Midwife vs OB-GYN: How Maternity Care Differs

Written by Igel Cudiera
Published September 7, 2026

A midwife and an OB-GYN are both qualified maternity care providers, but they are trained for different levels of clinical complexity. Midwives are licensed clinicians educated specifically in pregnancy, birth, postpartum and newborn care, and well-person gynecology, and their care centers on healthy pregnancy and physiologic birth. OB-GYNs are physicians trained in obstetrics and gynecology, including surgery, so they manage complex pregnancies, cesarean births, and complex gynecologic conditions. Many pregnancies involve both, and the right fit depends on your health history, how your pregnancy unfolds, and the kind of care you want.

"Which provider should I choose?" is really several questions stacked together: who is qualified to care for my particular pregnancy, where do I want to give birth, how much time do I want with my provider, and what happens if something changes along the way. This guide explains the differences in training, scope, and day-to-day care, and how the two professions work together, with a focus on how midwifery is licensed in New York.

What Is a Midwife?

A midwife is a licensed healthcare provider who cares for people through pregnancy, labor, birth, and the postpartum period, and who also provides gynecologic and reproductive health care outside of pregnancy. Midwives are primary care providers within their scope, not assistants to physicians.

Midwife-attended birth is more common than many people assume. The U.S. Government Accountability Office reports that midwives attended about 12% of U.S. births in 2021, and data compiled by the American College of Nurse-Midwives show births attended by certified nurse-midwives and certified midwives rising from 7.9% to 10.9% of all births between 2012 and 2022. Most of those births happen in hospitals, which surprises people who assume midwifery care only means home birth.

Within their scope, midwives:

• Provide complete prenatal care, including physical assessment and monitoring of you and your baby
• Order and interpret lab work, genetic screening, and ultrasound
• Prescribe medications, including contraception
• Attend labor and birth and care for the newborn immediately after birth
• Provide postpartum care, breastfeeding support, and early newborn care
• Provide well-person gynecologic care, family planning, and care across the reproductive lifespan

For a fuller picture of the role, see what midwives do across pregnancy, birth, and beyond.

What Is an OB-GYN?

An OB-GYN (obstetrician-gynecologist) is a physician (MD or DO) who has completed medical school followed by a four-year residency in obstetrics and gynecology, and who is typically board certified by the American Board of Obstetrics and Gynecology or its osteopathic counterpart. Residency covers both halves of the specialty: obstetrics, meaning pregnancy and birth, and gynecology, meaning reproductive health and surgery.

That surgical training is the clearest difference in capability. OB-GYNs perform cesarean births, operative vaginal births using vacuum or forceps, and gynecologic surgery, and they manage medical complications of pregnancy directly, from severe preeclampsia to placental problems.

Some OB-GYNs complete a fellowship in a subspecialty. The one families most often encounter is maternal-fetal medicine (MFM), sometimes called perinatology. MFM physicians focus on pregnancies with significant maternal or fetal complications and frequently co-manage care rather than take it over entirely.

OB-GYNs also care for many healthy, uncomplicated pregnancies, and physicians attend the large majority of U.S. births. Choosing an OB-GYN does not mean you expect complications.

Midwife vs. OB-GYN: Key Differences

Training and Credentials

How midwives are trained and licensed in New York

New York regulates midwifery closely, which is useful to know when you evaluate providers. The New York State Education Department (NYSED) licenses midwives, and using the title "midwife" in New York requires that license. To qualify, a midwife must complete a master's degree or higher in midwifery from an accredited or state-approved program and pass the national certification exam administered by the American Midwifery Certification Board.

Two credential pathways lead to the same New York license:

• Certified nurse-midwife (CNM): a registered nurse who completes graduate midwifery education
• Certified midwife (CM): someone who enters midwifery from a non-nursing background and completes the same graduate-level midwifery education and national exam

New York treats both as licensed midwives, and both appear as "LM" on New York birth certificates. Since November 1, 2010, New York licensed midwives have not needed a written practice agreement with a physician; they practice as independent clinicians and consult and refer as clinically appropriate. That is not true in every state, which is part of why midwifery looks different depending on where you live.

You may also encounter the certified professional midwife (CPM) credential, which is recognized in other states. CPMs are not licensed to practice in New York, so if you are choosing a midwife here, look for a New York licensed midwife. You can confirm any provider's license through the NYSED Office of the Professions online verification.

How OB-GYNs are trained

OB-GYNs complete four years of medical school and a four-year residency, then usually pursue board certification. Subspecialists such as maternal-fetal medicine physicians complete additional fellowship training. Physicians are licensed in New York separately from midwives, and board certification is a separate, voluntary credential.

Prenatal Care With a Midwife vs. an OB-GYN

The clinical content of prenatal care is largely the same across providers: blood pressure, urine checks, fetal growth, and the standard screenings at the standard intervals. What tends to differ is the shape of the visit.

