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Midwife vs. OB-GYN: What’s the Difference?

Deciding whether to have a midwife or OB-GYN is an incredibly personal decision you'll make. When choosing between the two, consider how your pregnancy is going. Are you having a high-risk pregnancy? Does affordability, or even wanting a relaxed birth in your home, matter more than being in a hospital?

Both midwives and OB-GYNs are highly trained experts in women’s health and pregnancy care. If you’re concerned about safety and comfort, you should know that both are highly talented in what they do. Finding someone who listens to you and your birth plan – can also be a strong indicator if they’re suitable to be your practitioner.

Still, selecting which one is right for you can be based on a multitude of other factors. All the what-ifs will be going through your head (like right now)–and while there’s no one catch-all answer, you should know the benefits of both.

Midwife vs. OB-GYN: What does each do?

Even before conception, you’ve probably already started exploring options on what type of practitioner you’d like for your pregnancy. The two most prominent options are:

  • An OB-GYN (obstetrician-gynecologist) or daily physician
  • A midwife who is either a CNM (certified nurse-midwife) or direct-entry midwife

Let’s look into what a midwife does, the benefits of using a midwife, and some common concerns soon-to-be moms may have about them.

What is a midwife?

A midwife is a healthcare provider who helps with pregnancy, childbirth, newborn care, and postpartum health. A midwife can provide routine reproductive care like pelvic exams and pap tests. Midwives are not generally physicians and often work with obstetricians and gynecologists to ensure you have access to needed care.

What does a midwife do?

Their services can differ depending on a midwife's credentials, certifications, and schools. In general, some of the health services a midwife can provide:

  • Prenatal appointments
  • Pap tests and breast exams
  • Screenings for STIs (sexually transmitted infections)
  • Ultrasounds and prenatal blood work
  • Family planning
  • Newborn care
  • Routine pregnancy monitoring
  • Postpartum care

What are the different types of midwives?

The major classifications of midwives will be certified midwives and non-certified midwives. Within those two, there are different types of midwives, including:

CM (Certified midwife): A CM will have completed their master’s degree in midwifery but haven’t completed nursing school. They’ll be certified by the American Midwifery Certification Board and can prescribe medications as needed. CMs are only licensed to practice in nine states. These include Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia.

CNM (Certified nurse midwife): Unlike a CM, a CNM has completed nursing school and has a graduate degree in midwifery. A CNM will not only be able to provide you with pregnancy care and delivery but can provide general reproductive care, prescriptions, lab test orders, and general diagnosis. A CNM is qualified to work in hospitals, homes, and birth centers.

CPM (Certified professional midwife): CPMs have completed their midwife coursework and are certified by the North American Registry of Midwives. CPMs can’t prescribe medications. A CPM can work in homes or at birth centers.

Lay or unlicensed midwife: Often self-taught, an unlicensed midwife doesn’t carry certification or a license to practice. They would have learned through self-education or received training through an apprenticeship. You will almost exclusively find them working in homes.

If you’re preparing to select a midwife as your practitioner, it’s best to ask if they’re a certified nurse or if they’re not certified. A certified nurse midwife can practice at hospitals, clinics, birth centers, or your home. A non-certified nurse will be limited to where they can practice.

Are there risks to using a midwife?

Most midwives will consult with OB-GYNs and other healthcare providers to mitigate risk. You’ll be recommended to work with a midwife who attends births in a hospital setting if you’re concerned about the delivery of your baby.

Can a midwife give an epidural?

You will find that some midwives can prescribe an epidural, but a midwife themselves can’t do it. Consultation with an anesthesiologist usually takes place in a hospital setting only.

What is an OB-GYN?

An OB-GYN (obstetrician-gynecologist) is a medical doctor who specializes in a woman’s reproductive health. They’re surgically trained and can perform c-sections (cesarean sections) when necessary. An OB-GYN’s education will include four years of medical school, a four-year residency program, and a three-year fellowship program.

An OB-GYN provides routine medical services and preventive screenings. You most likely already have an OB-GYN you visit yearly for exams.

Your OB-GYN will conduct office visits, perform surgery and assist in delivery. Most modern OB-GYNs will provide services through private practices. You may also have an OB-GYN that is part of a larger medical group (partners).

What are the training and education requirements for an OB-GYN?

Your doctor must first complete their bachelor’s degree alongside four years of medical school training to become an OB-GYN. Following medical school, they will be required to do four years of graduate-level education as a resident with a primary focus on obstetrics and gynecology. During this time, doctors will learn about women’s reproductive issues and other health-related issues.

This includes:
  • Prevention
  • Diagnosis
  • Treatment
  • Management

Doctors will be under the supervision of an attending doctor, typically in a hospital. Three additional years of training will be required to complete their residency. If all of that wasn’t a journey, they will be required to pass a specialty board certification exam from The American Board of Obstetrics and Gynecology.

Every six years, they will be required to take a maintenance exam to keep their certification.

Should I choose a midwife or OB-GYN for my pregnancy?

The biggest difference is that OB-GYNs are medical doctors. It’s common that women already have an OB-GYN they visit for their annual wellness exams. Midwives do provide a wide range of women’s health services, such as annual checkups, birth control, and menopause care, but in the case of a high-risk pregnancy, you will need to consult with an OB-GYN for specialized care.

Here are the most important things to consider when making your decision:

Is your pregnancy considered high-risk?

If your pregnancy is considered high risk or has a chance for complications, you’ll work with an OB-GYN who specializes in high-risk pregnancies. Midwives' focus is always on low-risk pregnancies and care.

What is considered a high-risk pregnancy?
If you are already experiencing medical conditions like diabetes or high blood pressure – you can expect your pregnancy to be high risk. Any pregnancy of multiples may be considered high risk also.

Where do you want to deliver your baby?

A home birth is a beautiful experience to share with your partner. If you’re low risk and considering a home birth, a midwife is an excellent choice for care providers.

Most births will still occur in a hospital setting – where both OB-GYNs and midwives can work together for delivery. That’s not to deter you from a home birth or say there are more risks involved to you for a home birth, but most will plan for hospital or attached birth center care.

How do you want to manage pain during your delivery?

Building this into your birth plan early is advised since you’ll want your partner, practitioner, and post-delivery care to be unified. If you’re planning on forgoing pain medication (or epidural), your OB-GYN and midwife can provide you with options. A midwife is going to specialize in natural childbirth versus an OB-GYN who will have options readily available the day of.

If you’re looking for peace of mind – make sure you’ve planned out where and how you’d like your birth plan to go! You’re in control and if you have a low-risk pregnancy, choose the option that brings you peace of mind. There’s a reason both options exist for soon-to-be moms – because they’re both viable and successful (depending on pregnancy risk).

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