Member Highlight: Debra Lowrance on breathing new life into obstetrical care
Debra Lowrance, DNP, APRN-FPA, CNM, WHNP, IBCLC, launched her career in nursing at a very young age. She earned her associate's degree from Lincoln Trail College before working in a small rural hospital, where she held several positions before being named manager of the OB-GYN unit. She recalls, "It was a small unit in a rural area, so I had the opportunity to do what I call 'evidence-based care.' It was easy for me to implement change based on current research, and I felt very invigorated by that."
Unfortunately, she later lost her management position. No longer able to facilitate changes she felt crucial, she chose to leave to pursue a bachelor's degree at Eastern Illinois University. During her studies, she gained a mentor that encouraged her to pursue a master's and to concentrate on the area she felt best in. Lowrance says, "I love women and babies, so I knew that was the only choice. That pretty much set the groundwork for me becoming a midwife." She finished her master's at the University of Illinois, where she would later complete her doctorate, as well as serve as an educator.
Paving the way for Labor of Love
Lowrance wanted to hit the ground running after completing her masters, and began working in a busy practice in Decatur, Illinois. She quickly realized there was a widespread lack of understanding of the role of a midwife, even encountering a hospital that tried to limit her scope of practice to less than what she could do as an RN. "There was a lot of trailblazing to be done. It took a lot of educating, a lot of standing our ground, and a lot of physician collaboration to finally get hospitals to understand our scope of practice and our roles." Lowrance worked alongside a physician in expanding the midwife program at her practice. In 2017, that same physician presented her with an idea for a hospitalist laborist program, wherein midwives would be staffed 24/7, responsible for triage and the majority of deliveries. The hospital embraced the idea, and upon execution, it was very well received.
Once the program was up and running, Lowrance still felt ready for change, as she felt increasingly ill at ease with what she was witnessing. "The OB-GYN system in the US isn't the greatest. We rank poorly in maternal mortality; I believe we're ranked #46 out of all countries, so about the same level as Iran. And at the time, I thought I could see why that was the case; taking on a large number of patients with a short amount of time allotted to each, a lack of continuity of care, hospitals trying to manage everything with lots of interventions. All things that go against what I had been taught in the midwifery model, which is a more physiological approach to birth. I became more and more disenchanted with that model of care and wanted to see birth in a different light, so I decided to take a chance and start my own business."
In 2018, Lowrance opened Labor of Love Midwifery and Women's Health in Robinson, Illinois. She and her team offer prenatal care, birth, and postpartum services and support. As the only Certified Nurse Midwife (CNM) providing homebirths in Southern Illinois, Lowrance is in high demand, covering a territory of up to three hours radius. She prides herself in creating a relaxed, comfortable environment where there is no waiting period, and appointments begin with a 30-45 minute conversation so she can fully grasp each patient's individual needs. Lowrance relishes the freedom that comes with having her own practice, often collaborating with other practitioners of a holistic or alternative nature, allowing her to offer patients further options and services from which they may benefit.
"Women need to know their rights, and they need to know that they can speak up."
She felt heartbroken by the mistreatment of women and obstetrical violence she witnessed in hospital settings, recalling, "We don't honor informed decision-making in those settings, and a lot of the time, we just push our own opinions, thoughts, and ideals on people, and we don't give them a choice. Birth happens; it's a very natural process.” Lowrance worries unnecessary use of interventions, and a lack of evidence-based care in the OB-GYN realm has become far too prevalent. For instance, physicians frequently choose to induce labor with artificial oxytocin once a mother hits the natural lull during labor-a lull meant to serve as a resting period before physical pushing begins. Lowrance imagines research has barely scratched the surface regarding the potential consequences of using unnatural hormones, reasoning, "If you flood the body with a synthetic form of oxytocin, it only makes sense that the receptors will think, 'We have enough oxytocin. We don't need to manufacture it.' So, what are those implications?"
It appears lack of research isn't the only problem, as Lowrance emphasizes, "The sad thing is that even when we do good research, and this research supports certain things, it's still not widely adopted in hospital settings." Around the year 2000, a research paper was published that indicated there might be worse outcomes with breech births. Hospitals across the US banned breech deliveries immediately, despite having skilled providers on staff that had never experienced any adverse results. Two years later, the doctors responsible for that research admitted it had been a flawed study, and there have been nearly 40 new papers since indicating vaginal breech is safe. Lowrance asserts, "If you have a skilled provider trained to do breech deliveries, there is no reason for a C-section. Yet, around 90-95% of women in the US are told they have to have one; and that is not evidence-based." Attempting vaginal birth following a C-section has also been widely banned by hospitals despite research showing high success rates, particularly among midwives. According to Lowrance, the current C-section rate in the US is approximately 32%. A number she feels is far too high, "When you look at homebirth practices, the transfer rate is less than 12%, and the transfer for C-section rate is even lower. So there's something to be said for natural, physiological labor."
ISAPN and fighting for midwifery
Lowrance currently serves as the CNM representative for ISAPN. She proclaims, "I vowed that whenever I became a midwife, I would work to spread midwifery. Legislation is probably the biggest piece of that, so I felt I had to get more involved. ISAPN worked so hard to get full practice authority, and I truly believe in the group because I can see they get things done."
Although a CNM like Lowrance may practice in Illinois, a Certified Professional Midwife (CPM) is still not permitted to practice within the state legally. With 35 other states now certifying professional midwives, Illinois has remained unreceptive to attempts to do so for over 20 years. Asked for her opinion, Lowrance responds, "CPMs provide a valuable skill set that not all midwives are trained in, home birth and birth center settings. So I believe we need that licensure in Illinois and I will continue to work towards that as best I can."
And Lowrance has done just that. She recently served as ISAPN's CNM Rep on the Senate appointed Home Birth Maternity Care Crisis Study Committee, assembled during the summer of 2019 following the reintroduction of the Midwives Practice Act's last Fall. Convening until December of 2019, Lowrance explains that the committee concluded with a unanimous vote in favor of licensing CPMs in Illinois. However, COVID hit shortly after, which has left the issue at somewhat of a standstill.
Year of the nurse and the midwife
In honor of the 200th anniversary of Florence Nightingale's birthday, the World Health Organization designated 2020 the "International Year of the Nurse and the Midwife." While midwives are the front line in obstetrical care in other countries, the US fails to award midwifery the same level of support. Lowrance contends, "We spend more money than any other country yet have the worst outcome, so what is wrong with this picture? One thing that keeps coming up is this lack of support for midwifery and a well-integrated system where birthing center births and homebirths are acceptable."
To others considering stepping out on their own, Lowrance advises, "Find a good mentor and ask lots of questions. I sought out people who had their own business who could answer my questions and give support, and having that mentor to help you get going is really helpful."