Congratulations on your pregnancy, mama! This is a time full of lots of excitement and decisions. And one of the first is if you’d like a midwife or an OB-GYN for your prenatal care and birth, so let’s break down having an OB vs. midwife, including comparing their education, training, prenatal care, benefits of a midwife vs. an OB, and more to help figure out which may be best for YOU!
What is a Midwife?
Midwives in the U.S. vary in what education and training they have received.
Nevertheless, a midwife is a trained medical professional who specializes in prenatal care, labor, childbirth, and holistic well women care including holistic gynecology.
A midwife is responsible for the well-being of both the mother and the baby during the pregnancy and birthing process.
Midwives can deliver babies at home, in a birthing center, or at a hospital. They typically provide low-intervention care and prioritize the mother’s natural birthing process.
Certified Nurse-Midwives (CNMs)
CNMs are nurses with a graduate degree in nurse-midwifery.
Before starting their master’s or doctorate in nurse-midwifery, they first must obtain a bachelor of science in nursing. Plus, most work for some time in the labor and delivery unit of a hospital before becoming student nurse-midwives.
CNM programs prepare students with experience in many physiologic births, births where interventions were medically necessary, pregnancy, postpartum, newborn care, gynecologic, and family planning services.
Nurse-midwives are advanced practice nurses and/or nurse practitioners who legally recognized in all U.S. jurisdictions and can prescribe medications and contraception.
They can work in hospitals, clinics, birth centers and can provide home births.
Certified Midwives (CMs)
CMs have the same scope of practice as CNMs, but they are only legal to practice in some states in the U.S., such as New York, Rhode Island, Maine, and a handful more.
Certified Midwives received a bachelor’s degree in a field other than nursing, then graduated from a master’s (or doctorate) level midwifery program. They have similar training to CNMs and conform to the same standards as CNMs, but do not have a nursing background.
While they’re direct-entry midwives, they are considered equal to CNMs (in the states where they are legal) because their scope is identical, and they are both highly educated.
I hope soon that CMs will be legally recognized in every state in the U.S. as they’re highly educated practitioners. We need more access to midwives to improve maternal and neonatal outcomes in the United States. Hopefully, soon we will see CMs legally recognized in every state, as nursing is not a sensible requirement to become a highly educated practitioner who also has the ability to diagnose and prescribe medications.
Certified Professional Midwives (CPMs)
Next, there are CPMs, which are legally recognized in 35 states in the U.S. Their education and training are focused on providing care in homes and freestanding birth centers. It’s crucial to remember that they have a different scope than hospital-trained CNMs and CMs.
CPMs need to have a high school diploma or equivalent to enter a CPM program, and there are a couple of different routes to becoming a CPM. Each route consists of formal, organized training.
How to become a cpm:
To become a CPM, one must earn an Associate or Bachelor of Science in Midwifery, which includes working with at least two preceptors and attend at least 55 births as an observer, assistant, and then the primary care midwife.
This option typically takes students 4-7 years to complete. And you can find the exact classes required in this program plan from the Midwives College of Utah here.
Lastly, for either route of becoming a CPM, they must first be BLS certified (Basic Life Support certified; just like every nurse you’ve ever known), NRP certified (Neonatal Resuscitation Provider certified; the same organization and certification every OB-GYN, hospital midwife, labor and delivery nurse, or NICU nurse have), and pass the NARM (North American Registry of Midwives) exam where they are tested on providing safe prenatal, childbirth, and postpartum care to mothers and babies.
Click here to view the study guide for the NARM Exam (pages 32-44).
What does a cpm do?
Unlike certified nurse-midwives and certified midwives, CPMs cannot prescribe medications, but they can obtain and administer all the medications needed for a safe birth in the select states where they are legally recognized.
Truthfully, it’s important to remember that if you have a practitioner, like a CPM, who is skilled in herbs, nutrition, and other lifestyle factors, you’re far less likely to ever need pharmaceuticals!
Certified Professional Midwives specialize in normal, healthy pregnancy and birth, are typically helpful in preventing complications, yet, are still trained emergency care professionals.
CPMs also have full practice authority without physician supervision or a “collaboration agreement” with an obstetrician (unlike many nurse-midwives and certified midwives).
Furthermore, CPMs can further their degree to a Bachelor’s or Master’s of Science in Midwifery, which can allow them to participate in research, become educators/professors, implement more positive changes in midwifery, and more!
Check out:
- 20 Questions You Need to Ask Your Care Provider
- The Business of Being Born
- Is Home Birth Safe? The Pros and Cons
- 21 Undeniable Benefits of the Midwifery Model of Care
Why I Want a Midwife
Midwifery care is growing for multiple reasons. I want a midwife because I know they are the best choice for the low-intervention birth I desire.
