May 12, 2020

When it comes to care provider options for pregnancy and birth it can be a little confusing. ob-gyns, midwives, doulas... who are all these professionals and which of them is qualified to deliver your baby? Choosing the right person for you may be a daunting task in those early days of pregnancy when you’d rather be sleeping or recovering from your latest bout of morning sickness. We’ll go through some options and considerations, so you can make the best choice for you and your family.

What is the difference between a midwife and an ob-gyn?

When it comes to the question of who will help you deliver you baby, the choice is usually between an ob-gyn (obstetrician-gynecologist) or a midwife. Ob-gyns are physicians who specialize in women’s reproductive health and will conduct regular office visits for well-woman care, as well as pregnancy and postpartum. They also assist in labor and delivery and perform c-sections and other surgeries when necessary.

Midwives are also women’s health professionals that are trained in providing care during pregnancy, labor, delivery, and postpartum. Midwifery care can be provided by certified nurse midwives (CNM), certified midwives (CMs), and certified professional midwives (CPMs).

• CNMs are registered nurses that must also pass a certification examination.
• CMs have similar training, and take the same certification exam, but do not have a nursing degree.
• CPMs do not have degree requirements, and are typically trained through apprenticeship programs, but must also pass a certification exam.

CNMs and CMs primarily work in hospitals and birth centers, and CPMs work exclusively in the home. The vast majority (94.3%) of midwife-attended hospital births are attended by CNMs.

The some considerations when deciding between an ob-gyn and a midwife include:

• Location. Ob-gyns usually only practice in a hospital. CNMs and CMs can practice in a hospital or birth center, and CPMs practice in the home. Where you would like to deliver may dictate who attends the birth.
• Risk of complications. Ob-gyns are trained in high-risk pregnancies and can perform surgery, where midwives cannot. In fact, some regulations prohibit midwives from caring for women at high risk.
• Interventions. While midwives support the use of appropriate interventions, midwife-attended births are found to reduce the use of analgesia (pain meds), and rates of episiotomies and instrument-assisted births. In addition, midwife care also increased the chance of breastfeeding and of a woman having a spontaneous vaginal birth.

If I have a midwife, can I get an epidural?

If you have an ob-gyn, an epidural is typically no big deal. You will already be in a hospital with an anesthesiologist on staff. However, if you have a midwife, it may or may not be an option. If you have a CNM and are giving birth in a hospital, the logistics would be the same as an ob-gyn. However, if you are in a birth center or at home, your options are more limited, and you will want to discuss them with your midwife.

If I have a midwife, what happens if I need a c-section?

If your risk of needing a c-section is low or moderate, you may decide to have a midwife as your care provider. However, the need for an unplanned or emergency c-section might still arise. If you have a CNM with hospital privileges, there will be an ob-gyn on call to perform the c-section. However, if you are in a birth center or at home, you will have to be transferred to a hospital.

What is a doula?

While doulas are not medical professionals and do not deliver babies, a doula may be part of your birth team. A doula provides education, resources, help making decisions and holistic, non-judgmental emotional support to families throughout pregnancy, birth and postpartum. They will help with comfort measures for mom during labor, breastfeeding, baby care, and postpartum healing.

Who Else Might Help Deliver My Baby?

Labor and delivery (L&D) nurses will come in and out during labor at a hospital. They manage IV drips, change bedsheets, coach women on pushing and delivery and assist the ob-gyn or midwife with any other tasks. You will often see your nurse far more than the doctor!

Maternal-fetal medicine (MFM) or perinatologists are ob-gyns that specialize in high-risk pregnancies. Sometimes they work with your primary ob-gyn and sometimes they become your main care provider. They may provide consultations and counseling, run additional tests, and assist in labor and delivery.

Family practitioners can also deliver your baby. This is more common in rural areas where other specialists are hard to come by but it is possible in bigger cities as well. One benefit would be continuity of care, as your family doctor might know you well and be able to care for your child going forward. A downside is that they often refer out for higher risk pregnancies and most don’t perform cesarean sections.

There is quite a bit of information to consider when deciding who will manage your care during pregnancy and there really are pros and cons to every kind of provider. Doing your research, speaking to other parents about their experiences, and hiring a doula can all help with the decision making process.

Sources:

MacDorman, M. F., & Singh, G. K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. Journal of epidemiology and community health, 52(5), 310–317. https://doi.org/10.1136/jech.52.5.310. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756707/pdf/v052p00310.pdf

Johantgen, M., et al (2012). Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008. Women's Health Issues, Volume 22, Issue 1, e73 - e81. https://doi.org/10.1016/j.whi.2011.06.005 Retrieved from: https://www.whijournal.com/article/S1049-3867(11)00160-5/fulltext

My Cleveland Clinic (2019). “Obstetric Health Care Providers: Choosing One Right for You.” Retrieved from:
https://my.clevelandclinic.org/health/articles/9698-obstetric-health-care-providers-choosing-one-right-for-you

Souter, Vivienne MD; Nethery, Elizabeth MSc; Kopas, MaryLou MN, ARNP, CNM; etc. “Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births.” Obstetrics and Gynecology. Retrieved from: https://journals.lww.com/greenjournal/Fulltext/2019/11000/Comparison_of_Midwifery_and_Obstetric_Care_in.20.aspx