Picking a provider for pregnancy can feel as overwhelming as picking out a name for your baby. Afterall, the care and advice you receive will greatly influence the health and experience of your pregnancy.
I wanted to share about the difference in my experience with a midwife vs OBGYN. I used an OBGYN for my first pregnancy and the second time I used midwives.
I had a lot of hesitation during my first pregnancy to choose midwifery due to my lack of knowledge about it and my NICU background.
I could not be more thankful for my choice to go with midwifery care for my second pregnancy.
In this post, I want to highlight the differences in my personal experience in the two routes of prenatal care. I hope it helps make the decision easier for you, whatever that may be.
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Midwife vs OBGYN
There are a lot of ways the midwifery model varies from an OBGYN in how they provide care for a low risk pregnancy.
I noticed it in the level of invasive tests they ordered, the time spent with me at each appointment, and the focus of each appointment.
Let’s get into the specifics.
1. No pelvic exams
During your first appointment with an OBGYN, there will likely be a pelvic exam for a pap smear and swab for STDs.
It is routine to test for STDs during prenatal care in both the midwifery model and at an OB.
You can test for every STD other than HPV using blood or urine so a pelvic exam is really unnecessary. If you would rather wait until after pregnancy to get a pap smear this is more likely to be accommodated in the midwifery model of care.
I personally enjoyed not having the stress of spreading my legs and being probed around by a provider during my prenatal appointments, especially since my partner and lifestyle hasn’t changed since my last pregnancy.
My midwife also did not do cervical checks starting at 36 weeks like I experienced at the OB.
2. Less pressure about vaccines
Now the CDC recommends pregnant women to get both a flu shot and a Tdap vaccine during pregnancy.
I wrote in depth on the ingredients of the Tdap vaccine and how this can affect the health of your pregnancy.
You are likely going to get educated and re-educated by an OBGYN group on why you should get these vaccines. I have even heard some horror stories of women being thrown out of a practice for refusing them.
You are less likely to be pressured on this topic from a midwife however I recommend bringing this up at the very beginning no matter what provider you choose so you can be transparent and don’t run into any problems in the future.
3. More Nutritional Counseling
One of the main focuses at my midwife visits was documenting my diet and nutrition coaching. They gave me a folder that contained a list of recommended foods at the beginning of pregnancy.
I was advised to eat a high protein diet.
Not once did my OBGYN ask me about my diet during my first pregnancy.
Many midwives will require their patients to stay within a certain BMI range to start and continue care with them because being obese makes your pregnancy higher risk.
I found it helpful to have the accountability checks at each of my appointments. I followed the high protein diet recommendation for the majority of my meals and ended up gaining only 28 pounds compared to the whooping 50 I gained with my first pregnancy.
4. Physical Activity Counseling
Exercise was another area of focus that came up during every midwife appointment which was not discussed at the OBGYN.
At my first appointment, I was given a folder that contained lists of recommended exercises during pregnancy as well as stretching routines that encourage the baby to get in optimal position at the end of pregnancy.
I reported my physical activity to my midwives at every appointment.
5. Less Medical Tests
When you go to an OBGYN for prenatal care, there is a more extensive regimen of tests that everyone gets despite their medical history. These include vital signs, frequent lab draws, weight checks, fetal dopplers, gestational diabetes screening, ultrasounds, pelvic exams, and urine dipstick for glucose, protein, and bacterial infection.
At a midwife, they did vital signs, weight checks, and a urine dipstick for protein and glucose at every appointment.
I chose to skip the ultrasound to reduce the exposure my baby had to EMF. We monitored the heart rate using a fetoscope or doppler later on in the pregnancy.
I was tested for gestational diabetes at my 28 week midwife appointment by simply eating a prescribed meal that contained 50 grams of carbs and then checking my blood sugar with a simple finger stick an hour later.
Monitoring for GD this way was a blessing compared to chugging Glucola which contains high fructose corn syrup, flavoring, and dye. I would never eat any of those chemicals in real life so it seemed strange to me to use them as a gauge on how my body handled simple sugars during pregnancy.
I went for labs once in the beginning of my pregnancy to test my blood for all the routine blood tests the OBGYN would order.
At the 28-week appointment, while taking my blood sugar they also took a drop of blood for my hemoglobin level to make sure I wasn’t anemic.
One more finger prick was done at the 36-week appointment for hemoglobin.
6. Personable appointments
My personal experience with prenatal care at an OBGYN felt cold and objective. I never saw the same doctor in a row and didn’t know which person would be delivering my baby. I was asked a routine set of questions and then the doctor left the room quickly.
At my midwife appointments, we spend 30-45 minutes just chatting about my personal life in addition to asking me about my diet and lifestyle. I truly saw how the midwifery model of care involved caring for the health of the whole mind and body of a pregnancy women.
It felt much more like a natural process verses a medical condition. My son was also welcomed and treated with respect at every appointment. There were toys for him to play with at the office and he very much looked forward to going to the appointments.
I had my first baby with an OBGYN before COVID. I can’t imagine how I would have managed trying to get care for him at every appointment in an OBGYN office with my husband deployed.
This baby came during the middle of the 2020 “pandemic” and yet my prenatal care felt as normal as can be using the midwifery model of care.
There were no masks, we developed a relationship, and even hugged each other towards the end of pregnancy.
It was wonderful and I know that would not have been my experience had I chose to go with an OBGYN.
7. Less Restrictions During Labor and Delivery
There are so many differences in the way you are allowed to labor with a midwife verses in the hospital with an OBGYN but I would like to point out just a few.
When you deliver on a labor and delivery floor, you are more likely to be placed on continuous fetal monitoring making it difficult to move around and stay active during labor.
As short as a few years ago, laboring women were placed on dietary restrictions as severe as nothing by mouth. When I had my son a few years ago, they had loosened the restrictions a bit and allowed for a clear liquid diet.
Labor is a marathon and women’s bodies still need nutrition to be able to function optimally, so I really enjoyed being in control of what I ate during labor.
Low risk women laboring with midwives are less likely to have interventions and complications during birth. (source) Perhaps this is due to the fact that you are less likely to be rushed with a midwife whereas, once you check into an OB ward, you are usually placed on a timeline for labor progression.
Lastly, it is more common to push from a laid back position when an OBGYN is delivering your baby. This gives them the opportunity to have more control over the baby’s exit and your perineum however, it is less than optimal for opening the pelvis, and more likely to lead to tearing.
Midwives generally allow women to listen to their bodies in the position they want to birth which leads to less time pushing and less perineal tears since the woman has more control and feeling. (source)
If this is your first pregnancy and you are struggling to choose between midwifery care and an OBGYN, you may consider choosing a birth center that is connected to a hospital.
Another great option is to use a Nurse Midwife which is an advanced practice nurse and can provide a hybrid approach because most of them deliver babies in a hospital setting.
If you have a low risk pregnancy, and are willing to eat a healthy diet, stay low stress, and exercise, you would likely be able to enjoy the home birth experience. You can read about mine here.
I have to omit that I enjoyed my midwife care so much more than the medical model and I am sure my bias comes out in my writing but I hope this information helps you in some way with your decision for prenatal care.