Midwifery visits are usually longer. In our practice, we schedule 45 minutes per prenatal visit, which leaves room to talk about sleep, nausea, work stress, a previous birth, and what a lab result actually means. Physician prenatal visits in a busy practice are often shorter and more focused. That is not a criticism; it reflects how obstetric practices are structured, and for someone who wants efficient, competent care without a long conversation, it works well.

Continuity is the other difference worth understanding. Ask any provider how many clinicians rotate through the practice and who is likely to be at your birth. Some obstetric groups have many physicians in a call rotation, and some midwifery practices do too. A 2024 Cochrane systematic review of 17 trials including 18,533 women found that midwife continuity-of-care models were associated with fewer cesarean and instrumental births, more spontaneous vaginal births, and more positive care experiences. Most of those studies were conducted in high-income countries where midwives worked within collaborative systems with obstetric backup.

Labor and Birth Care

Yes, a midwife can deliver a baby. Attending births is central to midwifery practice, and licensed midwives are trained to manage labor, birth, immediate newborn care, and obstetric emergencies including postpartum hemorrhage, shoulder dystocia, and newborn resuscitation.

The main differences during labor are presence and scope. A midwife typically stays with you through active labor. With an OB-GYN in a hospital, nurses usually provide most of the bedside care while the physician manages the labor clinically and attends the birth. If surgery is needed, an OB-GYN performs it.

Where a midwife can attend your birth depends on credentials, practice model, and hospital privileges. A hospital-based midwife meets you at the hospital, a birth center midwife attends births at the center, and a home birth midwife comes to you. With an OB-GYN, you give birth in a hospital. If birth setting is the real question behind "midwife or OB-GYN," read how home birth and hospital birth compare, which covers safety evidence, eligibility, and transfer in detail. A midwife can also attend a planned hospital birth.

Midwives do not place epidurals; epidurals are provided by anesthesia clinicians in a hospital. A hospital-based midwife can care for you in labor if you choose an epidural.

Postpartum Care

Both midwives and OB-GYNs provide postpartum care, including checks on healing, bleeding, blood pressure, mood, and feeding, and a discussion of contraception. Midwifery practices often build in more postpartum contact, and some, including home birth practices, provide postpartum visits at home and early newborn care. After the postpartum period, either type of provider can continue your routine gynecologic care; many people continue seeing their midwife for well-person gynecology.

When an OB-GYN May Become Involved

Every midwife assesses your pregnancy continuously, and when a pregnancy moves outside midwifery scope, the midwife consults, co-manages, or transfers care. Situations that commonly prompt physician involvement include:

• Preeclampsia or gestational hypertension
• Gestational diabetes that requires medication
• A baby in breech position at term
• Twins or higher-order multiples
• Preterm labor
• Placenta previa or concerns about placental function
• Significant fetal growth restriction
• Prior cesarean, depending on the setting and circumstances
• Pre-existing conditions such as certain heart, autoimmune, or clotting disorders

Not every consultation means leaving midwifery care. A midwife may consult an OB-GYN and continue as your primary provider; care may shift to shared management; or it may transfer fully. Many healthy pregnancies never need physician involvement at all. Whether you personally need an OB-GYN alongside a midwife, and how consultation, referral, and transfer work in New York, is covered in do you need an OB-GYN if you have a midwife?

Can a Midwife and an OB-GYN Work Together?

Yes, and collaboration is the norm. The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) maintain a joint statement of practice relations describing OB-GYNs and CNMs/CMs as educated, trained, and licensed independent clinicians who work in mutual collaboration within team-based care.

In practice, that looks like a midwife calling a physician colleague about a lab result, a hospital midwifery service working alongside an obstetric service, or a home birth midwife maintaining relationships with the hospitals in her transfer area. In New York, Education Law §6951 requires every licensed midwife to maintain collaborative relationships with an OB-GYN, an obstetric physician, or a hospital for consultation, collaborative management, and referral. When you interview any provider, ask what those relationships look like; a clear, specific answer is a good sign. Holistic Midwifery New York was co-founded by Judy Ribner, DNP, CNM, and Joshua U. Klein, MD, FACOG.

Who Might Choose a Midwife, and Who Might Choose an OB-GYN?

