OB or Midwife: Finding the Birth Provider that Works for You

Written by Erin Odom, Contributing Writer

If you’re expecting a baby (or hope to sometime in the future)–especially for the first time–your mind is probably spinning with questions. What supplements should you take? Should you exercise while pregnant? What’s the best pregnancy diet? And, of utmost importance, who should oversee your prenatal care and ultimately deliver your baby? Should you see an OB or midwife? And how do you find a birth provider that works for you?

These are questions no one should take lightly. But the last question I didn’t even think about during my first pregnancy. Even though it was 2008, I didn’t even know I had a choice besides using an obstetrician for my prenatal care and delivery. Since then, I’ve learned about Certified Nurse Midwives (CNMs) and Certified Professional Midwives (CPMs).*

Not all may be options in your state of residence (Obstetricians and CNMs are the only ones legally able to practice where I currently reside–North Carolina), but it’s wise to be aware of all your options before making a final decision.

Image by koadmunkee

Obstetricians (OBs)

Obstetricians are doctors. They have completed medical school, where they were trained to provide care for women during pregnancy, labor and post-labor. Most obstetricians are also trained to be gynecologists, with many possible areas of expertise, such as reproductive cancers or infertility. They are also trained as surgeons and are the only care providers who can perform C-sections (source).

Reasons to use an OB

  • You are a high-risk pregnancy. High risk does not necessarily include such conditions as gestational diabetes (I had it during my second pregnancy and used a CNM.), multiple babies or some other minor complications. High risk includes chronic, serious illnesses on the part of the mother or baby.
  • You feel most comfortable in a hospital setting. (That I know of, there are no OBs who practice in homes.)
  • You will require a C-section. 
  • It’s your only option. Even though I had no idea midwives still practiced when I had my first baby, I have since learned that, for where we were living at the time, an OB may have been my only option anyway. There are some areas where midwives are not available.

Certified Nurse Midwives (CNMs)

CNMs are essentially registered nurses who have received extra training to equip them to perform all of the same tasks as an obstetrician, except C-sections (source). I have used a CNM for both my second and current pregnancies. A CNM often practices in the same office as an obstetrician, and if an emergency arises (during pregnancy or labor/delivery), the obstetrician can back up the CNM and take over care if needed.

Where I receive my prenatal care, there are a handful of OBs and three midwives. I primarily see one midwife (who delivered my second baby), but any of the three could potentially deliver my baby–depending on who is on call at the hospital on that day.

The biggest difference I have seen is that CNMs are oftentimes more naturally-minded. They are accustomed to their clients preferring no or minimal interventions.

CNMs also spend more time getting to know their clients. My midwife feels like a friend. Instead of 5 or 10 minutes per prenatal visit (like I experienced when I used an OB during my first pregnancy), my midwife spends an average of 30-45 minutes with me per visit. Not only does she check my measurements and inquire about any difficulties, but we simply talk about life and get to know each other. This helps facilitate a mutual respect during labor. Also, my OB only entered the room when it was time for me to push during my first labor, but my midwife was there for the entirety of my time at the hospital (although she didn’t hover–and gave me privacy if I needed it!).

Reasons to use a CNM

  • You are a low-risk pregnancy but still want to deliver in a hospital (although some CNMs also deliver in birthing centers or even in homes).
  • You desire a natural birth.
  • You desire to get to know your birthing professional. You prefer to be a name instead of a number.

Image by eyeliam

Certified Professional Midwives (CPMs)

CPMs are skilled birthing professionals who are certified by the North American Registry of Midwives (source). They are able to perform all the same care as CNMs, but only practice in birthing centers or in homes. They are not required to obtain nursing degrees, although some CPMs do obtain both CPM and CNM status.

Many women who choose homebirth prefer the care of CPMs because their training includes an extensive amount of time attending home births. In fact, in order to become certified, they must attend a minimum of 20 births–10 of which must be in an out-of-hospital setting (source). Although CNMs can legally (in some states) deliver in homes, their training does not require the extensive out-of-hospital experiences.

Reason to Use a CPM:

  • You are a low-risk pregnancy.
  • You desire a homebirth or birthing center birth. 
  • You desire a natural birth.
  • You desire to get to know your birthing professional on a more personal level. 

Image by eyeliam

A Word about Doulas

I had never even heard of a doula until after my first child was born! A doula cannot deliver a baby or give prenatal care, but she is still a birth professional. The word “doula” literally means “a woman who serves.” A doula can serve as both an emotional and physical support to a woman before, during and after labor. Read more about doulas at DONA International.

*There are many different types of midwives beyond just CNMs and CPMs. This post is meant to give you a snapshot of some of the more common North American birthing professionals. For more information on midwives, visit the Midwives Alliance of North America.

What type of birthing professional do you prefer–OBs or midwives? 

Top image by eyeliam

About Erin O

Erin is a follower of Jesus, wife to Will and mommy to three little redheaded girls (born in 2008, 2010 and 2012). She is a life-long, professional dreamer and recovering overwhelmed homemaker. Her mission is to encourage, educate and empower her readers at The Humbled Homemaker to live a grace-filled, natural life. She is the author of a 200+-page eBook all about cloth diapering-- Confessions of a Cloth Diaper Convert: A Simple, Comprehensive Guide to Using Cloth Diapers.

