Birth By Us

An app that empowers Black women through birth – while giving health professionals insights to reduce preventable maternal deaths and complications.

Alycia is a 37-year-old Black woman who had just given birth to her baby boy, Adam. After being sent home from a C-section, she started to feel exhausted to the point where she could not even feed Adam. Scared, she contacted her provider but was told that her symptoms were due to her age and nothing else. Three days later, Alycia collapsed on her kitchen floor and entered into a 4-week coma due to a pregnancy-related complication. 

Unfortunately, as we listened to Alycia’s story in conducting our user research, we knew it wasn't unique. With rising maternal mortality rates triple those of any other developed nation, the United States today is clearly plagued by disparate birth outcomes (Taylor et al., 2022). At the same time, these rates are not equal, as they disproportionately affect women and birthing people of color, specifically Black people who are currently 3-4 times more likely to die in childbirth compared to their White counterparts often due to missed signs and routine dismissal from their providers (CDC, 2021). Additionally, as there are approximately 14 million Black women of reproductive age in the U.S., this is an issue affecting many (March of Dimes, 2022).

From statistics like this, combined with the fact that 84% of maternal deaths were deemed preventable as seen in data reported from Maternal Mortality Review Committees (multidisciplinary committees tasked with reviewing the circumstances surrounding each maternal death) it is clear that the U.S. healthcare system is failing its patients, especially Black women (CDC, 2022). 

As pre-medical Black women, we knew something needed to change, and that if they didn’t, we may fall prey to the very issues we aim to solve. Committed to centering the voices of key stakeholders, we began by listening. From August 2021 to June 2022, we conducted focus groups and individual interviews with over 120 stakeholders, including but not limited to Black women and birthing people, their partners, doulas, midwives, obstetricians, quality improvement experts, and academic researchers. 

In this research, a common pattern emerged: Black women and expectant parents like Alycia feel disempowered and fearful in their pregnancy and postpartum journeys, like they do not have the necessary resources to achieve an optimal perinatal outcome for themselves and their families. At the same time, we found that maternal care providers are aware of the statistics and want to effect change, but feel that they lack the critical insights and effective strategies they should implement to help eradicate this crisis.

Birth By Us (BBU) provides comprehensive check-ins at sequential points in pregnancy and postpartum through our research-focused quality questionnaires, which assess users’ vaginal, mental, sleep, and overall health; and evaluate users’ experiences with their care providers. Upon completion of each questionnaire, our app analyzes and uncovers users' top concerns, yielding tailored visit preparation and recommended culturally responsive resources. We do this because while research shows that patient-provider racial concordance is associated with improved patient perceptions of care, we recognize that finding a Black provider isn’t always possible so resources like ours can bridge the gap (Saha et al., 1999). Users will also be able to create their own birthing plan, which is critical in improving patient agency over their birthing experience. 

We also recognize that providing high-quality patient care isn’t easy, as we heard in our focus groups with maternal care providers, many citing lack of time and patient feedback as key obstacles on the road to improvement. Due to this, BBU supplies its users with shareable week-to-week health progress sheets capturing trends in users’ health data, which can be easily uploaded to electronic health portals and discussed at care appointments, saving crucial time. In addition, Birth By Us will take the guesswork out of improvement for maternal care providers by turning patients’ feedback collected in our questionnaires into comprehensive, routine quality reports placed side-by-side with valuable resources to help providers make impactful changes. 

Finally, we know that change is needed on a systems level as well because although researchers have found that it is racism, not race, driving health disparities, many still want to know what tangible changes they need to make to improve care. The BBU system will uniquely break down patient feedback to uncover facets of care related to implicit and unconscious bias among other holistic metrics.

Our target population is Black women in the US currently in the reproductive age range of 16-45. The maternal health market currently fails Black women resulting in persistent disparities during their pregnancy, birth, and postpartum period. 

For instance:

• Black women are three to four times more likely to die in childbirth than white women — regardless of education, income, or any other socioeconomic factors.

• 84% of maternal deaths are preventable and Black women are more likely to experience them

• The risk of postpartum depression is 1.6 times higher for Black women

• Black women experience physical "weathering" due to chronic stress, thus making postpartum recovery longer and riskier at an earlier age

We believe technology can provide sustainable and expedited avenues toward solving two crucial pieces of the Black maternal health crisis: implicit bias recognition and patient education dissemination. This is exactly where Birth By Us comes in. We aim to create a new vision for Black maternal health and to be known as the pregnancy, birth, and postpartum app for Black women and their families by innovatively introducing technology with payoffs for both parents and providers, combining data analytics with robust resources to help everyone achieve their best possible outcome.