Midwifery care may be a good fit if you:

• Have a healthy, uncomplicated pregnancy
• Want longer visits and a provider who knows your history
• Are planning a birth with minimal routine intervention
• Want the option of a birth center or home birth
• Value shared decision-making and want each recommendation explained
• Want continuity of care from a small team

An OB-GYN may be the better fit if you:

• Have a pregnancy that needs specialist care, or a chronic medical condition that affects pregnancy
• Are carrying multiples or have a known fetal condition
• Have a history of significant pregnancy complications
• Are planning, or likely to need, a cesarean birth
• Have an established relationship with a physician you trust
• Simply feel more comfortable with a physician, which is a legitimate reason on its own

Midwife vs. OB-GYN in New York: What's Specific Here

• One license, two credentials. CNMs and CMs are both "licensed midwives" in New York and are held to the same standard.
• Independent practice. Licensed midwives are not supervised by physicians and have not needed a written practice agreement since 2010, but they must maintain documented collaborative relationships and make that information available to patients.
• Prescribing. A licensed midwife certified to prescribe does not need a physician countersignature.
• Settings. Licensed midwives may practice in hospitals, clinics, birth centers, private offices, and clients' homes.
• CPMs. The CPM credential does not confer a New York license.
• Insurance. State-regulated health plans that cover maternity care must include the services of licensed midwives, though what you pay depends on your plan. See how insurance covers midwifery and home birth in New York and our insurance and billing page.

In New York City and on Long Island, families can generally find hospital-based midwifery services, birth centers, independent home birth practices, obstetric groups, and maternal-fetal medicine specialists, though availability varies by borough and insurance network. Holistic Midwifery New York is a team of four midwives serving families across New York City and Long Island, with offices in Brooklyn and the Five Towns; see the areas we serve.

Questions to Ask Before You Choose a Provider

• Given my health history, am I a good candidate for your care?
• How long are your prenatal visits, and how much of that time is with you?
• Who will attend my birth, and how many providers are in the rotation?
• What is your cesarean rate, and how do you calculate it?
• Under what circumstances would you consult a physician or transfer my care?
• If I transfer to a hospital during labor, what is your role after we arrive?
• How do I reach you between visits, and who answers after hours?
• What does your care cost, and how does my insurance apply?
• What does postpartum care include, and for how long?

For a deeper list, bring our 50 questions to ask when choosing a midwife to any consultation, including with an obstetric practice.

Common Questions About Midwives and OB-GYNs

Is a midwife a doctor?

No. A midwife is a licensed healthcare provider with graduate-level education in midwifery, not a physician. Some midwives hold doctoral degrees such as a Doctor of Nursing Practice (DNP), but they are not medical doctors and do not perform surgery.

Is a midwife or an OB-GYN better?

Neither is universally better; they are trained for different levels of complexity. Midwifery care is designed around healthy, low-risk pregnancy, while OB-GYNs also manage medical and surgical complications. The better fit depends on your health history, your pregnancy, where you want to give birth, and what you want your care to feel like.

Can I switch from an OB-GYN to a midwife during pregnancy?

Usually, yes. Many people transfer care during pregnancy, and practices differ in how late they accept transfers, so call and ask. Your new provider will request your records and review your history to confirm you are a candidate for their care.

Can I have a hospital birth with a midwife?

Yes. Most midwife-attended births in the United States take place in hospitals, and hospital-based midwives care for people who choose epidurals, inductions, and continuous monitoring, working alongside obstetric and anesthesia teams.

Can a midwife give me an epidural?

No. Epidurals are placed by anesthesia clinicians in a hospital. If you are cared for by a hospital-based midwife, you can still choose an epidural, and your midwife continues to care for you in labor.

What is the difference between a midwife and a doula?

A midwife is a licensed clinical provider who performs medical assessment and attends births. A doula provides continuous physical and emotional support but no clinical care. See midwife vs. doula for a full comparison.

This article is general educational information, not individualized medical advice. Recommendations about your pregnancy depend on your health history and clinical circumstances, which only a provider who knows your case can assess. Please speak with a licensed midwife or physician about your situation.

Sources

• New York State Education Department, Office of the Professions. Midwifery: License Requirements and Midwifery: Questions & Answers. Master's degree requirement, AMCB examination, CNM and CM titles, "LM" on New York birth certificates, independent practice, prescribing, practice settings, and removal of the written practice agreement requirement effective November 1, 2010.
• New York State Senate. Education Law §6951: Collaborative relationships.
• U.S. Government Accountability Office. Midwives: Information on Births, Workforce, and Midwifery Education (GAO-23-105861, April 2023). Midwives attended about 12% of U.S. births in 2021.
• American College of Nurse-Midwives. Access to Midwifery Care National Chartbook (PDF), using CDC WONDER natality data. CNM- and CM-attended births rose from 7.9% to 10.9% of all births, 2012–2022.
• American College of Obstetricians and Gynecologists and American College of Nurse-Midwives. Joint Statement of Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives.
• American College of Obstetricians and Gynecologists. Committee Opinion No. 697: Planned Home Birth. Obstetrics & Gynecology, April 2017 (reaffirmed 2020).
• Sandall J, Fernandez Turienzo C, Devane D, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 2024, CD004667.
• American Midwifery Certification Board. National certification for CNMs and CMs.
• American Board of Obstetrics and Gynecology. Board certification for OB-GYNs.