Treatise on the Ten Kinds of Childbirth

Discourse on the Ten Kinds of Childbirth

《十產論》

by Yang Zijian 楊子建 and quoted in Fu Ren Da Quan Liang Fang 婦人大全良方 (Compendium of Excellent Formulas for Women, composed in 1237 by Chen Ziming 陳自明, volume 17, chapter 2).

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(一)凡人生產,先知此十產証候,則生產之婦永無傷損性命。

(二)生產之間,性命最重。

(三)幸而孩子易生,人不知福,萬一有少艱難,則須臾之間,子母之命懸於絲發,但世人所患者,惟看生產。

(四)收生之人,少有精良妙手,緣此而多有傾性命。

(五)余因傷痛其事,不為無補。

1) Whenever humans give birth, you must first know the signs and symptoms of these ten [types of] childbirth so that the woman in childbirth will never suffer injury to her life.

2) For the duration of childbirth, [saving] life is the most important issue.

3) In fortunate cases, the child is born with ease, but people don’t [even] know how blessed they are. One in ten thousand has a bit of difficulties and then within an instant, the lives of the child and of the mother are as if hanging from a strand of hair. And yet everybody is worried about nothing but childbirth [per se, instead of training midwives etc.].

4) As for the birth attendants, there are few who are marked by refined excellence and subtlety in their hands. It is for this reason that lives are lost so commonly.

5) Because of the pain and suffering from this state of affairs, I could not stop myself from supplementing [the following account by adding methods at the end].

Number One: Right Childbirth 一曰正產

正產者,蓋婦人懷胎十月滿足,陰陽氣足,忽然腰腹作陣疼痛,相次胎氣頓陷,至於臍腹疼痛極甚,乃至腰間重痛,穀道挺迸,繼之漿破血下,兒子遂生,此名正產。

Right childbirth means that a pregnant woman has fulfilled the entire ten months of her pregnancy, so that yin and yang qì are sufficient. All of a sudden, she experiences intermittent pain in the lumbus and abdomen and immediately afterwards a caving in of fetal qì. When she reaches the point where the pain in the umbilical area and abdomen has become severe to the extreme, then [she also experiences] heaviness and pain in the lumbar area, and the rectum bulges to the point of bursting. Subsequently, thick liquid breaks and blood descends. Following this, the child is born. This is what is called “right childbirth.”

Number Two: Injurious Childbirth 二曰傷產

(一)傷產者,蓋婦人懷胎,忽有七月、八月而產;忽至九月、十月而產;忽有經一年、二年,乃至四年、五年而後產者。

(二)今獨以十月滿足為正產。

(三)蓋一人之生,陰注陽定,各有時日,不可改移。

(四)今有未產一月以前,忽然臍腹疼痛,有如欲產,仍卻無事,是名試月,非正產也。

(五)但一切產母,未有前面正產証候,即不可令人抱腰,產母亦不可妄亂用力。

(六)蓋欲產之婦,臍腹疼痛,兒身未順,收生之人,卻教產母虛亂用力,兒身纔方轉動,卻被產母用力一逼,遂使兒子錯路,忽橫忽倒,不能正生,皆緣產母未當用力之所致也。

(七)凡產母用力,須待兒子順身,臨逼門戶,方始用力一送,令兒下生,此方是產母之用力當也。

(八)若未有正產之候而用力傷早,並妄服藥餌,令兒下生,譬如揠苗而助之長,非獨無益,而又害之,此名傷產。

1) As for injurious childbirth, [it can refer to any situation when] a woman during pregnancy either gives birth in the seventh or eighth month, or reaches the ninth or tenth month and then gives birth, or passes one or two years, or even up to four or five years and only then gives birth.

2) It is only when the ten months are fulfilled that it constitutes a “right childbirth.”

3) For every single human life, yīn must pour in and yáng must secure, each having its appropriate timing. This cannot be altered and changed.

