Reproductive Freedom And... Birth Workers.mp3

Reproductive Freedom And... Birth Workers.mp3: Audio automatically transcribed by Sonix

Reproductive Freedom And... Birth Workers.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Briana Perry:
Hello, I'm Briana Perry. I'm Anna Carella, and we're the co-executive directors of Healthy and Free Tennessee, a state-wide network that strives to promote sexual reproductive health and freedom in Tennessee by advancing policies and practices which recognize these elements as essential to the overall well-being of all individuals and communities.

Anna Carella:
Reproductive Freedom And... highlights topics within reproductive freedom in Tennessee. Issues of reproductive freedom affect all people and this podcast showcases stories across a range of experiences. We hope you enjoy listening as much as we enjoyed putting it together. Birth workers, including midwives, doulas and ObGyns, are an important piece of the reproductive freedom movement. Reproductive freedom is not just about the ability to terminate a pregnancy or carry it to term. It's also about the quality of care that pregnant people have access to, how that differs by race and income, and what justice measures we can take to close the gap. The United States is the only developed country with the rising maternal mortality rate. This is largely driven by racial disparities in health care access. Black women are three to four times more likely to die of pregnancy related causes than white women.

Briana Perry:
Anna and I sat down with two birth workers in Memphis who are responding to the need for more equitable access to birth services and care for black women and people to address the disparities that black and other communities of color face.

Anna Carella:
Dr. Nikia Grayson is a family nurse midwife, anthropologist and public health activist. She's the only certified nurse midwife in Memphis who's able to do home births. She's worked for 10 years in public health and is devoted to serving and empowering people in marginalized communities. She currently works at Choice's Memphis Center for Reproductive Health, providing holistic care to people throughout their reproductive lives.

Briana Perry:
Mia Peake is a birth doula and founder of Peake Women's Wellness, an organization based in Memphis working to serve all women and families during their transition from pregnancy to birth. She is also the program manager at Abortion Care Network, an organization that supports independent abortion providers. She works to expand the full range of birth control options in abortion clinics across the country. We are so excited today to be in conversation with two phenomenal birth workers in Memphis, Maya Peake, a doula here, and Dr. Nikia Grayson, a certified nurse midwife. So thank you, ladies, for joining us today.

Dr. Nikia Grayson:
Thank you for having me. Yeah. Thank you for having us. Yeah.

Briana Perry:
So we just first want to begin with y'all's journey to y'all's respective fields. So, Mia, your journey to becoming a doula and Dr. Grayson, in your journey to becoming a certified nurse midwife. So if we can start there.

Mia Peake:
Yeah. So I have been in reproductive health for almost eight years in some capacity. I worked at a local abortion clinics. I first started as an intern at Feminist Women's Health Clinic and went to the Peace Corps and then finished up my master's at Meharry Medical College and that graduate program. So when I decided to come back to Memphis, I just basically saw a need and I started looking up like birth workers in Memphis. And I really didn't see a lot of information around like black women that were doing this work. So I just really just started contacting like black women that were doulas. And then I met one. And then basically she just showed me, like, what is going on in Memphis, Tennessee, what is needed? And then I just start doing it to start aligning myself with women that were doing birth work.

Dr. Nikia Grayson:
Hmm. This is much needed here. I think that what brought me to birth work that's a good question for me. I'm also someone who has a history in reproductive health and had been doing reproductive health for a long time in a different capacity, really focused more on HIV and AIDS and STIs. And so I started working on a project with the March of Dimes called Community Voices. Actually, I was working on it while I was a graduate student at the University of Memphis and I was working on my medical anthropology degree. And the project was to evaluate this program and it was the infant mortality program that was specifically focused on addressing infant mortality in the black community. And so they partnered with local churches to give infant mortality education to patients, to families. And in the process of evaluating the program, I would talk to families and interview these families and really hear their stories about lost infant loss and and really found that it was generational. And we really started to see what was the gap in the community. Why were black families experiencing infant loss at higher rates than their white counterparts and really saw that there were many issues, but one definitely was access to care and not just access to care in the in the sense of, oh, we have hospitals, we have doctors, we have emergency rooms, but access to care caring providers and providers of their choice.

