Should You Choose an OB-GYN or a Midwife?

Trying to decide who will deliver your baby? Read about the differences between an OB-GYN and a midwife before making your choice.

While OB-GYNs deliver the majority of babies in the United States, the number of babies delivered by nurse midwives has been steadily on the rise. In 2021, midwives attended 12% of births in the U.S. These licensed, independent health care providers often follow "low tech, high touch" protocols when handling pregnancy, labor, and birth.

Choosing who will deliver your baby is a highly personal decision and will depend on factors such as your medical status and history, if there are any complications with your pregnancy, and your own personal preferences.

If you're trying to choose between a midwife or an OB-GYN, here's a look at the differences and similarities between them, plus seven questions that will help you make the final call.

midwife instructs new mom in baby care in hospital

Getty Images / SDI Productions

Midwife vs. OB-GYN: What's the Difference?

Both certified midwives and OB-GYNs specialize in prenatal care, labor, and delivery. They're both licensed and highly regulated health care providers—and your health insurance covers their care if you're delivering in a hospital. Most insurance plans will also cover some share of a birthing center delivery, but home births are generally not covered.

Despite their similarities, midwives and OB-GYNs usually have different certifications, philosophies, and abilities (for example, OB-GYNs can perform surgeries, but midwives can't). Here's what to know about the similarities and differences between them.

Midwives

What is a midwife, and what does a midwife do? Certified nurse midwives (CNMs) are "the experts in normal pregnancies," says M. Christina Johnson, CNM, the director of Midwifery at GW Hospital and former director of professional practice and health policy at ACNM in Silver Spring, Maryland. Johnson says her profession is often best known by this saying: "low tech, high touch."

Certified nurse midwives earn bachelor's degrees in nursing, then work as registered nurses to gain experience in labor and delivery before going back to school for a two- or three-year master's degree program in midwifery. This graduate-level program must be accredited by the Accreditation Commission for Midwifery Education (ACME), according to the American College of Nurse-Midwives (ACNM). After passing a national certification exam, the individual can be professionally delegated as a CNM, which stands for certified nurse-midwife.

If the person isn't a registered nurse when they complete the certifications, they're designated a CM for certified midwife. CMs are only recognized in nine states (Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, and Virginia) and the District of Columbia.

Both CNMs and CMs can prescribe drugs, including pain medication and epidurals. Midwives also use technology such as fetal monitors, but they rely heavily on their clinical experience. They can't perform C-sections (though some may assist in the operating room).

Note that there are other types of midwives as well, including the following:

  • Certified professional midwife (CPM): Certification is based on knowledge and skillset, and it doesn't require an academic degree. CPMs are certified by the North American Registry of Midwives. They can't practice in every state.
  • Lay midwife: These types of midwives don't have any certification or licenses, and they've received informal training instead. They usually work in home settings.

OB-GYNs

Obstetrician-gynecologists (OB-GYNs) are medical doctors specializing in pregnancy, childbirth, and reproductive health. They must receive a bachelor’s degree and medical degree, and complete at least four years of accredited residency programs, before earning certification in their state. Some OB-GYNs also pursue niche specialties.

When working with an OB-GYN, "there's the perception that the physician is more likely to intervene in the birth," says OB-GYN Jennifer Niebyl, MD, professor of obstetrics and gynecology at the University of Iowa in Iowa City. That's partly because they can. Unlike midwives, OB-GYNs are trained to manage high-risk pregnancies and can perform surgeries like C-sections.

Research does show that OB-GYNs are more likely to use interventions (e.g., epidural anesthesia, episiotomies, and instrument deliveries). However, research also indicates that fetal and maternal outcomes are equally good when comparing OB-GYN and midwife births in low-risk pregnancies.

Choosing Your Caregiver: OB-GYN or Midwife?

Johnson and Dr. Niebyl say that who delivers your baby boils down to what you need, along with what your personal preferences may be. Sometimes, there may be no choice, such as if you need a C-section to deliver. But if you're grappling with the decision between working with an OB-GYN versus a midwife, the best thing to do is to start by answering these seven questions.

1. Is a vaginal birth your priority?

Both midwives and physicians are supporters of vaginal births in people who want them (assuming, of course, it's safe for their situation). However, it's always a good idea to talk to a potential provider about their policies. "You should ask about the doctor's C-section rate and philosophy," recommends Dr. Niebyl.

