Care Models
Understanding birth care models in the United States
By Parental Editorial · Published 2026-08-01 · Updated 2026-08-04
U.S. birth care commonly includes obstetric-led hospital care, midwifery models, and collaborative arrangements. Selecting a care model often depends on health needs, personal preferences, and local availability. Educational resources help you learn about and compare models, but your clinical eligibility is determined with licensed providers.
Obstetric and hospital-based care
Obstetrician-gynecologists (OB-GYNs) are physicians with specialized education in pregnancy, childbirth, and reproductive health. The American Board of Obstetrics and Gynecology describes OB-GYNs as physicians who provide medical and surgical care related to pregnancy and the female reproductive system, often practicing in hospital and clinic settings.
This model includes hospital-based resources such as continuous electronic monitoring, anesthesia services, or immediate surgical capability.
Midwifery models
According to the American College of Nurse-Midwives (ACNM), certified nurse-midwives (CNMs) and certified midwives (CMs) provide pregnancy, birth, postpartum, newborn, and related reproductive health care in partnership with families. In the United States, midwifery care may be offered in hospitals, birth centers, homes, clinics, and via telehealth, depending on state licensing and local regulations.
ACNM reports that most CNM/CM-attended births in recent U.S. data occur in hospitals, with smaller shares in freestanding birth centers and home births. In the United States, the scope of practice and which midwifery credentials are authorized vary by state rather than a national standard.
Community-based care models
Community-based care includes home births, birth centers, and other settings where midwives or other providers offer care without hospital affiliation.
This care model typically does not use a national or state-specific standard. This model also often includes culturally-specific practices and non-clinical birth workers. Each community-based care setting has its own policies and practices, and each provider has their own scope of services.
Shared care models
Shared care models include collaborative arrangements between obstetricians and midwives, or between obstetricians and other providers. These models often combine the strengths of very different provider types, such as the ability to offer hospital-based resources while also offering community-based, culturally-aligned care.
How education helps you choose
Childbirth education should clarify questions to ask (transfer plans, continuous labor support policies, lactation support availability) and should not pressure you toward one model. Use Parental courses and guidebook articles to prepare conversations with providers you are considering.
Frequently asked questions
- What is the difference between a midwife and a doula?
- This is a common question! A midwife is typically a licensed healthcare provider, such as a Certified Nurse-Midwife (CNM), who specializes in labor and birth care in a variety of settings, including hospitals, birth centers, homes, clinics, and via telehealth. A lay midwife, while often not a licensed provider, is often a highly trained birth companion who provides emotional, informational, and physical support during labor and birth. A doula is a non-clinical birth companion who provides emotional, informational, and physical support during labor and birth. Doulas often also serve the role of birth parent advocate, birth companion, and a valued cheerleader during the intensity of labor. While doulas are not licensed providers, they are trained to support parents in a variety of ways. Doulas and midwives both often offer continuous support from pregnancy through early postpartum, rather than a one-time visit. Both professions also emphasize childbirth education; it is common for doulas and midwives to offer structured childbirth education classes in addition to birth services. In fact, many of the childbirth educators on Parental are Certified Nurse Midwives or credentialed doulas!
- Can I switch care models during pregnancy?
- Yes. In fact, a care model or obstetric provider may change multiple times during pregnancy, depending on gestational timing, risk factors, and provider availability.
Sources
These links are references only and do not replace advice from your care team.
- Definition of an Obstetrician and Gynecologist · American Board of Obstetrics and Gynecology (ABOG)
- Definition of Midwifery and Scope of Practice of CNMs and CMs · American College of Nurse-Midwives (ACNM)
- Essential Facts about Midwives · American College of Nurse-Midwives (ACNM)