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What Makes Midwives and OBGYNS So Different

Midwives and OBGYNs are both professionals who can care for you and your baby but they are different in 3 big ways that you need to know about.

midwife pressing on a woman's pregnant belly, one thing midwives and obgyns do differently

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If you’re like me (and most women in America), you probably called the OBGYN when you found out you were pregnant. OBGYNs are the primary attendants at nearly 90% of births in America so chances are you did.

I went to an OBGYN clinic for my prenatal appointments for about 5 months of my first pregnancy. But every time, I left feeling disappointed and, honestly, a little frustrated.

I was grateful that my visits assured me every few weeks that my baby and I were safe and healthy, but I wanted more. I wanted someone to be excited with me. I wanted someone who helped me feel like being pregnant for the first time was a big deal!

I wanted someone to explain things I didn’t even know to ask about.

Though I didn’t fully know it at the time, I wanted a midwife.

The Option I Didn’t Know I Had

No one I knew had hired a midwife though. I didn’t even really know how a midwife was different from an OBGYN. 

Gratefully, I decided one day to see what I could learn. I turned to Google. And I found an amazing midwife who was exactly the kind of care provider I had been hoping for.

I know I’m not the only woman who’s had this kind of experience. I know I’m not the only one who didn’t realize that an OBGYN wasn’t my only option for good prenatal care. 

So I’m sharing what I’ve learned with you. 

This blog post is all about the differences between midwives and OBGYNs. Specifically, I explain the 3 big things that distinguish midwives from OBGYNs, with real-life examples of why each matters for you and your birth.

Only when you really understand your options can you make a truly informed choice, and that’s what I’m all about.

So without further ado, let’s get to it.

The Basics: What is an OBGYN?

Before we get to the big 3 differences between OBGYNs and midwives, let’s talk about who they are generally and their educational backgrounds.

OBGYN stands for obstetrician-gynecologist. An obstetrician is a doctor who works with women through pregnancy and childbirth. A gynecologist is a doctor who specializes in women’s health outside of pregnancy and birth. The two specialties are combined into one field of study; that’s why you see them paired most often as “OB-GYN.” 

Obstetrics and gynecology is a surgical field – OBGYNs are trained surgeons. In addition to surgery, OBGYNs perform annual wellness exams, test for and treat infections and other gynecological issues, and prescribe birth control.

OBGYNs work at typical doctors offices and that’s where you’ll go for prenatal appointments if you hire one. They attend births that happen in hospitals. 

Because they are trained in surgery and have the medical equipment needed for emergencies, OBGYNs care for high-risk pregnant women.

Educational Background of OBGYNs

OBGYNs first complete a 4-year bachelor’s degree in science or another pre-medicine degree. 

Then they attend medical school (which requires taking an entrance exam called the MCAT). Medical school is also a 4-year degree. It includes both clinical (hands-on practice with patients) and non-clinical study. 

After medical school, OBGYNs have another 4 years of training called “residency” (so that’s 12 years total). Residency is basically doing everything a doctor would do but under supervision.

After residency, OBGYNs take one more exam to receive their state license and then they can begin practicing on their own.

The Basics: What is a Midwife?

A midwife is a healthcare professional who typically cares for women through pregnancy, birth, and the first six weeks postpartum.

A midwife is not a doctor.

What and how much a midwife does depends on what kind of midwife she is. For in-depth explanations of the different types of midwives, check out So You Want a Midwife…What Kind?.

For the purposes of this article, I’ll just explain two things. 

  1. Midwives* are highly trained and well-qualified to attend births. They are required to meet strict educational requirements, complete high levels of hands-on experience, and pass exams to become certified.
  2. One kind of midwife – a certified-nurse midwife (CNM) – often practices in a very similar way to an OBGYN. They usually work in hospitals and are part of the typical American healthcare system. For this reason, when I talk about midwives in this article, I’m referring mostly to certified professional midwives – independent midwives who are usually self-employed and usually work in out-of-hospital settings.

Midwives (not CNMs) usually work in birth centers or from their own homes. They most often attend births that happen in birth centers or in women’s own homes. They do not perform surgery nor do they care for women outside of pregnancy and birth (unless they have additional education).

Midwives care for low-risk pregnant women. (And, by the way, most pregnancies are low-risk – only 6-8% are high-risk.)

