For Tanzye Hill, supporting a mother through pregnancy means helping her navigate medical appointments, understand her choices and prepare for the uncertainty of labor. In North Nashville, that work also means preparing other birth workers to serve families whose concerns can go unheard.
Through her organization, Birth Manifesta, Hill teaches women who want to enter birth work in Nashville. Her approach draws on advocacy, teaching and a family history of midwifery, rather than relying solely on the doula training that first brought her into the field.
The work is personal, but the stakes extend across Tennessee. The Tennessee Maternal Mortality Review Committee reported in 2025 that Black women experienced 116 deaths per 100,000 live births during 2021–2023. That rate was more than twice the rate for white women and four times the rate for Hispanic women.
Nashville birth workers are responding with education, emotional support and help navigating care. They are also pushing for a financial structure that would make doula services accessible to more families without requiring workers to routinely reduce their fees or serve clients for free.
Those efforts have brought the debate to TennCare, Tennessee’s Medicaid program. But years of legislative proposals have produced more movement toward studying and certifying doula services than paying for them.
A doula provides nonmedical support during pregnancy, childbirth and the postpartum period. That can include helping a patient prepare questions, develop a birth plan and communicate preferences to medical providers. The role differs from that of a midwife or obstetrician, who provides clinical care.
For Hill, the boundaries of that support reach well beyond labor. She describes community birth workers as people who help translate medical conversations and connect families with information that might otherwise be lost in a busy healthcare setting.
She has seen important information slip through gaps in Nashville care, but does not attribute every lapse to indifference. Providers, she said, are often carrying workloads that leave them overwhelmed.
Cornelia Graves, a maternal-fetal medicine specialist at Ascension Saint Thomas in Nashville, describes a related strain on Black physicians. She estimates that about nine active Black OB-GYNs practice in the city.
Insurance reimbursement can restrict how much time those doctors can devote to underserved patients, Graves said. The pressure to see more people while receiving less reimbursement makes the work difficult to sustain.
Recruitment presents another challenge. According to the Association of American Medical Colleges, OB-GYN residency applications in Tennessee fell 20.9% during the 2023–2024 application period, following a 13.6% decline the previous year. Across states with abortion bans, applications dropped 6.7% in the later period.
Graves said restrictive reproductive laws are only one part of the problem. Reimbursement difficulties, Tennessee’s lack of Medicaid expansion and struggles for professional respect also influence the environment in which doctors work.
Hill’s understanding of birth began in a very different setting. Her mother delivered four children with midwives in Texas during the 1980s. As a child, Hill remembered being present for a sibling’s hospital birth while eating cereal, an ordinary family moment rather than an experience defined by alarm.
Her great-great-grandmother had also been a midwife, delivering her own grandchildren. That history gave Hill a sense that helping families through birth was part of an inheritance she could carry forward.
Then, in 2014, her younger sister’s pregnancy exposed Hill to a sharply different experience. Hill said her sister encountered discrimination when seeking basic care and was abandoned by medical providers during labor over what they regarded as noncompliance.
Hill subsequently enrolled in a doula training program in Kentucky, where she was the only Black participant and the only person of color in her cohort. Once she began working in her community, she found that the training did not fully address the needs of the families she hoped to serve.
She turned to her experience as an advocate and teacher, along with the knowledge passed down through her family. Today, her work includes helping mothers prepare emotionally and spiritually for delivery. Depending on the person, that preparation might involve prayer or a mantra they can return to during labor.
Hill said fear often drives families to seek her help. For some Black mothers, the concern is not simply whether their birth preferences will be respected, but whether they will survive childbirth.
Elsewhere in Nashville, doula and advocate Kristin Mejia has been building support through Homeland Heart Birth and Wellness Center. The collective offers childbirth education, supplies and resources for local families while creating opportunities for women to become doulas.
Mejia entered birth work as a lactation consultant after her son’s birth 11 years ago and became an advocate for breastfeeding in public. Over the past three years, she has also worked with doulas in her collective to participate in a community health worker cohort.
Many families served by the organization have low incomes. That makes insurance coverage especially important: a service can be valuable and still remain beyond a household’s budget. Doulas who respond by charging little or nothing face their own challenge of sustaining the work.
The Tennessee push for coverage has repeatedly narrowed as proposals moved through the legislative process. In 2022, Sen. London Lamar, a Memphis Democrat, introduced SB 2150 to cover doula services through TennCare. The proposal was amended to focus instead on studying their benefits.
Another effort in 2023 led to a five-member Doula Services Advisory Committee. In 2025, House Bill 295 initially called for Medicaid coverage and a state doula certification process. An amendment removed the coverage requirement, leaving certification as its focus.
The advisory committee proposed reimbursement of up to $1,715. In January 2026, Lamar introduced a resolution urging TennCare to cover doula care, but the effort had not led to further action.
Mejia said the slow progress has been discouraging. Lamar’s loss in the August primaries deepened her concern about the future of the coverage campaign and the prospect of having to rebuild legislative support.
The debate is not limited to Tennessee. According to the March of Dimes, 26 states and Washington, D.C., allow doulas to enroll as Medicaid providers and bill independently. Advocates elsewhere in the South are also pursuing coverage, certification systems and advisory bodies.
For Nashville families, the issue connects the support available during an individual pregnancy with the ability of community organizations to keep providing it. Hill’s training and Mejia’s collective are building that support now. Their broader goal is to make it something families can reliably access, rather than something dependent on a worker’s ability to absorb the cost.