A Collaborative Model of Women’s Healthcare

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Interview with Jodi Winemiller, interim Medical Director at the Mission Bernal Woman’s Clinic, about providing for womens’ healthcare needs throughout their lifespan 

By Lee Burgess, President, Natural Resources Board of Directors

Welcome to the “Listen and Learn” Interview Series...part of our “It Takes a Village” Fundraising & Awareness Campaign

Midwives...OBGYN’s...Primary care physicians...Often we think of these healthcare providers as separate from one another. You interact with them at different points in your life depending on your health needs and life circumstances. 

But should this be the case? The Mission Bernal Woman’s Clinic is changing the game and providing for women’s healthcare needs a little differently, through a collaborative practice of OBGYNs and midwives that offer care throughout their clients’ lifespans.

In addition to prenatal childbirth and postpartum care, they offer wraparound mental health — a rarity in healthcare today. And not only are their methods collaborative, but they’re inclusive. The diversity seen in their patients is truly reflective of the different people groups and cultures seen in the San Francisco Bay Area. 

We’re excited to learn more about the Mission Bernal Woman’s Clinic today by spending some time with their lead midwife, and interim medical director, Jodi Winemiller. 

In this episode, we discuss: 

  • Jodi’s background and her work.
  • About the Mission Bernal Woman’s Clinic.
  • The Clinic’s Collaborative Care Team.

  • Receiving the 2021 Maternity Honor Roll Award.
  • How the hospital is becoming more “baby friendly.”
  • Three things new and expecting families should know.
  • How to connect with the Mission Bernal Woman’s Clinic.

Lee Burgess: Welcome to the Natural Resources It Takes a Village interview series. We are speaking to contributing members of the parenting and birth community here in the San Francisco Bay Area. Thank you so much for being with us and for supporting Natural Resources as a community non-profit supporting new and expecting families. 

My name is Lee Burgess and I'm the President of the Board of Directors at Natural Resources. Today it is my pleasure to introduce you to Jodi Winemiller, the lead midwife and interim medical director at the Mission Bernal Women's Clinic, formerly St. Luke's Women's Center. 

Jodi, thanks for joining us today. I've got to admit, I love talking to midwives so this is a treat for me. You're my third midwife that I've gotten to talk to in the week.

Jodi Winemiller: Wonderful.

Lee Burgess: I know.

Jodi Winemiller: You're on a roll then.

Lee Burgess: I know. For someone who's not having more children, it's a real treat to get to talk to so many midwives.

Jodi Winemiller: Well, thank you so much for having me join you today.

Jodis Background and Her Work

Lee Burgess: Absolutely. So to get things kicked off, can you share a bit more about yourself and the work you do at the Mission Bernal Women's Clinic?

Jodi Winemiller: Sure, I'd love to. So I'm originally from San Diego and I came to midwifery after working in public health, along the US Mexico border and it was through that work that I realized the important relationship between the health of women and the wellbeing of their families and communities. I first worked in a midwife only hospital-based practice in Connecticut and then later at Kaiser, before joining the Mission Bernal team back in 2013. 

I'd say I was drawn to the Mission Bernal Women's Clinic because of its dedication to really serving the community and it's focus on patient centered, patient driven care.

I had my own twins with the doctors and midwives at the practice and really was able to feel what it was like to be on the patient side of the care experience. Really getting the benefit of support from both the midwives and OBs during my pregnancy and birth. 

Then for the last couple of years, I've served as the lead midwife and I'm currently also the medical director at the women's clinic.

This means I get to help articulate and move us towards our goals as a practice and I'm also in a position where I can advocate for our patients, staff and the other providers on a system level. So it's been a really fulfilling position for me.


About the Mission Bernal Woman’s Clinic

Lee Burgess: How large is the staff at the clinic?

Jodi Winemiller: We have 11 midwives and six OBGYNs on staff and then our patient service representatives and our MAs are really part of that team as well and many of them were born in the old St Luke's Hospital and many of them have had babies with us throughout the years too. So it has that really close knit community clinic feel to it.

