Jess K - Postpartum Doula

Jess Kimball is a birth and postpartum doula with a passion for supporting families throughout the pregnancy, birth, and postpartum journey. She shares her personal journey of becoming a doula at a young age and the experiences that shaped her career choice. Jess explains the role of a doula and the difference between a doula and a midwife. She emphasizes the importance of doula care in improving maternal and infant outcomes and discusses the challenges of insurance coverage for doula services.

You can find out more about Jess by following the links below:
Website
Instagram

Takeaways

• Jess Kimball became a doula at a young age and has been providing birth and postpartum support for seven years.
• A doula provides emotional, physical, and educational support throughout pregnancy, birth, and postpartum.
• Midwives and doulas have different roles, with midwives providing medical care and doulas offering non-medical support.
• Doula care can improve maternal and infant outcomes, but insurance coverage for doula services is limited.
• There is a need for greater recognition and support for doula care to ensure access for all families. Accessible and affordable doula care is crucial during the perinatal period.
• Insurance and employers should cover doula services to ensure accessibility.
• Midwifery care and comprehensive reproductive health education are essential.
• Mental health support is vital in reducing maternal mortality rates.
• Community support and advocacy play a significant role in improving maternal health outcomes.
• There is a need for reproductive law and public policy focused on maternal health.

Transcript

Chelsea (00:02)
Hello! Today I'm here with Jess. Jess, how are you? I'm doing okay. It's one of those days, but I'm doing okay. Jess, I'm so excited to have you. It's been a long time coming. Jess is a graduate of my alma mater, which has gone through a few identity crises over since I graduated, so...

Jess Kimball (00:05)
I'm great. How are you?

Chelsea (00:28)
When I was there, was Johnson State College. When you were there, it was Vermont.

Jess Kimball (00:33)
When I applied, it was transitioning. By the time that I attended, it was Vermont State University. And I just graduated in my final class wrapped up in July of 2024.

Chelsea (00:47)
That's so exciting. I stumbled upon a post that you were in from the college, specifically in relation to one of my favorite professors, Gina Moreau. And we'll get into it. But before I dive even further and

Jess Kimball (00:49)
Thank you.

Chelsea (01:11)
listeners you'll figure out why I'm so excited to have Jess on. Could you kind of introduce yourself a little bit and tell us a little bit about your background?

Jess Kimball (01:20)
Yeah, so I am a birth and postpartum doula. I've been doing that for coming up on seven years now, which I think is...

kind of something unique about the work that I do. I got into the field at a very young age. I didn't plan to go to college. I really wanted to focus just on dual work, but I found myself kind of signing up for more and more classes, becoming a lactation counselor, a postnatal fitness instructor, personal trainer, just kind of like each year taking on some new training. I did my PMHC through Postpartum Support International and that really shifted my focus.

think to psychology, mental health, more to the postpartum period. And that is kind of what led me attending Vermont State. I had signed up for a class at Community College of Vermont, just anatomy and physiology. I wanted to pursue my CPM, Certified Professional Midwifery License, in Vermont and New Hampshire. And you have to take anatomy and physiology to practice in New Hampshire.

I signed up for that and then everything just kind of like domino affected from there. Like it just kind of all fell into place where three years went by and I was like, okay, I'm wrapping up a bachelor's degree in psychology and what am I going to do next? And it's just been really wonderful.

Chelsea (02:44)
I think what also super impressed me was the amount of experience you have for someone who is so young. Like, and I want to, I want to dive into that too, because like, you don't meet many people.

in their late teens and early 20s who are as invested in the birth realm as you are. How did that come about?

Jess Kimball (03:15)
Yeah, I mean I will give away my age, I'm 23. I graduated high school when I was 16 and I was already certified as a doula and I think that's another weird kind of piece to it. I...

Chelsea (03:18)
Yeah.

Jess Kimball (03:26)
look back now as a 23 year old who has friends who are in their mid and late 20s who are at a more similar place in life where they're building a career and they're trying to kind of settle down a bit. And I'm proud of it, but it was a very odd experience as a teenager to be like, no, I really just want to focus on work. And everyone is almost like, why, what are you doing? And I'm like, can't go to that party this weekend. I'm on call for a birth. And they're like, what are you

talking about you're 15, 16 years I, was, was definitely made fun of and kind of picked apart by my peers just because it's like, well, you know, some teens are working, some teens are like super focused on their academics because they want to get into a good college. And what I was doing was this very like niche thing

there are other young people who are in the field and I see a shift kind of happening where more young people are getting into Dula work and midwifery education earlier on But at the time there wasn't really anyone at least not in my area that was doing what I was doing and was close in age to me So it was kind of this weird Experience, but I think I think it really goes back to how I grew up I'm one of seven kids

My older brother was born in the car accidentally on the way to the hospital. And then with me, my mom was induced because they wanted to avoid another car birth. And I was just very fascinated by these differences in each experience that she had. You would think that...

Chelsea (04:44)
my gosh.

Jess Kimball (05:00)
seven textbook pregnancies would be pretty similar in how they played out, but they were all just so different and her experiences were so unique. And I loved her openness and willingness to talk about those experiences and include each of the kids. With my younger brother, he was born at home. And that wasn't something I was super involved in. I look back and I'm like, I wish I was like the one that cut the umbilical cord. But my sister, my older sister was the one.

Chelsea (05:27)
Mmm.

Jess Kimball (05:29)
and probably because I was only like four years old and he was born at night I was asleep but I remember going to all the midwifery appointments I remember this incredible midwife I remember waking up the next morning and at first I guess I was five when he was born I remember my sister waking me up and she was like the baby's here there's a baby and I said

No, you're just trying to get me to go to school. I was not a morning person, even now. Still not a morning person. I was like, I'm not getting up. So I went back to bed. About an hour went by and I was like, why didn't anyone come get me for school? And I go in the other room and there's this little, well, he's actually the biggest out of all of us, this chunky redheaded baby.

