CHOICES' new birth center is making history and reviving black midwifery in Memphis

[Editor's Note: This article originally stated Kemetra King was Nikia Grayson's apprentice. King is Grayson's practice partner. A correction was made.]

The 16,000-square-foot structure is nearly complete and the bright green facade is going up.

When finished, CHOICES: Memphis Center for Reproductive Health’s new Comprehensive Reproductive Health Center will be the only nonprofit in the country offering full-spectrum services under one roof. Those services include basic health screenings and treatment, prenatal care, LGBT+ services, menopause and miscarriage management, abortion, birth, and more.

As the name implies, the organization’s mission centers on supporting all possible options for an individual’s reproductive healthcare.

“The idea that all of these services are segregated into different locations, where some are stigmatized more than others, it’s all about politics. It’s not about medicine. It’s not about healthcare and well-being,” said Rebecca Terrell, CHOICES’ executive director.

“We are there for them regardless of what decision they make, and there are so few places that can truly and honestly say that."

The center’s grand opening will coincide with CHOICES’ largest annual fundraiser, Condomonium. It will be held April 18 at 1203 Poplar Avenue. Tickets are available here.

CHOICES sees the new center as an asset for all Memphians, particularly for birth choice.

The new facility will be the first licensed birth center in the city and will give clients the option of a luxurious labor experience that isn't in-home or in-hospital. 

CHOICES is also poised to help reclaim a centuries-old tradition in birth and pregnancy care—black midwifery.

Until the early 1900s, black midwives dominated birthcare in the United States. Now they're a tiny fraction of practitioners nationwide.

Three months ago, CHOICES' Nikia Grayson was Memphis’ only black certified nurse midwife or CNM who practiced in clinic, hospital, and home settings. Kemetra King recently completed her CNM certification. She learning the ropes as Grayson's new practice partner but will soon be practicing independently as CHOICES' and the city’s second black multi-locale CNM.

There is one other black CNM in Memphis. She only delivers at Regional One Medical Center.

“This is going to be amazing,” King said of CHOICES' new center. “We’re making history. That’s why when they said, ‘Do you want to come on board?,' I said, ‘Absolutely. I definitely want to be a part of this history.’”

A construction worker maneuvers equipment on the exterior of CHOICES' new full-spectrum reproductive center during an earlier phase of construction. The building is now nearing competition and will open in April. (Cole Bradley)

Black Women Birthed A Nation

“Midwifery is as old as the beginning of time,” said Grayson, who is CHOICES’ director of midwifery.

Until the early-1900s, birthcare in the South was virtually synonymous with black midwifery.

Prior to emancipation, black midwives were forced to attend white births, but they also chose to practice for themselves and fellow slaves and kept alive long-held medical traditions.

Post-emancipation, black midwives gained fuller automomy and continued practicing as respected professionals throughout the South. These were the granny or grand midwives. They assisted births and were seen as community leaders, healers, and bridges between black communities and white healthcare providers.

In 1900, only 5% of babies were born in hospitals, and many doctors and midwives practiced without medical degrees.

It was then that the newly emerging field of obstetrics and gynecology began to systematically dismantle the practice of midwifery. Leading physicians believed pregnancy was unnatural and sedation and other medical interventions were necessary at every labor. New standards and policies created significant barriers for black midwives to continue their practices.

The push to medicalize pregnancy worked. By 1960, 97% of births took place in hospitals and black midwives were all but gone. 

“[Black midwives] were wiped out through politics and policy that demonized them as being uncultured, uneducated, unclean, and dangerous," said Grayson.

Women's lib in the late 1960s and 1970s brought a modest resurgence in midwifery, but these midwives were overwhelmingly white.

Alongside complex qualifications, black women no longer had older black midwives for apprenticeships. Grayson said many midwifery programs at the time excluded black students and most white midwives refused to take on black apprentices.

Today, black CNMs account for less than 4% of CNMs nationwide.

“Their traditions and practices were ours,” said Grayson.

