Hello Expecting Parents! If this is your first pregnancy, you have recently moved, or you just didn’t like your previous provider, you may be looking for a Midwife or OBGYN for your prenatal care. Here is some information to hopefully help you in that decision.
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Before you can decide on which provider you want to go with, you have decide on a couple of other things first. First, you need to find out what your insurance covers. Before you decide on a doctor or practice, first make sure they are covered by your insurance; otherwise, you will be stuck paying out of pocket.
Once you have an idea of what will be covered by insurance, you need to decide what type of birth experience you want. The most common option is a hospital setting which you would then want an OBGYN or a Midwife that works in hospital settings. If you would prefer to have a birth center or home birth, you will most likely want to select a midwife as most OBGYN’s do not perform home births. If you are not sure what type of birth you would like, check out my post titled Home, Hospital, or Birth Center.
Midwives are trained in normal, low risk pregnancies. The main difference between midwives and OB/GYN’s are that they cannot perform surgery, use forceps or vacuum extractions, and typically do not take as many patients at any given time. The appointments are usually 45-60 minutes long, resulting in very few people going over the allotted time. This leads to a much shorter wait time. Most people prefer appointments with a midwife, as they have more time to talk to you about the pregnancy, answer questions, and provide more support.
There are several different types of midwives in the US. I was able to find this information and more through a portal at the American College of Nurse Midwives website. They will then direct you to ourmomentoftruth.com for more details on the differences.
Certified Nurse-Midwife (CNM):
A CNM is licensed in Nursing and Midwifery. They have at least a masters or doctorate degree and are certified by the American College of Nurse Midwives (ACME). CNM’s are able to prescribe medications and provide care throughout all stages of a woman’s life, not just pregnancy, birth and postpartum. They provide services in hospital settings, birthing centers, private practices, or home births and account for most midwives in US.
Certified Midwife (CM):
CM’s are very similar to CNM except they have a bachelor’s degree in something other than nursing. They then continue on to a graduate-level midwifery program accredited by ACME.
Certified Professional Midwife (CPM):
CPM’s are certified through North American Registry of Midwives (NARM) and can go through an apprentice program OR formal education. The services they provide are more limited than a CNM – and are only able to assist with pregnancy, birth, and postpartum. They provide care outside the hospital in birth centers or home settings. But are not able to prescribe most medications.
An OB/GYN can do everything a midwife does, but can also perform surgeries and manage high risk pregnancies. Most OB/GYN’s practice in small or large group settings, but a small number work solo. At a private practice, you can typically expect your OB to have office hours 2-4 days a week, surgery 1-1.5 days a week, and management of labor and delivery.
To become an OB/GYN, you need a minimum of 12 years schooling & experience. That includes 4 years for a bachelor’s degree, 4 years for graduate degree, and 4-5 years of residency. They then have the option to continue on for an additional 3 years in a fellowship program, but approximately 90 percent of OB/GYNs begin practice after completing their four-year residency.
The downside to seeing an OB/GYN, is that they are typically much busier and your appointments are only about 15-30 minutes long. It is common to have longer wait times for your appointments for two reasons.
First, if the person before you takes longer than the allotted time, it rolls over into your appointment.
Second, OB’s can get called away for emergency situations throughout the day and there typically isn’t enough buffer in their appointments to make up this time. This is when it is important to find out how your OB’s office handles situations like this.
I understand the importance of an OB having to leave mid day. If it were me giving birth, I would want my doctor to be there. However, at my first OB’s office, they would just let you show up to your appointment KNOWING that they were running 2-3+ hours behind. My husband and I sat for 2 hours before I had to ask how much longer. They never let us know when appointments might be running behind.
After switching offices, I never waited more than 15 minutes, and if my OB had to leave for a delivery, they would call BEFORE HAND and let me know. They gave the option of waiting, or being seen the next day. The office was open from 9-4 but they reserved the time slots from 8am-9am and 4pm-5pm for last minute appointments.
Just because a lot of OB/GYN offices are terrible at scheduling, doesn’t mean they all are – you just might have to ask around and read reviews to find a good office.
When selecting your provider, here are some questions to ask:
- How many doctors are in their on-call rotation?
- My second office had two doctors at the practice and they partnered with another practice, also with 2 OB/GYN’s. The first office had 8 doctors that rotated; cutting my chances of getting my OB in half!
- Will they try to attend your birth during normal business hours, even if they are not on call?
- I didn’t know this was an option until I was reading reviews for my second OB. Even if they were not on call, they would try to reschedule a patient or run over during a break to deliver your baby if possible. This was so comforting to know that my odds of getting my own OB was now greater than a 1 in 4 chance.
- How many doctors at the practice?
- I feel like the less the better! I really enjoyed the family vibe going on at my second office. They even remember who you are; unlike the big practice I switched from.
- Look at reviews for the doctor AND office!
- I did not realize how important it was to have competent AND friendly office staff. I was literally SCOLDED like a child after waiting 2.5 hours and finding out they were still an hour behind. The appointment line was super long so I just called in the car on my way back to work. After being talked down to, I cried in my car and then found another practice that night.
- Ask friends for recommendations.
- I would recommend asking multiple people to get a list, but still do your own research to see who you think will be the best match for your individual needs.
While a midwife is an expert in routine, low-risk pregnancies, OB/GYN’s are experts in handling more challenging pregnancies. With a first pregnancy, it is hard to know what type of pregnancy you are going to have.
I had a perfect pregnancy up until 36 weeks. This is when they would transfer you to an OB/GYN if you’re not already seeing one. You can read more about my birth story here if you are curious. I had already switched providers once during my pregnancy and it was very stressful. The only thing that made it an easy decision is that I was not happy with my previous office. I couldn’t imagine having to switch that late in my pregnancy, especially if I loved my midwife.
If you do choose a midwife, it may be worth it to see if they commonly work with an OB and how that transition would work if needed.
I hope this helped lay out the pros and cons of each. Whatever method you decide to go with, make sure you are comfortable with your provider. It is so important to trust your midwife or OB. If it doesn’t feel like the right fit, don’t be afraid to seek out a new provider! It is never too late in your pregnancy to make a switch if you are unhappy.
If you are just getting started, or you are planning to switch, here are some helpful tips for finding the right provider.
Start by going to your insurance website and there should be an option for finding a provider. This should give you a list of providers in your area, what practice they are located at, and it may even tell you if they are accepting new patients or not.
When I switched to a different doctor, I was determined to find a highly rated one. I went through and copy/pasted each name into google and saw how many stars they had. Anybody with at least 4 out of 5 stars made it into an excel sheet. Once I had a list of about 10 people, I started to read the reviews on each provider.
Don’t forget to look at reviews for the practice in general! You want the office staff to be just as amazing as your provider. If they are rude, it’s hard to get an appointment, or it’s typical to wait for hours at each visit, it can really put a negative spin on your prenatal experience.
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If you prefer to listen instead of read, check out my podcast on this topic here.