Doctor Or Midwife: Which Is Right For You?

As soon as you and your partner decide that it is baby-making time, you’ll want to start looking for medical practitioner to care for yourself and the eventual birth of your baby. Whether you choose an obstetrician-gynecologist (OB/GYN), a family physician, a certified nurse-midwife (CNM), or a direct-entry midwife will depend on a number factors. Where do you plan to give birth? What kind of experience do you want? What will your insurance pay for? And several others.

There has been a slow rise of home births - according to Choices in Childbirth as of January 2015, there has been a 71% increase - but home births are still viewed as unsafe even though recent studies show that planned home birth with a midwife is safe, cost effective and have health benefits beyond one pregnancy. So why aren’t more women choosing the midwife option?

Simply, the public is confused and not fully aware of other options. Robin Elise Weiss @RobinPregnancy, President of Lamaze International @LamazeOnline, states that the, “truth is that most women don't have accurate information about the types of providers available for the care of pregnancy. It is often assumed that an obstetrician is the only option. The truth is there are many options from a family practice doctor to a maternal fetal medicine specialist, to certified nurse midwives and certified professional midwives.” Adding to this sentiment is Birgitta Lauren @HealthyBabies, Prenatal Fitness/Nutrition Expert and President of Expecting Fitness, as she explains that “most women chose doctors and hospital births because of a century or more of indoctrination and propaganda by the medical industry, as they just can’t make any money off home births.”  

What is a midwife?

The term midwife means ‘with woman’ and choosing a midwife means that you’ll receive health care services that fit with your individual desires and needs as much as possible. Midwives view pregnancy as a natural state of being, and not a medicalized disease. Many people forget that OB/GYN’s are highly specialized surgeons. The average, healthy young woman doesn’t need a specialized surgeon to provide prenatal care. CNMs educate, empower and support their patients while providing comprehensive health care. As nurses, CNMs have the background to identify problems beyond their scope of practice and refer as needed.

Are there different types of midwives?

Yes in fact there three classifications: Certified Nurse Midwives (CNM), certified professional midwives, and direct-entry midwives. A CNM is a master’s prepared nurse with a specialty in midwifery and women’s health. CNM's have similar educational standards and training as Nurse Practitioners but specialize in midwifery and OB/GYN. CNM’s deliver in a variety of settings- home birth, birth clinics, and hospitals. The other types of midwives have some form of training and credentialing but are not nurses.

How can one decide what kind of practitioner to see for prenatal care and childbirth?

First, you need to be educated about options. “A lot depends on the health care available in your area and state laws. In West Los Angeles, if you want a Certified Nurse Midwife (CNM), you have to choose between a home birth, a birth clinic, or the midwifery services offered at UCLA” says Eyelle Sacher, a Certified Nurse Midwife and proprietor of Midwife of Santa Monica. “I’m applying for privileges at a private hospital, and if that goes through, I’ll be the only midwife on the west side to do a hospital delivery in a private practice setting. Debbie Frank, CNM used to deliver at St. John’s but she recently retired. The other midwives (most of them are not nurse midwives) do home births.”

What is your philosophy towards childbirth?

Is your philosophy towards childbirth a medical problem, where you want every test and piece of equipment possible, or a natural progression of a healthy woman? “Choosing which practitioner to use is obviously extremely personal, and starts with what kind of birth experience a mom/partner is looking to have. A holistic birth experience or a routine approach. If she were interested in more of a holistic approach, her choice would be a home birth or a birthing center. If she still wants no medication, but feels safer in a medical environment; or does want pain medication, a hospital is the way to go,” says Patty Moreno-Fletcher Labor & Post Partum Doula at Butterfly Babies NYC.

Furthermore, Laurie MacLeod, a certified nurse midwife at The Ohio State University Wexner Medical Center @OSUWexMed, says that, “for women who are considering natural childbirth or desire low intervention birth, a midwife can provide one on one support and research has demonstrated improved outcomes such as lower cesarean section rate, higher patient satisfaction and higher breastfeeding rates with midwifery care.”

Low risk vs. high risk pregnancy. Who is qualified to treat?

If your pregnancy is considered low risk, this  group of women will have the most options available to them. But if your pregnancy is considered high-risk, Dr. Sameer Kumar, a gynecologist at icliniq.com, states that, “in the case of complications during delivery like obstructed labor, delayed descent and others, the chances of maternal morbidity are fairly high which cannot be managed even by trained midwives and shall need a specialist's care and management.”

But Sacher explains that sometimes, “pregnancies start off as low risk, and women may develop complications that make them higher risk. These situations can often be co-managed by a nurse midwife in collaboration with a physician.”

So you want a natural home birth, does insurance cover it?

Robin Elise Weiss sees the rise in the rates of home birth skewing towards middle class Caucasian women. And even though other countries have home birth as a viable option and covered care, in the U.S. it is not covered by their insurance.

To even the playing field, women need to challenge the insurance companies to create an even playing field when choosing home versus hospital or midwife or doctor. When giving birth, the first thing on your mind shouldn’t be strictly cost saving.

Why did you choose a midwife?

SAG award-winning actress, Alysia Reiner @alysiareiner, who is best known for her role playing Natalie “FIG” Figueroa, the tough as nails assistant warden, in the hit Netflix series Orange Is The New Black, chose a midwife because she believes that, “women's bodies are magic and really believe in trying to minimize the medicalization of birth. I felt safer with a midwife, that it was more likely that I would have the kind of birth I wanted: more personal, more natural, and more ...miraculous.”