EBB 371 – Reclaiming Black Midwifery in the South with Dr. Nikia Grayson, Chief Clinical Officer of CHOICES in Memphis

Dr. Rebecca Dekker – 00:00:00:

Hi everyone, on today’s podcast we’re going to talk with Dr. Nikia Grayson, about her work at CHOICES Center for Reproductive Health in Memphis and how they’re expanding access to midwifery-led community-centered reproductive care. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast. Today, I’m so excited to talk with Dr. Nikia Grayson. Dr. Nikia Grayson is a nurse midwife, family nurse practitioner, and anthropologist advancing reproductive justice and health equity. As Chief Clinical Officer at CHOICES Center for Reproductive Health in Memphis, Tennessee, Nikia leads efforts to diversify midwifery and expand access to community-based, full-spectrum reproductive care, particularly for Black and Brown communities. With advanced degrees in public health, nursing, and anthropology, Dr. Grayson brings a unique, justice-centered approach to health care. Under her leadership, CHOICES has opened Memphis’ first and only birth center and launched the nation’s first Black midwifery fellowship. A disruptor of traditional health care systems, Dr. Grayson also serves as associate clinical professor at UCSF, where she works to transform midwifery education through culturally responsive and community-centered training. Dr. Grayson is committed to equipping future providers to practice at their full scope and meet the needs of underserved communities across the South of the United States and beyond. Dr. Grayson, welcome to the Evidence Based Birth® Podcast.

Dr. Nikia Grayson – 00:02:03:

Thanks. Thanks for having me. Follow you and your work for many years now. So it’s really great to be able to talk to you.

Dr. Rebecca Dekker – 00:02:09:

I remember I was first introduced to the work of CHOICES when I was in Memphis like eight or nine years ago. And there was like a little cohort of your staff there. And I was so impressed by what they had to say and what the work that they were doing. So it feels like. You know, it’s been a dream of mine for a long time to get to know more about CHOICES and to bring you on the podcast. So thank you for being here.

Dr. Nikia Grayson – 00:02:31:

Thank you.

Dr. Rebecca Dekker – 00:02:33:

Could you talk with us a little bit about what inspired the vision of CHOICES and how it evolved over time? Because from what I understand, it’s pretty unique in terms of like what a birth center does.

Dr. Nikia Grayson – 00:02:45:

Yeah, CHOICES was born out of a radical belief that, you know, reproductive and sexual health care should be comprehensive, affirming and accessible really to everyone. Right. Regardless of race, gender, identity, income, zip code. And so for us, CHOICES came about really in 1974, right after Roe. And it was a first trimester abortion clinic for many years. And we realized that we had resources that could really impact that community and their health. And so when we really started to diversify our services initially, it was really to help our LGBTQ community and those that were living with HIV. And our first grant was HIV grant. And so we recognized that the community that we were serving was needing more from us than what we had been provided initially. And so when I joined CHOICES, it was clear that while the organization had a strong foundation and reproductive health care and abortion care, because that’s what they had primarily done, there was something missing, especially in Memphis. And what was missing was we’re freely community-based birthing options, particularly for Black and Brown families. And so for me, it was how do we reconcile the legacy that Memphis had with Black Midwifery that really was systematically dismantled through medical racism and hospital regulation. And so our vision evolved, right? We weren’t just providing services. We really started to look at how can we reclaim these traditions, you know, build a workforce and really disrupt the system that had really excluded Black women and birthing people.

Dr. Rebecca Dekker – 00:04:28:

You mentioned like the medical racism in Memphis. Can you just kind of give our listeners who aren’t familiar with that area, you know, what are some of the biggest challenges facing families who are seeking health care of any kind in Memphis, but particularly birth care?

