Midwife v. Obstetrician
Congratulations on those two little blue lines! Now it is time to get that first appointment scheduled to meet your little babe. Did you know you have a choice between two types of providers to help you deliver your baby? You have the choice between a midwife or an obstetrician. Now you are probably wondering about the differences between the two, well keep on reading and I will help you make an educated selection that best fits you and your growing family’s needs.
Certified Nurse Midwife (CNM)
Midwives are practitioners that begin their careers as nurses, usually working in labor and delivery. After completing their bachelor’s degree, they must complete a midwifery graduate program that takes two to three years. After the completion of their graduate program where they gain real-life hands-on experience, the midwives must sit for their state licensing exam to become a Certified Nurse Midwife (CNM). The biggest difference between a CNM and an obstetrician (OB) is the natural and holistic approach to pregnancy and childbirth CNMs take. Also, CNMs don’t just work in the hospitals – they can work in birthing centers or facilitate home deliveries.
A cross-sectional study discerned that patients that had utilized a nurse midwife were less likely to need a c-section and had a lower risk for perineal tearing than a delivery with an obstetrician (Martin-Arribas, et al., 2022). CNMs encourage movement to help the progression of labor. Movement can include walking, dancing, bouncing on a yoga ball, or if you are at a point that you can’t move much due to an epidural, a peanut ball may be used, and the nursing staff is there to assist you in moving as much as possible while in the bed. CNMs will encourage you to deliver in any way that is most beneficial to you and safe – squatting with the squat bar on the bed or on your hands and knees. YOU DON’T HAVE TO DELIVER ON YOUR BACK! Gravity is your friend during labor and delivery, use it!
As a patient you will have more autonomy when utilizing a CNM as your provider to deliver your baby. Keep in mind that CNMs can only deliver low-medium risk pregnancies. CNMs can not complete surgical procedures which means if you must end up having a c-section you will end up with an OB. If you read my previous post about my labor and delivery experience you know that this is how my delivery ended.
Obstetricians (OB)
Obstetricians are medical doctors that use a more traditional/medical approach. The schooling for an OB is longer than that of a CNM – four years of medical school and then a residency to follow. Obstetricians only work in hospitals. OBs can perform surgical interventions (i.e. c-section) if needed. When a patient is delivering with an OB the lithotomy position (lying on your back with feet in stirrups) is utilized. Historically it is found that this is not beneficial for the mother but for the doctor. If you are determined to be a high-risk patient, you will probably have another type of OB on your care team called a Maternal Fetal Medicine (MFM) doctor. These providers specialize in high-risk pregnancy care. A great thing about going to the MFM from personal experience is seeing your baby more frequently and all the high-resolution ultrasounds you will get.
High-Risk Factors
- Pre-existing medical condition (i.e. obesity, asthma, diabetes)
- Pregnancy History (any complications in previous pregnancies – i.e. pre-eclampsia, miscarriages, stillbirths, preterm labor or any genetic conditions )
- Age (Women < 20 years old or Women > 35 years old)
- Location of Placenta
- History of Substance Abuse
- Rh Factor – blood types differ between mom and baby.
- Mom Rh (-) and Baby Rh (+)
- Multiples Babies
Making Your Decision
It is ultimately up to you who you initially chose for your provider to guide you through this journey. If you want to have more autonomy with your pregnancy, labor and delivery experience I highly encourage you to make your appointment with a midwife, but if you are a more traditional mama then you may want to pick an OB. There is no wrong answer, but I do encourage you to do your research and reach out to other moms in your community to see who they recommend for providers. Good luck on this journey mama, it is just beginning!