"Birth is about making mothers... strong, competent, capable mothers who trust themselves and know their inner strength." ~Barbara Katz Rothman

One of the first decisions any new expectant parent must make is choosing a care provider to support their pregnancy. One of the questions I am asked frequently is should that be an OB or a midwife? What is the difference and how do you choose?

Before I can every help anyone through this decision, they first have to clarify their birth vision and what is important to them for their pregnancy and birth. Once we have gone through this process, which can take some time, we can then move onto exploring the options that will best support their birth vision.

I find it is always important to understand what and who an expectant mother needs around her to make her feel safe and relaxed, because that is the best place for her to be for labor to flow as easily as possible.

I also like to find out how she responds in certain situations, does she need to have a support network in times of stress or does she prefer to be independent? Does she prefer to take charge or does is she more likely to be found supporting and caring for others? All of these kinds of clues provide insight into the kind of birth team she is more likely to feel safe and supported by.

Cases where an obstetrician, or OB, may be a better choice are if you feel more secure in the hospital with a provider who has training or experience for almost any situation that could arise, or if you are comforted by having a practitioner who has a standard protocol to make sure you have all the standard and routine tests and exams offered and available.

You may be less satisfied with an OB if you prefer to use as little intervention as possible and would rather choose the tests and exams you feel are important and if you have concerns over being viewed as a medical patient as OB's tend toward the view that birth is a medical event.

A certified practicing midwife or licensed midwife, CPM or LM, is a great choice for anyone who would like to have a less medical approach to birth. Often midwives attend births at freestanding birth centers or at your home, so you don't ever have to step foot in a hospital during your pregnancy. Midwives are more likely to inform you of all your options when it comes to prenatal tests and screening and birth options.

Midwives are trained to view birth as a normal and natural event, and because of this approach they often us a mother led approach rather than the physician led of an OB. If you prefer to birth out of the hospital, you will likely be looking to a midwife as your care provider.

Certified nurse midwives, or CNM, are nurses with a certification in midwifery. In many areas, CNM's attend births in hospitals or hospital associated birth centers, although some may also use freestanding birth centers or even attend home births. Because CNM's are nurses who often have experience in hospital based labor and delivery procedures, they can be a great middle ground for those who are not ready for a birth center or homebirth, but prefer to stay out of the hospital.

Here is what I appreciate most about midwives:

• They spend quality time with you, much more than the average OB has to spend with a patient.
• They put hand on your belly - most of my clients who have OB's as their provider report that their doctors never touch their belly with their hands.
• They stay with you throughout your birth, unlike OB's who aren't called in until either it's time to push or if there's a problem.
• They stay with you after the birth to make sure you adjust after birth and to help get breastfeeding started, in the hospital this is left to nurses, who can be amazing too, but you don't know who will be with you after the birth.
• They adapt to the type of support you need instead of expecting you to adapt to their policies, which is usually the case in hospitals.

I have spent very little time as a patient in the medical establishment, but I can say that I became very attached to my midwives, it is a unique relationship that exists under very few other circumstances. Over a decade later, I am still grateful to the compassionate and skilled support they each provided at my births.

Finally, every state has different laws about the practice of midwifery, learn more about how midwives support birth and the laws in your state by visiting MANA.org.