Dr. Nikia Grayson:
And what I found was that in the in the past, we had these healers and caregivers in our communities. There were midwives who they had been pretty much run out of business through politics and policy, and the midwives were the ones who really like who were caregivers and he was seen in our community and so I decided that's what I want to do and decided to go to become a nurse midwife. So I went to University of Tennessee Health Science Center here and got a master's in nursing and then did a doctorate in nursing at University of Tennessee. And then I did a postmaster's certificate in midwifery at Frontier Nursing University. So I have a certificate in nursing midwifery, but also I'm a family nurse practitioner also. So I was hoping to just fill the gap that I saw. And fulfill the legacy of those who came before us.

Briana Perry:
So yeah, yeah, definitely feel. So I want to tease apart and get a general understanding of what you all exactly do. So, Dr. Grayson, you kind of already talked about this history just briefly about midwives in the services they provide for their communities? A long time ago, how that shifted. So just starting with you, like what exactly does a midwife do with services today provide because we are seeing this resurges of midwifery?

Dr. Nikia Grayson:
Yeah, I think that we are definitely seeing a movement in our country of where midwives are being called upon again and we are seeing a resurgence of midwifery practice art that was almost lost. I mean, so midwives are health care providers and I'm a nurse midwife. There are different pathways to midwifery because I'm a nurse midwife. So I went to nursing school and then I went and did a graduate degree in midwifery. And then the they have certified professional midwives who are licensed midwives who also practice here in Tennessee. And they do a different program, but they're not nurses and they are more home, home, birth midwives. And so what we've seen now is that people are looking for different types of care. And so midwives are basically like providers who provide care for women doing their prenatal childbirth and postpartum care. Now, a nurse midwife, which is what I am, I also do work in Gyn care. So regular well woman, well person care, as well and exam. So yeah. And exams. So they're not everybody is not necessarily pregnant that I see. But I can care for a person from 13 to death pretty much, you know. So I'm caring for them along their reproductive lifespan and that is different for most nurses, most midwives. So nurse midwives, even though we can care for people along their reproductive life, most of them kind of focus on just when they are pregnant. And so we're able to provide prenatal care and like I said, do labor and delivery and do postpartum care as well. So, yeah, that's what we do.

Briana Perry:
Ok, so the entire course of like a person's reproductive lifestyle and women like through a reproductive age. I never knew that. I thought it was kind of like this. Focus on birth, labor, pregnancy. Yeah. Postpartum.

Dr. Nikia Grayson:
No, it's not is actually a focus on just the reproductive health. And so we provide care for people who have whatever issues it is. Could be they have a sexually transmitted infections or they are experiencing menopausal problems or whatever. I mean, we just we see a whole range of issues and what a lot of midwives do go to school specifically because they want to care for pregnant people. So a lot of them do specifically care for pregnant people. But I actually see pregnant people and I see transgender persons and I see women who come in for whatever gynecological issues that they have. So I do see a wide range of people within a week.

Briana Perry:
Ok, so providing this holistic care. So I want to go back to you, Mia, and just talking more about like doula care and a different type of doulas there are available for a person to access.

Mia Peake:
Yeah. So I am a labor doula, so it's different kinds of doulas. And I specialize in ensuring that and every doula is different they have their own like model. But because I have a masters in public health, I focus a lot on prevention. I meet with them at least three times prenatally. We talk about pain management, we talk about all the medical interventions. And then as a labor doula, Doula I'm there the entire time doing labor. Normally I don't leave until like if. They want to breastfeed like two hours postpartum, so, yeah, like that's essentially what the labor doula is. Do you have postpartum doulas? Normally they are there after the mom or the pregnant person has the baby and then they're helping cleaning up. They helping just assisting the mom to this new person, caring for the baby. Normally they're there in the night, you know, while mom gets some sleep assisting her or referring her to any like any people that specialize in certain kind of like postpartum work. Mm hmm. So, yeah, that's mainly my my focus is labor to being a labor doula, OK?

