Choosing a care provider will have a direct impact on the direction of your birth and the care you receive. So, it 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, for either an OB or a midwife. Neither of these options necessarily uncovers the practitioner’s birth philosophy or birth statistics, and the field of midwifery remains a bit of a mystery to many women.
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 it is: 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 they work: Your obstetrician (or other members of his or her practice) will follow your care throughout your pregnancy, although who will deliver your baby depends on who will be on call when you go in labor. Your obstetrician is also a surgeon. So if you need a cesarean , he or she 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 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, many of them may be quick to suggest medical or technological interventions before they’re actually needed. 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.
What to expect during labor: 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. 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.
What is is: A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth. They offer expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.
How they 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 while others solely attend home births.
The 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: 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.
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:
- 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?
- 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? Instrustmental like forceps or vacuum extraction? Are you content with these statistics?
- Are you drawn more towards medical support, such as having an ultrasound as often as possible, or are you comfortable with a hand-held doppler scope 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!