INTRODUCTION: The objective of this study was to compare unplanned cesarean deliveries, labor interventions, and maternal and neonatal adverse outcomes in low-risk pregnant patients receiving intrapartum care managed by obstetricians or midwives. METHODS: We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included healthy nulliparous and multiparous patients with a term, singleton, vertex fetus managed by obstetricians or midwives. We included both induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high-risk diagnosis requiring prelabor transfer from midwife to obstetrician care. RESULTS: Our cohort included 7,694 patients; 3,543 (46%) received care from an obstetrician and 4,151 (54%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% versus 15.2%, P<.01), including when analyzed by parity. Patients receiving obstetrician care more frequently experienced induction/augmentation, neuraxial anesthesia, and operative vaginal delivery. Patients of obstetricians had a higher maternal adverse composite outcome (23% versus 18%, P<.01). Midwifery patients had higher rates of shoulder dystocia (3% versus 2%, P<.01). In logistic regression, midwifery care had lower adjusted odds of unplanned cesarean birth (adjusted odds ratio, 0.49 [0.40–0.60] 95% CI). CONCLUSION: Wider integration of midwifery care for low-risk labor and delivery may reduce rates of unplanned cesarean delivery and optimize effective patient-centered care. Additional studies are needed to identify the mechanisms underlying these findings and the implications for systems-based change to improve vaginal delivery rates in the U.S.