A Short History of Birth in the US and how to Decide Between an OBGYN and a Midwife

How do you decide what kind of practitioner to see for prenatal care and birth?

Most women in our culture get pregnant and it’s a forgone conclusion that they start seeing an obstetrician and that they will deliver their babies in a hospital setting. However, midwives for centuries have been the primary method with which babies arrived in the world and midwifery is making a significant comeback.

Why? Here’s a short history of birth in the US:

In the post war years with sterilization becoming standard practice, there was a push to move labor from the home into the hospital under the assumption that it would make mothers and babies safer.

This transition essentially moved birth from the female domain to the male domain. Birth in this environment was seen less like a natural process and more like an emergency, with aggressive time lines and invasive procedures placed on laboring mothers. Meanwhile, midwives out in rural areas with little in the way of transport, equipment and medical training still had better infant and maternal mortality rates.1

Currently, the C-section rate in the US is approximately one in three2, a staggering number when compared with other industrialized nations.

It stands to reason that women report feeling like their births were managed for them or the decision to intervene with drugs and surgery was rushed.

The new research shows that women who feel comfortable with their birth plan, their birth partners and their environment will have shorter labor and less complications, and between 2004 and 2010, planned home birth rates went up a surprising 41%. 3 But let’s keep that number in perspective: 2004 saw .79 percent of moms giving birth at home, and by 2012, it grew to 1.28 percent.

According to a study published in the New England Journal of Medicine, it’s still statistically safer to have your baby in a hospital, but low-risk women who birthed at home had higher rates of spontaneous vaginal birth (93.6%)3

The medical community is starting to recognize the essential nature of comfort and control in successful birth, and so many hospitals employ midwives and have separate birthing centers with that aim. So for some mothers, being at the hospital with qualified doctors is that happy place. For others, it will mean being in the comfort of their own home with a midwife, a doula and their co-parent.

As soon as you conceive, you’ll want to start looking for a practitioner to care for you during pregnancy and the birth of your baby. Thankfully, we have the option of an obstetrician-gynecologist (ob-gyn), a family physician, or a certified nurse-midwife (CNM). Your choice will depend on a number of factors, including what kind of experience you want, where you plan to give birth, whether your pregnancy is normal or high risk, and what your insurance will cover.

If you have a medical condition such as high blood pressure, epilepsy, diabetes or heart disease, or had specific complications in a previous pregnancy, you will probably be considered high risk. In this case, you’ll need to see an obstetrician or possibly a maternal-fetal medicine specialist who specializes in high-risk pregnancies.

Be aware that if you start out with a midwife and develop a problem down the road such as premature labor, preeclampsia, or find out that you’re having twins, your midwife will transfer your to an obstetrician or perinatologist. In this case, you’re might consider getting a doula. For more on finding the right doula, check out our blog here: (insert blog link to How to Find the Right Doula)

Pregnancy and birth are complex yet elegant processes that have a mind of their own. In most cases, nature does what it is supposed to do. Midwives are the experts in normal birth – they know how to handle things like breech and identify things like stalls. It’s a truly rare event when a complication arises so quickly that a midwife cannot identify it and convey the mother to the hospital.

If you do go with the hospital birth option, make sure you ask questions about procedure, birth plans, birth partners and what the hospital’s polices are on medications, epidurals and Cesarean. Above all, make sure you are comfortable with the doctors and nurses in the facility because when you go into labor, whoever is on shift is you birthing team.

The most important consideration is your own piece of mind, and remember that all these decisions don’t need to be made right away. Take your time, do your research and talk to your partner so that you can arrive at the options that will help you bring your baby into the world with the most security possible.


  1. https://www.midwiferytoday.com/articles/timeline.asp
  2. https://www.statnews.com/2015/12/01/cesarean-section-childbirth/
  3. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract


About Susie Almaneih

Susie Almaneih spent several years during her young adulthood teaching children dance at her church group, as well as other cultural-based activities. Susie now spends as much time as she can giving back to the families in her community. Over the years, this love for community has evolved into a deeper love for delivering positive and creative content and awareness to families of all ages.

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