Memphis embraces midwife and doula services to improve health outcomes

Midwifery and doula support are no longer just something associated with the crunchy granola types or California new age lifestyles.

Alternative birth services such as SisterReach and the soon-to-open CHOICES birthing center are new to the market and bear the goal of improving birth outcomes for Memphis women and especially those from underprivileged neighborhoods.

Leading the way is Regional One Health, Memphis’ publicly owned hospital. The current iteration of the hospital’s clinical midwife program was launched in 2009.

“Regional One is the only hospital to have delivery privileges with nurse midwives,” said Angie Golding, Regional One Health director of strategic communications. “For many years Memphis has been known for high-risk pregnancies. We thought, ‘Why not look at other delivery options?’”

Shelby County’s infant mortality rate hit its lowest record in 2015 with 8.2 deaths per 1,000 live births, which represents a nearly 15 percent decrease from 2006 levels.

Of that figure, the infant mortality rate among African-American families is nearly double the rate for white families.

“We wanted to see want was not being met in the community for delivery and pregnancy needs and meet women there,” Golding said.

Despite having lagged behind its national counterparts for many years in offering birth options that deviate from physician-led births, Memphis is finally benefitting from new birth choices.

Many of these efforts have been in response to Memphis’ dismal infant and maternal mortality rates. Women of color living below the poverty line have been hardest hit and show some of the lowest birth outcomes and maternal success rates in the country.

“We wanted women to have the ability to choose how they plan and experience their childbirth. It’s an option everywhere else has, and we believe Memphis women deserve the choice too," Golding added.

Free services for women of color

Birth Strides, an organization launched in 2016, is on a mission to improve birth outcomes for women of color by providing free childbirth education and doula services in targeted neighborhoods.

Terri Lee-Johnson, executive director of Birth Strides, says the organization will give pregnant women of color living below the poverty line the support and education they to have happy and healthy pregnancies. Additionally, Lee-Johnson is also training to be a certified professional midwife.

Terri Lee-Johnson, executive director of Birth Strides, which provides free doula care and education to pregnant women of color.Lee-Johnson says she has personally seen many of the positive effects of doula support for Memphis women who have the odds stacked against them for a healthy delivery, pregnancy and motherhood. Doula support works to lower medical intervention during labor and provides a sense of autonomy and control before, during and after pregnancy.

Doula support during labor has also been proven to improve the health of the new born. Lee-Johnson points to a study published in 2013 which compared birth outcome success among two groups of pregnant women who are “socially disadvantaged.”

Data collected by the study shows that pregnant women who had a doula yielded better birth outcomes. The study states that expecting moms matched with a doula were four times less likely to have a low birth weight, two times less likely to experience birth complications and were more likely to initiate breastfeeding.

Making sure women of color are able to advocate for themselves in a medical setting is a major part of what Lee-Johnson wants to accomplish in her work.

“Medical settings have historically encompassed a lot of negative things for people of color,” she said “I want the mother to be an active and empowered participant in her delivery.”

“The person delivering can sometimes feel powerless and like they don’t have a voice. As a doula, I work to make sure that mom feels empowered and knows her options and rights.”

Lee-Johnson was inspired to start Birth Strides after working privately as a birth doula for about five years. After several years of practice, she felt frustrated that not everyone was able to financially access her services. She wanted to stop the cycle of negative birth outcomes at the root and address some of the systemic issues that contribute to poor birth outcomes.

“Throughout that time, I noticed I was not able to frequently serve the people that look like me. The financial access very quickly proved to be a barrier to black women accessing my doula services,” Lee-Johnson said, adding that Birth Strides will train residents in selected neighborhoods to provide their community with birth support.

“Even in communities where mothers are facing hardships like poverty and lack of services, having any kind of support system within their family and community improved their maternal and infant delivery and postpartum outcomes for mother and child.”

A growing trade

Brenda Loft and Miajennell Peake both moved to Memphis from Atlanta where they were alternative birth practitioners. At first glance, they thought there wasn’t a midwife culture in Memphis that would need their services. They’re glad to see that need is changing.
Loft says that people from all over the region travel to Memphis to deliver with the Regional One nurse midwives. Loft is one of six practicing nurse midwives at the hospital and also works as a University of Tennessee Health and Science Center instructor.

“People that request a Regional One nurse midwife are not quite comfortable delivering at home and they want evidence-based healthcare,” Loft said. “They know as a nurse midwife I can operate within the safety guidelines of the hospital but I can still provide a patient-centered birth in the hospital.”

“I think the Regional One nurse midwife program has started a dialogue and people are talking about it. The resident programs at Regional One Health trains future OBYGNs that end up staying here in Memphis."

The midwife program at Regional One Health offers a safe midwife delivery that with low medical intervention within the safe haven of a hospital if unforeseen complications do arise. Medical intervention tends to be low in nurse midwife deliveries because high-risk pregnancies are planned out of a midwife delivery and recommended for physician-led delivery.

Today the department has grown to include six full-time nurse midwives and two offices, Hollywood Primary Care and South Third Primary Care. The Hollywood location offers women and families prenatal care classes. Loft says the team hopes to expand to a third office in the near future.

