Midwives and obstetricians care for pregnant women through pregnancy, birth and the postpartum period. Educational requirements, work settings and responsibilities differ between the professions. Choose the career that is right for you based on whether you want to work in hospitals, birth centers or homes, while considering the length of professional preparation required for each position.
Obstetricians are highly trained surgeons who assist in the birth process and do surgery in births when necessary. They are required to attend undergraduate school, earn a doctorate in medical school, take a medical licensing exam, complete a residency and sit for a board certification exam in obstetrics. Obstetricians normally work in hospitals or supervise birth centers. In solo private practices, obstetricians have a good deal of control over daily scheduling, while large group practices require fast-paced days packed with as many patients as possible. Obstetricians who work in hospitals rely on nurses for labor support of the birthing mother and generally only assist with the actual delivery of the baby, whether vaginal or surgical. Obstetricians sometimes care for high-risk patients who are not good candidates for midwife care, such as those with pre-ecclampsia or uncontrolled gestational diabetes. Obstetricians also provide well-woman care to nonpregnant women on a regular basis.
Perinatologists are obstetricians who undergo additional training and board certification in caring for very high risk pregnancies, including those involving vasa previa, placenta previa, twins and multiples, mothers with serious pre-existing conditions and those involving serious birth defects. These highly trained surgeons must keep track of several risk factors at once and become very adept at surgical birth in stressful life-or-death situations. They work in technologically advanced clinic and hospital settings and communicate often with regular obstetricians, Neonatal Intensive Care Unit staffers and medical specialists such as oncologists, endocrinologists and cardiologists. Perinatologists do not focus on well-woman care, unless it is part of caring for a woman who is already in the middle of a complicated pregnancy
Certified Nurse Midwives
Certified nurse midwives, also known as CNMs, care for women with low-risk pregnancies and assist in normal vaginal births in all 50 states. They must earn a two- or four-year nursing degree, followed by a master's degree in midwifery, before they can begin caring for childbearing women. CNMs normally work in hospitals or birth centers, with a few also providing home birth services, though their training is not specific to out-of-hospital birth settings. CNMs who work in hospitals have similar demanding schedules and caseloads to obstetricians, while those working in birth centers or homes have a bit more control over how many clients they take on at once. CNMs who work in hospitals normally rely on nursing staffers for labor support, while those in birth centers tend to stay with the laboring mother during her entire labor and birth. Many CNMs also provide well-woman care to nonpregnant women, such as pap smears and basic blood panels.
Certified Professional Midwives
Certified professional midwives, also known as CPMs, are the only certified birth professionals specifically trained to provide care to birthing women in the out-of-hospital environment. They care for low-risk pregnant women in homes and birth centers in the 41 states where their practice is not illegal. They normally stay with a woman at home during her entire her labor and birth, returning to visit her for postpartum care a few days after the birth. CPMs monitor blood pressure, blood sugar, hemoglobin levels, fetal heart tones and bleeding, and perform minor suturing, care for the newborn and offer lifestyle guidance for birthing women. In some states, the scope of practice for CPMs also includes well-woman care, including pap smears, blood work and breast exams. CPMs train for three to five years as apprentices working under experienced midwives, attend numerous births and then sit for a certification exam designed by the North American Registry of Midwives.
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