A Mining City Story: Jenna Clark - Nurse Midwife

Guest: Jenna Clark, MSN, CNM, WHMP (Intermountain Health St. James Hospital)

Working in partnership with Megan Bristol (Ep. 05), Jenna offers midwifery care at St. James Hospital. Learn what makes midwifery different from an OB approach, and how Jenna made her professional transition. 

https://doctors.intermountainhealth.org/provider/jenevieve-l-clark/2197973

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Transcript

 Emily: Welcome to Mother Love Season 4. I'm Emily Freeman, Storytelling Coordinator at HMHB and your new host of the podcast. This season, we're launching a special series, A Mining City Story, co hosted by Cass Weber, whose motherhood journey we shared with you last season. The series will highlight the work of five labor and delivery nurses in Butte, Montana, who realized that more could be done for moms and babies in their care.

Through individual effort and community collaboration, they were able to expand resources and services for birthing families. Over three years and two pregnancies, Cass benefited from a transformation of Butte's perinatal landscape. This season on the podcast, she and I will speak to these nurses and care providers to learn more about what they did, why they did it, and the impact it had.

Our hope is that their stories might inspire you to seek out or create additional resources that your own community may need in order for families to thrive. I'm Emily, and you're listening to MotherLove. 

Cass: It would be nice to associate your name and your title with your voice. So if you wouldn't mind introducing yourself.

Jenna: I'm Jenna Clark. I'm a woman's health nurse practitioner and midwife in Butte. I work at St. James OBGYN currently. 

Cass: Thanks for being here. 

Jenna: Yeah, thanks. 

Cass: Well, let's just dive in and talk a little bit about. Kind of what your career trajectory has been, you've made this transition. Did you always know you wanted to work with moms and babies?

Jenna: My grandma was a labor and delivery nurse. And then she was the director of OB. So I worked in OB for about 40 plus years. And she, I mean, she's one of the strongest women I know. So I think following exactly what she wanted to do was easy to do. But she also, you could just – her passion for it was, you know, exactly what I wanted to do with my life.

And not necessarily that she had this passion for labor and delivery and moms and babies, but, but more so just finding that passion. So hearing her stories, things like that definitely kind of tipped me off to it. And then I started to, well, I went into nursing school. And I worked on the ambulance, just trying to decide kind of what I wanted to do, and that was great because I got to see a little bit of everything. And then when we got into our OB portion of it, it definitely, I felt more like a sponge. I was able to take it all in and definitely felt like this is where I was supposed to be. 

Cass: That's really cool. Did you go to [Montana] Tech? 

Jenna: Nope, so I went to the University of Jamestown in North Dakota.

Emily: So at some point you made a transition from being a labor and delivery nurse to being a midwife. Can you? Sort of in broad strokes, just kind of define the difference between like a midwifery model of care versus a more traditional, you know, OBGYN – although I'm not sure traditional is the best word there, because the midwife model is the more traditional – but the more commonly found these days?

Jenna: Absolutely. The midwifery model, what we really try to focus on is more of a holistic approach and thinking of mom and baby as more of a dyad instead of, you know, mom has this sort of sickness and it's a pregnancy. It's not really a sickness, you know, it's just something that we get to go through. And so looking at it as together, you know, what we do to mom is going to affect baby and vice versa. And not focusing on one or the other, because then I really do feel like we lose that connection between possibly mom and baby and between each other. So it's more, you know, that kind of mind, body, soul. Just looking at it as a whole, for sure. You know, I've worked with great OBGYNs as well, and there's a need for them too. You know, I think we can fit together very perfectly. They have that medical background, that knowledge, those interventions, and sometimes those are needed and it's nice to have them in our pocket too.

Cass: Definitely. And in Montana, are all midwives certified nurse midwives? Is that how that works here licensure wise or? 

Jenna: No. So, most of the midwives that you find working in a hospital, some birth centers too, are going to be your certified nurse midwives. And the biggest difference, you know, we all go to high school, we get certifications, but we go to nursing school and then get our masters and the certified nurse midwife. So we have other midwives that are working and delivering babies at home, if that's what you choose to do. And those are more of our, what you would call a lay midwife, I think is what more people can refer to, I guess. 

Cass: Sure. There's kind of those different tracks. That makes sense. Speaking from having experienced it and talking to other folks who've been in the OBGYN-centered care, experientially, it feels like we get to spend a lot more time with you as a provider. So there's fewer restrictions on length of appointments and you get to develop a lot more of a relationship it feels like. Is that normal? Is that because insurance is billed differently?  

