The Difference Between a Midwife and an OBGYN

When I found out I was pregnant with my son, one of the first things I did was research OBGYN's and make an appointment with one that I liked. I never even considered any other options. I honestly didn't even know I had any other options.

I had heard of a midwife before and knew what they were, or at least the basics, but I thought they were a thing of the past or only where people couldn't get to a doctor. I saw midwives as the last resort which couldn't be further from the truth.

A few years later I was a member of a summer mom's group. We met at the community pool in one of the local neighborhoods. As any mother knows, if you get a group of mom's together, especially those with young children, the subject of pregnancy and childbirth is bound to come up. In one of these many conversations we had that summer, one of the moms was telling us about her experience with her last baby and how it was so much better than with the others. I asked what made the difference and she said she used a midwife instead of an OBGYN and that she didn't give birth in a hospital but instead a birth center.

"Gasp!" Not giving birth in a hospital! She must be crazy! Immediately she had a million questions going at her. The more I listened, the more I realized that having a midwife and a non-hospital birth would have taken away all or at least most of all the things I hated about my first birth with my son. His birth story to come soon. I wasn't pregnant at the time and that was definitely far from my mind but when I learned I was pregnant with my daughter I went straight for the midwife and I am so glad I did. I have absolutely no regrets.

Midwives are Highly Qualified Medical Professionals
Becoming a midwife is no easy feat. Most midwives are also RN's which means a bachelor's degree along with clinical's and actually working in the field. Then they must go to school for midwifery which lasts 2-3 years. This is where they learn all about pregnancy and childbirth. After all of that, they are only a student midwife and then must complete clinical hours before becoming certified.

Although an OBGYN spends more time in school and training, a lot of this training has nothing to do with their specialty. Doctors must learn about and train in every specialty so a lot of that time is somewhat wasted. Midwives instead study pregnancy and childbirth alone after their initial degree which makes them more than qualified to handle difficult situations regarding pregnancy and childbirth.

You Can Have the Birth You Want
I remember when I was pregnant with my son I asked my doctor if he did, or would consider doing, delayed cord clamping. First, he looked at me like I was crazy, then he looked very annoyed by the question. He then proceeded to tell me that the benefits are minimal and that in order for the blood to go back into my son, he would have to hold my placenta up above his head for 1-5 minutes because only gravity would let the blood back into the baby. While pregnant with my daughter I realized this was a complete lie and that honestly he just didn't want to wait the 1-5 minutes for the blood, which goes in the baby on its own without the help of gravity, to go in the baby where it belongs.

Midwives are much more personal. They care about you and your baby and see you as more that a positive or negative statistic on their record. They are more open to what you want or need in labor and help you have the birth you want. I was able to move around as much as I wanted, they only checked the baby when necessary, which in a normal labor is not that often, I could eat and drink as I saw fit, and could push when I felt the urge.

In my personal experience with a midwife labor and delivery, I mostly stayed in one place and didn't eat through labor. However, I went into labor at around 11PM and when I arrived at the birth center, I was already 7cm dilated. I had her around 2AM so only 3 hours of labor total. An hour or so of this was at home making sure it was real labor since I had a horrible case of prodromal labor and then packing the car and driving the birth center. Half an hour, maybe a little longer, I was in transition and then about 5-7 min of pushing. So I was in active labor at the birth center for under an hour and a half. This didn't give me much time to sit around and snack. It was the last thing on my mind. Although I didn't deliver in the bathtub, I did labor there as soon as I arrived at the birth center until I needed to push, so I didn't move around much either. I was, however, glad that those options were available to me. It made me feel in control of my birth which any mother will tell you, can't be controlled by anyone. The sense of control though really helped me relax which was the complete opposite of my hospital birth.

Not As Many Interventions or Procedures
This can be a good thing or a bad thing based on your viewpoint and feelings toward these. For instance, most women like to be checked for dilation starting around 37 weeks. There isn't any medical reason for this most of the time, it is just for your knowledge. You can go from 0-5cm in an hour or you can stay at 4cm for 3 weeks. Every pregnancy is different, even with the same woman. It can get your hopes up for nothing or make you feel defeated, which can actually stall labor. This is why many midwives will only check you for dilation when it is medically necessary.

If you use a midwife at a birth center not affiliated with the hospital or have a home birth, you won't have access to certain pain control methods, such as an epidural. On the flip side, midwives typically have better knowledge of natural pain relief methods and will teach you and help you with these.

The use of forceps, vacuums, and other delivery devices are almost never seen with midwives. This can mean a longer pushing stage. Midwives are, however, more aware of techniques that will help move baby through the birth canal and through the pelvis, the usual reason for needing these in the first place. Either option will help get the baby out, some with more risk than others.

Midwives cannot perform c-sections. If you end up needing a c-section, you will have to be transferred to a doctor to perform it. The rate of c-sections is extremely low in midwife hired births, though.

The number of ultrasounds you get will differ greatly. With my OB-GYN I got 10-15 ultrasounds. With my midwife, I got 4 and the last one was about 5 sec long, literally. The first was to date the pregnancy and make sure there was only one baby at around 8 weeks. The second was my NT scan at around 12 weeks I think. The third my anatomy scan at around 20 weeks. The fourth was to be absolutely sure she was not breech which is why is was so short. They put the probe on my belly, said yes, that's a head, and that was that. You are still able to schedule a 3D/4D "fun" ultrasound if you wish.

Most Midwives Will Not Accept High-Risk Pregnancies
A high-risk pregnancy is defined differently depending on who you ask. Some midwives will take women pregnant with multiples, some will not. If I was with an OB-GYN for my second pregnancy, they would have categorized me as high-risk, but my midwife did not. I had a subchorionic hemorrhage, more on that in a later post.

Other things that might categorize you as high-risk could be trying a VBAC, multiple miscarriages, certain abnormalities with the baby such as a heart defect, early labor, pre-eclampsia, and any problems with past pregnancies or births.

Like I said before, every midwife is different so even if you have a risk factor, if you want a midwife to be your healthcare provider for your pregnancy, ask around and see if they will still take you as a patient.

Did you have a midwife or an OB-GYN for your pregnancy? What did you like/dislike about it? Have questions about midwife care? Let me know in the comments below. I would love to help you make the right decision for you and your family.


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