How do you know if you should work with a doctor or a midwife? Unfortunately there is no simple answer. But hopefully by considering the questions below, it will become clear to you which is the best match for your family.
(Start by deciding where you want to give birth – in a hospital, a birth center, or at home. Also, establish whether your pregnancy is considered low, moderate, or high risk. These factors may determine the choice of care providers for you.)
How much guidance do I want during labor and delivery?
An obstetrician follows a “medical management” model of care, in which he or she has more control and often directs the mother through the stages of labor and delivery. Some mothers may feel more comfortable letting someone with medical training tell them what they should do.
A midwife follows a “wait and see” model of care, in which she will only intervene if help is asked for or required. The midwife will follow the mother’s lead. Some mothers may like the feeling of empowerment this fosters, as well as the treatment of birth as a normal (non-medical) event.
During your labor and delivery, a doctor will come in a few times to measure your cervix and check you, and typically is present for the pushing and delivery stage. In between, nurses will manage your care. A nurse may have more than one woman to attend to, and her shift may end during your labor. A midwife stays with you throughout your entire labor and delivery.
How important is a natural birth to me?
It is possible to have a natural birth with either a doctor or a midwife. It is also possible to receive pain medications from either one (although in some states there are limitations on what midwives can prescribe). A midwife may encourage or offer natural forms of pain management before moving to medical interventions, whereas a doctor is more likely to offer pain medications. Also, obstetricians are able to perform cesareans, and they tend to offer these more often. A midwife will be more likely to view a C-section as an absolute last resort.
What will give me confidence in my provider?
EDUCATION/CREDENTIALS: An obstetrician will have 4 years of medical school, 3 years of internship/residency, and training in surgery. He or she will need to pass the board exams and obtain a license. There are several kinds of midwives; each differs slightly in the required education. Certified midwives (CM) and certified professional midwives (CPM) do not attend nursing school but are trained in midwifery and certified by one of two American organizations. CPMs are required to have knowledge and experience with out of hospital births. Certified nurse-midwives (CNM) are trained and certified as above and also attend nursing school. A lay midwife, or direct entry midwife, is trained through various educational programs and apprenticeships. She is not certified by an organization, though this does not mean that she is incompetent; on the contrary she may have many years of experience and training that parallels that of a CPM.
FAMILIARITY: Some families gain confidence in a provider through getting to know each other well. The number of prenatal visits is the same regardless of whether you’re seeing a doctor or a midwife; it’s the content of these visits that differs. With an OB, the appointments tend to be brief with a focus on the medical aspects of your care. You may spend part of your appointment with a nurse, and only see your doctor for a short time. With a midwife, the appointments tend to be longer, lending themselves to more conversation. A midwife will ask about your emotional well-being as well as the physical aspects of your pregnancy. She may involve you in your care; for example having you weigh yourself or take fundal measurements.
It is important to note that there are always exceptions to the guidelines above. You may come across an OB who offers very personalized care and focuses on preventive measures, or a midwife who takes a less natural approach and does not get to know you well. Regardless of the type of care you choose, your provider should be someone with experience, competency, and compassion with whom you feel comfortable. Don’t hesitate to “shop around” – your care provider plays a large part in how satisfying your prenatal care and birth experience will be.