Jenna: That is, you know, I think that's our goal and that's really something we strive for is having those relationships, being able to do the education. You know, you can't educate someone on a whole pregnancy in 10 minutes. It's just not possible. You can listen to a baby, yeah, but you can't really have that relationship. And that is something that both Megan and I, my partner, are very strong on is keeping our appointments long and being able to spend time because there's nothing worse than feeling like you have all these questions and you're getting pressured and pushed through an appointment.

Emily: How long has there been a midwife option at St. James? Is that relatively recent?

Jenna: Employed at St. James, about three years. However, Cindy Kaiser was here prior, and she worked in Butte for about 25 years. Sue Burton worked in Butte for about 26 years. She always tells me I just have to do 27 years. 

Emily: So these were midwives practicing in the hospital or in different spaces?

Jenna: Yep. So they had their own private practice, but they were delivering in the hospital. 

Emily: OK, gotcha. 

Cass: You were a labor and delivery nurse for a while. How long were you in OB? 

Jenna: Seven years. 

Cass: Wow. Jenna looks like she's. So it's all a little unbelievable, but, um, and then, so what made the transition happen? What made you want to go get your master's and start doing that kind of practice? 

Jenna: I think, I mean, there's two parts of it for sure there. I loved labor and delivery and I loved helping moms bring their babies into the world. You know, that was great, but it was always a little bittersweet, you know, you, I got to see him for 12 hours and then they were gone, you know, I didn't know their families really, or their stories, or get to follow up with them, and that was a huge part of it. I just kind of wanted to be more intertwined with their families, seeing them through their pregnancy and then seeing them through postpartum, especially postpartum is really important to me just with the mental health aspect and not being able to see that. And then, like I had talked about, we had Sue Burton. She was a midwife in town, and that was her job. I mean, she was meant to be a midwife. Truly, yes. Like, I can't say enough good things about her. And just watching her work, it was, it was hard not to want to do exactly what she was doing. 

Cass: I worked with Sue for Rowan. I was one of her last patients before she retired. And she had so much energy for it still, even though she was, like, at the end of her career and had just been doing it for so long and had such wisdom and whatnot. So, yeah, it was great to get to work with her. And then, so nice, one of the differences in my story with the midwife situation is that I did have the opportunity to have a midwife. I think Sue was the only one that was actually delivering babies in town in 2020 when I had Rowan. So I didn't have options. If I hadn't have liked Sue, I would have been, you know, unable to move forward with that model. But unlike some of the other provider situations that we're talking to here, I did get to have a midwife because there was one person doing that service in town. We had another midwife who just wasn't delivering babies and maybe there were some others, but I don't know if they were practicing and delivering babies at the time. I certainly couldn't track them down at that moment. 

Jenna: I think you're right. Yeah. It was just Sue. 

Cass: So I'm really grateful that I had that. But now people get to have options. They get to work with you or Megan or one of the other midwives in town that doesn't deliver at the hospital. Are there any other delivering at the hospital right now? 

Jenna: Not right now. No. We have a couple going to school, but no one delivering at the hospital right now. 

Cass: So it's just great to have those services getting expanded for people. 

Emily: And is going to school for that something that a working, you know, nurse could be doing that sort of on the side or what is the route? What does that look like? 

Jenna: I worked full time and was able to go through school. It was actually during COVID. So online, you know, we were going to have to travel a lot more and it maybe worked out a little bit for the better that we didn't have to, so I could keep working, but I was able to do that. And then I did my clinicals as I was working as well. It's busy, but it's doable, which is kind of nice. 

Cass: Yeah, it sounds tiring, but it's cool that it's possible.

Emily: You and Megan, you're the two midwives employed by St. James. Do you kind of share a caseload and then whoever's available on the day when baby is showing up? 

Jenna: Yep. 

Emily: That's a nice model. 

Jenna: Yeah, it has been really nice because we, you know, Megan and I practice very similarly as well. And so there's never a worry. If I'm on, I know this patient is getting the best care or if I'm not on, I should say. And then if there's a patient that I've delivered before, we definitely still have people that we would like to deliver even if we're not on, and we try to do that as well. 

