Choosing a care provider to deliver your baby is a very personal decision. In the United States, the vast majority of hospital births are attended by physicians. Less than 9 percent of hospital births are attended by midwives, but that number is growing. While OB-GYNs (obstetricians and gynecologists) and midwives perform similar functions, they may have different ideologies when it comes to labor and delivery. Depending on the setting and the circumstances, it’s entirely possible you may have both of these healthcare professionals attending your birthing experience.

Whether you choose a midwife or an OB-GYN, selecting a healthcare provider you trust and are comfortable with is essential, regardless of their certifications or birthing philosophies. No matter who you choose, your provider will work on your behalf to make your labor and delivery experience as safe and comfortable as possible.

So should you choose a midwife or an OB-GYN? Are there benefits to choosing one over the other? Let’s take a look at the differences and examine which one may be right for you.

The Difference Between an OB-GYN and a Midwife

Both midwives and OB-GYNs are experts in female reproductive medical care and guidance. They are trained to provide support with everything from prenatal care to childbirth to contraception. They also share the goal of wanting safe, positive results for their patients and their infants.

OB-GYNs

OB-GYNs are physicians who are can perform surgeries, including cesarean deliveries (C-sections) and episiotomies. They are also qualified to handle high-risk pregnancies and perform medical interventions, like inductions or assisted deliveries.

The American Board of Obstetrics and Gynecology (ABOG) requires OB-GYNs to graduate from an accredited, approved medical school and finish four years of residency. This includes training in obstetrics, gynecology, gynecological oncology, ultrasonography, and preventative care. In addition, they must pass the ACOG regulatory test and their state’s certification test.

These practitioners can work in a private or group practice, a clinic, or a hospital setting. Many OB-GYNs are also members of the American College of Obstetricians and Gynecologists (ACOG). 

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Midwives

A midwife is not a physician, but most have either earned a master’s degree or have received accredited training as recognized by the American College of Nurse-Midwives (ACNM) or the North American Registry of Midwives (NARM).

In general, midwives take a more holistic approach to pregnancy and postpartum care and concentrate on encouraging a vaginal birth. They tend to focus on patient education, including topics like nutrition, newborn care, and breastfeeding. While midwives often work in conjunction with a medical team, they try to reduce dependence on any medical interventions that are not critically needed.

In the United States, midwives can be divided into two broad categories: those who are nurses (certified nurse midwives, or CNMs) and those who enter the midwifery profession without first becoming a nurse (direct-entry midwives, or DEMs). Let’s take a look at the differences:

Certified Nurse Midwife (CNM)

CNMs are the most common type of midwife. They are also the most educated. CNMs are licensed as nurse practitioners (NPs) or advanced practice registered nurses (APRNs). They may practice anywhere in the United States and are typically qualified to prescribe contraception and medication. They are frequently employed by hospitals but may also work in birth centers or attend home births.

Direct-Entry Midwives (DEMs)

These are midwives who have a degree or training in a field other than nursing. Certified professional midwives (CPMs) are nationally certified but licensing requirements differ by state. They are the next most common after CNMs and can generally practice only in out-of-hospital settings like birth centers or homes. Other certifications vary by state and include licensed midwife (LM), registered midwife (RM), and certified midwife (CM). Lay midwives, or traditional midwives, are not professionally accredited and can vary widely in their skills, knowledge, and training. They are allowed to practice in some states, typically in more traditional or indigenous communities.

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How to Choose

Whether you choose to use an OB-GYN or a midwife is going to depend on what’s important to you and whether or not you have a high-risk pregnancy.

Reasons You May Want an OB-GYN

If you’re concerned about pre-existing medical conditions or if you have a high-risk pregnancy or prefer to have a cesarean delivery, it makes sense to select an OB-GYN. Many women visit an OB-GYN prior to becoming pregnant for routine reproductive healthcare screenings and may choose to simply continue treatment with that provider after learning they’re pregnant. If an emergency comes up during childbirth and a cesarean delivery becomes necessary, you can rest easy knowing your doctor is qualified to do the surgery.

Reasons You May Want a Midwife

A midwife is a great option for people who prefer a more natural approach to pregnancy and childbirth with minimal medical interventions and more holistic methods of pain management. It’s also a great option for those with pregnancies that are considered low-risk for complications. It’s important to understand that problems can arise even in a low-risk pregnancy so make sure to ask questions about your midwife’s plan for medical intervention should it become necessary.

The Bottom Line

There is no right or wrong answer when it comes to choosing a midwife or an OB-GYN to handle your prenatal, childbirth, and postpartum experiences. All providers will work together to make sure you have the safest, smoothest outcome possible. Who you choose to work with depends on your personal circumstances and what aligns best with your preferences. Do your research, interview candidates, talk to your insurance provider, and trust your instincts. 

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