Memphis midwives work to address racial disparities in care

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• IVETTE FELICIANO:

  Expectant mother Brittany Briggs is nervous. A year ago she wouldn't have had the opportunity to express her concerns in a setting like this, it's group prenatal care led every month by midwives Nikia Grayson and Jodilyn Owen.

• IVETTE FELICIANO:

  The women are meeting at Choices, a privately-funded reproductive health clinic in an underserved area of Memphis. Last year, Choices began offering midwifery care. Midwives here have already delivered 11 babies with 19 more on the way.

• NIKIA GRAYSON:

  We want you to leave our care stronger. We want you to leave our care knowing how you should be treated, that you are valued.

• IVETTE FELICIANO:

  Nikia Grayson is certified as both a midwife and a nurse practitioner. She also has Masters in Public Health and Anthropology. Grayson first studied infant mortality in the black community as a graduate student.

• NIKIA GRAYSON:

  In these families, the loss of a baby was almost normalized of course they grieved and it was very heartbreaking for them, but it was generational, what I found was lacking was access to care. And then the type of care they received, and how they didn't feel valued or heard.

• IVETTE FELICIANO:

  Before the 1900's many birth attendants across the south were black midwives. Now less than 4 percent of U.S. midwives are black.

• NIKIA GRAYSON:

  It was taken away from us, in our community, these are our traditions, and we're taking them back.

• IVETTE FELICIANO:

  Grayson is one of only eight black nurse-midwives in Memphis and one of just two black midwives in this predominantly African American city. In Memphis, within the first year African American babies die at a rate three times higher than that of white babies.

• NIKIA GRAYSON:

  I think that what we are now seeing is a demand for quality care, quality care that is sensitive to people's cultural needs, and the idea that the system needs to change in order to prevent these maternal and infant mortality outcomes that we're seeing.

• IVETTE FELICIANO:

  African American women are more likely to experience poverty and lack insurance which puts them at greater risk for poor maternal and infant health outcomes. But racial disparities persist even for black women who are college educated according to a study in the New England Journal of Medicine and an analysis by the New York City Department of Health.

• NIKIA GRAYSON:

  There's something wrong with the system when African American women who are college-educated and have great jobs can still have poorer outcomes than white women who are uneducated.

• IVETTE FELICIANO:

  Last year, the American College of Obstetricians and Gynecologists acknowledged that: "the racial and ethnic disparities in women's health, including higher rates of preterm birth and maternal mortality cannot be reversed without addressing racial bias, both implicit and explicit."

• DR. KIA PINCKNEY:

  The racial bias when it comes to black women having babies is hidden.

• IVETTE FELICIANO:

  Dr. Kia Pinckney is an Obstetrician at Regional One Hospital in Memphis. She says categorizing and diagnosing patients according to their race is part of American medical practice.

• DR. KIA PINCKNEY:

  That bias means it's kind of like we have shades when we're looking at this patient. So she's African American, most likely it's preeclampsia, so that prevents us from thinking of other differentials of what it could be. Could it be a migraine, or could it be just a headache because she didn't sleep last night because she was up with all her children.

• DR. NEEL SHAH:

  The truth is that black women are less believed when they have symptoms that are concerning, from pain to shortness of breath to other things that are really concerning.

• IVETTE FELICIANO:

  Dr. Neel Shah is an Obstetrician and Professor of Obstetrics at Harvard University. There is research backing him up: several studies, including from the University of Pennsylvania and in the New England Journal of Medicine, found that black patients with the same symptoms as white ones receive less pain medication and are referred to specialists less often.

• DR. NEEL SHAH:

  My biases can change the decisions that I make but it also affects the person across from me because she can see plainly what I'm not. And so as a result of that she feels like I'm not responding to her needs, and she's not ultimately getting what she needs out of the care that I'm trying to provide, and it leads to this sort of vicious cycle of distrust.

• IVETTE FELICIANO:

  In a national survey of over two thousand women, 21% of black mothers reported poor treatment from hospital staff which they attributed to race, ethnicity, cultural background or language. Just eight percent of white mothers reported similar poor treatment. Grayson has heard about poor treatment over and over again from her black patients and how it has created distrust and other barriers to care.

• NIKIA GRAYSON:

  One patient talked about how her pain was not managed well when she was in labor, and that she didn't feel that they believed her when she said she was in pain, others had Child Protective Services called on them if they express feelings of depression. And that keeps people from coming back to care.

