Midwife or Obgyn: What you need to know when choosing a care provider.

Ok, you’ve found out that you are pregnant, the first thing you are going to want to do is figure out who is going to be taking care of you and baby through the next few months… and the question is more frequently will you work with a Midwife or an Obgyn?

Now I’m going to say up front, that an Obgyn or a Midwife will not be for everyone and you will likely have a general “trend” in your area of which one is more popular or the norm. But we all need to do what is best for us and our baby so while I am including some things about my journey through pregnancy (had both with one pregnancy), I admit I’m a tad skewed to the Midwive’s rock camp. But that doesn’t mean that I think all Obgyn’s are horrible, we had a really nice one for most of our first pregnancy and I adore him. It just wasn’t our best option.

So please keep an open mind, and figure out what is going to work best for you and your family.

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Let’s start with the common things to think about when you are choosing your care provider. If you pick a Midwife or an Obgyn these things are still applicable.

Know Your Rights!

A big thing in most situations is knowing your rights,

You are in charge here.

I understand what it feels like to be intimidated when talking to a professional. Especially as a first time Mamma. Entering a world that is new, exciting, and possibly a little scary can be overwhelming and panic attack inducing (for me it was anyway).

However, you are paying for this service. Yes even if it is labeled as “free” like here in Canada you are still paying for it via your taxes. And there is no need to be intimidated, they are smart, sure, but still human and you are paying for their time.

Have you asked other Mamma’s who they liked/didn’t like?

This is likely one of the easiest things to do. Most women I know will tell you who they liked or didn’t like in the delivery room with them. I’s recommend asking the Mamma’s in your life who have given birth recently first.

Also when asking who, also ask WHY. Sometimes the reason someone didn’t work for one Mamma is the reason they will work for another Mamma.

For example, a friend of mine had used the same Doctor for her first 2 births, she loved that he was easy to talk to but hatted that he would let women labor longer then she wanted and she felt had tried to talk her out of using an epidural.

I was looking for a natural delivery so someone who would try and talk me out of pain meds seemed like a great idea.

If you are new in town try googling “midwives/obgyn’s in *insert town name” and look for online forums where care providers and their services are discussed. Or check in local Facebook chat rooms, just be prepared to be swamped with recommendations if you put a post up asking for advice as many women are very strongly opinionated on this one.

Close-up of a pregnant woman during medical visit

Have you interviewed your prospective care providers?

In my experience, this is critical to getting stellar care. And I recommend NOT signing up with either a Midwife or an OBGYN unless you have had a solid interview first and checked out at least 2 care providers before making this big decision.

This person is going to play a big role in your whole experience of motherhood and it is best to be sure of your decision.

Now in some areas, you may not have a lot of choice on who you can work with, I still think it’s important to interview them upfront to establish the type of relationship you want to have.

In some cases, care providers may not let you ask them questions (I had 2 that wouldn’t let me ask questions about the labor in the first meeting), in this case, observe what happens in your first meeting and listen to your gut.

Do you trust them?

I’m a big advocate for trusting the person who is going to see you in a vulnerable situation. And I’m not talking do you trust the position or job title (though that would be a bonus) I’m talking the person you are asking to care for you. Do you trust them as a human being?

Most of the time when we meet someone our “gut” will tell us if we like them or not. You are going to need to listen to that if you don’t have one right away but pick up on it later in the pregnancy, listen to it.

This person is not only going to see you naked, and possibly the most vulnerable you’ve ever been, and they are responsible for the safety of both you and baby during labour and delivery.

If you don’t trust the people on your support team you are going to be fighting to stay in control and likely fearful of what could happen. This will affect how you see your labor later if nothing else.

Oh, and welcome to Motherhood, where sometimes all you have to go off of is your gut instinct. So start practicing it now, if everything checks out and something doesn’t feel right then keep on looking.

Do they listen?

This one could take a couple of meetings, but when you ask questions or talk about things with them are they actually listening or just going through the motions?

In my initial round of interviews (I checked out 8 Obgyn’s and dismissed Midwives entierly at first) I found 3 never bothered to listen to me. I expressed a fear I had and it was smoothed over like I never said anything important and was literally told to “Trust me, you’ll be fine, I’ll take good care of you.”

Yeah, chances are when someone tells me to “trust them” not going to happen. But the tone that went with it told me they were not listening to my fears. And I crossed them off the list.

If they don’t listen to you, you are going to get frustrated with them sooner or later. They will dismiss something important to you because “they have seen it before” and all that crap. Also you are going to be wondering “what are they NOT telling me” at some point, and you can’t make the best choices for you and your baby if you don’t have all the info available.

As they are supposed to be advocating for you and your little one’s health listening skills are important to understand what it is that you need to feel taken care of.

Who are their Partners?

Ok, here we are going to start getting into some of the differences between Midwives and Obgyns.