4) Now it happens that before the month of childbirth is reached, the woman suddenly experiences pain in the umbilical area and abdomen, a sensation as if she were about to give birth, but still there is nothing happening. This is what is called “testing the month,” and it is not [yet] the real birth.

5) Nevertheless, in all cases of childbirth, before women experience the symptoms that precede the real birth, you must not let others hold them around the waist, and the mother in labor may also not wantonly exert force.

6) If a woman is about to give birth, [already experiencing] pain in the umbilical area and abdomen, but the child is not yet aligned correctly in the [mother’s] body, and the midwives nevertheless instruct the mother in labor to exert force wantonly and in vain, the child’s body will move just then but is forced in a certain direction by the mother’s exertion of force. This then causes the child to get stuck on the way, whether being transverse or upside down. The inability to have a right childbirth is always caused by the fact that the mother in labor exerted force before it was appropriate.

7) In all cases, the mother in labor must wait until the child is aligned correctly in her body before exerting force. Only when [the child] is pressing right up against the cervix can she begin to exert force, to cause the child to be delivered. This is the only appropriate time for the mother in labor to exert force.

8) If the mother exerts force before experiencing any symptoms of right childbirth, causing early damage, as well as when she recklessly takes medicinal preparations that cause the child to descend and be born, this is like pulling up a seedling to help it grow. Not only does it not provide any benefit, but it even injures her. This is what is called “injurious childbirth.”

Number Three: Expedited Childbirth 三曰催產

(一)催產者,言婦人欲產,漿破血下,臍腹作陣疼痛,其痛極甚,腰重、穀道挺迸,已見是正產之候,但兒卻未生,即可服藥以催之。

(二)忽有經及數日,產母困苦,已分明見得是正產之候,但兒子難生,亦可服藥以助產母之正氣,令兒速得下生,此名催生。

1) As for expedited childbirth, this refers to situations where a woman is about to give birth, her water has already broken and the blood descended, she is experiencing intermittent pain in the umbilical area and abdomen, this pain has become severe to the extreme, and it is accompanied by heaviness in the lumbus and bulging and bursting of the rectum. We are already seeing these signs of right childbirth and yet the child is nevertheless failing to be born. In this case it is permissible to administer medicinals to expedite [the birth].

2) Alternatively, several days have already passed and the mother in labor is suffering from exhaustion. We are able to clearly see these signs of right childbirth and yet the child is having difficulty being born. [In such cases,] it is also permissible to administer medicinals to assist the laboring mother’s right qì and cause the child to be able to descend and be born quickly. This is what is called “expedited childbirth.”

Number Four: Freezing Childbirth 四曰凍產

(一)凍產者,蓋言三冬之月,天氣寒冷,產母經血得冷,則凝結而不散。

(二)因其血之不散,以至兒子不能生下。

(三)此之一弊,為害最深,然世人不知覺。

(四)若冬月,產婦下部不可脫去綿衣,並不坐臥寒冷之處,當滿房著火,令遍房常有暖氣,常令產母背身向火,令臍下、腿膝間常有暖氣。

(五)若背上、心前少聞寒冷,須是暖炙綿衣以包之為貴,其血得熱則流散,使兒子易生,此名凍產。

(六)若春秋之間,天地少有陰濕寒冷之氣,亦可就房中以微炭火暖之為妙。

1) Freezing childbirth refers to situations where heaven’s qì is cold during the three months of winter and the laboring mother’s channel blood has contracted cold. As a result, it congeals and binds instead of dispersing.

2) Because of the failure of her blood to disperse, the child is then unable to be born by descending.

3) This particular misfortune constitutes the deepest of injuries. This is so, and yet most people are not aware of this.

4) If [labor happens to occur] in the winter months, the woman in labor must not remove the inner garments on her lower body, and she must also not sit or lie down in cold locations. The whole room should be filled with [the warmth of] a burning fire so that there is constant warmth all over the room. Always have the pregnant woman position herself with her back to the fire so that there is constant warmth below the umbilicus and between the legs and knees.

