Birth By Us

“Giving birth to my son was the happiest moment of my life. But, a few days into postpartum, I started to feel so weak. I told my doctor, but she brushed my concerns aside and told me they were normal. I collapsed 3 days later from eclampsia and was in a coma for weeks.” - Alycia, USA

“I thought they were giving me anesthesia, but it was pitocin. I have never felt such a horrible thing in my life...I just thought I was going to die, or he was going to die. One of the two” - Michele, Brazil

“The whole experience was dehumanizing. I feel traumatized” - Dina, UK

The world is in a maternal health crisis. The current global maternal mortality rate (MMR) is over triple the goal set by SDG 3.1 (global MMR of less than 70 per 100,000 births), and as demonstrated by the harrowing anecdotes above, those who do survive their perinatal experiences are often left scarred and with lasting complications. These issues are exacerbated by widening instances of obstetric racism, adversely affecting women of color – disproportionately Black women – who are routinely subjected to this type of oppression. In the U.S., where the MMR continues to rise despite it being one of the highest-income countries in the world,  Black women are currently 3-4 times more likely to die in childbirth compared to their White counterparts regardless of their education, income, or any other socio-economic factor. The CDC has found that 84% of maternal deaths in the U.S. are preventable, demonstrating that the healthcare system is failing its patients.

Looking globally, these issues are often worsened by poor healthcare infrastructure, but the underlying cause is the systemic racism that relegates Black women to the lowest social classes in many cultures and societies. In Brazil, for example, the MMR for Black and Brown women is double that of White women; and the rates are rising. 

Moreover, recent studies revealed that pregnancy-related complications can have negative health impacts on mom and baby later in life. As women are responsible for the physical, emotional, and economic health of their families and communities, these issues are not limited to the mother-baby dyad. An investment in women’s health is an investment in the health of our world.

As young Black women, we knew things needed to change, and that if they didn’t, we may fall prey to the very issues we aim to solve. Committed to listening to key stakeholders, we conducted focus groups and interviews with over 250 stakeholders worldwide over the past few years, including but not limited to Black birthing people, maternal care providers, and other experts.

In this research, we found that Black women and expectant parents feel disempowered and fearful in their pregnancy and postpartum journeys, saying things like “There are not enough resources for Black women.” 

Providers are aware of the statistics and want to improve outcomes, but lack the critical insights and effective strategies they should implement to help eradicate this crisis.

Birth By Us is a community-centered app reimagining the pregnancy, birth, and postpartum experience for women of color and guiding parents along that journey. The app checks in on users daily with questions centered around their holistic wellbeing and generates data-driven insights to help moms understand their health symptoms and trends. By providing users with the language around how they are feeling, we equip moms and their support teams with the tools they need to better advocate for her in situations where she unfortunately may not be listened to otherwise.

In addition to serving as an advocacy tool, these insights are designed to help moms and providers catch crucial warning signs early before they worsen in order to prevent maternal morbidity, mortality, and other long term negative effects. Community is also a key piece of the solution in order to help moms feel connected with others who can understand them on a deeper level. For this reason, we create in-app birthing groups and community so users can share stories, ask questions, and support one another on deep emotional levels.

The app also recommends users with expert-reviewed, personalized resources that are created from the lens of cultural competence, featuring videos and articles on essential pregnancy, birth, and postpartum topics; stories from other moms and families; product spotlights and more. Beyond this, we think expansively on what Black mothers need to thrive and are expanding our resource directory to include partnerships such as food delivery services, haircare, transportation, and more. In keeping with this, we also recognize the longstanding organizations at community and national levels who already have offerings created to support expectant parents. Birth By Us also provides a centralized space for these organizations as well as auxiliary providers like doulas and lactation consultants to amplify their work and reach a broader audience.

Finally, we 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 or printed and discussed at care appointments, saving crucial time and helping parents better understand their bodies. In addition, Birth By Us will make monitoring and evaluation easy for maternal care providers and organizations 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. 

