Should You Choose an OB-GYN or a Midwife?

While OB-GYNs deliver the majority of babies in the United States, the number of babies delivered by nurse midwives has steadily been on the rise. For instance, in 2018, 9.4% of births were attended by nurse midwives; by 2019, that number had risen to 9.9%; and by 2020, 10.3% of all births in the U.S. were attended by nurse midwives.

Choosing who will deliver your baby is a highly personal decision and may depend on factors such as your medical status and history, if there are any complications with your pregnancy, and your own personal preferences. If you're trying to choose between a midwife or an OB-GYN, here's a look at the differences and similarities between them, plus seven questions that will help you make the final call.

Midwife vs. OB-GYN: What's the Difference?

What's a midwife, and what does a midwife do? Certified Nurse Midwives (CNMs) are "the experts in normal pregnancies," says M. Christina Johnson, C.N.M., the current director of Midwifery at GW Hospital and former director of professional practice and health policy at ACNM in Silver Spring, Maryland. Johnson says her profession is often best known by this saying: low tech, high touch.

Nurse Midwives earn bachelor's degrees in nursing, then work as registered nurses to gain experience in labor and deliver before going back to school for a two- or three-year master's degree program in midwifery, according to the American College of Nurse-Midwives (ACNM). The professional designation is C.N.M. for certified nurse-midwife; in Rhode Island, New York and New Jersey, it's C.M. for certified midwife. C.N.M.s and C.M.s can prescribe drugs, including pain medication and epidurals. Midwives also use technology such as fetal monitors, but rely heavily on their clinical experience. They can't do C-sections (though some may assist in the operating room).

On the other hand, OB-GYNs have a different reputation and set of skills. "There's the perception that the physician is more likely to intervene in the birth," says OB-GYN Jennifer Niebyl, M.D., professor of obstetrics and gynecology at the University of Iowa in Iowa City. That's partly because they can. Unlike midwives, they are trained to manage high-risk pregnancies and can perform surgeries.

Research indeed shows that OB-GYNs are more likely to use interventions (e.g., epidural anesthesia, episiotomies, and instrument deliveries). However, research also indicates that fetal and maternal outcomes are equally good when comparing OB-GYN and midwife births in low-risk pregnancies.

Another important topic: payment for service. Both OB-GYNs and midwives are licensed and highly regulated health care providers in all 50 states—and your health insurance covers their care if you're delivering in a hospital. Most will also cover some share of a birthing center delivery, but home births are generally not covered.

Choosing Your Caregiver: OB-GYN or Midwife?

Niebyl and Johnson say that who you have deliver your baby boils down to what you need, along with what your personal preferences may be. Sometimes, there may be no choice, such as if you need a C-section to deliver, but if you're grappling with the decision between an OB-GYN and a midwife, the best thing to do is to start by answering these seven questions.

1. Is a vaginal birth your priority?

Both midwives and physicians are supporters of vaginal birth in people that want to give birth vaginally (assuming, of course, it's safe to do so). However, it's always a good idea to talk to your potential birthing expert about what their policies are about birth. "You should ask about the doctor's C-section rate and philosophy," recommends Niebyl. If it's important to you, make sure your care provider supports vaginal birth.

2. Do you want your caregiver with you during labor?

While every provider may be different, in general, nurse midwives may be able to provide a lot more one-on-one support because they deal primarily with low-risk pregnancies and birth and have a more hands-on approach with a nursing background than doctors do. "Nurse-midwives offer a lot of labor support. They spend more time with patients than a physician can because we get pulled in so many different directions," says Niebyl. If you have a doula (someone trained to support and help advocate for you through labor and delivery) or other support system, though, this may not be a deal breaker for you.

3. What are your plans for pain management?

You can choose an epidural with either a CNM or physician, so this is not a deal-breaker. "In a hospital setting, lots of midwives' patients ask for and get epidurals," says Niebyl. However, midwives may work more closely with you on medication-free methods to manage pain first. "We usually look for pain management techniques that support the natural process," says Judy Berk, C.N.M., a certified nurse-midwife at Brigham and Women's Hospital in Boston. "That might mean showers, massage, acupressure techniques, homeopathy, switching positions, or trying a birthing ball."

4. What will happen at the hospital?

Depending on the situation and your baby's status, some doctors may prefer that their patients stay more in bed with an IV, hooked up to a continuous fetal monitor. Midwives may encourage patients to move around and may be more likely to use intermittent rather than continuous monitoring, according to Johnson. However, this really does depend on many different factors, such as if you get an epidural, how your baby is handling labor, and if there are any other complications. It may be best to speak to your potential birthing team well before your delivery date to find out about their policies for childbirth in the hospital—and make sure they mesh with your expectations.

5. Do you want (or need) more support and advice for your transition to parenthood?

Midwives may be able to provide a bit more holistic care when it comes to guiding you through the transition into parenthood, especially in the postpartum phase. "Midwives do a lot of counseling for nutrition and exercise and also on the emotional changes that happen when it comes to becoming a parent for the first time or adding another child to the family," says Berk.

6. Are you considered high-risk?

"If you have a condition that would make your pregnancy high-risk, such as diabetes, or you're delivering twins, you should see an OB-GYN and deliver in a hospital," says Michele Hakakha, M.D., an OB-GYN in Beverly Hills and coauthor of Expecting 411: Clear Answers & Smart Advice for Your Pregnancy. Some midwives, though, co-manage higher-risk patients alongside OB-GYN colleagues; that means you may see both a midwife and an OB-GYN during your pregnancy. Who ultimately delivers your baby will likely depend on your medical circumstances.

If you had a Cesarean section with your first child, a midwife may still be an option for your second baby—even if a C-section has been recommended. Midwives don't perform surgery, but you can certainly discuss with your OB-GYN or midwife the possibility of a vaginal birth after C-section (VBAC). Right now, whether a midwife or an OB-GYN can offer VBACs is often dictated by a hospital's policy

7. Do you feel comfortable?

Justine Arian, a doula and birth coach in Huntington Beach, California, urges pregnant people to trust their instincts about whom they choose to deliver their babies and even where. "Meet different doctors and midwives and visit hospitals or birthing centers. Ask yourself, 'Is this where I see myself giving birth?'" says Arian. You can be sure you're not making decisions based on unfounded fears by taking the time to educate yourself about your options. "[People] have to give birth where they feel safest and most supported," she says.