Should You Go with an OB-GYN or a Midwife

Are you trying to decide who will give birth to your child and wondering, “Should you go with an OB-GYN or a midwife?” Before making this important decision, it is a good idea to become informed about the variations between an OB-GYN and a midwife, as each offers a different approach to prenatal care and childbirth.

Although OB-GYNs are responsible for delivering the vast majority of babies in the United States, the percentage of newborns brought into the world by nurse midwives has been continuously increasing. For instance, nurse midwives attended 9.4% of births in 2018, 9.9% of births in 2019, and 10.3% of all births in the United States in 2020. In 2018, that figure was 9.4%; in 2019, that number increased to 9.9%; in 2020, that number increased even further to 10.3%.

The selection of who will deliver your child is a highly personal one that can be influenced by various circumstances, including your current and past medical conditions, the presence or absence of any problems associated with your pregnancy, and your individual preferences. Here is a look at the differences and similarities between a midwife and an OB-GYN, as well as seven questions that can help you make the decision between the two medical professionals if you are attempting to decide between using one or the other.

What’s the Difference Between a Midwife and an OB-GYN?

What exactly does a midwife do, and what exactly is a midwife? According to M. Christina Johnson, C.N.M., the current director of Midwifery at GW Hospital, Certified Nurse Midwives (CNMs) are “the experts in normal pregnancies.” CNMs are also known as Certified Nurse-Midwives. According to Johnson, “low tech, high touch” is frequently used to describe her line of work best.

According to the American College of Nurse-Midwives, Nurse Midwives typically have bachelor’s degrees in nursing, work as RNs for a few years to gather experience in labor and delivery, and then complete a master’s degree program in midwifery that lasts between two and three years. Nurse Midwives are licensed to practice as independent health care professionals (ACNM). In most states, the professional designation is C.N.M., which stands for certified nurse-midwife. However, in Rhode Island, New York, and New Jersey, the title is C.M., which is for Certified Midwife. C.M.s and C.N.M.s are both qualified to write prescriptions for medications, such as epidurals and pain medication. Midwives make use of technology like fetal monitors, but a significant amount of their practice is based on clinical experience. They can’t do cesarean sections (though some may assist in the operating room).

On the other hand, obstetrician-gynecologists have a distinct set of talents and a different kind of reputation. There’s the idea that the physician is more inclined to intervene in the birth,” says an OB-GYN. But the reality is quite the opposite. That’s in part because they can. Unlike midwives, they are able to do surgery and have the training to handle high-risk pregnancies.

Indeed, research demonstrates that OB-GYNs are more prone to utilize interventions than other medical professionals (e.g., epidural anesthesia, episiotomies, and instrument deliveries). However, when an OB-GYN or a midwife witnesses the birth of a low-risk pregnancy, data suggests that the outcomes for both the fetus and the mother are comparable.

Another significant item to discuss is the payment for the service. In each of the 50 states, OB-GYNs and midwives are recognized as licensed and highly regulated healthcare practitioners. Your health insurance should cover the costs associated with these services if you choose to have your baby in a hospital. The majority of policies will also pay for a portion of the delivery costs incurred at a birthing center. However home births are typically not covered.

Who Should You Choose to Be Your Caregiver: an OB-GYN or a Midwife?

According to Niebyl and Johnson, the decision of who will deliver your baby should be based not only on what you require but also on any personal preferences you may have in this regard. If you are having trouble deciding between an OB-GYN and a midwife, the best thing for you to do is to begin by answering the seven questions that are listed below. In some cases, such as when a cesarean section is necessary for delivery, a woman may not have much of a say in the matter.

1. Is giving delivery vaginally one of your top priorities?

Both midwives and physicians are in favor of allowing women who wish to give birth vaginally the opportunity to do so (presuming, of course, that it is safe for them to give birth vaginally). Having said that, it is never a bad idea to inquire about the birthing practices of a potential birthing expert with whom you are considering working. Niebyl suggests that you inquire about the doctor’s C-section rate as well as their opinion regarding the procedure. If you want to give birth vaginally, you should make sure your healthcare professional is on board with the idea.

2. Do you want your caregiver to be present with you during labor?

Because of their focus on low-risk pregnancies and births, more hands-on approach, and nursing background, nurse midwives are more likely than doctors to be able to provide one-on-one support to their patients. Although not all service providers are the same, this remains true. Nurse midwives may be able to give significantly more individualized care. “There is a lot of help available during childbirth from nurse-midwives. They are able to devote more time to patients than a doctor can because we are constantly being pushed in a variety of different directions,” says Niebyl. This may not be a deal breaker if you have a doula (a person trained to assist and advocate for you during childbirth) or another support structure. However, if you do not have either of these, this may be a deal breaker for you.

3. What strategies do you have in place to manage the pain?

Because you can select an epidural with either a CNM or a physician, this should not be a deciding factor for you. According to Niebyl, “in a hospital context, a significant number of patients of midwives seek for and receive epidurals.” However, midwives may focus on non-drug pain relief strategies with you first before considering medication. Judy Berk, C.N.M., a certified nurse-midwife, says, “We normally search for pain management approaches that support the natural process.” It’s possible that this could entail taking baths, getting a massage, using acupressure techniques or homeopathy, changing postures, or using a birthing ball.

4. What will take place at the medical facility?

Some medical professionals could recommend to their patients that they spend more time in bed, connected to an IV and a continuous fetal monitor, depending on the circumstances and the condition of the baby. According to Johnson’s research, midwives are more likely to utilize intermittent monitoring than continuous monitoring, and they may also encourage patients to walk around. However, this does rely on a variety of other aspects, such as whether or not you choose to get an epidural, how your baby is coping with the labor process, and whether or not there are any additional issues. It is in your best interest to have a conversation with the people who might be a part of your birthing team well before the date you are due to give birth. During this conversation, you should inquire about the procedures that are followed in the hospital when women give birth, and you should also verify that these procedures are in line with

5. Could you use further assistance and guidance as you adjust to your new role as a parent?

Midwives may be able to provide a more holistic approach to care than other medical experts when it comes to easing your transition into parenthood, especially in the postpartum period. It has been noted by Berk that “midwives do a lot of counseling on nutrition and fitness as well as on the emotional changes that occur when becoming a parent for the first time or adding another kid to the family.” Counseling on topics such as diet, exercise, and the psychological effects of becoming a parent for the first time is a standard service provided by midwives.

6. Are you considered high-risk?

If you have a disease that would make your pregnancy high-risk, such as diabetes, or you’re delivering twins, you should consult an OB-GYN and deliver in a hospital. However, some midwives co-manage higher-risk patients with their OB-GYN colleagues. This implies that you may visit both a midwife and an OB-GYN during your pregnancy, depending on the patient’s needs. Who gives birth to your child will certainly be determined by the conditions around your pregnancy.

Even if you have been advised to have another C-section, you may still be able to give birth to your second kid with the assistance of a midwife, even if you had a Cesarean section with your first child. Although midwives do not conduct surgery, you and your OB-GYN or midwife can absolutely explore the prospect of giving birth vaginally following a cesarean section (VBAC). At this time, a hospital’s policy most typically decides whether a midwife or an OB-GYN is qualified to perform vaginal birth after cesarean sections (VBACs).

7. Do you feel comfortable?

Pregnant women should listen to their gut feelings when deciding who will deliver their infants and even where they will do it. Meet different doctors and midwives and visit hospitals or birthing centers. Ask yourself, “Do I picture myself giving birth here?” and be honest with yourself. You may be sure you’re not making judgments based on unwarranted worries by educating yourself about your options. People have to give birth in the environment where they feel the most supported and safest.

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