Midwife vs. OB-GYN: Which Is Right for You?

OB-GYN is short for obstetrician-gynecologist — a highly educated type of doctor who works in pregnancy, childbirth, and reproductive healthcare. Some specialize further in areas such as high-risk pregnancies and maternal-fetal medicine, infertility, cancer, and the pelvic floor. Their education is rigorous, including medical school, four or more years of residency, specialty exams, board certification, and annual licensing tests.

There are four types of midwives: certified nurse midwives, certified midwives, certified professional midwives, and traditional or unlicensed midwives. Certified nurse midwives are the most common type. They’ve attended nursing school, have a graduate degree in midwifery, and can work at home, a hospital, or a birth center. They can also write prescriptions nationwide and provide additional reproductive healthcare.

Training differs among the other midwives, as do their scope of care and which states they can practice in. Those known as traditional midwives don’t rely on a license and follow more historical midwifery practices. They help families deliver at home and often work with specific groups, such as Indigenous communities and religious communities.

Midwives tend to provide care for low-risk pregnancies. They don’t give epidurals and will provide referrals if a pregnancy exceeds their scope of care. OB-GYNs, on the other hand, can handle high-risk cases, perform cesarean sections, and offer more pain-management resources. To promote healthier birth rates, the U.S. needs both OB-GYNs and midwives: OB-GYNs to focus on high-risk care and midwives to help fill care gaps in low-risk pregnancies.

In the U.S., there are only 4 midwives employed per 1,000 live births. That rate is lower than in many other countries, such as Germany, France, Switzerland, the U.K., Sweden, and Australia. America’s maternal death rate was the only one among developed nations that increased between 2000 and 2015, despite the high cost of healthcare in the U.S. compared with other countries. Half of the deaths are caused by preventable conditions, such as embolisms, while reasons for the other half include inadequate healthcare access and rising obesity rates, among other factors.

To reduce the maternal mortality rate, experts agree that more midwives are needed. A major study found that U.S. states that do integrate midwives — Washington, New Mexico, and Oregon — have the best outcomes, while those that don’t — Alabama, Ohio, and Mississippi — have some of the worst. Studies link midwifery with reduced unnecessary intervention rates, improved maternal outcomes, improved newborn outcomes, and more cost savings, among other benefits.

The reason why there aren’t more midwives is complicated, but finances play a role. Medicaid funds midwifery, but private insurers aren’t required to do so. Many insurers either refuse to cover it or don’t have enough in-network midwives. It sets up a cost paradox in which people can’t afford to use their own money for a home birth, so they go to the hospital, where insurers wind up spending more money. On average, hospitals charge $13,000, while midwives charge between $3,000 and $9,000 for prenatal care, delivery, and postnatal care.

Technological innovation and stigma also factor in. Americans became wary of midwifery in the late 1800s because of germ theory and anesthesia. Technology made doctors maternity care experts and pushed midwives away. By the 1960s, midwives were largely out of a job. Now, if home births make the news, it’s often for negative reasons, such as a complicated delivery or bad outcome. That can make people think home births are irresponsible and unsafe, shaming them off the grid.

Not everybody carries a baby the same way or has the same preexisting health issues, so picking a care provider for your needs is important. In general, the healthier you are, the better chance you have of being able to use a midwife. Some reasons you might not be able to use a midwife include distance from a hospital facility, chronic health issues (such as diabetes or asthma), your age, and prenatal complications.

Asking yourself a few questions can help you determine whether to use a midwife or OB-GYN. For example, what kind of pregnancy, delivery, and postpartum care do you want? Where do you imagine giving birth? Do your area hospitals have specific rules around how you give birth? Do you want to give birth vaginally? Have you thought about what kind of pain medication you might want? What kind of support do you envision having during labor?

OB-GYNs give you the option to receive epidurals and other pain medication, a medical team standing by, and someone experienced in handling a medical crisis. Meanwhile, midwives offer you the birth location of your choice; family-friendly, holistic care; and more personalized care.

Having a baby is life-changing. There are many issues that expecting mothers should consider, including whether to use an OB-GYN or a midwife for prenatal care, delivery, and postnatal care. Each professional provides essential but different healthcare services, so making an informed choice is important.