‘You push, we catch’: A Q&A with Aya Wellness, the first Black-owned birth and wellness center in NC

The leaders of a groundbreaking birthing center in North Carolina on the Black maternal health crisis, what they do, and the racist roots of prejudice against midwives.

[The following is part of an ongoing Cardinal & Pine series on NC’s Black maternal health crisis. For more of the series, click here.]

Recently, we spoke to Tina Braimah and Amber Rodriguez at Aya Wellness—the first Black-owned birth and wellness center in NC—to better understand the work they do and how vital this care could be for rural communities.

Midwives could play an important role in improving North Carolina’s disparities in Black maternal health. Black women are three times more likely to die from pregnancy-related complications than white women.

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Here’s what they had to say:

[Editor’s Note: The following has been lightly edited for clarity and length.]

C&P: 

We’re really trying to bring some attention to the need for midwife services and doula services and general health care options for rural communities, and particularly rural communities of color, and anybody who’s been overlooked in terms of the health care system. 

So maybe y’all could talk to me a little bit about your business and how long you’ve been on the ground and what you do?

Tina Braimah: 

I am the primary midwife here at Aya Birth and Community Wellness. You may have remembered us at Sankofa Birth and Women’s Care, but we’re kind of expanding our services. 

We’re going from a small home birth practice to a community-based birth center practice. We’ve been in business … since 2017, and Amber joined me in 2019 for most of the part. 

We do provide prenatal care, we do births, we do postpartum care. As a CNM, I can provide care for the newborn up to 28 days. And so we can do this in your house. We have done it in a hotel, we’ve done it in a college dorm, in a camper, in a camper, wherever we’ve labored outside beside the chickens before whatever our clients want, we meet them where they are.

 

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C&P:

That’s really cool. Have arms, will travel.

Amber Rodriguez:

“You push we catch” is the password to our Wifi here in the building.

C&P:

For people who aren’t familiar with the kind of care that you provide, how would you describe it to them? How is this going to be different from if a person saw a doctor in the hospital?

Braimah:

So I think that we provide low-intervention, but I’m going to use the term, high-touch care. They can come to us just like they can a doctor. We see them for much of the same things along the same frequency. 

So in the beginning, you’re going to see them less frequent than you are as pregnancy progresses. And I think a lot of people get confused because they think, OK, so I’m going to go to my doctor first and then switch to the midwife. Not realizing that midwives do more than catch babies. 

We provide prenatal care from the time that you pee on the stick and say, ‘Hey, I got those double lines.’ Now what all the way up into six weeks postpartum and then beyond, because we can do contraception, we can do regular GYN or well person care. 

There’s so many things that people don’t understand about a midwife. But as a CNM, I also have prescribing authority. So if you come to me for a UTI or for some type of infection, anything like that, I can treat those things also.

Rodriguez:

I’d like to add that midwifery care is exceptionally relationship based. 

I think one of the bigger, broader differences is when Tina’s saying high-touch. Because our care is relationship-driven, we’re able to take in more pieces of the picture that if you were just in with your doctor for five, you’ve been waiting in the waiting room for two hours, and then you get in, see that doctor for five minutes, and then the nurse comes in and then you get out. 

With our practice specifically, I’ll just speak to what we do, you’re allotted an hour whether or not if you show up late, you’re still allotted that same timeframe, so whatever. But if you get there on time, you get your hour with the midwife. And so we are so much more relationship driven. We sit back and we listen and we talk, and we’re not just talking about: ‘Tell me about that baby and your pregnancy.’ It’s also: ‘How’s your husband? How are your other kids? How’s your family? Oh, who graduated from where?’ 

And so we’re building those relationships and it helps us to be able to see when something’s going wrong that’s just under the surface. So we’re able to say, ‘wow, your ankles look way puffier than they did the last time we saw you for an hour. Well, let me look a little further. Let me dig a little deeper into that.’ 

And so Tina and I have been able to 100% catch, diagnose and refer all issues that have needed to have an escalation of care for sure. A hundred percent of our practice, we have been able to say, even when it’s just like, oh, we’ve got that feeling and it just doesn’t feel or sound right. Our instinct kicks in, our experience kicks in, and we’re able to get them. We’ve had a client before who came in, we’re like, you definitely have preeclampsia.

It is coming. We see it. We can see it from a mile away. Go to the hospital. They went to the hospital. The hospital was like, ‘we don’t really see anything. You’re fine.’ Go home the next day, you better go back. Go to a different hospital. And sure enough, she had preeclampsia and had, it was a rough situation for her and her family. 

So the relationship piece I think is really, that’s like the meat and potatoes of what we do. 

Braimah:

I think that one more thing about that relationship piece is because you’ve seen the midwife for nine months, we’re part of the family. 

I still go to the farmer’s market and to the mall and I see people that are like, ‘Oh, mama Tina.’ And they’re like, she was your midwife and all kinds of things. I’m like, ‘how is that child in 2nd grade now?’ I delivered your little brother and your little sister. Those kinds of things. So there’s that family feel to it. 

