Should I work with a Midwife or an OBGYN?
Friday, October 14, 2022
Have you ever noticed that many pregnant people spend more time choosing their stroller than their midwife\* or OBGYN? When you're expecting, choosing your medical care-provider is one of the most important decisions you can make! Your midwife or doctor will shape how you think about your body your baby, and determine much of your labor, delivery, and postpartum experience.
To help you make the best possible choice, we want to walk you through
- The difference between midwives and obstetricians
- What to look for when interviewing a midwife or OB to make sure it’s a good fit
- How to find a midwife or OB near you
What’s the difference between a midwife and an OBGYN?
In many ways, midwives and obstetricians are two sides of the same coin. Both are medical professionals who support folks from adolescence through menopause in gynecological care including, pregnancy, labor and delivery, and postpartum care, provide routine GYN exams, Pap tests, and counseling for contraception and unplanned or unwanted pregnancy.
While there are some key medical differences in terms of scope (midwives for example are not trained surgeons and will not perform a cesarean birth), the primary differences come down to a quality of care. Elaine Keller-Duemig, CNM from Central Park Midwifery explained that “Midwives are generally trained medical providers who specialize in low risk pregnancy and birth. [The midwifery model of care] focuses on the whole person – not only the physical, but emotional and mental well-being also.” She went on to say that while they are both fully able to prescribe and use medications, midwifes “often know more about and recommend alternative treatments, such as acupuncture, chiropractic, supplements, herbs etc.”
The obstetric model of care, on the other hand, focuses on identifying and mitigating risk and complication. Since their education and training centers high-risk pregnancies and deliveries, Obstetricians, in general, are less familiar supporting low-risk, physiological birth.
Who should definitely work with an obstetrician?
While less than 10% of expectant parents choose to work with a midwife in the U.S., “most people can work with a midwife”, Keller-Duemig explains. For example, “there are some folks who say someone over 35 is ‘high risk,’ this does not mean you can’t work with a midwife. [Is Advanced Maternal Age even a risk?] While midwives can practice independently, they generally have relationships with physicians for referrals for issues both in pregnancy and outside of it (like endocrinologist for thyroid issues or OBs / MFM for OB issues).” Midwives can co-manage certain conditions like thyroid disease, mental health conditions (including on medication) and PCOS with other providers and can safely care for folks who desire a Vaginal Birth after Cesarean, or VBAC, after one prior cesarean.
Certain conditions like hypertension and pre-existing diabetes are however best suited for obstetrical care.
In general, Keller-Duemig encourages folks to reach out to a midwife for a consultation. “We always offer a call, and we go over history in detail. If we don’t think midwives are the best fit for someone, we will tell them and give them some other recommendations.”
Wait, what’s a Doula? Can I have a midwife and a doula?
A lot of people think midwifes and doulas are essentially the same – as in, some kind of “hippie-esq" support for pregnant folks – and that you would have one or another. This is definitely not the case! Doulas are completely non-medical individuals who provide physical, emotional, and educational support and counsel throughout pregnancy, labor and delivery. This means things like back rubs, cheerleading text-messages in the middle of the night, links to helpful articles to keep someone off the internet or connections with the best prenatal massage therapist in town. Best practice is to choose a midwife or obstetrician _and_ consider doula support in addition to your medical care since doulas have been shown to have many positive outcomes on labor and delivery, including shorter births, fewer interventions, and a reduced likelihood of cesarean birth.
How to choose a midwife or obstetrician?
As always at Birthsmarter, there’s no simple answer to this question. We know midwives who practice with the obstetrical model of care (straight to business and quick to intervene) and obstetricians who take a midwifery model of care approach (hands off, empowering, etc).
When making a decision of this magnitude, the truth is, it’s likely not going to be about choosing a midwife versus an OB after all. What you want to choose is an individual, or practice, as well as a birth location that best meets your needs. Whether they’re a midwife or OB is not the most important factor.