Lee Burgess: So what health services specifically do you provide at the Mission Bernal Women's Clinic and what populations do you serve? Is this just about having babies? Is it a greater scope than that?

Jodi Winemiller: So let me tackle the first component of that question first and that's what kind of work do we do? So we're a collaborative practice of midwives and OBGYNs that offer care throughout the lifespan. 

So nurse midwives like myself partner with patients throughout their prenatal care, birth and postpartum course, and our MDs are available 24/7 if things become more complicated in pregnancy during childbirth or the postpartum period.

Within our prenatal care we also offer group prenatal care, in which small groups of pregnant people at similar stages of the pregnancy meet with the nurse midwife for education care and support. Partners often join in to these sessions too and these groups are special in that they offer a chance to build community at this really important stage in someone's life and during the pandemic we're offering all of these groups virtually. 

In addition to prenatal childbirth and postpartum care, we offer wraparound mental health services and have a team of psychologists and psychiatrists that specializing in providing support in pregnancy and the postpartum period.

That includes free drop in postpartum support groups too that anybody can access virtually from their homes. Then in addition to our pregnancy related care, the nurse midwives provide GYN care for routine gynecologic exams, birth control, abortion care, and menopausal support and our doctors attend to more complex medical needs.

This can include treatment of gynecologic problems like infertility, pelvic pain, sexual issues, abnormal pap smears, fibroids, and offer a whole suite of minimally invasive GYN surgery. So really covering people from menarche or puberty all the way through their lifespan and through the post-menopausal period. 

Then, the second part of your question I think was what populations do we serve? So I think one of the very special things about the women's clinic is that the population we serve is truly representative of the mission and wider SF community. So we have a real payer mix with about 60% of our patients having Medi-Cal insurance and about 40% being privately insured.

We also have special programming for uninsured and under-insured patients, both prenatally and those seeking GYN services. I think that that payer mix is really unique to San Francisco, where care is unfortunately often siloed based on insurance types.

Lee Burgess: Mm-hmm.

Jodi Winemiller: We have a lot of patients with really deep roots in the community, like our staff members born in the old St Luke's Hospital, grew up in the neighborhood and we also have a lot of new immigrants really from all over the globe. It's always surprising. 

We have a lot of patients from Central America, Brazil, Yemen, Uzbekistan, Mongolia, Ukraine, really the list goes on. So we really try to tailor the care that we provide based on somebody's needs, based on somebody's historical roots and expectations of what prenatal care looks like in their home countries and then our own expectations for their prenatal care experience in their birth. 

Then of course, many of our patients are also new to the city and really drawn into it from the tech industry. So I would say that everybody... What they say about working at the clinic is that our patients are the best and it's really truly an amazing demographic mix. It keeps us on our toes in many ways.

Lee Burgess: I think I also read that you're able to provide a lot of these health services in multiple languages too. Isn't that true?

Jodi Winemiller: Yes, so our care providers speak a lot of languages. Most of us speak Spanish, Portuguese, Russian, Hindi, Tamil, Malayalam. So the whole kind of host of language options as well, kind of reflecting the diverse community that we serve.

Lee Burgess: So a lot of people who are getting ready to have kids aren't really sure about this doctor and midwife relationship. Because I think it can be a little confusing about how they work together or what roles they take in your prenatal and birth care. 


The Clinic’s Collaborative Care Team

Lee Burgess: So how do doctors and midwives work together at the Mission Bernal Women's Clinic and in the hospital to provide birthcare?

Jodi Winemiller: This is my favorite question. So we really have a truly collaborative practice. So there's an old adage in the midwifery community that every woman needs a midwife and some need a doctor too and this is something that I often overhear our doctors saying to people. They quote it and they really live by it.