We believe Birth By Us will positively impact parents’ lives by equipping birthing people with the tools and knowledge needed to be their health advocates and achieve their best birthing experience, contributing at large to a reduction in maternal health disparities. Additionally, Birth By Us helps partners by allowing them to take a more active role in the communal process of birth, understanding their birthing partner’s body and transitions, all while learning how to best support their own physical and mental well-being through curated resources. Finally, Birth By Us will aid providers in serving their patients with the best quality care by highlighting key areas of improvement along with best practices to continue.

We envision a world in which high-quality perinatal care is the standard for all parents, which is exactly why we are developing Birth By Us. By beginning with Black women and later expanding horizontally to serve other underserved communities, we hope to tackle this problem from the ground up. Black women have been historically left behind in innovative pursuits, but no longer. We are claiming our power and building something by us, for us – Birth By Us.

Mercy Oladipo is a co-founder of Birth By Us and a 4th-year undergraduate pre-med student at MIT studying computer science and molecular biology. She is an advocate for safe birthing practices with a passion for Black maternal health and is experienced in Python, SQL, project management, and website design. Additionally, she has previous experience in health informatics and public health research, and front-end engineering at MIT CSAIL, Tufts University Maternal Outcomes for Translational Health Equity Research Laboratory, and Willow Innovations, which will help in the necessary data analytics for our product. Linkedin: https://www.linkedin.com/in/me... 

Ijeoma Uche is a co-founder of Birth By Us and a 2nd-year pre-med graduate student at UC Berkeley pursuing a Masters in Public Health with a focus in Maternal, Child, and Adolescent Health. Prior, she spent her time at Brown University researching disparities in maternal health and is thrilled for the growth digital healthcare can bring to reproductive health. She also has specific expertise in R, biostatistics, and three years of experience in health informatics. Linkedin: https://www.linkedin.com/in/ij... 

Medical Advisory Board: 

Last year, we began to build our medical advisory board, including Dr. Chiamaka Onwuzurike, MD, MPH, an OB/GYN at Brigham and Women’s Hospital in Boston; and Dr. Kia Lannaman, MD, an OB/GYN and founder of Accessible Professionals, a network of health, education and legal professionals providing trustworthy information to support families online. As we grow, we plan to expand this board to include more key stakeholders and field experts such as Dr. Karen Sheffield- Abdullah PhD, RN, a CNM and professor at the University of Carolina School of Nursing, with whom we are already in communication.

Interns: 

Christina Kim (MIT Class of 2024) - UI/UX Design, Gabriel Sumayan Garcia (UC Berkeley Class of 2022) - Research and Resource Collection, Paola Gutierrez (UC Berkeley MBA Candidate Class of 2024)- Marketing and Business Development, and Easha Narayanan (UC Berkeley Class of 2026)- Business Development. 

Mentors:

We are mentored by Alexandra Manick and Ammar Ammar through MIT Sandbox; Lucas DiLeo and Sheryl Greenberg through MIT Venture Mentoring Service; Dr. Vanessa Nicholson through Tufts’ Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab; Dr. Jaspal Sandhu and Dr. Lindsay Parham through UC Berkeley Wallace Center for Maternal, Child, and Adolescent Health; and Dr. Jeff Rideout through UC Berkeley’s MPH and MBA program. They will help us with advice in areas of product and business and as we continue to fundraise and develop our model.

To date, we have spoken to over 120 stakeholders, sourcing critical feedback on our processes, implementation plans, and designs. Stakeholders include birthing people, doulas, obstetricians and midwives, nurses, partners, academic researchers, and quality improvement experts. 

To name a few: Dr. Elliot Main – Medical Director of the California Maternal Quality Care Collaborative, Dr. Monica McLemore – Tenured Associate Professor in the Family Health Care Nursing Department at UCSF, Dr. Ndidiamaka Amutah-Onukagha – Julia Okoro Professor of Black Maternal Health at Tufts University, Dr. Elizabeth Howell – Chair of the Department of Obstetrics & Gynecology at the Perelman School of Medicine, University of Pennsylvania Health System, and Dr. Jeff Rideout – CEO of the Integrated Healthcare Association.

Through these interviews, we gained insight into how to bridge the gap between providers’ care and patients’ reality. These insights along with the four years of qualitative research Ijeoma (co-founder of BBU) conducted at Brown University Women and Infants Hospital and birthing centers near UC Berkeley, we identified three core issues that resulted in our current product. We believe building a product with the community is the best way to create a solution best suited to improve maternal health disparities. Therefore we are committed to continuing to connect with the Black community for consistent feedback as we continue to refine our product. 

In addition, Mercy (co-founder of BBU) worked for 1.5 years as a research assistant in Tufts University’s MOTHER Lab, where she collaborated across product, marketing, and research to raise awareness and investigate black maternal health disparities. Secondly, as a product and engineering intern for Willow Innovations last summer, she led the digital product team in expanding diversity efforts and conceptualized new features with a focus on Black mothers.