Dr. Nikia Grayson – 00:04:44:

Yeah, I mean, I think that… Right now, you know, we’re seeing the dismantling of a lot of the efforts that we have made and conquered that has historically been in our community from Tennessee is pushback. We’re really giving back the monies around HIV prevention and education, which is something that is very important in our community. We’re seeing an increase now in those who are HIV positive between 2018 and 2024. The data shows us that there’s been like a 30 percent increase in those who are HIV positive. We’re seeing many in our community who are experiencing obstetric racism and obstetric violence and their experiences when they are birthing is not the best. That was one of the first things that we did when we decided to admit with free services was really to do an assessment of the community to determine what it was that they felt that they needed. And so, you know, holding these listening sessions and focus groups to really help to understand what our community needed. And then, of course, around gender affirming care. Right. So at CHOICES, we offer diverse services. We are a comprehensive justice center reproductive health care clinic. So we do birth and prenatal care and all of those things. And we also do gender affirming hormone therapy. We have about 250 transgender patients. We do family planning. We do comprehensive GYN care. And all of these services are really important to us. What we did, though, was add midwifery services and make the clinic a midwifery-Led clinic, which was very different, especially in Memphis where we did not have, and still don’t have, a large midwifery presence and population outside of our clinic. There’s only one hospital that will credential midwives, and they have maybe five or six nurse midwives. There are only a handful of certified professional midwives in our community, so I would say there’re less than 20 midwives in our community. So really understanding what has happened in our community in terms of, it’s so complex. I think about it, the medical system has offered fragmented care and really care that has been segregated, right? And so many of the Black and Brown families that we do care for really don’t have a whole lot of options and where they can receive services and even fewer options in terms of midwifery care. So that was one of the things that was really important to us is that we be a safe place and a medical home for everyone.

Dr. Rebecca Dekker – 00:07:09:

And so CHOICES became like the first and only so far birth center in the Memphis area. So what was the process like to make that a reality?

Dr. Nikia Grayson – 00:07:21:

It was a little… harder than I think people realize. First, I’ll say that… I felt called to midwifery to, you know, for a number of reasons. But when I finished my midwifery program, CHOICES embraced me. And it’s the only place that I’ve worked. And they’ve allowed in our amazing team to have a vision of how care should be delivered. And so for us, it was first really understanding what the community wanted. Right. You don’t want to build something that they don’t want and what they felt they needed. But then the other really big obstacle really has been the medical community. Right. Really educating the medical community on what midwifery is, what our scope of practice is, and really to to help them see us as not a threat, but as a partner in care. And so that part has been a little bit harder than most people would imagine. But also when we decided to add midwifery services and subsequently a birth center, we wanted to build a comprehensive reproductive health care clinic. And so we envisioned this amazing space that we have built from the ground up and opened our 15,000 square foot facility that has three birthing suites. We did that in August of 2020 in the middle of a pandemic. I don’t think people understand what it takes to really, one, raise the funds to build a building. And we were able to.

Dr. Rebecca Dekker – 00:08:40:

I know I’m just like dying to hear like who paid for this. That sounds incredible.

Dr. Nikia Grayson – 00:08:45:

Right. You know, like, first of all, let me say that we build this building and we owe nothing on it. Okay. You know, and so, you know, that was pretty amazing in itself, considering we had never done any major fundraising and had never done a capital campaign. But, you know, really opening this first and only birth center, it really wasn’t a small feat. You know, we really did have to navigate some really complex regulations and issues and raise millions of dollars and really challenge the institutional norms that, you know, question whether, you know, midwifery-led centers are safe and valid. Right. And so that’s something that we still are doing. So, you know, we really had, like I said, to educate the community, community leaders, state regulators and really challenge a hospital system that didn’t want to see a birth center.

Dr. Rebecca Dekker – 00:09:30:

Hospital systems that were essentially failing the community and they didn’t want you there.

Dr. Nikia Grayson – 00:09:35:

Yeah. Yeah. You know, but more than that, you know, we had to we had to build trust with our community and many of whom had only known hospital based birth, you know, so really getting them to a point where they could really become aware of what their options were. And that this was a safe and viable option for them was was a lot. So but of course, that’s opening. You know, we have we’ve been serving many families, you know, who choose birth center birth. And not just because our space is beautiful, but because of that model of care that we have presented them. And, you know, we offer them time and attention and culturally cultural connections and the belief that birth is not a medical emergency, but really is a human experience.

Dr. Rebecca Dekker – 00:10:15:

Yeah. So with all the obstacles you had to overcome, I’m sure you had to kind of really ground yourself in your like why. And you mentioned you felt called to midwifery. So would you be willing to share with us like what that experience was like? How did you know you were called? And specifically to this type of midwifery that’s so inclusive.