Read Newer Post
Read Older Post

Comments

  1. Rebecca Coursen says:

    There is also the option of a family practicioner (and I did not read all the comments to see if someone else mentioned this). We used our family practicioner for both of our kids- I labored and delivered in the hospital completely naturally for both (no meds at all) and did not feel pressure in the least to have drugs or a c-section. It wouldn’t be very cost effective for us to have highered a certified nurse midwife at the hospital becuase we would have just been paying extra people based on how the system works and I lovvvveee my doctor. I just thought I would throw that out there.

  2. I had your typical ob/hospital birth for my first 2 babies (2nd was an unnecessary induction). For our 3rd baby I used a midwife at a freestanding birthing center with a doula. She stopped catching babies so we drove over an hour to another freestanding birthing center with another midwife for our 4th baby.

    My midwives were FAR BETTER EXPERIENCES, not just emotionally but I felt safer physically. My midwives focused on nutrition/health/exercise to help me be at my best physical condition for pregnancy/birth. They wanted to AVOID problems/complications. They educated us and loved questions. My first OB, couldn’t give a rats behind about my symptoms of a complication and didn’t do a darned thing. My OB hated questions and rarely spent more than 2 mins with me and left us with unanswered questions. THe hospital didn’t want me out of bed, poked me, starved me and wouldn’t even let me drink, HAD to check me constantly, the bed was highly uncomfortable. It was a torture chamber literally.

    Hands down, our midwife/birthing center births totally rocked! It was so nice to NOT have to fill out pages of paperwork and answer tons of questions when we arrived (our midwives already had that information and knew us). It was wonderful not having strangers coming in and out (and leaving the door open exposing me). The birthing center wasn’t quite as comfortable as a home, but it was far more comfortable than a hospital. It was really nice to be supported in our decisions at the birthing center. Yes, we were happier and healthier with our midwives births.

  3. I felt like your article was VERY biased. The pictures you present for each category show your bias very clearly. In your photos, the women with the home experiences are shown as happy and comfortable, while the women with the hospital experiences have medical professionals who look distraught. This is not always the norm. I feel you picked and chose your pictures very intentionally. You are passive-aggressive in your comparisons between hospital births and nurse/midwife births. Through your article , you seem to be making a judgement call towards women who chose the hospital route. Who are you to judge or project a righteous attitude? I enjoy your blog, however I feel very disenchanted by reading this article. Your readers are smart enough to identify your false attempts at neutral journalism. I would respect you more if your were honest in your beliefs on this blog; don’t try and be neutral when you are obviously not.

    • Sadie, for some reason, this comment just came through. I am very sorry you feel that way. I am curious why you think I am “making a judgement call towards women who chose the hospital route” when I am about to have my 3rd hospital birth? Obviously, hospitals are where I feel most comfortable. As I stated in the article, I have used both an OB and a CNM.

      I did not choose my pictures based on whether or not the people looked “happy and comfortable” in the home or the medical professionals “looked distraught” in the hospital. To be honest, I am a very busy work-at-home mom, and I choose the quickest pictures I can find that come up with a quick FlickR Creative Commons search. I am surprised you found those in the second hospital picture–especially–anything but “happy and comfortable” because the mother in the picture is me. Perhaps I didn’t look like it, but I felt very happy and comfortable in the hospital where I had just birthed my second baby when the picture was taken. :) From the outside looking in, the first picture shows extreme concentration on the parts of the doctors and medical professionals. I know I for one want those who deliver my babies to be nothing by concentrated.

      Again, I am sorry you feel this way, but I was not in any way trying to deceive mine or Stephanie’s readers. The purpose of the post was education. I had no idea anyone but OBs existed when I had my first birth, and I think women should know of all their options. If you will read in the comments, many women had wonderful experience in hospitals with OBs. That truly is the best choice for some. And although I personally prefer hospital births (which I am assuming you do as well), I fully support and advocate for women who chose home birth, as my extensive research has shown it to be safe. I believe the safest place for any woman is where she feels more comfortable. And I feel most comfortable in a hospital. :)

  4. hey there, this is my first pregnancy and we are using a CNM. My husband and I are strongly leaning torwards a doula also, any words of widsom on doulas?

    • research the doulas in your area. Check out many different organizations. Find a doula or a group who supports your needs and goals. Look at how different doulas and organizations approach birth. Try to find a doula you really click with.

      Warm Wishes,
      Trina Baggett, Birth Arts International Doula , C.D. (Matrona)

  5. Erin, awesome post. Very informative for moms-to-be. I gave birth in a hospital both times. I felt more comfortable with that. But I did have negative experiences with breastfeeding…right off the bat. So I know an alternative birthing center would have likely been more supportive.

  6. I had a CNM… or rather, a whole group of them! There are 7-8 CNMs in my OB group, and I see them exclusively, including for routine gynecological care. I wanted a doula for my last delivery, but it didn’t work out.