“I feel like we've been gone so long,” said King.

A gathering in Nikia Grayson's office at the CHOICES midwifery center shows the changing landscape of midwifery care in Memphis, which has been dominated by white practitioners since the 1960s. L to R: patient Michelle Green; CNM and Director of Midwifery Nikia Grayson, CNM Kemetra King, student midwife Terri Lee-Johnson, and Alexius Hill, who is both Grayson's assistant and a birth doula. (Cole Bradley)

BIGGER IS BETTER

In addition to CNMs, CHOICES works with other birth practitioners including doulas and certified midwives. CNMs are the only midwives with hospital privileges.

The midwifery staff splits its time between two CHOICES locations, their primary clinic and midwifery center. The locations are small and can’t support additional students and practitioners. They're at capacity and currently taking no new midwifery clients. 

The new facility will bring their work under one roof and greatly expand capacities.

Clients will be treated to luxurious suites with built-in birthing pools, beautiful decor, and a tranquil outdoor courtyard and garden to labor in nature.

The upgrade is more than just aesthetic. It’s reproductive justice.

“The medical model is you have a healthy baby so that’s all that matters. That’s not all that matters. This is an experience,” said Grayson.

Currently, CHOICES is one of only two midwifery providers in Memphis accepting TennCare. The other is Regional One, but its patients can't choose a home or clinic birth. TennCare is Tennessee’s government-run healthcare for low-income families, and most of CHOICES’ current midwifery clients are covered by TennCare.

TennCare patients are often limited in their prenatal care options and may not have the privilege of one dedicated doctor throughout pregnancy. This is the case at Regional One's midwifery clinic. It’s also highly unlikely they’ll see the amenities of upscale doctors officers like beautiful art, massage chairs, water features, and soft robes.

The amenities and aesthetic of CHOICES' new birth center affords all clients the same experience regardless of insurance provider. The decor also reflects their majority-black birth clientele. African art and African American quilting codes influenced the design plans, including the green exterior tiles.

King said it's important for clients to see themselves in their environment and in their birthcare professional. While training, black patients wanted to see her because she was also black.  

“There are not a lot of midwives here. Not a lot black midwives in general,” she said. “They wanted someone who they could relate to, who knew the same struggles … They didn’t have like people to connect with.”

L to R: CHOICES Executive Director Rebecca Terrell, CNM and Director of Midwifery Nikia Grayson, and CNM Kemetra King stand in Terrell's office. They proudly display a rendering of the new full-spectrum reproductive health center and the luxurious garden courtyard attached to its birth suites. (Cole Bradley)

UNEQUAL CHOICE

CHOICES began offering midwifery services in 2017. Before then, there were virtually no affordable midwifery options in the Mid-South, as many other midwives in Memphis did not accept insurance and none accepted TennCare.

“If you were low-income and TennCare was your option for health insurance, then midwifery care was just not an option for you,” said Terrell.

Terrell said TennCare’s reimbursement rate is very low and their procedures are complicated and time consuming. Unpaid costs fall to the provider so they have little incentive to accept TennCare. CHOICES raises independent funds to cover what TennCare won't.

Similarly, it’s not profitable for hospitals to give CNMs admitting privileges and is often deemed a liability. 

Regional One is the only Memphis-area hospital that allows midwifery patients and practitioners, regardless of insurance provider. Clients can see their practitioner at a clinic for prenatal care but can only give birth at home or at Regional One.

“It’s a huge barrier that St. Francis and Methodist will not credential midwives that allow patients to have more options in terms of choosing the provider they want to be with,” said Grayson.

CHOICES’ new comprehensive center will offer a third option—their birthing suites. They hope once the birth center starts drawing revenue from non-TennCare patients, more hospitals will be willing to issue admitting privileges.
 

WHY MEMPHIS MIDWIVES MOVE TO NASHVILLE

Most of the disparity between the numbers of white and black midwives stems from an imbalance of resources.