Dr. Nikia Grayson – 00:10:34:

Yeah. You know. It’s interesting because I never saw myself as a provider. I am a researcher and I look more at systems and really think about the health from a macroscopic view. So to provide individual care has been different. But I was working on a project with the March of Dimes and where I had to help evaluate a project that they were doing. It was called Community Voices and it was a infant mortality project. And at the time, Memphis had the highest infant mortality rate in the country. And of course, the majority of those that were dying were Black babies. And so these families were part of this intervention. And I interviewed the families about their experiences with infant loss, but also their experiences with the medical system. And many of them talked about how they felt like their bodies were broken or that they didn’t trust the medical system and that many of their losses were generational. Right. They talked about their mothers and aunts and grandmothers and sisters and all of the loss that they had experienced in their families. And those stories really stuck with me. I was devastated by these stories. Right. And especially around the idea that they felt that their bodies were broken. And so I was talking to a friend of mine. Her name is Femi Ajanaku. She’s a sociologist in Memphis. And telling her about this, she’s an older Black woman. And she told me that she and her friends had had midwives when she was, you know, in childbearing years. And I was like, midwives? We don’t have any midwives in our community. You know, I was like, what are you talking about? And she’s like, yeah, you know, they sought out midwifery care. And she talked to me a little bit about the farm and some of the other, you know, happenings in Tennessee. And it really made me dig deeper into the history of midwifery in our country, but not just the history of midwifery in our country, the history of midwifery in the South. And what I saw was the systematic erasure of Black midwives in the South. And so those stories stayed with me, not just people I interviewed, but even the stories that I read. And so I felt called to reclaim and restore Black midwifery in the South, especially in Memphis, which is a predominantly Black community that was facing some of the highest infant mortality and maternal mortality rates in the country. So I went home and told my husband that I thought I was supposed to be a midwife. And he was like, okay, if that’s what you… if that’s what you feel. He’s like, you don’t really like people, you’re a researcher. But it worked out. I’m an amazing midwife. So I decided to go back to school. I went to University of Tennessee and got a nursing degree and then did a doctorate in nursing and my midwifery certificate. And when I graduated, I started at CHOICES. So CHOICES, I graduated and maybe a couple of weeks later was working at CHOICES to bring about that vision of reclaiming and restoring midwifery.

Dr. Rebecca Dekker – 00:13:33:

And you talked about the new birth center built in 2020, but were you all providing home birth care or prenatal care? What were you doing before that?

Dr. Nikia Grayson – 00:13:41:

When I started, there was no pathway for midwives really in our community, especially nurse midwives, right, to work in the community. So I did home birth. And as a nurse midwife, we are not trained in out-of-hospital birth. So I had two certified professional midwives that really helped me to come up to speed on what it was to provide community birth and out-of-hospital birth and did home birth while we worked to build the birth center. And while I was doing those home births, I really did challenge the hospital system, the only hospital that credentialed midwives in the community because I was bringing patients who needed to be transferred, who risked out to the hospital. And so during that time, they extended privileges to me. So I did home and hospital birth and it was good. But when we built the building, it was really my focus to do community birth. I really did enjoy doing out-of-hospital birth, but also I felt like being the first and only to really challenge that system and get privileges. I felt like I was in a fishbowl also. I felt like people were waiting for me to mess up, right? So I felt that more than support. And so for me, especially because we were also growing a team, it was also harder to cover multiple spaces. It was hard to cover home, birth center, and hospital. So really, I wanted to focus on this big, beautiful building we had just built and that we had put a lot of love and thought into. So yeah, so our focus really has become the birth center and helping people to have out-of-hospital births.

Dr. Rebecca Dekker – 00:15:14:

You mentioned building your team. So what did that look like? What does the team look like?

