Many pregnant individuals don’t realize how much choice they have regarding their care provider for childbirth in the United States, and the “Midwife versus OBGYN” debate can go on and on. Legally, births in the US can be attended by obstetrician-gynecologists (OBGYNs), family physicians, and midwives. Each provider has different training, credentials, and philosophies about birth. Generally, doctors follow the “Medical Model of Care,” while midwives adhere to the “Midwifery Model of Care.” Let’s explore these differences!
Common Misconceptions
A common misconception is that midwives only support home births or low-risk pregnancies. In reality, most midwives in the U.S. work in hospitals and can care for various patients, including those with higher-risk pregnancies. In the hospital setting, OBGYNs are available immediately to consult if complications arise during pregnancy or birth.
At Pittsburgh’s birth locations, midwives can support you in hospitals, at freestanding birth centers, or at home. The most popular midwife groups are the UPMC Magee-Womens Midwives, the Allegheny Health Midwives at Jefferson Hospital, and The Midwife Center for Birth & Women’s Health.
Midwifery Model vs. Medical Model
While pregnancy care isn’t black and white, the primary distinction is that midwives are the “experts of normal labor,” while OBGYNs are trained in surgery and high-risk pregnancy. Here are some key contrasts:
Midwifery Model of Care
- Focus on health, wellness, and prevention
- View labor/birth as normal physiological processes
- Use interventions less frequently, only when necessary
- Emphasize that “mother gives birth”
- Provide individualized care
Medical Model of Care
- Focus on managing problems and complications
- View labor/birth as dependent on technology
- Use interventions more frequently, often routinely
- Emphasize that “doctor delivers baby”
- Provide similar care for everyone
When considering care options, reflect on your values and the type of birth you envision.
Midwife Versus OBGYN: Training
Midwifery Training
Midwives specialize in managing and supporting healthy individuals with low-risk pregnancies. They prioritize informed decision-making and flexible care, often avoiding unnecessary tests and interventions.
OBGYN Training
OBGYN training emphasizes risk management and complications. While they are skilled in handling serious health issues, their focus may give less attention to emotional concerns or physiologic birth.
Where They Practice
In Pittsburgh, you can receive OBGYN care at many local hospitals, the most popular being UPMC Magee-Womens Hospital and West Penn Hospital. For midwifery, options include The Midwife Center for Birth & Women’s Health, UPMC Magee-Women’s Hospital, and AHN Jefferson Hospital.
Midwifery Practice
Many midwives attend births in hospitals and freestanding birth centers, as well as at home. The use of midwifery support has been increasing since the 1970s.
OBGYN Practice
Most OBGYNs practice in hospitals, though some may work in out-of-hospital settings. Prenatal and postpartum care typically occurs in office settings.
Midwife Versus OBGYN: Types of Practitioners
Both midwives and OBGYNs have different training levels. In Pennsylvania, most midwives are Certified Nurse Midwives (CNMs), but there are also Certified Professional Midwives (CPMs) and others.
Types of Midwives
- Certified Nurse Midwives (CNMs): Registered nurses with advanced education in midwifery, often practicing in hospitals or birth centers.
- Certified Midwives (CMs): Educated in midwifery but not registered nurses, practicing in select states.
- Certified Professional Midwives (CPMs): Direct-entry midwives without a nursing background, focusing on clinical experience.
- Lay, Traditional, and Grand Midwives: Practitioners who may or may not have formal training, often learning through apprenticeships.
Types of Physicians
- Obstetricians (OBGYNs): Physicians specialized in prenatal care, labor, birth, and surgery.
- Maternal-Fetal Medicine Specialists (MFMs): OBGYNs trained to manage complex pregnancies.
- Family Physicians (FPs): General practitioners who may provide prenatal and postpartum care.
Making the Right Choice
It’s never too late in pregnancy to choose a different care provider. It’s your prerogative as a pregnant person to make sure you work with a medical professional who makes you feel comfortable and supported! Consider interviewing various groups and touring hospitals or birth centers. Write down your questions and reflect on whether the provider listened and addressed your concerns.
If you’re still confused, or think that you might want a doula to help support you, consider reaching out to us! Emily’s “Confidence Building Birth Prep” offering can help guide you through finding a new provider and creating a birth plan.
When contemplating “midwife versus OBGYN,” where do you stand? If you’ve given birth before, what type of provider supported you, and how satisfied were you with that experience?
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