Doctor or Midwife: Which One is Right for You?

You took the test and the results were positive.  Congratulations!  You’re pregnant.  There are so many emotions that come with the realization that you will expand your family.  And there are also so many questions.  Will I have a girl or a boy? Do I want to deliver in a hospital or a birth center? Do I want a natural birth or an epidural? Another important question is deciding who will care for you during your pregnancy and your birth.  You know that you want a trusted, reliable, skilled provider who can help you navigate your pregnancy and delivery with care and compassion. This is a very personal decision to make.  Do you know your options?  Should you choose a OB/GYN doctor or a midwife?

Are an OB/GYN and a Midwife the Same Thing?

Midwives and doctors do have many similarities when it comes to caring for women.

• Both are highly trained and certified. 
• Both are experts in women’s health and pregnancy care who have extensive specialty training and experience in their field.
• Both are committed to your safety and comfort and are extremely passionate about what they do.
• Both will work with you to honor your pregnancy goals and birth plan, while also offering their expertise and information on your care options as your pregnancy progresses. 

Midwives and doctors strive to give you the best experience.  At CHI Health our midwives and maternity care doctors strive to provide your care your way. That means we all want to help you have the pregnancy care and child birthing experience you’re hoping for, regardless of who you choose as your provider.

What are the Differences Between a Doctor and Midwife?

Doctors and midwives have different credentials and educational backgrounds.  Most doctors are medical doctors (MD) or doctors of osteopathy (DO).  An obstetrician/gynecologist (OB/GYN) is a medical doctor who specializes in women’s reproductive health, as well as pregnancy care and delivering babies. They’re also surgically trained and can perform cesarean sections when necessary.  OB/GYNs complete four years of medical school and a four-year residency program.  Family Medicine doctors specialize in comprehensive health care for people of all ages.  They care for you during your pregnancy, your delivery, and can also take care of your baby after it’s delivered.  Some family medicine doctors can do extra procedures such as a vacuum extractions or cesarean sections.  They complete four years of medical school as well as a three-year residency program.

Just like OB/GYNs, midwives can provide a broad range of women’s health services such as annual checkups, family planning, and menopause care. But pregnancy, birth and postpartum care is what they’re most widely known for.  They work closely with the rest of your health care team (e.g. OB/GYN or family doctor) to meet your needs during your pregnancy. Many women continue to use their midwives for care after their delivery, too.  Certified nurse-midwives (CNMs) are registered nurses (RNs) who have master’s or doctorate degrees in nursing.  They are certified by the American Midwifery Certification Board and licensed by the state.  There are other types of midwives in the United States, however, all the midwives at CHI are CNMs.

Birthing: The Biggest Difference

The greatest difference between doctors and midwives is that they have different birthing specialties.  Depending on your needs, certain specialized care may be required for you and your baby’s health and safety.  And depending on your preferences, you may be looking for someone who has specific experience. Here are a few examples:

• High-risk vs. low-risk pregnancies – OB/GYNs can manage high-risk or complicated pregnancies such as women who are expecting twins or have preexisting medical conditions such as diabetes or high blood pressure. Midwives, on the other hand, can manage low-risk pregnancies and births.
• Approach to birthing process – Midwives usually follow a “low tech, high touch” approach to birthing. This typically means less induction of labor, less use of epidurals, and more “hands on” care.  Midwives are usually at your side when you are in active labor, during delivery, and help you adjust and breastfeed postpartum.  Doctors and midwives can offer all types of pain management options.
• Hydrotherapy and water births – While hydrotherapy is becoming more common in the hospital setting, it is very common with the midwifery specialty.  Water births can occur with midwives as well. CHI Health Birth Center at Immanuel and CHI Health Birth Center at Lincoln midwives offer the option of water birth.
• Cesarean sections – Midwives and some Family Medicine doctors can’t perform c-sections.  OB/GYNs have the surgical training to perform these procedures.  If you are seeing a midwife or Family Medicine doctor and require a cesarean before or during labor, these providers have agreements with collaborating OB/GYN’s to provide this service.  Most of the time the midwives and Family Medicine doctors are still with you during a cesarean if it is needed.
• Delivering in a birth center. - While CHI Health midwives do not deliver babies at home, all of the midwives at CHI Health can deliver babies in the hospital.  Some midwives will give you the option of delivery in a birth center.  When women with low-risk pregnancies want a birth center delivery, midwives are the professionals who support the labor and delivery process. CHI Health Birth Center at Immanuel is Nebraska’s only in-hospital birthing center. Located in Omaha, this center offers an unmedicated, low-intervention, route to an uncomplicated vaginal birth. Women who deliver here have the option of hydrotherapy or water birth, can move around freely, utilize intermittent monitoring, eat and drink as they wish, and deliver in any position that is comfortable to them. The postpartum stay is brief and these midwives will do a home visit the following day to check up on you and your baby. CHI Health also has a free-standing birth center located in Lincoln, Nebraska.  This free-standing birth center is in a separate building from the hospital. Again, this is for low-risk mothers planning an uncomplicated vaginal birth. They also offer hydrotherapy or water birth, allow women to eat and drink in labor, encourage position changes, and perform early discharge. Women who deliver here follow up at the birth center the following day with their newborn for a checkup.

Research demonstrates that midwife-led models of care lead to less epidurals, less use of forceps or vacuum, less preterm birth, and an increase in spontaneous vaginal birth.  This model also utilizes less artificial breaking of the bag of waters in labor, less episiotomy, and increased patient satisfaction (Sandall et al, 2016).

Your Decision is Personal

So, what should you consider when choosing between a doctor or midwife for pregnancy care? This is a very personal decision.  Your goals, preferences, and health and safety should all be top of mind. Here are some things to consider as you weigh your options.

• Is your pregnancy considered high risk?  If your pregnancy is deemed high risk or complicated, you’ll want work with an OB/GYN who may also coordinate care with a maternal-fetal medicine doctor, who specialize in high-risk pregnancies.  If you’re expecting twins, have diabetes, or other health complications, your pregnancy may be considered both high risk.
• Where do you want to deliver your baby?  If you are low-risk and are considering a birth center delivery, a midwife is likely at the top of your list of potential care providers.  If you are planning on a hospital birth, most doctors and midwives deliver at only one or two hospitals. So, when you’re choosing between a midwife and doctor, you may also be choosing a hospital to give birth at.
• How do you want to deliver your baby?  If you’re low risk and leaning toward a water birth or hypnobirthing, an experienced midwife is who you’ll want to look into. But regardless of risk, if you think you’d be more comfortable with a medical doctor providing your care, then an OB/GYN or Family Medicine doctor might be the best fit.  If you want a wide range of birthing and pain management options so you can have flexibility when birth day arrives, finding a midwife or a doctor who delivers at a hospital is key.
• What kind of coverage does your insurance plan offer?  Many women wonder if there is a cost difference for a doctor versus a midwife. But the cost of delivering a baby primarily varies based on where you deliver, what types of interventions you have, and what type of delivery you have, not who delivers your baby.  Also, it’s quite possible that not every hospital or birthing center is included in your specific insurance plan.
• What can I do if I still don’t know what provider to choose?  A good provider-patient relationship is necessary in all aspects of health care.  This is an important decision.  If you still cannot decide what type of provider you prefer, most of them will offer consultation visits.  This is where you can meet the provider either in person or online through a telemedicine visit.  You can ask all of your questions and determine where your best fit lies. 

Visit us online for more information on CHI Health Maternity Care and Midwifery.

Resources:

Sandall  J, Soltani  H, Gates  S, Shennan  A, Devane  D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5. Accessed 11 February 2021.