So midwives like myself are experts in low risk and uncomplicated pregnancy and childbirth and we're very skilled in knowing when something is normal and when it's not. Our doctor colleagues are always there ready to become more involved when complications arise, really at any stage in the process and sometimes this may take the form of our midwives consulting with an MD and sometimes this might be the MD becoming the primary provider for a patient. 

We have a pretty nuanced guideline for how we collaborate in certain scenarios, but really at the heart of that collaboration is that you're always getting the benefit of both doctor and midwifery care.

I would say that one of the biggest strengths of our practice is that we're constantly getting together to review the latest research on common pregnancy issues, discuss how new research should influence our patient care and really bring the most up-to-date information to our conversations with patients. 

This helps us continually build and hone in on this collaborative model and with that collaborative relationship in a hospital setting, the nice thing is that you really are never going to risk out of midwifery care. Even if we're not the primary we can still be there by your side supporting you during your birth and postpartum period too.

Receiving the 2021 Maternity Honor Roll Award

Lee Burgess: So I heard that the Mission Bernal Women's Clinic was recently awarded the 2021 Maternity Honor Roll Award, which sounds really cool. But can you share more? I mean, that sounds like something I'd want to be awarded too.

Jodi Winemiller: Yeah. I would love to.

Lee Burgess: I know, right? So could you share a bit about what that means?

Jodi Winemiller: Absolutely. So it essentially means that we're recognized for our low NTSV cesarean rate. NTSV is a way of tracking cesarean rates as a marker of quality care, it essentially tracks cesarean rates for lower risk pregnancies. In order to qualify for that metric it includes being a first-time mom with a term pregnancy, also a singleton pregnancy, so not twins or triplets, and then the baby being head down in the pelvis as opposed to breach. That can help kind of get rid of some of the outliers for people who may be at baseline would really benefit from a C-section like complicated triplet pregnancies, things like that. 

Cal Hospital Compare and an organization called CMQCC, which is the California Maternity Quality Care Collaborative, they are two groups that track and publish maternity statistics for hospital groups and the goal in the last few years has been a C-section rate of less than 23.9%.

So hospital groups who participate in this Cal Hospital Compare program and meet those certain quality metrics are recognized through this honor roll award. Our practice C-section rate varies, it's usually somewhere between 19 and 21% each year and then the interesting thing is that CMQCC is moving their target and next year the target will be a C-section rate below 21%.

Which I think is very exciting and we're all looking forward to utilizing tools that help us universally meet that goal in the California hospital systems. I really recommend looking at the CMQCC and the Cal Hospital Compare websites if you're trying to decide what hospital to partner with for your birth.

Lee Burgess: Yeah. So what would be some of the drivers to push down those cesarean rates? You mentioned technology, is it better testing? Better confidence in how the pregnancy is going?

Jodi Winemiller: Yeah. So I think it's complicated, right?

Lee Burgess: I'm sure.

Jodi Winemiller: We're always essentially reviewing cases where there are cesareans, right? To see where we could have tweaked things, is there anything that we could have done to avoid the cesarean for this patient. 

CMQCC specifically has a lot of tool kits for best practices. Some of the things that I think are important are allowing a lot of time for labor, right? Not calling a failed labor, or what we call dystocia labor, that hasn't progressed...until you really have done everything possible to get that person to their target goal of having a vaginal birth within the context of safety for mom and baby. 

So I would say that's a big marker and things like fetal monitoring, right? We know that intermittent fetal monitoring decreases cesarean rates without increasing risks to moms and babies. So there's a whole kind of bundle of best practices that help hospitals and provider groups meet those targets.

Lee Burgess: I think it's got to be comforting knowing that you guys are always learning and stretching and growing and examining what's happened in the past to just provide a high level of care.

Jodi Winemiller: That's true. Always moving towards the goal of best care, best experience possible and I think one of the things that we pride ourselves on as a group too. By focusing on individual needs, even when somebody doesn't end up with the birth scenario that they envisioned...I think a lot of our patients come through the other side of that experience feeling like they had a really truly good experience. Because they were involved every step of the way in the decision making process for themselves, for their baby, for their family.

