after the baby and placenta, use the previous insertion method. All cases of intestine or bladder protruding first are due to chronic Qi deficiency and prolapse from straining. For normal delivery, if there is no power to push, and the placenta or umbilical cord protrudes first, urgently instruct the midwife to tidy and push them back in. Wait for Qi to settle, then顺势 push from below. Do not delay; if delayed, the umbilical cord may protrude again, making it hard to manage.

Twins: When a pregnant woman delivers, if one baby is born and then another appears, this is a twin pregnancy. Only the midwife knows this. She should simply say she is retrieving the placenta and wait until the second birth to announce it, lest the shock cause complications for the mother.

Waiting for Placental Delivery: When the baby exits the birth canal, attendants should hold the mother's lower abdomen with both hands, and the mother should also hold her abdomen tightly to help the placenta descend. If the placenta is slow to come, do not panic. Burn straw paper and smoke the nose; the placenta will descend. If still delayed, urgently cut the umbilical cord and wash the baby. Tie the umbilical cord with soft cloth; this cord is very fragile, so tie it lightly but securely, then cut it. If the cord is not cut, blood may reflux into the uterus, causing distension and failure to descend, attacking the heart and causing injury. If the midwife is skilled, she can remove the placenta manually, which is convenient (method seen in the chapter on Retained Placenta).

Suffocation at Birth: It is normal for a newborn to cry immediately. If the baby is born silent and suffocated, some traditions suggest calling the father's name in sleep or patting the thighs to induce crying, but the mechanism is unclear. There is a membrane covering the infant's anus that blocks the air, preventing sound; patting breaks the membrane, allowing crying. If patting does not work, have a dexterous woman gently pierce it with the tip of a silver hairpin. If piercing is not possible, urgently wrap the baby tightly in warm cotton clothes and hold it close, do not let it loose, and do not cut the umbilical cord yet. Quickly soak the placenta in hot water; in cold weather, warm it near charcoal fire. Make a large oil-paper wick, light it, and wave it over the umbilical cord. Since the cord connects to the baby's navel, prolonged heat will internally鼓 (distend/stimulate), breaking the membrane. Once broken, the baby will cry and revive, then the cord can be cut and washed. Another method uses Qiai (Artemisia argyi, Moxa) twisted into a wick, soaked in sesame oil, smoked onto the umbilical cord until charred, generating internal heat to break the membrane. Another method involves popping the fontanelle with a lit rush pith (Deng Xin) a few times. All treat suffocation at birth.

Baby Born Dead: If a baby is born dead, urgently check the upper palate of the mouth for bubbles. Pop them with a finger, wipe the blood clean with cloth. If blood enters the throat, the baby dies; removing the blood brings life back. The white rice-like substance in the bubble, sharp as a needle tip, must also be scraped off to prevent it entering the throat.