Dr. Nikia Grayson – 00:15:19:

Yeah, the team is interesting. What that looked like was really, you know, Memphis is not a cool city, right? Like, you know, not like New York City or San Francisco or L.A. Where people want to come and live. So how do you make it an amazing prospect for the new midwives? So also because midwifery is not predominant in our community, we didn’t have any midwives that I can pull on from our community. So I really had to recruit from outside of Memphis. And so what I did was, you know, I speak and do grand rounds and all sorts of things to talk about midwifery, especially black midwifery. And I was at UCSF and I did the grand rounds there and met this student. Her name was Tolita Asagaro. And she was amazing and she had great questions. And from there, we just kept in touch. And when she graduated, I asked her, don’t you want to come to Memphis to help me build this? And we had pretty much finished the building. We hadn’t opened the building yet. And she was like, yeah, I think I did. And so she came and she’s still with us. And she’s amazing. Her fifth year was July 1st, 2025. And then we had a young lady who was local, who had known as a nurse and saw her in the hospital one day while I was doing my training. And she asked me what I was doing. I said, I’m doing my clinicals for midwifery. And she was like, we don’t have any midwives in the community. So I kind of talked to her about it. She went back to school, followed the same path I did. And when she graduated, we hired her. And so from there, we decided to create a midwifery fellowship, especially a Black midwifery fellowship, because at the time, and it’s still very low. But, you know, the number of Black midwives in the United States is not a lot. So at that time, it was maybe about 900 certified nurse midwives or certified midwives who identified as Black. About 1,100 now. But for me, it was important that we grow the number of Black midwives in our community, especially in the South. Representation is important. Representation matters. And so Fellowship was born to help to grow more Black midwives, but also to help them learn about reproductive justice and community birth and really comprehensive care. Because as midwives, especially nurse midwives, we are comprehensive reproductive health care providers. We don’t just provide prenatal care and catch babies. You know, we do, like I said, gender-affirming hormone therapy. We do abortion care. We do regular GYN services, family planning, all of those things. So it was important for me that we raise and grow comprehensive reproductive health care providers.

Dr. Rebecca Dekker – 00:17:49:

So what does that Black Midwifery Fellowship look like then? Is it a year or two years? Do they, you know, come live there? What all do they do during their fellowship?

Dr. Nikia Grayson – 00:17:57:

Yeah, so it is one year. So, you know, for me, the fellowship was really, you know, born from both, both urgency and vision, right? You know, the urgency being Black birthing people are dying and we need more providers who look like us and to understand us and to fight for our reproductive health and autonomy. Right. And of course, the vision being we knew that we wanted to change the system and wanted to really train the next generation of Black midwives. So that was really important to us. And so what it looks like, it is a year long fellowship and it really is more of a pipeline. You know, it is a to me, it’s a revolutionary model of education. So, yeah, we provide paid full scope clinical training, mentorship from Black midwives. And really, our core is rooted in Black feminism and Black feminist thought. And we provide them the opportunity to lead, teach and grow. So, like I said, it is a year long fellowship. It is a paid fellowship, which is a really important part of it as well, especially historically midwifery has not. Preceptorship and clinical training has not been a paid experience, but it is a paid experience. And for us, we wanted to create a safe space where we can train fellows who are now, you know, going on to be clinical leaders, educators and change makers, you know, really across the country. So while I would love to keep everybody at Memphis, at our Memphis clinic, we recognize that we want them to learn and grow and really to go into other spaces. Yeah.

Dr. Rebecca Dekker – 00:19:32:

Mm-hmm. That makes sense. Incredible opportunity. I love how it’s like you’re continuing to reclaim the heritage, you know, that you mentioned at the beginning. You mentioned that CHOICES was started after Roe. And then a few years ago, we had kind of a very different experience with Dobb’s decision. We had a nurse come on the podcast recently, Liz Carr, and she talked about how she did some training at your clinic, both before and after Dobb’s. I was wondering if you could go into more depth and just kind of share with our listeners how that decision affected the care you’re able to provide.

Dr. Nikia Grayson – 00:20:11:

Yeah, that was a hard day. I remember that day very well when the decision came down. But the Dobb’s decision, you know, really has stripped us and our community of fundamental rights, right? For Dobb’s CHOICES, you know, provided comprehensive abortion care in Tennessee and our patients could access the full spectrum of reproductive health care under one roof. So they could, we had those who were coming in for abortion. We had those who were also birthing in the building at the same time. It was really interesting, dynamic. It was really beautiful, honestly. But after Dobb’s and Tennessee, if you know, had the total ban, we had to cease abortion services in Memphis, which was very devastating and has been devastating to our community and the way we choose and practice. But we are committed to people’s reproductive autonomy and protecting that. And so because of that, and when we knew when the Supreme Court took up the Dobb’s case. The writing was on the walls.

