Midwife vs Doctor: Pros and Cons

Exploring the differences between care providers is one of the best gifts you can give yourself in pregnancy. Your chosen care team and birth space can significantly influence the experience of birth, and they have the potential to promote or hinder the physiological labor unfoldment process. Making informed choices founded in evidence based education and rooted in love is vital to supporting the pregnancy experience.

Midwife vs Doctor: Pros and Cons 

If you live in an area where both doctors and midwives are available, I invite you to truly investigate each option to determine what best aligns with your heart's desires for your care experience. When we harness the information available to us, such as safety perimeters and provider outcomes, we are better able to make informed choices that truly align with our family’s values. 

As each individual is so unique in circumstance, location, finances and state of wellbeing, there is just no one right option for everyone. Somehow we’ve created a society where certain people find satisfaction in voicing their opinions to pregnant women and others. Though outsiders may tell you what they feel is best, no one knows your body or your baby better than you do. You have complete authority over your pregnancy experience. You have the right to choose the path that helps you to feel the most supported. 

What is a Midwife? 

Midwifery is an ancient practice in which the midwife cared for birthing families through pregnancy. In old English, the term ‘midwife’ translates to “with-woman.” The history of midwifery is rich with various techniques, practices and supportive tools that vary culture to culture throughout the world. Midwives traditionally work as care providers throughout pregnancy, birth and postpartum, providing a unique form of holistic care that touches the emotional, physical and spiritual aspects of a human being.

For thousands of years, midwives have supported women and their families in all facets of the journey in bringing life into the world. They serve as advocates, guides, medical providers and friends devoted to the wellbeing of the most important people in a community; women and children. While most care providers solely focus on the medical aspect, midwives typically cleaned, cooked, nurtured, emotionally supported, celebrated and cared for the birthing person in a holistic, compassionate and loving way. 

As obstetrics grew in popularity in the early 1900s, midwifery was brutalized and delegitimized by profiting hospital establishments. Medical advancements have become incredibly effective in responding to maternal pathology. The downside to the birth of obstetrics was the rise of corporate medicine that came along with it, aiming to wipe midwives from existence.

While rich women were able to birth in hospitals, poor women could only afford midwife care, creating a narrative that encouraged women to birth in hospitals to avoid being seen as poor. Feminist women believed that avoiding the pain of childbirth with up and coming drugs was an integrated part of their path to societal liberation. Religious groups took part in demonizing and slandering midwives, calling them witches. 

Hospital birth bursted in popularity in 1978 when the American College of Obstetricians and Gynecologists released an article titled, Health Department Data shows Danger of Home Births. The report was very clearly biased and created to oppose home birth and draw more women to the hospital. The data collected included all out-of-hospital births; including women who gave birth en route to the hospital, women who were preterm and didn’t know they were pregnant, miscarriages, and more. In this way, statistics were fabricated to demonstrate the risks of home birth and increase hospital birth rates.

Today, midwifery has completely transformed into a regulated practice, varying state to state. The range of what state regulators consider to be low risk varies, with some states still outlawing any form of midwifery. The intention behind regulations and state guidelines is to ensure proper training and provide the best care possible to all families. It is important to note that every state has different guidelines in which midwives are legally allowed to practice under. Twins, VBAC (vaginal birth after cesarean) and providing care after 42 weeks gestation are the aspects of midwifery that are most greatly debated and vary state to state. I encourage you to share a conversation about transfers and regulations with any midwives you interview.

What is the difference in midwife licensure? 

Certified Nurse Midwives (CNMs)

CNMs collectively carry a more strict reputation. Some may find this to be off putting, while others find the advanced medical knowledge helps them feel safer in the birth space. 

• Most commonly serve families in birthing centers or hospitals, though some support home birth.
• Considered to be advanced practice registered nurses backed by the American College of Nurse-Midwives.
• Follow state regulations for midwifery.
• Often have a larger scope of practice compared to CPMs.

Certified Professional Midwives (CPMs)

CPMs have a reputation of carrying a naturally minded birth philosophy. A modern CPM often carries certain traditions and practices of ancient midwifery in an evidence based way. Many balance their knowledge of herbal remedies with their ability to utilize the tools of western medicine accessible to them.

• Accredited through North American Registry of Midwives (NARM).
• Often provide care in homes or private birthing centers.
• Follow state regulations for midwifery.

Read more about the varying types of midwife certifications here:

https://www.midwifeschooling.com/midwifery-roles-and-credentials/ 

What is an Authentic Midwife? 

Authentic midwives, no matter their regulation or training, are care providers who view birth as a natural process, strive to develop relationships with their clients, and genuinely care for the safety of parents and newborns. They hold the highest sense of reverence and respect for the autonomy of their clients, and support them in actualizing sovereignty throughout the journey of bringing life into the world. 

The questions listed at the end of this article are important tools to utilize when interviewing midwives. As midwives greatly vary in philosophy and licensure, the interview process can help you identify if the midwife of your choosing is one of authenticity, in resonance with your birth preference. 

What is an Obstetrician? 

