Pregnancy is a time of planning and decision-making. And one of the choices expecting parents make is who will provide their prenatal care and deliver their baby: an OB-GYN or a midwife?
To help you make that decision — and clear up some of the myths surrounding the two — we talked to providers from both professions.
First, it’s important to know that there are several types of midwives in the U.S. with different educational backgrounds and levels of training. If you are looking for a licensed medical professional who can provide general gynecologic care (think: annual exams, pap smears, managing contraception), prenatal care and also deliver babies in a hospital, your options are an OB-GYN or a certified nurse midwife. OB-GYNs are doctors who specialize in pregnancy, childbirth and women’s reproductive health. Certified nurse midwives, or CNMs, are registered nurses with a master’s degree in midwifery — patient-centered care during pregnancy, birth, postpartum and throughout a woman’s life.
As nurse-midwives, “we practice independently from physicians and can make our own diagnosis, treatment plans and provide prescriptions as necessary,” certified nurse-midwife Megan Cleveland of Southwest Midwives told HuffPost.
There are also certified midwives, or CMs, who have the same midwifery education, sit for the same board exam, and have the same scopes of practice as CNMs, according to the American College of Nurse-Midwives. However, unlike CNMs, CMs do not have to have a nursing license. Also, CMs are only licensed to practice in select states, while CNMs are licensed in all 50 states and other U.S. territories. The vast majority of CNMs and CMs deliver babies in hospitals.
“Midwives often have longer appointment times, smaller patient loads and more time to get to know patients and provide individualized care.”
- Megan Cleveland, certified nurse-midwife
Then there are certified professional midwives, or CPMs, who have no degree requirement but are certified through the North American Registry of Midwives. They work in birth centers and homes. Their scope of practice is limited to the pregnancy, birth and postpartum period.
Lay midwives are community midwives “who may have had little formal training or recognized professional education in midwifery,” certified nurse-midwife Mitra Davis, co-founder of Ask A Nurse Midwife, told HuffPost. “They learn their skills and knowledge by accompanying another birth attendant and/or by apprenticeship.” Lay midwives deliver babies in the home setting.
In this article, though, we’ll focus primarily on certified nurse-midwives (CNMs) and how they differ from OB-GYNs to help you better understand your options for a hospital delivery.
Generally speaking, midwives are experts in low-risk pregnancies, while OB-GYNs are experts in high-risk ones.
Women with pre-existing conditions like diabetes, high blood pressure, thyroid disease or significant risk factors during pregnancy would typically be “risked out” of midwifery care, said Dr. Nicole Rankins, an OB-GYN and host of the “All About Pregnancy & Birth” podcast.
However, in recent years there’s been a shift towards “more and more midwives caring for patients who traditionally would not be under midwifery care,” she told HuffPost.
Indeed, Cleveland, the certified nurse-midwife, said that some women — such as those over the age of 35 with a thyroid condition or a history of miscarriage — believe they’re not good candidates for midwifery care when, in fact, they might be.
“If you have been labeled ‘high risk’ but are interested in midwifery care, I would encourage you to consult with a CNM to see how your care would be individualized based on your risk factors.” In some cases, midwives and OB-GYNS co-manage higher-risk patients — so that might be an option.
Another difference is that OB-GYNs can perform cesarean sections while midwives cannot, though they may assist with the surgery.
“All midwives should have an agreement with a collaborating OB-GYN to perform a C-section,” Cleveland said. “Always ask a potential provider about this arrangement. In our hospital, our collaborating physicians are available 24/7, and we assist them with the surgical procedure.”
Midwives tend to spend more time with their patients and take a more holistic approach.
They’re known for longer prenatal visits, offering more one-on-one labor support and taking a whole-person approach to caring for their patients.
“Midwives often have longer appointment times, smaller patient loads and more time to get to know patients and provide individualized care,” Cleveland said.
Davis agreed, saying: Midwives pride themselves on building relationships with their patients and their families to “educate and walk you through your entire experience.”
That’s not to say that you won’t find an OB who takes time with their patients to answer questions and provides holistic care — it’s just not as common.
“I’ll be honest, we are not as likely to approach things that way because that’s not the way we’re trained,” Rankins said. “But it’s certainly possible.”
Also, the midwifery model of care views pregnancy and birth as “a normal part of a woman’s life instead of a disease process,” Cleveland explained. “We are constantly providing education, reassurance and guidance through the process while watching for any abnormalities that may arise.”
The medical model of care is more focused on preventing and managing the problems and complications that may occur during pregnancy and birth.
Midwives are less likely to use medical interventions during birth.
Studies have found lower rates of C-sections and labor inductions for women under the care of a midwife versus those under the care of an OB-GYN. So if having a low-intervention birth is important to you, this is something to consider.
On the other hand, some patients may be comforted by going with a physician who “has the capability to do a C-section or operative things, if need be,” Rankins said. “Some people do feel better in that regard and want that peace of mind.”
Midwives are known for unmedicated births and “look for pain management techniques that support the natural process,” certified nurse-midwife Judy Berk told Parents.com. That includes taking showers, switching positions or using a birthing ball.
But most midwives will support a woman’s decision to have an epidural if she chooses that route.
“I encourage women to have the birth experience they want,” Cleveland said. “If that includes an epidural or an elective induction, that is up to them. The most important thing is that women have the opportunity to make informed decisions about their own birth. Our practice offers unmedicated births, water births, nitrous oxide (laughing gas), IV pain medication or epidurals.”
Davis likened midwives to “chameleons” because they tailor their care to the individual’s needs.
“We offer labor support for women who choose to go without medical pain management, as well assistance to our laboring patients who wish to get an epidural,” she said.
Here’s how to find the right provider for you.
If having an unmedicated and low-intervention birth is your priority, then a midwife can be a great option. However, if you have more risk factors or medical needs, an OB-GYN may be a better fit — and in some cases, a necessity.
The most important thing isn’t whether your provider is a physician or a midwife — it’s finding someone who listens to you and makes you feel comfortable, Rankins said.
“Do they respect you and your opinion and your own expertise on your own body? Do they respond well when you have questions, take the time to answer, and aren’t rude or dismissive? Do they really take your concerns seriously?” she said.
Explore your options and meet with a few providers in your area, Cleveland suggested. You can also ask people in your social circle for referrals. (Just make sure the doctor or midwife is in-network with your insurance to keep costs down.)
“Not all OBGYNs or midwives are the same,” Cleveland said. “A good provider should offer a free consultation and an opportunity for you to ask questions about their practice, C-section rates, epidural rates, etc. You can learn a lot about a provider and if they would be a good fit for you in a 15-minute consultation.”
Consider basic logistics and other practical matters, such as how far away the office is and which hospital they deliver at.
“What is their availability for after-hours and coverage for the hospital?” Davis said. “How does the rotation for ‘call’ coverage work? Many solo practitioners collaborate with other colleagues to cover the hospital call. How many providers are in the practice? Often with a larger group, you may be seeing several providers.”
Most nurse-midwives collaborate with OB-GYNs, so ask questions, too, about how they work together and what the scope of their practice is, said Davis.
Rankins echoed how important it is for OB-GYNs and midwives to work well together to take “the best possible care of patients.”
It comes down to listening to your gut. How do you feel about this person, be it an OB-GYN or a midwife, and the care you’re receiving?
“Pregnancy and birth is an extremely vulnerable and special time in your life,” Cleveland said. “Choose a provider who listens to and encourages your questions, gives you evidence-based information, and helps you make your own decisions for you and your baby.”