Expect: OB-GYN approved pre and postnatal fitness

We launched Expect because American women today are more likely to die from pregnancy-related causes than their grandmothers. Maternal mortality has jumped 89% in just 3 years, the worst rate since 1965. A million plus more women suffer pregnancy complications from C-sections to complications.

We launched Expect because every day, almost 1,000 women die of preventable pregnancy and childbirth-related causes, and for every death, 30 experience unnecessary complications.

Proposed solutions such as increasing the number of healthcare workers are commendable and ultimately, necessary. However, these solutions can be time-consuming and costly. Prenatal fitness is one way we can rewrite this story now without further burdening our overworked healthcare providers. 

A groundswell of research now proves that prenatal fitness drastically reduces the complications that are driving our poor maternal health outcomes such as gestational diabetes, pregnancy-related high blood pressure and premature births.  Babies benefit with better brain development, stronger hearts, and lower rates of diabetes into adulthood.

Prenatal fitness is so powerful that in 2015 the American College of Obstetrics and Gynecologists (ACOG) reversed years of medical warnings and recommended women exercise at least 150 minutes a week in the pre and postnatal period.  The World Health Organization echoes this recommendation. 

Prenatal fitness requires special modifications for safety such as modifying balance exercises that challenge a woman’s changing center of gravity or newly lax joints, and limiting time spent lying on the back as this can reduce blood flow to the baby. The leading fitness brands, however, ignore and under serve this market. 

Expect Fitness offers a cost-effective and scientifically proven intervention that can improve outcomes for mothers and babies today: as the only maternal fitness platform approved by OB-GYNs that women can access via smartphones.

Expect is the only prenatal fitness company that requires OB-GYN approvals for each workout. This is crucial because safety concerns are the primary barrier to prenatal fitness. 

Expect is the only fitness company led by seasoned content creators. Founder Cook spent 22 years at MTV and was Head Creative of the MTV Video Music Awards, a and producer on TRL, and had the creative insight to bring the aesthetics of music videos to fitness. Our Chief Fitness Officer, Jillian Ternosky, is an Emmy-winner.

Expect is the only prenatal fitness company with a business-to-business model of selling to insurers rather than directly to end-users, which is a more sustainable and scalable approach. This provides Expect with two significant benefits over direct-to-consumer apps: it reduces acquisition costs and churn, as these insurers provide steady cohorts of moms. 

Expect has earned a coveted clinical study with the University of Alabama at Birmingham (UAB) due to our unique platform. UAB has an Exercise in Pregnancy gym, but found that women who lacked transportation, childcare, and work flexibility could not access it. They needed an accessible and equitable solution and loved that Expect, unlike other platforms, embraces racial diversity. Black women over-index on life-threatening maternal complications and have the most to gain seeing themselves represented in prenatal fitness content. 

Given the shortage of visually engaging, diverse, and doctor-approved fitness options, Expect has an opportunity to shape and dominate the maternal fitness landscape.

We have learned from our partners that the equity and access embedded in Expect sets it apart from other solutions.  

Expect operates on a SaaS Enterprise model, selling into various paying customers:

1. Employer wellness plans

2. Health insurance companies

3. Medicaid-state by state

4. Providers

5. Life insurance companies

The first four customer segments have a common goal of reducing healthcare spending, particularly related to women of childbearing age who are 270% more expensive to insure due to the cost of pregnancy-related complications. Expect mitigates this risk, making it an attractive solution for these customers. These enterprises cover Expect subscriptions for their members, as maternal fitness has been shown to drastically reduce the risk of costly pre and postnatal complications such as preterm births and C-sections, thereby making Expect's value proposition clear. Priced at $360 per person for a subscription, Expect's prenatal exercise solutions can result in cost savings of up to $3K per patient, as per the Society of Maternal-Fetal Medicine. 

