Here’s How To Choose Between An OB And A Midwife

Who should deliver your baby? The decision between an OB-GYN and a midwife is yours.

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Obstetrician or midwife? Midwife or obstetrician? If you’ve been waffling on the two, chances are you’re pregnant or planning to grow your family soon. (We know, we know, we’re mind readers, what can we say?) The truth is, picking between an OB-GYN and a midwife comes down to personal preference. Sure, there’s plenty to consider— What kind of birth do you want? Where do you want to deliver? What are you comfortable with?—but figuring out which questions are the most important (and what the implications of your answers are) can be a touch overwhelming. We won’t leave you hanging, though. Here’s what you need to know about OB-GYNs and midwives—and how to choose which one should walk you through your pregnancy and delivery.

Opting for an OB

Before you got pregnant, you saw a gynecologist. Now the office nurse says you have the option to see an obstetrician. Don’t want to change doctors? Good news: Technically, they’re the exact same person. To become an obstetrician and gynecologist (aka OB-GYN), these individuals have to graduate from medical school with a medical degree, and they have to focus specifically on the medical and surgical care of the female reproductive system and associated disorders. Their gynecology studies are focused on the reproductive system as a whole, but the obstetrics part of their studies is what makes them experts in caring for women while they’re expecting a baby and into the postpartum period. Most women who choose to have an OB-GYN perform their prenatal care and deliver their baby will see a general OB-GYN: one who can perform surgeries, manage labor and delivery, and take care of routine prenatal and postpartum care. Moms who have high-risk pregnancies are generally referred to OB-GYNs who have an even more in-depth specialty, allowing them to provide top-notch care for the mom-to-be and her fetus that’s based on specific medical considerations. So how do you know if an OB is right for you? Ask yourself these questions before you decide!

Is your pregnancy “high risk”?

This is a general term that can cover a wide variety of moms, from those who had problems during previous pregnancies to moms carrying multiples to women who have been diagnosed with preeclampsia or other pregnancy-related conditions. They’re generally at higher risk for C-section birth, which only an OB-GYN can perform, and their babies may need additional care from an OB-GYN who specializes in maternal/fetal medicine. Sometimes moms develop complications as the pregnancy progresses. If you start with a midwife and complications crop up, they may direct you to an OB-GYN for more advanced care.

Here’s How To Choose Between An OB And A Midwife

What kind of birth do you want?

OB-GYNs do not provide home birth care. Some do deliver in birthing centers, however, and some work with moms who want a waterbirth. If you have your heart set on a certain type of birth, ask your OB if it’s something they will do. If the answer is no, find out why. If there’s no medical reason that they’re saying no, you may want to explore your options, like finding a more accepting OB or switching to a midwife.

Do you trust your OB-GYN?

Choosing how to give birth and who to guide you through the process is incredibly personal. If you have an OB-GYN who you have seen for years and who you trust implicitly, that can go a long way toward making you feel more comfortable.

Where do you want your prenatal care to occur?

Most doctors will only meet you in their office, and the frequency of visits will increase as your pregnancy progresses, typically requiring you to visit the doctor at least once a week by the time you’re in your ninth month of pregnancy. Make sure you choose a practitioner whose approach to prenatal care corresponds to your needs.

Making the Most of What Midwives Have to Offer

Midwives have been around for centuries, but don’t let that fool you into thinking midwifery is outdated or old-fashioned. Today’s certified midwives and certified nurse midwives are medical professionals who can (and do!) deliver excellent care to hundreds of thousands of moms and their babies. These days, some 8 percent of babies come into this world via a midwife’s hands, and the number of people going into the field is on the rise. To get there, a midwife has to attend college at an institution accredited by the Accreditation Commission for Midwifery Education (ACME). Certified nurse-midwives are registered nurses who have graduated from an accredited nurse-midwifery education program and have passed a national certification examination. Certified midwives, on the other hand, receive a background in a health-related field other than nursing, but they must graduate from a midwifery education program accredited by ACME and take the same national certification exam.

Here’s How To Choose Between An OB And A Midwife
Midwives do not go to medical school, and thus they don’t have MD after their names like OB-GYNs do. That said, their studies cover similar content on the care and treatment of women’s health issues, including specialized studies on pregnancy, labor and delivery, and the postpartum period. Leaning toward a midwife? Ask yourself these questions:

Do you want to birth at home?

Home birth is on the rise in America, and midwives have been leading the charge. Not only are they the only medical practitioners who will come to your home to help you welcome your baby into the world, the largest ever study of home births found that planned home births among low-risk women with a midwife on hand result in low rates of interventions without an increase in adverse outcomes for mothers and babies. In other words, if you can birth at home with a midwife, it could mean less risk for you and baby!

What can a midwife do for you?

This may seem like an obvious question, but midwives do not have the same authority as an OB-GYN. Some states limit midwives to deliver only in hospitals and only allow them to see patients under the supervision of a medical doctor, while some limit the sorts of medications they can dispense for both you and your baby. What your midwife can do depends on where you live, so ask!   

What does your health insurance company say?

An increasing number of health insurance companies, including Medicaid, now cover midwives and their services, but the coverage limits vary; some will not cover a birthing center or home birth at all. Talk to your midwife and your insurance company to make sure you know what costs will be covered and can plan accordingly.

Do you want a VBAC?

Short for vaginal birth after C-section, VBAC got the stamp of approval from the American College of Obstetrics and Gynecologists back in 2010, but there are still a number of OB-GYNs who prefer to tell moms who’ve had a C-section before that they need to schedule another one. Midwives, on the other hand, do not perform C-sections and are often more willing to allow a woman to attempt a VBAC.

Do you want a little more one-on-one care?

Not all midwives will make home visits during the prenatal period, but some will! If you’re looking for that extra personal attention, a midwife might be the answer.   

Do you love your midwife?

Midwives don’t just deliver babies. Many of them perform regular care for women, seeing them for other reproductive health–related issues. If you’re already under the care of a midwife you trust, they might be the best person to help you through your pregnancy, too.

Who should you choose?

Let’s face it: There is no wrong answer here. Keep in mind that choosing one or other at the start of your pregnancy doesn’t mean you’re stuck with the decision. If a pregnancy becomes more complicated, for example, a midwife will refer you to an OB-GYN for medical care. They won’t be insulted that you’re making the change; they want you and your baby to be safe. On the other hand, if you start off with an OB-GYN and decide at some point in your pregnancy that you’d like a less traditional birth or want a more personalized approach to the delivery process, you may be able to switch to a midwife. What’s more, many midwives and doctors work together, providing a team approach to prenatal and postpartum care. Whether you have an OB-GYN or a midwife in the room when you add to your family, you’re with someone who’s had years of professional training to get this right. And ultimately, the type of birth you have (and the medical professional who’s there) needs to be right for your family.

Jeanne Sager
Jeanne Sager is a writer and photographer from upstate New York. She has strung words together for The New York Times, The Washington Post, The Atlantic, and more.

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