216 jen-der lee CHILDBIRTH IN EARLY IMPERIAL CHINA* by JEN-DER LEE (Institute of History and Philology, Academia Sinica) (English translation by Sabine Wilms) Abstract By the eighth century, medical texts had come to agree that an expecting mother should take herbal medicine in the last month of pregnancy to ensure a quick and safe delivery. Delivery charts, previously separated for different purposes, were inte- grated into one chart with twelve sub-charts for each month of the year. Women usually took vertical positions during delivery and were most likely supported under the arms by midwives. Ritual techniques and manual manipulations were applied to solve complications such as breech birth. The former often implied resonant relations between the baby, its mother and her husband, while the latter sometimes elicited criticism from male doctors as unnecessary interventions. The new mother would be restrained from social contact in the first month after delivery, because of both her need to rest and the fear of pollution. Friends and relatives, however, would bring over precious and nutritious food to “nourish her body,” said the medical texts, “not just to celebrate the child.” Introduction Procreation played a central role in women’s lives, and childbirth can be said to have been a crisis of life or death for pregnant women. If a pregnancy was successful, not only was the mother safe, but she also provided the household with descendants and labor. A smooth delivery was, as far as the family and community were con- cerned, a reason for celebration, as well as, for the participants and * This article first appeared in Chinese in the Bulletin of the Institute of History and Philology, Academia Sinica 67.3 (1996): 533-642. The English translation was done by Dr. Sabine Wilms and revised by the author to incorporate current research. The Appendix from the original Chinese version, containing herbal recipes for treating complications and for postpartum care, is integrated into the main text in the English version. © Brill, Leiden, 2005 NAN NÜ 7.2 Also available online – www.brill.nl nan7-2_lee.indd 216 12/13/2005 9:02:06 AM childbirth in early imperial china 217 helpers, an affirmation of their abilities and efforts. In the case of failure, the situation was entirely different. If the mother died and the child survived, the newborn child lost a mother, the household lost the mistress of the house, the situation of the surviving child became precarious, and poor families might have even lost their base of support. If the mother survived and the child died, then this failure at the last moment, after having nurtured the fetus for ten months, had an enormous impact on the parturient woman’s body and mind.1 A fetus that died in the womb, moreover, impacted the mother’s safety. And if both mother and child died, then the family and community were most likely grief-stricken, and it was hard for the birth attendants to avoid incurring blame. Birth is the stage at which the mother and the fetus separate af- ter ten months of pregnancy, and, in terms of the biological phe- nomenon, there is little difference between the past and the present, China and the outside world. But the medical management, rituals and taboos, and ideas and concepts surrounding this stage can nev- ertheless vary according to the culture of the times. Thus, the cir- cumstances of delivery in traditional Chinese society are well worth a thorough inquiry. Whether because searching for and gathering records is difficult, or whether scholars’ interest has yet to be stim- ulated, up to now monographs about traditional childbirth rituals and gynecological and obstetrical medicine are rare. Moreover, de- tailed studies of childbirth culture concentrate mostly on develop- ments in the late imperial period. Research studies on the situation in early imperial China are comparatively few.2 1 Although gestation is considered to be nine months in the West, traditional Chinese perceived it as to have been ten months. Even today, in popular language, people still use “ten months of pregnancy” (huaitai shiyue 懷胎十月) to describe a woman’s gestation pesiod. 