Additionally, I love the prenatal care that midwives can provide, including longer appointments and a more holistic view of managing my health for an optimal pregnancy, birth, and postpartum experience!
Furthermore, as I’d like to avoid medical interventions, I’d rather choose a midwife instead of an OB because one study found peaks of first-time cesareans for mothers were seen on weekdays, corresponding to the OB’s immediate pre-clinic time, lunchtime, and immediate post-clinic time.
However, these peaks were not seen on the weekend. And the risk of nonelective first-time cesareans during a weekday was about 1/3 (or about 33%) higher than on a weekend. This study concluded with: “During the workweek, factors other than medical necessity appear to have a marked association with both timing of delivery and rate of cesarean delivery and may affect up to one-third of primary cesarean deliveries” [1].
Additionally, I will have a birth doula with me for my labor and childbirth. Check out 7 Reasons You Need to Hire a Birth Doula to hear the evidence-based reasons why I definitely want a birth doula!
What is an OB vs. Midwife?
An OB-GYN is an obstetrician and gynecologist trained to perform surgeries such as cesarean deliveries (C-sections) and gynecological procedures.
OB-GYNs are trained to manage pregnancy-related complications with medical interventions such as medications to accelerate labor and birth, medical pain relief (including epidurals), forceps, ventouse (vacuum), or a cesarean.
OB-GYNs are doctors who have graduated from an accredited and approved medical school and have also completed 4 years of residency covering gynecology, obstetrics, ultrasonography, gynecological oncology, and preventative care.
Then they also pass a test regulated by the American Board of Obstetrics and Gynecology to earn a certification to practice in their state.
I commonly see other OB-GYNs and future OB-GYNs on social media including YouTube and Instagram say the two reasons they chose this field are because they love surgery and they enjoy the continuity of care.
This shouldn’t be surprising because they are surgeons, and most of them went to school years longer than many other people to perform surgery.
Therefore, if you have a low-risk pregnancy and desire a low-intervention birth, research shows fewer interventions and safe (possibly safer) outcomes for women who choose midwives [2].
Interested in reading my labor and delivery story with an OB-GYN? Click here!
The Benefits of a Midwife vs. an OB for a Low-Risk Pregnancy
If you’re interested in having a vaginal, unmedicated birth, then midwives are the experts in healthy, normal, low-intervention pregnancy and childbirth.
Midwives also provide more holistic care combined with modern medicine during the pregnancy and postpartum period, which is beneficial to me as I prefer using holistic methods when it’s possible and appropriate.
Midwives also reduce a pregnant woman’s reliance on medical interventions unless it’s vital, and this can be beneficial if you’re interested in avoiding any unnecessary medical interventions.
For example, if the OB wants to perform a C-section because of a “failure to progress,” but the nurse-midwife thinks the woman should be given more time to naturally progress, plus the midwife will probably have some natural induction methods she may suggest using for the mother.
But unfortunately, midwives currently only attend 8% of births in the U.S., Whereas in the UK and other developed countries, they attend over two-thirds of births.
Evidence-based benefits of hiring a midwife for pregnancy and childbirth include:
- Reduced infant mortality rates [3]
- Reduced need for medical interventions and inductions [4, 8]
- Higher satisfaction rates with quality of care [5]
- Reduced risk of preterm births [6]
- Reduced risk of having a cesarean delivery [7]
- Fewer episiotomies [8]
- Less likely to have an epidural [8]
Midwifery care is safe. Some say safer than physician care for women at a lower risk. Plus, people who use midwives report high levels of satisfaction with their care.
In a recent study, all 50 states were examined to integrate midwives (including CNMs, CPMs, and CMs) into their healthcare systems [9]. This study found that with higher integration, they had better birth outcomes for mothers and babies. This also led to more unmedicated births, fewer obstetric interventions, and fewer unwanted neonatal outcomes.
OB vs. Midwife: “What if I’m High-Risk?”
If you’re high-risk, you must also see an OB-GYN. If you originally had a certified nurse-midwife, then your midwife and an OB-GYN can work together to provide your prenatal and childbirth care. Even if you end up needing a cesarean, your nurse-midwife can assist an OB-GYN because that is another common part of their job responsibilities.
Continuing your care with your nurse-midwife and still having a doula is incredibly beneficial to lower the number of medical interventions during your labor and delivery.
