A midwife is not a doctor. Midwives are independently trained healthcare providers who specialize in pregnancy, childbirth, and postpartum care, but they do not attend medical school or complete a medical residency. That said, many midwives hold graduate degrees and can practice independently, prescribe medications, and manage most aspects of prenatal and birth care without a physician’s involvement.
How Midwife Training Differs From a Doctor’s
The education gap between a midwife and an obstetrician-gynecologist (OB/GYN) is significant in both length and focus. A certified nurse-midwife (CNM), the most common type in the U.S., completes a four-year nursing degree followed by a two-year master’s or three-year doctoral program in midwifery. That’s six to seven years of post-secondary education total.
An OB/GYN completes a four-year undergraduate degree, four years of medical school, and then four more years of residency training. That’s 12 years minimum. The residency years are where the biggest difference lies: OB/GYNs train extensively in surgery, intensive care, gynecologic oncology, and the management of critically ill patients. They learn to perform hysterectomies, laparoscopic procedures, and other complex surgeries that fall entirely outside a midwife’s scope.
Midwifery training focuses on normal, low-risk pregnancy and birth. It emphasizes a less interventional approach, with deep training in labor support, breastfeeding, newborn care, and well-woman gynecologic care like annual exams and contraception counseling.
Types of Midwives and What Each Can Do
Not all midwives have the same credentials, and the differences matter.
- Certified Nurse-Midwife (CNM): Trained in both nursing and midwifery with a master’s or doctoral degree. CNMs can practice in hospitals, birth centers, and home settings. They can prescribe medications and order lab work.
- Certified Midwife (CM): Holds a similar credential to a CNM but without a nursing degree. The clinical training and certification exam are otherwise the same.
- Certified Professional Midwife (CPM): Follows a different certification path that recognizes multiple routes of education, including apprenticeship. CPMs are required to have out-of-hospital birth experience and primarily attend births at home or in freestanding birth centers.
CNMs are the most widely recognized by insurance companies and healthcare systems. CPMs are licensed in some states but not all, and their scope of practice is more limited.
Where Midwives Can Practice Independently
As of early 2025, 25 U.S. states plus the District of Columbia grant certified nurse-midwives full independent practice and prescriptive authority. In these states, CNMs can manage patient care, prescribe medications, and make clinical decisions without physician oversight. States with full authority include New York, California’s neighbors like Arizona and Oregon, and others spread across the country from Alaska to Connecticut.
In the remaining states, CNMs need some form of collaborative agreement or physician supervision to practice. This doesn’t necessarily mean a doctor is in the room during care, but it does mean a formal relationship with a physician must be in place.
When You’d See a Midwife vs. a Doctor
Midwives are best suited for healthy, low-risk pregnancies. If your pregnancy is uncomplicated, a midwife can handle your entire prenatal care, deliver your baby, and manage your postpartum recovery. In 2021, midwives attended about 12% of all births in the United States.
High-risk pregnancies typically require an OB/GYN or a maternal-fetal medicine specialist. You’d generally be directed to a doctor if you have pre-existing conditions like type 2 diabetes or heart disease, if you’re carrying twins or multiples, or if you’ve had complications in previous pregnancies. Midwives who encounter unexpected complications during labor can transfer your care to an OB/GYN, and in hospital settings, this handoff can happen quickly.
Outside of pregnancy, CNMs also provide routine gynecologic care: Pap smears, contraception prescriptions, STI screening, and menopause management. This overlaps with what a primary care doctor or OB/GYN offers for basic reproductive health needs.
Cost and Insurance Differences
Midwifery care generally costs less than physician-led care. About half of U.S. states reimburse CNMs through Medicaid at the same rate as physicians providing identical services. In 20 other states, Medicaid reimburses CNMs at 75% to 98% of the physician rate. Private insurance coverage varies, but most major plans cover CNM services when the midwife practices within a recognized healthcare system.
The lower cost reflects the difference in training and scope rather than a difference in quality for low-risk care. Multiple large studies have found that midwife-led care for uncomplicated pregnancies produces outcomes comparable to physician-led care, often with lower rates of unnecessary interventions like unplanned cesarean sections.
What Midwives Cannot Do
The clearest line between midwives and doctors is surgery. A midwife cannot perform a cesarean section, hysterectomy, or any other surgical procedure. If you need an emergency C-section during labor, a surgeon (typically an OB/GYN) takes over. Midwives also do not manage gynecologic cancers, perform complex fertility treatments, or care for patients in surgical intensive care units.
This isn’t a limitation most people encounter during a normal pregnancy, but it’s the core reason hospitals staff both midwives and OB/GYNs. The two roles are designed to complement each other: midwives handle the majority of straightforward births, and physicians step in when medical or surgical complexity arises.