Becoming a midwife is costly and requires unpaid time and labor. White women make more money and white families hold more wealth and resources to help shoulder financial burdens.

CNMs already have a nursing degree and master’s degree and most are working nurses before pursuing midwifery. King has a master’s in nursing education. Grayson holds a master's in medical anthropology and a doctorate in nursing practice.

Alongside added educational cost for CNM certification and potential lost wages, there’s also an unofficial travel requirement for aspiring CNMs in Memphis.

Vanderbilt University in Nashville has the region’s only nurse-midwifery certification program, but it does not offer an online degree. It's also the only place to take official certification tests.

Most aspiring CNMs in Memphis move to Nashville for training. Many stay, as do CNMs from other locations. Becoming a CNM requires training under a CNM, and Nashville has the numbers.

CHOICES is the only place in Memphis where CNMs in training can practice in a clinic, home, and hospital setting. Grayson is the only Memphis-based birth practitioner who can supervising training in all three settings.

“One of the things you see is the education institutions are anchors for midwifery in the community,” said Grayson. “Because Vanderbilt has a program and partners with the hospitals and they have a birth center already there, it makes [training] a lot more accessible.”

Those who can’t relocate can expect to travel to Nashville for weekly classes and testing. Terrell did say that UT Health Sciences Center is starting a new nurse-midwifery certification program next year that will allow aspiring CNMs to train and test in Memphis. 

Still, wealthier white women have a better shot of launching a midwifery career.

Vehicles on Poplar Avenue whiz past the new CHOICES comprehensive reproductive health center during an earlier stage of construction. The building is now nearing competition and will open next month. (Cole Bradley)

Higher Standards for Healthy Patients

For racial minorities and people with subsidized healthcare, pregnancy and birth are often more stressful and less personal, respectful, accessible, and competent. 

Black infant mortality is twice the rate of white infant mortality and black pregnancies and births are up to four times more likely to end in the death of the parent. Black people who are pregnant are three times more likely to die from preeclampsia, which is likely due to a combination of factors including general health disparities and incompetent care. 

Grayson focuses on continuity of care. Her patients have her cell phone number.

“What we know is that people who build relationships with their provider and have that continuity of care, they’re provided a higher quality of care,” said Grayson.

“I’m reachable. I think that’s really important for providing care and addressing a lot of these issues we’re seeing in maternal health."

Grayson frequently spends an hour per visit with her patients checking in on their mental, physical, and emotional health, as well as the pregnancy. She encourages patients to listen to their bodies and spends time educating them on which symptoms to take seriously.

“You’re bringing your whole self to care. You don’t just bring your pregnant body,” she said. “It’s really important that we meet all of those needs and address you as a whole human being.”

Grayson said it’s easy to provide medical support. The emotional support is harder.

“I’m a social worker now and a counselor and things I never thought I would be, but it’s needed,” she said.

CHOICES hopes to add mental health services and referrals at its new facility. 
 

Continuing THE Grand Legacy

Grayson, Terrell, and King all share a dream of seeing the new comprehensive center grow into a hub for black midwifery, birth advocacy, and connections to the history and prestige of the grand midwives.

“We wanted to be a training site for black midwives to reclaim those traditions and our place here in the South,” said Grayson. “We’re already working on creating a fellowship opportunity for nurse midwives.”

They hope to see half a dozen CNMs working alongside other birth practitioners. They hope the majority are practitioners of color.

“We wanted it for patients, we wanted it for the community,” said Terrell of the birth center and full-spectrum services they’ll soon provide. “We want to see if our theory is correct—that this is a model people will respond to and whether we’re able to provide the level of care planned.”

“Remember that you have your own autonomy," said King. "This is your body. Whatever you want to do, that’s what we support you in. We are your voice, your advocate. We listen.”

Read more articles by Cole Bradley.

Cole Bradley is a native Memphian and graduate of the University of Memphis. Cole's worked locally as a researcher and community engagement strategist and began contributing to High Ground in Jan 2017. 
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