In my area when seeing a Midwife or Obgyn you usually get a “team” of them. Midwives here work in teams of 3, and rotate through being on call for their clients the same as Obgyns. However, with a Midwife you get to meet the whole team throughout your pregnancy in various appointments.

With your OBGYN not going to happen unless you ask for it (I did and was made to feel like crap because I requested it). With an OBGYN you also get whomever is “on-call” when you go into labour. So you may not have the doctor that helped you all the way through the pregnancy; and now you will have to figure out what the heck this new person is going to do (it can add stress to an already intense situation if you don’t get along with them as well).

So make sure you ask who their team is or if they have any partners. I would also recomend asking if you can meet them in advance and what their philosophies are on the questions below.

While it would be great if all the care providers working under one roof had the same philosopies that isn’t always the case and it is best to check in advance who may be stepping in during the delivery.

doctor listens to the baby's heartbeat  during childbirth

Where do they deliver?

Obgyns and Family Doctors in more rural areas will typically deliver at one hospital in the area. Obgyn’s in more urban areas may deliver in one or two hospitals.

Midwives, however, can deliver in hospitals, birth centre’s or at home (depending on their licensing and local regulations). So if you are looking for a home or birth center birth you may only be able to work with a Midwife.

It’s good to check on available locations, and if possible go for a tour of your options to see if you like one more then the other. If you have a particular location in mind that you want to deliver at then making sure your care provider delivers at that location is important.

How Long Have they Been Practicing?

There are benefits to both relatively new and relatively experienced care providers. Relatively newer ones will likely have the latest and greatest information since they just graduated.

However, the experience can be important, especially if you have a high-risk pregnancy or are a very-nervous Mamma. For me, I was deeply comforted by the fact that the Obgyn I was seeing in the first part of my pregnancy had been delivering babies for decades and had a ton of experience under his belt (until other things started to bug me).

In relation, the Midwife who delivered my little man was relatively new and had different more reassuring information to help calm my anxious thoughts with stats and figures that I needed.

What are their philosophies on…

High-Risk Pregnancy

If I had started with a Midwife earlier in my pregnacy I would have wanted to know what they deemed as “High-Risk”. Meaning under what conditions would they refer me to an OBGYN for care.

If you have had one in the past, or are concerned that you may be having one now it’s best to talk about it upfront. You will want someone looking after you who is experienced in the particular situation you are in.

Pain Relief

This often depends more on the location you deliver in. For instance, if you are home with a Midwife there isn’t going to be an option for an epidural. However, you may have other options.

Even if you want to go the “natural” or “no pain relief” route it’s a good idea to discuss this with your care provider. Things can and do often change quickly in birth and you want to know your choices upfront before all the intensity starts.

I personally didn’t want any medicines and was very adamant that I wouldn’t want them. But I was glad I sat down and discussed the details of each option because it meant I understood what I was saying “no” to.

Informed refusal is just as important as informed consent.

Induction

Some doctors are more likely to recommend induction earlier than others. Be sure to ask your care provider under what circumstances they would induce a person and how long past 40 weeks they will let a Mamma go over.

I’m also glad I asked how long I would be allowed to labor before they would recommend “speeding things up”. Each care provider will be different, but the closer you can get to what you want in ideal circumstances the less likely you will have to deal with being pressured into something you don’t want.

In my experience, Midwives tend to let you labour as long as everyone is safe (you and baby), if something looks like there could be a risk they’ll bring it to your attention early enough to give you time to make a choice.

From what I’ve heard there are many great OBGYN’s out there that will do the same thing. However, I’ve also heard stories where women have felt the doctor (or sometimes a nurse) steamrolled them into an intervention that later on they regretted. Remember Your safety and Baby’s safety come first, but you should still have enough notice in many situations to at least THINK about your choices/options.

Breech Deliveries

Ok, don’t freak out. Yes, the thought of delivering a breech baby scares the bejeezus out of me. However it is possible, and while a lot of doctors (and a number of midwives) won’t do it that is likely a good thing.

However, there are some very experienced Midwives and Doctors out there that can successfully do this. If you are looking to avoid a c-section at all costs you might want to look into Care Providers who handle this as well as ones that know how to turn a baby. (you are more likely to find a Midwife with the experience than a doctor from what I’ve seen)

My understanding is that one of the big reasons that most won’t do this is because a few inexperienced care providers did when they didn’t know what they were doing and due to the outcomes from those it got a bad rap after that.

Also just a note, there are stories all over the internet about babies turning as late as hours before delivery. So if kiddo is in a breech position talk about your options, sure, but give them some time to shift.

Doctor explaining an ultrasound to a pregnant woman using a tablet.

C-sections

Whether you are planning a c-section or not you should talk about this as a possibility. Birth does not always go according to the birth plans we so meticulously write out, and things happen and can change in the blink of an eye.

So talking about your care providers’ philosophy on C-Sections and importantly their rate & the hospital c-section rate can give you a guide to how quick they are to recommend one.

