The journey of pregnancy and childbirth involves a range of specialized professionals, each offering distinct expertise and a different philosophy of care. Expectant parents have several choices for primary delivery providers, whose training, legal scope of practice, and practice settings can vary significantly. Understanding these differences is helpful for determining the most suitable option for individual health circumstances and desired birth experience. This article clarifies the roles of the various individuals involved in delivering babies, from medical specialists to community-based practitioners.
The Medical Specialist
The Obstetrician-Gynecologist, commonly known as an OB/GYN, is a medical doctor (MD or DO) who has completed extensive post-graduate education and training. This includes medical school followed by a four-year residency program specifically focused on obstetrics and gynecology. This residency provides in-depth experience in managing both routine and complex reproductive health issues, including surgical interventions.
These specialists operate within the medical model of care, which emphasizes the ability to diagnose and treat both common and high-risk conditions. An OB/GYN is fully trained in managing obstetric emergencies, such as severe postpartum hemorrhage or fetal distress. They are the only professionals trained to perform major surgical procedures, including cesarean sections.
The primary practice setting for an OB/GYN is the hospital, where they have immediate access to operating rooms, anesthesia, and neonatal intensive care units. Their expertise is suited for individuals with pre-existing medical conditions or those who develop complications during pregnancy or labor. Their broad scope of practice also includes family planning, gynecological care, and preventive screenings across a woman’s lifespan.
Nursing and Midwifery Experts
Certified Nurse Midwives (CNMs) are advanced practice registered nurses (APRNs) who blend a nursing background with specialized midwifery education. To become a CNM, an individual must first be a Registered Nurse (RN) and then complete a graduate-level program, typically a Master of Science in Nursing or a Doctorate of Nursing Practice, which is accredited by the Accreditation Commission for Midwifery Education.
This training provides a dual focus, combining the medical monitoring skills of a nurse with a holistic, low-intervention approach to physiological birth. CNMs are legally authorized in all fifty states and are often recognized as primary care providers for women, offering services from adolescence through menopause. Their extensive scope includes gynecological care, family planning, and the ability to prescribe medications and order diagnostic tests.
CNMs attend births in a variety of settings, including large hospitals, freestanding birth centers, and sometimes the client’s home. They frequently work collaboratively with OB/GYNs, managing low-risk pregnancies independently while consulting with physicians for high-risk cases. In 2020, CNMs attended over 10% of all births in the United States, highlighting their integration into the mainstream healthcare system.
Community and Home Birth Practitioners
The Certified Professional Midwife (CPM) represents a distinct pathway into the profession, often referred to as the direct-entry model. CPMs are certified through the North American Registry of Midwives (NARM). Their education may involve formal programs accredited by the Midwifery Education Accreditation Council (MEAC) or through a structured apprenticeship.
This credential is the only one in the United States that specifically requires demonstration of clinical experience in out-of-hospital settings before certification is granted. CPMs primarily specialize in providing comprehensive care for low-risk pregnancies in either the client’s home or a freestanding birth center. Their training focuses on the normal, physiological process of birth.
The scope of practice and legal recognition for CPMs can vary significantly from state to state, with some states licensing them fully and others imposing restrictions or prohibiting their practice entirely. Their practice is centered on providing continuous care, education, and support throughout the prenatal, birth, and postpartum periods. While skilled in managing normal birth, their scope excludes surgical procedures and the management of high-risk conditions, which are transferred to medical doctors.
Support Roles That Do Not Deliver
A Doula is a trained professional who offers continuous emotional, physical, and informational support to a birthing person before, during, and after childbirth. They are non-clinical support personnel and do not possess the medical training or legal authority to perform medical procedures, monitor the fetus, or deliver the baby. Their role focuses on comfort measures, advocacy, and ensuring the client is informed during the process.
Family Medicine Physicians also play a role in maternity care, especially in areas with limited access to specialized obstetric providers. These doctors are trained to provide comprehensive care for individuals of all ages, and sometimes include obstetrics in their practice. While fewer than 10% of practicing family physicians currently deliver babies, they are the sole delivering physicians in a significant percentage of rural hospitals.
A Family Medicine Physician with obstetric privileges can manage low-risk pregnancies and perform vaginal deliveries, and in some cases, they may also perform cesarean deliveries. However, their training is broader than that of an OB/GYN, and they are less commonly involved in complex, high-risk cases, particularly in urban areas where specialist coverage is more readily available. The availability of family physicians who include obstetrics in their practice helps address provider shortages in underserved communities.