Employer wellness plans present a unique opportunity for Expect due to lower barriers to entry compared to health insurance companies. In addition to cost savings, corporate wellness plans have other motivations to offer Expect to employees. In our customer discovery interviews, global benefits directors have highlighted that maternal wellness benefits boost employee satisfaction, increase productivity, improve Gallup engagement survey scores, and reduce postpartum depression, which can negatively impact productivity and absenteeism. With the ongoing tight labor market for women, employers are particularly interested in providing benefits to female employees, especially when they become new moms and are more likely to exit the workforce. 

Given that over 40 percent of US births are covered by Medicaid, Medicaid is a key target for Expect. In our many Techstars mentor meetings, we learned that Medicaid has been aggressively innovating and in particular funding maternal health initiatives to improve our abysmal health outcomes. Expect’s study with University of Alabama at Birmingham is a pathway for Medicaid coverage in the state of Alabama as its Exercise in Pregnancy Clinic is currently covered by Medicaid, and we can build upon that success to expand to other states.

Providers in value based arrangements also recommend Expect to their pregnant patients, adding to the customer base. 

Finally, life insurers, particularly in the United States, where maternal mortality rates are the highest among developed countries, are interested in reducing maternal mortality payouts, and Expect can help address this concern.

After dominating the U.S. market, Expect will then expand internationally into English-speaking countries with high population and health insurance growth along with strong content production capabilities, and including India and Nigeria.

 Expect's end users are expectant moms who are seeking to improve their health and the health of their babies through engaging, OB-GYN approved prenatal fitness. As doctors increasingly recommend exercise during pregnancy, Expect is the only OB-GYN approved solution available to meet this demand.

Expect Fitness is a black woman and LGBTQ+ founded and led company.

Dara Cook, the Founder and CEO of Expect, brings over 20 years of experience creating world-class content and businesses from her career at MTV. Named one of the Most Influential Minorities in Cable, Cook was Head Creative of the Video Music Awards, producer on TRL with Carson Daly, and Senior Vice President who launched MTV’s podcast and touring businesses.

Cook graduated cum laude from the Wharton School of the University of Pennsylvania and was the first black Joseph Wharton and Ben Franklin Scholar in the University's history. After winning grant funding for Expect through Wharton's Entrepreneurship Acceleration Program, Cook went on to complete the General Management Program at Harvard Business School, where her presentation for Expect won the strategy competition. Cook also serves as a Trustee of the Helene Fuld College of Nursing in Harlem. Cook regularly engages with moms, community health leaders and doulas in her capacity as a member of both the Northern Manhattan Perinatal Partnership and the Wellville community.

Cofounder and CTO Joseph Pacheco graduated magna cum laude in Philosophy & Computer Science. Pacheco has worked with seven startups as full-time software engineer, technical cofounder, product manager and designer.  Joseph graduated magna cum laude from the University of Pennsylvania with a BA in Philosophy & Computer Science.

Chief Fitness Officer, Jillian Ternosky, won an Emmy for her work with MSG and was the Head of Production for ClassPass.

Lead advisor Rachel Villanueva is the immediate President of the National Medical Association, the largest and oldest national organization representing African American physicians and their patients in the U.S.

Special advisor Dr. I-Min Lee, is a professor at Harvard Medical School, world renown thought leader of physical activity and co-author of landmark studies on prenatal fitness impact on gestational diabetes & preeclampsia.

Expect has earned a coveted clinical study with top medical academic center University of Alabama at Birmingham (UAB), and won this study because of our unique platform. The results will be published in a medical journal. Despite having a pregnancy-focused gym, UAB found that women who lack transportation, childcare, and work flexibility can’t access it. They needed an equitable solution that could reach everyone, anywhere and Expect fills this need. 

Expect also has secured the following:

• Upcoming Trial with Penn Medicine's Helen O. Dickens Center for Women's Health. The majority of the women the Helen O. Dickens Center serves are Medicaid recipients. The Expect founders are delighted to partner with their alma mater to bring Expect to women in the West Philadelphia community. This partnership with Penn Medicine was facilitated by Expect advisory board member and University of Pennsylvania OB-GYN Dr. Helen Ryles.