5) If there is slight cold on the upper back or in front of the heart, it is of great value to wrap her in garments that have been heated up. As her blood receives the heat, it flows and disperses, causing the child to be born with ease. This is what is called “freezing childbirth.”

6) If there is a little yīn qì of dampness or cold in heaven or earth in the spring or autumn months, it is also wonderful to warm her with a small charcoal fire in the room.

Number Five: Heated Childbirth 五曰熱產

(一)熱產者,蓋言盛暑之月,欲產之婦當要其溫涼得所,不可因熱恣意取涼,反有傷損胎氣。

(二)又生產之處,不可多著人數,切恐人多,熱氣逼襲產母。

(三)蓋人之血氣,得熱則散,熱過則損。

(四)今當夏暑炎熱之盛,而產母氣虛,人氣一逼,則其血沸溢,而血得熱則上蒸,能令產母發熱頭痛,面赤昏昏如醉,乃至不知人事。

(五)世有名血暈者,緣此而成也,此名熱產。

(六)若值夏月,少有清涼之氣,陰雨之變,產母亦不可任意取涼,恐生大病。

1) Heated childbirth refers to situations during the months of exuberant summer-heat when the woman who is about to give birth wants to have the temperature adjusted just right, but you must not allow her to cool off as she pleases because of the heat. Otherwise it will injure the qì of the fetus.

2) Moreover, regarding the location of the birth, you must not have too many people present. This is because I fear that if there are too many people, the hot qì will distress and attack the mother in labor.

3) As for a person’s blood and qì, when the person contracts heat, they scatter. But if the heat is excessive, they are injured.

4) Now the present situation concerns an exuberance of scorching heat in the summer months, which is compounded by qì vacuity in the mother during labor. When a person’s qì is distressed, the blood boils and spills over. And when the blood contracts heat, it steams upward. This can cause the mother in labor to suffer from heat effusion and headache, a red face and clouded [consciousness] as if she were drunk, to the point of loss of consciousness.

5) There is a common name for this condition, namely “blood fainting”. It is formed because of this, and this is precisely what is called “heated childbirth.”

6) If it happens to be during the summer months and the weather is slightly cool, with overcast and rainy changes in the weather, you may also not allow the mother in labor to get cool as she wishes, for fear that this will engender a major illness.

Number Six: Transverse Childbirth 六曰橫產

(一)橫產者,蓋兒子下生,先露其手,忽先露其臀,此因未當用力而產母用力之過也。

(二)臍腹疼痛,兒身未順,則是產母用力一逼,遂致身橫而不能生下。

(三)不幸而有此証候,當令產母安然仰臥,令看生之人推而入去。凡推兒之法,先推其兒身,令直上,漸漸通手以中指摩其肩,推其上而正之,漸引指攀其耳而正之。

(四)須是產母仰臥,然後推兒直上,徐徐正之,候其身正、門路皆順,煎催生藥一盞,令產母吃了,方可令產母用力,令兒下生,此名橫產。

(五)倘若看生之人非精良妙手,不可依用此法,恐恣其愚,以傷人命。

1) As for transverse childbirth, this means that the child during delivery presents with the hands first, or presents with the buttocks first [i.e., breech]. This is caused by the mistake that the mother in labor should not have exerted strength yet but did.

2) There was pain in the umbilicus and abdomen but the child’s body was not yet aligned correctly [for delivery]. The woman in labor exerted strength for a push, causing the [child’s] body to be positioned transversely, as a result of which it cannot be delivered.

3) In the unfortunate case that you are faced with this symptom, you must order the woman in labor to lie quietly flat on her back and then order the midwife to push the baby and enter [the vagina]. In all cases the method of pushing the baby is as follows: First push the child’s body, causing it to go straight up. Then very gradually enter the hand through [the vagina] until you rub the [baby’s] shoulder with the middle finger. Push above it [or: push it up?] and straighten it out. Bit by bit stretch your finger, drag down the child’s ear, and correct the position.

