Ob/Gyn or Midwife: Understanding the Differences

Maybe you’re due for your annual well-woman exam. Or you’re pregnant and need to get your prenatal appointments on the calendar. Or perhaps you have questions about your breast cancer risk.

Who do you talk to? An Ob/Gyn or a midwife? Does it matter? What’s the difference anyway?

When it comes to your gynecological care, you have choices. And the right provider for you is a matter of your health needs and your comfort.

We talked with Ob/Gyn Natalie Adsuar, MD, about the similarities and differences between obstetricians, gynecologists and midwives — so you can make an informed decision about your care.

The differences between Ob/Gyns and midwives

The most immediate and easiest way to differentiate between Ob/Gyns and midwives is that Ob/Gyns are trained as doctors and surgeons. Midwives aren’t.

• Midwives are healthcare providers who cover a range of gynecological and pregnancy care. Their experience and education may vary.
• Obstetricians are physicians who specialize in pregnancy and childbirth.
• Gynecologists are physicians who care for women’s health overall, including things like gynecological surgery.

In the United States, obstetric and gynecological medicine is a combined medical program. Meaning, obstetricians are trained in gynecology, and gynecologists are trained in obstetrics. But their practice focus and subsequent training may vary. Many of these doctors, especially those who practice both, use the designation of Ob/Gyn.

Here’s a quick peek at the differences between Ob/Gyns and midwives.

Let’s take a deeper look.

What midwives can do

Midwives aren’t medical doctors. Though some may pursue a nursing or other doctorate in addition to their midwifery education, that isn’t the norm.

Midwifery training can vary, depending on where they practice and the standards in their state.

• Certified nurse midwives have undergraduate degrees in nursing and a graduate degree in midwifery. They can practice in healthcare offices and hospitals in all 50 U.S. states.
• Certified midwives have graduate degrees in midwifery but undergraduate training in other fields. They can only practice in certain states.
• Certified professional midwives may not have undergraduate or graduate degrees in the field but have completed other courses or certification programs. They can practice in a few U.S. states. They mostly work in birth centers or homes.
• Lay midwives haven’t completed formal training and almost exclusively practice in homes.

Certified nurse midwives routinely work alongside Ob/Gyns in women’s health offices and hospitals.

“Certified nurse midwives are an option for regular gynecological care and pregnancy care if you don’t need surgery or have complex medical needs,” Dr. Adsuar says.

Because they’re not physicians, midwives can’t perform surgery or deliver babies by Cesarean section. But a certified nurse midwife can be a good fit for low-risk pregnancies or uncomplicated medical care. That can include:

• Pap smears
• Breast exams
• Ordering blood work
• Vaginal exams
• Diagnosing and treating infections, like yeast infections, UTIs and STIs
• Birth control counseling and management, including prescriptions and IUDs
• Prenatal care
• Vaginal deliveries

Some people might tell you that midwives are the better choice if you prefer to follow a non-medicated birth plan. (As in, giving birth without an epidural or pain-relieving medication.)

And while midwives can help in assisting you in a medication-free birth, having a midwife as your provider doesn’t mean you can’t opt for medicated pain relief.

“Oftentimes, midwives are trained in a broader array of non-medical options for pain management, and they may have the opportunity to employ them more than some physicians might,” Dr. Adsuar clarifies. “But you can work with a midwife and still have medicated pain relief during labor, if that’s your choice. You can also see an Ob/Gyn and have a medication-free birth.”

What an Ob/Gyn can do

Ob/Gyns are doctors. They undergo at least 12 years of education beyond high school before becoming licensed in obstetrics and gynecology. We’re talking:

• Four years of undergraduate training
• Four years of medical school
• Four years of residency

Ob/Gyns are trained and educated to handle all aspects of women’s healthcare, from annual exams to complex surgeries of the female anatomy.

Essentially, Ob/Gyns can do everything a midwife can do. And then some.

“What sometimes happens is that someone will start with a midwife and then, they can ‘risk out’ due to a change in their health,” Dr. Adsuar notes. “An Ob/Gyn can step in and handle more complicated medical care. But Ob/Gyns also care for you if you don’t have complex healthcare needs. It’s a matter of your preference.”

You may be referred to an Ob/Gyn, rather than a midwife, if you have certain conditions like:

• High blood pressure
• Diabetes
• Advanced maternal age (pregnancy over the age of 35)
• Gynecological conditions like endometriosis or PCOS
• Pregnancy with multiples

And some Ob/Gyns choose to focus on particular aspects of women’s health. For example, some Ob/Gyns work exclusively with patients in the hospital as they deliver babies. Others may specialize in specific gynecological conditions or surgeries.

“The education gives you the credentials of Ob/Gyn, and then any additional training you choose can allow you to specialize from there,” Dr. Adsuar adds.

Ob/Gyn vs. midwife: Which is right for you?

Whether you should see an Ob/Gyn or midwife for your general healthcare or pregnancy care comes down to two things:

1. Your health needs
2. Your comfort

“If you have a medical condition that requires a physician’s care, you should see an Ob/Gyn,” Dr. Adsuar advises. “If you are generally healthy and don’t necessarily need a doctor’s intervention, it’s more about your comfort and finding a provider that you connect with.”

Often, too, Ob/Gyns and midwives work together to care for patients. It’s called a “collaborative care” model.

“Collaborative care offers you midwifery support, while physicians address higher-risk medical concerns. This is often the ideal model for many high-risk obstetric patients and families,” she continues.

Remember, also, that gynecological care is highly personal by nature. So, finding a provider that you connect with is important.

“The person that you see can make such a difference, especially with something as intimate and as personal as your gynecological health,” Dr. Adsuar recognizes. “Choose someone that you can have a frank conversation with about what you’re dealing with. The key to your health may hinge on that connection.”