  7. I started with an OB, then transitioned to a CNM who delivered in a hospital, and finally to a midwife in a freestanding birth center. I definitely loved the more personable feel with the midwife–sitting on her couch and chatting for 45 minutes instead of being perched on an exam table. I’ll be looking to do another water birth with a midwife for baby #2!

  8. Miranda says:

    Your experience delivering with midwives describes my own exactly! I switched from an O.B. to a midwife in the third trimester of my first pregnancy. I am so happy I chose to deliver with midwives. I have had all 3 good hospital birth experiences and my most recent birth left me feeling empowered and changed in a big way. My babies were all between 9 to 12 pounds at birth and I am fairly confident that I would have ended up with 3 c-sections if I hadn’t chosen a midwife. My first baby was delivered by the O.B. who practices at my midwives’ office. He was also the one who broke my water at the beginning of my labor with my second and third babies. The care of a midwife along with the support of an O.B. gave me the confidence I needed to approach birth without fear.

    I considered hiring a doula as well, but both my husband and I were confident that he could support me and communicate my wishes to hospital staff. I wouldn’t change a thing about my birth experiences!

  9. All four delivered by an OB:
    Baby #1 – both baby and I needed to be on oxygen
    Baby #2 – healthy, normal delivery
    Baby #3 – 6 weeks premature, NICU for 2 weeks
    Baby #4 – 4 weeks premature, otherwise healthy

    My OB allows the mom a lot more freedom than what I’ve heard about other OBs. The problem I had was more with the nurses – seemingly wanting to finish with me before their shifts were up. Several nurses were wonderful, especially the NICU nurses.

    I absolutely loved not having to worry about what my house looked like; the nice, clean hospital room with someone else doing the laundry; the nursery with caring nurses who would care for my babies while I grabbed a few hours of sleep; visiting hours when I had a houseful of extended family; knowing that if there was a medical emergency a doctor and ER were right there; and the few days of cable TV! :)

  10. Great article! I have had an OB for my first birth, LM(licensed midwife) for my second birth, CNM in a hospital for my 3rd birth, and CNM in a free standing birth center for my 4th birth.

    My first experience with the OB was terrible! I saw one OB for all my prenatals, but when I delivered it was an OB I had never met, and he had horrible bedside manner. All of the students around didn’t make it any better!! It was just a overwhelmingly bad experience, so it made me research more for my next birth.

    My second I researched and found a home birth midwife who would be willing to travel the hour to see me!(she was the closest one) It was amazing, and she almost missed the birth because my daughter came so fast!! That labor was 3 hours from start to delivery! She came right as I was in transition and she was almost crowning. It was so so great. She came to my house for every appointment, came for the delivery, and came a few days after the birth to follow up. I learned soooo much about labor and delivery with her too because she actually taught me things so much better than a child birth class at an OB clinic could.

    My 3rd birth we couldn’t afford to pay for the midwife, so we had to go with what was paid for on our insurance. At the hospital they had CNM’s who did prenatal care, but they only delivered your baby if they were on call when you went into labor. The care was so so. Not too bad/ not too great. The CNM’s were much more medically and rigidly minded than my previous LM was. IN the end, neither the CNM nor the OB delivered her though because she came so fast that the OB on call never made it to the room in time!! The nurse had to deliver her!

    With my 4th I wanted a home birth again, but again couldn’t afford it. I found a birth center in my area that took our insurance, so that is what we did! The CNM’s at the center were amazing! So much better than the ones at the hospital! They let me do what felt right in my body, and they let my body do what it needed to do to get the baby out. It was hands off, and just all around fabulous. This was actually my favorite birth of all of them because I was able to birth the way I needed and wanted to, but I didn’t have to worry about the house, making a mess, the kids: I was just a woman in labor instead of wife and mother in labor!

    As for doulas! I didn’t have one for any of my births. With the first I had no clue what they were, with the second we couldn’t afford it and there weren’t any in my area, and with the other two I was sure that my labors would be too short to even benefit from it. I however have decided to become one now that I am finished having children. I am passionate about childbirth and childbirth choice awareness, so since I am no longer having children of my own, I am expressing my love for childbirth by helping other women to achieve the birth of their dreams! :)
    I am certifying through Birth Arts International though rather than DONA because it better suits my holistic, spiritual, woman centered view of childbirth. The BAI website is http://www.birtharts.com. ☮

Trackbacks

  1. [...] be medical bills for your baby’s birth.  Whether you choose a hospital birth or you birth at home with a midwife, there WILL be bills – you WILL spend money. It only makes sense to be prepared for this [...]

  2. [...] no surprise to you that there will be medical bills for your baby’s birth.  Whether you choose a hospital birth or you birth at home with a midwife, there WILL be bills – you WILL spend money. It only makes sense to be prepared for this [...]

  3. [...] to you that there will be medical bills for your baby’s birth.  Whether you choose a hospital birth or you birth at home with a midwife, there WILL be bills – you WILL spend money. It only makes sense to be prepared for this [...]

  4. [...] OB or Midwife: Finding the Birth Provider that Works for You [...]

  5. [...] OB or Midwife: Finding the Birth Provider that Works for You [...]