Chelsea (05:58)
Yeah, me either.

Jess Kimball (06:13)
and my mom resting and we all went and made her breakfast in bed and were there like sitting beside her throughout the weeks to come and it was just like, it felt so natural and normal and I don't think that's the experience a lot of people have with birth or welcoming a sibling into their family.

I went through lot of shifts throughout my childhood of like, maybe I'll be a teacher because I love working with kids or

I don't know, maybe I'll just be a mom one day. Like I went through that kind of phase of like, well, I just want to be a mom. And then when I was 11 or 12 years old, I remember my mom saying, I think that you should be a midwife. I think that you should look at what a midwife is. And I started researching it and I had this whole like plan of like, I'm going to marry a doctor and have eight kids. like my whole life was like mapped out of like, this is what I want it to look like when I'm, when I'm an adult, because I loved growing up in a big family. Like I,

enjoyed it so much. So I thought, okay, well when I'm an adult, I'm gonna have a bunch of kids and we're gonna live in a house with a nice big yard so all the kids can play outside. I wanted my kids to have the wonderful childhood that I had. And then when looking into Midwifery, I was like, okay, this is really interesting. And being a slightly overly ambitious 11 year old, I was already like the neighborhood babysitter and had like a website for my babysitting business.

and ride my bike around the neighborhood. I was like, what do I do from here at 11, 12 years And by age 15, I was assisting at a newborn photography studio, super interested in birth photography, got my license and was like, I can drive. Why not start doing this now? I had done a semester at the high school in my town, but had transitioned to an online program in order to

Chelsea (07:42)
my gosh.

Jess Kimball (08:10)
to graduate early and to have some more flexibility in my schedule. So I was already working and doing high school and decided why not be on call for photographing a birth. And I went to that birth and there was a doula there and there were...

There was a service dog, were midwives, it was in a birth center, which was pretty uncommon for the Carolinas. That's where I lived in South Carolina at the time, but on the Charlotte border. And CPMs can't practice in North Carolina, but they can in the surrounding states, Virginia, Tennessee, Georgia, South Carolina. So there's just like a very interesting culture around home birth and natural birth in the Carolinas. But we had a nurse midwifery practice that

unfortunately shut down just because of funding reasons about two, three years after I attended that birth but it was really cool for me to be able to have this experience of midwives in a birth center in Charlotte, North Carolina with a service dog and a doula and this really just amazing powerful mom who was really determined to have a natural birth and did the photography and then

the birth wrapped up in the evening and because I had just gotten my license I wasn't allowed to drive after dark so we were trying to figure out okay is my mom gonna come pick me up from the birth or how am I getting home? The Doula, we had been in contact on Facebook already and kind of talking about I had nannied for her a little bit and she just kind of like a point of contact to talk about like

Chelsea (09:30)
no.

Jess Kimball (09:46)
midwifery goals, birth work, that sort of thing. She was like, I'm just gonna drive you home. I'll drive you home and let's just talk about kind what you're wanting to do. She was like, you know, midwifery's great.

But if you're going to go the nurse midwifery route, you're going to be in school for a long time because you need to get your masters. And that's a big investment financially and time wise if it's not actually what you want to do. So she really recommended becoming a doula first. And there was something about that experience of being at that birth and talking to her where it just felt like everything in the universe had lined up perfectly for me to be exactly where I was supposed to be and know exactly what I was supposed to do.

Chelsea (10:10)
Mm

Jess Kimball (10:27)
with my life. And there was still this piece of me that was like, okay, I'll do this for a couple years. And then the goal is still that I'm going to start a family and have a homestead one day and like focus on I think that pursuing a career is great, but I think that I want to stay home and raise a family.

And then I really got into doula work and it just kind of took off in a way that I wasn't expecting. I was given a lot of opportunities I know who have been doing this for over 20 years didn't have. And it felt like this was my purpose and the most fulfilling thing I could do with my And yeah, it's just kind of like...

and gone from there.

Chelsea (11:12)
It's rare to sort of find that feeling of of purpose when you're in your teens. When I was in my teens, I can tell you I 100 % had no idea what I was going to be doing with my life. what a cool way to sort come about it like.

you're right, it is this little like domino effect. I kinda liked babysitting and then I kinda was into photography and then I went to this birth and then I met with this doula and that's, it's, I don't, yeah, it's the universe being like, hey Jess, you might wanna check this out. That's so So for listeners who may be new, we've talked about this a little bit on the show before,

But can you explain what a doula is and the difference between a doula and a midwife?

Jess Kimball (12:05)
I can. I get this question often. Not so much when I was in Vermont. I think there was more of an understanding. But now that I'm back in a rural part of North Carolina, most people don't know what I'm saying when I say doula. They're like, what was that word?

Chelsea (12:14)
Yeah.

Are you too young for Gilmore Girls? Did you ever watch Gilmore Girls? Okay, how they named the baby Dula. That's just what I think.

Jess Kimball (12:26)
No, I've seen every episode. Yeah.

And there's still that idea around like, are doula's just this thing for like home birth parents who want to encapsulate their placenta and like do a lotus birth and not cut the umbilical cord and like that kind of thing, like giving birth out in the woods. And you know, I have been to some births that were like that, but I've also been to a lot of births that were in the hospital, got the epidural.

Chelsea (12:41)
Yeah.

Jess Kimball (12:58)
were induced, a c -section even, like I've seen the whole kind of spectrum of how it can go. But I think the basic definition of what a doula does is it's someone who provides emotional, physical, and educational support throughout pregnancy, birth, and postpartum.

It's kind of grown from there. There are death doulas who focus on people who are at the end of their life and kind of like in hospice and the death doula might like do some funeral planning, end of life planning and be there to like provide...

care for the person who's getting ready to pass and kind of hold space for them and their family. That's not the type of dual work that I do. I do some bereavement work around miscarriage and pregnancy loss and stillbirth. But other than that, it's really focused on bringing life into the world. And that could even be fertility support.

if a family is trying to conceive and struggling with that and kind of being there to answer their questions, go along to appointments with a fertility specialist, provide nutritional support because I do have additional trainings as a nutrition consultant. I kind of pull that piece in there too. But my care with families...