Obstetrician/Gynecologists (OBGYNs) are care providers who support gestating people prenatally, through labor and in immediate postpartum. These doctors are excellent sources of support for those who experience genuine maternal pathology and for those in emergency situations. OBGYNs undergo significant training, allowing them to have the ability to support a vast array of medical concerns a patient may present with. The ability in which they are able to support a laboring person varies from hospital to hospital, as strict, intervention-heavy hospital regulations and insurance limitations have woven themselves deep into maternal medicine. Though corporate medicine has complicated the obstetrical system, every doctor holds a unique birth philosophy that greatly influences one's experience with them. If you choose to have a hospital birth, I encourage you to tour the area and share interviews with the doctors available. 

 Midwife vs Doctor: Pros and Cons

As I illustrate the pros and cons of midwives and doctors, remember that every provider varies in experience, licensure and philosophy. Below I speak to the general reputation of each provider, as this information applies to many but not all. 

Midwife Pros & Doctor Cons

• Midwives are trained to support natural labor. Many of them carry ancient natural labor coping techniques from around the world, including chunging, rebozo methods, hypnobirthing and more. Obstetricians are trained to support patients in the presence of maternal pathology. They lack the knowledge many midwives carry to support a natural birth. 
• Midwives have higher rates of unmedicated births and breastfeeding, with lower rates of episiotomies and tearing, in comparison to obstetricians, nationwide. 
• A midwife’s goal is to support clients in actualizing a natural birth. Every obstetrician is different, though many have developed a reputation to manipulate a birthing person’s unfolding labor to increase speed due to hospital regulations or convenience. One downfall of corporate medicine is the hospital establishment and providers' ability to profit more from medicated births and cesarean births. 
• Midwives often offer more in-person support near the end of pregnancy and in early labor, including emotional surrender techniques and spinning babies positioning. 
• Midwife prenatal appointments are often longer than those of an obstetrician, allowing more time for a relationship to be built and questions to be answered. 
• Normally midwives work in small teams, allowing for clients to develop a relationship with the assistants. In a hospital with an OB, the labor care is provided by the nurse on shift. Doctors normally come in during the pushing stage, as well as some CNMs who work in hospitals. 

Doctor Pros & Midwife Cons

• Midwives have a much smaller scope of practice in comparison to a doctor, varying state to state. They’re able to provide services to low risk clients while obstetricians are able to provide services to those who do not fit in the low risk category. 
• Doctors are able to provide more advanced medical support throughout pregnancy, birth and postpartum. 
• Doctors are able to prescribe medications, as well as CNMs. CPMs are currently unable to prescribe medications. Clients who need medication management throughout pregnancy have to work with a primary care provider, as well as the midwife, for all their care to be covered. For this reason, many find doctors to be more convenient. 
• Often, doctors and the facility they work in are able to perform all forms of testing and ultrasound one may desire throughout pregnancy. Depending on the midwife’s license, many have to refer out for certain tests and ultrasounds. 
• Doctors are able to prescribe laboring clients with medications that many midwives are not able to provide, including epidurals, spinal blocks, pitocin and other labor augmenting medications, and more. Many CNMs in hospitals are able to support women under these medications. Home birth midwives are very limited in the scope of medication they can provide before, during and after labor. 

Now that we’ve illustrated pros and cons, how do you make the choice? 

The first step in choosing a provider is sitting with the sensations in your physical and emotional body after the appointment or interview is over. How did the visit make you feel? If you leave feeling discouraged, stressed or fearful, likely the same energy will manifest in your birth space. If you’re wanting to actualize a safe, joyful and autonomous birth, developing a relationship with a care provider that helps you feel heard, respected and supported is necessary. 

Questions to ask your doctor or midwife

1. What is your birth philosophy?
2. How long have you been supporting women and birthing people?
3. How many births do you attend per month?
4. OB: What is your cesarean rate? What are your intervention rates?
5. Midwife: What are your transfer rates?
6. Do you work with a team or alone?
7. Are your service reviews posted somewhere?
8. Who will attend my labor if you can’t be present?
9. What is your experience with herbs, homeopathy, and alternative medicine for pregnancy and labor support?
10. Do you provide nutritional support during pregnancy and labor?
11. What is the total cost of care?
12. Will you respect my right to refuse any forms of testing or interventions?
13. What does autonomy in the birth space mean to you?
14. Are you willing to give me as much privacy as I request? 
15. What are your thoughts on vaginal exams?
16. How many weeks gestation will you continue to support me?
17. At what point will you recommend labor inducing interventions? Will you respect my decision to decline? 
18. Will you support me if I choose to have a vaginal breech delivery?
19. Will you support me if I choose to have a vaginal twin delivery?
20. Do you support water birth? 
21. Will you honor my decisions for immediate postpartum, the birth of my placenta and the treatment of my newborn? 
22. Do you promote delayed cord clamping and skin to skin? 
23. What does your postpartum care look like?
24. What is your philosophy on newborn care?
25. Do you offer breast or infant feeding support?  

Photos by @whenabellyblooms