Did you know that in Ontario, you have the choice to see either an OB-GYN or a midwife for primary care of your pregnancy?

But how do you know which of these two options is best for you and your pregnancy? First some differences and similarities.

Midwives are health-care professionals who provide government-funded expert primary care to pregnant people and their newborns. Through pregnancy, labour, birth and the first six weeks after birth, you will be cared for by a small group of midwives. This continuity of care means that you are likely to know the midwife who delivers your baby.

As midwives are experts in low-risk pregnancy and birth, midwifery clients will not see an OB unless there are concerns or complications. If complications arise, midwives can consult with an OB or, if necessary, transfer a client’s care to one. If care is transferred, midwives continue to support their clients and resume primary care when it is possible. You don’t need a referral from a doctor to have a midwife; just contact your local clinic directly.

While there may be a common misconception that midwives are only for home births, that’s not all they do! However they are the go-to choice (only choice) if you plan on having a home birth. About 80% of their deliveries happen at hospitals. Midwives view birth as a normal physiological process and not a medical event. They use a combination of nonpharmaceutical and medical comfort measures throughout labor and delivery. Throughout their care they also recognize the parents as the primary decision makers when it comes to their care and practice informed consent throughout the pregnancy, birth, and postpartum periods. Informed consent is the process of explaining all advantages, disadvantages, and risks associated with any one thing and ensuring the individual is informed on all sides of a decision in order to make the best decision for themselves and their family.

While I love a midwife, OBs have their place. Midwives are the experts on normal, low-risk pregnancy, so it makes sense that the OBs would handle all the rest. That would include anything labeled as a high-risk pregnancy for example someone with hypertension, diabetes (T1 or T2), and sometimes multiples. OBs also are trained surgeons, meaning they have the ability to use forceps, vacuum, and perform C/Sections; all of which midwives are not allowed to do.

While under OB care as well it is important to note that they will most likely not be the one delivering your baby either. While under OB care the one delivering your baby is whoever is at the hospital you’re delivering that day. This could luckily be your OB that you’ve been seeing for the past 9 months or a completely random one from a different clinic. Compared to midwife care where you will likely meet all, if not most of, the midwives in the group before labor and unless your midwife is at another birth or not on call that day, your midwife or someone you’ve already met will be the one delivering your baby.

For the postpartum period, those six weeks also have some differences in care. Midwives see both the birthing person and baby during that time with a mix of at home visits and clinic appointments. The OB is generally just one appointment at the six week mark in the clinical setting and either a pediatrician or the family doctor sees the baby after the hospital stay and the birthing person is only seen if they make an appointment with their family doctor for themselves or an earlier appointment with the OB.

In terms of care during the pregnancy; midwives are generally reachable by their patients at any time for serious inquires. The patient would page the midwife with their question or concern and the midwife will get back to them providing advice on what to do or go to the hospital where they will meet them for care. For an OB as a patient you will need to either wait until office hours to call and speak to a staff member or head right to the hospital to get checked out by the OB on call. Midwife appointments are generally longer than an OB appointment as well. This means there is more time to ask questions and more opportunity for individualized care.

With knowing all of this, what is the best choice for you?

If you are someone that would be considered high risk during your pregnancy, then chances are you will end up with an OB. However, for someone who is considered low-risk and healthy you have more of a choice. The top three things to consider when making the choice is first what kind of birth are you hoping for, secondly what kind of care throughout pregnancy are you looking for, and third what does your support system look like postpartum.

I say those three things because those are the main areas where the OB and midwife differ. If you are hoping for a home birth, choose a midwife because OBs do not perform home births. If you are hoping for an unmedicated birth either an OB or midwife will do, make sure to have a doula with you to give you your best chances. If you want an epidural either are a good option as well.

For the second point, if you want care that is more individualized and want to build a one-on-one relationship then choose a midwife. Both OBs and midwives have the ‘risk’ of not being present at your birth, but with an OB it is more likely that it will be someone you haven’t met before. However, with an OB it is generally nurses and your partner and doula that you interact with during your labor and they are only there for the final bit, so if it doesn’t bother you having the hospital room mostly to yourself and occasionally being checked in on by the nurse until the end then choose an OB.

For the third point, if you have an amazing support system of family, friends, a postpartum doula, etc. then an OB can be a good option. With an OB if you’re discharged before the 24 hour mark then you have to go back to the hospital for things like hearing testing and the heel prick labs; if you are confident that you have the support to do this then an OB could be a good choice. The next time baby is seen is at the 7-10 day mark by the family doctor or pediatrician. If you aren’t worried about that and have the support, OBs are a good choice.

On the other side of that, If you don’t have as amazing a support system, or it’s your first child and are more anxious the multiple well visits at home from your midwife may be more reassuring. Midwives are also more educated on breastfeeding and can provide support in those early days or refer to a IBCLC as needed. With a midwife you are more likely to be discharged early from the hospital and are seen at the 24 hour mark, 3 day mark, and 5-7 day mark at home then seen at regular intervals at the clinic. The hearing test is done in the community for an appointment time that you schedule with them. If you want or need the extra support postpartum then a midwife could be the option for you.

Which would you choose, and why? Let me know! Did I miss anything?