It could be attending a birth and providing support throughout the pregnancy, like really getting to know the family and their goals, and then supporting the birth by doing, like counter pressure, showing their partner how to do counter pressure so that they can be active at the birth. A lot of times the partner wants to be active but might not know how, so I'm there to guide that or step in if they need to step out for a minute, or if they don't have a partner, then I'm that person that's able to offer support. and it could be

Chelsea (14:35)
Mm -hmm.

Jess Kimball (14:44)
just like if they're really in the zone, they're laboring, the contractions are really powerful, and a new nurse comes in because a shift change happened, I can kind go over and be like, hey, here's kind of where my client's at. We want to keep the lights low. We're trying to keep the room pretty quiet. Here's their birth plan. You know, if something comes up and there's an emergency, we're prepared to adapt for that. But this is kind of what we're.

Chelsea (14:55)
Mm.

Jess Kimball (15:10)
hoping what we're aiming for with this experience. Instead of my client having to like...

Chelsea (15:13)
Yeah.

Jess Kimball (15:16)
feel like they need to stop whatever they're doing mid -contraction and educate this person who just came in the room on what their goals are and advocate for themselves. I'm not making decisions for my client or pushing a certain narrative. My goal is just to kind of ease the experience by being someone who can speak up for them. That birth plan we come up with oftentimes changes. No one knows

what that experience is going to be like and how you're going to react until you're in it. And it can even differ from one baby to the next. So I provide a very flexible, meet you where you're at type of care. I don't have strong bias on natural versus medicated birth. I really, I want to talk to the family and get to know them and figure out what their ideal experience would be and try to support that.

Chelsea (15:51)
Mm -hmm.

Jess Kimball (16:13)
And then the big thing I do is postpartum care. So I do overnight support. It's usually for anywhere from three to 12 weeks postpartum. I'm there overnight taking care of the baby. A lot of people assume...

Chelsea (16:22)
my god.

Jess Kimball (16:28)
because I'm there with the baby that maybe the parents are just sleeping through the whole night but oftentimes that's not the case. Sometimes it's a mom who had a c -section and they really just aren't in a place where they can be up walking around at night. It's dark, they might have stairs in their house and it's just hard to like to get around so I'm there to bring the baby to them to nurse if they want to or maybe they're pumping. I go and put the milk away, clean the pump parts, bring them back so they're able to just get as much rest as possible. So I'm kind of doing those in -between tasks.

And most of the babies I work with end up sleeping through the night pretty quickly. And I think it's because there's this low stress environment and there's someone whose job is just to respond to babies' cues and less of that kind of, I don't know what I'm doing, I'm stressed out, the baby's crying overnight, hectic.

experience that so many parents find themselves in. So I'm kind of there to educate them on what I'm noticing with their baby, how I'm responding to their cues so that they can take whatever I've learned and implement it during the day and on nights that I'm not there. And I definitely, see a huge difference in how the babies are on the nights that I'm there versus when I'm not. And it's not because I'm doing this like special thing where

Chelsea (17:23)
Yeah.

Jess Kimball (17:47)
I'm just so, so great with babies that they just magically fall asleep when I'm there. I think it's that they feed off of their parents' stress. And when I arrive and I'm able to say, like, okay, you can go take a shower or rest, I'm gonna handle all the bottles that are in the sink and prep something for you to eat. And I'm gonna hold your baby for you if that's what you need me to do. They just kind of...

Chelsea (17:49)
Hahaha

Mm.

Jess Kimball (18:11)
relax and the baby relaxes and the night seems to go a lot better and I think a lot of people view it as this luxury of which it is in our country it is a luxury to have a doula but I think it goes back to this whole thing of like it takes a village and we're supposed to be supporting each other and in so many cultures when someone has a baby all of the women in the community gather to support that mother

Chelsea (18:12)
Yeah.

Yeah.

Jess Kimball (18:39)
and it's not even about just like here I'll hold your baby so you can take a shower sometimes it's I'll do everything else that needs to be done in your house so you can feel comfortable just holding your baby I'm not here to take your baby and I'm not childcare so whatever it is that the mother needs I'm there to kind of step there is this

Chelsea (18:50)
Yeah.

Jess Kimball (19:00)
confusion that a lot of people have between a doula and a midwife. I get this very often. People ask me what I do for work. I tell them and they say, so you're a midwife. I'm like, no, if I was a midwife, I would have said I'm a midwife. I do work at a midwifery school. So I think that also throws people for a loop because they're like, what does she do exactly? But I'm not a midwife there. I work in the admissions and outreach.

Chelsea (19:11)
No.

Yeah.

I'm

Jess Kimball (19:26)
so I'm more of like the admin in behind the scenes. But in the US we have two types of midwives. have certified professional midwives and certified nurse midwives. CPMs can practice less than 40 states currently, but it's changing. There's a big push to kind of increase where they can practice. They can practice.

in the home birth setting in any state where they can legally practice and in some states where they can legally practice they can practice in a birth center. Vermont is interesting because Vermont doesn't allow freestanding birth centers so they can't practice there because we can't have them but New Hampshire there are freestanding birth centers so someone could be licensed in both states and go and practice in.

in a birth center. Depending on the state, that'll determine kind of what their scope is. Some CPMs are responsible for lot of like newborn health care for the first eight weeks of life. That's kind of the standard in Maine. And then that care gets switched over to a pediatrician. But states like New Hampshire, they're not really doing as much of the pediatric kind of.

basic newborn healthcare, they do the initial newborn exam but then that switches to a pediatrician pretty quickly. So it's interesting, each state kind of determines the scope differently versus a nurse midwife where we have national standards they can practice in every single state. Depending on the state's laws that'll determine kind of how they practice because again Vermont can't have free standing birth centers so even though...