Briana Perry:
And I'm trying to think about it like some other type of services. I know, like there are abortion doulas. So they just support a person while they are getting an abortion and they stop right there, like

Mia Peake:
Normally with abortion, they just stop. So I know like a lot of like the independent abortion clinics, even like I think Planned Parenthood, they have like abortion doulas that there they are basically like giving them knowledge about what's going to happen, just being that emotional, that person, another person in the room to provide some emotional care to that person that's going through that process.

Briana Perry:
Ok, so if a person was a full spectrum doula, what would that be?

Mia Peake:
Right. It really depends on what they consider like the full spectrum. So I've heard of even like death Doulas that are there like assisting people with the process of grief. So majority of the time, the full spectrum is postpartum labor and then you may abortion doula is included as well. Mhm.

Briana Perry:
So now you have your own doula business Peake Wellness. So if you can talk more about that business, like what is the mission goals and the work that you all have been doing.

Mia Peake:
Right. So Peake Wellness is two years and basically we it's me and then one of my past clients use a doula as well. We assist women in decreasing the chances of trauma around birth. So it's not we have this goal of having a natural birth that we include anybody, a C-section, schedule, C-section. It doesn't have to be a natural birth. We just want to make sure that each person has a baby. We decrease their chances of birth trauma. We want them to be informed what they want them to basically just enjoy this process of giving birth.

Briana Perry:
And so I know you also have well, not recently given birth, but you do now, but you did within two years. And so I wanted to kind of talk more about your birth experience, especially as a black woman. What was that like? And did you have a doula? What was your support team like?

Mia Peake:
Absolutely. So I was a doula actually before I gave birth. But I was, you know, in Memphis, Tennessee, is no birth centers in Memphis, Tennessee. I didn't know at that time any midwives, so I did my research and trying to find the most equipped OB in the city, I met with them a couple of times and it was basically this disconnect. You know, I was very excited. I came with my birth plan, you know, wanting them to be on board with, like, the natural way that I wanted to give birth. And it seemed as if this person did not want did hear me. It just really was open to, like, my needs and wants. And basically at that time, I was working at a I was working at Choices and they were there building the birth center in Memphis, Tennessee. And I told the midwife that was the new hire, that I was pregnant. And she basically asked me, would you be interested in home birth? And before that, I never really thought of a home birth because again, like, I didn't want to spend four thousand dollars. I didn't think this was accessible to me. And I didn't honestly know anybody that had a home birth. And then I guess, like the stars aligned and had two incredible midwives and one birth student midwife there with me. And it was absolutely what I wanted. I wanted to move around. I wanted to be able to eat. I wanted to be I wanted to drink. I wanted my partner to be there. And I was able to do all that and in my home. So definitely if you're if you're able to have a home birth, I definitely recommend, you know, looking into it for sure.

Briana Perry:
And you mentioned how you didn't know that was a possibility. Do you think that other pregnant people in Memphis and Tennessee don't know the variety of options when it comes to their particular birth? And if so, why do you think that's the case?

Mia Peake:
Absolutely. I think a lot of people just don't they don't know like the option around like home birth or I think one of the biggest barriers is the affordability for the longest. You know, you have to spend three, three to five thousand dollars to even have a home birth. A lot of midwives and I think the key discussed is, you know, you have two different midwives, you know, majority of the certified professional midwives. They do the home births. So that means that they normally don't take insurance. So majority of the time you have to pay out of pocket. And of course, like, that's not accessible or accessible to a lot of people, especially if they're going to have a new baby. They don't want to spend four or five thousand dollars on just, you know, home birth. So I think the affordability is the biggest barrier and then, you know, just feeling comfortable with somebody that looks like you. Right. So I know even for me, even when I was going down the OB track, I wanted someone to look like me, quite frankly. And that's why I chose that OB and she had a Masters in counseling. So I was thinking, like this person would have a great bedside, manners. But yeah, I think one of the one of the reasons why we don't have a lot of people, particularly black people, that think that this is accessible is because we don't have the diversity of midwives in Memphis, Tennessee.

Briana Perry:
I want to come back to you, Dr. Grayson, on a diversity like tip in how I was the makeup of midwifery now, you know, kind of heard about a lot of white midwives, but a lot of, are black people represented in the field. And if so, or if not so like, why is that the case?

