How to Choose Between an Obstetrician and a Midwife

In the United States, most people choose to receive their prenatal care from an obstetrician-gynecologist (OB-GYN) and give birth in the hospital under their care. However, there are other options, including using a certified nurse-midwife (CNM) for prenatal care and during childbirth. If you aren't sure which is right for you, consider your risk level in addition to your hopes for prenatal care and your childbirth experience.

Method 1

Method 1 of 5:

Differentiating Between Obstetricians and Midwives

1
Understand what the “obstetrician-gynecologist” title means. OB-GYNs are physicians who specialize in women's health. They complete medical school and an obstetric residency program. Then, they take written and oral exams to achieve board certification with the American College of Obstetricians and Gynecologists, the official organization for obstetricians and gynecologists in the United States.^{[1]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
- OB-GYNs are trained to perform surgery (including cesarean section), handle complications associated with pregnancy and childbirth, and prescribe medications.
- Some OB-GYNs complete additional training to specialize in particular aspects of women's health care, such as infertility treatment or gynecological cancer.
2
Know what the “certified nurse-midwife” designation represents. CNMs complete nursing school, become registered nurses, and then complete a graduate degree program in midwifery, such as a master's or doctoral degree. Then, they pass exams to achieve certification from the American College of Nurse Midwives, the official organization for midwives in the United States.^{[2]XResearch source}
- Midwives can generally prescribe medications, depending on state law, but they cannot perform surgery or handle high-risk cases.
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3
Recognize that OB-GYNs have a highly-medicalized approach. Because obstetricians are M.D.s, they approach pregnancy and childbirth through a scientific and medical lens. This approach has advantages and disadvantages. A medical approach is beneficial if you have a higher risk pregnancy and are likely to need specialized medical care. OB-GYNs are the only health care professionals who can handle any complication that develops, including the need for surgery.^{[3]XResearch source}
- On the other hand, a medical approach sometimes leads to unnecessary drugs or interventions. Some people who use OB-GYNs find that their pregnancies and birth experiences become unnecessarily medicalized. Childbirth is a natural process, and most healthy people do not need high-tech interventions.
You can try to have a natural birth with either an obstetrician or a nurse-midwife. In general, though, those who use midwives tend to use less pain medication and fewer interventions, and they are much less likely to wind up needing cesarean sections.^{[4]XResearch source}
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Method 2

Method 2 of 5:

Evaluating Your Risk Level

1
Choose an OB-GYN if you have a high-risk pregnancy. Obstetricians are generally the best choice for any pregnancy that is considered “high-risk.” If you have a chronic health problem like heart disease or epilepsy, your pregnancy will likely fall into this category. You'll need to see an obstetrician and, in some cases, a perinatologist (a specialist in high risk pregnancies).^{[5]XResearch source}
- Note that in many areas, you may be able to see a midwife for normal prenatal visits and an obstetrician or other medical specialist for your medical needs. Regardless, your obstetrician will be in charge of your pregnancy and delivery.
2
Opt for an OB-GYN if you had problems with a previous pregnancy. If you have been pregnant before, consider any complications. If you developed gestational diabetes, preeclampsia, or another problem, had an emergency cesarean section or other medical interventions, you may want to choose an obstetrician trained to deal with those scenarios. If not, you can safely consider using a midwife instead.^{[6]XResearch source}
- Know that a previous cesarean section does not necessarily make you high risk. Depending on the reasons for your c-section, you may be able to have a normal pregnancy and a vaginal birth. Talk to your healthcare provider, but if having a vaginal birth after a previous cesarean section (VBAC) is important to you, consider using a midwife. Midwives have much better success rates for VBACs.
3
Select an OB-GYN if you're having multiples. If you find you are carrying twins or triplets, you may need an obstetrician to help you deal with the medical problems that carrying multiples can present.^{[7]XResearch source}
- If you are pregnant with a single baby, you can safely use a midwife.
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Method 3

Method 3 of 5:

Thinking about Prenatal Care

Whichever health care professional you choose, you will check in monthly through your seventh month or so, then biweekly for the eighth month and weekly during the ninth. Both practitioners will check your weight, measure your belly, test your urine, and listen to the fetal heartbeat.^{[8]XResearch source}
Whichever practitioner you choose, you will have access to prenatal screening, laboratory work, ultrasounds, amniocentesis, and other testing.^{[9]XResearch source}
3
Choose a CNM if you want to spend more time with your provider. While both types of providers offer the same prenatal care, midwives tend to spend more time with their patients. Most set aside extra time to answer all of your questions, provide extra information about your pregnancy, and discuss any concerns you may have.^{[10]XResearch source}
- Good obstetricians will listen and answer your questions too, but they are usually more rushed and therefore prioritize getting through each appointment efficiently.
4
Opt for a CNM if you want more emotional support. There are exceptions, but in general, midwives provide more emotional support. Obstetricians understand their job to be providing medical care to pregnant people; midwives take a more holistic approach.^{[11]XResearch source}
- Some people want a supportive practitioner who will listen to their concerns and offer emotional support; others prefer a more businesslike relationship, seeking emotional support from other people, like their partners, friends, and family members.
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Method 4