Chelsea (20:55)
Right.

Jess Kimball (20:57)
A nurse midwife should be able to practice in one. We don't have them in Vermont, so they just can't do that. A nurse midwife goes through nursing school and has a master's in nurse midwifery, and they can prescribe medication like birth control. It's a little more medical. It's an RN, a BSN.

and then the masters of nurse midwifery. So they've gone through all of this nursing training before they even get into the midwifery education. While a professional midwife just does midwifery education and that's their complete focus. And that includes well -person care. So they might be doing someone's you know, yearly checkup. They might be providing some kind of counseling on fertility and

Chelsea (21:41)
Yeah.

Jess Kimball (21:46)
just basically productive health. So it's not just, you don't just see a midwife for pregnancy and birth. And that's kind of a misconception in the US too, is that we go to OBGYNs for like birth control and pap smears and all of that. But in other countries, they typically go to a midwife. And what we're kind of seeing is that

If we switch to that model of care worldwide, if everyone who is low risk went to a midwife for pregnancy, and that could be in a hospital, could be a medicated birth, it doesn't have to be birth center or home birth, but if everyone went to a midwife for pregnancy or for their basic reproductive health needs, the maternal mortality rate would decline by up to 83%. That's what the World Health Organization has reported. So we

that we see these great benefits of midwifery care but our country has this very medicalized outlook on birth and people typically go to an OBGYN. So I think there's kind of when looking at doulas versus midwives versus OBs I kind of like put it on this spectrum of like a doula is the non -medical provider at this end who offers support and then we kind of get into like CPMs, CNMs and then OBs are kind of towards the other end of that spectrum for the type of care.

and level of care that they're providing.

Chelsea (23:07)
that was a beautiful explanation. That was super detailed.

It's really, really interesting to hear you talk about the different levels of care and what's being done in other countries. I am in Vermont. did. So I went to a midwifery center, but it's not a birthing center. So I would go and I would see midwives for all of my checks.

but I had to birth in the hospital. and the midwives were there. The midwives, ultimately, actually, I think it was an OB because I had a C -section the second time, but yeah, so it just, depends on where you are. And, reiterating a lot of the things that you said, we are one of, well, we are,

We, our statistics are the worst for any developed nation in terms of maternal mortality and infant mortality. And it's ridiculous. But yes, other developed nations and, and otherwise, like you bring a baby into the world and the mother or the birthing person is just enveloped in care. And that's not happening here. And that's

Jess Kimball (24:23)
Mm

Chelsea (24:27)
what I find so beautiful about doulas. And I didn't even know. I mean, again, I'm going to go back to that, that Gilmore Girls reference. Like my only understanding of a doula was Gilmore Girls. And it was Luke's hippie sister had a doula and then thought it was a cool name and named her baby doula. So even when I was going through

Jess Kimball (24:47)
I think.

Chelsea (24:55)
having my own children. was like, I didn't even know. I didn't even know that was a thing. At this point in the country, correct me if I'm wrong, insurance does not cover it, which is another reason a lot of people associate it as kind of like this luxury, like almost bougie wonder what your thoughts are on that.

Jess Kimball (25:18)
Yeah, it's really interesting because you get people who think it is like this hippie kind of thing and that's what the media kind of shows anytime a duel is mentioned in some kind of... Like even the show Virgin River that's on Netflix, that's... Yeah, it's a show that my mom and I both loved watching and it's one those good Netflix shows that it's a little bit...

Chelsea (25:35)
I haven't seen that one.

You

Yeah.

Jess Kimball (25:45)
over the top dramatic, but it's a good show. It's based on a book series, I think, but there's someone who was giving birth to twins and she's like, you know, want to have a home birth and I want a doula. And everyone's like, but this doula this home birth stuff, like just give birth in the hospital. And there's this idea that it's safer. But I did see this post recently from an ER doctor that was like, why do we have this idea that the hospital is safe? If you don't need to go to the hospital, you shouldn't go to the hospital.

Chelsea (26:13)
Yeah.

Jess Kimball (26:13)
There's like people here like you really want to and they weren't talking about births specifically they were talking more about people who just like go to the ER for things that Maybe you didn't need to go to the ER for But there is this kind of like idea in America that when you're not feeling well like just a little bit sick or something's off you go to the hospital and that can be Dangerous because you could end up more sick by going there

But yeah, insurance doesn't cover doula services and I think the birth doula stuff is viewed as this hippie -dippie kind of...

Western medicine type of thing and then postpartum doulas because of the overnight care It's viewed kind of as like a night nanny or a baby nurse which we can't call ourselves baby nurses because we're not nurses and But that's the way a lot of people understand what a postpartum doula does if they're doing nighttime care And that's viewed as this huge luxury like I just get to hand my baby to someone and go to sleep But there's misconceptions around like what the care actually looks like did have one client

Chelsea (26:57)
Alright.

Jess Kimball (27:15)
who has bipolar and had an experience being catatonic at one point in their lifetime and having just a really severe mental health history. And when talking to her doctor, she really wanted overnight support and they wrote a prescription for doula care.

Chelsea (27:36)
wow!

Jess Kimball (27:37)
build the insurance for my services, but the insurance only reimbursed 13%. So when we're getting up to like $15 ,000 in 13 % isn't that much. But the only reason they could do that was because of how severe her mental health history was in the risk of her experiencing psychosis postpartum. And we know from all the research that sleep is one of the biggest preventative measures we can

Chelsea (27:42)
Ugh.

No.

Jess Kimball (28:03)
So that was a unique situation where insurance covered some of it. In North Carolina, Medicaid is very different than what it is in Vermont. are different Medicaids through different insurers, like Blue Cross Blue Shield has Medicaid, UnitedHealthcare has Medicaid, versus in Vermont where we have Green Mountain Care, and that's the Medicaid, and the policies that are kind of set for that are the same.

