Set to mark 30 years as a practicing nurse-midwife in October, Lisa Kane Low, Ph.D., is still clearing up false stereotypes about her life's work.
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"People ask me: 'You went to college for that?'" says Low, a practicing certified nurse-midwife at University of Michigan's Von Voigtlander Women's Hospital and associate dean at the University of Michigan School of Nursing. Since May 2016, Low is also the president of the American College of Nurse-Midwives. "The biggest misconception is that we only do home births and don't have the level of education or knowledge we do."
According to figures provided by the American College of Nurse-Midwives, there are slightly more than 11,200 practicing members in the United States (underscoring Low's point, 94 percent of midwife-assisted births took place in hospitals in 2014, the most recent year for which statistics are available).
The career has two paths: certified midwife, which requires a health-related bachelor's degree plus additional training, and, a far more prevalent option, nurse-midwife — with those under the latter designation classified as registered nurses who receive additional extensive midwifery training.
That's why, beyond advising a woman before and during childbirth, midwives often provide many of the same gynecologic care services as their primary-care counterparts — including nutrition counseling, family-planning guidance, prescriptions and physical exams.
Still, the centuries-old profession is known for representing a unique emotional quotient.
"It's not a power position," says Low. "It's a personal position."
She spoke recently about the scope and heart of her job.
Why might women seek out a midwife?
Low: We're really tailoring the care they want to their unique needs … on an intimate one-to-one level. Sometimes, we're doing a lot of re-education of what might be in people's best interests or to find the best resources available to them
It's a lot about the sharing of information to build a partnership with the women and families we work with. For the majority of women who come to see us, we're able to provide them with a lifetime of care.
How has midwifery changed in your decades of practice?
Low: Clearly, more people know about us and seek out the care and services we provide. I also would say that I have gone from being the only midwife in a practice — or one of very few — to being an integrated part of a larger health system.
When I first started out, we tended to do our thing at one end of the hall. Now, there is more opportunity for collaboration and to be engaged at different levels in that spectrum of care — from the low-risk healthy family all the way through the most complex care situations.
Could you describe the typical connection between a midwife and a standard OB-GYN?
Low: Our relationship has, on a national level, matured and grown. Our organizations work well together. We are collaborating on many more projects and areas of leadership to make a difference in women's health.
On a local level, many of us have grown up with each other … working shoulder to shoulder in training. There have been physicians who have taken the courses I teach and who are now in leadership positions; they're employing midwives because they had early exposure to the value of nurse-midwifery.
To what extent do the roles of doulas and nurse-midwives intersect?
Low: Doulas provide the emotional and social support; they don't provide any of the health and medical care. We complement each other very nicely. It's an added opportunity for women to feel like they've got a full circle of care.
They bring some of the same principles of philosophy to the services they offer. Doulas are about education, information and support. That's all part of the midwifery model as well.
How else are midwives shaping care standards?
Low: You're seeing a lot more midwives involved in clinical research, with some involved around specific care practices — management of second-stage labor, delayed cord clamping — not things the average person would know about.
Nurse-midwives have been at the forefront of pushing for a better understanding about the physiological side of pregnancy and childbirth. They've also done a lot of research about access to contraception and reproductive health issues.