One of the first things you need to do once you realize you’re pregnant is to find a health practitioner who is specialized in prenatal care. For most people, that means choosing between an OB-GYN (obstetrician and gynecologist) or a midwife.
Both professionals are well versed in prenatal care. But as you scour the internet, you’ll find that some people are firmly team OB-GYN or team midwife.
While midwives and OB-GYNs offer similar services, they may offer different philosophies about labor and birth. And in some settings, and if certain circumstances arise, you may be working with both a midwife and an OB-GYN.
Finding a patient-centered care provider you trust and who makes you feel comfortable is important, no matter the approach and no matter what the titles are of the people who will be taking care of you and your baby.
Bottom line: All involved should be working on behalf of the pregnant person, making your childbirth experience as smooth and safe as possible.
So… how do you choose between an OB-GYN and a midwife? Is one better than the other? What’s the difference between them anyway? And which one is right for you?
Starting with the similarities, both midwives and OB-GYNs are trained to provide medical care, support, and guidance in the following areas:
And, again, both types of healthcare professionals ultimately want to see the very best outcome for their pregnant patients and their babies.
The OB-GYN difference: training, certification, accreditation
OB-GYNs, or obstetricians, are medical doctors who are also trained to perform surgeries. As it relates to pregnancy, these surgeries can include cesarean deliveries (C-sections) and episiotomies.
OB-GYNs are also trained to manage pregnancy-related complications with medical interventions such as inductions or assisted deliveries.
OB-GYNs must meet the requirements outlined by the American Board of Obstetrics and Gynecology (ABOG). These include graduating from an accredited and approved medical school and completing 4 years of residency covering gynecology, obstetrics, ultrasonography, gynecological oncology, and preventative care.
They must also pass a test regulated by the ABOG and earn state certification to practice in their state.
OB-GYNs can practice in hospitals, clinics, or a private or group practice. Note that some OB-GYNs pursue additional studies and specialize in specific niches such as infertility or fetal medicine.
Many OB-GYNs belong to the professional organization The American College of Obstetricians and Gynecologists (ACOG). Here are statements on their mission, vision, and core values.
The midwife difference: training, certification, accreditation
Midwives aren’t medical doctors, but the majority have a master’s degree or have attended an accredited education program. Most adhere to certification requirements as set forth by the American College of Nurse-Midwives (ACNM) or the North American Registry of Midwives (NARM).
A midwife’s scope of practice can vary widely throughout the United States, depending on the classification of midwife and the limitations mandated by each state.
And understanding the classification of midwives can be very confusing!
Types of midwives
In general, midwives in the United States can be categorized into two main categories: certified nurse midwives (CNMs) and direct-entry midwives (DEMs). A direct-entry midwife is anyone who enters directly into the field of midwifery without becoming a nurse first. Beyond that, here’s what you need to know:
- For the sake of this article, direct-entry midwives (DEMs) include certified professional midwives (CPMs) and traditional midwives.
- CPMs have a national certification, but there are a few states where they can’t legally be licensed. When they can be licensed, the license is usually called “licensed midwife (LM)” or “registered midwife (RM).” Depending on the state, midwives might just identify by the license name (LM), rather than saying CPM. In some states CPMs practice without licenses.
- Traditional midwives are allowed to practice in some states, usually in more traditional communities or in indigenous communities. Their training can vary widely.
- The term lay midwife is still used sometimes, but has a pretty nebulous definition.
- Certified nurse midwives (CNMs) are licensed as advanced practice registered nurses (APRNs) or nurse practitioners (NPs). They can practice in every state and generally can prescribe contraception. They most often work in hospitals, but can also work in clinics birth centers, and providing home birth.
- Certified midwives (CMs) have the same scope as CNMs, but aren’t recognized in very many states (only 6). While they’re technically direct-entry midwives, they’re generally considered in the same category as CNMs since their scope is the same.
CNMs are by far the most common and have the most education CMs are kind of the little sister to CNMs: less education, but same scope of practice. There are not very many CMs.
CPMs are the next most common. There are fewer and fewer traditional or “lay” midwives all the time, as ACNM and NARM have joined forces to make sure that all new midwives have attended an accredited educational program.
CNMs and CMs can work in any setting, but most work in hospitals. DEMs and CPMs can generally practice only in out-of-hospital settings like birth centers or homes.
Other midwife differences
Aside from training and accreditation, midwives focus more on encouraging vaginal birth and providing holistic care for pregnancy and the postpartum period. There’s an emphasis on education, with a focus on topics such as nutrition, breastfeeding, and infant care.
