obstetrics

Midwife or OB-GYN: Credentials, Scope, and How to Choose

By Dr. Adeeb Alshahrour · September 19, 2022

Midwives and obstetricians are not two grades of the same job, and they are not opposites. They are two distinct professions with overlapping scope, both regulated, both evidence-based, and both capable of excellent care. What differs is training pathway, legal scope, and where each usually attends birth.

Two things people commonly get wrong deserve correcting up front. Midwifery in the United States is not "non-medical" care built on herbal remedies — certified nurse-midwives are licensed independent clinicians who prescribe medication, order and interpret tests, place IUDs, manage labor, suture, and provide care well beyond pregnancy. And "midwife" is not one credential. It is at least three, with meaningfully different training and different legal authority depending on the state.

The credentials, plainly

Certified nurse-midwife (CNM)

A CNM is a registered nurse who has completed a graduate degree in midwifery from a program accredited by the Accreditation Commission for Midwifery Education and passed the national board examination of the American Midwifery Certification Board.

CNMs are licensed in all fifty states and DC, and have prescriptive authority in every jurisdiction. Their scope is not limited to birth: it includes prenatal and postpartum care, contraception, well-woman visits, cervical screening, STI care, and menopause care. Most CNM-attended births in the US happen in hospitals, not at home.

Certified midwife (CM)

A CM completes the same accredited graduate midwifery education and sits the same board exam as a CNM, but enters from a non-nursing background. Core competencies and scope are the same.

The practical difference is legal recognition. The CM credential is licensed in only a limited number of states — New York, New Jersey, Delaware, Maine, Rhode Island, Maryland, Minnesota, and several others, with more states adding it. Illinois does not currently license CMs.

Certified professional midwife (CPM)

A CPM is certified by the North American Registry of Midwives through a competency-based pathway — an accredited midwifery program or a structured apprenticeship — specifically oriented to out-of-hospital birth: homes and freestanding birth centers.

CPMs are licensed in roughly 37 states, including Illinois, which created a licensure pathway in 2021 under the Licensed Certified Professional Midwife Practice Act, administered by IDFPR. Scope, prescriptive authority, and what a CPM may carry or administer vary substantially by state law. CPMs generally do not have hospital privileges and do not attend hospital births.

You may also see LM (licensed midwife) or LCPM, which are state licensing titles rather than national certifications. Ask which national certification sits behind the state title.

Obstetrician-gynecologist (OB-GYN)

An OB-GYN completes a bachelor's degree, four years of medical school, and a four-year residency in obstetrics and gynecology, then may take board certification through the American Board of Obstetrics and Gynecology. Some go on to a fellowship — maternal-fetal medicine for high-risk pregnancy, reproductive endocrinology and infertility, gynecologic oncology, or urogynecology.

The training is surgical as well as medical. An OB-GYN performs cesarean deliveries, operative vaginal deliveries, and gynecologic surgery, and manages medical complications of pregnancy directly.

What each can and cannot do

The honest summary is a difference in ceiling, not in quality.

Both provide prenatal visits, labor support, delivery of an uncomplicated vaginal birth, postpartum care, newborn transition, contraception, and routine gynecologic care.
Only an OB-GYN performs cesarean delivery, forceps or vacuum delivery, and gynecologic surgery. When a birth needs an operation, it needs a physician.
CNMs and CMs prescribe, admit and manage labor in hospitals where they hold privileges, and care for patients across the lifespan — not only during pregnancy.
CPMs are trained and licensed specifically for planned out-of-hospital birth in low-risk pregnancy, within whatever their state permits.

It is not true that midwives are untrained in emergencies. Midwifery education includes recognizing and initially managing hemorrhage, shoulder dystocia, and neonatal resuscitation. What a midwife does not have is the ability to move to an operating room independently — which is exactly why transfer and collaboration arrangements exist.

What happens when a pregnancy stops being low risk

This is the question that matters most, and it is where you should press hardest when you interview anyone.

Risk is not fixed at your first visit. Gestational diabetes, preeclampsia, growth restriction, a breech baby at term, twins, a placenta in the wrong place, or labor that stalls can all appear in a pregnancy that started out entirely straightforward. Roughly one in three US births is a cesarean, and most of those were not planned at booking.

Ask your prospective provider:

Who do you consult with, by name? A midwife should be able to tell you the physician or practice they collaborate with.
Where would I be transferred, and how far is it? For a planned home birth, ask about the transfer hospital and the realistic travel time in traffic.
Would my care be handed over entirely, or co-managed? In hospital practices, a common answer is that the midwife continues to provide care and the physician manages the operative or medical component.
Who is actually in the room at 3am? Practices rotate. The person you see at every prenatal visit is often not the person on call the night you deliver.

ACOG and the American College of Nurse-Midwives have a standing joint statement supporting team-based, collaborative practice between OB-GYNs and CNMs/CMs. Where that collaboration is genuine and pre-arranged, the handoff is smooth. Where it is improvised, it is not. That is the variable worth investigating.

Choosing based on your actual situation

A midwife-led model fits well if your pregnancy is low risk, you want longer visits and a strongly physiologic approach to labor, you want to minimize routine intervention, and you have confirmed how escalation would work.

Physician-led obstetric care fits better if you have a pre-existing condition such as chronic hypertension, diabetes, a clotting disorder, cardiac or autoimmune disease, or obesity with associated risk; you are carrying twins or more; you have had a prior cesarean, preterm birth, preeclampsia, or a stillbirth; you are pregnant through IVF or at an age associated with higher risk; or a complication has already been identified.

Either can be right if you are low risk and delivering in a hospital. In that setting the practical differences narrow considerably — the same labor and delivery unit, the same monitoring options, the same access to an epidural, the same operating room down the hall.

Two things are not good reasons to choose: cost assumptions, which vary by plan and are rarely what people expect, and the idea that one option is "more natural." A physician-attended birth can be low-intervention. A midwife-attended birth can involve an epidural and continuous monitoring. Ask about the individual provider's practice, not the profession's reputation.

Where WOHCC fits

At the Women's Healthcare Center of Chicago, obstetric care is physician-led. Dr. Adeeb Alshahrour provides prenatal care, attends deliveries, and performs cesarean and gynecologic surgery, and speaks English, Arabic, and Spanish directly with patients. Deliveries take place at Saint Mary of Nazareth Hospital, 2233 W. Division Street.

If you are early in pregnancy and still deciding, the most useful thing you can do is book a visit and ask these questions out loud. You are allowed to interview more than one provider, and you are allowed to change your mind later in pregnancy.

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Medical disclaimer

This article is general health information, not medical advice for any individual. Scope of practice for midwives is set by state law and changes; confirm current Illinois requirements with IDFPR or directly with the provider. In pregnancy, heavy bleeding, severe headache with visual changes, severe abdominal pain, fluid leaking before term, or reduced fetal movement warrants immediate assessment regardless of who is providing your care.