What's the Difference Between Doctors and Midwives?

This is a question I get asked a lot by patients or potential patients seeking an obstetric provider. The answer consists of many things and some different philosophies in general. Of course, there are some midwives who practice differently, and some obstetricians who practice differently, so you can't put everyone into the same nutshell, but here are the main differences. Doctors have been to medical school and have done a residency in their specialty area which includes surgery and management of high risk medical conditions. Certified Nurse Midwives (CNM's) have received Bachelor's degrees in nursing and have most have gone to graduate schools for Master's degrees in nurse midwifery. We do clinical hours and deliveries over about 2 yrs of school which consists of clinic time managing pregnancy, primary care, and gynecologic care. We also deliver babies and assist c/sections in many hospitals. Some do deliveries in birth centers and a small portion about 4% in this country do home births. Direct Entry Midwives are midwives who have had some training usually about 1 yr and perform most deliveries at home or in birth centers. There are also lay midwives who learn the trade from experience and time with other lay midwives. They perform home births.

The general philosophy of midwives is that pregnancy and childbirth is a natural and normal process that requires care of the woman, but that less intervention usually leads to better outcomes-such as a lower c/section rate. We also focus on educating our patients about things to watch for and do during pregnancy to encourage a healthy mom and baby and vaginal birth. We offer more time during prenatal visits to educate our patients and to really take time to know them and care for them. Most of us, myself included want our patients to feel that their desires are being addressed and that we are giving our patients educated options to choose from to meet their desires for childbirth. I personally don't think there is just one way that is the best way. I think natural births are wonderful, but there are some women that do not desire this and just because you choose a midwife doesn't mean you can't use medication or an epidural if desired. We/I just want you to be comfortable and safe and feel like you had a great experience. We never put your safety on the back burner either. We do intervene when necessary and consult or manage your care with an obstetrician if things are varying from a normal safe path. That being said, most midwives have lower c/section rates, bigger babies, and less preterm delivery. Part of the latter is likely because of the education time we try to take with our patients.

Last but not least, midwives usually spend more time with you during your labor offering labor support or emotional support and advocating with the nurses and other care providers on your behalf to help you get the birth experience you want. So, if you are

considering a midwife, come on in, you won't be disappointed!