When you find out you’re pregnant, one of the first decisions to make is who will be your pregnancy care provider. While you’re probably anxious and excited to make sure that everything is going well with your little one, you shouldn’t rush into choosing a provider. You want someone who has an attitude about pregnancy and birth that aligns with your own. How can you narrow down your options when it sometimes seems like you’re just picking someone from a hat?
The vast majority of women are attended to by obstetricians (OB-GYNs), but the number of midwife-attended births has steadily risen since data was first made available in 1989. While obstetricians are the most popular option, more and more women are attracted to the natural, holistic, personalized approach offered by midwifery care. So which pregnancy care provider is right for you? And what’s the difference, anyway?
Education and Training
OB-GYNs complete four years of medical school and a four-year residency program. Some also complete a three-year fellowship specializing in a particular area, such as infertility. There are several types of midwives, and each has a different level of training. In 2014, over 91% of midwife-attended births were attended by CNMs or CMs, but you may encounter a provider who is a Certified Professional Midwife or Direct-Entry Midwife. Here’s a quick look at the four most common certifications and qualifications.
- Certified Nurse-Midwife. A Certified Nurse-Midwife, or CNM, has completed a bachelor’s degree in nursing and also holds a graduate-level degree from a nurse-midwife program. CNMs are required to pass an exam before receiving certification from the American Midwifery Certification Board.
- Certified Midwife. A Certified Midwife may not hold a nursing degree, but he or she must have completed a graduate-level midwife program and passed the certification exam administered by the Certification Board. The Certification Board allows CNMs and CMs to provide the same care, but the title given to the provider varies by state.
- Certified Professional Midwife. A Certified Professional Midwife (CPM) has been certified by the North American Registry of Midwives (NARM) after graduating from a midwifery program or completing an apprenticeship with a Certified Midwife. CPMs must also pass an exam issued by NARM.
- Direct-Entry Midwife. There is currently no certification or licensing body for this type of midwife, and the legal requirements on training and education vary from state to state. These midwives often offer services for home births.
Models of Care
OB-GYNs are trained to care for patients with high-risk pregnancies, where medical intervention is necessary for either the mother or her baby. Unlike OB-GYNs, midwives do not perform C-sections or use vacuums or forceps during delivery. This is understandable when you look at how each type of provider views childbirth. OB-GYNs follow a medical model of care in which birth is viewed as a process with potential complications. Midwives look at pregnancy as a natural part of life rather than a medical condition, and seek to establish a more personal relationship with the mother-to-be. Her individual desires and emotions should be addressed during discussions about her child’s birth so that she – and her body – remain in control of her birth experience. Midwifery adheres to a philosophy of care that emphasizes the belief that pregnancy and birth are normal events and intervention should therefore be avoided unless it becomes absolutely necessary.
In alignment with their view of birth as a medical procedure, OB-GYNs may be more likely to prescribe or suggest medications to manage the pain of labor and delivery. Midwives, on the other hand, might promote the use of techniques like massage, positional changes, water immersion, and patterned breathing.
At Baby+Company, we have several options for pain management, including nitrous oxide and TENS units. Like other birth centers, we do not offer epidurals. If you are confident that you’re going to want an epidural for your labor and delivery, a birth center is probably not the best choice for you. If you would like to deliver naturally, a midwife will have several suggestions and recommendations for non-invasive pain management techniques.
The Birth Experience
What type of birth experience do you want? In the hospital, you are unlikely to have the freedom to move around during labor or to try different positions. You may receive an IV or continuous fetal monitoring under the care of an OB-GYN. On the other hand, research has shown that women under the care of a midwife are less likely to receive an episiotomy or epidural, more likely to achieve a spontaneous vaginal birth, and are more likely to report that they were satisfied with their birth experience.
Before you make a decision on your care provider, ask lots of questions. Talk about your wishes with potential providers, and understand what you will and will not be able to do in each scenario. Other moms are great resources for finding out the best (and the worst!) providers in your area. Figure out what’s most important to you, and find a pregnancy care provider whose vision for your birth aligns with your own.