Looking for a Midwife? Here’s What You Should Know

One of the first of many decisions you’ll have to make once you find out you’re having a baby is choosing a healthcare practitioner who will provide compassionate care throughout your pregnancy and postpartum journey.

Traditionally, you’ll have two choices: an OB-GYN or a midwife. If you are considering a midwife, understanding the differences can help you make the choice that is best for you.

Different Types of Midwives 

A midwife provides evidence-based, personalized and comprehensive prenatal care during labor and delivery, as well as postpartum care. There are different types of midwives, and the care they provide and where they work depends on their education, training and certification. 

There are three main types of midwives: 

Certified nurse-midwife (CNM). A certified nurse-midwife has an RN license and a master’s degree with a focus on women’s healthcare. CNMs work in all birth settings, including hospitals, birthing centers or their patient’s home. They can also provide well-woman care throughout a woman’s life. 

Certified midwife (CM). A certified midwife has the same level of education as a CNM, but no nursing background. A CM’s primary focus is providing prenatal and postpartum care. They often work in birthing centers and assist with home births. Depending on the state, some CMs can work in medical clinics and doctor’s offices. 

Lay/traditional midwife. A lay midwife does not have a master’s degree but does obtain a license from a recognized organization. Lay midwives have informal training through apprenticeships and self-guided study, and most often provide care for women who are giving birth at home or in a birthing center.

6 Ways a Midwife Is Different From an OB-GYN

Like midwives, OB-GYNs specialize in women’s health. OB-GYNs are specially trained medical doctors who provide care for anything related to a woman’s reproductive system, including pregnancy, childbirth and the postpartum period. There are six main ways receiving care from a midwife is different from an OB-GYN:

Education

An OB-GYN goes through four years of medical school and four years of medical OB-GYN residency, where they are surgically trained and learn to perform C-sections. There are different levels of midwifery education and training, but most have a master’s degree and/or have attended an accredited education program for midwifery.

Low-Risk vs. High-Risk Pregnancy

Midwives most often provide care for low-risk pregnancies and births, while OB-GYNs tend to take the lead with patients who have high-risk pregnancies, are experiencing complications or have pre-existing medical conditions. OB-GYNs perform C-sections and provide other interventions in case of an emergency.

If you are working with a midwife and your pregnancy is deemed high-risk at any point, your care may be transferred to an OB-GYN, or the midwife and OB-GYN will work collaboratively to ensure the best outcome for mother and baby.

Different Models of Care

The midwifery model of care is mother/child based. It views pregnancy and childbirth as normal biological processes rather than medical issues that require intervention, and takes a “low tech, high touch” approach. Midwives recognize that while medical interventions are sometimes necessary, they do not need to be routine. Midwives can still manage and deliver patients with epidurals.

OB-GYNs generally approach patient care from a medical standpoint. OB-GYNs are more likely to perform ultrasounds, episiotomies and epidurals during pregnancies.

Time Spent with Patients

Midwives’ patients are typically low risk, giving midwives more time to provide education and emotional support and answer questions. In some cases, the midwife you see for your prenatal appointments will be the same one who is with you throughout your labor and delivery.

More recently, midwives and OB-GYNs are working with physician groups, where certain doctors (not always the same one) see patients for their prenatal appointments, and another team of doctors work at the hospital to assist with deliveries. This means the provider you see may not be the same provider who is with you during delivery.

Birth Settings 

OB-GYNs almost always assist with births in a hospital-based birth center. Depending on their training and certification, midwives can attend births in a few different settings, including hospital-based birth centers, freestanding birth centers and home births.

Postpartum Care

Both OB-GYNs and midwives provide postpartum care. Some midwives offer home visits in the postpartum period. In addition to providing care for the mother for six weeks post-delivery, midwives can also help with breastfeeding.

OB-GYNs generally see patients for a six-week postpartum checkup, at which point you return to your primary care physician for ongoing healthcare, and your baby will see a pediatrician.

Both an OB-GYN and midwife can continue OB-GYN services to you after six weeks postpartum.

Trying To Decide? Consider These Questions 

Before you choose between a midwife and an OB/GYN, you may want to consider these questions:

• Is your pregnancy high risk or low risk?

• What type of setting do you want to give birth in? (home, birthing center, hospital)

• Are you comfortable working with a team of care providers or do you prefer a solo provider?

• What types of pain management do you want to consider when giving birth?

• Do you prefer fewer interventions or more medical support?

No matter what you choose, midwives and OB-GYNs all aim to provide comprehensive, safe prenatal and postpartum care.