Midwives & OB-GYNs: Aligning your Birth vision with a supportive Care Provider
From the moment you find out your’e pregnant or even try to conceive you are met with so many decisions about your birth and parenting journey. One of the biggest choices you’ll make for your birth is with whom you give birth. For some this feels like a no-brainer, go with the OBGYN that does your annual checkup that’s covered by insurance. While this choice may seem straightforward or the most stress-free it actually often comes with a lot of unexpected hurdles. It’s important to be intentional early on with choosing your care provider so you can find someone who aligns best with your birth vision. Some of the first questions you’ll want to ask are, Midwife or OBGYN? What type of care do I want to receive during birth? and Where do I want to give birth?
Who Aligns with my birth vision best? Midwife or OBGYN?
The best way to answer this question for yourself is to understand the major similarities and differences between these two care providers.
Similarities
They both assist in the delivery of babies!
They both can assist in medicated and unmedicated births depending on birth location.
They both can and do work in the Hospital setting.
They are both educated, certified, highly trained, and qualified.
Differences
OBGYN
Obstetrician- Gynecologist, OBs
They are medical Drs. who specialize in women’s reproductive health.
They are trained in surgery and are the exclusive option for elective or emergent cesarean birth.
They complete four years of medical school, a four-year residency program, and a three-year fellowship.
They are experts in managing high-risk pregnancies and delivieries.
They follow the Medical Model of care.
Midwife
CNM, CPM, CM, Traditional
They assist births in hospitals, birth centers, and at home.
They are trained, certified, and educated in several different ways(2)
They do not perform surgery or cesarean birth.
They specialize in the use of water birth and mobility during birth.
They follow the Midwife Model of care.
What type of care do I want to receive during birth?
There are two models of care used in Western birth education.
The Medical and The Midwife.
Medical Model of Care
Derived in the early 19th century during the creation of modern gynecology led by exclusively white male Drs. In America, we consider James Marion Sims “the father of modern gynecology” who began his research in 1844 by surgically experimenting on enslaved black women.(1) The concept of the Medical Model of Care or “medical paradigm of childbirth” was first defined by Dr. Joseph DeLee in 1915 and still remains the functional education in American obstetrics and gynecology(3)
Defined as this…
They view themselves as primarily responsible for births they attend. And that Birth is the work of doctors, nurses, and other experts with the woman/birthing person being the receptive patient.
They are trained to focus on the medical aspects of birth.
They are trained to see childbirth as a pathological process meaning a process that should be fixed or relieved due to the intense physical and emotional stress it puts the birthing person through.
Their training has a low emphasis on long or personalized care, emotional support or using understandable language for their patients during pregnancy/birth.
Their training has a high emphasis of demonstrating a dominant-subordinate relationship with the birthing person and relying proactively on technology to avoid risk over reacting to the natural process of birth.
The Midwife Model of Care
Derived from the palaeolithic era (40,000 B.C.) Indigenous cultures all over the world practiced various traditions around birth, many of them spiritual and rooted in nature and herbal medicine. (4) The concept of the Midwife model of care in America is attributed to Mary Breckinridge in the 1920s when she introduced Frontier Nursing Services which was a community-based education program that still is taught in most American Midwife education today. Though the origins of these ideas reach much further back and in America can be heavily influenced by the enslaved American midwives of the South(5)
Defined as this…
They view the birthing person as primarily responsible for their choices regarding the birth and baby. Often referred to as mother-centered care. They share in decision-making with the birthing person.
They view birth as a family event, a normal part of a birthing person’s life, and life transforming.
They are trained in the natural and physiological progression of labor and birth.
Their training has a high emphasis on continuative personalized care, emotional/mental health support, and explaining things with evidence based and relatable language/visuals that all birthing people can understand.
Their training has a low emphasisi on using technology without urgent need and authoritative decision making.
I want to clarify here, In both columns, I refer to the training or views of both of these professions rather than a broad brush painting all OBs and Midwives the same. Each individual care provider will have their own values, contradictions to their training, and ways they blend both models of care into their practice. But It is still important to understand the underlying belief systems from which both are educated.
Where do I want to give birth?
Now that you have an idea of the differences between the OBGYN and the Midwife as well as the differing “Models of Care” this may immediately direct you to the birthplace that feels right for you. You may also approach your birth knowing exactly where you want to birth and seek out a care provider that serves in that location. But there may still be a few important things to consider as you try to align your birth vision with the best care provider…
If you lean more toward a Hospital birth
It’s important to remember that you can choose an OBGYN or Midwife (CNM) as your care provider. For many this is the best of both worlds, receiving the Midwife model of care but within the safety of a hospital. Many also choose a practice that has both OBGYN and Midwives on staff so they can feel supported no matter the level of risk they encounter during their pregnancy or delivery. Take time to research care providers, where they assist births, and how often.
Locality is not always the most important. Unless you have a history of precipitous birth or plan to labor well into active labor at home, it’s more important to spend 9 months with a care provider you trust and feel alignment with than focussing only on the commute to the hospital.
if you lean more toward Out-of-Hospital birth
Free-standing birth centers can be a great in-between for those who want the comfort of home but also want to be close to the hospital in case of emergency. Most birth centers have emergency protocols in place and relationships with their closest hospital to make the transfer of care smooth and fast. They are most often run by midwives and operate fully under the Midwife Model of care rather than practicing in contradiction with the Medical model of care that runs most hospitals. Unfortunately, birth centers are still under a lot of scrutiny and restriction in the US and are not always locally available.
Choose your Midwife wisely. If you are planning a home birth it’s important to still be intentional in hiring your Midwife. Just like OBGYNs they are unique and each practice in their own way both in alignment with the Midwife model of care and in contradiction. They are typically self-employed so they have their own set of boundaries that cover their comfortability and type of birth support. They also are certified in different ways and may have restrictions that impact the type of births they can attend.(2)
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Photographer, Mom, Birth Keeper, Blogger, and total Nerd when it comes to the History of Birth and Evidence Based Maternity care!
Educational Articles and Sources to Learn More From
(1)Origins of American Gynecology : Black Subjectivity and the Origins of American Gynecology By Rachel Zellars
(2)Different Types of Midwives:
CNM: Certified nurse midwives are registered nurses (RNs) who have masters or doctorate degrees in nursing. They have also received their American Midwifery Certification Board certification.
CPM: Certified professional midwives are specialists who have demonstrated their knowledge and skills in providing midwifery services, and been certified by the North American Registry of Midwives.
Cm: Certified midwives are non-nurses who have earned a post-graduate degree in midwifery, and have also been certified by the American Midwifery Certification Board.
Traditional: Midwives who have been trained with hands-on experience or apprenticeship over many years. They may or may not choose to certify or receive a degree.
(3)The History of Midwifery- Learn more about the history of American gynecology Judith P. Rooks, CNM, MPH, MS, originally published May 30, 2012
(4)The Origins of Midwifery - International Confederation of Midwifery