Dr. Nikia Grayson:
I want to first say that Mia was amazing in birth. I had the pleasure of being my one of Mia's midwives and she was amazing. And she did a really great job. And she was actually my first home birth. And her and Sophia and I did not think that she was going to make it wouldn't be in hospital, but she did amazingly well. And actually, Mia was the one who really gave me the faith to be able to do home births, because a lot of the people that were coming to see us, that wanted home births, I just I didn't know they could make it, you know, especially because I was trained in a system I was trained in the hospital, had only seen birth in the hospital and most nurse midwives. That is the only way they do see birth. And the way we practice is usually in hospitals and not not not home births or and not that many birth centers in the country. So. Mia taught me a lot about myself and about women and the strength that they, you know, that they have and she was amazing in them. Yeah. So it was a really good experience. Uh, yes. About midwives in the United States. Well, midwifery in the United States is I mean I mean, you know, you have midwives here forever and there aren't that many midwives in the south. And if you look at a lot of the health disparities or, you know, inequities that we see, a lot of them, we're focused in the south, especially the southeastern section of the United States. And this is still the you know, those numbers kind of reflect what we've seen in terms of midwifery as well, you know, the lack of midwives and the birth outcomes being not as great. So the reason that they are not that many midwives in the South is that the laws are different from state to state, unfortunately, and the restrictions on midwifery can be kind of harmful.

Briana Perry:
What are some of those restrictions?

Dr. Nikia Grayson:
Yeah, some of those restrictions are so in each state. In all of the 50 states certified nurse midwives are allowed to practice how they practice is different. So because certified midwives certified nurse midwives are considered advanced practice nurses, so like a family nurse practitioner, so they are allowed their license to practice in the 50 states. But some of the states require them to have what they call supervision, supervision by a physician or they have what they call collaborative agreements with physicians. So a physician does not agree to be their supervisor or collaborative physician, then they cannot practice. Yeah. And so there are some states that they don't have that they can act as independent practitioners. They are maybe. Twenty three, I think, states where they can act as independent practitioners, where they don't have to have that supervisory role or that collaborative role.

Briana Perry:
Is Tennessee one of them?

Dr. Nikia Grayson:
Tennessee is not one of them. Tennessee requires that they have what they call a collaborative agreement. And so that, of course, makes it hard because here in Memphis, there are no midwives that work outside of regional hospital. So. If the OBs in the community don't support midwifery or are willing to collaborate with midwives or nurse midwives in the community, then they don't have a job opportunity. So, yeah, is is really is really interesting why that is. But they are not that many midwives in the country as a whole, you know, and then women of color only make up about four or five percent of those midwives

Briana Perry:
Only four or five?

Dr. Nikia Grayson:
Four to five percent. And then black midwives specifically only make about two or three percent of that. So they are not a lot of us. There are a lot of barriers to becoming midwives in the United States and definitely a lot of barriers for people of color.

Briana Perry:
So what is the logic behind these restrictions? Like having these agreements.

Dr. Nikia Grayson:
It is about power. It's about power and control. Yeah, it's about power and control. And this is what we we're seeing across the United States, not just with nurse midwives, but also with family nurse practitioners who have to have these agreements as well and are not able to practice in their full scope of practice. And so many of the associations across the state, like Tennessee Nurses Association and many of the other National American Nursing Association, many of these national organizations are lobbying to, of course, have these rules overturned. So they're working really hard and diligently to to get advanced practice nurses to be able to work within their full scope. But this is an ongoing fight.

Briana Perry:
Ok, ideally like people will be working together, but it's a struggle of our power who can do what and provide services. Mm hmm. So Mia kinda thinking about, like, the availability of midwives. I'm also thinking about the availability of doulas and thinking about black doulas doulas of color as well. But because I know there's like a lot of conversation about and just different research that talks about people having access to Doulas. So what does that look like in Memphis and then also across the state of Tennessee, like this demand for doulas, but also the availability of doulas and then also black doulas who are available?