Chelsea (28:24)
Yeah.

Jess Kimball (28:29)
throughout the whole state because it's just the one Medicaid. So North Carolina's been kind of interesting. UnitedHealthcare is doing reimbursement for doula services, but it's a very lengthy process to get in network with them and it's hard to get a hold of anyone. So that one has kind of been just...

not going well for a lot of people. And then Healthy Blue Medicaid, they're choosing one doula per region of North Carolina. So I ended up having a partnership with Blue Cross Blue Shield and did a free

Blue Cross Blue Shield has community centers all throughout the US and there are centers where you can go and sign up for insurance but you can also just go and receive services for free if you're a member of the community and they're not allowed to offer you insurance unless you say like, hey I'd like to talk to you about signing up for Blue Cross. So you go in there and you can go to any class that they have or event they have going on and you're not going to get bombarded with this like, hey come switch to Blue Cross. they're really interesting these centers a lot of people don't know what they're

Chelsea (29:02)
Yeah.

Jess Kimball (29:26)
for, the one that I have in my community has a fresh produce stand where you can go and just get fresh produce, whatever you need. Usually people aren't even taking it so they end up throwing a lot of it away. So I really encourage people to go and check out these centers and see what they have. They have different classes and

Chelsea (29:34)
wow.

Yeah.

Jess Kimball (29:45)
one near me does like bingo, yoga, like all different little things throughout the week. But they paid me to do a class there for, it was a perinatal support group, so we did pregnancy and postpartum, and used resources from UNC Chapel Hill's fourth trimester project to kind of provide some curriculum and structure on what the education would be. A lot of it was just people asking questions and me being able to answer them, but I used like the safe sleep.

Chelsea (29:57)
Mm

Jess Kimball (30:12)
guide that they have, the postpartum plan, their little booklet on, it's called Healthy Mom Healthy Baby, but it's a free resource. They'll ship anywhere in the country to anyone who wants to get these resources out. But they were kind of way to educate people on like, well, what are the warning signs of pregnancy and postpartum? When do you call your doctor? When do you schedule a follow -up appointment? When do you go to the ER or call 911? Like, kind of what to watch out for. They have resources on.

for partners, so on how to be a supportive partner throughout pregnancy and postpartum, but also like what to watch out for, how to care for the baby.

those sorts of things. So this was kind of a way for me to offer something that was not individual care, it was a group, but it was a small group and I had a lot of time to just talk to each person that was there and provide them with support. So it was more of just the educational and emotional piece of the support, but it was a way where I could make it free for the community. And we have this really awesome bakery called Stick Boy that is incredible. If anyone ever comes to Boone, is the place.

to check out, but they catered the event for free. So we would get together in the morning and eat really, really good food and talk about pregnancy and birth and whatever was going on. sometimes I'd have a guest speaker come. Sometimes I would have some kind of demonstration I was doing, like how to swaddle the baby, how to your baby. Sometimes it was more of just like a check -in where I'd give out some of the resources, but we would just kind of see where it went naturally. So I've found some unique ways to

Chelsea (31:23)
my gosh.

Jess Kimball (31:49)
try to get insurance involved or get care to be free. I am a network with Healthy Blue, so Medicaid, that's another type of Medicaid in North Carolina, people who have that. I do a sliding scale and

I can, I accept a lower rate for birth support and just accept what the insurance pays so they don't have to pay a difference or anything like that. But so far, most of the families in North Carolina have United Medicaid and I haven't met too many families that have Healthy Blue. So I'm in network, I can accept that insurance, not much has happened with that. I will say,

Chelsea (32:23)
Yeah.

Jess Kimball (32:30)
employers who are covering each doula services. So one of the big ones is carrot fertility. It's a don't know too much about what exactly they do, but I know a lot of work remotely for them. And then Maven, that's a clinic that my mom actually works for as a doula. does postpartum planning, but they have doulas on staff, lactation consultants,

Chelsea (32:40)
Yeah, I haven't heard of them.

Jess Kimball (32:54)
all different providers. think they also have like midwives and nurses so people can receive telehealth through Maven. So I know some employers are signing up with Maven and then their staff gets the services from Maven for free. carrot is something different. They do support with fertility but what they're doing is their staff is receiving reimbursement for doula services as a benefit.

Chelsea (33:02)
Yeah.

Jess Kimball (33:20)
I know a few people in North Carolina who work for Carat and have received a check from them to pay for doula services and were able to receive birth support and quite a few hours of postpartum care. So that's been really awesome to see and I think it's a great investment for employers to make because that support leads to their staff coming back at the end of their maternity leave and not needing a maternity leave extension. So it is a good return on investment for them.

Chelsea (33:36)
Yeah.

Yeah, absolutely. So many things that you said, I'm so glad you talked about. So one in particular, when you were talking about Blue Cross Blue Shield, I have Blue Cross Blue Shield and did not know about that. I I knew that they had a benefit where I basically had a nurse assigned to me when I was pregnant and she still calls me every once in a while and my youngest is two.

So I knew I had that, but I didn't know about these centers. I didn't know about the education. didn't know. And what I think is so important about that, we've talked about this on the podcast as well too, is that...

There, there is a certain level of privilege that you have to sort of acknowledge in the birthing world. And the care that you receive is going to differ based on your demographics. And that is absolutely horrible and absolutely disgusting. But knowing that this is a service that is free. If I'm understanding correctly, you can go to this, to this place, whether you have Blue Cross Blue Shield or not, and receive education.

throughout your pregnancy and

Jess Kimball (35:00)
on the center. This was something that we, it was the first time it was offered in North Carolina, so I kind of piloted it because the area of North Carolina I'm in is starting to be considered a maternity care desert. We just lost our lactation services at the hospital in Watauga County, which is where Boone is, which is really interesting because we have Appalachian State College there. There are a lot of,

Chelsea (35:01)
Yeah.