Dr. Rebecca Dekker – 00:21:09:

And then the decision was leaked early.

Dr. Nikia Grayson – 00:21:11:

It was leaked early, but we knew when they took the case that we were going to lose abortion access in the South. They had been coming for abortion for many years at that point and throwing anything at the wall that was stitched. We had many trap laws, you know, the targeted regulation of abortion provided laws on the books. And so for us, it was really important to be ahead of that. But when they took up the Dobb’s case, we pivoted quickly. We thought we were going to have time to really enjoy this new building we built and started in a birth center. But we recognized that that was very short lived and we decided that we needed to open a second clinic. We also recognized that we would lose abortion access across the South, all of the Southern states. And for us, we needed to find a place that we could continue to provide those services that was close to our clinic. And we knew that, you know, our patients would have to travel. So we opened a second clinic in Carbondale, Illinois, which is about three hours from our Memphis clinic. And so that is where our patients who seek care from us travel to, as well as I go back and forth. Not all of the midwives do, but I do go back and forth between the two clinics. I am the chief clinical officer of both our Carbondale clinic as well as our Memphis clinic. And so for us, it was important that we establish that clinic so that we can have established patient navigation services, such as, you know, travel support and funding and coordination. And of course, that clinic offers comprehensive care as well. They offer contraception as well as gender affirming care. Because one of the things that is also happening in the South is a huge target on LGBTQ rights. And we’re seeing a lot of anti-LGBTQ laws being passed, especially in Tennessee. And so many of the patients that we were seeing before are going to that clinic. So we’ve been intentional about creating spaces where people can get safe, evidence-based, comprehensive reproductive health care.

Dr. Rebecca Dekker – 00:23:08:

Okay, that’s a twist I didn’t see coming. Like Southern Illinois, I have ancestors, that used to live there. I remember learning about it.

Dr. Nikia Grayson – 00:23:17:

I know. Well, you know, Illinois, they have protective laws around reproductive freedom. Governor Pritzer has been very intentional about providing access to comprehensive reproductive health care, including abortion care, and also really making it possible for advanced practice clinicians, nurse midwives, family nurse practitioners to be able to provide abortion care in Illinois. And it really is a game changer because what we’re seeing is that there are a lot of advanced practice clinicians that want to provide abortion care, but they have not been able to. And honestly, our educational programs have not really trained us in that way. Right. Even though it’s in our scope of practice, even the training that that I got was more on the job training as opposed to that comprehensive training that we should have got in our educational programs. But we’re seeing a pivot in that. We’re seeing several programs now that are really focused on training advanced practice clinicians like nurse midwives and family nurse practitioners.

Dr. Rebecca Dekker – 00:24:15:

So that’s good to know. Is there anything else you want to tell us about what CHOICES is doing or what you’re doing? I’m also really curious to learn how you take care of yourself.

Dr. Nikia Grayson – 00:24:26:

