Making The Decision: Midwives, OBGYNs, & Other Birth Professionals
Finding The Perfect Match For Your Birth
Introduction
Congratulations! If you are taking the time to read this blog post, it is likely that you are expecting a child in the coming months. Parenthood comes with many decisions—the type of prenatal supplements you will take, where you will birth, who will be on your care team, and where your baby will sleep—just to name a few. Taking the step to educate yourself on health care providers is a great first step. This individual, or team of people, will provide prenatal care, assist in delivering your flesh and blood, and majorly impact your birthing experience. It is not a small role that a provider plays; therefore, it is not a small decision to make. The intent of this blog post is to give you a comprehensive view of your main options for birthing providers, including their educational backgrounds, training, skill sets, and philosophies surrounding childbirth.
The main players in the birthing world are obstetrician-gynecologists (OBGYNs), certified nurse midwives (CNMs), direct-entry midwives, lay midwives, and doulas. Each of these roles are well qualified to support you through labor and delivery. It’s up to you to find the provider that fits your individual needs and desires for the birth process.
As you read the post, you will notice that there are many factors that will weigh into your decision: financial costs, likelihood and accessibility to interventions, pain management preferences, and general comfort or ease with the provider. With many options available, there is every reason that you will be able to find a provider that aligns with your birth plan. Here we go!
OBGYNs
OBGYNs are the birthing providers that you see on television and at the theatre. Although they have not been around the longest, OBGYNs are well known as they are backed by the medical field and hospitals. OBGYNs (obstetrician-gynecologists) are highly educated medical doctors who specialize in pregnancy, childbirth, women's reproductive health, and are trained surgeons.
Education: 4 years of medical school + 4 years of residency training in obstetrics & gynecology.
Care:
Prenatal care: monitor fetal development, preform tests & exams, provide nutrition and lifestyle guidelines, and identify potential complications. This includes routine checkups, ultrasounds, and genetic testing if desired.
Labor & delivery: may perform interventions if necessary, such as administering epidurals for pain management, vacuum/forceps assisted births, episiotomies, and cesarean sections. OBGYN’s will often push for an induction of labor, which may lead to many interventions unfolding from there.
Postpartum: will see you at six weeks postpartum to check on healing, talk about birth control, and monitor your mental health.
Specializations:
High-risk pregnancies
Maternal-fetal medicine
Infertility
Pelvic floor
Cesarean sections
Hospital births
You may prefer an OBGYN if:
You would like access to an epidural and other interventions during labor.
You would like a medical team on stand-by.
You are concerned about preexisting conditions.
You have already established a solid relationship with your OBGYN pre-pregnancy.
Potential down-sides: OBGYNS tend to emphasize symptom control instead of wellness. Appointments are typically around 10 minutes, with wait times close to 45 minutes. For many OBGYNs, factors within the medical model ingrains in them an assumption that labor and delivery will be problematic unless proven otherwise. Higher likelihood of induction.
Certified Nurse Midwives
Photo by A Doula On The Go
Certified nurse midwives (CNMs) are registered nurses who have completed specialized training in midwifery. They are educated in both nursing and midwifery, allowing them to provide a unique blend of medical care and emotional support during pregnancy, labor, and birth. CNMs can prescribe medications as well as deliver babies in hospitals, birth centers, and homes.
Education: Nursing graduate degrees—master’s or doctorate. Passed a national certification exam administered by the American Midwifery Certification Board. Licensed in all 50 states.
Care:
Prenatal care: monitor fetal development, preform tests & exams, provide emotional support and patient education on nutrition, exercise, breastfeeding, and newborn care without a time crunch. They can also identify potential complications. CNM’s often are known to create relaxing environments for mothers and their children, and allow for older siblings to be involved in the excitement of preparing for a new sibling.
Labor & delivery: CNM’s will help you labor and deliver your baby in a way that feels natural to you. Want to birth standing up? Go for it. Do you want to labor in a tub during active labor? They will fill it for you. Do you want to nourish yourself with food and water throughout labor? It is encouraged! CNM’s may handle some complications, offer guidance on pain management without medication, and use interventions only when medically necessary.
Postpartum: with a great emphasis on relationship building throughout pregnancy and labor, postpartum care becomes a natural progression of their scope of care. CNM’s will see you at six weeks postpartum (if not before) to check on healing, talk about birth control, monitor your mental health, and support with breastfeeding or infant care questions.