2 Guo Licheng 郭立誠, Zhongguo shengyu lisu kao 中國生育禮俗考 (Taipei: Wenshizhe chubanshe, 1971), is probably the earliest work on this subject. It describes the childbirth culture of traditional society, including praying for a son, fetal education, and all other aspects of childbirth rituals. Ma Dazheng 馬大正, Zhongguo fuchanke fazhanshi 中國婦產科發展史 (Shanxi: Kexue jiaoyu chubanshe, 1991), summarizes the development of Chinese gynecological and obstetrical science from pre-Qin (221-207 BCE) to the Republican period. Zhang Zhibin 張志斌, Gudai Zhongyi fuchanke jibingshi 古代中醫婦產科疾病史 (Beijing: Zhongyi guji chubanshe, 2000), is the most recent general history on gynecological and obstetrical disorders and includes discussions on childbirth complications. See the review [infra]. For discussions of specific periods, such as Patricia Ebrey’s description of the abilities of people in the Song dynasty (960- nan7-2_lee.indd 217 12/13/2005 9:02:07 AM 218 jen-der lee When researching the issue of infant abandonment in early im- perial China, I realized that, following maternal death in childbirth, poor families had no choice but to consider abandoning the newborn. Therefore I wonder whether the many instances of infant abandon- ment at that time might not suggest the frequent occurrence of ma- ternal death in childbirth?3 Moreover, in my research on women’s lives in early imperial China, I found that women married mostly be- tween the ages of fourteen and eighteen, and the statistics on wom- en’s lifespans revealed that women’s death rate peaked between the ages of twenty and thirty. This seems to suggest that childbirth-re- lated conditions might have been one of the major causes of death for women at that time.4 In ancient times, methods of birth control and abortion were not sufficiently refined and widespread, which 1279) to care for women in childbirth, see Ebrey, The Inner Quarters: Marriage and the Lives of Chinese Women in the Song Period (Berkeley: University of California Press, 1993), 172-76. Xiong Bingzhen (Ping-chen Hsiung) 熊秉真, in her examination of pediatric medicine in late imperial China, also touches upon the issues of childbirth care. See Xiong Bingzhen 熊秉貞, Youyou: chuantong zhongguo de qiangbao zhidao 幼幼—傳統中國的 襁褓之道 (Taipei: Lianjing chubangongsi, 1995), 53-102. Charlotte Furth’s inspiring accounts describe the changes and continuities in gestation and birth from the Song to the late imperial period; Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History, 960-1665 (Berkeley: University of California Press, 1999), 94-133, 134-54; and more recently, Yi-Li Wu, “Ghost Fetuses, False Pregnancies, and the Parameters of Medical Uncertainty in Classical Chinese Gynecology,” Nan Nü: Men, Women and Gender in Early and Imperial China 4.2 (2002): 170-206. Only a few studies deal with the earlier periods, e.g., Li Jianmin 李建民, “Mawangdui Hanmu boshu ‘Yuzang maibao tu’ jianzheng” 馬王堆漢墓帛書禹藏埋胞圖箋證, Bulletin of the Institute of History and Philology, Academia Sinica 中央研究院歷史語言研究所集刊 65.4 (1994): 725-832. Li’s article discusses placenta burial customs and rituals as well as the idea of correspondence between Heaven and the human world in early China. But Li’s article, like Xiong’s book, concentrates on the survival and growth of the newborn and relatively seldom touches on the childbearing woman. My article on wet nurses also touches upon postpartum care; see Jen-der Lee, “Wet Nurses in Early Imperial China,” Nan Nü: 2.1 (2000): 1-39. A more recent study by Sabine Wilms on women’s medicine and its manifestations on the female body discusses the medicinal and cultural significance of childbirth to some extent. See Wilms, “The Female Body in Medieval Chinese Medicine: A Translation and Interpretation of the ‘Women’s Recipes’ in Sun Simiao’s Beiji qianjin yaofang,” (Ph.D. diss., University of Arizona, 2002), 59-84. 3 Li Zhende ( Jen-der Lee) 李貞德, “Han Sui zhijian de ‘shengzi buju’ wenti” 漢隋 之間的生子不舉問題, Bulletin of the Institute of History and Philology, Academia Sinica 66.3 (1995): 747-812. 4 Jen-der Lee, “The Life of Women in the Six Dynasties,” Journal of Women and Gender Studies 婦女與兩性學刊 4 (1993): 47-80, Tables I, V. nan7-2_lee.indd 218 12/13/2005 9:02:07 AM childbirth in early imperial china 219 increased women’s chances of pregnancy.5 If a woman married at age fourteen, stopped menstruating at forty-nine, and gave birth to ten children, she was involved in childrearing for most of her adult years, giving birth approximately once every three years. Since be- sides delivering her own children, a woman also observed, discussed, and assisted in the deliveries of her female friends’ and relatives’ chil- dren, birth was a common experience in most women’s lives. Reproduction also influenced women’s physical and emotional health. In the view of the Liu-Song (420-79) doctor Chen Yanzhi 陳延之, among women who marry and undergo childbirth too ear- ly, “the root of the kidneys has not yet been established, and birth then injures the kidneys,” with the result that young wives “have illnesses that are difficult to treat” and “those who do not fall ill are also ruined.”6 Chu Cheng 褚澄, a doctor of the Southern Qi 5 For a discussion of acupuncture and drug treatments for birth control and abortion in early imperial China, see Li Zhende, “Han Sui zhijian de ‘shengzi buju’ wenti,” section entitled “Avoiding pregnancy, preventing birth, and inducing abortion,” 787-94. Li Yinhe 李銀河 has researched the culture of birth in modern China and found that among women currently seventy to eighty years old, some had given birth seven, eight, or up to ten times.