Our target audience begins with reproductive-age (16-45) Black women in the U.S. as we bear the brunt of the perinatal disparities in the nation. 

Birth By Us aims to create a new vision for maternal health and to be known as the pregnancy, birth, and postpartum app for women of color and their families by innovatively introducing technology with payoffs for both parents and providers, providing expedited avenues toward solving two crucial pieces of the Black maternal health crisis: implicit bias recognition and patient empowerment.

Birth By Us positively impacts 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. Our current users already resonate with the value BBU has added to their lives, noting how the app helps them better understand their bodies and explain their needs and concerns to their healthcare providers. Users also note how despite prenatal and postpartum appointments being so short, they are now more efficient. This is key to note as our current audience is diverse in many ways –- income, education, location, etc. –- but feelings of being “unheard” or “misunderstood” were almost universal across these socioeconomic demarcations. In this way, this value proposition improves experiences and outcomes for the community at large.

This highlights a clear value-add for providers and hospital systems as incidences of severe maternal morbidity costs the healthcare system upwards of $1.5 Billion in the United States alone. This, coupled with the fact that 84% of maternal deaths in the U.S. were deemed preventable, shows that solutions like BBU that focus on improving patient safety and quality have the potential to introduce substantial cost-savings for providers and payers. Provider feedback generated by Birth By Us adds to this impact by highlighting actionable steps towards improving patient outcomes and experiences.

While we intentionally begin with Black women, we see the need for this solution across other marginalized communities and around the world as we know issues of obstetric racism and violence know no borders. For example, Indigenous Americans also suffer from poor maternal outcomes and experiences, and can benefit from BBU in order to facilitate community support, highlight local and national resources, and improve patient education among other things.

In terms of a global expansion, we have already begun conducting research on the ways in which obstetric racism manifests in Brazil and how we can support mapping the resource landscape in regions across the country. We also recognize that in many fragile contexts such as in Nigeria where the MMR is one of the highest in the world, issues around infrastructure and care delay supersede racism as driving factors. Birth By Us can close the gaps in these contexts as our data-driven insights encourage moms’ care seeking behaviors so warning signs are appropriately brought up to the appropriate professional and our resource directory allows mom to connect with providers and local organizations in their communities.

As young Black women, we started Birth By Us because we look forward to a future where pregnancy and postpartum are experiences surrounded by joy and not marked by fear. Before creating any sort of solution, we spent years listening to voices of Black mothers, providers, and more so we could devise a solution that took into consideration the perspectives of all stakeholders. 

To date, we have spoken with over 250 stakeholders and continue to conduct regular focus groups to garner feedback and ground our work as we develop and iterate on our features. Through Birth By Us, we have built a community where we are personally connected to our users and have the privilege of being able to directly ask them questions about the product and co-design in meaningful ways since they know who is behind the work. 

Our team in particular brings extensive knowledge across this field. To be more specific, outside of her technical background and experience, Mercy (co-founder) also brings global knowledge of maternal health equity as she is a Fulbright Scholar conducting research across Brazil on the manifestations of obstetric racism and collective reimagination of maternal experience in collaboration with the University of Sao Paulo and Black Women’s Institutes across the country. Ijeoma (co-founder) has conducted considerable research in women’s health at several institutions across the U.S. and has done similar community-based women’s health work in Nigeria where her family has deep connections in the healthcare ecosystem. Abena (strategic partnerships) is trained as a birth doula and has previous experience working with community organizations to scale their impact; she is also connected to various hospital networks in Ghana where the MMR is over 8x that of the United States. Luyi (business development and partnerships) has cross-cutting expertise on delivering value-based care from the angles of public health, business, and operations.

In spring 2023, we completed building our MVP and released it in a beta period over summer 2023 with 120 Black pregnant and postpartum users across the United States. In beta, we regularly garnered feedback from moms through surveys and interviews, allowing us to hear their feedback on the product at that stage. We heard how moms by and large loved the product, noting how the insights helped them ask better questions to their providers and give names to the ways they were feeling physically and emotionally. 

