Although midwives and obstetricians both deliver babies, the similarities stop there. They are educated, licensed and compensated differently and usually work in different settings. There is sometimes friction between the two groups, as physicians see birth as safe only in a hospital, while many midwives support the concept that low-risk mothers can deliver at home. In addition, midwives and obstetricians compete for patients in many areas.
Obstetricians are physicians who complete the usual course of education: college, medical school and residency, which takes about 10 or 11 years. Many obstetricians also take advantage of an extended training position called a fellowship. Obstetricians are trained to manage both normal pregnancies and abnormal births that may need the use of forceps or other instruments to deliver the baby, as well as caesarian sections. Obstetrical training also includes extensive training in subjects such as surgery, fertility management, cancers of the reproductive organs and possible genetic problems. Obstetricians must be licensed in all states.
There are five different types of midwives: certified nurse midwives, certified professional midwives, certified midwives, direct entry midwives and lay midwives. Certified nurse midwives belong to a group of registered nurses called advanced practice nurses. Certified professional midwives are trained only in midwifery and regulated by the North American Registry of Midwives. Certified midwives must have a bachelor’s degree and midwifery training; they are certified by the American College of Nurse Midwives. Direct-entry and lay midwives are not necessarily nurses and are often trained informally.
Midwife Education, Certification and Licensing
Certified nurse midwives are educated in both nursing and midwifery; they must have at least a master’s degree. Certified professional midwives receive the same training as certified nurse midwives but are not nurses. Certified midwives must have a bachelor’s degree and midwifery training. Direct-entry and lay midwives may learn the profession through self-study, apprenticeship, a midwifery program or a college/university program. The education of a midwife may take about two years for a formal educational program, an indefinite amount of time for an apprenticeship or self-study or a total of six to eight years for a master's-prepared certified nurse midwife. The American College of Nurse Midwives and the North American Registry of Midwives are the certifying bodies for educational programs and professional certification. Only Oregon and Utah as of January 2013 do not require licensing for midwives.
Services and Work Settings
Both midwives and obstetricians provide primary care gynecological services to women of all ages. These may include family planning, preconception care for women who are preparing to have a child and pregnancy care including labor, delivery and post-partum care. Obstetricians limit their services to women, but midwives may care for a normal newborn during the first 28 days of life and may treat male partners for sexually transmitted infections. Obstetricians usually practice in private offices and hospitals, while midwives may practice in ambulatory care clinics, birthing centers, patients’ homes or their own homes. Many certified nurse midwives practice collaboratively with a physician or hospital, and often refer complicated or high-risk cases.
Risk and Salaries
In terms of risk, each group, obstetricians and midwives, has an infant mortality rate of about 1.7 per 1,000 births, according to a May 2009 article in “Time Magazine.” However, a low-risk birth can quickly become an emergency, so immediate access to a hospital is important. In terms of salary, obstetricians earned an average annual salary of $218,610 in 2011, according to the Bureau of Labor Statistics. The American College of Nurse-Midwives reports that CNMs and CMs earned an average of $114,152 per year in 2010, the last year a survey was conducted.
Beth Greenwood is an RN and has been a writer since 2010. She specializes in medical and health topics, as well as career articles about health care professions. Greenwood holds an Associate of Science in nursing from Shasta College.