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 and pregnancy care, you have choices. And the right provider for you is a matter of your health needs and comfort.

We talked with Ob/Gyn Natalie Adsuar, MD, and certified nurse midwife Susan Hudson, CNM, 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 way to differentiate between Ob/Gyns and midwives is that Ob/Gyns are trained as medical doctors and surgeons. While midwives aren’t typically doctors, all certified midwives hold advanced degrees, and some do have a doctorate. They all provide expert gynecologic and pregnancy care.

Their training is different, as is their approach to care.

“Midwives are trained to look at pregnancy and women’s health through the lens of ‘normal’ and to recognize when things move beyond that scope,” Hudson explains. “Ob/Gyns, on the other hand, are trained to diagnose and treat medical conditions, which is essential for when complications arise.”

Let’s take a deeper look.

What midwives can do

The midwives you’ll find working in accredited hospitals and medical centers are formally educated in gynecological and pregnancy care. Certified nurse midwives like Hudson have graduate degrees in nursing or midwifery.

Midwives aren’t medical doctors, though some may earn a nursing or other doctorate in addition to their graduate degree.

It’s worth noting that the terminology can get confusing. Some people may mistakenly think of midwifery as a self-taught practice (à la Call the Midwife). And there are lay midwife practitioners out there who haven’t undergone formal training. They tend to attend home births and aren’t certified to practice in hospitals.

A certified nurse midwife can be a good fit for most gynecological 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. 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.

It’s your call.

“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.

That’s part of the holistic nature of midwifery practice, Hudson adds. “As midwives, we often have the opportunity to spend more time on patient education and hands-on support than a physician would.”

What an Ob/Gyn can do

Ob/Gyns are doctors of obstetrics (pregnancy and childbirth) and gynecology (women’s health). They undergo at least 12 years of education beyond high school before becoming licensed in obstetrics and gynecology.

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.

Ob/Gyns are trained and educated to handle everything from annual women’s health exams to surgeries of the female anatomy. They can care for all pregnancies, including those with complications, and perform surgeries such as Cesarean sections and hysterectomies.

“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 explains. “An Ob/Gyn is needed for highly complicated medical care. But Ob/Gyns can also care for you if you don’t have complex healthcare needs. It’s a matter of your preference.”

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,” she 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

“Midwives at most facilities tend to care for people with low-to-moderate risk,” Hudson clarifies. “And we collaborate closely with our Ob/Gyn colleagues to ensure that people with higher risk get the level of care they need.”

Ob/Gyns and midwives working together to care for patients is called a “collaborative care” model.

“Collaborative care offers appropriate midwifery care for those who can benefit, while physicians address higher-risk medical concerns,” Dr. Adsuar confirms.

When considering whether you choose to see a midwife or an Ob/Gyn, it’s important to remember that gynecological care is highly personal by nature. So, finding a provider that you connect with might be the first step.

“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.”

Hudson agrees, adding, “If you see a midwife and they recommend an Ob/Gyn, trust that advice. It’s about getting the right care for your unique situation.”