Ob-Gyn vs. Midwife: How to Choose Your Pregnancy Care Provider
Pregnancy is full of many exciting decisions. One of the first—and arguably most important—is choosing your healthcare provider. The choice between a doctor and a midwife will determine many aspects of your prenatal care and will also help inform the kind of birth you have.
Understanding some of the fundamental differences between ob-gyn care and midwife care can help you make your decision. In many ways, the two are similar: Both provide care in the months leading up to birth, during labor and delivery, and in the first few weeks postpartum. The differences are largely around their training, education, philosophy, and time spent with you during labor.
Here’s a closer look at both kinds of care to help you as you make your birthing decisions.
What Does an Obstetrician Do?
Ob-gyns (short for “obstetrician-gynecologists”) care for women before birth, throughout pregnancy, during childbirth, and in the first few weeks postpartum. They provide routine prenatal care and diagnose and treat pregnancy complications. Obstetricians may work in a clinic, hospital, medical office, or university, and some have private practices.
If you have an obstetrician, you'll plan to deliver your baby at a hospital or hospital-based birth center. "As a physician, we typically have several patients [in labor at the same time]," says Hector O. Chapa, M.D., a board-certified ob-gyn at Texas A&M College of Medicine. "This may limit our bedside contact." Fortunately, labor and delivery nurses are there to help and are the first line for patient care in between visits from the ob-gyn, Chapa says.
"This is why medicine and nursing function as one team. Nurses are considered our partners in care,” he says.
If you choose an ob-gyn for your pregnancy and birthing care, you can expect them to:
- Perform exams, lab tests, and prenatal screening
- Measure your baby’s size, growth, and position in the uterus
- Monitor your pregnancy using blood tests, ultrasounds, and urinalysis
- Detect any complications and work with specialists, such as maternal-fetal medicine providers, as needed
- Treat conditions that affect your pregnancy or baby
- Handle labor and delivery, including induction, medications, and emergencies
- Perform a cesarean section if needed
- Provide postpartum care
What Does a Midwife Do?
A midwife does many of the same things as an ob-gyn—providing gynecological care, plus prenatal and obstetric care—but is typically only recommended for low-risk births and gynecology. “Midwives are the gold standard for low-risk pregnancies around the world,” says Jeni Rector, L.M., C.P.M., D.E.M., who owns the Village Midwife and Birth Center, in Newport News, Virginia.
Midwives are trained to provide healthcare for during pregnancy, birth, and postpartum, as well as newborn care. Since midwives see pregnancy and birth as a natural process, they tend to be more open to nontraditional approaches to modern labor and delivery practices. These may include the use of herbs, tinctures, homeopathy, and traditional Chinese medicine, Rector says.
Midwives tend to be less strapped for time than ob-gyns and may be able to spend more time with their patients during labor, but it does vary. "I've spent two days, and I've spent three hours with patients," Rector says. She says she recently spent 12 hours with a mom in labor at her birth center.
"Midwives really try their best to be with the laboring woman," says Melinda Hurst, a certified nurse-midwife who works at an urban hospital in the South Bay area of California."But labor can take a long time."
You may also find that a midwife tends to provide care with a personalized approach. “Midwifery care is led by the pregnant person,” Rector says. “They tell the midwife what they want, and we help come up with a plan to get there.” That may include avoiding pain medication, if that’s what you want. (Note that you can still use an ob-gyn if you want a medication-free birth.)
Midwives and nurse-midwives who are certified can practice at hospitals, clinics, birth centers, or in homes and offer a variety of services.
If you’re considering working with a midwife for your low-risk pregnancy, the care you can expect to receive includes:
- Ordering labs, ultrasounds, and consultations
- Treating common discomforts of pregnancy
- Educating pregnant people on nutrition, lactation, and future family planning
- Providing postpartum care for you and your baby
Ob-Gyn vs. Midwife: Which Is Right for You?
When making the choice between a doctor and a midwife, the most important thing to remember is that midwives are best reserved for low-risk pregnancies.
“[Midwives] can deliver a baby,” says Cheruba Prabakar, M.D., a board certified ob-gyn who practices in Oakland, California. “But they’re not surgeons. If there is a complication, a midwife cannot handle that.” So, if you need a C-section, or you need assistance from a vacuum to help deliver the baby, an obstetrician will be called on, she says.
You may also be referred to an ob-gyn during your pregnancy if it becomes high risk—for example, if you’re diagnosed with preeclampsia or gestational diabetes. A pregnancy will likely also be considered high risk from the beginning if you have been managing diabetes or high blood pressure before you became pregnant, or if you’re pregnant with twins.
Do Your Homework
If you’re considered low risk and are exploring both doctors and midwives, do your research when choosing a provider. It’s a good idea to meet with both an ob-gyn and a midwife and ask them about their respective practices. Consider what kind of birth you might want. Ideally, you should select a provider whose ideas about birth align with your own. Here are some things to ask yourself while establishing your pregnancy care provider:
- Are you comfortable seeing a provider specializing in low-risk pregnancy, or would you prefer someone with high-risk training, as well?
- Which caregiver will make you feel most comfortable?
- Which setting would you want to give birth in?
Cost may be a factor too. Typically, many health insurance plans will help pay for the cost of either a midwife or an ob-gyn, so either could be in your price range, but choosing a specific provider who’s in-network for your plan may help you save significantly.
Talk to your individual health insurance company if you have specific questions around what your policy covers and what you’ll be expected to pay out of pocket for prenatal and postpartum care.
Safety Is Paramount
A provider (midwife or doctor) is a good choice so long as you feel confident about the safety of you and your baby during pregnancy and delivery. If you go with a midwife, be sure they have a physician on call in case of an emergency. “Nothing is really normal about delivery,” Prabakar says. “In a split second, things can happen. That’s why your midwife must have a backup plan.”
The goal for any doctor or midwife should be the safety of the birthing parent and baby, Rector says. “Sometimes, the plan has to change for it to remain safe, and that’s when collaboration with a doctor or hospital is helpful,” she continues. “When doctors and midwives work together, the process of getting to that goal can be more natural and holistic.”
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