Oh, my gosh. I’m, Rebecca, I’m so not good at that, right? So. CHOICES is really exceptional. Like I said, it is a revolutionary model of care and that we are very focused on providing evidence-based, compassionate, nonjudgmental, comprehensive reproductive health care, right? We recognize people’s bodily autonomy. We recognize that people are the experts of their own lives and that we are providers who have a resource and that we’re partnering with our community and our patients. And so for me, that is very justice focused. That’s a really important part of the work we do is part of our mission. And for that reason, we have really put ourselves in a space where we are fighting and really will continue to fight for our community and our patients. What do I do? I do a lot of different things. It seems that I wear a lot of hats. So I’m also at the University of California, San Francisco, which I fly back and forth to be a co-director of the Midwifery Program. I do clinical work out there one week a month, the second week of every month. So I fly to California to do that starting actually this month. August. So I’ll be out there one week a month to do clinical care out there. I do go to our Carbondale Clinic, not as much as I used to. Fortunately, we have an amazing team at our Carbondale Clinic, and I only hear great things about them from our patients because a lot of our patients that go to Carbondale, they do get other care in our Memphis Clinic where there’s family planning. Many of them do come back to us when they are ready to parent and they want to be pregnant and they come back to us for those services. So I always hear amazing things about our Carbondale clinic, which I’m not surprised because they’re pretty dope. I think that. For me. Right now, I feel like I have to hold up a wall that is crumbling all around us. And so I think it’s not just me. I recognize that our team feels the same way that we are working in the face of some really daunting moments right now. And so we’re doing what we can to protect people as well as protect ourselves. And, you know, when we have gone from a civil fight to possibly a criminal fight. Right. And so protecting ourselves from criminal prosecution, protecting ourselves from being targeted, which is very easy to be targeted in the South, providing these type of services. But we recognize that, that things will change. Right. We have to continue. We have someone has to stay and fight and educate the next group of providers that are coming behind us. So that kind of keeps us grounded, even in the days where there are very few wins. And I feel like most days. We have very few wins, but in talking to our patients and being able to see them and hear their stories and hear how grateful they are that we are here and the care that we provide, that really does help.

Dr. Rebecca Dekker – 00:27:19:

And you’re not alone because you’re doing it as a team.

Dr. Nikia Grayson – 00:27:22:

Yeah.

Dr. Rebecca Dekker – 00:27:23:

Which makes a big difference.

Dr. Nikia Grayson – 00:27:24:

Yeah. You ask about self-care, so I’m not real good at that. So, which is why I was taking this time off and really was pushed to take this time off by our CEO, Jennifer Pepper. Jennifer and I call us the Wonder Twins. Jennifer was like, okay, look, you have been on call 24-7. You have been flying back and forth from California to Tennessee, going to Illinois, and you need to take a break. And so she had tried to get me to do it last year, but I was like, hey, wait a minute, I don’t think this is the time. So I took that time this summer to just really just focus on not just myself, but my kids, right, because this work really has taken me away from my children. My children are, my son will be 12 tomorrow, 12, and my daughter’s 13. And so I’ve been doing this work for about 10, 11 years. And so it’s really taken me away from them in a lot of those moments because midwifery is 24 hours a day. So this time for us to be a way to go out the country, we went to Southeast Asia and West Africa. It’s been amazing to be with them. My husband told me they were going to drive me crazy being with them 24-7. And they did, but it was really great. And we created some great moments and memories. So for me, I think that coming back, I recognize that that self-care piece is important, but it’s also. Really hard when you are a community-based midwife, right? You don’t have the resources and team that a hospital has. We are, you know, community-based birth is very different. You know, people come in, we have an unmedicated birth. So you’re supporting them in a very different way. And so I really have been thinking about, you know, what we’ll do different, not just for myself, but for our team. We want our team to stay healthy and strong. We have an amazing group of midwives that we work with who are really committed to providing reproductive justice-focused care for our community, right? And so how do we build that in? I think we at CHOICES have been intentional about taking care of people and each other, but I do think there are other things that we can do as well.

Dr. Rebecca Dekker – 00:29:31:

Well, thank you for sharing that about your sabbatical. And I’m grateful to your colleague as well for helping you to take that time off. Sometimes we need that outside person to be like, hey, it’s time for a break.

Dr. Nikia Grayson – 00:29:45:

Right. Yeah. And, you know, so like I said, this is mission work, right? For us, this is not a hospital.

Dr. Rebecca Dekker – 00:29:50:

It’s not a shift.

Dr. Nikia Grayson – 00:29:52:

Yeah. We really get to know our patients. And like I said, our clinic is really focused in reproductive justice and CHOICES. It isn’t just a slogan, right? We’re talking it’s a structure. It’s embedded in how we hire, how we train, how we care and really how we show up for our patients and our community. It really means for us being centering patient autonomy and, you know, informed decision making and accepting informed refusal. That’s a really hard part for a lot of providers, really offering that care that’s trauma informed and culturally congruent and gender affirming and really listening deeply. Right. So listening deeply and valuing the lived experiences of our patients more than clinical data is really important.

