Q&A with the New President of the American College of Nurse-Midwives; What She Wants Every Woman to Know About Giving Birth

Lisa Kane Low, Ph.D., CNM, FACNM, FAAN, was inducted as president of the American College of Nurse-Midwives (ACNM) at the conclusion of the ACNM Annual Meeting on May 26, 2016 (see the ACNM release with all new incoming officers). She is the Associate Dean for Practice and Professional Graduate Studies at the University of Michigan School of Nursing (UMSN) and a U-M associate professor of Nursing, Women’s Studies, and Obstetrics and Gynecology. Dr. Kane Low’s research focuses on evidence-based practices to promote optimal childbirth outcomes. She has been active in ACNM for nearly 30 years.

Q: How would you describe the role of midwifery in today’s health care system?

A: I’m hoping we are at a tipping point. The United States has some of the poorest maternity care outcomes of developed nations and yet we spend the most. When midwives are part of the system, they can change the way care is provided and improve outcomes.

Q: What would you like people to know about midwifery care?

I think the biggest thing is that you get individualized, tailored care. Midwives work very hard to engage with women and their families about their choices and options. We do that work well informed by evidence so we can offer the best options for that individual person.

Q: What made you want to be president of ACNM?

A: I went to my first ACNM conference even before I was a midwife. I saw people passionately articulating the beliefs that I held and that was really exciting. Prior ACNM leadership made significant progress in building collaborations, particularly around standards for education and regulations, and I was inspired to see that momentum continue.

Q: What are your goals as ACNM president?

• Making sure our organization is financially well positioned to continue the kind of policy and member service work we’ve been doing all along, and building on it.
• Continuing the work we have initiated related to diversity and inclusion as we increase the midwifery workforce.
• Expanding our consumer campaign to raise awareness about the role of midwives and the outcomes of midwifery care.
• Continuing our strategic projects around physiologic birth and the reduction of cesarean births that demonstrate midwifery leadership in quality improvement. I’d also like to add a focus on VBAC (vaginal birth after cesarean). Midwives have shown great success in supporting women to successful VBAC but it’s an area that has been left out of the mainstream conversation.

Q: How does patient engagement in midwifery compare to other health care services?

A: The recent national conversations about patient engagement and shared decisions are really what midwives have been doing for years. We work with individuals who seek our care to understand their values and beliefs, and tailor care to meet that family’s needs.

Q: What are the biggest challenges facing midwives today?

A: Some states, including Michigan, have regulations restricting the scope of practice for advanced practice registered nurses (APRNs), including midwives, which create barriers in practicing to their full education. Much of ACNM’s policy work has been pulled into the conversation about educational standards and licensure for Certified Professional Midwives, but there has been less attention and less success in APRN full practice authority initiatives, and that has been frustrating.

Editor’s note: More than 20 states have granted full practice authority to APRNs. Legislation to grant full access is under consideration in many other states.

Q: What is the relationship between midwives and physicians?

We’re in agreement on many ways we can work together. However, we do approach some of the same issues from different perspectives. We have agreed to disagree on some policy perspectives such as home birth, water birth, and scope of practice legislation. But I absolutely believe our only way forward in changing maternity care is through collaboration, and we are working hard with our ACOG (American Congress of Obstetricians and Gynecologists) colleagues with that goal in mind.  There may also be economic advantages at play between providers, which can make some people perceive midwives as competitors to physicians.

Q: Why do you say "midwifery is one of those best-kept secrets"?

You don’t know what you don’t have until you have it. People may have a perfectly fine experience with giving birth, but they don’t know what might have been different. And that’s where I think we have opportunities. It can be even more positive and satisfying for families when they have someone really invested in their needs.

Q: What would you like people to know about UMSN’s midwifery program?

UMSN’s program is an amazing example of where midwifery is today. We have strong expertise in global health, and we have faculty engaged in national policy and writing national standards. The ability for our students to work collaboratively with their mentors, particularly at U-M Health System, really allows them to understand the challenges and the joy that come with the career of being a midwife. Our program is about quality practice, but also political engagement and appreciation for the role you can have in improving care outcomes. We have amazing students and preceptors, as well as faculty. Together I believe we create a very strong program that launches new midwives into their careers with solid philosophies and beliefs about the role they can play in making a difference.