Mia Peake:
Right. So I know that for the longest, like doulas have been noted as being like a luxury service for like. Yeah, the only people they could spend. Fourteen, fifteen, sixteen hundred dollars. Right. And I know like when I came, that's kind of what the scope was, you know, like, even like they like certain agencies that, you know, you basically show up in, you know, the clientele look completely different. They were more in like Germantown area, East Memphis, East Memphis, not in like the urban area, a majority of like people of color. It was just priced out where they couldn't really assist access it. And then so to make my services kind of more accessible, I do kind of meet people where they are. We do payment plans, you know, and then, you know, we have an organization called Birth Strides that they are doing phenomenal work, but they are grant funded organization. So obviously they can in I think their set up is if you live in a certain zip code, you get a doula free. But as far as like a private doula, you know, because you are a business you can't necessarily have, doula you know, you can't work for free. So you just try to meet, you know, clients in the best way possible. And for me, like a a payment plan has really worked.

Mia Peake:
I don't feel comfortable with my services charging fifteen or sixteen hundred dollars. I do not know any doulas, particularly in the South, that are just like full time doulas. You know, we have a couple that we call like Rockstar, you know, doula rock stars where they have different packages like trainings and they do plus an encapsulation and other things. But you don't really have like a lot to doulas that are just doing this completely full time, especially with the target population that I'm interested in. So it it is a conversation about Medicare reimbursement that is going about. But, you know, if midwives are having a very difficult time and with Medicaid reimbursement, you can just only imagine what the reimbursement rate is going to be for doulas. Right. So I don't necessarily think that is like the end all when it comes to, like, making sure doulas are accessible. But I think they you know, like the studies show that, you know, they are important. Right. So doulas increase the chances of just a better birth outcome, increases breastfeeding rates, decreases like cesarean rates. So all this is evidence based. But as far as accessibility, that's something that we haven't really solved because, again, like it could be very expensive to get a doula. Maybe a marginalized population.

Dr. Nikia Grayson:
You know, we have a broken system, right, and maybe a broken health care system and. I mean, until we really start to address that and, you know, address to the structural racism and violence that we see in this system, then, you know, we will always have those who who can afford luxury services and those who can't. And, you know, with the marginalized people kind of being on the outside. So.

Briana Perry:
Hmm. Do you feel like kind of like you saying initially, like this was this is like luxury, like service and like the people of a certain class had access to doulas. Do you think it's important, therefore, for people who come from a low socioeconomic status, who come from black and brown communities to have doulas that look like them?

Mia Peake:
Absolutely, yeah. So, you know, when I first started, you know, I was with a particular organization and their clientele was completely different. And it was this disconnect, to be honest. You know, like first they would just show up at births without like any prenatal education in the beginning. So I literally would just meet women. And when they're in the most vulnerable

Briana Perry:
Right then and they

Mia Peake:
Would make it, you know, so then, that would be very difficult to create a rapport. And I feel like I wouldn't necessarily needed. But I do you know, I pride myself on creating a sisterhood with my clients, you know, that I'm able to go to their baby showers. I'm able to, like, continue this, you know, relationship even after birth. And I think that's very important because having a baby can be so isolating and a lot of these women, the way that they want to parent is completely different from where they came from. So they want to connect with people that, you know, that are breastfeeding, you know, like even with I know with my mom and her mom didn't even breastfeed. So it was very important for me to connect with women that were pregnant and, you know, had the same kind of parenting style that I wanted to implement with my child. And you can do that with the doula. Like they opened up a gateway of, like, birth workers to you. So if you're having issues with birth with breastfeeding, they can introduce you to the the the community that breastfeeding or if you want to do cloth diapers like that, is you not the crazy person, the holistic person in the group. You have this like ongoing community. And I think that's what a lot of people are missing that could ultimately I don't know if it's like you can, you know, research it, but I know, like, community is so important when you're when you're having a baby, you know? So I think that in itself improves birth outcomes and just living in general.

