The Difference Between Midwives and OBs (and which one I'm choosing this time) - Erin's Inside Job

The Difference Between Midwives and OBs (and which one I’m choosing this time)

When I first got pregnant with Miles, I wasn’t particularly educated about birthing options. I assumed you went to an OB, they delivered your baby, and that was it. Anything other than that was non-medicated home births that I had no interest in (far from the truth). I scoffed at women during the hospital tour who questioned about whether their doulas could be there or who wanted their babies immediately after birth to do skin-to-skin rather than having the nurses take them for measurements and such. I felt that you let doctors deliver the baby and everything else was new-agey and weird.

After my pre and postnatal experience, my understanding and opinions changed tremendously. I learned that there are many different options for care prior to, during, and after the birth of your baby. I realized that maternal care in this country is severely lacking and as a mother you really need to advocate for what you feel is best and educate yourself far more than I expected. I learned that the U.S. performs C-sections at a rate significantly higher than other countries (although not the highest) and that that rate has been increasing globally over the years. Racism is found even in perinatal care, with black women dying at a significantly higher rate during pregnancy and delivery than white women. I quickly realized that postnatal care is almost laughable, when in my opinion it’s even more important than when you are still pregnant (assuming you have an uncomplicated pregnancy).

So with this second pregnancy, I knew I wanted a better experience. To be fair, I didn’t have a particularly BAD experience the first time around — Miles needed to be delivered via c-section because of his positioning and the fact that his umbilical cord was wrapped around him — but I think the care that I got from doctors could have been better. So far I’ve been really happy with my decision and wanted to take time in this post to address something that had me confused for a long time: the difference between midwifes and OBs.

Difference between midwives and OBs

Even after choosing the midwife practice here at the University of North Carolina, I was still confused about what exactly the difference was, considering that both the OBs and the midwives practiced out of the same office. When I was finally able to meet in person (due to COVID a lot of our appointments are virtual), I made sure to ask her to tell me the differences so that I had a better understanding. The way she explained it was actually really helpful.

If you have a normal pregnancy, your experience with a midwife and an OB is generally the same (hence my confusion). The main difference comes during labor, where midwives are able to be much more present with you during the birth because they are not being pulled in as many directions. She mentioned, and I experienced, that when delivering with an OB, it’s the nurses who mainly help during labor and the doctor swoops in at the end to deliver.

OBs play a crucial role if you have a more complicated pregnancy. They have more schooling than midwives and specialize more in complicated cases and are able to perform surgical interventions if needed (midwives are not). If the mother has a preexisting condition that could cause complications such as diabetes or hypertension, or is carrying multiples, that is where and OB is a better choice (and often required).

So, given that my previous pregnancy had no complications, I decided that I wanted to try working with the midwife practice for a number of reasons:

  • Midwives — and this practice specifically — have a high success rate for vaginal births after cesarean (VBAC), which is something that I want to try for
  • They provide more education to patients
  • They are more present during delivery and able to offer support and encouragement

Misconceptions about midwives

I admit that I wasn’t fully informed about midwifery until I started doing my own research and shared some of Neil’s initial beliefs when I first told him, such as not being able to use an epidural and having to give birth in a water tub somewhere. Absolutely fine, but just not personally in my birth plan.

Once I discovered that midwives can:

  • deliver in the hospital
  • provide an epidural
  • OBs are available if there are any complications (such as needing a c-section again)

I was sold. My previous perinatal and delivery experience simply made me realize that I wanted a little more of a personal touch for such a personal endeavor.

What about doulas?

I don’t think you can have the discussion about midwives and OBs without also talking about doulas. A doula is defined as:

a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.

A doula is not a trained medical professional and can not provide medical services, but rather provides support in a variety of other ways. He or she is able to help coach you through the labor process, show you helpful techniques, and also provide postpartum care in terms of breastfeeding and simply acclimating to parenthood. A doula is with you for your entire labor and delivery and serves as your advocate throughout the process.

Currently, with the pandemic still affecting hospitals around the country, I know that many people haven’t been able to have the support of a doula in the delivery room. Hopefully things will change sooner than later, but delivery during this time has posed many issues, including some partners not even being allowed admission.

Basically, when deciding about prenatal care, there is the decision of who will monitor the progression and delivery of your baby (OB or midwife) and if you’d like further support in the form of a doula.

Hopefully this helped clear up any confusion. This has been my experience, so if you have any further information to add, feel free to do so in the comments. Also let me know if you have any other questions I can address and I’ll be sure to update this post!

2 comments on “The Difference Between Midwives and OBs (and which one I’m choosing this time)

  1. Great post on the differences. I researched a lot going into both pregnancies with Myri and Shreyan. I’d say that there are still many variable effecting the availability with a midwife during the actual delivery. For instance, are there other moms also in labor at the same time? Are they adequately staffed at that moment? The greatest benefit of a doula is ensuring that you have a knowledgeable attendant’s continuous care. When I decided to move forward with Myri’s homebirth, I personally was sold with the fact that my doula as well as my registered midwives would be able to provide me with the continuous support I wanted. In Shreyan’s 70 hour birthing marathon, I still don’t remember who all I saw in all those shift changes. I was so happy that he finally came into this world that it didn’t really matter who was there and when. Lol! Still, it left me with a feeling of disconnect and lacking a personal touch. Maybe if I would have had a doula or that continuous support, I would have relaxed, opened up and given birth more easily? My experience of the two different births, and my background in holistic adjunctive healthcare (reiki and craniosacral therapy) has led me to pursue midwifery as a profession! I became a DONA trained birth and postpartum doula last year!

    It’s also important to know that each state has its own rules and regulations surrounding midwifery (registered midwives vs. certified nurse midwives.) It is hard to generalize the efficacy and knowledge of each, but I am personally exploring these throughout nursing school. I LOVE this topic, so if you ever want any additional info, I would love to help!

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