Okay.

Okay.

Yeah.

Jess Kimball (35:27)
really career oriented people who are highly educated and understand the benefits of these services. It's very different than my experience being in like the upper valley of Vermont and New Hampshire where we have Dartmouth and that kind of having such a highly educated population that's that kind of pushes what we're seeing offered in the community and to be in a different college town with very highly educated professors and doctors and

to those services just kind of go away and nobody really saying too much about it. It's been interesting. So one of the things that Blue Cross did was this group as kind of a way to fill the gap and see if that kind of, yeah, fill that gap. yeah.

Chelsea (35:55)
Yeah.

sort of alter the it sounds what an impact that made. think what that also highlights and what a lot of parents and new parents, especially first time parents, is you don't know where to look. you don't, because you don't know what you're looking for.

A lot of us are, well, I guess I'm not a first time parent anymore, it's just like, yeah, you get pregnant, you go to the hospital, you have a baby and you figure it out. But actually looking into what resources are available to you, even if it means you have to travel a little bit. I know of a lot of places that will also let you can bring your kids with you if you have other But getting that education is

so crucial. And by education, I mean everything from what you're experiencing during pregnancy and what you can expect postpartum. And I love that you incorporate partners and what to look out for.

but like, where did mental health come into all of this and how did that kind of, where did that domino get set up?

Jess Kimball (37:13)
I think, you know, I connect this back to something you were just saying about like, of the demographics that we see. And I think, I want to point out really quick just that I don't think that people should...

If I'm offering a service that's free to the community, I understand that there could be some harm in that with, you know, we have a maternal mortality rate that's three to four times higher for people of color. And same with our infant mortality rate. And that's just looking at the maternal mortality portion of that. We know for every single experience in pregnancy, the outcomes are worse for people of color in the U .S.

Chelsea (37:48)
Mm

Jess Kimball (37:49)
And I don't want someone to feel like they have to use my services just because they exist. But what I will say is I think that doulas are a really good starting point. Where if someone wanted to reach out to the Blue Cross Community Center in Vermont and start a similar group. And there were people of color in the community who were like, I don't really feel comfortable having a white doula. I want a doula who like me and understands my experience.

that doula might know someone. So you might not need to use that service, but it can just be a good starting point. So if someone's kind of like, don't want to attend the group, I still recommend reaching out. I think that part of the reason I recommend that is because I think

Chelsea (38:16)
Right.

Jess Kimball (38:31)
In the US, we're given a burden of advocating for ourselves as women, especially, but that burden increases in pregnancy. So you were saying you didn't know about some of the resources that exist.

Chelsea (38:41)
Mm -hmm.

Jess Kimball (38:46)
I did some research and Blue Cross differs state to state, but Vermont will, Blue Cross will reimburse for childbirth education classes, they'll reimburse for a perinatal fitness class. So if you go into some kind of workout class, you can get reimbursed for that. That differs state to state. So,

Chelsea (39:02)
Mm

Jess Kimball (39:03)
I think having a doula is really great because they can kind of advocate for you and let you know what exists outside of, you know, like the basic things you know about in your community. But we're given this burden of like, I to advocate for myself at appointments. I have to do all of this research. And I've gone through a lot of experiences in my life I struggled with my mental health and I...

had a really great community to lean on, but I had to really be an advocate for myself. And I looked at that situation and was like, okay, why did this go the way it did? Why did I process my trauma in the way that I did and recover and kind of experience that post -traumatic growth instead of...

I mean, I experienced the post -traumatic stress as well, why did I grow from it while other people are so stuck? And I look at the community I have, and I think that's such a key piece to it. And then while completing my degree in psychology, so much of the research says that what determines if we experience a trauma versus just like...

Chelsea (39:48)
Yeah.

Jess Kimball (40:07)
That was a really big event in my life, but I didn't experience the emotional response of it being a trauma. That's determined by the community we have. So I looked at that and the experiences I had growing up, and it just made sense that when someone has a baby, we support them.

Chelsea (40:16)
Mm -hmm.

Jess Kimball (40:25)
And then as I kind of educated myself some more, I learned that behavioral issues, that's the second leading cause of maternal mortality in the US. And 80 % of maternal mortality, when we say maternal mortality, 80 % of those deaths are happening in our community postpartum. They're not happening in the hospital. People hear maternal mortality and they think someone, you dies while...

Chelsea (40:50)
Like died in childbirth. Yeah.

Jess Kimball (40:51)
during childbirth while they're actively in labor or giving birth and that's not what's happening. It's like we send them home with a seven pound baby in a seven pound car seat. We say don't lift more than ten pounds but I'm gonna hand you fourteen to carry around all week. And then we wonder why someone's hemorrhaging or why they're stressed out and exhausted and reach this point where

Chelsea (41:07)
Yep.

Jess Kimball (41:18)
They're just so overwhelmed and the hormonal shifts that are happening, it's just too much. We already have a mental health crisis in the US and then you throw in all of the factors of postpartum isolation, hormonal changes, all of it. I think that it's just something.

Chelsea (41:28)
Yes.

Jess Kimball (41:38)
that my own experiences with mental health and my experiences growing up really just created this kind of passion and concern around mental health. And then just working as a doula and the things that I've seen, it just kind of went from there.

Chelsea (41:53)
I think that's been one of the hardest things for me in this and doing this is that I've always been a mental health advocate. I mean, I have my own mental health challenges anyway. It sounds like maybe we can relate to on this a little bit, but like narrowing it in in the perinatal field.

feels almost like like I can I can at least make an impact here. Like I can't change the whole system. I wish I could. And I will still fight for all mental health rights and advocacy. But at least right now, like this, this seems to be where I feel called and it seems to be where you feel called as well.

Jess Kimball (42:39)
Yeah, and I do find myself kind of in this interesting place of that shifting a little bit. I got accepted to Vermont Law School, so I'll be attending their restorative justice program this fall. And then I'd like to eventually move into the JD, depending on LSAT scores and how everything goes, what life throws at me. But my hope is to practice as a lawyer and to focus on reproductive law. And I would like to also work in public policy, focused on maternal health policy.