• Trial with Philadelphia’s Womb.ish, to help doulas keep expectant and new moms accountable to fitness goals by accessing our app. Doulas are critical partners in maternal health, as they encourage women to exercise and stay healthy during their pregnancies.

• Upcoming trial with the Department of Health and Human Services’s Healthy Start program in various cities throughout the country.

• Trial with New York City Department of Health’s Public Health Action Center in Brooklyn.

• Expect opened the March of Dimes’s largest March for Babies walk last year with a special warm up to prepare walkers for their journey.

Deploying maternal health solutions involves many different partners, including healthcare organizations and providers, community leaders, and the mothers themselves. Expect Fitness, as a social enterprise focused on pre and postnatal fitness, would benefit from the Solve Global Challenge in several ways.

Firstly, the Solve Global Challenge provides a platform for Expect Fitness to showcase our innovative approach to maternal health and fitness. By participating in the challenge, Expect would have the opportunity to connect with healthcare organizations, providers, and community leaders who are also working towards improving maternal health outcomes. This could lead to partnerships and collaborations that would help to scale our impact.

Secondly, the Solve Global Challenge offers a platform for thought leadership, where Expect can contribute to the conversation on maternal health and fitness. By sharing our experiences and insights with other participants, Expect Fitness can help to elevate maternal fitness to its rightful place as a necessary part of our approaches to solve our maternal health crisis. 

Finally, winning the Solve Global Challenge would provide Expect Fitness with funding and resources that we need to scale our programs and reach more women.

Expect's direct competitors are streaming video apps that offer prenatal and postnatal fitness. These include Peloton, Obe Fitness, Juna, The Bloom Method, The Sculpt Society Mama, Glo, Knocked-Up Fitness, The Bump Method, Baby2Body, and Every Mother. However, none of these competitors have workouts approved by OB-GYNs.

Founder Dara Cook conducted extensive research on existing prenatal fitness apps and found that women often question the safety of exercises and whether professionals have reviewed the routines. For example, one user wrote in an App Store review of the competitive fitness app Baby2Body, "[W]ho creates these workouts? One had a lot of bridge exercises so I was on my back for a long time and there were reclined twists which can be unsafe. I hope they have certified instructors creating these workouts because women are trusting you." Expect's layer of OB-GYN approvals mitigates these concerns.

In addition, Expect is the only maternal fitness company that prioritizes diversity of talent and exercise type to reflect all women and their varied preferences. For instance, Peloton has only 87 prenatal videos out of 10,000, all of them are yoga/stretching, and none feature Black or Asian women.

Furthermore, some of the other fitness solutions, such as Juna, have low production quality, which drives down engagement. Expect's high production value and diverse talent and exercise type are critical differentiators from these direct competitors.

The stakes of the status quo in maternal health are high and rising: the U.S. maternal mortality rate jumped 89% in the pandemic. 

When we zoom in, the maternal health map reveals a reason for this reality. Over a third of U.S. counties are maternal care deserts, lacking OB-GYNs and birthing hospitals. As a result, many women go without prenatal care, and complicated cases are often untreated. The long-term trends of hospital closures and a declining number of doctors and nurses in the workforce are a warning sign that our already poor maternal health outcomes are likely to get worse.

This is why Expect’s initiatives, such as our clinical study with the University of Alabama at Birmingham (UAB), are so significant. UAB is an oasis within our healthcare desert. Named the top five OB-GYN department in America, UAB cares for women and babies far beyond Birmingham, including rural Alabama and neighboring Mississippi. UAB is eager to work with Expect because we solve a critical problem: our doctor-approved maternal fitness platform can improve outcomes outside of the hospital.

In a country where the people and places that can treat complex cases are in short supply, one of our only avenues to simplify cases is through prevention. Exercising safely during pregnancy, with a platform designed to engage all mothers, is one of our most effective ways to save and improve lives now.

The long-term impact for women who survive pregnancy related complications is devastating. A recent study led by a researcher at the Perelman School of Medicine at the University of Pennsylvania found that these complications lead to higher risk of death as long as 50 years later.  

