A provider should view you, mama, as the authority and most important person in your birth space. Choosing a provider who disagrees with this philosophy, regardless of what title the provider has, will likely lead to a stressful and traumatic birth experience.
One of the very first decisions pregnant mamas usually make is who their provider will be during pregnancy and eventually birth. The sad reality is, though, that most don’t put a lot of thought into this crucial decision. In general, most women will just continue seeing their regular OBGYN that they’ve been going to for their annual well-woman checks. Presumably, there’s some kind of trust and relationship there from previous care, but choosing your provider for birth is a decision to put some thought into and may not be as simple as continuing care with your regular OBGYN.
Today, there’s an approximately 90/10 split of births being attended by OBGYNs versus midwives in the US.
So how do you choose a provider? Who should you choose? OB? Midwife? Family practitioner? None?
What do you want out of Birth?
Before you can pick a provider, you need to be clear on what YOU want out of your birth experience (this download can help!!).
Knowing what you want your birth to look and feel like can help you develop your non-negotiables for a provider. It can also help you create a list of questions to ask when interviewing potential providers.
Interview, Interview, Interview
An interview can feel so formal, but it’s very important to picking the right provider for your maternity care. Don’t overwhelm yourself, but try to interview two or three options that seem close to your ideal provider based on research and recommendations.
A note on recommendations – don’t take recommendations from mamas who have different birth desires than you! A previous client of mine chose her OB based on a recommendation from a friend who loved the OB. That’s wonderful, but the friend had a fully induced and medicated birth while my client was seeking spontaneous labor and an unmedicated birth. Unsurprisingly, my client had a hard time working with this OB.
What’s right for you might not be right for your friends, and that’s ok!
OB or Midwife?
While an OB and a midwife both “do the same thing” – aka care for women through pregnancy and birth – their basic philosophies and approaches to that job differ vastly in general.
OBs tend to operate in a more medical frame of mind, opting for interventions and medical assistance in pregnancy and birth, while midwives are more likely to stand back and let the natural process of labor and birth happen, trusting mama’s body’s wisdom.
In the US, most births – 98% – occur in hospitals, and OBs attend the vast majority of those births. (If you’re like me and find that wild, check out this podcast for a quick overview of how we went from nearly 100% homebirths to nearly 100% hospital births within about 100 years 
)
The reality is OBs are trained surgeons who specialize in managing high-risk pregnancies and births which begs the question why the heck are low-risk mamas seeing a high-risk specialist? It seems like an irresponsible use of resources.
The old adage “when you’re a hammer, everything looks like a nail” comes to mind – if you’re trained to find problems to fix and you’re trained to use medications or surgery as the solution, you will find problems and use the tools you have in your arsenal to use fix them.
Unfortunately, the rise in licensure and certifications has created a rise in midwives who practice more within the framework of the medical model rather than in line with more traditional midwifery practices honoring the mother’s wisdom and birth abilities.
A traditional midwife is experienced in supporting true physiological birth, a birth free from medical interventions dictated by the mother’s body and the baby.
In the world of midwifery, there are a variety of titles you might see – CNM (certified nurse midwife), CPM (certified professional midwife), DEM (direct entry midwife), village midwife, traditional midwife, or lay midwife. I’m sure there are more, too!
Knowing that no provider is the same as any other, regardless of what they call themselves, data shows that OBs are more likely to rely on medical interventions that midwives, both in pregnancy and in labor and birth. A higher percentage of OB-attended births will see instrument-assisted deliveries or end in c-sections.
The choice in provider is not as binary as most think – you can choose to have your birth attended by an OB, midwife, neither, both, or another provider entirely (in some countries, a family practitioner will attend births).
Cost
Unfortunately, most insurance plans don’t allow for many deviations from the norm when it comes to birth choices. An OB-attended hospital birth is likely covered while a midwife-attended homebirth rarely is.
At the end of the day, finances often become a huge part of any life decision, birth included.
Many midwives are willing to work with mamas on financing options and plans while OBs typically don’t have much room to negotiate. Additionally, sometimes even with insurance coverage, hitting your deductible will cost more than a midwife outside of the system would have cost.
My midwife was expensive. We were hopeful we might be able to submit to insurance for some reimbursement, but my husband and I decided regardless, the cost was worth it to have the birth we wanted.
To me, there was no amount of money someone could pay me to birth in a place where I was uncomfortable or wouldn’t be respected as the authority.
So....OB or midwife?
I’m sure you’re picking up on a theme of my blog by now….the choice is entirely yours, mama. If you’re low-risk and seeking an unmedicated, hands-off birth, a midwife is likely your best option. If you’re high-risk or have no interest in letting the physiological process play out, an OB is probably your best provider (and my blog will probably annoy you 
).
Starting with the understanding of what you want birth to look like will make the decision of what kind of provider you want to hire much easier. Don’t skip the step of meeting with yourself before you meet with providers.
And remember, your medical attendant is just one piece of your birth team puzzle, a birth team that should be there to help your birth vision become reality.