2. Do you want your caregiver with you during labor?

While every provider may be different, midwives generally provide more one-on-one support because they deal primarily with low-risk pregnancies, and they have a more hands-on approach than doctors do.

"Nurse-midwives offer a lot of labor support. They spend more time with patients than a physician can because we get pulled in so many different directions," says Dr. Niebyl. If you have a doula (someone trained to support and help advocate for you through labor and delivery) or other support system, though, this may not be a deal breaker for you.

3. What's your plan for pain management?

As long as you are in a hospital setting, you can choose to have an epidural whether you're in the care of a certified midwife or a physician, so this shouldn't be a deal-breaker. If, on the other hand, you plan to give birth in a birth center or at home, you won't have access to an epidural for pain management.

"In a hospital setting, lots of midwives' patients ask for and get epidurals," says Dr. Niebyl. However, midwives may work more closely with you on medication-free methods to manage pain first. "We usually look for pain management techniques that support the natural process," says Judy Berk, CNM, a certified nurse-midwife at Brigham and Women's Hospital in Boston. "That might mean showers, massage, acupressure techniques, homeopathy, switching positions, or trying a birthing ball."

4. What will happen at the hospital?

Depending on the situation and your baby's status, some doctors may prefer that their patients stay in bed with an IV, hooked up to a continuous fetal monitor. Midwives may encourage patients to move around more, and they often prefer intermittent rather than continuous monitoring, according to Johnson.

Of course, how you and your baby are monitored during labor will depend on many different factors, such as whether you get an epidural, how your baby is handling labor, and if there are any other complications. It may be best to speak to your potential birthing team before your due date to find out about their policies for childbirth in the hospital—and make sure they mesh with your expectations.

5. Do you want more support and advice for your transition to parenthood?

Midwives may be able to provide a bit more holistic care when it comes to guiding you through the transition into parenthood, especially in the postpartum phase. "Midwives do a lot of counseling for nutrition and exercise and also on the emotional changes that happen when it comes to becoming a parent for the first time or adding another child to the family," says Berk.

6. Is your pregnancy considered high-risk?

"If you have a condition that would make your pregnancy high-risk, such as gestational diabetes, or you're delivering twins, you should see an OB-GYN and deliver in a hospital," says Michele Hakakha, MD, an OB-GYN in Beverly Hills and co-author of Expecting 411: Clear Answers & Smart Advice for Your Pregnancy.

Some midwives co-manage higher-risk patients alongside OB-GYN colleagues; that means you may see both a midwife and an OB-GYN during your pregnancy. Who ultimately delivers your baby will likely depend on your medical circumstances.

If you had a Cesarean section with your first child, a midwife may still be an option for your second baby. Midwives don't perform surgery, but you can certainly discuss with your OB-GYN or midwife the possibility of a vaginal birth after C-section (VBAC). Whether a midwife or an OB-GYN can offer VBACs is often dictated by hospital policy.

7. Do you feel comfortable?

Justine Arian, a doula and birth coach in Huntington Beach, California, urges pregnant people to trust their instincts about who they choose to deliver their babies and even where. "Meet different doctors and midwives and visit hospitals or birthing centers. Ask yourself, 'Is this where I see myself giving birth?'" says Arian.

You can be sure you're not making decisions based on unfounded fears by taking the time to educate yourself about your options. "[People] have to give birth where they feel safest and most supported," she says.

Key Takeaway

If you're choosing between a midwife and an OB-GYN, know that each decision has its pros and cons, and one isn't necessarily better than the other. The choice might be influenced by your specific pregnancy circumstances, personal preferences, insurance policy, and more. Talk to a trusted health care provider for guidance.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Midwives: Information on Births, Workforce, and Midwifery Education. U.S. Government Accountability Office. 2023.

  2. The Cost of Home Birth in the United States. International Journal of Environmental Research and Public Health. 2021.

  3. Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives. American College of Nurse-Midwives. Updated 2021.

  4. Certified Midwife Credential. American College of Nurse-Midwives.

  5. Comparison of Certified Nurse-Midwives, Certified Midwives, Certified Professional Midwives Clarifying the Distinctions Among Professional Midwifery Credentials in the U.S. American College of Nurse-Midwives. 2017.

  6. Education, Training, and Certification for OBGYN. University of Illinois College of Medicine.

  7. Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births. Obstet Gynecol. 2019.

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