Cass: Worked out well for me. I ended up never getting to meet Megan, actually. But, it was nice to know that that was available and in the background, because with Sue that wasn't. It was just like, okay, well, if something changes...and man, she was a trooper with me. We were in there for, she was sleeping in that cot in the hospital for a long time while I was in labor. And she was definitely a trooper, but yeah, there was no one to relieve her, and she wanted to stay because things were rocky. So, and then she had a really good relationship, it seemed like, with the OBGYNs and being able to call them in as soon as it was necessary for me too.

So yeah, having that tiered level of support so that you know you can have this more relationship-focused experience with a midwife, but then you also know you have the backup of a surgeon. Someone who can jump in and monitor more closely, just somewhere you can ask questions or if you're a high risk for any reason, there's that additional level of support is so nice. It helps relieve anxiety, I feel like, for moms probably. 

Jena: It is kind of the best of both worlds, you know, because you don't risk out of our care, which is nice because they're always in the background and we're talking to them and so if you had history of preeclampsia or whatever it may be, you know, we can still see you, and see you through your pregnancy and have them in the background as well.

Emily: Is the birthing facility itself different where the midwives deliver versus the OB? Unfortunately not. That's one of the things that we are definitely building towards. I would like to just start with even just one room that was, you know, very cozy, very home-like, low intervention. Tub. We'll get there.

Cass: Tub would be cool. 

Jenna: Yes, yes. It's hopeful. 

Emily: It's easy, I think, to look at a place like Montana. And rural areas in general as just places of scarcity or lack, you know, a food desert, a birth desert, you know, and it's so encouraging to know that it really does seem to change just one person at a time and all of a sudden, look around, you've got this whole little village of birth practitioners that just simply wasn't there and it was built person by person. It wasn't some large-scale top-down initiative across the whole state. It was just like individuals feeling motivated and passionate and doing something about it. Just really neat. 

Cass: It's very cool. I'm really curious, and if you don't want to talk about it, it's totally okay. But how being pregnant has like shifted things. This is your first baby, right? So what are you seeing now? What has been your experience? 

Jenna: There's definitely, you know, I can talk about round ligament pain and just something as little as that, but having not experienced it, you know, you don't get a full feel for it, but also the anxiety, you know, I know birth, I know delivery and just that anxiety of myself going into it that I just, I don't know. And that opens my eyes for moms for sure. And it just makes me feel a little bit better about like, for sure what we do, you know, like walking through it and how much that's helpful. And I just delivered my little sister's baby two weeks ago.

Cass: Wow. 

Jenna: Yes. Which was fabulous. Yeah, and just even seeing it was her first as well and being able to go through that together and you know, Did this weird thing happen to you and being able to kind of bounce it off each other? It's been great. 

Cass: That is great, something special about having women in your family that you can ask because it does feel like your bodies kind of behave similar ways and you can be like, did this, I've never heard anybody else talk about this, but is this happening to you? And it's like, Oh yeah, that happened to mom. And I think grandma talked about it, you know? Oh yeah. Right. 

Jenna: And there's things that you feel comfortable talking to your spouse about, you know, but my spouse has no idea like if that's normal or not, he's just like, oh, I'm sorry, sounds uncomfortable. 

Emily: It'll be interesting to be on the other side of this working and, and what it's going to do for you for your own, just like professional development as a midwife.

Jenna: For sure. Yeah. Yeah. No, definitely. 

Emily: It's a whole other level of certification. 

Jenna: Yes. Yeah. No, I think it's been really helpful. I mean, even as little as, you know, figuring out what helped me with heartburn and seeing if that helps somebody else, you know, just. A hundred percent. Yeah. I think so. You can say oh, I, I do get that actually. 

Emily: Do your clients get excited when you're at the same stage they are? 

Jenna: Yeah. It has been fun. You can see the anxiety on them a little bit. Oh, right. Are you going to go first? But also very excited. They have great patience.

Cass: That's really fun. Are you able to have care here? Is there like, do you have to go somewhere else? I don't know how that works when you're a provider and if it's allowed. I don't know. 

Jenna: No, it works great. I can see Megan and it's been fabulous. It's also really calms me. Megan and I have known each other for a long time. Our husbands work together. We went to school together, you know, really followed each other's path. And so to have her, it's basically like seeing my sister for OB care and I don't know what else would be more comforting. 

Cass: That's so cool. I love that. 

