Midwife or Doctor
Which Should I Choose?

Choosing a midwife or doctor is an important step in having the birth you want. Here you'll learn the difference between the two and how to choose the perfect midwife or doctor for you.

What’s the Difference Between a Midwife and a Doctor?

One of the main differences between a midwife and a doctor is the type of education they receive. An obstetrician is a doctor that specializes in pregnancy and birth. He or she has gone to medical school and is trained to do surgery. Obstetricians don’t attend home births. A small few attend births at birth centers.

A midwife is trained in all things related to pregnancy and birth, but does not go to medical school. Although midwives don’t carry the title of doctor, they are no less competent to provide care for pregnancy and birth. In fact, countries where midwifery care is the norm have the best outcomes for both moms and babies.

Midwives specialize in low and moderate risk pregnancies in healthy women. Midwives only refer women to physicians when there is a problem, and they do not perform C-Sections. Some midwives attend homebirths, and some only work in hospitals.

Did you know you could choose a Family Practitioner? Many family doctors are also qualified to do prenatal care and delivery. They are not surgeons, like obstetricians, so they don’t do C-Sections. If you have a family doctor you already love, this might be a good option!

Different Models of Care

There are two general models of care for pregnancy and birth. One is the midwifery model of care and the other is obstetrical management.

Under the midwifery model of care, pregnancy and childbirth are considered normal events, not medical ones. The focus is on preventative care during pregnancy.

Prenatal appointments with midwives are generally longer. Midwives take a lot of time to answer questions and talk about nutrition.

The use of the midwifery model of care has been proven to reduce the likelihood of C-Section and other intervention, including the use or forceps and vacuum. The midwifery model follows a “wait and see” approach during labor and birth. This means that medical interventions are not used unless there is a medical necessity for them.

Obstetrical, or medical management, tends toward more intervention in order to have more “control” over labor and delivery. A care provider who operates mainly under this model is likely to use many interventions during labor, such as pitocin to speed up labor. Using many interventions during labor when they aren’t needed leads to more Cesarean births.

Generally, midwives practice the midwifery model of care and obstetricians tend to take more of a management approach. However, there are exceptions. It’s important to note when you’re choosing a midwife or doctor that not all midwives practice the midwifery model of care, and not all doctors use a lot of intervention. It’s important to ask questions when you’re looking for a care provider. That way you can choose a midwife or doctor that suits your preferences.

Types of Midwives

There are a few different kinds of midwives. It can be a bit confusing, so here's a breakdown of the different titles midwives can hold.

The two main groups of midwives are Certified Nurse Midwives, who focus on both nursing and midwifery, and Direct Entry Midwives, who focus only on midwifery. The first two on the list generally practice in hospitals, and the rest specialize in birth center and home birth.

Certified Nurse Midwife (CNM) Certified Nurse Midwives have graduated from nursing school and are further trained in midwifery. They are certified through the American College of Nurse Midwives (ACNM).

Certified Midwife (CM) Certified Midwives are not nurses, but they are trained in midwifery and are also certified through the ACNM.

Certified Professional Midwife (CPM) CPMs are certified through the North American Registry of Midwives (NARM). This is a national credential and in order to be certified, they must meet many qualifications. The NARM requires knowledge and experience with out of hospital birth.

Licensed Midwife (LM) Licensed Midwives are licensed by the state they live in. Not all states offer licensure for midwives. A licensed midwife may also be a CPM. Certification through NARM is a national credential, and licensing is done through the state.

Lay Midwife A lay midwife is not certified or licensed. This doesn’t mean that she is uneducated or incompetent. It just means that she has not chosen to certify or get licensed, or that certification wasn’t available for the particular education she’s received. Many lay midwives have many years of experience and are extremely competent care providers.

Tips for Choosing a Midwife or Doctor

Before you choose your doctor or midwife, you should get an idea of what your philosophy of birth is. What would your perfect birth be like? How do you expect to be taken care of?

After you have a clear idea of what type of care you want, you can look for someone who will meet your expectations. You can interview a few midwives or doctors and find out what type of care they practice, and choose from there. Remember, whoever you choose is working for you! You’re paying them! You should have someone who will give you the type of care you want.

Here are a couple tips for interviewing a midwife or doctor

• Ask open ended questions. Also, try not to make your opinion obvious. You want to get an honest answer from their point of view. Here are a couple examples:
“How do you feel about…?”
“How do you handle…?”
“When do you recommend…?”

• If you don’t get a clear answer, dig deeper. Here’s an example I hear a lot. A woman might ask her doctor what his philosophy is on doing episiotomies. The doctor says something like, “I only do them when necessary.” Well, that doesn’t really tell you anything, does it? What exactly does he consider “necessary?” How often does he find it “necessary?”

I’ve seen midwives who’ve never done episiotomies out of a thousand or more births, and I’ve also seen midwives who claim to only do them when “necessary” but they still do them an awful lot!

If you don’t get a clear answer, ask more questions until you do.

• Note how comfortable you are with the person. Birth is a personal thing. You want a midwife or doctor you feel comfortable with. Do you seem to mesh well with her? Do you feel like you could ask him embarrassing questions without feeling weird? Making sure you trust your care provider and feel comfortable with him or her is one of the most important things.

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