OB or Midwife? Choosing a Birth Care Provider

Choosing a Birth Care Provider That is Best For You

You will have many choices to make during your pregnancy and birth, some more important than others. One very important decision you will make during pregnancy is choosing a birth care provider that is right for you to help you deliver your baby.  Making an informed decision about your health care provider can help you achieve the birth plan experience that you desire.

There are a lot of ways to find a pregnancy care provider, but one of the best ways is to talk to your friends and family members who have had babies and get recommendations from them. Ask them if they liked their provider, was he/she easy or difficult to talk to, did she have a positive birth experience? It’s good to remember that the same provider who suits your friend may not be the best match for you. It never hurts to meet with 2-3 providers before selecting one.

This post provides information on the different types of maternity care models and birth care providers with emphasis on the difference between an obgyn and midwife.

Types of Birth Care Providers 

• Obstetricians (OB’s)
• Family physicians
• Midwives

Types of Models of Care

Medical Model of Care

• More focus on managing complications and issues
• Greater dependence on technology in labor
• Typically use interventions at higher rates
• Provide a similar approach to care for every person

Midwifery Model of Care

• Focus is on health, wellness and prevention when possible
• View labor and birth as a normal physiological process
• Rely on interventions at lower rates, only when needed
• Provide a more individualized approach to care

Quick Facts

• All of these providers are qualified to provide prenatal care and health services throughout pregnancy, labor and birth.
• All are able to provide the same tests during pregnancy such as ultrasounds and blood work.
• Each provider type offers a different style of care, which will be a better fit depending on your preferences and needs.

Obstetrician-Gynecologists 

Obstetrician-Gynecologists (also known as an OB or OB GYN) are medical doctors that specialize in women’s health care.

• Completed 4 years of medical school and additional training in a 4-year surgical residency program.
• Received training to diagnose and manage complications and emergency care in pregnancy and birth.
• Many OBGYN’s have also completed a 3-year fellowship to specialize in a specific area such as infertility.
• A Maternal Fetal Medicine Specialist is an OB who has completed an additional years of training in high-risk pregnancy.
• Obstetricians receive their certification from the American Board of Obstetrics and Gynecology

Good to Know

OBGYN’s practice under the medical model of care.  They are an excellent choice for high-risk pregnancies due to a medical condition like heart disease, or diabetes.  OBGYN’s also care for low-risk women without specific medical concerns.  Obstetricians are usually part of a rotating on-call group so it is not guaranteed that the same doctor you have seen during pregnancy will attend you in labor. However, most obstetricians offer a “meet and greet”, so that you can be familiar with the other potential doctors who may be there for your delivery. OBGYN’s oversee labor (labor support may be provided by the labor and delivery nurses that are on staff at the hospital) and arrive to support you during the time of delivery.

To learn more about Obstetricians visit:

https://www.facs.org/education/resources/residency-search/specialties/obgyn

Family Physicians

Family physicians (FP’s) are doctors who have studied family practice medicine. They typically practice under the medical model of care.

• They are trained in various fields of medicine that include obstetrics, pediatrics, surgery, and internal medicine.
• Some family doctors provide prenatal care to pregnant women and will attend you in childbirth.
• Others only provide prenatal care only and will require that you have an OB or midwife care for you during childbirth.

Good to Know

Family physicians normally handle healthy women with low-risk pregnancies and most attend hospital birth deliveries. They are also trained to take care of your baby after delivery.

Midwives

Midwives have supported women in pregnancy and childbirth for centuries and are considered experts in normal pregnancy and birth and practice under the midwifery model of care.

• Provide prenatal care, labor and birth support and follow-up care after your baby is born.
• Midwifery care treats pregnancy and birth as a normal, natural occurrence and strive to help you avoid unnecessary medical interventions whenever possible.
• Midwives typically spend a lot of time with you during prenatal visits (generally between 30 minutes to 1 hour) in order to develop a strong relationship with you.
• They typically provide education on fertility, nutrition, exercise, emotional health, breastfeeding, new baby care and more which aids in informed decision making.

Good to Know

If you desire a more personalized experience with minimal intervention, a midwife could be a good option for you.

Midwives often offer more birth choices and birth options than any other type of birth provider.

Your health insurance should cover a midwives’ care if you deliver in the hospital setting, and a portion if you chose to deliver in a birth center. Home births are typically not covered but be sure to check with your insurance provider before ruling this option out.

Types of Midwives

Below are several of the most common types of midwives. Depending on whether you would like to have your baby in a hospital, a birth center, or at home it’s best to know what kind of certifications or support you would like. The information below will help you determine the type of midwife you want to work with.

