Wait, we have options?

When thinking about what kind of healthcare provider you want by your side during pregnancy, labor, and delivery, you may want to prioritize medical expertise and access to interventions or consider a more holistic approach. Or you may want to explore hybrid options such as midwife-led care with doctor backup to combine the benefits of both approaches. 

Either way, your healthcare provider should make you feel comfortable, safe, and empowered. Your decision about this is related to your birth preferences and where you want to give birth, and you can review our articles on these here and here, respectively.

Types of midwives

In the US, there are three main certifications for midwifery: Certified Nurse Midwives, Certified Midwives, and Certified Professional Midwives. There are also Traditional Midwives, sometimes called lay midwives or community midwives. These are uncertified or unlicensed midwives who often have informal education, such as apprenticeships or self-study, rather than a formal education from accredited institutions.‍

Certified Nurse Midwives

Certified Nurse Midwives are registered nurses who have received their certification as midwives. They are licensed to practice in all settings in all 50 states and DC but primarily practice at hospitals. How independently they can practice and how widely available they are depends on each state's rules regarding whether they must be supervised or have a collaborative agreement with a physician.‍

Certified Midwives

Certified Midwives are non-nurses who have earned a postgraduate degree in midwifery and received their certification. They are legally recognized to practice in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and DC. CMs can practice in all settings but primarily practice at hospitals. How independently they can practice and how widely available they are depends on each state's rules regarding whether they must be supervised or have a collaborative agreement with a physician.‍

Certified Professional Midwives

Certified Personal Midwives are legally recognized to practice in 36 states and DC. CPMs are independent practitioners and attend births at birthing centers or homes. How widely available they are depends on each state's rules.

Types of doctors

Obstetricians (OBs) are doctors who care for women and their babies during pregnancy and childbirth. Obstetrician gynecologists (OB/GYNs) are medical doctors who combine two disciplines: obstetrics and gynecology. Gynecology is the care of women's reproductive organs and health, while obstetrics involves the care of pregnant women, including the delivery of babies.

Overview of similarities & differences

Approach to care

Midwives often take a more holistic approach to pregnancy and childbirth, focusing on the emotional and physical well-being of the mother. They provide personalized care and support throughout the journey. Midwives often spend more time with their clients, offering nutrition, exercise, and stress management guidance to promote a healthy pregnancy. 

Doctors generally approach childbirth from a medical perspective, utilizing their training to manage various medical situations. Their primary focus is identifying and addressing potential complications to ensure the mother and baby's safety. 

Scope of practice

Midwives are trained to handle low-risk pregnancies and deliveries. They offer continuous support throughout your pregnancy, during labor, and in the postpartum period, helping you navigate the challenges and joys of becoming a parent.

Doctors are equipped to manage both low-risk and high-risk pregnancies, as well as complications that may arise during pregnancy or childbirth. If you have a pre-existing medical condition or develop complications during your pregnancy, you may feel more comfortable working with a doctor. Doctors can perform surgical interventions, such as cesarean sections (C-sections), if necessary and have access to advanced medical technology and resources. 

Place of practice

Certified midwives often work in hospitals, birthing centers, or provide home birth services. Doctors primarily deliver babies in hospitals. 

Birthing centers and home settings offer a more intimate and personalized experience for couples who prefer a non-hospital environment. However, hospitals are equipped with advanced medical technology and resources, which can be invaluable in case of complications or emergencies during labor and delivery. 

Prenatal care

When it comes to prenatal care, both midwives and doctors aim to ensure the health and well-being of you and your baby throughout your pregnancy. Midwives typically offer longer, more frequent appointments, giving you ample time to discuss your concerns, ask questions, and build a trusting relationship with your care provider. 

Doctors, on the other hand, may have shorter, more structured appointments due to their schedules and patient load. 

Both midwives and doctors follow standard guidelines to track your baby's growth and development. Midwives tend to use non-invasive, evidence-based methods when possible. Doctors rely more on medical interventions and technology for monitoring and testing that is evidence-based. 

Labor & delivery

Midwives are typically with you through your labor and delivery. They are trained to guide you through various breathing exercises to help you focus, relax, and manage the intensity of contractions. They may also teach relaxation techniques such as visualization or meditation to help you stay calm and centered throughout labor and delivery. 

Midwives often recommend water therapy, including laboring in a birthing pool or a warm shower, as water can ease pain, promote relaxation, and make the birthing experience more comfortable.

Doctors, on the other hand, are often present during the final stages of labor. A labor and delivery nurse will coach you through labor and delivery. Doctors provide a variety of medical pain relief options, including epidurals and other interventions. They are also trained to manage medical procedures like continuous fetal monitoring, labor induction, and assisted delivery methods, such as forceps or vacuum extraction, if necessary.

Continuity of care

Whether you're seeing a doctor or a midwife, the person who attends to you during labor and delivery may not be the same provider you've seen throughout your pregnancy. Some practices will encourage you to meet various healthcare providers during prenatal visits to ensure familiarity and comfort with different team members.

