OB-GYN, midwife, family medicine with OB, women’s healthcare nurse-practitioner: What’s the difference?

If you or someone in your family needs reproductive healthcare, you might be confused about where to turn. After all, there's an alphabet soup of providers. What's the difference between OBs, GYNs, FMOBs, CNMs and WHNPs?

Let's break it down, acronym by acronym.

Reproductive health involves preventive care along with the diagnosis and treatment of conditions related to menstruation, fertility, menopause, pregnancy, childbirth and breast health.

If, like many people, you aren't sure how obstetricians, gynecologists, nurse practitioners and certified nurse-midwives differ in the ways they offer reproductive care, read on for details.

OB and GYN: What's the difference?

Most doctors who work in reproductive healthcare serve as both obstetricians and gynecologists. They're called OB-GYNs for short.

Obstetricians, or OBs, are doctors who care for pregnant people. Most people start seeing an OB early in the second trimester, or at about 12 weeks. They continue care through the six weeks following birth, also known as postpartum. OBs have surgical training. They can deliver babies vaginally or through surgeries called C-sections. They also specialize in diagnosing and treating pregnancy-related complications. If you are expecting twins or have a high-risk pregnancy, you may choose care from an OB.

Gynecologists, or GYNs, are doctors who specialize in the female reproductive system. You can choose to see a gynecologist for:

• Preventive/wellness care
• Birth control
• Vaginal infections
• Cancer screening
• Menstrual conditions
• Ovarian cysts
• Care during perimenopause and menopause

GYNs also have surgical training. They do many types of gynecological procedures, including removal of the uterus (hysterectomy) and the ovaries (oophorectomy).

“I feel honored to share so many important moments with women including the joy of childbirth, the sorrow of losing a pregnancy, the challenges of undergoing surgery, and decisions about protecting our health,” says Nena Barnhart, MD, a PeaceHealth OB-GYN in Bellingham, Washington.

How is FMOB different from OB-GYN?

Another option for maternity care is to see a family medicine doctor with training in pregnancy and childbirth. This type of primary care provider is known as FMOB, for family medicine with obstetrics.

FMOBs are primary care doctors who have experience in reproductive healthcare and see patients of all ages. As PCPs, they stay with  you before, during and after childbirth as you and your family grow.  

FMOBs can be board certified with obstetrics or with obstetrics and an added qualification that allows them to do surgical deliveries. Board certification means that they meet high national standards for extra training and experience in their focus area.

PeaceHealth offers family medicine with obstetrics in Vancouver and Longview, Washington.

WHNP: Why might I see a nurse practitioner instead of a doctor?

Have you ever tried to see your primary care doctor, but saw a nurse practitioner instead? People with serious conditions need the expertise of doctors with specialized training. But nurse practitioners play an important role by providing care for common conditions. This is true for reproductive healthcare, too.

Nurse practitioners are registered nurses with advanced education and clinical training. Like doctors, they can:

• Do physical exams and prenatal exams
• Diagnose and treat illnesses
• Offer care for low-risk pregnancies
• Order lab work and ultrasounds
• Prescribe medications

Specialized nurse practitioners who work with OB-GYNs are called women's healthcare nurse practitioners, or WHNPs. They offer routine care. NPs also can connect you with birth control, including inserting and removing IUDs and implants like Nexplanon. They may care for you through pregnancy and postpartum, but they do not deliver babies.

Depending on how your provider’s office works, if you choose to see an OB-GYN when you are pregnant, you may also be seen by NPs during your prenatal care.

CNM and WHNP: What's the difference between nurse practitioners and certified nurse-midwives?

Certified nurse-midwives, or CNMs, are nurse practitioners with specialized education, training and certification. This allows them to care for low-risk pregnancies and deliver babies in hospitals and in homes.

CNMs may also assist surgeons if necessary to support their patients’ care. “Most often, if a midwifery patient needs a surgical delivery, the midwives consult with an OB-GYN doctor and assist the primary surgeon with a cesarean delivery and/or a tubal ligation,” says Dana Hansen, a certified nurse-midwife who leads the midwifery department for PeaceHealth Medical Group in Bellingham.

In addition to managing labor, delivery and postpartum needs, CNMs offer reproductive healthcare beyond pregnancy, Hansen adds.

You can see a CNM for the same care you would get from a nurse practitioner, starting in your teens and continuing through older adulthood. This includes:

• Physical exams and prenatal exams
• Diagnosing and treating illnesses
• Caring for low-risk pregnancies
• Ordering lab work and ultrasounds
• Prescribing medication

What to consider when choosing an OB-GYN, FMOB, CNM or WHNP

Everyone’s healthcare needs are a little different. When you choose a reproductive health provider, you’ll need to think about what matters most to you and act accordingly.

Here are some things to consider:

• Affordability: Most health insurance plans cover care provided by OB-GYNs, CNMs and WHNPs. You’ll generally have the most coverage when you see a provider who is in-network with your insurance. Some providers also offer flexible payment options and sliding-scale fees. At PeaceHealth, we care for everyone, regardless of their ability to pay. We offer financial help based on family size and income.
• Access: If it’s important for you to see a reproductive health provider soon, it's a good idea to ask how far out they are scheduling for new patients and for follow-up visits. Ask if you'll see the same provider each time, or if you can get in sooner when you see someone else on their team. For convenience, try to find a provider that is nearby and has privileges at your local hospital.
• Health equity: As you look for a new provider, consider whether they approach care with regard to your whole self, not just your reproductive system. Women of color, for example, have poorer birth outcomes than white women. If that’s a concern, look for providers who are knowledgeable about the issues that lead to disparities in care for people of color. Similarly, ask about providers' LGBTQ+ inclusivity and training if that's relevant to you. How respectful and knowledgeable are they about providing gender-affirming care?
• Sensitivity to past experiences: Whether you’re being seen during pregnancy, for a routine exam, or in search of a diagnosis, reproductive health visits are very intimate. This type of care can be upsetting for people who have experienced sexual violence. Before your first visit, you can ask the provider what they will do to help you feel comfortable and safe. Ask them how they will handle it if you have a trauma response while in their care.

A personal choice

You know your body and your needs best. Try to find someone who makes you feel comfortable. What that looks like will be different for everyone. Don’t be afraid to ask questions that will help you make an informed choice and find the right person for you at any age or stage of life.