OBGYN or Midwife? How to decide what's best for your pregnancy

Many people don’t think about what type of provider they want for their pregnancy until they’re trying to conceive or have recently found out they’re pregnant. This makes sense because it’s not on our radar until it’s needed. In the United States an OBGYN has been the standard provider for women’s health no matter the age or stage of fertility, however, social media has made many people more aware of midwives as an option too. There are a few types of pregnancy care providers and the key to choosing a pregnancy care provider is in understanding these different types and how they align with what you want for your birth.

Midwife vs. OBGYN

An OBGYN (Obstetrician-Gynecologist) is a medical doctor who specializes in women’s reproductive health, pregnancy, and childbirth. During pregnancy, an OBGYN provides prenatal care, does lab work and ultrasounds, monitors for complications, and attends births in hospitals. OB-GYNs are trained to manage both routine and high-risk pregnancies, and are trained in surgical procedures, such as a cesarean delivery.

A Midwife is a provider who cares for pregnant women and their baby throughout pregnancy, labor, birth, and for a few weeks after birth. They can also provide routine exams, treat minor illnesses, and other common health problems. Midwives practice both in and out of hospitals depending on their training and licensure.

The main difference in prenatal care when seeing a Midwife or OBGYN is their approach to the labor process based on the training they received. Midwives are trained in the physiological process of birth, so they encourage birth to proceed naturally: let labor start on its own, use minimal interventions, don’t push for a faster labor. They also remain present throughout labor. OBGYN care often follows a medical model, with shorter appointments and care provided by one of several doctors within a practice. They often come in and out during labor, staying fully once pushing begins. 

Types of Medical Doctors

There are other subtypes of medical doctors that you may interact with during pregnancy or who may attend births. Besides an OBGYN you may also have heard of a MFM (Maternal Fetal Medicine) doctor or a FM (Family Practitioner). A MFM is also known as a perinatologist. This is a doctor that you would see in addition to your pregnancy provider. They are trained to order and interpret advanced imaging and tests for high-risk conditions like gestational abnormalities, gestational diabetes, genetic illnesses, multiple births, etc. They don’t usually attend births unless it’s a complex delivery. A FM is ideal if you want “cradle-to-grave” care. They can see you before pregnancy, do all your prenatal care, and then become your baby’s primary doctor after birth.

Types of Midwives

There are also subtypes of midwives that define where they practice and what type of training they have received. A CNM (Certified Nurse-Midwife) has completed a graduate level nurse-midwife program. CNM’s typically practice in hospitals, although they can practice out of hospital. Direct Entry Midwife (DEM) is a midwife who enters the profession through midwifery-specific education rather than nursing school. A Certified Professional Midwife (CPM) has received training through apprenticeships and education and has passed a certification process through a nationally recognized organization. Licensed Direct Entry Midwife (LDEM) means a midwife has gone through the process of becoming licensed through the state they practice in. In many cases, an LDEM is also a CPM, but licensing requirements and scope of practice vary by state. DEM, CPM, and LDEM are all trained in prenatal, birth, and postpartum care, newborn assessment, emergency skills, and clear protocols for consultation or transfer to medical care when needed. They practice at birth centers and in homes. 

How to choose a pregnancy provider for YOU

Some high risk pregnancies should stay with an OBGYN who has the level of medical training, monitoring, and intervention that falls outside the scope of midwifery care. OB-GYNs are physicians trained to recognize, manage, and respond quickly to complications that can affect the health of the pregnant person or baby. Other than a high-risk pregnancy, almost all pregnant people are good candidates to see a Midwife or Family Practitioner. Choosing a Midwife, OBGYN, or FM throughout pregnancy, labor, and birth is usually a matter of preference. Here are a few questions to help guide what type of provider meets your medical needs, values, and vision for birth:

• How do they approach pregnancy and birth—more medical, physiologic, or a blend?

• How do they view interventions like inductions, continuous monitoring, or epidurals?

• How do they support informed decision-making?

• How long are prenatal appointments?

• What comfort measures do they support during labor?

• What are their rates for inductions, cesareans, or assisted births?

• How do they decide when an intervention is necessary?

• Who will attend my birth if my primary provider is unavailable?

• How long does their postpartum care extend?

There is not one right type of provider for everyone, so it’s good to become familiar with all types of providers and their approach to pregnancy and birth. Then you can compare if their approach and beliefs around birth match yours. Even when you decide on what type of provider you want, each provider is different from another. Some practice very similarly to the training they received, and others practice differently than you would expect based on their credentials. Interview several providers and don’t be afraid to change if you see red flags that they don’t approach birth the way you would like. It can be a pain to switch providers and deal with all the paperwork and financial change during a pregnancy, but it’s worth it to have the type of birth you want.

No matter what type of provider you do decide to go with, adding a doula to your team can help fill in the gaps to provide continuous emotional support, education, and advocacy. A doula can support any type of birth and is available to answer questions quickly and find resources. Having a supportive provider, doula, partner, and any other close family members or friends can make all the difference in feeling safe and cared for during such an important time.