*Note: Not all state requirements are the same and some people do practice midwifery without any formal education or certifications. Be careful when choosing who to hire. For your safety and the safety of your baby, please hire someone who has the proper education to care for you the way you want and know when more help than they can offer is needed.

Midwives and OBGYNs: 3 Big Differences

As you can see, midwives and OBGYNs differ in educational background and scope of practice. It’s good to know that, but that’s not really what affects you.

What really matters are the three things I’ll explain in the rest of this article. These are the things that, to a very large degree, determine the kind of birth experience you have.

Generally, OBGYNs and midwives differ in these three main ways:

  1. Beliefs about the birth process,
  2. Approach to prenatal care, and
  3. Methods of managing labor, birth, and immediate postpartum.

Of course, not every OBGYN is the same and neither is every midwife. I generalize because I can’t address every possible difference and because, from everything I’ve learned, my claims aren’t that far off for the majority of either group. 

So let’s get into it.

1. Beliefs About the Birth Process

If I had to choose one thing to explain the difference between obstetric care and midwifery (pronounced mid-WIH-fer-ee), it would be the belief of what birth is.

In the medical field, doctors and nurses are trained to approach childbirth as a medical event. They have to – it’s a doctor’s job to know what can go wrong and what to do in emergencies. That’s why we have hospitals.

Because of this background, many doctors tend to turn to medicine and technology to manage labor actively. They are usually more comfortable with fast labor that is closely monitored.

The concern here lies in the tendency to view – and, therefore, treat – childbirth with a medical lens even when it might unfold smoothly if no interventions were begun.

Midwives, on the other hand, view childbirth as a natural, normal process.

They believe that birth, if left alone, will usually be safe and uncomplicated. They trust mothers to follow their intuition and use their minds and bodies to manage labor, while still monitoring for signs of emergencies in non-obtrusive ways.

2. Approach to Prenatal Care

As I mentioned at the beginning of this blog post, the prenatal care I was receiving at my OBGYN clinic was the thing that eventually led me to consider something other than the medical model of care. Nothing was necessarily wrong, I just wanted more.

Appointments with an OBGYN

To help you understand, let me explain a few things about prenatal appointments with an OBGYN.

First, it’s possible that you’ll see different OBGYNs at each visit, rather than the same one every time. The clinic I went to employed 7 different OBGYNs and I had no choice of who I saw every time; it was just whoever was there that day.

Second, OBGYNs don’t have much time to meet with each patient.

Sometimes it’s just the nature of the system they work in and they have very little say when it comes to their schedules. Sometimes it’s because of financial reasons. Sometimes it’s just that so many patients need to be seen and doctors don’t want to work 24/7 (because they have a life and a family too!). 

Third, OBGYNs (and doctors in general) aren’t trained in preventative care – the focus of their education was on disease, specialty care, and technology. So that’s what they focus on in practice.

At my appointments, a nurse checked my vital signs then the doctor checked my baby’s heart rate, and that was it. There was no discussion of nutrition or exercise or education about how best to manage pregnancy and prepare for labor.

Appointments with a Midwife

Contrast all that with my experience with my midwife. My appointments were always with her, and only her. I knew and trusted her. She knew my story and remembered what we’d talked about last time. 

We always spent at least an hour together. She was self-employed and that meant she could set her own schedule. 

At my appointments, my midwife always checked my vital signs and my baby’s heart rate, but we spent the majority of our time together talking. She not only answered my questions but also taught me things I didn’t even know to ask about. 

All of a sudden, I loved going to my prenatal appointments. Finally, I knew what to do to keep myself and my baby safe and healthy. Beyond that, I was learning about and preparing for labor.

In addition to the benefits of better prenatal care during pregnancy, having a midwife meant I knew exactly who was going to be at my birth.

And I didn’t just know who she was, I knew her well and had spent lots of time with her. That made it much easier to relax and stay focused during labor.

3. Methods of Managing Labor, Birth, and Immediate Postpartum

Both OBGYNs and midwives are there to help you safely birth your baby, but they often accomplish that in very different ways. This will be easiest to illustrate with a few examples. 

Example 1: Induction and Interventions

Let’s say you are approaching 40 weeks. You and your baby are healthy and have no complications, but you are wondering if there are any concerns with going past 40 weeks.

