These are all great questions, but I suggest they're far too general, and the biases of those who can answer, in context, are going to be really strong.
There is no dominant model. My take at some answers is below, after a bit of commentary.
If the OB aspects of FM are a particular interest for you, my suggestion is to seek diverse experiences as a premed and during med school. Spend time with a MFM ObGyn who sees the world through risk-colored glasses and views prenatal care as inadequate 99% of the time. Spend time with a laborist. Spend time in an ObGyn private practice where the patient's doctor is the
group, and the patient has a 1 in 7 (for instance) chance of having her prenatal doc do her delivery. Spend time in an old-fashioned practice where the doc who does the prenatal care answers the pager for all (usually) his patients. Spend time in a Kaiser where the model is now Ob or Gyn, not both. Spend time with a FM+OB doc, in clinic as well as in the hospital. Spend time in a free clinic that does Medicaid signups. Spend time in rural, suburban and metro areas.
I also suggest that it's plenty to just work on finding out
what you like in a realistic context. And seriously, not kidding, the first time you can really wrap your brain around a real taste of what any specialty is going to be like is during 3rd year. Even if you've worked as a scribe or a nurse or paramedic, even if you ask all the right questions as a premed, you still are very unlikely to be able to process the information out of context. And in my experience, with a couple decades of work experience before medicine, and supposedly a mature perspective, I still was surprised as hell during 3rd year, and spent a good portion of 4th year processing the information.
I assume somebody told you there's a shortage of OB doctors. Based on what? Based on a specific clinical situation where call is heavy, pay is low and malpractice is high? Based on how long it takes to get a hired recruiter to fill a position? There is exactly no shortage of OB docs in desirable locations. Any OB shortage is very specific to the context.
and the rise of laborists in OB
As above, this "rise" either exists, or doesn't, based on context. There have been laborists in various clinical contexts for decades, since hospitals figured out that the laborist model solved some problems (and of course created some problems) and starting hiring ObGyns to do the job. The vast majority of hospitals are not going to deny privileges to community ObGyns who can bring in revenue, so even in hospitals that hire laborists, there are still regular ObGyns, and in some cases, FM+OB providers.
will lead to potentially more ability for family med doctors (especially on east coast) to do prenatal care and then have the women deliver at the nearby hospital with a laborist?
Well, most of the motivation to do a model like this has little to do with medicine, and a lot to do with accountable/managed care and cost management. For instance, if a hospital as part of a health system gets a capitated payment for a pregnancy, that system is highly motivated to reduce the costs of the whole package. Whatever model makes the usual cost of a pregnancy as low as possible, that's the model that wins. If I'm a health system administrator and I have a FM clinic with a decent ultrasound setup, absolutely I'm pushing for prenatal care to go there until/unless the pregnancy is high risk, and the programs I'm pushing for pregnant women are going to sell the advantages of birthing with a laborist.
Generally any pregnant woman with health insurance has to pick a provider, and that provider is part of a package that goes to 60 days postpartum (models vary, this is the Medicaid model). If I'm an FM doc and I want to do the prenatal and postnatal care but not the delivery, I can't get anywhere with that desire until I find a hospital and ObGyn practice (possibly a laborist service) that will just do the delivery, and between the 2-3 parties we then have to get health insurers to agree, and the duplicate malpractice exposure is probably the stickiest point. From my perspective (pre-residency! what do I know?!?) I can't see a scenario where an FM doc is the one pushing for this as a model that makes sense to all providers and payors
and patients.
Also, do you think the the emphasis now on a more personal and holistic approach to pregnancy and birth (with many more women choosing midwives)
Nothing new about this. The media periodically decides they want to report on home births and midwifery as if they are novel/weird/preferable. Or they report on how home birth with a midwife is the norm in the Netherlands so why isn't it here? (Answer: prenatal care isn't assumed in the US, also malpractice here is a strong deterrent.) The wealthiest women have the privilege to decide that they want a natural/normal/traditional birth. The rest of women
who are insured have a menu that is set by insurers, who negotiate with hospitals and provider practices on what the insurer will pay for, and then the hospitals and providers decide if they want midwives involved or not.
Midwives in private practice are vastly outnumbered by midwives who work for hospitals or provider practices. "Centering birth" and "birth friendly" and "personal" birth experiences are marketing, generally, and
may be backed up by a facility-specific willingness to provide birthing tubs, birthing balls, and to allow food, doulas, ambulation, skin-to-skin, etc. Of note, midwives
are midlevels when they work for a hospital or for an ObGyn practice. They're typically workhorses churning through patients just like a PA or NP.
would also lead to more women choosing/ actively choosing to go to family med doctors, who may have/ seem to have a more holistic approach to child birth?
Well, first, the hospital is the bottom line here. You as the provider can do 8 months of prenatal care and 2 months of postnatal care that includes sage burning and invoking the goddess or what have you, but the 48-72 hours a woman spends in the hospital are going to be the only thing that matters from a "did I get the birth I wanted" perspective. In a high risk hospital, it's really depressing to see the birth plans that women bring in. Somebody, a midwife or ObGyn or FM doc, usually very well-versed in bad birth experiences, took the time to walk a pregnant woman through a list of the things that holistically matter during delivery, such as "I would like a quiet room during the birth" or "I would like all personnel to knock before entering the delivery room, to ask before entering, and to introduce themselves" or specifics on the baby/cord/father/meds/nurses, all of which are common sense things to want, that the patient then comes to believe are reasonable expectations, and then the hospital L&D floor is going to do whatever the hell it usually does.
Sure, there are women who will approach FM docs in the interest of a more holistic experience than a pitocin-pushing epidural-enthusiast "I'm gonna cut her if she's not at 10 cm in the next hour" ObGyn, and there are ObGyns who have/want a holistic reputation, but any doc who supports holistic birth is
choosing that battle, is
losing that battle when fetal distress comes along, and is
subject to the support of the hospital administration.
tl;dr: it depends.
Best of luck to you.
