Pregnancy: Choosing a Doctor or Midwife

Getting prenatal care is an important step towards ensuring a healthy pregnancy. This Hub explains the difference between doctors and midwives, in order to give you a better idea of the prenatal care provider options that you have. Pregnancy provider options include: Obstetricians, Perinatologists, Family Practice Doctors, and Midwives. Also, there are multiple classifications of Midwives: Certified Nurse Midwives (CNM), Direct Entry Midwives (DEM), Certified Midwives (CM), Certified Professional Midwives (CPM), and Lay Midwives. Overwhelmed yet? I'll try to explain things and make them a little more understandable for you.

Prenatal care is the care of women trying to get pregnant, during pregnancy and up to 6 weeks after delivery. Prenatal care is important to promote ideal conditions for women trying to become pregnant. Providers will discuss nutrition, diet, and exercise for women during these stages of pregnancy. Routine screens will be performed during pregnancy that help detect birth defects or other fetal conditions, as well as common pregnancy complications. Some of which can be treated during pregnancy leading to the best possible outcomes for both mom's and babies.

Routine prenatal care follows this guideline, unless a pregnancy is high risk or complications develop.

· Weeks 4-28: monthly visits

· Weeks 28-36: biweekly visits

· Weeks 36-delivery: weekly visits

Obstetricians are medically trained doctors specializing in the care of women's reproductive tract. Almost all Obstetricians are also Gynecologists, but not all Gynecologists are Obstetricians. These highly trained professionals deliver in hospitals and are equipped to deal with commonly occurring pregnancy complications. Some Obstetricians deal with high risk pregnancies, while others defer all or certain high risk conditions to a Perinatologist. Obstetricians are licensed and regulated to practice in all 50 states.

Perinatologists are medically trained doctors who have completed training in Obstetrics and Gynecology and has continued on to study two or three additional years in caring for high risk fetal and maternal conditions. These practitioners are often referred to as Maternal Fetal Medicine Doctors. They care for high risk pregnancies, deliver in the hospital setting, and are licensed and legal in all 50 states.

Family practice doctors are able to deliver babies in some hospitals. These doctors are medically trained to care for people of all ages. Their focus is mostly primary preventative care, and often defer to specialists for significant complications. Family practice doctors care for low risk pregnancies and delivery in hospitals, and are licensed and legal to practice in all 50 states.

Certified Nurse Midwives (CNM) are advanced practice nurses holding at least a Masters degree. They must complete midwifery training through an accredited program, pass board examinations, and are legal in all 50 states. These professionals do not require out of hospital training for licensure. CNM's can deliver out side of hospitals, but they most commonly deliver in the hospital setting, and care for women with low risk pregnancies.

Direct Entry Midwives (DEM) have studies the art of midwifery through apprenticeship, an unaccredited midwifery school, or self study. DEM's are considered lay midwives, unless they meet the requirements of becoming either a Certified Professional Midwife (CPM), or a Certified Midwives (CM). There exists no regulated course of study, or minimum education requirement for this type of midwife, and their legality greatly varies by state. Direct Entry Midwives deliver in out of hospital settings, and care for women with low risk pregnancies.

Certified Professional Midwives (CPM) are not required to be nurses. Both DEM's and CNM's may obtain this certification. Out of hospital experience is required, as well as both hands on and written examination completion. CPM's care for women with low risk pregnancies and most commonly deliver in out of hospital settings. Legality varies by state.

Certified Midwives (CM) are trained in midwifery but have not studied to be nurses. These practioners are accredited yet do not meet the criteria of direct entry midwives. Education requirements of Certified Midwives and legality is limited and determined by individual states. CM's deliver out of hospital.

Lay Midwives are unlicensed practioners who have learned through self study or apprenticeship. The care for women with low risk pregnancies in out of hospital settings. Legality is limited and determined by individual state. Lay Midwives often practice without regulation.

Choosing a provider for your prenatal care is a very important decision, not to be taken lightly. The doctor or midwife that you select for your prenatal care will be with you during this most significant time in your life. You are entrusting this person, or group of people with bringing your precious cargo safely into this world. Take time to think about your hopes and preferences about prenatal care, delivery type, and location. Interview providers and ask questions important to you before making a selection. Be sure that their beliefs and practices align with yours. You would not want to select someone who you do not trust or who does not support your beliefs or preferences. There are many styles of practice relating to prenatal care and delivery; so with some research and effort you can easily find the option best suited to meet your needs.

There exists many differences between doctors and midwives. Generally speaking Doctors are medically trained and view pregnancy as a medical condition. they are trained to look for what is wrong and treat it. their appointment times are shorter, Doctors only deliver in hospitals, and are more likely to perform interventions to keep the pregnancy and labor "on track". Midwives view pregnancy as a natural state of being and let nature take its course either without intervention, or with natural interventions. Midwives are allotted more time to spend with their patients, take more of a hands on approach during labor and childbirth, and may deliver in hospitals, birth centers or homes.