Method 4 of 5:

Considering the Childbirth Experience

1
Select a CNM if you want to give birth in a birthing center or at home. Birthing centers are alternatives to hospitals; they aim to provide a comfortable and lower-tech setting for healthy people with low-risk pregnancies to give birth. Unlike hospitals, they tend to let you wear your own clothes, eat when you are hungry, and soak in a warm bath during labor and delivery if desired. Note that if an emergency arises, you will need to be transported to a hospital.^{[12]XResearch source}
- If you want to give birth at home, you will definitely need a midwife, and you may need to do some research to find a CNM in your area who is willing to deliver your baby at home. For most healthy people with low-risk pregnancies, home birth is safe.
- Be aware, however, that if you develop any complications, you will need to get to a hospital as quickly as possible.
- In addition, know that many health insurance plans do not cover home births.
In most cases, a CNM can deliver your baby at a hospital, as long as they have privileges there. Most OB-GYNs deliver babies in hospitals and don't use birthing centers or deliver babies in patients' homes, but some OB-GYNs may own birthing centers that incorporate the skills of a midwife.^{[13]XResearch source}
3
Pick a CNM if invested you are invested in a natural childbirth experience. If you are healthy, have a low-risk pregnancy, and want to give birth without unnecessary medications, interventions, or surgeries, then a CNM may be right for you. In general, midwives do a better job at coaching their patients through labor and delivery naturally.^{[14]XResearch source}
- Those who give birth with midwives are less likely, for example, to wind up with epidurals, episiotomies, forceps deliveries, or cesarean sections.
4
Go with an OB-GYN if you think you'll want pain medication. Generally speaking, you'll have more options for pain management with an obstetrician (and obstetricians will be more likely to suggest pain medication). Midwives will be more likely to suggest natural pain relief techniques (breathing, massage, changing your position, laboring in a warm bath) instead.^{[15]XResearch source}
- Note that if you deliver in a hospital, you can get an epidural with either type of practitioner.
5
Choose a CNM if you want a personal touch from your practitioner. Many midwives will stay with you from the early stages of labor through the delivery of your baby, coaching you and providing various kinds of support. If this is desirable to you, you should look for a CNM rather than an OB-GYN.^{[16]XResearch source}
- Obstetricians will usually check in on you periodically until it is time to deliver your baby, but they will not stay by your side; in general, they leave most of that care to nurses.
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Method 5

Method 5 of 5:

Making the Decision

If you have a spouse or partner, talk to that person about what kind of prenatal care and childbirth experience you want. While you are the one having the baby, they should also have a chance to voice preferences and concerns.
2
Ask for recommendations from friends who have recently given birth. If you know people who have recently given birth, talk to them about their experiences. They may have insights about obstetricians and midwives, and they may be able to answer your questions.^{[17]XResearch source}
- Furthermore, if they live in your area, they can recommend (or advise against) certain practitioners.
3
Meet with potential health care providers. If you are low risk and still undecided about which kind of practitioner you want, get referrals for at least one of each, and meet with them to discuss your concerns and answer your questions.^{[18]XResearch source}
- Ask them about their approaches to prenatal visits and pain management during labor, and find out where they deliver their patients' babies. Choose the practitioner that feels like the best fit for you personally.
4
Follow your instincts. If you have done your research and considered all the options, then go with your gut. Assuming that you are healthy and have no serious pregnancy-related risks, there really is no wrong decision here.^{[19]XResearch source}
- If you feel more comfortable in a hospital setting with a physician managing your pregnancy, labor, and delivery, then go with an obstetrician.
- If you feel more comfortable approaching pregnancy from a natural perspective and want a provider who will stay by your side throughout your labor and delivery, then go with a midwife.
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In some states, certified nurse-midwives are simply called certified midwives (CMs). Both designations reflect training, certification, and the ability to prescribe drugs.
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Don't forget that the individual practitioner is just as important as the degree and certification. Whether you choose an obstetrician or a midwife, find someone with whom you feel comfortable.
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Always contact your health insurance company to confirm the details of your plan and make sure the services of your desired midwife or obstetrician will be covered. Most insurance plans will cover either one, but you can avoid unpleasant surprises by checking in advance.
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