Dr. Nikia Grayson:
And I think we're building that community here. I would say that. Um, Mia and I do a lot of work together, and I think that that has been the key to a lot of successful outcomes for us. We talk about the women or the families we serve, and we make a plan together for them and and really work really hard to to find resources for them. And I mean, we were just talking about last night about we are social workers. We were just talking about this last night because we have we have a client in common and and just talking about some of the needs that she has and how we can connect her with these services. And I'll be very honest, when I went to school and decided to become a midwife, I never thought that I was going to be a social worker and a counselor and all of those things. You know, just because

Mia Peake:
It's the population that we serve,

Dr. Nikia Grayson:
The population that we serve and is is hard work but is rewarding work. And it really is the hardest work I've ever done in my life. And so I don't think that I saw it the way that it is unfolding. Some of it I did with other pieces I didn't. So we'll see. We just going to continue to chip away at a lot of the issues we see in the community and figure out ways to increase the number of birth workers in the community. I mean, Mia and I talk about that a lot also because it sucks being only it sucks being only in some of these spaces that, you know, we shouldn't be only in in 2019.

Briana Perry:
And expanding that. And I hear both of you are talking about this need to build community and show up for these folks in, you know, just trust building and just letting them know that you're here for them and you know, you serve is like a social worker and that being a part of the holistic services that you all provide. So thinking about like being a part of the community and providing resources for the community, I know you hosted an event in April, Melinated Birth Yoga. And I just was curious, like what was the inspiration for that event and like what was the unmet need that you felt like that event was going to feel.

Mia Peake:
Yeah. Yeah. So I'm a person of faith and in Memphis, Tennessee, like, I think we're like number one on like having the number one number of churches per capita in the entire nation. And I see increasing like. Churches, but I see like health disparities as well. You know, so it's this disconnect of, like, healing. And I wanted to just bring attention to getting more, particularly like black women interested in other in other ways of healing. Other than faith. And I think it kind of played out where we had the setting at a local church, you know, because, you know, you can go to church and you can also just does not have tools around stress, so I wanted to bring that, but also highlight the importance of the options of birth, the birth options in Memphis, Tennessee. So that's basically what it was. I wanted to get give people another tool around birth and healing.

Briana Perry:
Yeah. What was the response from event? It was great.

Mia Peake:
Yeah, it was the first one and it was really nice to see, like, black women rest and sleep and nap, you know, so many pregnant bodies just being in community and just expressing going over the birth story. Right. So that was very important because it's not a lot of spaces for people to talk about the birth story or trauma or not great experience. But it was just beautiful to see women really express and just feel vulnerable around birth. So we definitely want to do it again. I think it's something that we were even thinking about going in different states,

Briana Perry:
Take it on the road

Mia Peake:
Before and yeah, yeah, it was very beautiful. We had a lot of people that came and sponsored the event. So, yeah, it was very it was it was great.

Briana Perry:
But Dr. Grayson, you mention like kind of this, this tiredness of being only you and Mia. So, you know, Memphis, a majority black city, my hometown of Memphis. And with that being said, there's this lack of black majority black birth workers, like, why is that the case? Is that true for the rest of Tennessee?

Dr. Nikia Grayson:
You know, that's a good question. Um. Well, I mean, in terms of of midwives, this the case, Memphis, not necessarily in terms of a OBs, I think is maybe 50 50 for the OB's in terms of you know, black, white or, you know, even male, female, I think they're running about 50 50 for OBs, but for midwives, it's different. So in Memphis, there are not that many midwives, home birth midwives or midwives to practice.

Briana Perry:
So in general there are not a lot.

Dr. Nikia Grayson:
Not here in Memphis. And so I'm considered like a community midwife and I'm a midwife, a nurse midwife who can both do planned hospital births or home births. And I'm the only provider in the city that does that in the city. I'm the only one. Mm hmm. Yes. A lot of pressure is a lot of work is a lot of work is a lot of pressure. Yeah. Yeah. So I do have patients who want to go and have a planned hospital birth and we do that. And then I have those who want a home birth and we do those as well. And so it's a lot of work because this model is very different. It's very relationship based. And, you know, you get to know people in a very different way when they come for care. They're not coming for a quick visit. Some visits are hour long, some longer. They personal their personal connection. And you really do get to know each other very well. And so by the time that they are they ready to give birth, you really know them. And so it's, uh, it's very therapeutic as well.