Certified Nurse-Midwife (CNM)

• Certified Nurse Midwives, CNM’s have been practicing in the United States since the 1920’s.
• Most midwives in the United States are CNM’s.
• Licensed in both registered nursing  and midwifery. CNM’s hold at least a masters degree or doctorate degree.
• Accredited by the Accreditation Commission for Midwifery Education (ACME).
• Provide healthcare throughout a woman’s lifespan including annual GYN exams; pregnancy, birth, postpartum and newborn care; family planning for childbearing women and management of menopause.
• Able to prescribe a full range of medications, pain management and treatments.
• Work in many different settings, including hospitals, private practices, birthing centers, and homes.

Certified Midwife (CM)

• CM’s have a bachelor’s degree in a health-related field other than nursing.
• Hold a Master’s degree from a midwifery education program accredited by ACME.
• They receive the same preparation as CNMs, provide the same services and practice in the same settings
• Able to prescribe a full range of medications and treatments.

Certified Professional Midwife (CPM)

• CPM’s are professional, independent practitioners trained in midwifery.
• Provide pregnancy, birth, and care after birth.
• Care for women outside of the hospital, often in birth centers and homes.
• Meet the standards set by The North American Registry of Midwives (NARM).

Direct Entry Midwife (DEM)

• DEM’s practice independently.
• Trained and certified in Midwifery through either: midwifery school, college program or apprenticeship.
• Provide women with complete prenatal care
• Attend women in labor at home or at birthing centers.

To learn more about Midwives or the Midwifery Model of Care visit:

American College of Nurse-Midwives – Our Moment of Truth http://ourmomentoftruth.com/your-health/what-is-a-midwife/

Midwives Alliance North America – https://mana.org/about-midwives/what-is-a-midwife

Interviewing a Birth Care Provider

There are lots of resources available that suggest interview questions to ask a birth care provider. Here is a selection of questions you may want to ask a Midwife or OB:

• What does a typical prenatal visit consist of? How much time do you typically spend?
• What is your philosophy about birth?
• Should I write a birth plan?
• Will I have a chance to get to know each of the doctors or midwives that will potentially be on call during my labor?
• What is your policy on labor induction?
• How long past my expected due date will I be able to go before intervention is required?
• What is your C-section rate and what percentage of patients have cesarean sections?
• What situations would warrant a C-section?
• What type of fetal monitors does your practice use? Intermittent auscultation or continuous monitoring?
• How do you feel about eating and drinking during labor?
• What are your thoughts on pain medication?
• What is your policy on (vaginal birth after cesarean) VBAC?
• What is your VBAC success rate?
• What birthing options do you offer – (besides birthing on my back)? Can I labor in water, use a birth ball, walk and move around?
• Do you offer waterbirth and birth tubs?
• Do you find patients using these comfort measures often?

How to Know if Your Birth Care Provider is a Good Fit For You

Taking the time to make an informed decision about your health care provider can help you be in the best position to achieve the birth plan experience that you desire.

Be sure to ask lots of questions and express any concerns at your prenatal appointments. If you feel great about your provider, keeping the lines of communication open will help build up to the level of trust you need for labor.

If you aren’t sure about your provider, then asking questions and expressing yourself are extremely important. Find out how they usually care for clients in labor, step by step. Notice how they respond to your questions and concerns. This will either help strengthen the relationship, or may reveal that you should consider finding a provider who is a better fit for you.

Choosing a Place to Deliver

Deciding between hospital or birthing center or birth at home can be challenging but it is worth the effort to explore all the options that may be available to you and your baby.

Additional Resources that May be Helpful:

If you’re still on the fence about what you’re looking for in a caregiver, you might want to consider taking the Birth Profile Assessment & Beyond the Birth Plan Childbirth Course – both really make choosing a provider and birth place much easier!

The Birth Profile Assessment highlights areas in your personalty, beliefs and support system to help you see what type of birth provider and birth place are a good fit for you as you consider an OB or Midwife, Hospital or Birth Center or even birth at home.

Unlike other childbirth classes, the Beyond the Birth Plan Childbirth Course focuses on you, the laboring person. Because YOU are the one who is going to be in labor, we thought it important to tailor the class to you, based on your actual personality, beliefs, and preferences. The Beyond the Birth Plan Childbirth Class takes the scores from the Birth Profile Assessment and shows you areas where you need to focus your attention. This birth course is self-paced and is filled with comfort measures, pain relief options, and partner support modules.  This course gives you all the tools and educational resources you need to have confidence in planning for your baby’s arrival.

Disclaimer: Pregnancy by Design’s information is not a substitute for professional medical advice or treatment. Always ask your healthcare provider, doctor or midwife about any health concerns you may have.

Cited Research:

American College of Nurse-Midwives – Our Moment of Truth. What is a Midwife?  Retrieved from http://ourmomentoftruth.com/your-health/what-is-a-midwife/.

American College of Surgeons. Obstetrics and Gynecology.  Retrieved from https://www.facs.org/education/resources/residency-search/specialties/obgyn.

Midwives Alliance North America.  What is a Midwife? Retrieved from https://mana.org/about-midwives/what-is-a-midwife.