Black women are building movements in Memphis. MLK50: Justice Through Journalism is spotlighting women whose names may not be easily recognizable, but who are forces in the fight for voting rights, access to health care, criminal justice reform and on other critical issues.
Nikia Grayson is the second of six women in our series, “Unsung, Unbowed, Unstoppable,” who are being profiled over three months, all nominated by their peers and our staff.
Nikia Grayson was not prepared for the first birth she attended.
She was 22, and in the hospital room while one of her best friends gave birth. The doctor performed an episiotomy, which Grayson did not expect. When the baby, her now adult godson, was born, he was covered in vernix – a white substance that coats some infants’ skin during birth. The whole event was overwhelming.
“I think I had PTSD; it was so traumatizing,” she said, recounting the birth two decades later. “And I was like, ‘Oh my God, I never want to see that again.’”
Today, not only does Grayson regularly witness births, she’s frequently the medical professional guiding people through pregnancy. As a certified nurse midwife and director of clinical services at CHOICES, a Memphis clinic for reproductive health care, Grayson spends her days conducting hour-long prenatal exams, talking to people about their sexual and reproductive health and, yes, helping deliver babies.
“Grassroots Perspective”
CHOICES, and Grayson’s determination to rebuild a tattered tradition of midwifery, is part of a nationwide movement to recognize the expertise and benefits of midwives’ care. Grayson sees more non-traditional providers like doulas, lactation counselors and childbirth educators carving space in a rigid health care system. And she believes they can help provide resources to Black women and traditionally under-resourced communities that can often be overlooked or dismissed in the medical system.
“I wanted to be part of the community effort, because I recognized power in people and communities. That was what really got me to midwifery.”
— Nikia Grayson
Her route to midwifery was winding, with stops in journalism, public health and anthropology. Grayson was born to a single mother in Brooklyn, and raised in the Washington area, where she graduated high school. She majored in print journalism at Howard University, with a minor in photography. Though her initial collegiate dream was sports photography, Grayson – whose work ethic is tireless – has since garnered nearly half a dozen post-graduate degrees, she said, in public health, anthropology, nursing and midwifery.
Unsung, Unbowed, Unstoppable
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When she’s not seeing patients, the mother of two children teaches classes at the University of Memphis and the Midwives College of Utah, both online during the pandemic. And her first love, photography, is never far. She often takes cameras to births, she said, allowing her to help document the experience for new parents.
But before she began practicing, Grayson studied reproductive justice from a macro level, examining public health and anthropological outcomes of racial inequalities. On a post-college trip to West Africa, Grayson was struck by villages and towns decimated by communicable diseases like HIV and polio, and began pursuing public health.
“(I) realized a lot of the ailments people were experiencing in other countries, like HIV, were really hitting our own communities hard. And I was completely oblivious to that,” she said. In 2003, when Grayson and her husband moved to Memphis, she continued her work on HIV and sexual and reproductive health initiatives, focusing on harm reduction. She got her first masters, in public health, at Howard, and a second, in anthropology, at the University of Memphis, where she was first introduced to maternal and child health.
“Anthropology, especially medical anthropology, looks at health from a grassroots perspective, more of a bottom up perspective, looking at communities and really engaging communities. I think that was what I found that was different from a public health program, which was more top down. And I wanted to be part of the community effort, because I recognized power in people and communities,” she said. “That was what really got me to midwifery.”
It was while she was helping evaluate a program aimed at addressing high infant mortality rates in Memphis that she learned from older Black women in the community that historically, midwives had helped provide their comprehensive care. They assisted not just in prenatal care and childbirth, but also worked as reliable, general healers.
According to government data, Black women are more than three times more likely than white women to die of pregnancy-related complications. And the Black infant mortality rate is 2.3 times that of white infants.
As she learned more about midwifery, Grayson discovered how American medical providers worked to undermine the profession – especially Black midwives – in the 19th and 20th centuries. She came to see a gap in the health care system, both in the South and across the nation, and she wanted to fill those gaps by restoring midwifery to the South and in Black communities.
“The centering of Black and brown families was really important, because those families, those underserved, those most marginalized communities are the ones that usually don’t get to experience this type of care.”
“I always knew that to me, my work was, OK, how can I help to bring this back to our community and how can I help to open the door for other midwives?”
She trained as a nurse, going to school during the day and attending to high risk labor and delivery patients in hospitals in the evening – an opportunity that allowed her to see how she didn’t want to practice as much as how she did.
Obstetrics and gynecology are “amazing,” fields, she says, and she maintains respect for what they do. But watching patients tethered to hospital beds, monitors and IVs, and unaware of their birthing plan or other options available to them, crystalized for Grayson the ways in which midwives can serve a different role.
She wanted people giving birth to be asked to consent to exams, to be allowed to move freely in labor, to avoid unnecessary cesareans, to refuse care they don’t want and, perhaps most importantly, to learn from their providers. A prenatal visit to an OBGYN can last fewer than 10 minutes, Grayson said. But at CHOICES, midwives typically spend an hour with patients, educating them on pregnancy, the birth, parenthood and generally helping them understand what they can expect.
A New Home
CHOICES is a comprehensive facility, providing all aspects of reproductive care – including well-person exams (often formerly referred to as “well-woman” exams), gender-affirming hormone management, basic fertility assistance, menopause management, birth control, abortions, labor and delivery, lacation information and post-natal care. Advocates tout that it’s the first and only non-hospital birthing center in Memphis, and note that it’s the first non-profit clinic in the nation to provide both abortions and birthing care.
The clinic started as Memphis Center for Reproductive Health in 1974, a cash-only clinic based in a house in Midtown. It moved to a nearby clinic in 2008, rebranded as CHOICES in 2009 and began accepting TennCare in 2010, shortly after the passage of the Affordable Care Act. This opened the practice to patients who normally would have been priced out of expensive midwives who often only accept cash.
In September, CHOICES moved to a large, bright new building in Midtown. The lobby area, which can double as an event space, has mid century modern armchairs where patients can flip through a compilation of Annie Leibovitz photography or browse a coffee table book on Memphis while they wait to be seen
Along with exam and procedure rooms, the building has three spacious birthing suites, each with a full bed with a plush comforter and pillows, a massive soaking tub for water births or just for lounging, and an ensuite bathroom.
When the midwifery practice at CHOICES first opened in 2017, the community response was “explosive,” Grayson said.
“The centering of Black and brown families – which is a really big part of what we do here at CHOICES – was really important, because those families, those underserved, those most marginalized communities are the ones that usually don’t get to experience this type of care,” she said.
Grayson says she remembers every baby she’s helped deliver, whether in a hospital, at home or at the birthing center. She’s credentialed at Regional One Health Medical Center: For some pregnancies, including high risk ones, a hospital birth is the right choice, she said.
“It’s all in what people want and choose. And that’s what’s really important to us – that they have a choice of what setting they feel best in,” she said.
“Everybody deserves a midwife. Everybody deserves respectful care. Everybody deserves high quality, non-judgmental, evidence-based care. Everybody deserves to be heard.”
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