Dr. Nikia Grayson:
I would say that, like I said, the visits are about an hour long and. And then the postpartum care is different as well, so. I see my patients more in postpartum than most obstetric gynecologists do, and so I think that that care is really different, is really important, is very much needed, and it will really help to address to me, it really will help to address the maternal mortality numbers we're seeing in the black community, because once you really get to know someone and trust them and recognize that they are really the expert of their own life and their body in their experience and and that you as a partner with them to, you know, on this journey toward parenthood and really helping them to prepare for for motherhood or parenthood. I think that's really I really feel like this what my job is. And so it's different from, you know, being in a clinic where you see 20 people a day, you know, I mean, I only see five or six. Yeah. And that's OK, because I spent a lot of time

Briana Perry:
With those five of those five or

Dr. Nikia Grayson:
Six people. Yes, yes, yes, yes.

Briana Perry:
I know lots of folks are excited about the opening of choices new birthing center is going to be opening very soon. And so I want to see if you could talk more about, like, the vision for that, like how it's different and the first of its kind and more so about the midwifery model of care that they're trying to center the birthing center. Right.

Dr. Nikia Grayson:
Well, choices, as you know, Choices, which is Memphis Center for Reproductive Help here, start off as a first trimester abortion clinic right after Roe and has really evolved into this amazing, eclectic, independent clinic. You know, this sits in Memphis, Tennessee, you know, and so what the vision right now is and we're ever changing based on our community needs, but the vision is to to provide this full spectrum care, which really is this full spectrum reproductive care where we care for people, regardless of, you know, whether they're men, women, children, we see all of them. And so what we're trying to do now is what we are doing, I should say, because we really are doing is provide people with options in Memphis. And so choices has started. Now, when did we start this? In 2016, I would say in 2016, we decided to, um, to provide midwifery services, add midwifery services to the services that were already there, which were, of course, like the first trimester abortions, and transgender care. We have a large transgender clinic as well and decided to add midwifery services. And the the goal was to the idea was that we were going to bring midwifery services to communities that did not have it as an option. Basically, there are many the majority of births in Tennessee are are on Medicaid or. Yeah. Persons who give birth on Medicaid.

Dr. Nikia Grayson:
And so for that reason, they really kind of cut out a lot of services that could be available to them. And so we wanted to bring midwifery services and that option of birth choices to the most marginalized communities and really allow them to have the same experience experience that we were seeing. White women were able to pay for our pocket in terms of midwifery care. And so what we decided to do was we were going to take anybody to walk through the door. And that first year we did in that first year was absolutely crazy. It was like we are crazy. And we took everybody that walked through the door that we could and regardless of the insurance they had and we kind of just worked it out. And so what we found was that we had the most diverse group of patients, you know, some people who were who had, you know, high levels of formal education. All of them were highly educated. I mean, they they knew a lot a lot about their bodies. They knew a lot about what they wanted. They knew a lot about reproductive health, you know, but like I said, some who were had higher levels of formal education and then there were some who had five or six children already. I mean, the that diversity was an experience.

Briana Perry:
Yeah.

Dr. Nikia Grayson:
Yeah. It was a very different experience with each family. And so we wanted to make sure that everyone had access to the best care, you know, this high quality, nonjudgmental care that was centered around them. It was very personal, very individualized and wanted to to meet not only their medical needs, but we also want to meet the social and emotional needs as well, and I think we did a good job of it. I mean, we were we were ever learning and ever changing. And, you know, we definitely fail fast so that we can recover, but I tell everybody, I feel like this model of adding birth services to, you know, this clinic that was, like I said, initially a first trimester abortion clinic. Initially, we weren't sure how we were going to be perceived in the community. And I think that we were. We've received much better than

Briana Perry:
Expected

Dr. Nikia Grayson:
and we Expected. Not initially. 40 births,

Dr. Nikia Grayson:
Yeah, we had we had like a a something like that, maybe a little bit more. But I think we were not perceived well initially. But I think that, you know, you just do the work

Briana Perry:
And build those relationships.