Through our focus groups with Black parents, we found that many used apps during their pregnancy journeys, but were left unsatisfied by the resources offered through current solutions.

Pregnancy and Motherhood Apps: Ovia Pregnancy and BabyCenter Pregnancy Tracker are among the top pregnancy apps in the U.S. as reported by Forbes Health (Berger, 2022). Both include resources that track menstrual cycles, monitor babies’ growth, and help answer pregnancy questions. However, their efforts are not directed to address or find contributing factors to the maternal health crisis that disproportionately affects people of color. Ovia also excludes access to the provider and clinical-based resources. 

Integrated Care Delivery Platforms: Platforms like Mahmee are built with the goal to serve Black communities by connecting mothers to all of the providers they may need along their journey (obstetrician, pediatrician, lactation consultant, etc.). But to gain access to a dedicated care team and high-quality support, users must pay $149 per month, a price that is out of reach for many expectant parents. 

Provider Directory Platforms: Irth and HealthinHerHue also stand out as players in this space, aiming to serve the Black community by providing a directory of culturally-responsive healthcare providers. However, these platforms have struggled to make their directories as robust as necessary and so provider options are slim in size and scope. 

Community-Based Organizations: Outside of these products, current efforts to eradicate disparities in maternal health are largely focused on working towards large-scale policy changes or the creation of community-based/grassroots organizations supplying maternal care. For example, the Maternal Outcomes for Translational Health Equity (MOTHER) Lab at Tufts’ University hosts a free Black Maternal Health Conference each year, allowing all stakeholders to come together for a day of intentional reflection and education. In addition, the National Birth Equity Collaborative continues to be a strong advocate for birth equity, supporting maternal health equity research through their Birth Equity Scholars program and working towards advancing legislative policy changes in collaboration with the Black Maternal Health Caucus. 

We acknowledge that these efforts have pushed the issue in the right direction, but at the same time maternal mortality rates continue to rise and while the Black women we spoke to cited being more aware of these disparities now, many still feel that they do not have tangible support to help them along their specific journeys, which is exactly what a systematized consumer-facing app can provide. Further, unlike the current alternatives, our app will be able to reach underserved communities and give them the imperative patient education, support, and healthcare access necessary to achieve better birthing outcomes.   

For the next year, our key milestones are: (1) create a high-functioning web-based app, (2) conduct our first pilot with a minimum of 500 Medicaid Black patients in March 2022, (3) build an advisory board with experienced maternal health professionals and experienced industry mentors, (4) pitch to medical groups and hospital systems with the goal of obtaining letters of intent to confirm our business model, (5) develop and release the mobile app version of Birth By Us on Apple and Google app stores, with the goal of achieving 56,000 downloads; We hope to utilize the resources and support obtained through the SOLVE Challenge to achieve this goal. 

To ensure the project produces a meaningful impact, we will do rounds of testing and are keeping the app free to improve access. As a patient education tool, our product aids providers and produces reports that can be easily uploaded to existing systems rather than making them learn a new piece of technology. One consideration of this is that providers have limited time in appointments with each patient. Our app aids this rather than adding burden because its tailored visit preparation helps guide the conversation ensuring that top concerns are addressed. In this way, we are confident that our product will positively impact the lives of Black birthing people along their perinatal journeys. In fact, we already launched our waiting list and have 160 potential users in line, writing things like “Excited to have access! This will be extremely helpful!” and “Finally! Something for us! Excited to see what there is to offer”.

After completing customer discovery on our own and with support from MIT NSF I-Corps Spark, we already created the beta version of Birth By Us for a 4-week beta testing period and will be rolling out the product in a free 6-month alpha launch in late February. As we onboard users, we will be assessing our product on our ability to meet specific quality metrics outlined below: 

• Improve overall patient satisfaction with their perinatal experience as measured through our custom quality questionnaires. 

• Increase user intention and follow through of exclusively breastfeeding 

• Increase users’ care/appointment compliance

• Increase the number of users seeking timely medical care following a flagged warning sign and decrease the incidence of complications overtime on a per-user basis

All metrics will be compared to the average state rate to determine the significance of our impact.

Our solution relies on technology as we are creating an integrated mobile application. In this app, we will have custom benchmark questionnaires that the user takes in order to evaluate the quality of their pregnancy journey (how are they feeling – mentally, emotionally, physically –, have they experienced any adverse outcomes, etc.) as well as the quality of care that their provider is giving them. These answers will inform the insights we give providers along the way while allowing us to track and analyze patterns in user experience, and recommend them correct modules and resources to help them improve their experience in real-time. 

We leverage technology in our solution by placing these questionnaires with digital resources on every aspect of the pregnancy continuum all to be accessed from any device.

