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Eight years ago when I had my first son, I initially met with an OB-GYN recommended to me by a friend. I adored him—as well as his partners: a dynamic team of certified nurse-midwives. After learning that midwives tend to spend a lot of time with patients, have relatively few patients who require Cesarean sections and also encourage medication-free deliveries, I decided to have a midwife from the practice deliver my baby.
While OB-GYNs remain the go-to professionals for baby delivery in the United States, midwives are growing in popularity. In 1989, certified nurse-midwives delivered 3.2 percent of all U.S. babies. In 2008, that number had risen to 7.5 percent. Choosing who will deliver your baby is a highly personal decision. If you’re trying to choose between an OB-GYN or a midwife, here’s a look at the dif- ferences and similarities between them, plus seven questions that will help you make the final call.
M.D. vs. midwife: the basics Most people know that OB-GYNs have had four years of medical school. They have also completed a four-year residency program in which they are trained to be surgical-medical doctors, and many have also completed a three-year fellowship to specialize, for example, in infertility or gynecological oncology. Yet, many people don’t realize that midwives are also highly trained health care professionals, says Carolyn Havens Niemann, C.N.M., a certified nurse-midwife at Princeton Midwifery Care in Lawrenceville, N.J.
The majority of midwives earn bachelor’s degrees, then work as registered nurses and go back to school for a two- or three-year master’s degree program in midwifery, according to the American College of Nurse-Midwives (ACNM). The professional designation is C.N.M. for certified nurse-midwife; in Rhode Island, New York and New Jersey, it’s C.M. for certified midwife. C.N.M.s and C.M.s can prescribe drugs, including pain medication.
Both are licensed and highly regulated health care providers in all 50 states and, yes, your health insurance covers their care if you’re delivering in a hospital. Most will also cover some share of a birthing center delivery, but home births are generally not covered. More than 96 percent of births attended by C.N.M.s and C.M.s happen in hospitals, while a little more than 2 percent are in birthing centers and only about 1.7 percent at home.
The birth experience “Midwives are the experts in normal pregnancies,” says M. Christina Johnson, C.N.M., director of professional practice and health policy at ACNM in Silver Spring, Md. Johnson says her profession is often best known by this saying: low tech, high touch. Midwives use technology such as fetal monitors, but rely heavily on their clinical experience.
OB-GYNs, as a profession, have a different reputation and set of skills. “There’s the perception that the physician is more likely to intervene in the birth,” says OB-GYN Jennifer Niebyl, M.D., professor of obstetrics and gynecology at the University of Iowa in Iowa City. That’s partly because they can. Unlike midwives, they are trained to manage high-risk pregnancies and can perform surgeries. Midwives can’t do C-sections (though some may assist in the operating room). OB-GYNs can also use forceps and vacuums to facilitate delivery, whereas midwives are legally prohibited from doing so.
And, indeed, research shows that OB-GYNs are more likely to use interventions (e.g., epidural anesthesia, episiotomies and instrument deliveries). A 1997 study published in the American Journal of Public Health compared two groups of women with low-risk pregnancies. The researchers found that C.N.M.s used 12.2 percent fewer interventions than physicians. The same study found that the women who saw midwives rather than OB-GYNs had 4.8 percent fewer C-sections. Yet, more importantly, research has also shown that fetal and maternal outcomes are equally good when comparing OB-GYN and midwife births.
Choosing your caregiver Niebyl and Johnson say that who you have deliver your baby boils down to what you need. If you’re grappling with the decision between an OB-GYN and a midwife, the best thing to do is to start by answering these seven questions: