Choosing an OB-GYN or Midwife

Pain Management

Is it true that I can't get pain medication or an epidural if I deliver with a midwife?

Many women are surprised to learn that CNMs can provide them with an epidural during labor. Certified nurse midwives delivering on the labor and delivery floor of a hospital have the same authority as OB-GYNs to order epidurals for their patients. (Neither CNMs nor OB-GYNs actually administer the epidural; an obstetric anesthesiologist does it.)

If a woman decides she needs an epidural while laboring in a hospital birthing suite, she will be moved to the labor and delivery wing. Midwives performing home births or delivering at a freestanding birth center cannot supply women with an epidural. All CNMs can, however, provide patients with pain relievers such as Nubain, Stadol, and Demerol. At your preconception visit, find out which pain medications the midwife can offer and her feelings about their use. The last thing you want while in labor is to discover that your CNM cannot (or will not) supply you with the pain medication you need.

Prenatal Visits

Assuming you are experiencing an uncomplicated pregnancy, your prenatal visits with an OB-GYN and a CNM will be very much the same. Both will schedule your appointments at similar intervals (roughly once a month until the 28th week, once every two to three weeks until week 36, and then once a week until you deliver). They will weigh you, listen to your baby's heartbeat with a fetal monitor, measure your belly, and test your urine for proteins and sugar.

Certified nurse midwives, like OB-GYNs, can order blood tests and lab work, refer you to specialists, and arrange for all necessary screenings and diagnostic tests. Both OB-GYNs and CNMs should inform you of both the benefits and the risks associated with some of these screenings and procedures.

Appointments with a CNM are generally longer than those with an OB-GYN. Skyrocketing malpractice insurance is driving many OB-GYNs out of the baby delivering business. This translates into busier days and tighter schedules for those still practicing. CNMs have traditionally put great emphasis on answering women's questions and providing them with comprehensive health and wellness information. That said, there are many OB-GYNs who are wonderfully thorough and spend quality time with their patients.