Currently, in the United States, there are approximately 14 million Black women between the ages of reproductive age and 561,000 Black or African American births each year. This presents a huge opportunity for impact and scale as we continue to grow our solution. We plan to serve 10% (~ 56,000 Black women and birthing people) of the current population in the next year. We currently have a waitlist of over 160 potential users from running two weeks' worth of low-budget ads on meta. We believe with a strong marketing strategy, we will be able to reach our target audience and obtain 10% of the current market share.

One potential challenge in our implementation is the concern around data privacy and HIPAA compliance. We are proactively avoiding this by working with the MIT/BU Startup Law Clinic to draft privacy and data-use agreements that are reflective of our needs and values. Additionally, we will not share anything without explicit user consent as they have to select which pieces of their data to share and with whom. Users also have the option to compile their insights into a PDF which they can freely share.

Another concern is that providers will not change their behavior even with our insights and recommendations. However, we are piloting with provider groups at the administration level so they can enforce standards of care throughout their system. We will also work closely with doulas and community-based birthing centers to connect with our users.

We are currently partnering with the UC Berkeley Wallace Center for Maternal Child and Adolescent Health, a multidisciplinary research and training center consisting of UC Berkeley faculty, staff, and students that aim to advance the health of parents, adolescents, and children with technology, innovation, and community engagement. The Wallace Center aims to harness innovative technologies as a means of reducing maternal and child health inequities and diminishing the digital divide between those with ready access to the health benefits of technology and those who do not. 

In this partnership, we are connecting maternity care providers and researchers in northern California to continue to refine our application to best serve our users. Through this collaboration, we are also engaging with ACOG (who produces practice guidelines for health care professionals and educational materials for patients, provides practice management and career support, facilitates programs and initiatives to improve women’s health, and advocates for members and patients) and conducting an IRB study in which we are surveying maternity healthcare providers and payers in order to establish a digital platform that will help all maternity clinicians successfully fulfill patients' needs.

From our customer interviews both with maternal care providers and birthing people, we have discovered that our biggest value propositions lie in three main areas. Firstly, we are quantifying and measuring provider progress on factors associated with health equity, which has never been done before and provides an opportunity for hospital systems and birthing centers to show actionable commitment to change. Secondly, we provide tailored visit preparation based on users’ answers to our questionnaire, highlighting main concerns to bring up to their provider. This also aids providers by saving them time on patient education and ensures that both parties' concerns are addressed given the limited-time nature of hospital appointments. Thirdly, we offer birthing people the opportunity to provide feedback to their provider. Many hospitals do not have formal systems for patient feedback and every birthing person we talked to said that they wish they had a platform that would have allowed them to give anonymous feedback during their pregnancy journeys. 

After conducting interviews with our potential customers, we derived three revenue streams: in-app subscriptions for parents, white labeling for healthcare providers, and contracts with health plans/insurance groups. 

Our in-app subscription will be a freemium model priced at $4.99 per month or $29.99 per year. We believe parents will be able to benefit from our application by achieving early detection of pregnancy complications, reducing healthcare costs, at-home health tracking between appointments and up to one year postpartum, and learning from our curated resources specific to the Black birthing experience. 

White labeling will be offered to hospitals, physician groups, and birthing centers at a price of $150 per patient. With our service, they will be able to have at-home patient monitoring, reduce unnecessary medical visits, decrease operational costs, improve patient communication, medical adherence, and continuity of care,  as well as optimize time spent with patients to increase practice efficiency. 

Lastly, for health plans/ insurance groups, we believe our application will be able to increase prenatal and postpartum visits among Black birthing people and achieve early detection for pregnancy and postpartum complications which will also result in a reduced rate of C-section rates for low-risk and high-risk pregnancies. We will position this option for our third year of operations because we will need a substantial amount of data to secure an insurance contract. Due to the fact that 3.3 million Black women are covered by Medicaid, it is our primary healthcare plan of choice. Medicaid has already shown interest in investing in digital health platforms (like Birth By Us) that are created to serve the needs of underrepresented communities.

Through a subscription model, we plan to sell our application by first using a  B2C model for a fee for service then directly to a B2B2C model where we will be white labeling our app to hospitals and birthing clinics so that all patients can have full access to our resources free of charge. In the near future, we will be expanding our B2B2C model and directing our efforts to obtain contracts with health plans or insurance groups. In the meantime, we are applying for grants and seeking angel investments to sustain our current operational costs and begin our HIPAA compliance requirements. Further, we plan to expand our application to serve other underserved populations that suffer similar maternal health disadvantages (eg. Hispanic [866,000 birth/yr] and American Indian or Alaska Native communities [27,000 birth/yr]) to increase our market share and global impact.