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Doctor or Midwife:
Which Would You Choose?

woman contemplating w thought bubbleSomeone asked this question on cafe mom. At the moment I did not have the time to answer it and when I went back I couldn’t find the question, so I’m answering it in this post.

The short answer is: the initials after a person’s name do not signify the quality of care they provide. You want an ob provider who is medically competent and with whom you feel comfortable asking questions. These can take the form of either a doctor or a midwife. If you want the detailed answer, read on:

What is the difference between a doctor and midwife? 

A doctor has a medical degree and training (4 yrs college + 4 yrs med school + 4 yrs ob-gyn residency). A certified nurse midwife has a regular nursing degree plus two to three years’ additional training in “low-risk” obstetrics. Often midwives are previous ob nurses who, after years of working as a nurse decided to make the transition to certified nurse midwife and become a baby catcher.

A midwife who was a labor nurse in “her previous life” often has loads of experience managing pregnant women–”low” and “high” risk–sometimes 10 or 20 years.

The Person, Not the LettersHospital worker in Maternity ward

As in any field, it’s not the letters after the  name that make a person a good practitioner. Bet you can’t tell if this woman is a doctor, midwife, or labor nurse just by looking at her. She could be any of the above.

Who is “nicer”–doctor or midwife?

I’ve known several doctors who I thought were terrible and midwives who I thought were extremely competent and (even better practitioners than some doctors). The reverse is also true: I’ve known many wonderful doctors and some truly horrifying nurse midwives.

The degree does not make the person.

You have to evaluate whether you’re a match with your ob provider by how comfortable you feel with her credentials, her knowledge base, her demeanor, and her bedside manner.

Are you more likely to have a c-section if you see a doctor?

Maybe. Since doctors are able to perform c-sections (and mid-wives are not) they offer them more readily to their patients. A midwife who’s labored with you for 12 hours may have more emotional investment in your labor and be less likely to abandon the attempt at vaginal birth to call her physician back-up in to do a c-section.

Doctors also bear the brunt of the malpractice risk: people don’t sue midwives, they sue doctors. So doctors may be more likely to practice defensive medicine for fear of being sued. When an obstetrician is sued it is usually for “not doing” a c-section, rather than”not doing” a vaginal birth. The combination of defensive medicine and patient choice cesarean has led the c-section rate to skyrocket to over 31% from 26% in the past ten years. History check: the c-section rate in 1970 was 5%.

So now, who will you pick and why?

My first baby was delivered by a doctor, someone who I really enjoyed working with. My second baby was delivered by my best friend, an outstanding certified nurse midwife. Both births were wonderful experiences (and yes, I did get epidurals for both).

What was your birth experience like with a doctor? with a midwife?

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{ 7 comments… add one }

  • Pam February 5, 2009, 9:03 pm

    An age old debate.
    It is difficult to choose. A midwife means ‘with woman’ and as a rule work in partnership with women. Midwives have a duty to empower women to believe that normal birth is achieveable and is safe. Midwives are best in the role of being soley responsible for normal pregnancy which proceeds to normal vaginal birth without complication and being responsible for normal uncomplicated postnatal period. Unfortunately as argued by medical staff ‘normal’ can only be diagnosed in retrospect it cannot be assumed to be anticipated.
    The medical perspective is to anticipate and plan for the worse case senario and the concept of “Foreseable harm”, which was first coined by Justice Benjamin Cardozo in 1916 serves as the basis for all mal practice suits in the U.S. reinforces that attitude. This attitude of lawyers makes pregnancy and childbirth incredibly complicated for those responsible for delivering care.
    I work in an entirely different system and value myself as an autonomous practitioner in my own right and I am no doctors ‘hand maiden’ to provide all the one on one support and then have someone in a white coat swan in at the last moment ‘catch’ the baby and then leave me to clean up.
    I believe there is room in the U.S. system for midwives but only with adequate legislation, governance, and professional bodies in place to monitor training and professional development. An obstetric nurse may have 10yrs experience working in a hospital but believe me it is no substitue for actually being responsible for someones care, identifiying deviations from the normal and then ensuring that the correct referral is made at the correct time.
    I had 10yrs labour ward experience in the UK before coming out to New Zealand but to actually carry a caseload of 50-60 women a year provide 24hr/7days a week on call and only have 2 obstetricians to work with on a unit which takes care of 500 women a year was a different matter.
    The obstetricans did 1 in 2 on call and I was only expected to call them when i had a real problem they expected me to already have done blood work already know that we would be going to theatre so they would meet me at the theatre door ready to go. I had no room for error and I could not call them out on a whim.
    Being married to a Doctor makes for some interesting debates in our household on the subject of pregnancy and childbirth mostly we agree but there are times when we have to agree to disagree.
    This is a good post it raises some interesting points and i don`t envy anyone having to make the choice, what i firmly believe in is informed choice and then the person taking responsibility for that choice.
    We can all make a judgement in retrospect.

    • Shelley Binkley February 6, 2009, 10:08 am

      @Pam–Wow! Pam thank you so much for the insightful and thought-provoking comment on this issue. I guess the history of obstetrics in the U.S. is that it took the approach of seeing pregnancy as a disease state rather than as a normal extension of women’s health. I think that accounts for the patriarchal approach to pregnancy in the U.S. vs. in Australia, New Zealand and other countries. I’d like to do more research into learning why the medical model for pregnancy dominated the evolution of obstetrics in the U.S. vs. in other developed nations during the 1900′s. More on this later…..

  • Tony Spencer March 2, 2009, 7:37 pm

    Doctors also bear the brunt of the malpractice risk: people don’t sue midwives, they sue doctors. So doctors may be more likely to practice defensive medicine for fear of being sued.

    This may sound silly but I wonder if any patients have ever signed a contract indemnifying the doctor performing the delivery in advance so as to minimize the risk of unnecessary c-section. It seems reasonable enough to me for mothers and fathers that feel strongly enough about the merit and professional history of a doctor they’ve interacted with in the months preceding the birth.

    • Shelley Binkley March 4, 2009, 7:37 pm

      @Tony It’s not a silly question. An indemnifying contract for doctors would be unenforceable in most if not all states. Even if a person “signs on the dotted line” as with any informed consent document, this does not indemnify the healthcare provider against “malpractice” claims. TY for the feedback, very interesting.

  • Tony Spencer March 4, 2009, 7:45 pm

    Ah I see. Hmm. Perhaps we need some new legislation that will allow for the doctor and clinic to be protected if the patient chooses to sign a contract. Tort reform never seems to get any legs in this country though so I won’t hold my breath.

  • Tony Spencer March 4, 2009, 7:50 pm

    But perhaps this rise in c-sections is attributable to good doctors just doing their part to prevent cerebral palsy. *wink wink* :)

    • Shelley Binkley March 5, 2009, 8:18 am

      @Tony I’m really glad you brought up that point! Here are the statistics: Although the c-section rate has risen from 5% in 1970 to 31% @ present time, the incidence of cerebral palsy has INCREASED, not declined. A lot of research has been done on C.P. and the weight of evidence shows C.P. is most often caused by prematurity and intrauterine “events” that occurred prior to the onset of labor. Less than 1% of cerebral palsy has been found to be attributable to intrapartum asphyxia (lack of oxygen during labor). C-section during labor for “abnormal fetal heart rate tracings” has NOT reduced the incidence of cerebral palsy. TY for the stimulating comment–you gave me an idea for another blog post! Please keep commenting and asking questions.

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