Written by Amy Howerska

After the initial euphoria (and sometimes shock) of discovering you’re pregnant, the next big thought might be: What type of pregnancy care is best? The two medical practitioners typically involved in pregnancy and birth are obstetrician-gynecologists (OB-GYN) and midwives, but what’s the difference? And do you have to choose one or the other?

OB-GYNs and midwives have different training and backgrounds, but both deliver excellent care before, during, and after pregnancy. Many (though not all) hospitals and clinics make you decide between the two instead of having them collaborate. As a result, some people may end up choosing an OB-GYN even though they’re interested in a midwife because they don’t want to lose continuity of care if any issues complicate the pregnancy. 

The truth is that you can have both an OB-GYN and a midwife on your care team. An OB-GYN and midwife collaborative care team is one of the core principles of care at Millie because it gets our patients the best of both worlds and can improve outcomes. We’re here to explain it all.

What is an OB-GYN?

An OB-GYN is a medical doctor who specializes in gynecology and pregnancy, which includes both prenatal and postnatal care. During four years of medical school and four years of residency, OB-GYNs become the leading medical experts in all aspects of reproductive healthcare for women and birthing people. 

In addition to being the most extensively trained clinicians in caring for birthing people throughout the entire reproductive lifespan (including pregnancy and birth), OB-GYNs are also skilled surgeons. This gives OB-GYNs a large focus as clinicians: They’re experts in providing gynecological care, managing more complicated pregnancies, and they have the knowledge and training needed to perform interventions when necessary — like cesarean sections (C-sections). Essentially, when there’s a complicated pregnancy or delivery that requires tough decisions and medical intervention, it’s the OB-GYN who directs care.

If someone’s pregnancy is considered high-risk* with anticipated complications, an OB-GYN may be best suited to provide care and close monitoring through labor and delivery. Some pregnant people who begin care with a midwife may be referred to an OB-GYN if their pregnancy becomes high-risk. Others may be assigned a maternal-fetal medicine (MFM) specialist from the beginning of their pregnancy. (MFMs are OB-GYNs with fellowship training in high-risk obstetrics.)

What is a midwife? And how are they different from OB-GYNs?

OB-GYNs and midwives bring different perspectives to the table, but they have the same overarching goal: healthy pregnancies, safe births, and healthy babies. Midwives are in particular known for their intimate knowledge of the labor process and their limited-intervention approach. They’re able to meet about 90% of the medical needs that come up during pregnancy and childbirth, which means they’re especially suited for lower-risk pregnancies.

There are different types of midwives, but all of Millie’s are Certified Nurse-Midwives (CNMs). CNMs are trained and licensed as both Registered Nurses and midwives as well as certified by the American Midwifery Certification Board. Their training and qualification mean they’re able to work at home births, birthing centers, and hospital settings (though all Millie births are hospital births).

Midwives have, unsurprisingly, been around longer than the modern doctor: The practice of midwifery can be traced back to Indigenous cultures during the Paleolithic era (40,000 B.C.!). It wasn’t until the early 1900s that midwives were largely replaced by white men in the fledgling field of gynecology, though we saw an increase in midwifery in the ‘60s and ‘70s. Between 2003 and 2018, the percentage of midwife-attended births in hospitals also rose by almost 12%.

In the U.K., as well as many other high-income countries, midwife-attended births continue to outnumber OB-attended ones. Although there are many factors that contribute to maternal mortality rates, it’s worth noting that the U.K.’s maternal mortality rate is less than one-third of what it is in the U.S. Increasing access to midwives has even been proposed to help eliminate racial disparities in maternal mortality in the U.S.

What are the benefits of having both a midwife and an OB-GYN?

We see the benefits of collaborative care play out in the research. First, we know that when midwives are involved in care, there can be lower rates of medical intervention overall, lower rates of C-section and assisted vaginal delivery, and higher rates of patient satisfaction.

Leveraging both midwives and OB-GYNs in a collaborative care model can also improve outcomes. Like midwifery care, we see fewer interventions and more patient satisfaction. We also see lower rates of neonatal ICU admissions. Collaborative care between a midwife and an OB-GYN has also been associated with higher rates of vaginal birth after C-section (VBAC).

Collaborative care between an OB-GYN and midwife gets you all the benefits of both clinical approaches, with a focus on limited interventions as well as deep medical training and surgical expertise.

Millie’s OB-midwife model

At Millie, our philosophy is three-prong: 1) everyone deserves a midwife, 2) everyone deserves an OB-GYN, and 3) everyone should have access to both. Millie patients with lower-risk pregnancies will receive all of their prenatal care with a midwife and meet with an OB-GYN when desired or necessary. Patients with moderate or higher-risk pregnancies will have care co-managed by a midwife and an OB-GYN. Between visits and throughout your care at Millie, the OB-GYN and midwife on your care team will be in constant contact to ensure you have all the support you need.

Our collaborative, holistic approach understands that excellent maternity care is about more than checking clinical boxes. Sometimes you’ll need the answers to questions about everything from pain management to the size of your areolas. Sometimes you’ll just want to talk to someone about being pregnant or about what to expect once the baby makes their big entrance (that first big poop can be a bit of a shocker). Your collaborative care team will always be there for you with far more than standard instructions and a “call me if you need me.”

Your care team also includes a practicing doula for one-on-one coaching and emotional support through pregnancy. Traditionally, doulas are hired outside of the clinic or hospital where care is being provided — meaning they may never get to talk to the healthcare providers on your care team. Because we know just how powerful doulas can be for better pregnancy and birth outcomes, we’ve integrated them into the Millie care model as guides and support people through pregnancy and postpartum. By incorporating a doula alongside your midwife and OB-GYN, all of your care providers will be on the same page.

At Millie, we’re on a mission to improve maternity care from the inside out. And collaborative care is the underpinning of the many ways we’re setting out to do that.

‍*Millie providers define “high-risk” pregnancies as pregnancies in which the person has either preexisting health conditions (for example, high blood pressure, diabetes, kidney disease, autoimmune disorders like lupus or multiple sclerosis) or pregnancy-related health conditions (for example, fetal birth defects or fetal genetic conditions, severe preeclampsia, twins or triplets, or gestational diabetes managed with insulin).

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