Specializations:
Low-risk pregnancies
Hospital, birth center, or home births
You may prefer a CNM if:
You view birth as a natural process.
You desire personalized care and significant time with your provider.
You desire an intervention-free birth.
Potential down-sides: In the event your pregnancy becomes a high-risk pregnancy, you may have to switch providers or birthing locations.
Local DFW CNMs:
Certified Professional Midwives
Certified professional midwives focus their education and training specifically on midwifery, without first becoming nurses. They typically complete a midwifery education program and pass a national certification exam to obtain their credentials.
Education: Midwifery program accredited by the Midwifery Education Accreditation Council. This is a three-to-four-year program that consists of classroom learning and clinical training. Education focuses entirely on pregnancy, birth, women’s health, and newborn care. CPM’s need to pass a national certification exam administered by the North American Registry of Midwives. They are licensed and regulated in about half of U.S. states currently. Scope of practice varies by state.
Care:
Pregnancy: Standard care similar to CNMs. With a CPM, you may receive pregnancy and childbirth education, assessment of baby’s health and positioning, and referrals as needed to other providers,
Labor & Delivery: CPM’s facilitate birth at home or at a birth center. Like any midwife, they will monitor baby’s heart rate, keep an eye on mama’s vital signs, and preform cervical checks only when given permission.
Postpartum: In the DFW area, many CPM’s will visit you 3+ times in the weeks following birth. Postpartum visits will include an assessment of mama’s well being as well as her baby. Physical exams will be performed, baby’s weight gain will be documented, on-going screenings will take place for postpartum depression, as well as education and support for breastfeeding.
Specializations:
Low-risk pregnancies
Birth center or home birth settings
You may prefer a CPM if:
You desire a minimally invasive approach.
You view pregnancy and birth holistically.
You desire personalized care and significant time with your provider.
You desire an intervention-free birth.
Potential down-sides: In the event your pregnancy becomes a high-risk pregnancy, you may have to switch providers or birthing locations.
Local DFW CPMs:
Gentle Beginnings - Cheryl Gaspard & Donna Miller
Sunshine Birth Company & Kueo Birth Center - Jasmin Kanevski
Lay Midwives
Lay Midwives are not licensed or certified by any accredited body. Many of these women have been practicing for decades and provide an alternative for those seeking a natural home birth with minimal medical intervention.
Education: Experience-based knowledge of childbirth from apprenticeships or self-study. No formal education.
Care: Prenatal, birthing, and postpartum care depends entirely on the lay midwife and their scope of practice.
Specializations:
Low-risk pregnancies
Home birth settings
You may prefer a Lay Midwife if:
You desire a home birth with minimal, if any, medical interventions.
You view pregnancy and birth holistically.
You are a low-income family.
Potential down-sides:
Lay midwifery is illegal in some states.
Since they are not regulated, quality can very greatly. You will need to gather references and do your due diligence.
In the event your pregnancy becomes a high-risk pregnancy, you may have to switch providers or birthing locations.
Doulas
Photo by A Doula On The Go
Doula work is our bread and butter here at Babymoon Concierge. The primary role of our birth doulas is to help women achieve the birth experience they desire through intentional support. Doulas provide physical support such as activating pressure points, guiding you through birthing positions, and holding you steady through contractions. On top of that, doulas provide emotional support that carry new parents through pregnancy, childbirth, and postpartum. Unlike the other providers mentioned above, birth doulas do not provide medical care. We are trained professionals and are very good at our craft, but we do not offer medical care of make medical decisions for you.
Whether you are a first-time mama desiring a natural birth, a mama who is pregnant after a season of infertility, a mama of multiples, a mama going for her VBAC, a mama with a planned Cesarean birth, or a surrogate mama, our services were built with you in mind. Our birth Doulas work closely with the partner and birth team to give the mama the best support possible.
Research shows that doula attended births lead to:
Shorter time in labor
Reduced need for pain-relief medication during labor
Fewer cesarean sections
Fewer need for medical interventions
Fewer negative childbirth experiences
Better communication between pregnant people and their health care providers
A few ways that our birth doulas shine:
Doulas can be there from the moment you call while in active labor until the baby is in your arms. They are excellent in guiding women through breathing techniques, providing massage, encouraging labor to progress with intentional positioning, and offering other comfort measures.
We can help relay your birth preferences to your birth team and providers. When you are in the zone, it is so helpful to know that another person knows what you want and can support your choices.
Does birth make you a little anxious? We’ve been there and we understand. Doulas provide emotional encouragement and reassurance before, during, and after birth. You’ll get through it, promise!
