Midwife or OB?

Hi all,

Really glad to find this community, especially since I am having a dilemma about where to go next in my career and could use some advice! I have seen a few midwives on here and am especially interested in hearing from those who have experience with midwifery.

Some background on me: I’m 29, have a B.S. in Biology, a M.A. in Humanities and Social Thought from NYU, and am finishing a B.S.N to become an RN within the next few months. Roundabout way of getting to Med School? Yes! My cumulative GPA is 3.9 and I haven’t taken the MCAT yet.

My passion has always been women’s health, and I went into nursing with the intention of becoming a Nurse Midwife. I worked as an assistant to a Nurse Midwife and have a deep commitment to normal and empowering birth. For those who don’t know, a Nurse Midwife is a mid-level provider (nurse practitioner) who provides evidence based primary care throughout a woman’s reproductive years. Nurse midwives generally attend low-risk pregnancies.

However, now the nursing field is looking to require a Doctor of Nursing Practice as a requirement for entry into practice in the near future. Additionally, since midwifery is extremely marginalized where I currently live, I would need to specialize in both Family Nurse Practitioner and Nurse Midwifery to have any shot at the already scarce job opportunities here. Honestly, I just don’t see the point in getting a doctorate in two specialties - then graduate to no job opportunities, little respect from medical colleagues (not to mention active pushback from medical lobbies), and with a limited scope and autonomy. I hate to be so negative, especially since I absolutely love midwifery, but I don’t know if I want to sign up for a life of struggling for jobs, credibility, and having docs breathing down my lab coat my entire career. Midwives do incredible, transformative work and I don’t think these attitudes or conditions are at all fair - but I also want to be realistic about the challenges I would face.

I tell myself that if I went to med school, I could be an excellent OB, serve as an ally to midwives and families who want a low-intervention birth, maybe even open a birth center one day and work collaboratively with midwives. I tell myself that I could work on making hospital policies better for women, improve maternal mortality in this country, have job security and a deeper medical knowledge and preparedness.

If all the challenges to being a midwife weren’t present, i know I would want to practice using the midwife’s model of care - and I wouldn’t feel the need to seek medical school training. But as it stands, I am heavily leaning towards applying to med school, but with the fear that I won’t be able to bring my values into OB culture and practice with a low-tech model I know and love. I would be miserable pushing inductions and c-sections all day. But I would be so so happy if I could be part of the change that needs to happen to bring c-section rates down.

Any advice? Midwives who are in med school, why did you jump ship? Am I looking into med school for the wrong reasons?

Thank you!!


I have no advice except this: could you move?

I live near Cincinnati, OH and we have a healthy relationship between OBs and CNMs. In fact, when I had my son, I was high-risk for the first trimester so I saw OBs, and then when the miscarry risk was minute, they asked if I wanted to change to a midwife because the OBs generally only handled high-risk births unless there was a preference. I gave birth in a hospital with both OBs and CNMs on the floor and was able to somewhat follow my birth plan (although since my water broke early, things changed a bit and I had to go on pitocin, but that’s another story for another day). I greatly appreciated the care I received from both sides as well as the partnership they all had together. Maybe you could find an environment more like that?

Honestly, I’ve been really weighing this decision, too, because I can see myself being a few different types of doctors, but I can also see myself being a CNM, too.

You might want to directly talk to Kate429 by private message.

I second talking to Kate, and researching where you want to live and work in the future.

Thanks for the replies…

I did message Kate, awesome advice!

I wish I could move, but alas my partner has an amazing job, I like where I live, and we want to start a family soon without uprooting. Just doesn’t make sense to relocate for now. Plus, there are few good med schools nearby.

On the topic of moving – how realistic is it to think I might attend med school and residency in the same geographical area? I know that’s a basic question, but it’s kind of important for us. My partner is an academic - and they generally don’t really have the option to decide where they live!

I don’t feel the need to apply to all the most competitive residency programs – my priority is staying here and keeping a growing family together in one place. Can I stay put where I am?

Thank you again!

I don’t speak from any experience - I am currently in the application process, and didn’t apply to any of my state schools.

However, what my pre-med advisor, and many people on OPM, tend to say is “apply early, apply broadly.” I’ve seen OPM’ers and SDN’ers be rejected or ignored by their in-state schools - which they considered safety schools - and get accepted to schools they never thought would look at their application.

My suggestion would be to call your state schools and explain where you are in the process and ask what you need to do to increase your odds of getting in at their school. Check back in after a year, update them and get more direction. Do everything possible to make yourself into their ideal student, and you increase your chances. But there are no guarantees.

If you only apply to your in-state school you have less chances to be offered secondaries/interviews than if you apply to more. You may end up becoming a re-applicant and waiting 2 or more years to get in.

Good luck!

Ok, been busy! Let me weigh in on open.

You’ve mentioned you would really like to not move. I second what Pixie has said…you will want to apply more broadly than just your state but I like the idea of calling your state schools and seeing what they are looking for.

Regarding residency – you don’t really get to “pick” where you do your residency. You can schedule 4th year clinical rotations at your top choices and try to really “wow” them. Programs are much more likely to accept residents that they have had a chance to check out.

Regarding the CNM/MD/DO question - as I mentioned before, I think going for a family medicine specialty rather than OB/Gyn might make you happier. The scope of obstetrical practice for family practice docs who do OB is fairly similar to CNM’s, in that they generally manage vaginal delivery of generally healthy pregnant women. If the women become high-risk, they might very well be referred to a high risk OB practice, and you would generally refer for sections (although family practice docs can do an extra year fellowship and be certified to do their own sections). You could confine yourself to low-risk and low-interventive birthing.

One reason many FP docs don’t do OB is the cost of malpractice insurance ($30,000 - 60,000/yr). you can’t do enough births to pay for that, probably! My own plan is to work for a rural health clinic (RHC) or a federally qualified health center (FQHC), in which case I would be covered by federal tort law and not need to pay for malpractice insurance. Or, if you worked with a practice of OB’s, your insurance might be payed for by the practice.

If you just want to do births, however, you could go the CNM route. Yes, its a struggle if you have to contend with an area that is not collaborative. I’d suggest talking with CNM’s in the area, and asking if you could come to an ACNM chapter meeting for the state, as you would then hear all the nitty-gritty of the current and projected future milieu.