History of Female Reproductive Medicine There is a proverb in Taiwan Province Province, China: "If you have more babies, the chickens will smell good; However, four boards. However, faced with the tense moment of childbirth, 1500 years ago, women in ancient China did not lie in bed during childbirth, nor did doctors help the parturient to give birth with peace of mind. The ancients took maternity as the center, surrounded by female midwives, and lived through life and death. Interview with Jen-der Lee, a researcher at the Institute of History and Linguistics, Academia Sinica. Through time and space, we can see how ancient gynecological medicine constructed the process of women's pregnancy, pregnancy and delivery, and get a glimpse of the gender view of body and medical care.

In the China TV series "Do you know that it should be green, fat, red and thin? Ming Lan, the heroine, stood on the crossbar and gritted her teeth to give birth to a fat son. This scene makes many fans worry, but they also wonder: shouldn't production be in bed? From the TV series "Do you know that it should be green, fat, red and thin? Sitting on the grass-ancient women didn't give birth in bed. "Madam, push, push, you can see the child's head! The parturient is lying in bed, and the midwife keeps opening the thick bed for examination. This kind of labor scene is often seen in China's costume dramas. However, if we compare medical books and literature, the picture may be a bit bug-the most common way for ancient women to give birth is not lying flat on the bed, but squatting upright on the ground to give birth!

"In ancient times, a woman sat on the grass after giving birth to a child. If she practiced dharma, she would die. It can be seen from this passage of doctors in the Southern and Northern Dynasties that women's childbirth is not only life-threatening, but also they have to get out of bed and squat underground to give birth. The ground will be covered with haystacks or hides, on the one hand, to prevent the baby from falling on the ground and being injured, on the other hand, to prevent the blood from polluting the house and offending the gods.

However, production is a life-and-death marathon with exhausted physical strength. Squatting in a vertical position is easy to exert strength, but it is difficult to support for more than ten hours. Because of this, we need several "waist huggers" (also called "midwives") in the delivery room. These midwives stood behind the parturient, hugging and supporting her armpits to reassure the parturient; The other is in front of the mother, ready to welcome the newborn. The word "childbirth" is rare in ancient books, and it was widely used after the Song Dynasty. If people 1500 years ago said "hold your waist", it was ready to deliver a woman.

However, production is so hard, why aren't the ancients in soft and comfortable beds?

Jen-der Lee speculated that this should be the main reason to facilitate the maternal exertion and fetal anterograde. In addition, according to the literature before the Tang Dynasty, the height of the bed can reach several feet (one foot is about 23 cm). There were countless times in the Southern Dynasties when pregnant women wanted to lose their children and "threw themselves on the ground". Put yourself in others' shoes. For a pregnant woman with a big belly and a midwife with her waist around her, lying in a high bed may not be the best choice for childbirth. Of course, material conditions may also need to be taken into account. In ancient times, life was not as good and convenient as modern life. Furniture such as beds and beds are far more precious than today. If it is soaked in a lot of blood, it will be scrapped.

China Sichuan Dazu Baodingshan stone carving is said to have been built by Zhao Zhifeng, a monk in the Song Dynasty. Among them, the stone statue of "Pain during childbirth" vividly presents the childbirth scene of ancient women. The parturient gave birth upright, with a midwife holding her waist behind her back and a midwife preparing to deliver the baby in front. Jen-der Lee raises a baby every month, and the ancient pregnant mother gave birth by eating and drinking, which is not only an important event for women to survive, but also a crucial moment for male society to carry on the family line. Since the Han dynasty, the medical care for women's bodies has obviously focused on "fertility", and there are suggestions and taboos for nursed back to health during pregnancy, childbirth and postpartum.

Between the 5th and 7th centuries, this accumulated knowledge began to be summarized and integrated. On the basis of sexualized body view, it gradually tends to be standardized and consistent, which laid the foundation for China obstetrics and gynecology to become an independent discipline in the Song Dynasty.

For example, Zhang Zhongjing, a medical sage in the Han Dynasty, suggested that pregnant women often take Danggui San. Doctors in the Southern Dynasties advocated taking "Danshen Ointment" prepared with Danshen, Ginseng and Angelica. Assist delivery in the seventh month of pregnancy. However, Xu Zhicai in the Northern Qi Dynasty said that "Danshen Cream" was too slippery and should be eaten in October. In the Tang Dynasty, Sun Simiao adopted Xu Zhicai's viewpoint. In the Song Dynasty, the saying of taking anti-abortion medicine in July was no longer circulated.