If your care provider is an OBGYN, he or she will likely recommend an induction. You agree, so you schedule the induction.

On the appointed day, you show up to the hospital, check in, change into a hospital gown, get hooked up to fetal monitoring systems, and then receive Pitocin through an IV and contractions begin.

If your care provider is a midwife, she will likely explain that the average first-time mom goes 41 weeks and 1 day before labor begins. She’ll reassure you that that is totally safe and acceptable.

She’ll probably say that she recommends you allow labor to begin spontaneously, when your body and your baby are ready.

These kinds of responses are typical. You’d likely get similar answers on the topics of pain management, length of labor, and more. OBGYNs tend to turn to routine medical interventions whereas midwives most often encourage movement, relaxation, and other natural, non-medical techniques to help.

Example 2: Baby’s Position

The ideal position for a baby to be in when labor starts is with his head down and his nose pointing towards mom’s spine. That is most often the case, but sometimes the baby turns upright. This position is called “breech.”

If a mom reaches full term (39 weeks) and her baby is still breech, her OBGYN will almost certainly deliver that baby by c-section

graphic showing one ideally-positioned baby and one breech baby

A midwife would handle it differently, not only once labor starts but long before that. 

During pregnancy, many midwives recommend regularly doing certain exercises that encourage your baby to settle into the correct position. My midwife also encourages her clients to avoid reclined sitting positions during the third trimester, for the same reason.

If a baby is still breech when labor starts, your midwife might recommend the Miles Circuit, which is a series of 3 movements that encourages your baby to rotate.

If your baby doesn’t turn, you still don’t have to have a c-section. Some midwives are comfortable delivering breech babies vaginally.

Example 3: Newborn Tests

After a baby is born, care providers want to ensure that the baby is healthy and breathing. These routine checks are grouped into one exam called the Apgar test and need not take more than a few seconds. What happens next is what differs.

If your care provider is an OBGYN, chances are the umbilical cord will be clamped and cut immediately and then your baby will be bathed, measured, weighed, given a shot and eye ointment, wrapped in a blanket and a hat, and then given to you. 

If your care provider is a midwife, she will likely place your baby on your abdomen immediately after ensuring that he or she is breathing and responsive.

You will choose how long to delay clamping and cutting the umbilical cord. Your midwife will likely recommend you rub the vernix into your newborn’s skin, rather than washing it off.

Measuring and weighing will happen after you’ve had at least an hour to hold your baby and to attempt breastfeeding. The shot and eye ointment will likely be offered as an option but will be left up to your discretion. 

Last Thoughts

So there you have it. Three big differences between midwives and OBGYNs (the ones that really affect your pregnancy and birth experience).

With those three things in mind, you’re much more prepared to make an informed choice. If you still aren’t sure whether you should hire a midwife or an OBGYN, check out Midwife or OBGYN: Which is Right For Me? (15 Questions to Help You Decide).

Midwives Achieve Better Birth Outcomes

In addition to the 3 things we just went over, there’s one other thing I want to know as you consider the differences between midwives and OBGYNs.

Studies have found time and time again that midwives achieve better birth outcomes. Even just in the US, areas in which midwives are more common have higher rates of vaginal birth and breastfeeding and lower rates of c-section, preterm birth, and neonatal death.

My Recommendation

I also want to give you my recommendation. Everyone is different and I don’t know your circumstances, but I always wished someone would give me more than information. I wished people would share their honest recommendation about things like this.

So here’s mine.

I recommend you hire a midwife.

If you are low-risk (which is most of us) it just makes sense to hire a midwife.

Midwives are the experts on normal pregnancy and childbirth. OBGYNs specialize in complications, emergencies, and surgery. Midwives view birth as a normal, natural process and trust each woman’s body to be able to birth effectively as it was designed to. OBGYNs tend to rely on medication and technology.

A midwife will have the time and education to teach you what you need to know and prepare you for a healthy, safe pregnancy and labor. An OBGYN usually won’t.

And midwives are more likely to help you achieve the birth outcomes you want (and avoid the ones you don’t). 

Ultimately, you’ll know what feels right for you. Be brave and follow that. You’ll be glad you did.

Until next time,

Allison

READ MORE >> Who to Hire: Benefits of Hiring a Midwife

READ MORE >> So You Want a Midwife…What Kind?

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