OBs vs. Midwives vs. Family Doctors - Which to Pick?
You’re pregnant, congratulations! Now what?
Arguably one of the first decisions you’ll have to make when you get that positive pregnancy test is which care provider you want throughout your pregnancy and birth. There are 3 options, all with various pros and cons, and it really comes down to what YOU feel most comfortable with. Here’s a quick rundown of your options, and note that all of these options are covered by OHIP - there is no need to worry about paying out of pocket whether you choose a midwife, OB, or family doc (I repeat, midwives are covered by OHIP too!)
OBs are trained medical doctors with a bucketload of medical training behind them. They are ideal for those with pregnancy complications or who are considered high-risk, but will also look after those who are considered low-risk. They attend births at hospitals only, and can perform cesarean sections if needed. Your OB may not be the one delivering your baby though, it will all depend on whether they are on-call when you are ready to deliver. Their prenatal visits tend to be the shortest, and your first and only visit with them after birth will be at 6 weeks postpartum. You do typically need a referral to see an OB (which you can get from a family doctor or walk-in clinic) and you may not start seeing your OB until after the 20th week of pregnancy.
Midwives are trained with a 4-year undergraduate university degree and are ideal for low-risk pregnancies. They attend births in hospitals, birth centres, and at home, and you have the benefit of having built a relationship with the person who will be at your birth (whether it’s your primary midwife or a backup). They are able to order many of the same tests and procedures as obstetricians but there are some areas that fall outside of their scope of practice - in some cases there is the possibility of having a shared care model, where they will consult with an Obstetrician or Maternal Fetal Medicine Specialist, but your primary care provider will remain the midwifery clinic. Prenatal appointments with midwives are the longest, and they will do home visits after birth during the first few weeks postpartum - which can be a godsend when you are caring for a tiny new human! You do not need a referral to a midwife - many clinics have intake forms on their website, or give them a call and see whether they have availability on your due date and go from there.
Many family doctors also have a background in obstetrics and are affiliated with Obstetric Practices in hospitals. They are a good balance between the medicalized approach that OBs specialize in and the more natural approach to birth that midwives have. Family doctors have much of the same medical training that OBs have (that is, bucketloads), but do not perform c-sections. They attend births in hospitals, but like OBs they use an on-call system within the Obstetrical Practice, which means your family doctor may not be the one attending your birth. A benefit though is that they can follow you and your new baby well after the 6-week postpartum period. If your family doctor does not deliver babies, it is still possible for them to follow you throughout much of your pregnancy, but an OB or midwife would take over care towards the end of your pregnancy.
So how do you decide which option is best for you? Here are some questions to ask that may help you decide:
• How much support do I think I need after birth? Think about after your birth - do you have a good support system to lean on and ask questions of, do you feel confident taking on a new parenting role, do you feel like you will need extra support in the postpartum period? If you feel like extra support is needed, a midwife might be a good option. Not only do they have more regular visits with you after birth until 6 weeks, but they’re also available by phone 24/7 if you have urgent questions.
• Are you considered high-risk? If that’s the case, your best bet is to go with an OB for your care, who has the scope of practice to cover all possible pregnancy and birth complications.
• Where do you intend to deliver? In Ontario, only midwives can deliver at home or at one of the 3 birth centres in the province. All three options can deliver in hospital - and yes, midwives can order medicinal pain relief within the hospital setting just like a doctor can.
Whichever care provider you decide to use, it’s super important to make sure that you’re comfortable with them, that you’re able to ask questions (and get answers!), and that you feel heard and validated.
If you want more information, you can check out the Society of Obstetricians and Gynaecologists of Canada, the Association of Ontario Midwives, or look for a family doctor near you through the College of Physicians and Surgeons of Ontario.