Childbirth At Its Best by Nial Ettinghausen

    Review of Skilled Childbirth At Home (1975) in paperback by Dr. Nial Ettinghausen D.C., D.P.
    Revised and re-published as Childbirth At Its Best (1980) in hardback

    Reviewed by Ronnie Falcao, LM

    Copies of this book are still available

    These books are an interesting snapshot of the remnants of doctor-attended homebirths.  Although Dr. Ettinghausen was trained as an Osteopathic Physician* and a Drugless Practitioner rather than an M.D., he expresses the hope that "doctors/obstetricians" will routinely offer homebirth care.  He then discusses the reasons why this is unlikely to happen and proclaims that we must alternately support a return to midwifery care in the home.

    Indeed, his attendance at homebirth is described as very non-interventive, as if directly descended from the very best that true midwifery can offer - an experienced blend of watching, waiting, trusting and prudent intervention.

    The books begin with a discussion of the rightness of the home as the place of birth.  There is a detailed discourse on his empirical observations regarding the superior safety of homebirth, although he declines to reference the research or studies that statistically support homebirth safety.

    His personal statistics are impressive:

    Out of 2261 homebirths, there were 3 transports for blood loss, 1 for shock and only 1 post-partum infection. It's not entirely clear what the neonatal death rate is - I believe he transferred care for pre-labor fetal deaths. The statistics report 6 stillbirths and 5 newborn deaths after hospital transport.

    Homebirth midwives will be astonished at the numbers in his practice.  In the peak year, 1975, there were 438 labors resulting in 422 homebirths.  As far as I can tell, he attended all of these, improbable as it seems.

    It is mentioned in several different places that the book is not meant as a manual for unassisted childbirth.  However, in the introductory acknowledgment, the compiler and editor, Stephen L. Smoke, writes, "It was my hope that this book, though not intended to be a do-it-yourself manual for childbirth, would contain enough information so that . . . anyone, including myself - in an emergency - could assist his wife or a friend in delivering a baby."

    Indeed, the book is written to be easily understood by non-professionals, and it contains simple explanations and solutions for the most common complications of labor and birth.  These are listed as "Helps for the Practicing Midwife" and include anterior lip, false labor, controlling labor, prolapsed arm, shoulder dystocia, twins, persistent posterior, cord prolapse, cord around neck, delayed placental separation, and breech and face presentations.

    This book is wonderfully supportive of birth as a natural physiological process.  There is also a clear focus on birth as a family-centered event.

    There is also a strong emphasis on the husband's role in providing labor support:  "When a pregnant woman needs to be comforted, where does she want to be?  She wants to be in her husband's arms.  She wants him to comfort her, to love her, to assure her that all is well."  and "One husband giving his love and support outweighs in value all the sedatives and medicines in the world."

    "We who have put many hours into this book, want it to achieve these goals:  first, for the family to be united and the father to be at his rightful place; secondly, for the mother to know that love is all around her; and lastly, for the baby to feel the comfort and assurance that all is well."

    My personal assessment of this book is that it is a valuable addition to a midwife's personal library, primarily for its historical value.  I wouldn't include it in my lending library because of the emphasis on doctor-attended homebirth and because there are a few outdated pieces of advice.

    Despite the book's many protestations on this point, I think its greatest value is as a reference to the unassisted childbirth movement, especially the God-based, husband-centric cultures.

    * Dr. Nial Ettinghausen received his license as a Drugless Practitioner in 1939 and his license to practice Chiropractics in 1942.

Copies of This Book Are Still Available

Although these books are out of print, a very satisfied client of the late Dr. Ettinghausen bought up the inventory and is offering these for sale: Please send check and order information to:
Jerry Gentry
Rt 2 Box 198
Big Sandy, TX 75755

This book review by Ronnie Falcao

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