Dr. Rebecca Dekker – 00:30:37:

As like a full spectrum birth center that really focuses on evidence-based care, one of the things I know you all do is work closely with doulas. Can you talk a little bit about the role that doulas play at CHOICES in Memphis?

Dr. Nikia Grayson – 00:30:51:

Yeah, you know, like for me, I recognize that doulas really were born out of midwifery work, right? So before midwifery was demonized and pushed into extinction, you know, the way we practice was to care about people in that way. You know, it’s relationship-based care. And so for us, with the evolution of midwifery and recognizing that to be able to provide care to more people, we need more support. And so for us, it has been really important that we partner with doulas, especially the doulas of color that are in our community. We’re trained at a training that we offer at CHOICES, because when I started the midwifery services, we only had two black doulas in the community. And so we recognized that was an issue, especially because people needed that support and that education that a lot of doulas bring. So we hosted doula training. Many of the doulas that came to this training were my former patients. And now they are the doulas in the community. And it’s so great to see them. They come in the building with, you know, with our patients and our doulas with our patients. And a few of them are now actually studying to be midwives. And so I get to see them in the community. They reach out. They have questions. They need trainings. And we invite them in the building. So for us, it’s really important to have a comprehensive team. We want our patients to have people they know and trust. And so they really can choose any doula. And we’re more than happy to work with them. And another thing that we do is we do a lot of community education. So I invite like Spinning Babies or Breech Without Borders or the best training. Many of them have come to Memphis and come to our building. And we just open it up to all of the doulas in our community as well. All of those who are really interested in birth work. We want to grow a community. It’s also being an only, right? Who wants to be an only? We need a community. We need a village. And so a lot of the trainings that we bring to our clinic, we don’t charge people. We don’t charge the doulas and really anybody, any of the students to come and participate in as well.

Dr. Rebecca Dekker – 00:32:52:

I was going to say on your website, if people in the area want to go look, there are free doula trainings available.

Dr. Nikia Grayson – 00:32:59:

Yeah.

Dr. Rebecca Dekker – 00:32:59:

CHOICES. And you have a really robust training. Like it’s not just one weekend. What all do they do?

Dr. Nikia Grayson – 00:33:06:

Yeah, you know, one, we do a lot of drills. I think it’s important, especially being out of hospital, that your skill set is high. And if you are a doula or even a midwifery student, a lot of times we don’t necessarily get those opportunities. So especially around emergencies, because our hope is that we don’t have any emergencies, right? But we definitely need to be prepared. So we do, you know, NRP training. We do, like I said, drills around, you know, dystocia, hemorrhage, any of the emergencies that you can think of, but also ways to provide like comfort measures and all of the things for people who are choosing, especially if they’re choosing out of hospital birth, but also if they choose a hospital birth. We want people to choose whatever setting makes them feel safe and happy. So for us, we even have patients who want hospital births and they come to us for care and then they birth in the hospital and come back. So, you know, for CHOICES, I guess it’s about how do we build a community? And so we are investing in that community and really, you know, try to be good community partners.

Dr. Rebecca Dekker – 00:34:12:

And showing that you value the caregivers too, like, you know, you’re paying the midwife fellowship. It looks like there’s also an option to get a stipend to do the training as it works. Can you talk about that? Because that is something that’s usually unheard of.

Dr. Nikia Grayson – 00:34:27:

Yeah. You know, I think what we realize that CHOICES is, you know, people need to grow in whatever way. We also recognize they may not be with us forever. Right. People have other goals and aspirations and we want to support that. So we do offer stipend staff to do whatever trainings they want to do. And I think that that’s important. We’re investing in people. Right. It’s not just, you know, you work at CHOICES and you work for us. We want you to learn and grow. And when you feel like your time with us is up, we want you to go and be happy. And we want to support you in whatever that looks like as well. So, yeah, I think that’s really important.

Dr. Rebecca Dekker – 00:35:04:

So I have one more question for you, Dr. Grayson. And that is, you know, a lot of our listeners are birth workers and they have a lot of dreams. And, you know, there’s a lot. Like you talked about, daunting obstacles to fulfilling your dreams or seeing your vision for your community come true. What advice would you give to someone who’s interested in like replicating maybe elements of CHOICES model in their own communities, whether it be a freestanding birth center or free doula trainings or anything that you’re doing through your mission? Like what advice do you have for other birth workers out there?

