OB-GYN or Midwife, Hospital or Home? We Help You Decide

When it comes to giving birth, you have a lot of options—and that might feel overwhelming. Depending upon where you live, you can probably choose your care provider and place of birth. Read on to learn more about all the choices ahead of you and to decide what will work best for your family.

Choosing Your Care Provider

In the United States, two different types of providers are trained to assist people giving birth. One type, OB-GYNs, are doctors with a specialty in obstetrics, the branch of medicine and surgery focused on childbirth, and gynecology, which is focused on female reproductive care. OB-GYNs, sometimes referred to simply as OBs, are most often trained in the medical model of childbirth, a school of thought centered on preventing and treating complications, and deliver babies in hospitals. OB-GYNs are trained to deliver babies vaginally and also surgically—that is, via Cesarean section. While most OB-GYNs are MDs who have completed residency training in specialized OB-GYN programs, some doctors of osteopathy or DOs also do residency training in obstetrics and gynecology, and some family physicians deliver babies and have the training to do surgical births.

Another type of care provider is a midwife. In the US, midwives attend births in hospitals, birth centers, and in birthing people’s homes. There are several ways to become a midwife. Certified Nurse Midwives or CNMs have been to nursing school and are advanced practice nurses, while Certified Professional Midwives or CPMs are trained via midwifery schools and apprentice programs. You are more likely to find a CNM in any birthing location, while CPMs tend to support birth in out of hospital settings. Midwives usually follow the midwifery model of care, which treats childbearing as a normal process and avoids interventions unless they are medically necessary. Midwives often work collaboratively with and refer more medically complex and higher risk cases to OB-GYNs.

You may already have a care provider whom you see for well-person care. If they deliver babies and you’re happy with the place of birth, you could easily decide to stick with them for your pregnancy care. It’s also okay to speak with several care providers and choose who you feel is the best fit for your birth. As we’ll discuss in the next section, your choice of care provider is closely linked to your choice of birthing place.

Hospital, birth center, or home?

Hospitals are where most babies in the US are born. Some babies are born in large hospitals, while others are born at small hospitals. You might choose to have your baby in the hospital if it makes you more comfortable, you must do so because you have a complicated pregnancy, or you are expecting a baby with a health complication. In many hospitals, you have access to the full range of pain medication that can be used during labor and delivery, including epidural anesthesia, and the availability of a C-section if you want or need one. If your baby is born in a hospital, either a medical doctor or a certified nurse midwife will likely assist you.

Birth centers have sprung up across the US, and they are generally staffed by midwives and nurses. You might choose a birth center if you have a low-risk pregnancy and if you are planning for an unmedicated birth—though many birth centers offer access to some pain relief options such as nitrous oxide, also known as laughing gas. Some birth centers are in standalone buildings and some are adjacent to or even in the same building as hospitals. Good birth centers are prepared for emergencies during and shortly after baby’s birth and have a collaborating relationship with a local hospital in case you need to transfer your care there.

Like birth center birth, a home birth might be a good choice for you if you are low risk and plan not to use medication to cope with the discomfort of labor. To plan for a home birth, you must find a midwife—or midwifery team—who attends home births. You would then likely see that person or team for all your prenatal care, either at their office or in your home. Leading up to the birth of your baby, you and your midwife will prepare your home for birth with appropriate supplies. When the time comes to give birth, you stay home and the care team comes to you. Like the midwives at birth centers, home birth midwives are prepared for emergencies and often have collaboration agreements with local doctors and hospitals, should more complex medical care be required.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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