Reviewed by Chaunie Brusie, RN, BSN
If you’ve ever wondered what the difference in care between a midwife vs. OB/GYN is, fortunately I’ve had experiences with both.
I’ve given birth in a hospital four times—three times with a physician and once with a midwife, who was a CNM (Certified Nurse Midwife). My experience with a midwife was great: I appreciated her willingness to communicate about each step of the pregnancy and every decision I needed to make. I’ve also had two great experiences, and one not-so-great, with an OB/GYN.
Ultimately, I found that where I was delivering played as big of a role in my experience as who was helping me in the type of birth I had. Before you select your care provider, here is what you need to know about choosing between a midwife vs OB/GYN for the birth of your child.
In this article:
Midwife vs. OB/GYN: Education
Education, approach to care, and delivery setting are a few of factors that can set midwifery apart from OB/GYN care for pregnant women. An OB/GYN must complete medical school, followed by a four-year residency, and then rotations in their specialty field. These care providers must achieve and maintain certification through the ACOG, or American Board of Obstetrics & Gynecology. Certified Nurse Midwives, or CNMs, are registered nurses who have sought out an additional three years of graduate study and then certification from the American Midwifery Certification Board, or AMCB. They can provide a full range of prenatal, pregnancy, postpartum, and women’s health care. There are also two other types of midwives: professional and lay midwives. A professional midwife isn’t a registered nurse, but has met requirements set by the North American Registry of Midwives (NARM). Lay midwives are different from professional midwives or CNMS because they are not required to have a college or graduate degree. Instead, they are self-taught or learn under another lay midwife, many times in the community. Since they are not licensed or registered with the state, there isn’t a set of education or training standards they are held to.
Midwife vs OB/GYN: Approach to Care
Both midwives and OB/GYNs adhere to professional standards of care for pregnant people, but their approach to care will be largely influenced by their medical education, professional experience, and the level of continued education required for maintaining their licensure. In my experience, having given birth in three different hospitals, there are certain practices that are standard across the board. For instance, both CNMs and OB/GYNs will defer to guidelines the ACOG provides for everything from prenatal vitamins, pregnancy nutrition, ultrasounds, and fetal monitoring during labor. However, there are other practices that might be influenced by their professional experience or the culture of the hospital, such as methods of pain management, how they monitor maternal mental health, or how hands on they are during a birth. Generally, a midwife is perceived to be more natural-minded and expecting parents may seek them out if they desire to give birth without an epidural or with minimal medical intervention or more one-on-one care. However, that doesn't mean you can't get have an epidural birth with a midwife--it just means that you may have different options of support available to you if you would like to go medication-free during birth. In my experience, my certified nurse midwife was more than happy to discuss a variety of options for managing my postpartum depression and preparing for pain management during birth. However, when it came to giving birth it was ultimately the nurses and the hospital culture that played the biggest role in how I labored and managed my pain.Where You’ll Deliver
Both Certified Nurse Midwives and Certified Midwives can provide care in a hospital setting, birthing centers, or at home in some states, according to the American College of Nurse-Midwives. In some states, CNMs must operate under the supervision of a physician which could prevent them from offering home birth services. If you want a home birth under a midwife, your best bet would be to turn to a lay or professional midwife. According to the Midwives Alliance North America, midwives must have home birth experience to achieve their certification.
How to Choose a Midwife vs. Doctor
Choosing between a midwife and a doctor is ultimately about knowing what you want from your prenatal care and your labor and delivery. If you prefer to give birth in a hospital setting, an OG/GYN may be your only option since not all hospitals have practicing midwives. For expecting parents with exceptional medical needs or complicated pregnancies, such is if you're pregnant with twins, working with a physician may provide the most security and access to resources you require for a safe birth. Midwives do not typically provide C-sections on their own, so if you already know that you will be giving birth this way, an OB/GYN is a good choice for you. For parents who would prefer the least amount of intervention, a midwife may provide a more personalized, one-on-one approach to care and a low intervention environment for labor and delivery. For instance, a midwife can help support you during labor and provide pain relief options outside of an epidural. Your birthing team also plays a vital role in the type of birth you want to have. For this reason, hiring a doula can be a great choice for parents with specific goals for how they labor and give birth. A doula is trained to support mom and her vision for birth at home and in hospital settings. These care providers do not assist with birth. Instead, they can help mom with pain management, provide emotional support, and give breastfeeding guidance after the baby arrives.What Happens if You Want to Switch Your Doctor?
If you decide that you’d like to switch from a midwife to a doctor, or vice a versa, you always have the right—even at any point in your pregnancy. To make the switch, you can speak with your existing care provider to provide an explanation or you can simply make an appointment with your new birth professional. You will need to fill out the appropriate form allowing them to obtain your medical records. Before switching providers, verify that the new hospital or care provider is in-network with your insurance. If you are exploring a home birth, it may not be covered by insurance but they should be able to give you a quote for paying out-of-pocket. It is also important to consider any payments you’ve made to your existing healthcare provider and if that will be refunded if it was an advanced payment for your labor, delivery, and hospital stay.The Bottom Line
Saying each pregnancy is different may feel like a cliché, but there is a reason it is said so often — it’s true! When choosing the best care provider for you and your growing baby, consider your hopes for your pregnancy and delivery along with your specific medical needs. Once you’ve decided between a midwife or an OB/GYN, don’t forget to do your research on the hospital and the specific healthcare professional you hope to work with. Learning about their philosophy of care and the experience of their patients can be just as important as deciding between a midwife vs. OB/GYN.Frequently Asked Questions