4) You must have the woman in labor lie flat on her back and only when this is so [have the midwife] push the baby straight up and then slowly slowly correct [the baby’s] position. Wait until the baby’s body is corrected and the cervix and vagina are all properly aligned. Then brew a small cup of birth-hastening medicine and have the woman in labor ingest it. Only then can you allow the woman in labor to exert strength and cause the child to be delivered. This is called transverse childbirth.

5) In any situations where the midwife is not highly skilled with subtle hands, you cannot rely on this method because I fear she will indulge her foolishness and thereby damage somebody’s life.

Number Seven: Upside Down Childbirth 七曰倒產

(一)倒產者,蓋因其母胎氣不足,關鍵不牢,用力太早,致令兒子不能回轉順生,便只直下先露其足也。

(二)治之之法,當令產母於床上仰臥,令看生之人推其足,入去分毫。

(三)不得令產母用力,亦不得驚恐,候兒自順。

(四)若經久不生,卻令看生之人輕輕用手內人「in some editions 入」門中,推其足,令就一畔直上,令兒頭一畔漸漸順下,直待兒子身轉,門路正當,然後煎催生藥,令產母服一盞後,方始用力一送,令兒生下,此名倒產。

(五)若看生之人非精良妙手,不可依用此法,恐恣其愚,以傷人命。

1) As for upside down childbirth, now this is caused by insufficiency of maternal or fetal qi, so that the bolt on the door was insecure, and she exerted her strength too early. As a result, the child is unable to turn around and align itself properly for the birth but instead is coming straight down, presenting with the feet first.

2) The method for treating this is as follows: You must order the woman in labor to lie flat on her back on a bed, and then order the midwife to push [the baby’s] feet back in just a tiny bit.

3) You must not allow the woman in labor to exert any strength, and you must also not expose her to panic or fear but wait until the child aligns itself spontaneously.

4) If a long time passes without the child being born, then you can have the midwife very very lightly use her hand and insert it into the cervix. Push the baby’s feet in, making them go straight up on one side and causing the baby’s head to very gradually align itself downward. Wait until the baby’s body has turned around and the cervix and vagina are straight as they should be, and only then brew some birth-hastening medicine. After you make the woman in labor drink one small cup, only then may she begin to exert strength for a push, to cause the baby to be delivered. This is what is called upside down birth.

5) If the midwife not highly skilled with subtle hands, you cannot rely on this method because I fear that she will indulge her foolishness and thereby damage somebody’s life.

Number Eight: Diagonal Childbirth 八曰偏產

(一)偏產者,蓋因兒子回轉,其身未順,生路未正,卻被產母用力一逼,致令兒頭偏拄左腿,忽偏拄右腿,致令兒雖近人門而不能生下。

(二)但云兒已露頂,然不知兒之所露即非頂也,忽左額角、忽右額角而已。

(三)謂兒頭偏拄一畔,以此不能生。

(四)收之之法,當令產母於床上仰臥,令看生之人輕輕推兒近上,以手正其頭,令兒頭頂端正向人門,然後令產母用力一送,即使兒子生下。

(五)若是小兒頭之後骨偏拄穀道,即令兒卻只露額,當令看生之人,以一件綿衣炙令溫暖用裹手,急於穀道外旁輕輕推兒頭令正,即便令產母用力送兒生也,此名偏產。

(六)凡於穀道外旁推兒頭正,須推其上而正之,仍是小用輕力推些上,兒而正之也。

(七)若看生之人非精良妙手,不可依用此法,恐恣其愚,以傷人命。

1) As for diagonal childbirth, now, this [condition] is one where the baby has turned around but its body is not yet properly aligned and the road to birth is not yet straight. And yet, the woman in labor exerted strength for a push, causing the child’s head to slant diagonally against the [mother’s] left leg, or against the right leg. The result is that the baby cannot be delivered even though it is close to the cervix.

