Physicians and midwives are the main options for medical support during labor. But what’s the difference between midwife and OB GYN care when you’re planning a natural birth? Let’s take a deep dive into the type of physicians and midwives that you can choose for your birth.
Physicians for Natural Birth
Family Practice Doctors (FP)
FPs are physicians that specialize in the care of the entire family. Some of them also provide maternity care as part of their practice. They may or may not have done an OB GYN residency. They work with healthy, low-risk pregnant women “Low risk” means there’s nothing to indicate that there will be any complications at birth.
FPs typically delivery babies at hospitals, and they can perform or assist a cesarean birth, if necessary. For better or for worse, they aren’t usually as experienced at performing c sections as other types of physicians.
Obstetricician (OB GYN)
An OB GYN is a physician that spends 4 years after medical school studying female reproduction, pregnancy and childbirth. They also study medical and surgical care for women. The can treat low and high-risk moms, and they can perform a cesarean birth. They typically only help deliver babies at hospitals.
A perinatologist is a physician who has attended even more school after becoming an OB GYN to specialize in the care of women who have high-risk pregnancies. Their patients are experiencing or are at risk for health problems during their pregnancy.
Women typically see their normal OB who will work alongside the perinatologist as needed during the pregnancy. Usually perinatologists stay in the office — the OB will likely be the one to help deliver the baby in the hospital (1).
Midwives for Natural Birth
A lay midwife has received informal training through an apprenticeship or self study. There’s not formal licensure for this type of midwife, and they’re not recognized by most state certifying bodies. For this reason, they don’t accept insurance but usually offer competitive self-pay rates. A lay midwife typically only practices in home settings.
Certified Professional Midwife (CPM)
A Certified Professional Midwife has received formal training, and then obtains certification through the North American Registry of Midwives. A CPM must pass a written exam and also pass a hands-on demonstration to receive certification. Their schooling can take 1-5 years after high school. They typically practice in homes or birth centers with healthy, low-risk women (2).
Certified Nurse Midwife (CNM)
Certified Nurse Midwives are registered nurses who have additionally obtained a master’s degree specializing in reproductive care. They then certify through the American Midwifery Certification Board. CNMs are recognized in all states, and can practice in a birth center or hospital (3).
CNMs specialize in healthy, low-risk pregnancies and consult with doctors as needed. They do not perform cesarean births. If a c section were necessary, the on-call doctor would perform the surgery, instead.
Difference Between Midwife and OB GYN
Physicians and midwives bring varying benefits to the table. Let’s briefly sum up what we learned about the difference between midwife and OB GYN care.
|Some are certified and licensed, some are not|
|Work with low-risk, healthy |
|Can not perform cesarean birth|
|Work in homes, birth centers, |
|Have between 1 and 8 years of |
school and training after high
|Less likely to intervene |
|Primary source of prenatal care throughout the world|
|All are certified and licensed to |
|Work with both low-risk and|
|Can perform a cesarean birth|
|Usually only work in hospitals, |
but may oversee birth centers
|Have between 11 and 16 years of school and training after high |
|More likely to intervene |
|Used more than midwives in the United States|
Physicians and Midwives: How Do They Stack Up?
Throughout the world, midwives are the primary source of prenatal care. In the United States, physicians are the norm. So which one is the best choice for natural birth?
Midwives Intervene Less
When your plan is a simple, natural birth without lots of medical procedures, a midwife is statistically your best bet. Studies of women who gave birth in a hospital under the care of licensed midwives were (4):
- Less likely to experience episiotomy and assisted delivery
- Less likely to use pain medication in labor
- More likely to have a spontaneous vaginal birth — one that starts on its own.
Midwives Give You More 1:1 Time
There’s a general belief that midwives spend more time with you during labor than physicians do — that they offer a lot more labor support. In my experience, I’ve found this to be true at least half of the time, but certainly not always. It depends on how many patients they have and the style of the medical practice. You’ll want to ask about this specifically when you interview your midwife.
OB GYN May Be More Accessible for a Hospital Birth
Remember that only Certified Nurse Midwives can work in hospitals. And if your plan is to give birth in a hospital, midwives are much less common than physicians. You may struggle to find one within a reasonable distance from you, or one that is in-network with your health insurance.
Additionally, it’s generally recognized that not every woman is a good candidate for a midwife. Women who are pregnant with twins or triplets, who have medical complications, or whose babies have medical complications may be safer with an obstetrician who specializes in high-risk care.
Physicians and Midwives: Who’s the Best Choice for Natural Birth?
There’s no right or wrong choice here. You have to select a provider that best fits your birth philosophy and comfort level. You can have an amazing natural birth with a doctor OR a midwife. (In contrast, you can experience a highly-medicalized birth with doctor or a midwife.)
Midwives #1 for Natural Birth
If you were going to choose a doctor or midwife out of a hat, a midwife is statistically offers you the best chance for a natural birth. But not all midwives are equally supportive of natural birth, so it’s always best to ask around and get specific recommendations.
But Doctors Can Support Natural Birth, Too!
If, for whatever reason, a midwife is not an option for you, don’t worry! 4 of my own 5 natural hospital births were attended by physicians, and they were amazing advocates for me. Of course, I worked hard to communicate my plans for a natural birth during pregnancy. But it’s always paid of at birth with a highly supportive team of doctors and nurses who are eager to help me reach my goal
At the end of the day, it really comes down to the specific physician and midwife that you choose. You’ve got to do your homework, meet with them 1:1, and ask a lot of questions! Are you ready to take the next step?
Now it’s time to read: Interview Questions to Ask OB GYN or Midwife
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
(1) Simkin, P. (2010). Pregnancy, Childbirth and the Newborn, 4th edition. Meadowbrook Press
(2)North American Registry of Midwives. Retrieved at http://narm.org/
(3)American Midwifery Certification Board. Retrieved at https://www.amcbmidwife.org/
(4) Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub3.