“It takes more effort and more energy, both nurse midwife and patient are tired during a delivery, but it is a really beautiful experience,” she added.

Miajenell Peake, another Atlanta transplant, is a birth doula who found her way to Memphis. Peake is the community outreach coordinator at CHOICES. She also runs her own birth doula business, Peake Women’s Wellness.  

“When you are in labor, you have a power struggle. The physician has the safety of mom and baby in their hands,” Peake said with her hand over her own baby bump, the new arrival expected any day now. And yes, she will be using a doula.

“The person delivering can sometimes feel powerless and like they don’t have a voice. As a doula, I work to make sure that mom feels empowered and knows her options and rights.”

Peake believes every mother should experience doula support during her pregnancy. Her practice serves women through the entire course of their pregnancy with several meetings and discussions even before the delivery and postpartum check-ups.

Miajenell Peake is the community outreach coordinator at CHOICES. She also runs her own birth doula business, Peake Women's Wellness.She supports women through natural births, water births, home births and hospital births. Meeting women where they are, both physically and financially, is a big part of Peake’s mission in Memphis. She offers her services free to teens.

On moving to Memphis, Peake said that she had her reservations about the city since it seemed to lack doula opportunities. She’s found her calling at CHOICES, which plans to build a comprehensive reproductive healthcare center with birthing, mental health care and abortions under the same roof.

Peake will train doulas at the new birth center. She hopes that through that process she can inspire new interest in doula and midwifery practices. Providing doula job opportunities and training to women, particularly to women of color, is a large part of Peake’s mission.

“We really want to attract women of color because they are not largely represented in the midwives and doulas working now in Memphis,” she said.

Now that she has found her calling in Memphis, Peake looks forward to seeing the change the doula and midwife community will make in Memphis.

A decade of birth care

While many of these birth services are brand new, there has been a small core of midwives in Memphis that offered their services for years.

Amy Stewart-Banbury, a certified professional midwife, is one such provider who owns Trillium WomenCare, which as been serving women since 2007. In 2012, Brooke Prudhomme joined the practice and together the two have offered home birth services, doula services, postpartum care as well as monitrice services, which provides a birth attendant who is certified in a field of maternal-child health such as nursing, midwifery or medical training.

Additionally, the practice offers a plethora of classes and workshops such as prenatal yoga, childbirth education and relaxation techniques for labor.

Stewart-Banbury explains that accredited midwives have to be certified by the North American Registry of Midwives as well as the state of Tennessee.

Brooke Prudhomme (L) and Amy Stewart-Banbury run their own practice, Trillium WomenCare.“We provide prenatal care, attend home births and we are trained in neonatal resuscitation and suturing,” she said. “But we also spend an average of an hour with our clients at each prenatal appointment. We are on call 24/7 until six weeks postpartum. We wipe laboring women’s faces down with cold washcloths, empty puke buckets, and help partners play a meaningful role in their child’s birth.”

For an average home birth, Stewart-Banbury and her partner will see a client 10 to 14 times for prenatal visits.

During labor, they will remain with mom until delivery and then stay to do a newborn exam, check mom’s vials, clean up and give instructions to parents as to what is expect and what to look out for in the next couple of hours.

The midwife will then return 24 hours later to perform state mandated newborn tests and check on mom and baby. In-home checks continue for up to six weeks.

“We take postpartum care just as seriously as we take prenatal care,” she said. “The pressure that new mothers feel can be overwhelming. Brooke and I make every effort to listen to, monitor, help and encourage new parents during the first six weeks of postpartum.”

‘Less and less foreign’

Attitudes toward midwifery and doula practices are changing with institutions like Regional One Health paving the way and normalizing the practice of alternative, low-medical intervention for low-risk pregnancies.

Loft notes that the Regional One partnership with the nurse-midwife team will result in more upcoming doctors that are exposed to these birth options and familiarized with their potential benefits.

“I think the Regional One nurse midwife program has started a dialogue and people are talking about it. The resident programs at Regional One Health trains future OBYGNs that end up staying here in Memphis,” said Loft.

"Nurse-midwifery is starting to become less and less foreign. It’s changing perspectives.”

“If our nurse midwife program started six years ago, then we have already put some doctors that have been exposed to this type of nurse-midwifery practice. Nurse-midwifery is starting to become less and less foreign. It’s changing perspectives.”

Providing choice seems to be the resounding chorus when speaking to the members of the Memphis midwife and doula community. Many of the birth providers have seen a recent surge in request for their services and it seems that after years of lagging behind peer cities, Memphis is finally ready to present these options to its population.

That increase in services, coupled with the passion to change Memphis’ appalling birth rates, is bringing the birth community together. All members want to see more reproductive choices for women in Memphis and more doula and midwife training available to a diverse audience of people.

Stewart-Banbury notes that she is excited to see more collaboration grow in Memphis between doctors, nurses, doulas, midwives and other childbirth professionals.

“In most places, even within Tennessee, women are not made to choose between a midwife, doctor, or doula, but rather they have the freedom to choose which combination of these childbirth professionals they would like to have attend their birth,” she said.

“If doctors, midwives, and doulas all have the same goal of a healthy mother and healthy baby, then why can’t we all work together toward this goal?”