Postpartum care

After your baby is born, both midwives and doctors provide postpartum care to ensure a smooth recovery for you and your baby. Midwives often offer more extensive postpartum support, with home visits and longer follow-up appointments. They focus on your physical and emotional well-being, providing guidance on self-care, healing, and adjusting to life with a new baby. 

Midwives are also well-versed in breastfeeding support and can offer resources and advice to help you establish a successful breastfeeding relationship with your baby.

Doctors also provide postpartum care, typically through office visits. They monitor your physical recovery, ensuring that you are healing properly and addressing any concerns that may arise. Doctors can provide medical treatment if needed, such as prescribing medication for postpartum depression or managing postpartum complications. While doctors may not have as much time to devote to breastfeeding support, they can still offer guidance and refer you to lactation consultants or other resources in your area.

Hybrid options

Midwife-led care with doctor support combines the benefits of midwifery and medical practices. In this approach, midwives handle most of the care, but they work with doctors if complications arise or if the pregnancy is high-risk. For instance, if a woman in labor needs an epidural, or if there are concerns about fetal monitoring or a possible C-section, the midwife will help transition her to a doctor’s care.

This model aims to offer the best of both worlds: the personalized, supportive care of a midwife along with the medical expertise and interventions of a doctor.

Factors to consider when choosing

Birth preferences 

When it comes to choosing between a midwife and a doctor for your pregnancy and childbirth, consider your birth preferences. If you value a more holistic approach to childbirth and desire a strong emotional connection with your care provider, a midwife might be the right choice for you. 

On the other hand, if you feel more comfortable with a medical approach and prefer a care provider with extensive training in managing complications, a doctor might be a better fit. 

Your health & the health of your baby

If you have a low-risk pregnancy and no existing health issues, a midwife can provide complete care throughout your pregnancy and childbirth. They are trained to spot complications and can refer you to a doctor if needed.

On the other hand, if you have a high-risk pregnancy—like gestational diabetes, preeclampsia, or multiple births—you may need a doctor’s expertise. Doctors are equipped to handle complex medical situations and can offer specialized care to ensure your safety and that of your baby.

If you have a pre-existing condition or develop complications, it’s important to have a doctor closely monitor your progress and take action if necessary.

Availability in your area

In some places, midwives might be more common, while in others, doctors may be easier to access. Look into what’s available in your community, considering how close they are to your home, their hospital privileges, and whether they have backup medical support.

If you have a specific birthing center or hospital in mind, check which providers are allowed to admit patients there. Some centers may only work with midwives, while others have both midwives and doctors. If you’re considering a home birth, make sure local midwives offer this option and have a plan for hospital transfer if needed. Understanding the availability of midwives and doctors in your area will help you make a choice that fits your needs and preferences.

Costs & insurance coverage

Review your insurance policy to understand which services and providers are covered. Some insurance plans may fully cover midwifery care, while others may have limitations or require additional out-of-pocket expenses. Similarly, investigate the coverage for doctor visits, hospital stays, and potential interventions.

In general, midwifery care may be less expensive than doctor-led care, particularly if you have a low-risk pregnancy and plan for a natural, unmedicated birth. However, if complications arise and you require medical interventions or a C-section, the costs can increase significantly. 

It's essential to have open discussions with your insurance provider and the prospective care providers to understand the financial implications of your choice (see our article on this).

Giving yourselves time to research 

You can start by gathering information from reliable sources, such as professional organizations, government health agencies, and reputable parenting websites. The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) are excellent resources for learning about the roles and qualifications of doctors and midwives, respectively. 

You can also find valuable information in pregnancy books, childbirth education classes, and conversations with friends and family members who have recently given birth.

Scheduling consultations

Meeting with providers that you're considering will help you understand each provider’s approach and find the best fit for you. They’re a chance to ask questions, express concerns, and see how the provider communicates.

During your meetings, ask about their experience and how they handle various decision points during pregnancy and childbirth. Find out about their appointment availability and policies for after-hours care and emergencies. If you have specific needs or preferences, like wanting a water birth or having a history of anxiety, discuss these to see if they can accommodate your wishes.

Pay attention to how well the provider listens to your concerns and whether they take the time to answer your questions thoroughly and respectfully. The right provider should make you feel heard, supported, and empowered during your pregnancy and birth experience.

Trusting your instincts 

Your care provider will be your partner during this important journey, so it’s vital to choose someone you trust and who respects your choices. 

I switched from an OB/GYN to a care center with both midwives and doctors during my first trimester. My OB/GYN was great, but as a first-time mom, I had a lot of basic questions that I felt awkward asking.

After the switch, my pregnancy went well, and despite a rough start, my labor, delivery, and postpartum experience at the hospital were great. My midwife was an essential component of this. She explained everything clearly, made sure I was in charge of my decisions, and provided excellent support. While it may seem like basic care, I learned from talking to other women that it’s not always the case.

Even though I had a positive experience with my midwife, I’d still consider both doctors and midwives for future pregnancies. I think my experience could have been very different if the midwife on duty when I arrived at the hospital had been someone else.

Additional resources:

• Midwife vs. OB-GYN: Who’s Right for You? (Healthline)
• Should You Choose an OB-GYN or a Midwife? (Parents)

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