What's the Difference Between an Ob/Gyn and Midwife?

People looking for care during pregnancy may be surprised to learn that there are different options available. While patients may see a variety of clinicians depending on their unique situation and medical history, two of the most common are obstetrician gynecologists and certified nurse midwives.

An obstetrician gynecologist (Ob/Gyn) and certified nurse midwife (CNM) both provide prenatal care, deliver babies and offer postpartum support. Yet there are a few key differences between them. An Ob/Gyn is a physician with either an MD or DO degree who has gone to college, medical school and then completes a four year training in obstetrics and gynecology called a residency. A CNM has a bachelor’s degree in nursing in addition to a master’s degree, which requires clinical training.

A doula, often confused with a midwife, provides support before, during and after delivery but does not provide any medical care as they are a lay person. Their presence is evidence-based however and has been associated with lower rates of cesarean.

Prenatal care

Patients seeing a CNM may have more time with their clinician during routine prenatal visits. That allows midwives to focus on education and psychosocial issues that can impact pregnancy, however there is an increasing focus on this in Ob/Gyn care as well.

An Ob/Gyn may be a better fit for patients with a preexisting medical condition that makes them higher risk. Depending on the condition, some of those patients can still see a CNM for prenatal care if they wish, with the addition of visits with an Ob/Gyn, maternal fetal medicine doctor or other specialist.

“I think there's more overlap between OB and midwife practices than people realize and that really in a lot of places they work collaboratively,” said Sarah Cross, MD, chair of Obstetrics and Gynecology at Lawrence + Memorial Hospital and associate professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine.

Many practices include both Ob/Gyns and CNMs, allowing patients the opportunity to meet with both providers during their pregnancy.

“There's been a real shift from the old days where you would pick a specific provider, be it a midwife or a doctor, and that you would see that person for all your visits. So, most practices are now a group practice model, but that's generally the same for physicians and midwives,” said Cross.

During delivery

Lawrence + Memorial Hospital Certified Nurse Midwife Jennifer O’Day says a big misconception she hears is that midwives only do home births. In fact, many deliver babies in a hospital. Midwives stay with patients while they push, whereas patients seeing an Ob/Gyn may push more with a nurse. Midwives have more of a focus on natural delivery options, but their patients still have access to pain management medication including epidurals.

However, only doctors have the training and skills to perform cesarean births and operative vaginal births with a vacuum or forceps. Patients who previously had a cesarean can try for a trial of labor after cesarean (TOLAC) with a midwife (or a doctor). If cesarean is necessary, a doctor will be there to perform the surgery.

“We always have a doctor backing us up 24/7,” said O’Day. “The doctor would take over and do the cesarean. That said, we go in the operating room with our patients. We don’t just leave them high and dry and not see them again. We are also rounding on them after as well.”

Wellness visits

Pregnancy may be the first time a patient is interacting with either of these providers. But patients need routine care throughout their life, not just during pregnancy. Both Ob/Gyns and CNMs can see patients for wellness visits as well as important screenings like pap smears and sexually transmitted infection (STI) testing.

Looking for an Ob/Gyn or CNM? Find one here.