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Debra Lowrance, a certified nurse-midwife who is also president of the newly-formed Illinois State Home Birth Association, displays a map she’s been working on showing coverage of the state by midwives who can perform home births.
Photo by Tammie Sloup
Debra Lowrance holds up a map of Illinois with a handful of names and regions outlined in orange, green, yellow and black highlighter.
In 21 counties, pregnant women must travel 28.4 miles or more to the closest birthing hospital, according to an Aug. 1 March of Dimes report.
However, many if not all the counties identified in that report are covered by a certified nurse-midwife (CNM) who can perform at-home births, Lowrance explains, pointing to her map.
Lowrance, a longtime CNM who previously worked in and managed hospital obstetrics units, runs her own midwifery and women’s health care service based in Robinson. Labor of Love Midwifery and Women’s Health LLC opened five years ago, and Lowrance and her team offer prenatal care, birth and postpartum services and support. Lowrance sees about 50 to 60 clients per year within a 60-mile radius in southeastern Illinois.
As president of the recently formed Illinois State Home Birth Association, Lowrance said one of the group’s goals is to create an interactive map in Illinois showing where midwife services are available for at-home births. A new website also serves as an educational hub and a directory for midwives.
She’s long been an advocate for midwifery in a state that decades ago outlawed the practice, allowing midwifery to be performed by only advanced practice nurses with midwife certification.
But the gears are in motion for that to change.
In 2021, Gov. JB Pritzker signed the Midwives Practice Act, which allows for midwives without a nursing degree to go through a newly-created licensing process and be legally recognized by the state to provide care before, during and after delivery.
The first draft of proposed rules was issued in December 2022, moved through the proposed rules process, and ultimately the Joint Committee on Administrative Rules (JCAR) objected to the rulemaking proposed by the Illinois Department of Financial and Professional Regulation (IDFPR). IDFPR is working to develop a new set of rules based on feedback from JCAR.
Lowrance, who served on an advisory Senate committee while the legislation was being drafted, said she hopes the rules are ironed out by 2024.
Filling void in maternal care services a balancing act
Building a system in which pregnant woman across the state can have equal maternal care takes a collaborative, coordinated and transparent system where all parties are working together.
As a practicing obstetrician-gynecologist, Dr. Lisa Masinter has seen what complications can happen with birthing women outside of a hospital setting. However, the deputy director of the Office of Women’s Health and Family Services (OWHFS) with the Illinois Department of Public Health said midwives are “absolutely” part of the solution to increasing access to OB care.
“I’m very mindful of the balance and the tension between access and quality, and how we can build a system that can be as coordinated as possible,” Masinter said during the Illinois Rural Health Summit held Oct. 10 in Springfield. “When we have patients who choose to have their birth outside of the hospital setting, we want to honor that choice.
“And we want to make it as easy as possible. I do think it is one pathway that can facilitate offloading the need for only thinking about providers in the hospital setting.”
The Illinois Department of Healthcare and Family Services (HFS), Illinois’ Medicaid agency, is also looking to add provider types, including for certified professional midwives.
“(HFS will be) launching some new provider types and services in the next year. Things like lactation consultants, doulas, licensed certified professional midwives and home visiting,” said Kelly Cunningham, Medicaid administrator, Division of Medical Programs, HFS. “So, we’re trying to expand the types of individuals that can provide services reimbursable by Medicaid that can support pregnant individuals.”