You've gotten that coveted positive pregnancy test. Congratulations! Now it’s time to make some choices about your pregnancy medical team — specifically the type of practitioner you want guiding you through the next nine months. Whoever you choose will play a big role in your pregnancy care and in the delivery of your baby.
But with so many options — an OB/GYN, a midwife, a family practice doctor, a maternal fetal medicine specialist (aka perinatologist) or some combination — how do you decide on the perfect pregnancy practitioner for you?
This guide breaks down the types of pregnancy doctors[1] and other practitioners so you can figure out which one is the best fit for your situation. As you weigh your options, keep your family history, health and priorities in mind. Having a clear picture of what you want out of your pregnancy and birth experience is important when it comes to choosing a pregnancy doctor or midwife.
What is a prenatal care practitioner?
A prenatal care practitioner is a medical professional who cares for expectant women for the duration of their pregnancies. This type of care is available from a number of different health providers, each with their own specific training and expertise.
Prenatal care practitioners are in charge of your appointments during pregnancy. During visits you’ll be weighed, have your blood pressure and urine taken, and get answers to questions or concerns you have about your baby and the many changes your body is undergoing.
As your pregnancy progresses, your prenatal doctor or midwife will also order ultrasounds and various other prenatal tests.
What are the different types of pregnancy doctors and practitioners?
The five main types of pregnancy doctors and practitioners include:
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OB/GYNs
Certified nurse-midwives
Direct-entry midwives or certified professional midwives
Family practice doctors
Maternal fetal medicine specialists or perinatologists
Here’s more on each kind of pregnancy practitioner and what to expect from them.
OB/GYN
If you select an obstetrician-gynecologist (OB/GYN), you’ll be joining the more than 90 percent of women who opt for this type of physician. An OB/GYN has a medical degree, post-medical school training solely in women’s reproductive and general health, and experience handling every medical aspect of pregnancy, from labor and delivery to the postpartum period, as well as any complications and twin pregnancies.
An OB/GYN also administers pap spears, contraception and breast exams. And because your OB/GYN can function as your primary care physician, they can continue to serve as your medical professional after the baby arrives. If you are among the 1 in 3 women who require a C-section, OB/GYNs are trained to perform those as well.
An OB/GYN might be right for you if you’ve had one over the years whom you already love, you have a high-risk pregnancy, or you want to have the option of using an epidural during childbirth.
OB/GYNs are more likely than midwives to use surgical or technological interventions during labor and delivery, though most still focus on trying for vaginal births unless medically necessary.
Certified nurse-midwife (CNM)
A certified nurse-midwife is a registered nurse who has completed accredited graduate-level programs in midwifery. They have also passed a certification exam administered by the American Midwifery Certification Board and are licensed by the American College of Nurse-Midwives to practice in all 50 states and U.S. territories.[2]
CNMs are trained to care for women who expect to have a low-risk pregnancy, and they work to provide individualized care with minimal technological intervention. Their focus is on reducing birth injury and trauma, on vaginal births and natural births (i.e. those without pain medication), and on avoiding C-sections if possible.
This type of midwife also handles primary health care needs, such as preconception advice, newborn care, family planning and treatment for sexually transmitted diseases (STDs).
A CNM often focuses on more natural approaches to labor, labor pain, and delivery (such as breathing techniques and hydrotherapy), and may be more likely than an M.D. to offer nutritional and breastfeeding support.
CNMs work in hospitals and birthing centers, though some also perform home births. In certain settings, they can prescribe epidurals and labor-inducing medication.
A certified nurse-midwife might be right for you if having a vaginal or natural birth is your number one priority (or you'd like to avoid a C-section unless medically necessary). Certified nurse-midwives tend to have much lower cesarean delivery rates and higher rates of vaginal birth after cesarean than physicians.
You may also opt to enlist a CNM if you’re on a tight budget (prenatal care costs with a CNM tend to be lower than with OB/GYNs). You can get info and help finding a midwife at Midwife.org.
However, you might need a doctor if your low-risk pregnancy turns high-risk (most CNMs do use a physician as a backup in case of complications because they don’t perform C-sections). And you may need to be transferred to a hospital from a birthing center if you want an epidural or need a C-section.
Direct-entry midwife or certified professional midwife (CPM)
Nearly all direct-entry midwives are certified professional midwives (CPMs), those trained in midwifery without a nursing degree like CNMs have. A CPM is often an independent practitioner who is educated via self-study, apprenticeship, a midwifery school, or college program separate from nursing.
