DECATUR – Modern medicine has birthing down to a science.
But Decatur mom Alyssa Swengel didn't want science, she wanted a midwife.
“It's a natural occurrence,” her husband Mike Swengel said. “It's not a medical procedure.”
The family recently moved to Decatur from Wisconsin. Their first child was born there in a free-standing birth center. They reached out to Certified Nurse Midwife Debra Lowrance soon after arriving.
“We knew we wanted to be with a midwife,” Alyssa Swengel said.
Swengel started having contractions one evening last week and texted Lowrance, but decided to labor at home.
“We knew the longer we waited, there would be less intervention,” Swengel said.
They arrived at the hospital at 12:15 a.m. where they met Lowrance in the emergency room. The midwife delivered a 9 pound, 9 ounce Franklin a little more than half an hour later.
Only Certified Nurse Midwives, advanced practitioner nurses who work under a physician, can practice in Illinois. They can attend homebirths by collaborating with an overseeing doctor. However, the closest midwife with homebirth permission is in Peoria. Certified Professional Midwives are independent practitioners licensed by other states.
Ashley Price is president of the Illinois Friends of Midwives, a consumer advocacy group that wants to improve homebirths.
"Our primary goal is to license professional midwives to attend births at home," Price said.
While much of the push for midwifery is in the Chicago area, Price, who is in Champaign, said there is great need downstate. She's even had desperate women try to hire her as a midwife.
“We want the home birth community integrated into the system, so it's safer for everybody,” Price said.
Last spring, the group lobbied in Springfield for the Home Birth Safety Act, which would license independent midwives. It didn't pass.
Debra Lowrance has been practicing as a midwife through the Vita Center for Women for about a year.
“I've always worked with women and babies,” Lowrance said. “And that's where my passion is.”
Lowrance is one of two CNMs in Decatur. She said about 80 percent of pregnancies are low risk and those are the women midwives treats. The midwifery approach is a more natural one that encourages women to change positions, eat if they want and be monitored intermittently.
“I offer to advocate for them to do as natural a birth as they can in a hospital setting,” Lowrance said.
Much of her work is similar to that of a physician. She does everything from monitoring and prenatal care to the actual hospital delivery.
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Lowrance's works keeps her busy. On average she attends 10 to 20 births a month in local hospitals. She said she would love to do homebirths someday, but does not at the moment.
As the medical system grew around hospitals in the 1900s, she said the role of a midwife vanished.
“People will look at you and say 'oh you're a midwife? I didn't realize we had those,' ” Lowrance said.
But there is an element of risk for the mother and baby that comes with every homebirth.
Dr. Gretchen Byrkit is an independent obstetrics/gynecology physician who delivers babies at the Decatur Memorial Hospital family birth center. She said while most women expect low-risk pregnancies, that can change in an instant.
“You can have a low-risk patient have a disastrous outcome,” Byrkit said.
As a physician she sees everything that could possibly go wrong. She said even in a hospital, an emergency such as cord prolapse, where the umbilical cord passes through the cervix before the child cutting off oxygen, is dangerous.
“You don’t have time for an ambulance when these bad things happen,” Byrkit said. “It’s too late when you’re at home.”
However, she did say there is not always one right way for every woman, especially when it comes to a mother's position during labor and birth. Depending on the hospital, women can ask to move or use a bar to support a squatting position, available at DMH.
“When it’s not working the modern traditional way, then our role is to say ‘hey, let’s try these other things,' ” she said.
As far as high C-section rates deterring women, Byrkit said it is important to distinguish between first-time and returning patients. Once a woman has a C-section, most physicians are wary of delivering vaginally because they're at risk for litigation. Although it doesn't happen often, the surgical scar can rip, causing a uterine rupture where the baby can be expelled into the abdominal cavity.
“There are some insurance companies who won’t cover their patients if they try,” Byrkit said.
Lowrance said hospitals have a place in birthing, but they are limited by rules and regulations, and providers perform many interventions which, in her opinion, have led to a lot of unwarranted C-sections.
“The mainstream medical model has become so afraid for liability purposes to let women do what they should naturally in labor,” Lowrance said.
Midwives in Illinois do not have much independence, but Lowrance suggested loosening licensing restrictions on collaborations between CNMs and physicians as a solution.
“There are lots of federal agencies that are pushing for advanced practitioner nurses to have more autonomy nationwide,” Lowrance said.
By not licensing Certified Professional Midwives, Ashley Price said women are opting to have unassisted homebirths or break the law by seeking CPMs who are then prosecuted.
“We have no way of distinguishing between trained experienced midwives and rouge midwives,” Price said.
Many families choose midwives because they have no insurance. Amish women traditionally rely on underground midwives. Price said close to the border, women who want homebirths travel to neighbor states. In the past decade, Indiana, Wisconsin and Missouri have licensed CPMs to practice.
“Things have gotten better in the past few years, just not here,” Price said.