Emily: Can you think of a story that you want to share about a particular patient who you think really benefited from the midwife model or maybe someone who is kind of trying to decide which route to go and chose midwifery and benefited from it. Is there anyone that comes to mind? 

Jenna: I do, you know, I, what really comes to mind is we, when we think about delivery and we think about this joyous time and having our spouses there and whatever it may be, but there are instances where you don't have that support system. And I definitely have patients that do not have that support system, and that I feel like a couple of times that I've really noticed this is very genuine and helpful. You know, when you don't have someone that you're going to call when you're in labor, you call your midwife and then we get to be there and be that for you. And I feel really lucky to be able to be that person. Not only delivering their baby, that's really special, but being able to be someone that they can lean on and, you know, be there in that time. I think we just don't think about that aspect of it. 

Emily: That's great. That's a really good point. Not everyone has any kind of support system and that I think can be a blind spot sometimes to providers or books, just assuming people have family a partner, you know trusted safe relationships around them.

Jenna: Right. Yeah. 

Emily: So that's an honor that you get to kind of sit in that seat too. 

Jenna: Yes, absolutely. No, it's, you know, and walking through their hardships that, let's say addiction, you know, those are tough things to deal with anyways. When you don't have a support system, it makes it a lot worse. So having someone, you know, that's in your corner and believing in you, it's, it's been really neat to be on this side of it for sure.

Cass: Yeah, that's great. I mean, having the extra level of support that comes from midwife when you do have to go do something more and with more interventions, like have a C-section like I did, getting to have you and Sue in the room during the operation and part of the team is such a nice, you have such a good relationship. By then you've spent so many hours with each other and in that scary moment knowing that that person is there and helping to play your music and do all your things.

Emily: Well, and I love you know that word you use, you know someone believing in you. For me in my experience with midwives it seemed there seems to be this just core belief that a woman and her body can make this happen, and and just feeling feeling believed in, like the like the lens through which I was viewed as a patient was one of, you can do this and we're here to support you, versus here are all the things that might go wrong and, and not to in any way disparage the OBGYN model, but I just, there's something extra in that midwife model of like, yep, your body knows what it's doing and you know what you're doing and we got you and we'll catch you if you fall.

Cass: One of the things that I think is great about having the multi-tiered system when you're working with a midwife for me was you're like a filter. You get to be a little bit of a blockade from some of the medical model opinions about older moms. I was 36 when Isla was born, I think, and moms that are going past date and the pressure that's getting put on from the team, the OBGYN team, I'm sure was there. And you were getting the pressure rather than me, the patient, getting the pressure about we're going past date. Things are not normal. What's going on? I didn't have to feel any of that because you were dealing. 

Jenna: Oh, yeah. An advocate, and happy to be so, you know, I mean we want you safe for sure, but I mean just presenting options instead of fearmongering basically. I remember sprinting up, we had a locum. A locum is someone that comes in, not from Butte and just, it helps us cover and usually it's covering our OBGYNs. And I remember sprinting up the stairs when the nurses called me and said that they were on the floor and they didn't like the strip and they were going to talk to my patient so that I could get in the room before and talk to my patient before so that they didn't scare them.

But it's things like that. Cause then once you have that in your head, you know, something could go wrong with you. Something can go wrong with your baby. Then you're like, Oh, okay, well maybe I'll stop and do this, you know? 

Cass: Yeah. Having that trusted relationship-based person helping to interpret the medical knowledge, helping to guide that and just have a little more soft handling is really useful. 

Emily: If you could give advice to someone considering a similar career transition to the one that you made, what would be some first steps? Maybe they're working in a hospital that doesn't yet have a lot of awareness or embracing of the midwife model, how would you navigate that if you're already a working professional in labor and delivery? But you kind of want to move towards this whole midwife game. 

Jenna: You know a lot of midwives will take people to shadow them and I think that's a great first start just to make sure you know because it's time-consuming for sure. You know, I think people have like this great idea, it's going to be so fun, but you have to have your whole heart and soul into it and have to be able to, I'm going to commit myself at 3am after I haven't slept all day, you know, or whatever it may be. And so I think that's a great start just to make sure, you know, you're stepping into something that you actually, you know, know what you're looking at, but also I really do think we're making a good transition as far as we're listening to our moms and listening to letting them listen to their bodies. I feel like it's coming in, whether that be looking at midwifery schools and seeing how you can get in that way and there's a bunch of midwifery Facebook groups and things like that, that people can walk you through.