In addition, Xu Zhicai also provides a detailed "formula for raising a fetus in the next month", suggesting suitable grains and meat for pregnant women according to the month of pregnancy, and then nourishing them with prescriptions. In modern times, this is almost like the "monthly recipe recommendation" of pregnant mothers, which supplements appropriate nutrition for all stages of fetal development.

Raising a baby has good luck, and naturally there are taboos. China's concept of meridians was established after the Han Dynasty, and medical books also mentioned acupoints that should be avoided every month in order to avoid accidental abortion.

Don't eat soy sauce, don't listen to bad words, the tradition of prenatal education goes on for a long time, eat more children's skin and less touch their pregnancy. All kinds of experiences have made many modern expectant mothers feel heavy pressure-mommy is not alone, and this kind of trouble also exists among ancient women!

Ancient medical prescriptions not only recorded herbs and acupuncture, but also recorded superstitious therapies that seem to exist today. Because in the pre-scientific civilization era, "prescription" was a method to eliminate diseases and save lives, and herbal medicine was also a prescription to ward off evil spirits, which was recorded in medical prescriptions to ensure the safety and smoothness of parturient and parturient.

The following is also available to doctors.

It is not advisable to eat soy sauce during pregnancy, and the child's skin will be black. Don't eat ginger, lest you have a child with six fingers like ginger. If you want to have a son, you can watch chickens, tigers and leopards and play with swords. If you want a daughter, you might as well wear earrings and beads, and Yu Pei jingle! If you expect your child to be clever, kind and polite, then pay attention, don't eat the meat if it is not cut correctly, don't sit at the table if it is not correct, don't pay attention to it if it is indecent, don't listen, don't say anything-because pregnant women will be affected by "the external image will become the internal image".

Who said that the ancients were very different from us? The "prenatal education" that people are accustomed to today was written into medical prescriptions as early as 1000 years ago and existed in the life world of the ancients.

Jen-der Lee mentioned that,

These methods seem unscientific, but they actually reflect China's "Qi's body view".

At that time, people used "qi" to understand the world. Heaven and earth contain gas, and people are born of gas. Qi circulates in everything and interacts with our bodies. People and things that are ugly or beautiful on the outside will affect the fetus through the mother. Therefore, some scholars say, "All stupid and ugly children are named after their mothers. The quality of children has become the standard for judging pregnant women's words and deeds.

Mother's heart is bitter, ancient and modern!

Seeking pregnancy, seeking men and seeking good men, from prenatal care to prenatal education, are all aimed at making pregnant women not only live well, but also live well-"seeking pregnancy, seeking men and seeking good men" and making them famous in World War I!

The battle reached the most critical moment, "labor in labor."

The property owner must prepare the site in advance, which can be a room in the house or another property or property account. The location of the delivery room is not arbitrary, but should follow the direction of the production month to avoid misfortune and to be smooth and safe. For example, "in the first month, the weather went south and the mother was facing south ... it was so lucky." 」

This whole set of good and ill luck theories corresponding to time and orientation also includes the concept of the interaction between man and nature, and time, space and people are mutually influenced. There are "birthday maps" in medical books, such as January, February and March. So that producers can prepare every step of delivery according to the birth chart of the month of delivery.

In addition to the orientation of delivery, the birth chart is also used to "bury the fetus" after delivery. The ancients believed that the afterbirth (placenta) and the baby are interrelated and must be properly buried; If something goes wrong, the fate of the child will be affected. Among the cultural relics unearthed in Mawangdui, there is a "Jade Treasure Map", which indicates the burial direction of fetal membranes in different production months. In the Sui and Tang Dynasties, a "December map" began to appear, which integrated the positions that should be paid attention to, such as sitting on grass, giving birth and burying cells. In the Tang Dynasty, Wang Dao's "The Secret of Outer Taiwan" collected the December map of Cui Shi. At the time of labor, the person holding the waist (helping the parturient) has been waiting by, accompanying and comforting the parturient, helping the parturient to relax, and the parturient can sit, lie and walk, mainly for comfort. When will you start to exert your strength? Modern medical treatment is based on "opening a few fingers", while ancient judgment is based on "how painful it is". Premature exertion can easily lead to poor physical strength; You can't start sitting on the grass until the mother is in great pain, which means she is close to giving birth.

Even if the whole labor process goes smoothly, it will take more than ten hours. The lying-in woman gives birth squatting, and the one who holds the waist gives birth in tandem. If you are short of manpower or the labor process is too long, you need assistive devices to come to the stage. For example, in the costume drama of the Edo era in Japan, you hung the beam with clothes and tied it to the pregnant woman's hand, or hung a crossbar to help her lean hard. In the dowry of Japanese-ruled China's Taiwan Province Province, there is a baby bucket, and the parturient squats on the side of the bucket, holding on to the side of the bucket for support and exerting strength. The early Chinese dowry in Hong Kong also had a toilet called "descendants bucket", which was probably used as an auxiliary production.