Birth doulas are pros at providing pain relief and comfort strategies that don’t involve medical intervention. Think hydrotherapy, birthing balls, breathing patterns, etc.
Most doulas are also qualified to give you great postpartum care! The early days of breastfeeding can be tricky with all the new transitions and lack of sleep. A doula can help ease this season of change with their expertise of newborn care, breastfeeding, and postpartum support for the mother.
Questions to Ask When Hiring a Provider
This is the time where you have to speak up! Now that you have learned many of the options that are in front of you as an expectant parent, it is time that you begin to communicate your preferences. Until you start conversations with your potential providers, it is impossible to know what the “right fit” will be for your family. Here are a couple questions we encourage you to research or interview your potential provider about. This list is not exhaustive, but it is helpful!
Licensing and Credentials:
Are you licensed in this state? Ask to see proof of their license. *see the qualifications for an OBGYN or midwife to know what to look for
What credentials and certifications do you have?
Are you affiliated with any hospitals or birth centers? If so, which ones? *Birthing location is so important! Know what feels right to you.
Experience:
How long have you been practicing? *Look for several years of experience.
How many births have you attended? *Although higher numbers indicate more experience, there is also something to be said about coming fresh off training. Don’t be afraid to hire a newbie if they feel like the perfect fit!
Have you worked with someone like me before? *First-time mom, VBAC mom, etc.
Fees:
What is your fee for prenatal care and delivery? *Get quotes from multiple providers to see the average cost.
What expenses does that include vs. what are add-ons? *Many places offer package deals where you can pick and choose what you want. Make sure you know the bottom-line cost, and what may be thrown in.
Do you accept my insurance? *Confirm they are in-network and the fees work with your coverage.
Is there a payment plan? *Ask about paying in installments if needed. Babymoon Concierge offers payment plans.
Insurance Coverage
Do we wish that every birth experience was covered by insurance? Yes. Is that a reality? Sadly, no. When hiring a birth provider, one of the most important considerations is what your insurance will cover. Confirming insurance coverage ahead of time will help avoid large out-of-pocket expenses for your birth. And it saves you from cultivating false expectations. Here's what we know about insurance coverage for different birth providers:
Which birth providers does your insurance cover?
OBGYNs almost always accept insurance and will be covered under your plan.
Most insurance plans cover Certified Nurse Midwives (CNMs) but check with your specific plan to confirm coverage.
Lay midwives have no formal training and do not have a license. They are not covered by insurance.
Most insurance does not cover doulas. You'll pay out-of-pocket for a doula. Companies like Carrot DO offer postpartum doula care, so be sure to check.
Conclusion - Making the Decision
As you know after reading this post, there are many factors that go into making this decision. Determine where you stand on the following principles, and trust your gut as you take steps forward.
Philosophy of care – How do you view pregnancy and birth? OBGYNs tend to view pregnancy and birth through a medical lens, while midwives focus on the natural process.
Hospital vs out-of-hospital birth – Where do you envision yourself giving birth? OBGYNs deliver in hospitals, while midwives offer home or birth center options.
Interventions – What interventions do you want access to? What do you want to steer clear of? OBGYNs are more likely to use interventions like induction, epidurals, episiotomies, forceps, vacuum delivery, and C-sections. Midwives favor fewer interventions. Doulas can help advocate for your wishes.
Continuity of care – How much access will I have to my birth team? Midwives often provide care throughout pregnancy and attend the birth. OBGYNs may not be on call when you deliver. Doulas provide continuous support in labor.
Comfort level – How do you feel in the provider’s presence? Consider how comfortable you feel with each type of provider's approach, bedside manner, and communication style.
Insurance coverage - Confirm whether each provider accepts your insurance. Out-of-hospital births may not be covered.
Hospital privileges - Some midwives don't have hospital privileges, which impacts options if a hospital transfer is needed.
Licensing and credentials - Ensure any midwife is properly licensed and certified. Doulas aren't licensed but may be certified.
The fact that you made it through all your options shows how ready you are to find your birth provider. It may seem daunting now, but it will be so worth it as you take steps to welcome your child into the world. We spend months planning weddings and graduation parties and weeks determining the perfect nursery set up. Your birth experience deserves some intention and thought, too. When you find a provider that makes you feel safe and is aligned with your birth vision, you will breathe a sigh of relief. It’s worth it. Good luck!
Annie Webb
Birth + postpartum doula
Admin Assistant