Safety of Care

It sounds like you’re both united on the level of your needs: you both want a safe birth and a healthy baby. A good thing to do would be to listen empathically to what he is saying (mirror back his underlying feelings and needs) and ask what he hears you saying. Then you find that you’re in agreement on a deep level, but not in agreement about strategies, based on different understanding. As you are finding, shifting from the dominant paradigm that the American obstetrical model provides the safest and best birth while midwifery care does not involves a lot of re-education, but science is on your side, and you still have plenty of time ahead of you.

In fact, midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes. The safety of midwifery care has been established by a large body of mainstream research. I don’t know of any one site that would convince your fiancé, but since it sounds like he wants “objective science,” I’d go for the big guns and search PubMed, the U.S. National Library of Medicine's database of over 4,000 biomedical journals. Most are too technical to want to read, but you might copy the abstract and the source to share. Here a few quotes from recent studies:

“In terms of quality, satisfaction, and costs the midwifery model for pregnancy and maternity care has been found to be beneficial to women and families, resulting in good outcomes and cost savings....With its focus on pregnancy as a s normal life event and health promotion for women of all ages, them midwifery model of car is an appropriate alternative or complement to the medical approach to childbirth.” (from a position paper in the American Journal of Public Health, 91:3, March 2001).

At the state level, in California the Pew Health Profession Commission and UCSF Taskforce on Midwifery concluded in 1999, “It is the finding and vision of the Taskforce that the midwifery model of care is an essential element of comprehensive health care for women and their families that should be embraced by, and incorporated into, the health care system and made available to all women.” These and other quotes can we found at the Citizens for Midwifery website.

My favorite, a meta-study was done in Canada that pulls together all the studies in English concerning best practices in pregnancy and birth, is described in a book for the public called A Guide to Effective Care in Pregnancy and Childbirth, edited by Murray Enkin. Their conclusion: “It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by an obstetric specialist….Midwives and general practitioners, on the other hand, are primarily oriented to the care of women with normal pregnancies, and are likely to have more detailed knowledge of individual women.”

Anne Diamond summarizes other studies: “In 1998, the National Center for Health Statistics released its findings that the risk of infant mortality occurring in the first 28 days of life was 33% lower for births attended by certified nurse midwives. It also found that the risk of a low birthweight infant was 31% lower. A survey published by the Public Citizen Research Group found that the Cesarean section rate for certified nurse-midwifery practices attending hospital births was 11.6% — half the overall Cesarean rate for the United States. These outcomes were achieved with a substantially lower use of drugs, anesthesia, and episiotomy.

The safety of birth center care has also been clearly demonstrated by research. Most notably, a study was published in the New England Journal of Medicine in December, 1989, which examined over 11,000 births in 84 birth centers and revealed a Cesarean section rate of 4.4% and an overall infant mortality rate of 1.3 per 1,000 births (as compared to a national infant mortality rate of over 9 per 1,000 births in 1989).”

Walk lightly and just slip him an article with breakfast every few weeks.
Good luck! Rahima