2) But it is also said that [this term] refers to [a situation] where the baby is already showing the top of its head but you do not know whether what is showing is in fact not the head but either the left or the right frontal eminence.

3) [In either case,] it refers to the baby’s head being slanted diagonally to either side, as a result of which it cannot be born.

4) The way to control this [situation] is as follows: Order the woman in labor to lie flat on her back on a bed and order the midwife to push the baby upward very very lightly. Make the midwife use her hand to straighten out the baby’s head so that the tip of the head points straight toward at the cervix. When this is so, then tell the woman in labor to exert strength for a push, and this will allow the baby to be delivered.

5) If it is the back of the baby’s head that is slanted diagonally and propped against the [mother’s] rectum, which is then causing the baby to only show the frontal eminence, in that case order the midwife to toast a piece of silk cloth until warm and wrap it around her hand. Have her press with this on the outside of the rectum and very very lightly push on the baby’s head to straighten it out. [Only] then order the woman in labor to exert force and push the baby out to deliver it. This is what is called diagonal childbirth.

6) In all cases of pressing against the outside of the rectum to push the baby’s head straight, the midwife must push it upward and then straighten it out, again and again using a little bit of light force to push slightly upward, and the child will then straighten out.

7) If the midwife is not highly skilled with subtle hands, you cannot rely on this method because I fear she will indulge her foolishness and thereby damage somebody’s life.

Number Nine: Impeded Childbirth 九曰礙產

(一)礙產者,蓋言兒身已順,門路俱正,兒子已露正頂而不能生下。

(二)蓋因兒身回轉,肚帶攀其肩,以此露正頂而不能生,此名礙產。

(三)收之之法,當令產母於床上仰臥,令看生之人輕輕推兒近上,徐徐引手,以中指按兒肩下其肚帶也。

(四)仍須候兒身正順,方令產母用力一送,使兒子下生,此名礙產。

(五)若看生之人非精良妙手,不可依用此法,恐恣其愚,以傷人命。

1) As for impeded childbirth, now this describes a situation where the baby’s body is already aligned correctly and the cervix and vagina are both correctly positioned, the child is already showing the top of the head properly, and yet it cannot be delivered.

2) Perhaps this happened because the baby’s body in the process of turning around caused the umbilical cord to climb up around the baby’s shoulders. For this reason the baby is emerging with the correct part of its head and yet cannot be delivered. This is called “impeded childbirth.”

3) The way of controlling this situation is as follows: Order the woman in labor to lie flat on her back on a bed and order the midwife to very lightly push the baby upward. Very very slowly make her stretch her hand and use the middle finger to push on the baby’s shoulders and pull the umbilical cord down.

4) You still have to wait until the baby’s body is aligned straight, and only then order the woman in labor to exert strength for a push and allow the baby to be delivered. This is called impeded childbirth.

5) If the midwife not highly skilled with subtle hands, you cannot rely on this method because I fear that she will indulge her foolishness and thereby damage somebody’s life.

Number Ten: Sitting Childbirth 十曰坐產

(一)坐產者,蓋言兒子之欲生,當從高處牢繫一條手巾,令產母以手攀之,輕輕屈足坐身,令兒生下,非令產母臨生兒時坐著一物,此名坐產。

(二)若是產母兒將欲生,卻令坐著一物,即抵著兒路,不能生也。

1) As for sitting childbirth, now this refers to a situation where the baby is about to be born and you firmly tie a piece of cloth from a high place. Order the woman in labor to pull on it with her hands and very lightly bend her knees and assume a sitting position, causing the child to be delivered. Do not allow the woman in labor at the time of delivering the baby to sit on anything. This is what is called sitting childbirth.

2) If the woman in labor is just about to give birth and yet she is still sitting on something, this will block the child’s path and she will not be able to give birth.

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