The baby is born, hold it open! What happened after the baby was born safely?

In costume dramas, it is often played like this: the mother tried her best to give birth to the baby and said weakly and eagerly, "Bring the baby to me quickly." The actual situation of the historical site is unknown, but from the perspective of ancient Chinese medicine, this process is a "big mistake."

At this time, the midwife must hold the child away, and must not reveal the baby's gender, so as to avoid surprise and psychological trauma to the mother. Because even if the baby is born smoothly, this life and death marathon is still not over. Blood collapse, placental failure and lochia are all risks, so we must pay close attention to the life safety of the parturient for three days after delivery, and it is still in the observation period for three to seven days. Until it is confirmed that there is no fatal lesion and the alarm is lifted, you can begin to nourish and recuperate, but you can only work and rest normally after 30 days, just like the familiar "confinement".

The "three aunts and six grandmothers" who accompany the parturient must have risks in childbirth. If you are unfortunate enough to encounter dystocia, in addition to using soup, there are also records of "the hand of God" in medical books.

Because the maternal fetal position is not correct, the fetal hand comes out first, and if you are not careful, you may die in dystocia. Fortunately, the midwife pushed the fetus back to the birth canal, * * * turned positive, and finally gave birth safely and smoothly.

Similar records are not uncommon. In ancient Hebrew literature, skilled midwives delivered dystocia twins. Medical books between Han and Tang dynasties also say that if the fetal hand reaches out first, it can be pushed back to rebirth. Interestingly, before the instructions in the medical book are postponed, you can write your father's name on the palm of your hand and threaten to "turn your rebellious son over a new leaf"!

"Male doctors emphasize paternal induction of labor, but it can be inferred from this record that midwives at that time may have clinical skills to rescue dystocia. Jen-der Lee's analysis: "There will be no doctor in the whole production process, and the producer actually plays the most important role. 」

However, the medical books were written by men, collected by men and set up by men. It is difficult for this group of midwives who silently support their wives to enter the "elegant hall". In the long history, they only belong to one of the traditional three aunts and six grandmothers. They don't have the name of a doctor and the right to speak, but they may be professionals who really practice and impart knowledge about childbirth, and accompany the parturient through the difficulties of life and death.

Sitting in confinement, prenatal education and eating less soy sauce, if not an ancient medical prescription, may be considered as the experience sharing of mom forum. Jen-der Lee used "the bottom of history" to explain it. Traditional historiography pays attention to the changes and changes of large-scale systems. However, behind the earth-shaking rise and fall, many Chang Min concepts have actually quietly settled at the bottom of the long river of history, which has not changed for thousands of years and still profoundly affects us today. Istok committed suicide and regained his mother's medical subjectivity. Throughout the birth process of the ancients, the biggest difference between them and now is "birth * * *". Why on earth did a woman change from standing or squatting to lying down to give birth?

According to Jen-der Lee's analysis, vertical * * * was a common delivery mode in the east and west in the past, and it turned to lying flat, about after the rise of hospital system in18-19th century.

The production space has moved from a familiar home to an institution, and the main body of the parturient has changed from a mother to a doctor, gradually changing the production experience of women.

Taking the doctor as the main axis of surgery, lying flat for women has become a more convenient posture for medical treatment. With the help of modern medical care, many high-risk pregnant women can give birth smoothly, greatly reducing the chance of death during childbirth. However, a high degree of medical intervention also separates the production from the female subject experience, and reverses the maternal-centered delivery process.

Jen-der Lee, who has been paying attention to the history of gender medicine for many years, is often invited to share it. In the past time and space, women had a variety of pregnancy and childbirth experiences, and mothers and midwives worked together; Passive lying, which is up to the practitioner, is not a fixed standard answer. However, she also reminded that this is not an absolute dichotomy of resisting medical treatment and returning to tradition, but learning from different time and space through historical materials and seeing the possibility of multiple choices.

"History is like a huge database. Understanding human experience in different time and space can help us to reflect on and understand the current environment and its phenomena, which is not necessarily the only choice. Jen-der Lee expressed the worry of many years' research: "This is not only the worry of studying the history of fertility or women, but also the important value and significance of history as a humanities subject. 」

"Holistic Birth" is a birth movement that has arisen in recent years. I hope to reduce unnecessary medical measures and restore the experience of "maternity as the main body". Through full discussion, understanding and support, accompany the parturient in all stages of delivery, such as going to the hospital, giving birth at home, squatting down and giving birth in water … so that the parturient has the opportunity to "choose how to give birth". iStock