Choosing a care provider for pregnancy will have a direct impact on the direction of your birth and the care you receive. So, choosing your obstetrician or midwife is a decision that you shouldn't make lightly. Many expectant women either stay with the same care provider they've used for their regular well-woman yearly check-ups or ask a friend for a referral.
To help you understand the basics about these practitioners and find the prenatal provider that is right for you, I've outlined the differences between obstetricians and midwives. While both professions try to offer the best possible care to women and want both mom and baby to be healthy, they often use different routes to get there.
What is a midwife?
A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy and birth. They offer expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.
How midwives work
A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, such as being high risk or have preexisting health issues, she would refer the mama-to-be to other healthcare providers for additional consultation or care.
There are also different types of midwives: Direct Entry Midwives, Certified Professional Midwives, and Certified Nurse Midwives. Depending on their credentials and training, some midwives work in hospitals or birth centers while others solely attend home births.
The midwifery model of care
Midwives believe that birth is a natural physiological process that should be inherently trusted. This is more of a "watch and see and then react" mentality.
What to expect during labor with a midwife
Midwives will tend to be more present during labor and will be more holistically based, allowing more space for the labor to unfold naturally before moving to medical interventions. Of note, if you would like an epidural you can definitely still go to a midwife—you'll just choose one who offers in-hospital births.
What is an obstetrician, or OB?
A physician who delivers babies and practices obstetrics, the art and science of managing pregnancy, labor and the puerperium (the time immediately after delivery).
How obstetricians work
Your obstetrician (or other members of their practice) will follow your care throughout your pregnancy, although who delivers your baby often depends on who will be on call when you go in labor. Your obstetrician is also a surgeon. So if you need a Cesarean section, they will be the one performing the procedure. Finally, OBs are best at handling high-risk pregnancies, which require more monitoring and perhaps extra treatment.
The obstetric model of care
Obstetricians tend to focus on the pathologic potential of pregnancy and birth. They see birth as a medical condition, which means that, to prevent complications, some of them may be quick to suggest medical or technological interventions. For example, some practices or hospitals require doctors to administer a dose of Pitocin (a synthetic version of the hormone oxytocin) when the baby is born to speed up the delivery of the placenta and prevent excessive bleeding. (It is important to know that some midwives do this as well.)
What to expect during labor with an obstetrician
Doctors often rely heavily on their support team (labor and delivery nurses and, if you deliver at a teaching hospital, residents) and are intermittently present during labor, because they are usually caring for several patients at a time. Until you are ready to push the baby out, your OB will come in and out to check on your progress and “manage" your labor. Some doctors will do so by simply monitoring your and baby's vitals and letting labor take its course, while others take measures to speed up the process or, as mentioned before, prevent potential complications.
Should you have a midwife or an obstetrician?
Neither of these approaches are wrong, so the determining factor would be your personal preference as well as your individual health. For those unsure about which path to take, here are some questions to consider:
- Is your pregnancy high risk?
- What is your personal birth philosophy and which model of care would help you feel most respected and safe?
- Are you comfortable with routine interventions such as full-time external fetal monitoring as opposed to intermittent monitoring? Of note, both types of providers can do both of these types of monitoring. If you have a preference, simply ask the provider if it's a possibility.
- How involved are you looking to have your care provider during prenatal appointments and at the birth?
- What are the care provider's intervention statistics for things like induction, Cesarean section, instrumental births like forceps or vacuum extraction, and episiotomies? Are you content with these statistics?
- Are you drawn more towards medical support, such as having an ultrasound as often as possible, or do you feel more comfortable with less interventions and having the care provider be more hands on?
After honestly answering these questions, take your time to find the right match for you. Ultimately, whomever you choose should help you feel secure, confident and supported during pregnancy and throughout your birth. Happy birthing!