Differences Between an OB and a Midwife
Choosing a practitioner to guide you through pregnancy and deliver your baby can be one of the most difficult decisions you'll face once you find out you're pregnant. Some women have gynecologists who they love who are also practicing obstetricians (OBs), which make the choice easier. For others, finding this person can be a daunting challenge, especially if when you're considering the differences between an OB and a midwife. While there is a large variance between individual personalities and philosophies, there are some fundamental differences between an OB and a midwife.
Education level is one of the most significant differences between an OB and a midwife. OBs are medical doctors, meaning that they've completed medical school, residency and passed appropriate boards to become certified to practice medicine. A Certified Nurse Midwife (CNM) starts out as a registered nurse (RN) and goes on to complete a midwifery program in an accredited program. Many midwifes work out of a physician's office or practice to have access to their expertise should a complication arise during a pregnancy or delivery. While there is some disparity between educational requirements, midwifes receive specialized education in pregnancy, labor and delivery, cutting the duration of their schooling.
A midwife can perform most of the same prenatal care an OB can. They will monitor you much in the same way and give you access to all the same prenatal tests. A doctor will have more training in performing and correctly reading an ultrasound, so if you see a midwife who doesn't work in a practice, you may need to go to a center that performs ultrasounds. Midwives can prescribe most medications related to your prenatal care as well. There aren't too many differences between an OB and a midwife in what prenatal care is performed, but they may approach your visits differently. Some women find that midwives are more personal, and are concerned with your emotional progress through your pregnancy as well as your physical progress. They may be less hurried, more attentive to your concerns, fears, etc.
Labor & Delivery
There are many differences between an OB and a midwife when it comes to the subject of labor and delivery. While a large majority of OBs may encourage and support natural childbirth that includes no pain medication and few medical interventions, you can almost guarantee that a midwife will do everything possible to support your choices to avoid medical intervention. The vast majority of OBs do deliver in hospitals, so if you don't want a hospital birth, you should opt for a midwife. Many midwives offer the option of delivering your child at home or in a birthing center instead of a hospital.
A hectic schedule may mean that your OB has time constraints, and may encourage medical interventions should your labor stall out or slow down. While both OBs and midwives put you and your baby's health and safety at the forefront, statistics show that OBs are more likely to use or recommend drugs for pain management during labor, and use medical interventions such as vacuum, forceps, episiotomy or cesarean during delivery. Births that are attended by midwives have fewer medical interventions and a lower rate of cesarean sections.
While midwives can utilize these interventions as well (with the exception of a cesarean), when necessary, they may take the time to employ other methods of pain management such as breathing and meditations exercises, birth ball and water. During delivery, a midwife can help women get into positions that better facilitate delivery, such as rocking or squatting. In order to avoid an episiotomy, a midwife may massage the perineum.
After the delivery, your midwife may also be certified in lactation consulting, which may be of particular benefit if you're new to nursing or are struggling to get the baby to latch on. Many women find the additional support some midwives can provide to be what they need to face the long road of pregnancy and the difficulties of labor and delivery.
The choice to choose an OB or a midwife is a personal one, where you should consider your personality and requirements of a caregiver. You may find an OB that is just as supportive and warm, and is willing to help you have a natural childbirth. Be sure to check with your insurance to be sure that the services of a midwife would be covered. Further, if you are considered high risk due to preexisting diseases or conditions, or develop one during pregnancy, you should also be in the care of an OB.