Expect’s vision is to make a population-level impact and solve the maternal health crisis with our most underutilized, actionable weapon: fitness. Given the dearth of engaging, doctor-approved, inclusive solutions, Expect can create and dominate the maternal fitness landscape and save and improve lives now.

Reduction in maternal mortality ratio in communities in which we operate

Reduction in rate of gestational diabetes in communities in which we operate

Reduction in rate of preeclampsia in communities in which we operate

Reduction in rate of premature births in communities in which we operate

Our theory of change emerges from our deep beliefs about pregnancy:  that we women are at our strongest when we are pregnant, so strong we can shepherd another life into the world. However, many women feel powerless during pregnancy, at the mercy of healthcare professionals and complex healthcare systems.

Expect believes the most profound change emerges from our locus of control: ourselves. We should be the ultimate experts and executors of our bodies, and we all have the responsibility to provide our most vulnerable with the tools to exercise this unalienable right.

Streaming video for broad access

Expect is diversity. We were founded by a Black woman, and our leadership team is LGBTQ+.  Our OB-GYN board is racially diverse, and our content is inclusive of race, gender, sexual orientation, and women of varying physical abilities. We also empower women crew members, with women leading production and taking the helm of Director of Photography. We are proud to be a diverse and inclusive company, and we are committed to creating a better world for all women.

Expect sells into employer-sponsored health plans, providers and health insurance to cover the $20 a month subscriptions for their women members, or $360 in total for the full 18-month pre and postnatal period. Peer reviewed studies prove that prenatal fitness interventions save insurers $3,000 per woman, making the return on Expect clear. Incentivized by the reduction in costly complications that maternal fitness delivers, our enterprise partners funnel steady cohorts of moms to Expect. 

Most entrants in maternal fitness are direct to consumer, a business model which suffers from dual pressures–high acquisition costs per member and high inherent churn, as the pre and postnatal periods are finite and the average American woman has two children–explaining the lack of sophisticated prenatal fitness apps in the marketplace. In the Expect model, however, enterprises who are motivated by the high costs of maternal complications, market Expect to the women in their ecosystem. Expect’s innovative business model enables us to sustain and scale.

To achieve profitability, the key factor on the revenue side is to acquire enterprise clients with low acquisition costs. Fortunately, Expect's CEO Dara Cook has a sales background and was able to secure the company's first major institutional client, the University of Alabama at Birmingham's Exercise in Pregnancy Clinic, from a cold email she sent on a Friday evening. Her first job out of Wharton was as an Account Executive for a Softbank-owned media company and Cook leveraged this early business-to-business sales experience to personally close this trial. As Expect's Head of Sales, she is enthusiastic about continuing in this role.

On the cost side, Expect's focus on the pre and postnatal periods helps to reduce content production budgets. We can repeatedly share our content with new groups of mothers, maximizing its impact and efficiency, unlike general market fitness apps which have high costs due to being on a “production treadmill.”

Lastly, the content production industry can be insular, and producers often charge corporate customers a premium over insiders. Cook's two decades of experience at MTV have provided her with a rich network of content producers whom she has been able to employ cost-effectively to produce new content for Expect, and key advantage over fitness entrants without this unique background.

Expect has been fortunate to receive grants and funding from renowned institutions, highlighting the merit of our solution and team. These include:

• A $50,000 grant from Tiger Global Impact Ventures: Accelerate (HER) Fund in partnership with The Global Entrepreneurship Network & Hello Alice in 2022.
• $20,000 from Harvard Business School as part of the Black New Venture Competition in 2022.
• $10,000 from Wharton School of Business through their Entrepreneurship Acceleration Program in 2019.

In addition to these non-dilutive grants, Expect has secured $200,000 in funding from a friends and family round, including contributions from founder Dara Cook's classmates at Harvard Business School and angel investors Jacob and Kristina Brodie based in Haverford, Pennsylvania. Expect also received $20,000 in equity funding from Techstars in the form of a convertible note. Techstars startups are supported by lifetime access to worldwide network and benefits of more than $400,000 of cash equivalent hosting, accounting, and legal support.