Many moms also mentioned that they loved checking in with themselves on Birth By Us everyday as a way to hold them accountable to doing something small that was just for them as many of our beta users, and many Black women in general, are the emotional support pillars of their families and friends and are busy holding up the burdens of others. Based on this, we focused on enhancing the daily check-in UX, introducing new questions and an improved look and feel. Finally, moms in beta expressed their desire for community in order to connect with other moms so we immediately set up a Facebook group for our users, facilitating conversations with thoughtful and fun questions.

With the edits above among other improvements, we iterated and released our alpha version which is live now on web and is serving over 750 moms across the country and has several 5 star reviews. We are also currently partnering on a federally-funded grant with Momentum Park, a physician-led non-profit as the tech platform used for their SHERO (Shaping Health Equitable Reproductive Outcomes) initiative which provides peer-to-peer pregnancy and postpartum support for Black women in New Orleans, LA. Through this pilot, we will be onboarding 2,500 moms onto Birth By Us and iterating on the product to best meet their needs.

We are so grateful to already be a part of the Solve ecosystem as SOLV[ED] innovators and as such, have seen firsthand how Solve’s support has transformed the scale and potential of our solution. For example, we have remained in contact with the other SOLV[ED] teams and amplified each other’s solutions by sharing relevant opportunities amongst the cohort. We have also fostered relationships with the mentors provided by Solve such as Catherine Griffin of Impactable X. The financial support received through SOLV[ED] has also enabled us to grow our team to sharpen our strategic partnerships and business strategy. This growth has also revealed areas for improvement amongst our founding team across areas of management, strategic hiring, and impact monitoring which is why we were highly motivated to apply for the Solve challenge in order to benefit from the 9 month virtual program focused on addressing some of these challenges.

In addition, we would love the opportunity to connect with other teams in our specific niche at a global scale in order to cross collaborate, brainstorm, and collectively work towards our goals. Finally, one financial challenge we face is around having the capital to onboard full-time development staff and we are confident that Solve support can help us reach that goal and think creatively on how to leverage our collective networks and sharpen our capacity.

Through our focus groups with 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. Both include resources that track menstrual cycles, monitor babies’ growth, and help answer pregnancy questions. However, their offerings are fragmented, achieving shallow breadth at addressing parents’ concerns. We combat this by centering BBU as a centralized point solution connecting insights, community, access to professionals and more all in one place. In addition, these products are not directed at addressing or finding contributing factors to the maternal health crisis that disproportionately affects people of color, leaving a large and unaddressed gap. 

Digital Health Platforms for Black Women: Mae, a digital health platform focused solely on serving Black women through pregnancy, shows promise towards supporting Black pregnant people through their perinatal journey. In addition, instead of taking a preventative approach to inform parents of health warning signs, Mae only asks users hyper-specific questions that prompt a trip to the emergency room rather than early engagement with perinatal care providers – consuming excess time and money for patients and providers. 

Integrated Care Delivery Platforms: Platforms like Mahmee are built 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 and the underinsured. 

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 such as the MOTHER Lab's annual Black Maternal Health Conference, Reproductive Health Impact’s Birth Equity Scholars program, and legislative policy changes in collaboration with the Black Maternal Health Caucus.

While these are important, progress can be slow, and maternal mortality rates are still rising. Our tech solution aims to bridge the gaps in local organizations and overcome maternity deserts, providing tangible support to Black women in underserved areas. By expanding our view of what a mother needs to thrive and integrating all of those pieces in one easy-to-use platform, we disrupt the status quo of fragmented offerings and revolutionize this space, providing high-quality payoffs for all stakeholders.

