I remember a young couple sitting in my office, a little overwhelmed but excited, as they started planning for their first baby. “Doctor,” the mom-to-be asked, “we’ve heard about using a midwife. What exactly do they do? Is it different from having an Ob/Gyn?” It’s a wonderful question, and one I hear quite often. Choosing who will guide you through pregnancy and childbirth is such a personal decision, and it’s great you’re exploring all your options.
So, let’s talk about what a midwife is. Think of them as healthcare partners who specialize in pregnancy, childbirth, newborn care, and the postpartum period – that time after your baby arrives. Many also offer routine women’s health services, like pelvic exams, Pap tests, and advice on birth control. What often draws people to a midwife is their approach; it tends to be very supportive of the body’s natural processes during pregnancy and birth. If you’re hoping for a birth with minimal medical intervention, or perhaps even a home birth, a midwife might be someone you’re considering.
It’s good to know that midwives usually aren’t medical doctors. They often work closely with obstetricians and gynecologists (we call them Ob/Gyns) in hospitals. This teamwork ensures you have access to a full spectrum of care if needed. Generally, a midwife is a fantastic option if your pregnancy is considered low-risk, or if you have only very mild health concerns.
What Does a Midwife Do?
The specific services a midwife can offer really depend on their qualifications – their certifications, schooling, and where they practice. Certified midwives and certified nurse midwives generally offer the widest range of services.
Here’s a peek at what a midwife might do for you:
- Regular prenatal appointments to monitor your health and your baby’s growth.
- Ordering and interpreting ultrasounds and prenatal blood work.
- Being there with you during labor and delivery, and providing initial newborn care.
- Offering postpartum care to support your recovery.
- Educating you on important topics like nutrition, breastfeeding (lactation), fertility, and other aspects of your reproductive well-being.
- Helping with birth control and family planning.
- Performing Pap tests and breast exams.
- Screening for sexually transmitted infections (STIs) and other vaginal infections.
A certified nurse midwife (CNM), for example, can practice in hospitals, clinics, birth centers, or even in your home. If a midwife isn’t certified, their practice locations might be more limited. It’s always a good idea to ask about their credentials and check with your chosen hospital or birth center about their policies for midwife care.
Understanding Different Types of Midwives
There isn’t just one “type” of midwife. It can get a bit confusing, I know! Here’s a quick rundown:
- Certified Nurse Midwives (CNMs): These professionals have completed nursing school and then earned a graduate degree in midwifery. They can provide a broad range of care, including pregnancy and delivery, general reproductive health, prescribing medication, ordering lab tests, and diagnosing conditions. CNMs are certified by the American Midwifery Certification Board and can practice in all 50 states and D.C. They’re often found in hospitals, homes, and birth centers.
- Certified Midwives (CMs): CMs also hold a master’s degree in midwifery, but their undergraduate degree was in a field other than nursing. They are also certified by the American Midwifery Certification Board and can prescribe medications. However, CMs are only licensed to practice in a handful of states.
- Certified Professional Midwives (CPMs): You’ll typically find CPMs working in birth centers or attending home births. They’ve completed specific coursework and are certified by the North American Registry of Midwives. CPMs are not licensed in all states and generally cannot prescribe medications.
- Unlicensed or Lay Midwives: These individuals don’t hold a formal certification or license. Their training might come from self-study or apprenticeships. They almost exclusively attend home births.
Midwife or Ob/Gyn: What’s the Difference for You?
The main differences between an Ob/Gyn and a midwife lie in their training and their overall approach to care.
Midwives are known for providing a very supportive, hands-on experience, viewing pregnancy and birth as natural life events rather than medical conditions that always need managing. They’re often more open to non-traditional approaches to labor and delivery. Many people choose a midwife because they desire a more relaxed, personalized birthing experience.
Ob/Gyns, on the other hand, are medical doctors who have completed medical school and specialized training in obstetrics and gynecology. They are equipped to handle high-risk pregnancies and any complications that might arise during delivery, using medical or surgical interventions that midwives typically can’t perform.