While certified midwives will often work with a labor and delivery team that can include an OB-GYN, in general, they focus on reducing a pregnant woman’s reliance on medical interventions unless it’s absolutely necessary.
Evidence has shown that the benefits of relying on a midwife for pregnancy and birth can include:
reduced infant mortality rates reduced need for interventions and inductions - higher satisfaction rates with quality of care
- reduced risk of preterm births
reduced risk for having a cesarean delivery
ACNM is the professional association that represents CNMs and CMs in the United States. Here is a statement on their philosophy of care.
Typically, midwives are a more economical choice for pregnancy since the cost for routine prenatal care visits is usually cheaper than with an OB-GYN and is even covered by Medicaid.
However, you should always consult with your insurance provider to confirm what prenatal services are covered and their associated costs.
If you have a low risk pregnancy, whether you are seeing a midwife or OB-GYN, you’ll most likely stick to a similar prenatal checkup schedule. This means one monthly appointment for the first 6 months, two bi-monthly appointments during months 7 and 8, and a weekly appointment in your ninth month of pregnancy.
That said, you might see a midwife at a birthing center or even in your home. In any setting, a midwife is likely to spend more time with you during your prenatal visits than an OB-GYN would, answering your questions, providing education and getting to know you.
During those appointments, a midwife may also focus on your holistic care and provide recommendations for other therapeutic solutions like chiropractors or massage therapy.
Another main difference between using an OB-GYN or a midwife will come into play during labor and delivery.
As we’ve noted, midwives prioritize natural pain management techniques during labor and delivery. However, this doesn’t mean that if you tell them you’d like to use pain medications they’ll veto your request. (Nor does it mean that an OB-GYN will encourage pain medications if you’re aiming for a medication-free birth!)
Generally speaking, a midwife will not recommend a cesarean delivery unless it’s considered absolutely medically necessary. On the flip side, that doesn’t mean that all OB-GYNs are advocating for C-sections either.
If you choose to give birth at home or in some birth centers, the midwife you see during your prenatal visits will likely be the same midwife who is there with you during labor and delivery.
Sometimes with hospital-based midwives and OB-GYNs it’s not always guaranteed that your provider from your prenatal visits will be available when it’s time to deliver your baby — it may depend on who from the practice is on call overnight!
What about doulas?
Doulas are labor coaches that provide the physical and emotional support you need to push through labor and birth. They prioritize natural methods for pain management such as relaxation, breathing, movement, and positioning. They can also provide much-appreciated support and guidance to your partner.
Doulas often work with midwives or doctors as part of the labor and delivery team, and evidence has shown that having a doula present for labor and birth
If you’re thinking about working with a doula for your birth, check to see if your insurance covers their costs — often doulas are not covered by insurance. The most important factor when choosing a doula is finding someone you trust and connect with since they will be your labor support when it’s go-time.
So, which is the better choice for you, an OB-GYN or a midwife? The answer is going to depend on what’s important to you and whether or not you fall into the category of a high risk pregnancy.
You might prefer an OB-GYN if…
An OB-GYN can be an excellent choice for prenatal care if you have a high risk pregnancy, would like to deliver via C-section, or are concerned about preexisting medical issues.
Since OB-GYNs also treat women who aren’t pregnant, a patient who already has a beloved OB-GYN might decide to continue treatment with that physician once they get a positive pregnancy test. If a labor emergency arises and a C-section is needed, you’ll have the peace of mind that your doctor is trained to perform surgery.
You might prefer a midwife if…
A midwife can be a great choice if your pregnancy is deemed low risk. This care provider is ideal for women who want a more holistic approach to pregnancy and recommendations (and encouragement) for nonmedical interventions to deal with the aches and pains of pregnancy as well as labor and delivery.
Additionally, a midwife is usually covered by insurance, can be cheaper than an OB-GYN, and some also offer home visits.
Even if your pregnancy is high risk you can see a midwife, but be sure that the midwife you choose is part of a medical team, or able to consult with or call in an OB-GYN in case complications occur.
Also, recognize that complications can occur even in low risk pregnancies, so it’s a good idea to fully understand what your midwife’s plan is for medical intervention, if needed.
There are pros and cons for choosing midwives or OB-GYNs to manage your prenatal care, labor, and delivery. There’s no right or wrong choice — it depends on which is best for your specific circumstances, and what gives you the most peace of mind.
As with any medical decision, do your research, talk to providers you trust, consult your insurance, and go with your gut.