Dr. Nikia Grayson:
Absolutely. And now we I think we have a really good relationship with the community in which we can't take everybody, you know. And so our hope is that this model can be replicated where you see these full spectrum clinics, you know, across the country and providing people with the care that they need is high quality, nonjudgmental care and factual base care. That was really important as well. You know, to not use power and intimidation in birth work was really important and to listen to people and listen to families and listen to women

Briana Perry:
And trusting them as the experts

Dr. Nikia Grayson:
Trusting them as the experts of their bodies and honoring them and respecting them. So that was really important to us. And I think that we you know, we are continuing in that way and continuing in that model. And hopefully our next goal is to, like I said, to increase the number of birth work and specifically birth workers of color in the city of Memphis. So we definitely need more help and we're looking and the goal of the birth center is not just to to provide access to, you know, these birth services for the community, but also to be a training ground for birth workers of color.

Briana Perry:
That's amazing. Thank you so much for the work that you are doing and building these relationships in groundedness, working a community and trusting these folks as the experts of their lived experiences like it's greatly appreciated. So just this last question. If people wanted to connect with the work that you all are doing and want to learn more about you all, how could they go about doing so?

Dr. Nikia Grayson:
Well, they can find me at choices, I'm there five days a week, so, you know, of course, choices- Memphis Center for Reproductive Health. Our website is MemphisChoices.org or they can find me on my website, which is my name, NikiaGrayson.com. I don't think it's too hard to find me and Mia in the city. We are around.

Mia Peake:
Yeah, yeah. And my website is PeakeWomensWellness.com. So yeah, I think just shoot me an email. Yeah.

Dr. Nikia Grayson:
Mhm. Yeah. I think that, I think people know where to find us now. Um I don't think we're doing a whole lot of advertising these days and no, we know a lot of business so. Yeah. Yeah but no really. Yeah it is. And we really want to help others to do the work because it's a lot of work that needs to be done and it's a lot for just a handful of people to do it. So yeah. And what we're also seeing is a lot of the families that we serve, the, the women in them decide to become birth workers as well.

Briana Perry:
And Mia you talked about that, how your former client is now working with you. You were her doula and she's working with you now.

Mia Peake:
Yeah. Like, I don't know what it is like when they have a baby with us. They just opens another, like a different way of looking at birth to them and they want to be in it, you know. Absolutely.

Dr. Nikia Grayson:
And so we end up meeting these wonderful families and women and we help them and then they turn, turn, turn around and help others. And it's really, you know, paying it forward. And so I think it's a beautiful thing. We hosted a doula training here last year in October.

Mia Peake:
And I think a majority of the people we. Yeah.

Briana Perry:
We work with.

Dr. Nikia Grayson:
Yeah, absolutely. Yeah.

Mia Peake:
We trained 17.

Briana Perry:
Yeah. I was in there. Yeah, yeah. Yeah.

Dr. Nikia Grayson:
And so our goal is to increase those numbers and of it's a little easier to train them to be doulas than it is to, to train them, to be midwives. But um our goal is to also help grow midwives in the city. You know, the midwifery training is, you know, a longer process and then also finding preceptors, which is which is what has been a big area for a lot of midwives. Student midwives of color has been finding preceptor opportunities and clinical training sites has been a problem. But many of the organizations are now stepping up to try to address those issues as well, recognizing that historically black and brown persons have been shut out of these clinical experiences. And now so this has become a focus for many of the organizations. You know, ACNM, which is the American College of Nurse Midwives and MANA Midwifery Alliance of North America and several other organizations now are having this focus and this push to definitely center black and brown students. So the hope and prayer is that we will see more midwives of color come out of this. So, yeah,

Briana Perry:
Here in Memphis and across the state. Absolutely. Yeah. Well, thank you so much for joining us. I really enjoyed this conversation and we will continue to uplift the work y'all do.

Dr. Nikia Grayson:
Ok, great. Thanks so much.

Briana Perry:
Thank you for joining us for this podcast brought to you by Healthy and Free Tennessee. Healthy and Free Tennessee is a state wide coalition whose mission is to promote sexual reproductive health and freedom in Tennessee by advancing policies and practices which recognize these elements as essential to the overall well-being of all individuals and communities. Please find us online at www.healthyandfreetn.org On Instagram @healthyfreetn. And on Facebook and Twitter. @healthyandfreetn.

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