Dr. Nikia Grayson – 00:35:41:

I say do it. You know, a lot of people are afraid and they don’t know where to start. I say do it afraid and really just start anywhere. I have so many people reach out to me, you know, asking for advice about midwifery and starting a birth center. And Rebecca, I invite every one of them to Memphis. And we’ve been visited by so many people. I just put it on the calendar and I tell the team, okay, I’ll say that I’ll tell you like Birth Detroit came to visit us. I was like, okay, Birth Detroit’s coming to visit. This is what they’re doing. This is what, you know, they’ve asked us about. So they’ll come and we’ll host them for several days and really allow them to meet with the team. You know, we have built an amazing team. We have a development team that works on grants and communications. We have a business team that works on the policies, you know, and all of those things that does credentialing.

Dr. Rebecca Dekker – 00:36:35:

And say, do you have a legal team to help you with all the navigating the mess in Tennessee?

Dr. Nikia Grayson – 00:36:40:

Yeah, we do. We do. And also Center for Reproductive Rights is our legal team. And they’ve been extremely helpful helping us navigate all of the things. But yeah, we are open book, right? We recognize that people need to, one, feel inspired, but also know how to start. And for us, just, hey, come look at what we did. Don’t make the same mistakes we did. Right. And so we pretty much share everything that we do and always have. I think that’s part of our model as well, because we don’t operate from a scarcity mentality, right? Where we have to hoard knowledge or resources. But, you know, I tell people that do come to visit us, especially like birth centers or people who are looking to open a birth center. You know, you do have to build a model that is rooted in values, not just services. Right. And really understand your why and why you chose to do it. Invest in your workforce and workforce development, which is what we’re talking about, like paying our trainees. And mentorship and, you know, making room really for them to lead. And, you know, my advice is also to create a collaborative ecosystem. You know, working with doulas and physicians and nurses and therapists and advocates and really patients themselves. We even have patients on our board. Right. So that’s really important part of it. And, you know, and I tell everyone, don’t wait for permission. Don’t wait for the system to to give you permission. You have to be bold because, you know, the system that we’re trying to create, it wasn’t built for us. Right. This system that we’re challenging really wasn’t built for us. And so the system that we’re trying to change, we have to be the change that we want to see in the community. And so we have to be willing to to build something new and to take those risks and don’t be afraid to fail. And then, of course, like you said, really take care of yourselves. Right. As you do this work, because this work is extremely heavy, but it’s also sacred and protecting your joy and really never forgetting why you’re doing what you’re doing. And what we’re doing is liberatory work is liberation. And so that’s what keeps me grounded. And that’s usually the advice I give to those who reach out and those who come to visit us. But like I said, we also we are open book. We share our resources. We’ll tell you, you know, what we did. It worked and what didn’t work because we need more people in this fight.

Dr. Rebecca Dekker – 00:38:55:

That is true. Thank you so much, Dr. Grayson, for the inspiration you’ve brought us all today. And I would encourage our listeners, you can go to yourCHOICES.org and it just starts playing this beautiful video of the peaceful, gorgeous space you all created with the colorful outside. And then you walk in and it’s just the sanctuary.

Dr. Nikia Grayson – 00:39:16:

Yeah, it’s really colorful, too. You cannot build it if you are, you know, if you are driving around, you know, it’s on the big yellow and green building. But it’s a beautiful building. And I don’t know. And I was actually, you know, like I said, I travel quite a bit these days. And I was on a flight and I was coming back. And I looked out the window and I could see the building as we were coming into land. And it made me feel some sort of way. I felt pride. I felt all sorts of things. So, yeah, it’s amazing.

Dr. Rebecca Dekker – 00:39:45:

It’s definitely a beacon for your community and the safe space. So thank you so much for being part of that and for coming to tell us all about it today. Today’s podcast was brought to you by the Evidence Based Birth® Professional Membership. The free articles and podcasts we provide to the public are supported by our professional membership program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories. We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit ebbirth.com/membership.