But also from a medical point of view or a care point of view, when I’m at your house, our job as midwives are to be able to be there and hold space for you, but at the same time, be able to identify when things are outside of the parameters of normal. 

And if I tell somebody, don’t, this doesn’t look good to me. I’ve seen A, B and C, I think we need to go in (to the hospital). If they have that relationship with me, they’re more likely to ask me whatever questions they have. We’re going to discuss it, but they’re more likely to say, OK, I believe you. I trust you. Let’s go.’ (Instead of sitting) there and going back and forth for 20 minutes when time is of the essence.

C&P:

How many babies would you say you’ve delivered at this point?

Braimah:

I’m going to say as a practice, probably close to 200 over the years. Some of those are our babies and some of those are other midwives that’ll call and say, ‘Hey, I have something coming up, or I have two births going on. Can you back me up?’ So that is one big thing about the midwifery community. We back each other up and we realize that there are so few of us that do what we do, that we have to have that network.

C&P:

North Carolina, as you’re well aware, is a diverse state, as diverse as any. And people like to see someone on the other side of the desk who looks like them sometimes. So can you talk a little bit about the importance of providing diversity in the midwifery community?

Braimah:

Yeah, I think it’s very important to find a provider that understands you. This whole idea of finding culturally competent providers and providers that understand your lived experiences is something that’s very difficult in North Carolina, not even North Carolina, throughout the country. 

So midwives of color make up about 7% of all midwives, whether we’re talking CNMs or CPMs. And in North Carolina, I started my practice in 2017. At the time, I was the first Black midwife attending home births in the state since the grand midwives in the sixties and seventies. 

So people were seeking out my care from all over the state. But I told you we operated within a two hour radius. And so it wasn’t possible for me to go see somebody on the coast or somebody in Charlotte. So I think that there are a lot of things that can be done to increase access, but one of the biggest ones is increasing access for people who want to provide this type of care, increasing learning opportunities.

One of the things that I do is I run Mocha Midwifery Collective, which is an organization that trains BIPOC people for birth assistance. We bring them in from all over the country, and we live in a house and they learn from Black midwives, and then they go back to their communities to provide that type of care. 

And what we hope that that will do is kind of feed the system of people who want to become midwives, not just birth assistants. So we’ve had people come to that training that aren’t even here in North Carolina that have come and said, ‘Hey, you know what? When I left that training, I said, I’m going back to nursing school and are halfway done with nursing school right now.’

I think that’s important. Scholarships to the universities. East Carolina University has the only midwifery program in the state, but making sure that they have scholarships and make it affordable for people of color.

The other thing is doulas. There’s no shortage of doulas in North Carolina. There’s no shortage. But making sure that we get legislation and things like that in place which levels the playing field, which allows doulas to get the training that they need and be able to be paid for the work they do. 

Because we know that people who come from disadvantaged communities or people of color, often we can’t afford to just go and volunteer as a doula, as a midwife. 

We can’t afford the $500,000 training to come out, and then we need to pay for childcare, and we got to have transportation to those types of things. 

So I think there’s so many things that need to be done in terms of funding, in terms of accessibility, in terms of knowledge.Just getting the word out that being a doula or being a midwife is something that’s a viable career option for you, that’s going to pay, that’s going to help you serve your community and feed your family.

C&P:

And we know as well that, in NC, you can’t use Medicaid money on doulas. 

Braimah: 

You cannot. There are 11 states that have approved Medicaid for doulas, but there are some social programs through some of the Medicaid-based providers. I believe we were at a workshop the other night and they said, WellCare and is it WellCare, WellCare and United health care or two organizations that are providing doulas? 

So I think the word is getting out. There’s a lot of conversation about it. It is coming. North Carolina is just very slow.

Rodriguez:

Something that I would like to add on, Billy, that, as a white person, the maternal health crisis affects everyone. It affects everyone. 

And I can tell you without a shadow of a doubt that the benefit, the richness, the culture, the love, the compassion that Black midwives bring would benefit everybody. 

White women have the upper hand in most spaces that we walk into. It’s crap. But it is what it is. But that leaves us with all just the exact same homogeneous version of maternal care. So we’re looking at a very heavy white male perspective, white male dominated field. And we know that the midwives, the original midwives in this country were Black midwives. They were Indigenous midwives. And then you had the big push to get midwifery out to make it look like, oh, they’re just…

Braimah:

Unclean…

Rodriguez:

Unclean outcomes, the witches in the woods and those kinds of things. 

When it was those Indigenous practices, those practices that came from Africa that were all the way down to hygiene, just hand washing, cleaning the dishes, cleaning the spaces, those were things that were done by women already. 

And when we started moving toward, OK, well everybody just delivering in the hospital and the doctors were just basically the doctors who were from the morgue, the morticians who are coming up to catch babies, all of a sudden, all the women are dying, all the infections, the babies are dying. Babies are dying postpartum in their newborn stages. 

And so I would just like to say that pushing for more midwives of color benefits everyone. It benefits everyone.