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Differences Between OB GYNs and Midwives: How to Choose?

by Katlyn Joy | June 10, 2013 12:00 AM
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Today's expectant mothers in the U.S. have more choices than ever before in the type of birth and the birth attendants. You can deliver at home, at a birthing center or at a hospital. You can have a midwife, an obstetrician, or a family doctor as your health care provider.

Some choices depend on your location and what is available to you in your geographic area. If the nearest birth center is an hour away, you are unlikely to be able to have your baby there. If you have a high risk pregnancy, your options get smaller as well. Midwives don't handle high risk pregnancies.

Differences Between Obstetricians and Midwives

- Doctors earn bachelor's degrees and then complete four years of medical school. Ob-gyns then complete a four-year residency to become surgically trained medical doctors. Many will go on to finish a three-year fellowship in a specialty such as fertility medicine or gynecological oncology for instance.

- Most midwives finish a bachelor's degree and then go on to complete a Master's program in midwifery which can take from two to three years. Some have advanced education to the doctorate level.

- Both are regulated health professionals and will be certified by a licensing board. There are different options for midwives, which we will look at in depth.

- The philosophy of care is different for medical physicians and midwives. In comparing ob-gyns and midwives, ob's are more likely to use interventions at births and have higher c-section rates compared to midwives. According to a 1997 study, midwives used 12.2 percent fewer interventions. According to the same study, the cesarean rate was also 4.8 percent lower with midwives.

- The outcome of births in looking at mother and baby health however was equal.

- Ob-gyns are the medical providers for moderate to high risk pregnancies. Midwives cannot perform c-sections or use vacuum extractors or forceps on delivering mothers.

Types of Midwives

While it's simple to identify a medical doctor: family physician or ob-gyn, you may not know or understand the various classifications of midwives. Here's a simple breakdown.

Certified Nurse Midwife (CNM)
They have completed nursing school with at minimum a bachelor's degree but perhaps a Master's or even doctorate. They have both nursing and midwifery training. They are licensed to practice in their state and have passed certification exams. They may assist doctors at births and generally practice in hospitals. They are certified through the American College of Nurse Midwives or ACNM.

Certified Midwives ( CM)
They are trained as midwives only, not as nurses, and are certified through the ACNM. Not all states recognize this certification for licensing purposes however.

Certified Professional Midwife (CPM)
A CPM must receive training in midwifery and pass exams as well as be evaluated in hands-on skills. A CPM is certified by the North American Registry of Midwives or NARM and must be experienced in out-of-hospital births. These midwives generally attend births at homes or birthing centers rather than hospitals. Not all states accept this certification for licensing.

Licensed Midwife (LM)
This midwife is licensed by her state and may be a CPM. Individual states set their own licensing standards so the educational and certification standards will vary.

Lay or Direct Entry Midwife
The education and training of a lay midwife varies greatly. Some states do not allow lay midwives to practice at all while others allow for licensing. Some lay midwives have training through formal education, workshops, apprenticeships or other combinations of programs. Usually their practices are in home births.

Choosing Your Provider

When choosing a birth provider, you need to consider your options in your geographical area, what licensed providers are available in your state, and what type of birth you are anticipating. If you have a chronic serious health concern such as diabetes or heart issues, or you have had a significant complication in previous births, you may not be a good candidate for a standing birth center or home birth.

Are you worried about being close to a high level of care for preemies because you previously have a preterm baby? You may feel comfortable with a birth center that is attached to a hospital with a top NICU department. Are you hesitant to use a physician with a higher rate of interventions or c-sections? A midwife may be a better fit for you.

Found out the regulations of your state, what birthing facilities are in your vicinity and get recommendations from people. Interview potential health care providers, being sure to ask about what their experience and philosophy is, where they practice and whether they accept your insurance. Get a feel for the practice from the front office to the support staff because during your pregnancy you will be encountering all these people on a regular basis.

When talking to the provider, note whether you felt rushed, talked down to or uncomfortable in any way. Does the provider's age, gender or background training make you feel confident and at ease? If it's not a good fit from the start, move on. Finding the right provider is a key to a positive and most importantly, safe and healthy birth.

Sources: KidsHealth.org, March of Dimes, Time Magazine

Katlyn Joy is a mother to 7 children, and a freelance writer. She earned her Master of Arts in Creative Writing and Poetry, and a Bachelor of Arts in English and was previously an adviser to new mothers on breastfeeding through a maternity home program. She currently resides in Colorado with her family.

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