Midwife vs. OBGYN: What’s the Difference and Who Should I Choose?

Pregnancy and birth are full of decisions like choosing names, prenatal screening test selection, and pain medication options. One of the first decisions you must make is who to see for your prenatal care. Midwives and doctors in the United States provide prenatal care and attend births. The midwife vs. OBGYN models of care have different beliefs and views about pregnancy and childbirth. Understanding the differences between midwives vs. OBGYN doctors will help you make this critical decision.

Midwife vs. OBGYN

What Is a Midwife?

What is a midwife? Midwives are experts in normal pregnancy and birth. Their training is focused on keeping the mother and baby as safe and healthy as possible.^2,18

Certified nurse midwives (CNMs) and certified midwives (CMs) provide the most complete care of the four types of midwives. They can provide:⁴

• prenatal care
• care during labor and birth, including delivery
• postpartum care
• newborn care for the first 28 days
• breastfeeding support
• prescriptions
• orders for and interpretation of tests
• assistance with Cesarean sections
• care in offices, hospitals, birth centers, and homes
• routine gynecological care outside of pregnancy

Midwife Training

There are four types of midwives with different experiences and education. Each type of midwife provides varying levels of care in different settings.^3,5,6,7

Certified Nurse Midwife (CNM)

CNMs are registered nurses with a graduate degree in midwifery and are certified under the American Midwifery Certification Board. They earn their bachelor’s degrees in nursing, then (maybe) work as registered nurses and return to school for a two- or three-year graduate-level midwifery education program. They are certified through the American Midwifery Certification Board (AMCB).²¹ They can deliver in all settings (home, birth center, or hospital), depending on state regulations. CNMs can prescribe drugs, including pain medication.¹²

Certified Midwife (CM)

CMs are highly trained midwives who do not have nursing training or a nursing degree. CMs have a non-nursing undergraduate degree. They then complete a graduate-level education program. They meet the same requirements and are certified through the same certification board as CNMs.²¹ CMs are recognized in the District of Columbia and the following nine states, where they can practice in any birth setting:^22,23

• Delaware
• Hawaii
• Maine
• Maryland
• New Jersey
• New York
• Oklahoma
• Rhode Island
• Virginia

Certified Professional Midwife (CPM)

CPMs are licensed and trained in midwifery only. For education, they can go to a Midwifery Education Accreditation Council (MEAC) accredited school or one that isn’t accredited.²⁴ (Depending on the program, it could take one year or up to five years to complete.) CPMs are certified through the North American Registry of Midwives (NARM).²⁵ They must also have a preceptor to supervise them and help them translate theory into practice. Through their apprenticeship (usually one to two years), students observe and assist with a minimum number of prenatal exams, births, and postpartum exams. Because they are not nurses or physicians and cannot write prescriptions, they can only deliver in peoples’ homes (home birth) or birth centers. Since they can only work outside the hospital, they don’t need physician oversight.²²

Lay Midwife

Lay midwives (also called traditional midwives) usually have informal, non-medical training and are not certified or licensed. Their training consists of independent study or an apprenticeship. Lay midwives are not licensed or certified. They don’t have nursing or medical training, and there is no legislation to guide their practice. Lay midwives are not considered healthcare professionals.²⁶

A certified nurse midwife (CNM) is the type of midwife you are most likely to encounter in a hospital setting. Most CNMs attend births in hospitals; they are licensed and can prescribe medications in all 50 states. CNMs are the most common type of midwife.³

Benefits of a Midwife

There are multiple benefits to care provided by a licensed and regulated midwife vs. OBGYN. Some of the benefits include:^8,9,11,20

• decreased interventions
• decreased Cesarean births
• reduced use of forceps and vacuums for delivery
• lower risk of preterm birth
• increased satisfaction with the birth experience
• reduced chance of an episiotomy
• less-severe tearing
• fewer epidurals
• lower cost
• hands-on approach
• increased rate of vaginal birth after cesarean section (VBAC)

What Is an OBGYN?

An OBGYN is a doctor with special training in obstetrics and gynecology. An OBGYN can be either a medical doctor (M.D.) or a doctor of osteopathic medicine (D.O.) Both are fully trained and licensed doctors.¹³

OBGYN Training

OBGYNs have an undergraduate degree (usually in a science-related field) and then attend four years of medical school. Following medical school, they complete a four-year residency program in obstetrics and gynecology. This residency program prepares them to care for women’s reproductive health and involves surgical training.^12,19

OBGYNs can also obtain certification from the American Board of Obstetrics and Gynecology. Certification is not required but is evidence that a doctor has done more than the minimum requirements.¹⁴

An OB or OBGYN specializes in women’s health. They are experts in diseases and complications, and OBGYNs are also surgeons. They perform Cesarean sections and gynecological surgeries.¹²

