Once you find out you’re pregnant, there are so many decisions to make. One of the most important parts of preparing for your baby’s arrival is deciding who will care for you during your pregnancy and delivery.
At that point, you may wonder: What exactly is a midwife? Should I use a midwife or an OB?
How is a midwife different than an OB?
Both obstetricians (OBs) and midwives are highly trained, experienced practitioners capable of caring for pregnant women and safely delivering babies. But there are important differences between the two.
An obstetrician attends medical school for four years and then completes four years of residency. Many will also complete fellowships and receive certification from the American Board of Obstetrics and Gynecology.
Certifications and licensing requirements for midwives vary. Some are registered nurses with graduate degrees in midwifery (CNMs); others, like certified midwives (CMs) and Certified Professional Midwives (CPMs) have different educational backgrounds, experiences, and certifications.
While both can provide routine gynecologic and obstetric care (including writing prescriptions and providing ultrasounds), they are not the same.
Midwives generally care for women in low-risk pregnancies, while an OB cares for a range of patients, from low to high risk. Midwives also don’t perform surgery, so if a low-risk pregnancy or delivery becomes too risky, or even emergent, an OB will be called in.
Why do people choose a midwife instead of an OB?
Many women select a midwife because they would like a natural, medication-free delivery or more personal attention. Midwives tend to be more actively involved throughout the pregnancy, delivery, and postpartum process.
During labor, the midwife is typically present for much of the time, playing an active supporting role until it’s time for delivery.
With an OB, the schedule of care often rotates between practitioners throughout a pregnancy. During labor, the doctor will typically check in periodically, but only provide active care as needed until it’s time to deliver.
Some women may also select a midwife because they want a home birth. Most OBs will not attend or assist with a home birth — and many states go so far as to ban them from participating.
Questions to help you decide
The choice between a midwife and an OB really comes down to your personal preferences and unique health situation. A few questions that might help you decide are:
- Are you planning on medical interventions, such as an epidural?
- Is your pregnancy or delivery considered high risk?
- Are you planning to (or likely to) have a c-section?
If your answer to any of these questions is “yes,” an OB is probably your best (and possibly only) option. If not, you may want to consider these questions:
- Is the birthing environment important to you?
- Do you feel you want a closer, more personal level of care?
- Are you hoping for a natural delivery or delivery with few interventions?
If so, a midwife may be right for you.
Can I still deliver at a hospital if I choose a midwife?
Choosing a midwife used to seriously limit your ability to have a planned hospital delivery, but things have changed a lot in recent years. While hospitals still employ mostly obstetricians, many have also added certified nurse midwives (CNMs) to their staff.
Of course, in most areas, it’s not super important who your hospital directly employs. What really matters is where your preferred provider does their deliveries. In general, once you choose a private practitioner, they will tell you what hospital, if any, they have delivery privileges or affiliations with.
Many midwives operate out of birth centers. Sometimes these birthing centers are freestanding, other times they are located near (or even adjacent to and affiliated with) hospitals. Still, some midwives, like OBs, are able to deliver at local hospitals (again, assuming a low-risk, low-intervention birth).
So . . . is a midwife birth right for me?
This is a truly personal decision. Assuming your pregnancy is low-risk, you have to decide what situation and what provider is the best fit for you.
But can you have the best of both worlds? Some medical practices work in teams, giving pregnant women access to both obstetricians and midwives. This gives you more flexibility as your pregnancy progresses.
Being an informed patient and understanding all your options will help you make the best choice for you and your pregnancy.