To find one for the facilities in your area you may need to check online resources. I personally was petrified of having one so I asked a lot of questions to try and understand what my Obgyn thought of the process… and got nowhere. A blanket “if we need to we will” was not reassuring and way in general for me to be ok with it.

To be clear I am not against C-sections, and I would hate for someone to think I was. My understanding is that if possible it’s better to avoid major surgery if it isn’t necessary. But there are certainly many times and cases where C-Sections are not just necessary but critical.

And YES I firmly belive that if there was a baby inside you and it is now outside you YOU GAVE BIRTH! I don’t care if it came out an incision or your vagina. You’re a Mamma who gave birth <3

Also a note here, C-Sections are getting safer, but it is a good idea to ask about the top five complications associated with them.

VBAC’s (Vaginal Birth After C-Section)

Not all doctors or Midwives will work with you for a VBAC, so if that is your goal it’s best to know upfront if they are willing to do one.

To my understanding, there are some conditions around these and it’s an important idea to make sure you are a good candidate for one. If there is no reason you shouldn’t attempt a VBAC, then make sure you find I care provider who is on board with your goal.

Abuse Survivors…

Mamma’s I hope you have never had to deal with any kind of abuse, however, if you have you need to know what your team is prepared to do to help you deal with anything that might crop up during your delivery.

As a survivor myself, this aspect of my care influenced my choice to switch from my Obgyn to the Midwife team. I just didn’t feel like I was getting heard when it came to my fears around what would happen.

And I’ll admit, I was petrified of admitting that I had been abused. Heck Typing this out for the world to read scares the piss out of me. But you need to be upfront with your care provider. They can help you navigate this exciting and often scary time in your life.

And the right care provider will help you feel more empowered. They can’t necessarily do that if they don’t know about your history. And sometimes what is a routine procedure may be more traumatizing to you because it triggers something from your past. It’s important that those around you know so they can do their best to reduce if not eliminate those issues in advance.

While I never fully felt like my Doctor understood what I was saying about what I survived and how I was responding to things (I was overly protective of my baby and reacted hashly when anyone tried to touch my stomach). I do know that if I hadn’t told them I likely would have had some people touching with out asking and that for me was a huge no-no.

At this point, if you haven’t already I highly recommend looking into getting a Doula on your team as well. While some OBGYN’s won’t work with them, every Midwife I’ve met does. A good experienced Doula can help you by going to appointments with you, helping you voice your concerns to your care providers (especially if you are intimidated), and is with you all the way through the labour and delivery looking out for you!

I worked with a Doula for our first son’s birth and am working with the same one for our second son’s birth as well because it was the BEST CHOICE I ever made in my own care. Ask your Doula all the same questions you do your Midwife/OBGYN to get a feel for their philosophies as well. Their job is to back you. I would also ask them if they have experienced working with abuse survivors before as well, mine had and it made a world of difference.

You will also want a solid understanding of the Stages of Labor, this was likely the biggest help for me in understanding what my body was doing as it was doing it. That and trusting the people in the space around me would work with me. It really is important to know who you should have in the delivery room with you.

Mother giving birth to a baby. Newborn baby in delivery room. Mom holding her new born child after labor. Female pregnant patient in a modern hospital. Parent and infant first moments of bonding.

After the Birth Philosophies…

I’m going to put this here as a general “what are their thoughts” type thing. And get into more of the details in another post. But You’ll want a general idea of what to expect after kiddo is born.

Will you get the chance to do skin-on-skin right away (and yes in some c-sections this can still happen fairly quickly). And things like delayed cord clamping or saving for the future or any one of the other options from breastfeeding to the way they will stitch up any tears are a good idea to get a general feel for.

As you get farther into the relationship with your Care Provider you will naturally ask more questions. Go with it, and let your gut guide you.

I know my birth story was an incredible experience and I will always remember it as an empowering and uplifting time in my life.

The Big Difference between Midwife and OBGYN

So after all that, what really is the big difference between a Midwife and an OBGYN?

Well, as stated above, the location of the delivery, and the ability to perform C-Sections. Midwives while well trained and medical professionals in their own right are not trained for major surgery. If you need a C-Section then there will be an OBGYN involved.

But also some of your pain relief options will vary. While laughing gas and natural pain management techniques will be available with both, if you are looking for an epidural you will need an OBGYN.

The biggest thing I noticed a difference in was more of a personality thing between care providers. Midwives seemed a lot more focused on how normal and natural this all is, and while they were on the lookout for possible complications they were also very good at providing more information then I knew to ask for.

The Doctors I saw kept making me feel like being pregnant was the equivalent of a major disease that needed treating… and I personally never saw my kiddo as a parasite that needed removal (though one nurse actually referred to him as such).

The biggest thing is that you need to be comfortable with who you are talking to. The more comfortable you are the more likely you will be comfortable asking questions about the topics you want to discuss.

And in my opinion, you need to be able to trust that your care provider will work with you, not just within a set of predetermined parameters.

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