CPMs must have experience delivering babies at home, as they perform those types of births much more than CNMs do. Some CPMs also work in birthing centers.
A CPM might be right for you if you are 100 percent set on having a vaginal, natural birth at home and you don’t have a high-risk pregnancy or any complications. You can find one in your area via the Midwives Alliance of North America.
Some CPMs are certified through the North American Registry of Midwives (NARM) while others are not, which affects where they can practice (currently, CPMs are licensed in 34 states and Washington D.C.).
With a CPM, families may receive less reimbursement from insurance for prenatal costs, and CPMs can’t prescribe medications or order lab tests, since state licensure is required.
Family practice doctor
If you go this route, you’ll essentially enjoy a one-stop shop for all your medical needs, since a family practice doctor is trained in primary care, maternal care and pediatric care. This means they can serve as your internist, OB/GYN, and even, when the time comes, your baby’s pediatrician.
This kind of practitioner might be right for you if you want the same doctor for all your and your family’s various health needs.
However, if complications crop up during your pregnancy and/or there’s a chance you’ll need a C-section, you’ll have to be referred to an obstetrician. Most family medicine doctors typically only oversee low-risk pregnancies and will transfer any high-risk cases to either OB/GYNs or maternal fetal medicine specialists (or both), including those that will likely result in C-section births, which family physicians usually don’t perform.
Maternal fetal medicine specialist or perinatologist
If you have a high-risk pregnancy, you may want to see or be referred to a doctor specializing in those types of pregnancies and pregnancy complications called a maternal fetal medicine specialist (MFM), or perinatologist.
This might happen if you're pregnant with twins or multiples; have a pregnancy complication like preeclampsia, placenta previa or HELLP Syndrome; have an IVF pregnancy; are under age 18 or over age 35; have had a history of pregnancy complications or preterm labor; or have a pre-existing condition like diabetes, a heart condition, or high blood pressure (to name a few).
Perinatologists are OB/GYNs who have completed an OB residency and then an additional three-year fellowship learning how to care for people with high-risk pregnancies.
An MFM may be in the cards for you if you're particularly high-risk or your doctor feels that your situation or complications warrant additional care and attention from a specialist. Some perinatologists deliver babies, while others stick to the prenatal care only and have OB/GYNs handle the actual labor and delivery.
How should you choose your pregnancy doctor or midwife?
As you're looking into the various options, ask yourself the following questions:
Are you at risk of any complications? Are you pregnant with twins or multiples? Do you have high blood pressure, a heart condition or diabetes? Are you at a higher risk of a pregnancy complication like preeclampsia or gestational diabetes?
Where would you like to deliver? Do you want to have your baby in a hospital, birthing center or at home?
Would you like a natural birth or one with pain medication? Think about whether avoiding medications during birth is important to you or if there's a good chance you'll want an epidural.
Think about what approach to prenatal care, testing, labor, medications and birth experiences you'd feel most comfortable with and choose a pregnancy doctor or midwife accordingly. Being well-informed about the various kinds of prenatal practitioners and what each typically does (or is certified to do) will help you find the right fit.
If you currently have an OB/GYN, take stock of your relationship. Do you feel comfortable having them handle your pregnancy and the delivery of your baby, or would you rather shop around for a new one? You may also want to factor in the hospital they're affiliated with, since that's where you'd be giving birth if you have a hospital birth.
You can also talk to other parents in your area, as well as your general practitioner doctor if you have one, for referrals and advice.
Should you hire a doula?
No matter which practitioner you choose, you might also want to consider hiring a doula as an add-on to your care. A doula doesn’t have medical training, but she’ll work with your OB/GYN or midwife as head cheerleader, providing emotional support during pregnancy, delivery and beyond.
A doula can be especially helpful if you want or need to go to an OB/GYN but are concerned about missing out on the more hands-on physical and emotional support midwives are known to provide. And that support goes for your partner if you have one too. Doulas also work to ensure that the non-birthing partner’s emotional needs are met during the birthing process.
Having a baby can seem daunting, especially when you’re a first-time parent. But the more informed you are, the better you’ll be able to make the right choice about what kind of pregnancy doctor will guide you through those monumental nine-plus months and bring your beautiful baby into the world.
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