Here are some of the most important considerations:
Birth Location: while midwives can work in any setting, obstetricians typically only attend hospital births. If you want to explore giving birth in a birthing center or at home, you’ll want to find a midwife who offers out of hospital support. If you want to deliver in a hospital, you can interview midwives and OBs.
Quality of Prenatal Care: in general, obstetricians have busy offices and cannot spend a lot of time with their patients. While this is sometimes true for hospital based midwifery practices, midwives tend to take fewer patients and allot more time for each visit. (In some cases we’re talking about the difference between a 15 minute versus 60 minute appointment!) If you’re interested in developing a more personal relationship with your care provider, having longer appointments, and getting prenatal education from your medical provider, look for this in your consultation with any prenatal provider.
Labor and Delivery Support: it’s so hard to know what you’re looking for until you’ve had at least one baby, but it’s important to get a sense of what giving birth under their care will feel like. Download our free guide on the questions to ask your midwife or OB here.
Postpartum Care: For anyone who’s given birth, it’s apparent that parents need more support after delivery, not less. But, it’s typical for folks to have 1 arbitrary visit at 6 weeks postpartum. To help reduce maternal mortality and comprehensively support families, ACOG now recommends that postpartum care is an ongoing process though this not yet common practice. How much support, how often would you like postpartum? Is your provider familiar with common complications such as lactation challenges, perinatal mood and anxiety disorders, and pelvic health concerns?
Costs (and how to pay)
Unfortunately, in our world, money talks. Some people choose to start their provider search based on who and what is covered under their insurance plan. This may not always be the best case since some families are in a position to pay out of pocket. Some midwives have sliding scale payment tiers based on insurance reimbursement or your income level. It’s always worth having a conversation with the provider you’re interested in working with to see if there’s a way to make the finances work. And, sometimes it’s just very worth the investment to have the prenatal, birth, and postpartum experience you’re hoping for!
How to find a midwife or OB near me?
If you want recommendations for doctors or midwives, we would recommend asking a local childbirth educator or doula for referrals. Because they interact with many pregnant people and witness births or hear birth stories on the regular, birth educators and doulas have a very broad perspective. This will likely be more helpful than taking a recommendation from a friend or colleague.
“In pregnancy, we prefer folks reach out as soon as they know they would like a midwife. Preference is as early as possible.” - Keller-Duemig
Elaine Keller-Duemig, CNM from Central Park Midwifery said: “Sometimes you can find a provider to switch to, if you’re unhappy with you OB. But this can be challenging for many groups, like ours, who are small and only have a certain number of spots per month. No matter how far along someone is, we always encourage them to reach out. If we can’t help, we often give a list of other providers for folks to check out.”
You got this. We’re here for you.
\*There are a few types of midwifes in the United States. For the purposes of this post and our work at Birthsmarter, when we use the term “midwife” we are primarily referencing CNMs and CMs.
- Certified Nurse Midwives, or CNMs are the most widely recognized midwives. Licensed in all 50 states, CNMs obtain a nursing degree, gain clinical experience in labor + delivery, and then advance to a graduate degree in midwifery. CNMs have full prescriptive privileges and can care for patients in hospitals, birthing centers, or attend home-births.
- Certified Midwives, or CMs have an identical scope of practice to CNMs. The only difference between a Certified Midwife and a Certified Nurse Midwife is that CMs do not need to become licensed as nurses prior to completing their midwifery education and training. This is a newer designation (as of the late 1990s, in order to gradate more midwifes). CMs still have limited licensure across the United States, though many states are lobbying to recognize the certification.
- Certified Professional Midwives, or CPMs are midwives who meet the requirements of the North American Registry of Midwives, as opposed to the American Midwifery Certification Board (like CNMs and CMs). CPMs are not able to gain licensure in every state, are limited to practicing in birthing centers, offices, and at home births and have limited prescriptive abilities.
- Traditional Midwives are unlicensed individuals who complete apprenticeship, or self-study. The training, experience, and competency of traditional midwives, can obviously vary dramatically.
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