Lee Burgess: Yeah. Having had two births myself I think that's kind of one of the things you want, is to come out the other side and feel like you had some control over a situation that is just kind of uniquely primal in a lot of ways.

Jodi Winemiller: Absolutely, that's a good way to describe it. Uniquely primal, I love it.

How the Hospital is Becoming More “Baby Friendly”

Lee Burgess: So as you’re working with these metrics and tracking cesarean rates... I know that the hospital's also working towards being more Baby Friendly. So what does that mean? Is that different than some of these other birth targets?

Jodi Winemiller: Yeah, so “Baby Friendly” is a hospital certification program that was launched by the World Health Organization and UNICEF, and it's aimed at helping families successfully initiate and continue breastfeeding their babies. 

So the organization Baby Friendly USA gives special recognition or accreditation to hospitals that met their baby friendly benchmarks. Essentially it means that the hospital is taking additional steps to really help promote and support successful breastfeeding. 

So right now the nurses, doctors, midwives are all completing additional training that's centered around helping mothers and families initiate and maintain breastfeeding and also manage common difficulties, both in the hospital and postpartum. 

This includes prioritizing things like the golden hour and skin to skin after the baby is born on a hospital-wide level and also providing robust lactation support in the hospital and when you go home from the hospital. So something that we're all very excited about, it's something that's actually going to be a requirement for California hospitals in 2024.

 We're hoping to meet that goal much sooner, by the beginning of next year and we're well on the way in what we call our “Baby Friendly journey” which we're all very excited about. Yeah.

Lee Burgess: So you are a parent yourself.

Jodi Winemiller: Mm-hmm.


3 Things New and Expecting Families Should Know

Lee Burgess: Not just taking care of other parents and parents to be. So what would be three things you wish you could tell every kind of pregnant or expecting family?

Jodi Winemiller: So I pulled all the midwives in my practice for this question.

Lee Burgess: Oh, look at that. 

Jodi Winemiller: For many midwives, I would say it in my own words.

Lee Burgess: Okay.

Jodi Winemiller: But I think there are a few things that we would really like to share with people planning pregnancies or people who are new to their pregnancy journey. 

I think one is that pregnancy is a time to view your relationships through the lens of teamwork, whether that be with your partner, your family or your wider community. 

Secondly, I would say that even in its most straightforward iterations pregnancy birth and the postpartum period is always a true journey often with many unexpected twists and turns and it's important to stay flexible in your expectations of yourself and the process and to be kind to yourself within that. 

Then lastly, this is something that everybody said, stay hydrated and stretch often.

Lee Burgess: That is totally a midwife answer by the way. I like that. As we all should stay very hydrated. I have a very large bottle of water next to me while we're doing this recording. Well, that's great. 

How to Connect with the Mission Bernal Woman’s Clinic

Lee Burgess: Well, if people want to learn more about the Mission Bernal Women's Clinic, either for birth or for the other care that you offer in kind of the woman's life cycle how should they do that?

Jodi Winemiller: So you can find out more about us on the Sutter Mission Bernal Women's Clinic website. You could also connect with us on social media, Instagram and Facebook, and we'll respond to messages there with just general inquiries. 

We're also hosting a virtual webinar on November 9th where you can ask questions of myself and other providers and you can always call the clinic directly to schedule a consult or ask to speak with one of the midwives or doctors about the services we provide. We're very accessible.

Lee Burgess: Great. So if someone is kind of shopping around to learn more about their care, they can do a consult if they want to talk about birth options and what it would look like working with you guys?

Jodi Winemiller: Absolutely, we would love that.

Lee Burgess: Great. Well, thank you so much for taking time out of your busy day of taking care of other people to chat with us and thank you all for listening to this installment of the, It Takes a Village interview series by Natural resources. You can find this and additional information on our website at naturalresources-sf.com and we hope you'll learn more and support. We'll see you next time. Thank you so much, Jodi.

Jodi Winemiller: Thank you so much.

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