In the world of prenatal care, two types of providers are often discussed: obstetricians/gynecologists (OB/GYNs) and midwives. While both play crucial roles in maternal health care, understanding the differences between them can help patients make the best and most informed decisions about their care options.
Credentials and Education
Both professions provide quality prenatal care and deliver babies, but differences in credentials, education, and the type of care provided separates them.
“Besides our education and training practice, some of the main differences are that midwives take care of a lower-risk population and tend to provide a lot of labor support,” says Abigail Rizk, CNM/MSN, a certified nurse midwife at University of Utah Health. “OB/GYNs can care for higher-risk patients, or if there’s the need for something beyond a midwife’s scope of care, like a c-section, forceps assist, major postpartum hemorrhage, or a complex laceration that would need to be repaired by a surgeon.”
OB/GYNs
OB/GYNs are medical doctors who specialize in women’s reproductive health, including pregnancy, childbirth, and postpartum care. They have typically completed four years of medical school, four years of a residency, and a three-year fellowship. OB/GYNs are surgically trained to perform c-sections and can provide care for high-risk pregnancies. They can prescribe medication and contraception.
After completing their residency and getting their license to practice, OB/GYNs can also pursue certification from the American Board of Obstetrics and Gynecology (ABOG). This certification is optional but requires passing exams and shows they have taken extra steps to acquire the knowledge and skills needed to provide the best possible care to their patients.
Midwives
There are different levels of certification for midwives, but all of them are trained to care for patients throughout their pregnancy, labor and delivery, and postpartum recovery. Midwives provide labor support and can deliver babies vaginally but cannot do surgical procedures such as c-sections.
- Certified Nurse-Midwife (CNM): CNMs are registered nurses (RNs) who have completed advanced education and training in midwifery. They typically hold a bachelor’s degree in nursing and a master’s degree in nurse-midwifery or a Doctor of Nursing Practice degree. They also have certification from the American Midwifery Certification Board (AMCB). They can prescribe medication and contraception. CNMs most often practice in a hospital setting and support medical interventions, such as induction of labor or epidurals, if necessary or desired by the patient.
- Certified Midwife (CM): A CM is not a registered nurse but often has a background in a different health-related field. CMs have completed graduate-level education in midwifery and are also certified by the AMCB, which requires passing the same certification exam as CNMs.
- Certified Professional Midwife (CPM): These are specialists who have earned certification from the North American Registry of Midwives. CPMs have extensive training and experience providing care in out-of-hospital settings, such as in people’s homes or birthing centers.
- Direct-Entry Midwife (DEM): While these types of midwives have trained with another midwife, they do not have a certification. They typically provide care for home births or in private birthing centers. They cannot prescribe medication or contraception.
Choosing Your Care
Deciding who you want to provide your prenatal care and deliver your baby is a very personal decision that depends on unique factors in each pregnancy.
Care during your pregnancy with an OB/GYN or midwife will often look very similar. Both will do labs, ultrasounds, and monitor things like blood pressure and baby’s growth.
The main differences in what kind of care you choose come during labor and delivery.
When choosing your provider(s), take the following into consideration:
- Birth experience and location: Do you prefer a hospital setting with access to medical interventions and surgical facilities, or do you prefer a birth with ample labor support in a home or private birthing center?
- Risk factors: Do you have a high-risk pregnancy that may require specialized care or a low-risk pregnancy?
- Personal beliefs: Do you prioritize medical interventions, or do you align more closely with a holistic and natural approach to childbirth?
- Pain management: Do you want an epidural, or are you interested in learning to cope with the pain in a natural way, such as breathing techniques, massage, or water therapy?
- Postpartum support: Are you interested in comprehensive help with postpartum maternal well-being and breastfeeding, or are you primarily focused on medical follow-up and recovery?
“What kind of care you choose really depends on what kind of birth experience you’re looking for and where you’re planning to deliver. It’s really important to think about what’s important to you, find a provider you’re comfortable with, and agree with their philosophy of care.”
Working Together
It’s important to note that many OB/GYNS and midwives can work collaboratively and often partner with one another. You could labor in a hospital setting with a midwife providing labor support and only have an OB/GYN step in for any necessary interventions, such as a c-section or use of a vacuum or forceps.
Similarly, you could also go through labor at home or a private birthing center and have your midwife transfer you to a trusted OB/GYN if needed.
“We often work very closely together, and it can be a really beautiful balance of practices,” Rizk says.
Childbirth is unpredictable, but making a birth plan and choosing a provide that aligns with your wishes will help you deliver your baby in the way that’s best for you.