Now, this doesn’t mean an Ob/Gyn won’t provide supportive, personalized care, or be open to your wishes! Many absolutely do. If you’re unsure, I always suggest meeting with both types of providers. See who you connect with, whose philosophy aligns with your hopes for your pregnancy and birth. It’s your journey, after all.
Is one “better” than the other?
Honestly, it’s all about what’s right for you and your specific situation. A midwife is often a wonderful choice for low-risk pregnancies – and most pregnancies in the U.S. are indeed low-risk.
Some potential upsides people find with midwife care include:
- A lower chance of needing labor induction or an assisted delivery (like with forceps or vacuum).
- A reduced likelihood of a cesarean birth (C-section).
- Less frequent use of epidurals or other pain medications.
- A lower risk of severe perineal tears (tears near the vaginal opening during birth).
- More flexibility if you’re considering a home birth.
- A feeling of greater control over your care decisions.
Could a Midwife Be Right for Me?
If you’re experiencing a low-risk, straightforward pregnancy and you’re looking for a deeply personal relationship with your care provider, a midwife could be an excellent fit.
However, if you have certain health conditions that could make your pregnancy or delivery more complicated, it’s often best to have close collaboration between your midwife and an obstetrician. Some of these conditions might include:
- High blood pressure
- Diabetes
- A history of seizures
- Previous high-risk pregnancies
- If you’re expecting multiples (twins, triplets, etc.)
If you do decide to go with a midwife, I really encourage you to find one who is licensed and certified to practice in your state.
Are there risks?
Midwives are trained to recognize when things might be heading outside the range of normal. They consult with Ob/Gyns, maternal-fetal medicine specialists (doctors who specialize in high-risk pregnancies), and other healthcare providers to help manage any risks. If you’re concerned about potential complications during delivery, working with a midwife who attends births in a hospital can offer a good safety net.
A Quick Note: Midwife vs. Doula
Sometimes people get midwives and doulas confused. A doula (the word means “female helper” in Greek) is a trained professional who provides emotional, physical, and informational support during labor and birth. They can help you manage contractions, suggest comfort measures, and be your cheerleader. Super valuable! But they don’t have medical training and don’t provide medical care.
A Few More Common Questions
I often get asked a couple more things:
- Do midwives do C-sections? No, midwives can’t perform C-sections themselves, but they can certainly assist in the operating room. If a C-section becomes necessary, a collaborating physician will take over the surgical part of your care.
- Do midwives give epidurals? Some midwives can prescribe epidurals, but they don’t administer them. That’s the job of an anesthesiologist or a certified registered nurse anesthetist (CRNA). These specialists are usually only available in hospital settings.
Before you choose a midwife, it’s a great idea to chat with a few. See who you click with. Here are some questions you might want to ask:
- Where will I deliver my baby (hospital, birth center, home)?
- What kind of training and certification do you have?
- How long have you been a midwife?
- Roughly how many births have you attended?
- What are your philosophies or values when it comes to childbirth?
- What kinds of tests or screenings do you typically perform during pregnancy?
- Does my insurance cover any of your services?
- Do you have established relationships with local Ob/Gyns if a consultation or transfer of care is needed?
Take-Home Message: Choosing Your Midwife
Deciding on your birth support is a big step. Here’s what to keep in mind about working with a midwife:
- A midwife offers specialized care for pregnancy, birth, and postpartum, often with a holistic, natural approach.
- They are a great option for low-risk pregnancies.
- Different types of midwives (CNM, CM, CPM) have different qualifications and scopes of practice.
- Midwives often work alongside Ob/Gyns, especially in hospital settings.
- Choosing between a midwife and an Ob/Gyn is a personal decision based on your health, preferences, and desired birth experience.
- Always ask questions and ensure your chosen midwife is properly credentialed.
This is such an exciting time, and finding the right support is key. You’re exploring your options, and that’s a wonderful first step. You’re not alone in this.