Our existing maternal health care system is inadequate and fails to meet the needs of women, but completely overhauling it will require significant time and effort. We aim to revolutionize maternal health care by amplifying patient empowerment and leveraging innovative technology solutions to address its shortcomings and improve maternal outcomes immediately while fitting in seamlessly with the current and future maternal health system.

Currently, pregnant and postpartum Black women around the world routinely feel dismissed, unheard, and discriminated against along their perinatal journeys leading to poor and too-often deadly outcomes. Birth By Us works to improve these experiences and give mothers of color the tools they need to thrive by integrating research-based check ins and insights, culturally-competent resources, and community engagement into an easy-to-use platform. 

By using the app, mothers are now able to receive personalized support along their journey, foster community with others, and voice the ways they feel on everything from treatment by their care team to the reasons behind their mood on a specific day. Providers and organizations are able to receive actionable feedback on how they can improve their services and care delivery, specifically for patients of color. And, community organizations are able to amplify the work they've already been doing to create resources and opportunities for expectant parents and families.

All in all, this creates improved health outcomes and experiences for moms who now come into each appointment equipped with the knowledge to describe how they're feeling and with tailored questions for their provider. This improvement in rates of maternal mortality, maternal morbidity, and preventable complications in turn causes a ripple effect as healthier moms are more active participants in their families, jobs, and communities. We have already received feedback from users demonstrating this saying how “Birth By Us makes me more confident going in and asking questions to my provider” and “BBU gave me the language to effectively communicate my concerns with my care provider.”

Providers are now constantly upskilling to adapt to new patient scenarios, they become more receptive to feedback as they see an increase in positive patient interactions and numbers as they learn and grow. And finally, community organizations receive more funding in order to innovate and provide tangible support to families after measuring positive outcomes from an increased client base.

In this way, by centering the needs of Black women, Birth By Us sets the stage for more empowered communities and better healthcare delivery around the world.

We focus our impact goals on the most important metrics to our stakeholder groups. Our primary goal is in alignment with SDG 3.1: “By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births,” but we go beyond this as survival should not be the baseline for a quality perinatal experience. We seek to improve maternal experience and healthcare satisfaction for marginalized birthing people as measured by our wellness check ins and provider quality questionnaires. 

Our second goal is to increase overall patient activation rates and feelings of agency around their healthcare experiences. We measure this by collecting and analyzing data regarding the proportion of users who contact a trusted healthcare provider upon receiving an urgent warning sign in the app. Along with this, we seek to improve rates of appointment compliance and timely prenatal care to 70% and 80% respectively over the next 2 years , and measure that using our appointment calendar feature and provider evaluation questionnaire so that we are checking in with moms to see how their appointments actually went. These goals represent a substantial increase from global averages and would demonstrate the impact of Birth By Us towards these important metrics.

Another goal to be achieved in the next 5 years is to conduct a randomized control trial of Birth By Us in a low-income setting with a Global South nation, namely Brazil, Nigeria, or Ghana where our team is already deeply connected. This is of particular importance as we see how BBU can provide a clear benefit to mothers and birthing people, and also be leveraged as a monitoring and evaluation tool in order to support the on-the-ground work already being done in these local ecosystems.

Finally, we seek to increase the utilization of existing evidence-based initiatives and programs that provide support for expecting parents and families. For many organizations, future funding is directly correlated with usage of provided offerings and so by focusing on increasing these rates we not only connect moms with trusted resources, but invest in the sustainability of that offering for families in the future.

Our solution relies on technology as we have made a full-stack app that can be accessed cross-platform in order to reach parents exactly where they are. The app guides the user through a holistic questionnaire to understand how they are feeling mentally, emotionally, and physically along with how their previous appointments have gone in order to generate data-driven insights to facilitate better patient-provider interactions. 

Our holistic approach and culturally competent resources rely on the ancestral practices of doula care and midwifery, which have been shown to improve outcomes and experiences in modern settings. We also aim to expand access to doula care through an auxiliary provider marketplace that we look forward to developing in-app.

