I want a hospital birth, but do I want a doctor or midwife?

You’re having a baby! It probably goes without saying that your mind is overflowing with questions after having just received this life-altering news. One of the most pressing of those questions is probably who your care provider should be. You know you want to give birth in a hospital, but you also know that there are so many doctors to choose from, and now you’ve also heard that there are in-hospital midwives. Where do you even start in navigating all of your options? Right here!

What is the difference between a doctor and an in-hospital midwife?

There are three main differences between a doctor (OB-GYN) and an in-hospital midwife (CNM):

  1. Education
  2. Models of care
  3. Types of pregnancies they care for (high risk or low risk)

Education.

In order to practice as an OB-GYN, a physician is required to have completed a bachelor’s degree, four years of medical school, and a four to seven-year medical residency that includes surgical training and is specific to obstetrics and gynecology. 

In the state of Utah, there are four different types of midwives that can legally practice (the differences of which you can learn about in this blog post), but the only type of midwife that can practice in a hospital setting is a Certified Nurse Midwife (CNM). CNMs must be Registered Nurses and they must also complete a Master’s Degree in Nurse-Midwifery.

Models of care.

The typical model of care for an OB-GYN is more medically-focused and medically-managed. Medical interventions are more commonly introduced and utilized under the OB-GYN model of care. An OB-GYN will typically play a very small role in the birth itself, as they are usually only present to catch the baby and for a brief period after the baby has been born. OB-GYNs are trained surgeons and can perform cesarean sections, if necessary.

The midwifery model of care is usually more naturally-focused and mother-and-child driven. The approach to care is typically more hands-off and less prone to medical intervention. A midwife is more likely to play a more active role in the labor and birth process. CNMs are able to carry medications and write prescriptions. They cannot, however, perform cesarean sections, so if a cesarean section becomes necessary, an OB-GYN will have to perform it.

It is important to remember that these are just general descriptions of the typical models of care for these two types of providers. This is not to say that these models of care are always implemented by every OB-GYN or midwife. There are certainly OB-GYNs that implement a model of care that is more like that of a midwife and vice versa.

Types of pregnancies they care for.

OB-GYNs can care for women with high or low-risk pregnancies. Some OB-GYNs specialize in or have more experience in certain types of high-risk scenarios, such as pre-eclampsia, placenta previa, multiples, etc.

CNMs typically only care for women with low-risk pregnancies. If a patient is receiving care from a CNM and later develops problems that cause her pregnancy to be deemed high-risk, it is likely that the patient will need to transfer care to an OB-GYN.

The choice to go with an OB-GYN or a CNM can seem daunting, but it essentially all comes down to what is most important to you pertaining to your birth experience.

Is it important to you that your provider be able to handle any and all medical scenarios that could potentially occur? Then an OB-GYN might be the best choice for you. Or is it more important to you that your provider play a more active role in your labor and birth experience? Because if that’s the case, a CNM might be more up your alley. Either way, the choice is entirely yours and your intuition will be your greatest guide!

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