Choosing Your Birth Team: Why Your Provider, Practice & Location Matter

Jun 23

One of the most important decisions you’ll make in your pregnancy isn’t the baby name or which car seat to buy—it’s who will support you during birth.

Many people assume that where they give birth and who attends their birth is simply a matter of scheduling. But in reality, your provider, practice, and birth location have a significant impact on your birth experience, the interventions you may be offered, and even your emotional and physical outcomes.

This article breaks down the four main types of providers who attend births in the United States and helps you understand how these choices can shape your care.

1. OB/GYNs (Obstetrician-Gynecologists)

OBs are medical doctors (MDs or DOs) who specialize in pregnancy, birth, surgery, and reproductive health. They are trained to diagnose and treat complications, perform cesareans and other surgeries, and manage high-risk situations.

Scope of practice: High-risk and low-risk pregnancies, surgical and medical management of birth
Typical setting: Hospitals
Philosophy of care: Often follows a medical model—birth is approached as a potential emergency until proven otherwise
Intervention rates: Generally higher rates of induction, epidurals, continuous fetal monitoring, and cesareans

OBs are essential when complications arise. However, even for low-risk pregnancies, OB-led care may default to a more intervention-based approach unless you’re working with a provider who strongly supports physiologic birth.

2. CNMs (Certified Nurse-Midwives) and CMs (Certified Midwives)

Both CNMs and CMs are nationally certified midwives who provide care for pregnancy, birth, postpartum, and beyond. CNMs are registered nurses with advanced midwifery training, while CMs complete the same graduate-level midwifery education but are not nurses. Their scope of practice is identical, though licensure varies by state.

Colorado currently licenses CNMs, while CMs are not yet recognized for licensure in all settings.

Scope of practice: Low- to moderate-risk pregnancy, vaginal birth, comprehensive prenatal and postpartum care
Typical setting: Hospitals, birth centers, and sometimes home (depending on licensure and regulation)
Philosophy of care: Emphasizes physiologic birth, informed consent, shared decision-making, and relationship-based care
Intervention rates: Lower than OB-led care; midwives tend to rely on fewer routine interventions

Working with a midwife can be an excellent option for people seeking a more holistic, respectful, and less intervention-heavy birth.

3. CPMs (Certified Professional Midwives)

CPMs are trained specifically in out-of-hospital birth, such as home birth or freestanding birth centers. Their education includes apprenticeship-based learning and often direct-entry midwifery schools. They are licensed in many states, including Colorado, though licensure laws vary widely.

Scope of practice: Low-risk pregnancies and births; skilled in managing normal physiologic birth at home or in community settings
Typical setting: Home or freestanding birth center
Philosophy of care: Deeply relationship-centered and prevention-focused, emphasizing trust in the body’s ability to birth
Intervention rates: Very low, as CPMs work outside hospital systems and offer continuous, personalized care

CPMs are a strong option for families wanting a home birth or a deeply personalized experience with fewer systemic pressures. They are not authorized to attend births in hospitals and do not carry surgical backup.

4. Family Medicine Doctors (with Maternity Training)

Some family medicine doctors offer full-spectrum care, including prenatal care and vaginal birth attendance, particularly in rural or community hospital settings. Their approach may vary widely depending on personal philosophy, training, and hospital culture.

Scope of practice: Low-risk pregnancy and birth, often with a strong focus on continuity of care
Typical setting: Hospitals or rural clinics
Philosophy of care: Can vary, but many family physicians provide highly personalized and community-rooted care
Intervention rates: Variable—often lower than OBs, but influenced by hospital protocols

Family doctors who attend births can offer a beautiful model of continuity, especially if they have been your provider for other aspects of care.

Why This Matters

Research shows that your choice of provider significantly affects your likelihood of experiencing certain interventions, like cesarean birth, induction, or continuous fetal monitoring—even when your medical risk is low. That’s why it’s important to understand:

What your provider’s philosophy of birth is
What limitations their practice or hospital policies might impose
How aligned they are with your birth preferences

Even within a single hospital or birth center, provider practices can vary greatly.

Questions to Ask When Choosing a Provider

What is your approach to physiologic birth?
What is your induction and cesarean rate?
Do you support movement during labor and pushing in different positions?
What happens if I go past my due date?
How do you work with doulas or other birth team members?

Asking these questions early can help you understand whether your provider and location will support the type of birth you want.

Final Thoughts

Birth is not one-size-fits-all. Choosing the right provider, practice, and birth setting can make the difference between feeling disempowered and feeling supported. Whether you’re leaning toward midwifery care, planning a hospital birth with an OB, or exploring a birth center or home birth, the key is alignment—between your values and the team supporting you.

You deserve care that respects your autonomy, honors your body, and supports your vision for birth.

References

American College of Obstetricians and Gynecologists. (2023). Levels of Maternal Care.
https://www.acog.org
— Describes the roles of OB/GYNs and how they are trained to manage high-risk pregnancies and complications.
American College of Nurse-Midwives. (2023). Definition of Midwifery and Scope of Practice.
https://www.midwife.org
— Clarifies the training, scope, and settings for Certified Nurse-Midwives (CNMs).
American Midwifery Certification Board. (2024). Certified Midwife Credential.
https://www.amcbmidwife.org
— Details the certification and scope of Certified Midwives (CMs) and where they are licensed to practice.
North American Registry of Midwives. (2024). What is a CPM?
https://www.narm.org
— Outlines the role and education of Certified Professional Midwives (CPMs), including state-by-state licensure.
Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S. (2013). Listening to Mothers III: Pregnancy and Birth Report.
https://www.nationalpartnership.org
— Large national survey of maternity experiences in the U.S., including provider type and birth outcomes.
National Academies of Sciences, Engineering, and Medicine. (2020). Birth Settings in America: Outcomes, Quality, Access, and Choice.
https://nap.nationalacademies.org/catalog/25636
— Comprehensive comparison of hospital, birth center, and home births, with data on outcomes by provider type.
Vedam, S., Stoll, K., et al. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLOS ONE, 13(2): e0192523.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523
— Shows how midwifery integration affects maternal outcomes, cesarean rates, and patient satisfaction.
American Academy of Family Physicians. (2023). Family Medicine Maternity Care.
https://www.aafp.org
— Explains the scope of family physicians who attend births, including training and care models.
Goer, H. & Romano, A. (2012). Optimal Care in Childbirth: The Case for a Physiologic Approach. Classic Day Publishing.
— Comprehensive review of evidence-based birth practices and how provider type influences intervention rates.