Center of Excellence Nurse Midwifery Fellowship Program

Until the mid-20th century, Black midwives, especially in southern regions, were the primary health care providers for Black, Indigenous, immigrant, and white pregnant people alike. Black midwives, also called “Granny midwives,'' were enslaved women and community healers who utilized many techniques and practices passed down from generation to generation, which could be traced back to many parts of Africa. Granny midwives were essential to the health and wellbeing of their communities. They not only provided obstetric care to pregnant people, but also provided many other reproductive and medical health services, including abortions.

The number of Black midwives across the nation began to dwindle in the early 20th century. A national smear campaign organized by the public health, social welfare, and obstetric community stereotyped Black midwives as unclean, uneducated, and dangerous. Childbirth began to be seen as a medicalized procedure rather than a natural phenomenon. Physicians, predominantly white wealthy males, emerged as the primary care providers. Hospitals were seen as places that were safe, hygienic, and clean environments to deliver a child compared to having a child a home. Although intensive research in the 1930s revealed that better birth outcomes were achieved by midwives compared to physicians, Black midwives were blamed for the nation’s mortality rates. The combination of negative messaging campaigns and the passing of new laws and policies regulating the practice of medicine and who could provide services like attending childbirth resulted in only fifteen percent of babies being delivered by a midwife by 1930. The ramifications of their absence in the communities across the nation can be seen today.

Today, people of color experience worse health outcomes than white patients. Compared to white pregnant people, Black pregnant people are four times or more likely to die from pregnancy-related causes. Specifically, even when Black pregnant people’s socioeconomic, marital, and educational levels are higher compared to white pregnant people, the risk of experiencing a negative outcome during pregnancy is still great. Studies show that people who choose a midwife as their care provider during pregnancy and childbirth experience lower numbers of medical  interventions and better outcomes for both birthing patient and baby. Moreover, several studies confirm that among low-risk pregnant people, planned home births result in low rates of interventions without an increase in adverse outcomes for both pregnant person and baby. While the rate of out-of-hospital births have increased significantly in the last 50 years, from 0.3 percent in 1975 to a little less than 2 percent of all births today, Black pregnant people are still primarily delivering in hospitals.

Presently, Tennessee matches the national rate of nearly twice the number of Black infants dying in comparison to white infants. Many studies show that states that had integrated midwifery care, where midwives and traditional healthcare providers engage in inter-professional collaboration, were associated with significantly higher rates of physiologic birth, fewer obstetric interventions, and fewer adverse neonatal outcomes. Overall, the more included midwives are in the prenatal and postpartum process, the better the health outcomes for pregnant people and their babies.

CHOICES: Memphis Center for Reproductive Health seeks to do its part by not only increasing the number of Black midwives who are exposed to the full spectrum of sexual and reproductive health services in the South, but to give all pregnant people options to choose which type of care is best for them.

CHOICES was founded in 1974 - we've been a trusted provider of patient-centered medical care in the Mid-South for almost 50 years. CHOICES provides a full spectrum reproductive and sexual health practice with a range of services for more than 4,000 patients each year. Many patients are un- or under-insured and receive outside funding to assist with the cost of medical services provided. Services include medication and procedural abortions, perinatal care and out-of-hospital birth, gender-affirming hormone management, HIV testing and prevention, birth control, and sexual wellness. CHOICES is the only independent abortion provider in Memphis, Tennessee. With the opening of its new health and birth center in September 2020, CHOICES became the first nonprofit health care provider in the country to offer both birth services and abortion care under one roof. Grounded in the principles of reproductive justice, CHOICES centers those with the least access to quality, affordable, inclusive care. To learn more about our patient demographics, please review CHOICES 2020 Annual Report. 

The Center of Excellence Nurse Midwifery Fellowship Program at CHOICES: Memphis Center for Reproductive Health seeks to not only introduce recently graduated nurse midwives to CHOICES’ values and the full spectrum of sexual and reproductive health services, but to align each fellow with reproductive and social justice principles. CHOICES hopes that each fellow will leave the program fully equipped to practice and care in a more inclusive, patient-centered way and take action to dismantle all systems of reproductive oppression and injustices in their own community and beyond.