Chelsea (42:50)
wow

Yeah!

Jess Kimball (43:10)
I have this kind of outlook and I think because of the research I've read recently in the classes I've taken at Vermont State, but we see that good mental health outcomes for, I'm going to say mother, but birthing parent, but if we're looking at like the nuclear family, good mental health outcomes for the mother impacts the mental health outcomes of the father and the children throughout their whole life. just wrote, my final paper was on

Chelsea (43:23)
Yeah.

Yeah.

Jess Kimball (43:36)
how experiencing trauma while you're pregnant, how that impacts that infant for the rest of their life. And I wanted to look at that, not just how does it impact the mother. I think, you know, the birthing parent is at the center of it. We need to take care of that person because they're responsible for so much in that family dynamic. And if we care for that one person, it's going to have this kind of butterfly effect. But it was interesting to write this paper and look at, well, how has the infant impacted? And I think...

Chelsea (43:41)
Yeah.

Jess Kimball (44:03)
I look at it as if I support one family and improve their outcome, that impacts their children, their relationship, because the biggest risk of divorce happening is in the first year of the first child's life. So it impacts their relationship and the foundation for their family. It impacts their children, which then will impact their children. And it has this butterfly effect of like, well, I talked to one person and supported one person, but really it helped more people.

Chelsea (44:24)
Mm -hmm.

Jess Kimball (44:32)
So I try to look at it as that, but I also remind myself that if it even just helps one person, that's enough for me. But I do hope to go on to do even more and kind of, I don't know, the fiery passion that I have around mental health and maternal healthcare and right to choose where you give birth and how you give birth and how your pregnancy goes and...

Chelsea (44:40)
Yeah.

Mm

Jess Kimball (44:59)
when and how you get pregnant. All of that makes me want to do just a little bit more and kind of work in policy and law.

Chelsea (45:09)
I love it. I am even more excited talking to you now and knowing this. I was excited to begin with because what you're doing is incredibly powerful and impactful. again, I think maybe it's becoming more common and you're probably a better judge of that than I am, but like...

To see someone so passionate about this in your stage of life gives me hope.

that this will continue and to hear you say that you really want to go into law and that you want to go into policy making it's like yes please we need you we need you we need your voice we and it all goes back to advocating and it all goes back to it does tie back into being a doula you are advocating for for mothers and birthing people who may not be able to advocate for themselves in the moment

So I'm so excited for you. I'm gonna be, I mean, I'm gonna be following along. I think it's There's so much more that I could get into and that we could dive into, but I think to kind of bring us full circle, I would...

Jess Kimball (46:13)
Thank you.

Chelsea (46:32)
love to get well before I even get into that I want to reiterate to listeners just what Jess has been saying over and over again like this may seem like something that is hippie -dippy or it may seem like something that's a luxury or it may seem just look into it all it takes is just looking into it and I and I really really really hope that

I see before my children, both of my girls and I hope that if and when they choose to have children that it's a norm. Like doula care is a norm and midwifery is a norm and it's not this crazy mysterious thing. So step one, just look into it. Just get on Google and doula's in my area.

Jess Kimball (47:12)
Thank

Shop around if you're looking for a doula. Shop around, ask questions. There are doulas who...

don't provide the same style of care that I provide and are a little more like, nope, I only attend home birth. Then there's people who are really focused on navigating the hospital system and that's their area of expertise. And if you have concerns around what your experience in the hospital is going to be like and navigating all of that, they're the doula for you. It's not like a, you know, you don't have to just pick the first one you come across like Google, like interview them, get to know them. It's a very intimate.

Chelsea (47:53)
Yeah.

Ha ha ha ha!

Jess Kimball (48:03)
form of care during a very vulnerable time and I think people deserve someone that they feel aligned with and someone that feels safe to them.

Chelsea (48:12)
Absolutely. And what a difference it will make in the postpartum period and the perinatal period, just all around. so this is a question I haven't got to ask for a while. And so I'm excited to ask it. If you could envision the perfect scenario, so you are planning what

maternal health care and mental health care looks like for I mean, I will focus on here in the US. If you could if you could do an overhaul, what would be the main things that you would say? Yep, this is what we need. This is what we need for maternal care.

Jess Kimball (48:53)
It's interesting because there's so many layers to it. I think I'm like a base level.

Chelsea (48:58)
I know.

Jess Kimball (49:03)
it would be that we have either insurance or some kind of funding that covers doula services. So insurance or state grants, like some kind of funding where it's just covered. Anyone can get a doula. I don't think it should be assigned by the practice that you're going to because I think that people need to have choice because it is such an intimate form of care. And they might choose not to have one. So leaving that option kind of open.

Chelsea (49:12)
Mm -hmm.

Jess Kimball (49:28)
I would love if in the US I remember when I was...

I like 13. I went to an OBGYN for the first time because I had irregular periods. I was put on birth control real quick because I got my period for three months straight and it didn't stop. And they said, well, you you're not anemic, but that is an inconvenience. So we'll just put you on birth control to regulate it. And then any appointment I had after that was with this, this older man and we're in the South and it's kinda, it was just kinda weird. Like it just made me, felt like I couldn't really talk about what I was going through.

Chelsea (49:44)
Mm.

Ugh... Ugh... Yeah...

Jess Kimball (50:02)
And I think that there are a lot of people who go to an OBGYN or midwifery practice for the first time when they are like 13 years old. And we're seeing that be even younger because children get their period so early in the U .S. So I would like to see midwives be the first person that someone sees they're kind of entering stages of puberty and need guidance on that.

Chelsea (50:15)
Mm -hmm.