Remember that if you’re low-risk when seeing a midwife, you will be continuously assessed to be still low-risk during prenatal care and on the day you’re giving birth. This ensures that both you and your baby are entirely safe with midwifery care since surgery is one of the only things an OB-GYN can do that a midwife is not trained to.
OB vs. Midwife: Your Prenatal Care
Suppose you have a low-risk pregnancy, whether you’re seeing a midwife or an OB-GYN. In that case, you’ll likely stick to a routine prenatal checkup schedule. This looks like seeing your midwife or OB-GYN once a month for the first 6 months, and then twice a month during months 7 and 8, then weekly appointments during your 9th month.
When seeing a midwife, you might have your appointments at a birthing center or even at your home! Regardless of the setting, you’re likely to spend more time with your midwife during appointments than you would with an OB-GYN, as doctors typically have 15 minutes slots for each appointment. A midwife typically gives you time to answer your questions, provide education, and get to know you.
During these appointments, a midwife may also focus on holistic care and provide recommendations for therapeutic solutions, such as seeing a chiropractor or massage therapist.
Also, midwives are typically cheaper than an OB-GYN, and Medicaid even covers them!
However, always consult with your insurance provider to confirm what prenatal services are covered.
OB vs. Midwife: Your Labor and Birth
Your birth experience can vary greatly depending on if you choose a midwife or an OB-GYN. And as we talked about above, this has a lot to do with their differences in training, but also their involvement in your labor and childbirth is vastly different.
Since OB-GYNs are specialized to care for high-risk pregnancies and complications, they aren’t going to be a part of your labor care; that’s what your labor and delivery nurse is for. But midwives are incredibly involved in your labor and childbirth care because they are both your “nurse” and the maternal care provider there for the birth of your baby and making sure you and baby are healthy in addition to being educated to get you the care you or your baby needs immediately if anything looks concerning.
It’s also important to know that if you decide to give birth in a hospital with an OB-GYN, it’s pretty unlikely that you’ll have the OB-GYN you saw for your prenatal visits as the doctor delivering your baby. It just depends on who is on call the day you give birth!
Likewise, if you’re seeing a Nurse-Midwife through your hospital, they also usually rotate who is on call as well, even for their hospital birthing center. With this, I would recommend rotating the midwives who work in the setting you’re attending for your prenatal appointments so that you can get to know each of them!
Have You Made Your Birth Plan?
Having the same midwife can be really reassuring, especially for the mamas who make a birth plan and communicate with their healthcare provider about their desires.
Interested in making your own birth plan? Check out this detailed, printable birth plan and make it custom to all of your desires for your labor, delivery, and hospital or birth center stay!
I personally love birth plans, and I think they are necessary for women, whether you have your birth with a midwife or an OB-GYN, to help ensure clear communication of your wants and needs for your birth experience!
If you’re feeling unsure about making a birth plan check out: How to Make a Birth Plan – Free Template!
Still Need Help Deciding Between an OB vs. Midwife?
It’s crucial to continue researching your options until you feel confident and comfortable with your decision. Deciding between an OB vs. a midwife is one of the most impactful choices you will make in your birth experience, with the second one being where you choose to give birth.
Childbirth will be one of the most significant and memorable moments in your life, and you deserve a birth that you can look back on, knowing you were empowered, in control, respected, and supported.
By using a birth plan like this one below, you have options laid out for you to look more into before labor begins. (link early labor blog post) You can talk about these options with your OB or midwife, doula, childbirth educator, etc., for more guidance as well, which ultimately ensures you’re educated and prepared to go into labor.
If you’d like this birth plan template, fill out the pop-up on my website! The Birthing Balance Birth Plan will show you all the options you can learn about in The Balanced Birth Course(Coming soon!), then the last page of the birth plan provides a template to write out your wishes in a list format so that there’s nothing written on your birth plan that you do not want!
And remember, each care provider is different! If you’re like me and looking to avoid as many medical interventions as possible, you can still find an amazing OB-GYN to help you achieve that goal safely.
You got this, mama!
If you have any questions or comments, please leave them in the comments below!
Recommended Resources about Human Rights in Childbirth
Sources
[1] Patterns of obstetric interventions
[2] See note 5, Chapter 19; Lancet special series on midwifery (2014) available at https://www.thelancet.com/series/midwifery
[3] Reducing neonatal mortality with nurse-midwives
[4] The cost of nurse-midwifery care
[5] Evaluation of satisfaction with midwifery care
[6] Midwife‐led continuity models versus other models of care for childbearing women
[7] Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births
[9] Integration of midwives in all 50 states
DISCLAIMER: This post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding you or your baby’s health. Please read my Medical Disclaimer for more info
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