Options: Family Physicians and Obstetricians for Maternity Care



What types of caregivers provide maternity care? What are my options?

What are the "Midwifery model of care" and the "Medical model of care"?

What are characteristics of medical training and practice for maternity care?

Where do physicians practice? What are trends in the use of physician care?

What types of physicians provide maternity care?


What types of caregivers provide maternity care? What are my options?

Several types of midwives and several types of physicians provide prenatal care, attend births, and care for women after birth in the United States. This page provides information about these options.

The great majority of childbearing women in the U.S. are well and healthy, and can consider choosing from among the full range of maternity caregivers. If you have a serious medical condition or are at high-risk for developing such a condition, you will probably want to (1) be in the care of a doctor who has completed a residency and is board-certified in obstetrics (see below), and (2) plan to give birth in a hospital. Maternity caregivers understand and can advise you about situations that may call for more specialized care.

What are the "Midwifery model of care" and the "Medical model of care"?

Views of the childbearing process and of appropriate care for childbearing women vary. Two contrasting perspectives are often called the "midwifery Model of Care" and the "Medical Model of Care." There are striking differences in the two models. These differences can have a great impact on your experience and outcomes.

Here are some contrasts between the two models:

Midwifery Model of Care

Focus on health, wellness,
   prevention
Labor/birth as normal
   physiological processes
Lower rates of using
   interventions
Mother gives birth
Care is individualized

Medical Model of Care

Focus on managing problems
   and complications
Labor/birth as dependent on
   technology
Higher rates of using
   interventions
Doctor delivers baby
Care is routinized

Naturally, the midwifery model describes the practice of many midwives, and the medical model describes the practice of many doctors. But many caregivers combine elements of both. It is possible, but less common, to find doctors whose practice most closely resembles the midwifery model of care and midwives whose practice most closely resembles the medical model.

Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs and values. Many women have a clear preference for one or the other of these models.

Physicians and Maternity Care

What are characteristics of medical training and practice for maternity care?

Medical training for maternity care emphasizes expertise in identifying and managing risks and complications. For this reason, doctors who provide maternity care, and especially obstetric specialists, are optimal caregivers for women with serious health problems or risks for such problems.

Because of this focus on problems, medical maternity care may emphasize physical concerns and give less attention to emotional matters or normal childbearing processes. From this perspective, many tests and treatments may be recommended for well women to be sure nothing is wrong or in case a problem may arise. The role of the doctor may be to take charge by managing care and delivering the baby. Rules, restrictions, and routines may be applied to most women.

Where do physicians practice? What are trends in the use of physician care?

Nearly all physician-attended births in the U.S. are in hospitals. A small number of physicians attend births in out-of-hospital birth centers or in homes. They provide prenatal care and care after birth in office settings.

Physicians attend over 90 percent of births in the U.S. at this time. With the growth of midwifery care in the U.S. during the last quarter century, this proportion has been declining.

What types of physicians provide maternity care?

Family physicians (FPs) are doctors who provide cradle-to-grave care to the whole family and approach care from a family-oriented perspective. They address needs and concerns relating to all bodily systems. This means that they can provide ongoing care for mothers, babies, and other family members.

Roughly 25 percent of family practice physicians provide maternity care and attend births. They may work together with an obstetrician or refer to an obstetrician if a complication arises. Quite a few FPs are trained in surgery and perform cesarean sections. A "board-certified" family physician has: received an MD or DO degree from an accredited school, completed three years of training and practice in an accredited family practice residency program, and passed an examination given by the American Board of Family Practice. All 50 states license family physicians.

Studies comparing practice styles of family physicians to other maternity caregivers have generally found that women using FPs are more likely than midwives and less likely than obstetricians to have common maternity interventions, such as cesarean section, episiotomy, and labor induction. FPs may combine both an obstetric style of maternity practice and a view of childbirth as an important family event and normal life process. Within family medicine, general family care leads seamlessly to maternity care. And maternity care leads directly into women's postpartum health care, and newborn and baby care.

Obstetricians are doctors who have special training in prenatal care, labor, birth, high-risk pregnancy, and surgery. Many obstetricians also provide gynecological care and other health services to women.

Obstetricians are well-suited to care for women with established serious medical problems or who are at high risk for developing such problems. Many obstetricians approach birth as a medical event best managed by highly trained specialists. Obstetricians tend to have higher rates of interventions (such as cesareans and episiotomy) than family physicians and midwives, even when the health status and risk level of women is similar.

Providers who are "board-certified" in obstetrics and gynecology have: received an MD or DO degree (see below) from an accredited school, completed at least four years of training and practice in an accredited obstetrics and gynecology residency program, and passed an examination given by the American Board of Obstetrics and Gynecology. All 50 states license obstetricians.

Osteopaths (DOs) are graduates of accredited colleges of osteopathic medicine. Osteopathic medicine complements use of medical tests and treatments with hands-on diagnosis and treatment known as "osteopathic manipulative treatment." This approach gives special attention to muscles, bones, and nerves. Nearly all DOs complete residency training in a specialized area of medicine. Osteopaths trained in family medicine or in obstetrics and gynecology may provide maternity care. Osteopaths are "board-certified" in these specialties if they receive the DO degree, complete an accredited residency program, and pass the examination given by the American Board of Family Practice, The American Board of Obstetrics and Gynecology, or the corresponding specialty boards of the American Osteopathic Association. All 50 states license DOs, and they attend about four percent of births in the U.S.

We do not have good information to help us characterize the maternity care practice style of osteopaths. Osteopaths may combine both an obstetric style of maternity practice and a view of childbirth as a normal physiological process.

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Best Evidence: Caregiver

Most recent page update: 3/15/2011


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