Benefits of an OBGYN

There are benefits to having an OBGYN care for you during your pregnancy and birth, such as:¹²

• having a broad scope of practice
• managing high-risk pregnancies
• the ability to perform Cesarean sections
• the ability to perform vacuum and forceps deliveries
  • Midwives cannot legally use forceps in the United States as a second-stage intervention²⁰

Similarities Between Midwives and OBGYNs

Certified nurse midwives and OBGYN doctors have many similarities:

1. Both are highly trained, licensed, and regulated in all 50 states.
2. Both types of specialists can prescribe medications.
3. Both place a priority on your safety and the safety of your baby.
4. Both desire you to have a positive experience.

In many settings, midwives and OBGYNs work as a team. They communicate about the patients in labor. The midwife often cares for their patients in collaboration with an OBGYN. They consult when complications arise but often remain the primary provider caring for their patients. Sometimes the OB-GYN manages complications, such as pre-eclampsia, and the midwife oversees the normal labor process.²⁸

Differences Between Midwives and OBGYNs

There are also some differences between certified nurse midwives and OBGYNs.

1. OBGYNs manage high-risk pregnancies and complications. Many midwives care for women with high-risk pregnancies in collaboration with an OBGYN. Midwives are trained to handle emergencies and complications until an OBGYN is available.¹⁶
2. OBGYNs only deliver babies in a hospital. Certified nurse midwives deliver in the hospital and birth centers. Occasionally, they also attend home births.^16,17
3. Midwives offer more options for delivery, like water births, squatting positions, and hands and knees. OBGYNs are more likely to deliver your baby while you’re in bed and on your back.¹⁷
4. Midwives spend more time with you during labor. They utilize many techniques to promote the natural progression of labor and birth. Midwives focus on providing holistic care, including education and support. Midwives see pregnancy and birth as a normal process and provide care that supports this philosophy.^15,16
5. Midwives also offer well-women care outside of pregnancy. Midwives’ model of care is all about “low tech, high touch.” They use technology such as fetal monitors and pain medications but rely heavily on their clinical experience and are more present and hands-on.^27,29
6. Another difference between a midwife and an OBGYN is that midwives believe the mother gives birth, while OBGYNs focus on the doctor delivering the baby.¹⁸
7. The most significant difference between OBGYNs and certified nurse midwives is that OBGYNs are surgeons who can perform Cesarean deliveries. Many certified nurse midwives receive training to assist in C-sections, so they may still be present at your birth even though they can’t perform the surgery.¹⁵

Doula vs. Midwife

Doulas are trained professionals who support women during and shortly after childbirth. They provide physical, emotional, and information support. Doulas help women have healthy and satisfying birth experiences. Doulas can have a positive impact on the whole family.¹

Doulas do not deliver your baby like a midwife or OBGYN does. Midwives and OBGYNs provide medical care, while a doula provides support.

Deciding Between a Midwife vs. OBGYN

There is no right or wrong answer when choosing a doctor or a midwife to care for you during your pregnancy. Some women go to a practice with both. You can ask yourself some questions to help you decide. Consider the following questions:

• Is a vaginal birth your priority?
• Do you want your care provider with you during labor?
• What are you planning to do for pain management?
• What are you hoping will happen at the hospital?
• Do you want (or need) more support in your transition to parenthood?
• Are you considered high-risk?
• Do you want to deliver out of the hospital?
• What is your philosophy regarding birth?

Tips on Deciding

Besides asking yourself some questions, let’s look at some tips to help you decide.

• Talk with your partner or closest support people.
• Remember, this is your decision. Try not to let family and friends pressure you. Listen to your intuition.
• Make a list of priorities regarding your pregnancy, labor, and birth. Determine which type of provider best matches your needs.
• Look into how the different midwives and OBGYNs practice. How large is the group? Will your doctor or midwife be at your birth? How long are the prenatal appointments?
• Pregnancy and birth have a unique set of needs. Your gynecology provider may or may not be the one that best matches your needs. Only you know the answer to this.
• You can decide after your first prenatal visit. Some women see different doctors and midwives before settling on the one they feel most comfortable with.
• Consider the birth setting that you prefer. Your choice of provider is closely connected to where you give birth.
• Confirm which maternity providers your insurance covers. Midwives are only sometimes listed in your plan if employed in a physician practice.¹⁸

You now have much to consider regarding choosing a midwife vs. OBGYN. Both have pros and cons. But maybe a team approach can give you the best midwifery care and OBGYN expertise. It’s essential to take your time and do your research. Your decision is vital for you and your baby. Every situation is unique, and only you know the best provider. Welcome to parenting by making this first significant decision!