The Fellowship is set to begin January 2022 with a 12 month commitment. Applicants will be accepted on a 6 months rolling basis. Each fellow will receive a salary of $85,000 and up to $3,000 of relocation expenses reimbursed. As a nurse midwifery fellow, you will be considered a full time employee who is eligible to participate in CHOICES’ major medical, vision, dental, and group life insurance coverage. After 6 months of employment, you will be eligible to participate in our 401k retirement plan and receive up to a 2% of salary match, as well as 10 days of paid sick leave, 15 days of paid vacation leave, and 10 paid holidays annually.

Each fellow will have the unique opportunity to attend various types of  births in three settings (hospital, home, and birth center) under the supervision and guidance of CHOICES' birth team, while also working alongside other health care professionals such as community birth leaders, gynecologists, obstetricians, and urologists. Fellowship experience includes 4-6 clinic days, twelve 24-hour call shifts, regular debriefing, evaluation, and group meetings.

The Center of Excellence Nurse Midwifery Fellowship Program consists of five unique pillars.

1. 1. Full-scope reproductive health services education and training
      • Fellows will learn to perform full-spectrum sexual and reproductive health care procedures:
        • Gender-affirming hormone management/HRT
        • STI testing and treatment
        • Pap smear
        • HIV prevention, testing, and referrals
        • Menopause counseling and management
        • Birth control consultation
        • Procedural and medication abortion services
        • IUD and implant insertions and removals
        • Primary prenatal care and childbirth
        • Postpartum and newborn care
   2. Black Feminist Thought
      • The fellowship centers the experiences of Black women, understanding their position in relation to racism, sexism, and classism, as well as other social and political identities. The population of Memphis, TN is more than 60% Black, and the majority of CHOICES' patients identify as Black women. Here we will learn more about the intersectionality of Black people’s lived experiences by learning from reproductive and social justice leaders locally and nationally.
   3. Leadership & Mentorship
      • CHOICES is invested in the personal and professional growth of each fellow. Each fellow will have the opportunity to learn leadership skills that will assist them in establishing or administering their own health care facility.
   4. Neonatal & Postnatal Training
      • CHOICES’ midwives are responsible for care for newborn babies up to 28 days. The primary goal here is to improve neonatal and postnatal skill-set in all three birth settings: homebirth, birth center, and hospital.
   5. Community & Patient-Centered Care
      • Patients are partners and active collaborators with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective. Fellows will cultivate the art of listening to patients' needs and wants before acting and working together to choose which medical services best support their desires and needs.

Qualifications

• Person who identifies as Black or African American
• Degree: Master’s Degree in Nursing with a specialization in Nurse Midwifery
• Graduated from an accredited CNM program less than one year ago
• Licensure, Certification, and /or Registration: Certified Nurse Midwife license and DEA registration in state of TN
• Eligibility to practice in the Medicare and Medicaid programs
• Eligible for malpractice liability insurance
• Knowledge of nursing and midwifery principles, practices, and procedures
• Eager to learn other reproductive health services outside of midwifery
• Willingness to learn and provide patient care to all that is rooted in reproductive and social justice frameworks
• Excellent communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders
• Eligible or current licensure as an CNM in Tennessee
• Current NRP and BLS certifications
• Basic ultrasound skills desirable
• A commitment to teamwork and partnership; ability to collaborate with care providers and patients
• Personal qualities of integrity, credibility, and dedication to the mission of CHOICES

How to Apply

To apply, please email the following materials to Jazlyn Christie, Human Resources Coordinator, at [email protected]. Applications are accepted until October 11th, 2021. Please indicate clearly that you are applying for The Center of Excellence Nurse Midwifery Fellowship Program.

• Cover letter stating the reasons for interest and career goals
• Three references (must either be on electronic letterhead with an electronic signature or a scanned PDF of the letter on letterhead with a signature)
• Curriculum vitae/resume

Two fellows will be selected and notified by November 5th. Please contact Miajenell Peake, Midwifery Coordinator, if you have any questions or concerns at [email protected]

CHOICES will not discriminate in employment opportunities based on race, color, religion, gender, marital status, sexual orientation, national origin, age, disability, parental status, body size, gender or gender identity or any characteristic protected by law.

At CHOICES, we know that diversity is imperative. Evidence has shown that diverse teams are more creative, better at solving problems and making decisions, happier, stronger, and more engaged. Having a diverse team is not only good for us - it is vital for our patients. We are committed to fostering our team of passionate, talented employees who look like the community that we serve. We highly encourage people of color, people from working class backgrounds, and LGBTQIA+ candidates to apply. People who have personal experience with abortion, pregnancy, miscarriage, birth, adoption, and/or parenting are also encouraged to apply.