Whether you are looking to become pregnant, are pregnant with your first baby, or are expecting your sixth, finding the right provider can make all the difference. But with all of the options out there, how do you know which is the right one for you? If you are trying to decide between an OB/GYN and a Midwife, then you have come to the right place! I am laying it all out for you so that you can make the best and most informed decision that is right for you and your baby.

What is a Midwife?

A midwife is a trained health professional that provides independent care for women at all stages of life. They may provide preconception counseling, prenatal, birth, and postnatal care, as well as standard routine care for women and family planning. Midwives hold one of three certifications, Certified Midwife (CM), Certified Nurse Midwife (CNM) or Certified Professional Midwife (CPM). CMs and CNMs both hold graduate degrees, have completed an accredited program, and have passed a national certification exam. CNMs hold a graduate degree, as well as a degree in nursing, and CPMs have additional training specializing in delivering babies outside of hospitals. ¹ Just like OB/GYNs, Midwives can prescribe medication and order various lab tests, making them just as encompassing as visiting an OB/GYN’s office.

Unlike many in the medical profession, midwives believe that birth is a natural phenomenon that needs minimal intervention unless there is a clear and present health problem. Depending on your personal preferences for birth, midwives will let you labor on your own without intervention unless they see a reason to intervene, or they will be as hands on as you ask them to be. In comparison, the modern hospital birth setting is largely based around the doctor’s preferences, schedule, or other factors that can leave the woman feeling unheard or disrespected.

Midwives typically see clients at their office for prenatal appointments, but some home birth midwives offer in-home prenatal appointments. Midwives may practice either in a hospital, at a free-standing birth center, or within the client’s home. If a midwife is practicing outside of a hospital, she may have a consulting physician that she works with on a case by case basis. Additionally, if you are transferred for any reason during labor, midwives have “privileges” at different hospitals, giving them the right to deliver at that hospital if need be. The same goes for birthing centers. Some midwives may primarily do home births, but will have privileges with local birthing centers if a client is more comfortable with that as opposed to a home birth.

Difference Between an OB/GYN and a Midwife

Prenatal care between an OB/GYN and Midwife is largely the same. The main difference may include some of the supplement recommendations and the amount of time you spend with your provider. OB/GYN offices are often very busy and many women feel rushed in their appointments, only having between 15 and 30 minutes to discuss their questions or concerns. In comparison, many midwives set aside a full hour with their clients, ensuring you have plenty of time to ask questions, and build a trusting relationship so that you feel as comfortable as possible.

Like I mentioned before, midwives often focus on more natural approaches. During parental visits, especially your first one, they may spend some time discussing your diet during pregnancy, exercise recommendations, as well as additional physiological options, such as chiropractic care. Some OB/GYNs may make this a priority in their office visits as well, but it is a hallmark of midwifery care.

Hospital Birth vs. Out-of-Hospital Birth

Prior to the modern medical system, women had their babies within their home, either with a midwife present or other women from their family. In 1935, only 37% of births took place at the hospital, but by 1970, just 35 years later, hospital births accounted for over 99% of births in the United States.² Today, 98% of births take place in hospitals, while only 1.64% take place at a birth center or in the home.

Overall, the care you receive during pregnancy will be fairly similar with both a midwife and an OB/GYN. The biggest difference happens during labor and birth. Your midwife will typically be present for the entirety of your active labor and birth. With OB/GYNs in the hospital, you may spend a lot of time during labor with a nurse and your OB/GYN may only be present when it comes time to push. For some women, this is not an issue, but many women may feel more comfortable with the same practitioner or same few practitioners as opposed to the luck of the draw during delivery.

Standard Practice in Hospitals That You Want to Avoid

In hospitals, there are a number of protocols that are standard practice that may or may not be beneficial or necessary, including:

• The use of forceps, vacuum or other intervention
• Requiring women to lay on their backs for birth as opposed to having freedom of movement
• The use of Pitocin, even if it may not be necessary
• Immediately cutting the cord as opposed to delayed cord clamping
• C-Section in a non-medical emergency situation
• Many OB/GYNs will not agree to a vaginal birth after cesarian (VBAC)
• Inducing labor when not medically necessary
• Continuous Electronic Fetal Monitoring: requiring mom to be hooked up to a machine to monitor the baby’s heartbeat. This restricts movement during labor and may increase the chance of a cesarean or delivery with forceps.²
• Early Epidurals
• Routine rupturing of the amniotic sack: Also known as breaking your water, many doctors do this in order to strengthen contractions and shorten labor, but there is very little evidence to support this practice.
• Routine Episiotomies: Doctors will make a cut in the perineum to make a wider opening for baby. However this is not typically necessary, except when using forceps or a vacuum, and often causes more damage than it helps.

For more information on why the traditional hospital setting and “best practices” are not in fact the best practices, I highly encourage you to read, Ina May’s Guide to Childbirth.

Which Should You Choose?

The decision is ultimately yours. If you are healthy, do not have any pre-existing conditions, and want to have a natural birth with minimal intervention, I highly recommend going with a midwife as your provider. If you may be considered high risk i.e. you are over 35, you are obese, or you have other pre-existing medical conditions, then the traditional OB/GYN route may be right for you. However, even if you are high-risk, I would consider looking for a midwife that practices in a hospital. This option gives you the model of care from a midwife, but with the comfort of having the hospital’s services should you need them.

Keep in mind, most midwives, especially those that practice outside of the hospital, will evaluate your level of risk. Some midwives will not take high-risk clients, but some will if there is additional support. Additionally, if this is your second birth and your first birth was a cesarean, be sure you ask your potential midwife if they accept VBAC candidates. Some midwives will, but only at birthing centers, while some birthing centers and home birth midwives will not take VBAC clients.

Stay Tuned

I hope this post has given you some more information to help you decide which provider is the right one for you. If you are interested in pursuing the midwife route, stay tuned for my next post, How to Interview a Midwife. For my favorite pregnancy resources and prenatal supplements, head over to The Ladenbod List.

If you, or someone you know, are currently pregnant, and are interested in pursuing a home birth in the DFW area, I cannot recommend Danielle Hogan enough. She is incredibly kind, calming, and is hands down the best midwife I have worked with. And if you want to know more about my experience with her, feel free to drop a comment below or send me a message.