• IVETTE FELICIANO:

  That bias, coupled with short patient visits, means obstetricians can have a hard time digging into root causes of a patient's problems, says Dr. Pinckney.

• DR. KIA PINCKNEY:

  I don't necessarily have the time to sit there and do the educational component or the preventive things. I don't have the time to sit there and say, "So how are you doing today? Tell me about your kids," and really building that relationship.

• DR. NEEL SHAH:

  I think we have to have a more thoughtful way of thinking about the way that our biases are structured into the system, from the way that we do informed consent to the way that we interact with patients every step along the way, from intake, from triage to nursing, to the care team.

• NIKIA GRAYSON:

  Oh, he didn't like that.

• KETRICE:

  No, he fights back.

• NIKIA GRAYSON:

  Can you feel him?

• KETRICE:

  Yeah.

• IVETTE FELICIANO:

  And that is where midwives Grayson and Owen come in, working to counteract that bias and re-establish trust through midwifery care. As certified nurse-midwives, they are trained in the full spectrum of low risk gynecological and obstetric care, short of surgery. In addition to physical checkups and tests, they also address their patients' mental, social, and emotional needs.

• NIKIA GRAYSON:

  all of our visits are an hour long. I want to get to know who they are as a person and what's important to them and what their daily life is like. So we talk, and we talk about family and stress and what makes them happy.

• IVETTE FELICIANO:

  Midwife Jodilyn Owen says the goal is to build relationships with women allowing them to see and deal with warning signs before they become urgent medical issues.

• JODILYN OWEN:

  It is through listening that we start to understand the challenges she's facing that can convert a non-pregnancy issue into a pregnancy emergency. So if we allow hypertension to develop, it will develop into preeclampsia. So in our model, we're saying, I see you are developing this, I'm going to intervene using the lowest resistance model first.

• IVETTE FELICIANO:

  75% of their patients are on Medicaid. For some, simply getting to a doctor's appointment can be a challenge.

• JODILYN OWEN:

  If you imagine a woman who is working shift work and has no control over her schedule; she doesn't have a car so she's bound by a bus schedule. She'll walk in 15 minutes late and they'll tell her she can't be seen that day. She's been sitting on a bus for an hour and a half and is pretty sure she'll never do that again.

• IVETTE FELICIANO:

  And so, Grayson and Owen go out of their way to make sure they are available to their patients.

• NIKIA GRAYSON:

  We meet them where they are, both literally and figuratively we visit many of our patients at home. A lot of times that they have an appointment to come to our office and they don't make it, we'll call them and like okay, are you okay, do you need us to come see you?

• IVETTE FELICIANO:

  And the commitment doesn't end when the baby is born.

• NIKIA GRAYSON:

  The postpartum care that we provide for them is really, really key in the middle of the night they know they can text us or call us.

• IVETTE FELICIANO:

  Alexius Hill still remembers the multiple visits in the weeks after Grayson and Owen delivered her daughter Chloe 9 months ago.

• ALEXIUS HILL:

  Jodilyn and Nikia would come and check on how chloe would latch on, check on if I had any bleeding, ask me about any concerns I might have. They made sure I ate right still even after delivering Chloe, made sure I consumed enough water. So even until this point now it still feels like they're there.

• IVETTE FELICIANO:

  In 2014, the medical journal the Lancet concluded that including midwifery care in health systems reduces maternal and newborn mortality. And a study in the American Journal of Obstetrics and Gynecology found that participating in group prenatal care can reduce the risk of preterm birth, especially for black women.

• DR. NEEL SHAH:

  When we look at what's obviously different between the way we organize our maternal health system and the rest of the world, midwives are on the periphery in our country, and they're right at the center of care everywhere else. Really it shouldn't be about midwives versus OBs. It's about trying to provide women options for care, and also ideally access to both.

• IVETTE FELICIANO:

  Grayson and Owen agree, and have formed partnerships with Memphis obstetricians, including Dr. Pinckney.

• DR. KIA PINCKNEY:

  We need the midwives and they need us if they need a surgeon, if there's an emergency then we can be there for them.

• DR. NEEL SHAH:

  The norm ought to be providing people with care that's safe and supportive and empowering. We should be able to do all three.

• IVETTE FELICIANO:

  Grayson and Owen are planning an apprenticeship program at Choices to train more midwives of color.

• NIKIA GRAYSON:

  It's a privilege for me to be able to provide care to black women. When they find me they are relieved, and they talk about that. I think they see in me they see themselves.