And I just really think talking to someone that has had experience and has been through it, it's helpful. 

Cass: Yeah. I love that mentorship model. Your clinical hours, did you do those with Sue? 

Jenna: Yep. 

Cass: So you do get to like really kind of have that old-school mentorship. And they get to pass, hopefully, some of their wisdom onto you. 

Jenna: There's still things that I do that I can hear her in the back of my head. I mean, I talk to Sue often, so. 

Emily: How do you see the landscape of this type of work changing in Butte? Just perinatal support in general, birth related people, resources, what do you, what are you noticing being on the inside? 

Jenna: I am really excited about it. I feel like, you know, you see little things popping up everywhere. You know, we're focusing on women's mental health, which wasn't really a focus before. You know, I have therapists that I can refer patients to that is perinatal mental health, and then we have a psychologist that actually focuses on perinatal mental health. And then we have craniosacral therapy and great physical therapists and chiropractors. And I just feel like we're really kind of coming around. And especially for Butte. I mean, Butte, who would have thought? I definitely feel like we have a great group of people that are supporting our women, which is fabulous. It's exciting. 

Cass: Yeah, it's really cool to see. The growth in the difference. Yes. Yeah. And feel it for folks. 

Jenna: Yeah. No, it's good. 

Emily: What do you think, what would you like to see to encourage this growth? Are there opportunities for sort of more networking or community building within… 

Jenna: One of the biggest things that I think It would be great to move towards, you know, we have obviously like having our lower-intervention rooms, having things that look and feel more like home, but you still have that safety if you need it, but also there's a type of OB care that's called “centering” and it's more focused towards, you know, you and probably like five six other women that are about the same gestation.

You have a two-hour long visit which, one, brings you with your OB a little bit longer and you get to know each other, but then you're creating this community as well. So you're learning about your pregnancy, we're normalizing it and not locking you in a room and hiding you away, but then you also come out with, and you can ask these questions, you know, is this happening to you as well? So you're not as secluded and we have a better group of women kind of supporting each other. 

Emily: That’s an amazing idea. And then you have ideally like some level of a built-in baby-friend community when you're on the other side of it, and where it's so easy to get isolated. And so is that something that St. James is looking into? 

Jenna: Not yet. It has great evidence behind it. There are places that do it. I think it would make a huge difference, you know, and you don't have to do it, but 

Cass: Yeah, something to manifest for the future. What a cool peek into the future. 

Emily: Yeah, absolutely. 

Cass: Especially for those moms who maybe don't have the support like you were talking about, um, to be able to connect to some people going through the same thing. And yeah, that's wonderful. 

Jenna: It's a great model for sure. I definitely did not come up with it, but I love it. 

Cass: Well, and always good when there's evidence around it working and being functional, it's easier to sell to folks that way. 

Absolutely. Yes. Yeah. I'll just keep talking. 

Cass: Squeaky wheel. You're good at being a squeaky wheel. You're a good advocate for your patients. I'm sure you could do it for that sort of thing too.. 

Emily: Well, and it seems like it would provide a nice opportunity for a more, you know, whether it was a more seasoned mom who'd already had a baby, you know, or an older mom and a younger mom, like, just more sharing of experiences and wisdom.

Jenna: Yeah. 

Emily: Cool. Any questions for us or anything you think that we should have asked that you'd like to share? 

Jenna: I don't think so. 

Cass: Awesome. Well, thanks so much. 

Jenna: Thank you guys. 

Emily: Mother Love season four was produced by Brooke Boone Miller with music by Fred Krase. Special thanks to Shelby Carver with Platinum Real Estate for use of her podcasting studio. Mother Love is a project of Healthy Mothers, Healthy Babies, the Montana Coalition. A non profit organization dedicated to improving the health, safety, and well being of Montana families by supporting mothers and babies ages 0 to 3.

Opinions and views expressed in these interviews do not necessarily represent the views of HMHB as an organization. Visit us at hmhb-mt.org to learn more about who we are and what we do. If this episode of a Mining City Story resonated with you, and you're interested in finding similar services in your own community, We invite you to check out LIFTS, our statewide online resource guide, at hmhb-lifts.org. If you're a provider of care to moms and babies in Montana, we encourage you to get in touch and list your services in LIFTS at no cost. Thanks for listening. We hope you'll join us next time for more stories of pregnancy and parenting in Montana.