Congratulations! You just found out you are pregnant. Now what? I meet many pregnant people in my practice who are facing one of the most important decisions of their pregnancy journey: what type of health care provider is right for you, and how is a midwife different from an OB-GYN?

Let’s start with the basics

Midwifery care is a holistic and personalized approach to pregnancy, childbirth, and gynecological care. High cesarean rates and patient dissatisfaction nationally have motivated many people to look to midwives to receive high-quality care that respects their preferences and provides additional support and education as they navigate this life transition.  

But what is a midwife? How is a midwife different from other maternity care providers? And why do people choose a midwife? In this article, we will explore these questions and more, including questions to ask when interviewing a maternity care provider.

What is a Midwife?

A midwife is a trained healthcare provider specializing in sexual and reproductive healthcare. Midwives are experts in providing prenatal, birth, and postpartum care for people with low- to moderate-risk pregnancies. They also provide high-quality gynecologic care for people of all ages.

OB/GYN physicians, by comparison, are experts in the management of high-risk pregnancies, as well as the care of pregnant people with preexisting medical conditions.

How is a Midwife Different?

One of the key differences between midwives and other maternity care providers is their approach to care. Midwives are known for their evidence-based, personalized approach; they partner with their clients to make decisions with a client’s input and preferences in mind, using their experience and the available science to help people navigate their options. Midwives often spend more time with their clients than traditional OB-GYNs, focusing on building trust and providing emotional support throughout the pregnancy and birth process.

Midwives have expertise in supporting people through the birth process. They work to minimize interventions and medical procedures unless they are necessary. As a result, multiple studies have demonstrated midwifery-led care to reduce adverse outcomes and birth interventions and improve people’s satisfaction with their birth experience.

Why Do People Choose a Midwife?

There are many reasons why people choose a midwife for their maternity care. Some people are drawn to the personalized and holistic approach that midwives provide, while others are seeking a low-intervention birth experience. Midwives are also known for delivering excellent emotional support, which can be especially important during the childbearing year.

Other benefits of working with a midwife include lower rates of interventions and complications. Midwives are trained to recognize and manage complications, but midwives’ philosophy is that labor and birth are normal life processes. Midwifery care supports the normal unfolding of these processes while keeping a watchful eye out for complications. Midwives avoid interventions in the absence of serious medical complications and center the birthing person on shared decision-making about their care. This can lead to a safer and more positive birth experience.

Key Questions to Ask When Interviewing a Maternity Care Provider

If you are considering working with a midwife or other maternity care provider, it’s important to ask the right questions to ensure they are a good fit for you and your needs. 

Here are five key questions to ask when interviewing a maternity care provider:

1. What is your philosophy on pregnancy and childbirth?

This question can help you understand the provider’s approach to care and whether it aligns with your own values and goals. If you are interested in having a low-intervention birth experience, it is important to work with a provider who has experience and a philosophy that is consistent with supporting the normal birth process. 

2. What services and tools do you offer to enhance my prenatal, birth, and postpartum experience?

Some midwives offer extra services, such as group prenatal care, information about doula support, breastfeeding support, childbirth education classes, and/or waterbirth. If these are of interest to you, ask if the provider can help you access these tools.

3. What are my options for pain management in labor? 

Understanding the provider’s approach to and options for pain relief in labor can help you make an informed decision based on your own preferences for your birth experience. 

A common misconception is that midwives only care for people who want a “natural” birth without pain medications. While midwives do have additional training and enthusiasm for supporting physiologic birth, hospital-based midwives offer the full range of pharmacologic and non-pharmacologic tools for pain management. Midwives have no agenda when it comes to how you want to manage labor pain and support people in choosing pain medications if that is what they want/need. At Legacy, midwives offer laughing gas/nitrous oxide, IV pain medicine, epidurals, water immersion/birth, doula support, birthing balls/stools, and support for people staying mobile/upright during labor and birth.

4. What is your c-section rate? 

Some people will need a c-section to have their baby. The national average c-section rate in the U.S. is over 30%. The Legacy midwifery practice at Randall Children’s Hospital’s overall c-section rate for 2022 was 19%. This includes an 84% success rate for people attempting a vaginal birth after a previous c-section (VBAC). If you have had a previous c-section, and are interested in a VBAC, ask if the provider is supportive of people attempting a VBAC: do they recommend a c-section if labor does not start on its own? What is their rate of successful VBAC?

5. How do you handle complications? What happens if my pregnancy becomes high-risk or I need a c-section?

Midwives are trained to recognize and manage complications, and it is important to understand how your provider will handle any potential issues that arise during pregnancy or birth. Midwives in Oregon work with collaborating OB-GYNs and maternal-fetal medicine physicians, who are available 24/7 for consultation if pregnancy or birth complications occur, and who can assume care if the issue is outside the midwife’s scope of practice or a c-section is needed.

For more information about Legacy Medical Group Midwifery at Emanuel and St Helens and to make an appointment for a free 20-minute consultation today, call 503-413-4500 or visit www.legacyhealth.org