Many women think they know what a midwife is, but most don’t really understand the differences between a midwife and an obstetrician (or even a midwife and a doula). Most of the women I have asked think that midwives are ‘lay midwives’ with little education or training (if at all) that only do home births, and they believe it’s unsafe. These misconceptions are why I’m explaining the two (midwives and OB/GYNs) so that you can better understand each. Here are the four main differences between midwives and OB/GYNs.
Midwife vs. OB/GYN
An OB/GYN goes through four years of formal medical school, four years of a medical residency that involves surgical training, and an additional three years in a residency specific to obstetrics and gynecology. They are specifically trained to manage high-risk pregnancies and can perform surgeries. Midwives cannot perform C-sections; they would need to transfer their patient to a doctor at a hospital for a C-section (though some CNMs may assist in the operating room if they work for that hospital). OB/GYNs can also use forceps and vacuums to facilitate delivery, whereas midwives are not legally allowed to use these second-stage interventions.
There are two different kinds of midwives, CNMs (Certified Nurse Midwives) and CPMs (Certified Professional Midwives).1,2
CNMs are women that earned their bachelor’s degrees, then (maybe) worked as registered nurses and went back to school for a two or three-year master’s degree program in midwifery. Depending on state regulations, they can deliver in all settings (home, birth center, or hospital), and CNMs can prescribe drugs, including pain medication.
CPMs are women who are licensed and trained in midwifery only. For education, they can go to a MEAC-accredited school or one that isn’t accredited. (Depending on the program, it could take them one year or up to five years to complete.) They also must have a preceptor. Through their apprenticeship (usually one to two years), students will observe and assist with a minimum number of prenatal exams, births, postpartum exams, and prenatal exams. They are not nurses or physicians and cannot write prescriptions. Because of this, they can only deliver in peoples’ homes (home birth) or birth center. Since they can only work outside of the hospital, they are not required to have physician oversight.
2. Model of Care
Obstetricians are trained to care for women with complicated, high-risk pregnancies and births. The medical model is about controlled medical management of a safe and healthy pregnancy and birth. This view of childbirth has led to medical interventions that are not always necessary and are not optimal for positive birth outcomes. Physicians are more likely to intervene during labor and birth because they can. Again, unlike midwives, they have access to medications and instruments and can perform interventions and surgery. (This is why in other countries, women primarily have a midwife, and if they experience complications or are high-risk, they receive care from an OB/GYN.)
In most cases, OB/GYNs have never seen a home birth or a birth in a birthing center. I’ve actually met several residents who have never seen a natural birth (no pain medication) in a hospital. They were shocked and bewildered when my clients had their babies naturally with no medical interventions on purpose. A big reason why some doctors have not seen a woman give birth naturally is 1) most women who choose a hospital birth want pain medication. Reason 2) doctors are trained to know what to do when things go wrong and don’t specialize in normal pregnancies and births like midwives. This can cause them to want to react and intervene during normal and healthy labor because this is what they have been trained to do.
Midwives (CPMs and CNMs) are the experts in normal, healthy pregnancies. They are trained to focus on supporting women through their pregnancy and labor, providing regular prenatal care to the mother and her baby, as well as providing postnatal care and breastfeeding support. (Most OB/GYNs do not have training in breastfeeding support.) Midwives’ model of care is all about “low tech, high touch.” They use technology such as fetal monitors but rely heavily on their clinical experience and are more present and hands-on.
3. Healthy vs. High-Risk Pregnancies
OB/GYNs are trained to handle any complications and high-risk pregnancies. If there are any complications with your pregnancy, or if you develop any while you are pregnant and under the care of a midwife, you will be referred to an obstetrician.
Midwives are trained to deal with women having normal, uncomplicated, low-risk pregnancies. This is the main difference between doctors and midwives.
4. The Birthing Experience
An OB/GYN works in shifts and is on call for their patients. They are balancing their prenatal appointments, well-woman appointments, scheduled surgeries, and their patients that are in labor and delivery. Because they take multiple due dates each month, there is often more than one woman at a time in labor. This requires the doctor to divide their time between them all. This usually means shorter prenatal visits (typically 5-15 minutes) and less one-on-one interaction in labor, during the delivery, and after the birth. There is also the potential of your doctor not being on-call and not being present at all during your birth when you go into labor.
A midwife works with the mother from the time true labor begins through the baby’s birth. They only take a few due dates per month, so they are much more likely to be there for your labor and birth. In my experience, midwives have more knowledge of how to help labor naturally progress and often more patience regarding the process of labor and birth. (They have backups in case of emergencies, illness, etc., that you can meet in advance.) They can also spend more time with their patients during their prenatal visits (usually one hour for each appointment).
Research suggests that healthy women and babies experience higher rates of normal birth and lower rates of intervention, such as labor induction, pain medications, epidurals, and other medical/surgical interventions when cared for by a midwife.3,4,5,6,7 A big part of that is they believe that birth is a healthy and normal process that does not need to be intervened or interrupted (unless medically necessary) by medical interventions. Another reason is they do not have access to those medical interventions like doctors do.
Hopefully, this sheds some light on the differences between a midwife vs. OB/GYN. One is trained to work with high-risk, complicated pregnancies, and the other is trained to work with normal, low-risk, healthy pregnancies. One will have to limit their time with you due to their high work volume, and the other will be able to give you more individualized care. Both are great options. Determining which you would prefer for your pregnancy and birth experience is up to you.