Jess Kimball (50:29)
I think that should be normalized, just midwives for pregnancy and birth, but midwives for just basic reproductive health And then from there, midwives for low risk birth. And I think that one of the things that needs to be done is to educate the community. That doesn't mean that everyone has to have a natural birth or an unmedicated birth.

Chelsea (50:44)
Yes.

Right?

Jess Kimball (50:52)
Midwives can deliver in a hospital. Nurse midwives can deliver in hospital. And if you deliver in a hospital, you can still get an epidural. It's just you have a midwife who, the way that I explain it, you had said that midwives are the baby catchers. And the only reason I stopped using that is because I had a dad who caught every baby in the hospital.

Chelsea (51:00)
yeah.

Jess Kimball (51:12)
in the hospital, he caught the baby. The providers let him. It was very important to him that he caught the baby. he got to catch the baby. And I've had moms that, know, birthing people who catch their own baby. But midwives are trained in how pregnancy looks and acts and how birth looks and acts while an OB is trained in how to get a baby out. So OBs kind of operate from this state of urgency.

which is why we see a lot of pitocin being given, a lot of interventions, because they're trying to get the baby out. That's their background. So I think people should see a nurse midwife if they're low risk. And then if there is urgency, a midwife can do a lot of the interventions. They cannot do a C -section. So if we reach that level of urgency and it becomes an emergency, then...

you're in a hospital, there's an OB on staff on call, they're ready to go. They can do the C -section if it's needed. If they know that the pregnancy is high risk, you're already seeing a maternal fetal medicine doctor and an OB. That should be the standard for high risk. But in a low risk pregnancy, the best outcomes happen when a nurse midwife is the provider.

So I think shifting to that, where when you first see a reproductive health care provider, you're seeing a midwife. And we kind of move along that spectrum based on how your health moves on that spectrum.

Chelsea (52:31)
Mm

I agree with you a hundred percent. I don't like to, I don't know if that's true. I'll have to go back and listen. was going to say, I don't like to give my opinion. I try not to give my opinion. But I agree a hundred percent. And if it is an emergency and if it is high risk, then that's one thing. But if it is low risk...

it really is taking a more holistic approach. Treat the treat the person, not the condition necessarily.

Jess Kimball (53:00)
Exactly. I think, you know, I'm keeping my vision simple because that to me is like, we could see that one day. And then we look at what happens and we go from there. And if that happens in the next 10 years, I might say, okay, well now here's what I think we need to do to make this even better. But that's kind of my, like, if we could just get there and provide individualized care.

Chelsea (53:07)
Yeah.

Yeah.

Great!

Hahaha

Jess Kimball (53:27)
whole human care. Let's look at the person as a whole. Let's get to know them. Midwives have longer appointments, so there's more time to ask questions, to really get to know the provider. I think if my dream, if I could like, would be that the provider that you see in your pregnancy is the provider who is there at the birth.

Chelsea (53:29)
Mm -hmm.

Yeah. yeah, dream.

Jess Kimball (53:49)
but we don't really see that anymore. see a lot of big practices where you see multiple providers, unless you're working with like a CPM where you know that person's on call for your birth. I don't think that that's something we'll get back to just because that's a lot of time on call and the risk of burnout becomes so high, but I was very impressed. One of my closest friends, I met her after she had her baby and

Chelsea (53:49)
Yeah.

Yeah.

Jess Kimball (54:11)
She gave birth at a hospital in our, I live outside of Boone in a very small mountain town, and she gave birth at the hospital in our town, and she goes to a private practice doctor who, their whole thing is like a new take on modern medicine. So you pay $45 a month, they don't bill your insurance, you just pay $45 a month, and that covers any healthcare you need. Any appointments, therapy, anything. The provider she saw there,

Chelsea (54:34)
Wow.

Jess Kimball (54:40)
They did bill her insurance for the birth, but that provider that she saw was on call. So when she went to this hospital that this person isn't even affiliated with, they were able to call this provider and she came from home and delivered her son. So that was really interesting to me because we don't really see that anymore. And if we're not going to see that, then I think we just need to educate families more on like...

Chelsea (54:54)
wow.

Yeah.

Jess Kimball (55:05)
this is the person you're seeing, these are the providers you're seeing throughout your pregnancy, but there's a chance that none of these providers will even be there the day that you give birth. And let's just talk through that and mentally prepare for that instead of people kind of going into it, this idea of like, well I saw these four providers at this practice, one of them will be there and...

Chelsea (55:25)
it's the whole continuity of care thing. Like, yeah, I love it. Well, I don't mean this in any sort of condescending way at all. I am so impressed with, I just, I am, I'm so impressed with you, with your drive. Obviously, it's important to me because it's in an area that I care so much about, but just in general, to all.

Jess Kimball (55:36)
Thank you.

Chelsea (55:51)
to anyone that says that our younger generation is not motivated, I would argue Jess as a perfect example here. And it's not just Jess. I have a sister and a brother who are literally encompassing you. And one is just a tiny bit younger and one is just a tiny bit older. And they are some of the most driven people that I know and they want to make change. And we need you. We need you guys. we do. And,

Jess Kimball (56:15)
Thank you.

Chelsea (56:16)
Listeners, just check out your options. Look at your options. And if you can't be an advocate for yourself, find someone who can advocate for your needs and your wants. Jess, where can my listeners find you if they want to learn more about you?

Jess Kimball (56:35)
I would say my website is jess -kimble .com

Chelsea (56:37)
Okay.

Awesome. That will be in my show notes so that they can find you. I'm excited to see where you go from here. If you're back up in Vermont, I would love to, I can't do coffee, but I'd love to sit down for some sort of baked treat or something. my gosh. I love it.

Jess Kimball (56:47)
Thank you.

Absolutely, yeah, I'll be back up there eventually. Vermont still has a big piece of my heart.

Chelsea (57:05)
Yeah, I'm not going anywhere. But thank you so much for coming on and thank you for the work that you're doing. yeah, just excited for you.

Jess Kimball (57:16)
Thank you. It was great chatting with you.