We are currently expanding our insights to integrate AI responsibly in order to better serve mothers and families.

In the short term, this AI integration looks like leveraging existing natural language processing (NLP) models like BERT for sentiment classification on provider feedback, specifically parsing through user-entered free text information on how their provider interactions went. By employing this model, we will be able to supplement the quantitative data we already collect with new information like the frequency of words/terms and different emotions in order to help providers build more empathy with their patients. This integration would also aid us in serving as a measurement and evaluation tool specifically in fragile contexts where there is not the infrastructure to sift through mountains of data in order to understand impact or areas of improvement for community-led solutions.

In the long term, we train our own model through supervised learning on various prediction tasks, namely: 

(1) After taking in data on demographics, users’ day-to-day health patterns, users’ care-seeking behaviors, patient-provider interactions, social determinants of health, and health outcomes; what are the correlations among those with poor health outcomes and experiences. What are the correlations among those with positive health outcomes and experiences?

(2) After analyzing the above data, what are actionable areas providers can improve care and potentially lead to better outcomes and experiences for their patients.

By employing machine learning towards answering these questions, we recognize the potential for bias and undue harm to our communities. This is why we look to construct a model that takes in a training set that is similar to the settings in which we hope to deploy our findings in order to avoid bias caused by missing or gappy data sets. We also plan to build out an interdisciplinary team prior to model creation and testing in order to solicit feedback from top ethical machine learning and AI bias researchers. We have already began pursuing HIPAA compliance and look forward to gaining support on GDPR and other compliance measures in order to ensure we are implementing the highest standard of data security.

In this way, we seek to move beyond the current rhetoric of “the problem is racism, not race,” and start specifically naming contributing factors to the global maternal health crisis, highlighting tangible solutions to improve our lives and communities.

PT Volunteer (Co-Founders are unpaid): 2

PT Contractors: 4

Our team has been working to bring the vision of Birth By Us to life for over 3 years and we are excited to have been able to achieve several milestones along this journey. Previously, each of our co-founders and team members bring years of mixed-methods research experience in maternal health equity and health disparities.

As a Black women owned and founded company, we have always strove to make our team reflective of the populations we hope to serve. We value diversity across many lines and have understood what this looks like in our user base (e.g. socio-economic status, location, heritage, sexual orientation, etc.). In keeping with this, we directly ask team applicants about what diversity means to them and listen for times when they have strove to create more equitable environments for others. As we open new job opportunities, we put extra effort towards recruiting diverse candidates at every stage. 

One way this manifests is through our social impact internship program, which we are now running for our second summer in partnership with the MIT PKG Center for Public Service and MIT Innovation Headquarters. For this internship, we specifically outreach to identity-based groups on campus like the Black Student Union, Society of Women Engineers, and the National Society of Black Engineers in order to encourage applications and let students know that there are opportunities to leverage their technology skills for the betterment of communities.

In terms of creating and maintaining a welcoming and inclusive environment for staff, we have weekly all-team meetings so no one’s work is siloed and conduct regular retrospectives in order to ask ourselves what we need to start, stop, and continue as well as give kudos and shoutouts across the team. We intentionally do not operate under hierarchy and encourage cross-collaboration within the team. For example, we have team members with several advanced degrees as well as team members still in college, but the contributions of both are valued and weighted equally. 

We have also built our advisory board to be as diverse as possible while reflecting the needs of the stakeholders we serve. As such, we are proud to regularly receive feedback from moms who use our product, obstetricians, midwives, doulas, public health researchers, technologists, and insurance representatives. By building authentic relationships with and between different stakeholders, we are excited to create a solution that truly works for everyone and centers the lived experiences of those who matter most. 

From our 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 had the ability to give anonymous feedback during their care journey.

After conducting interviews with our potential customers and considering an equitable approach, we devised a subscription-based model with varying payers including employers, maternal care providers, and insurance in order to shift the burden of payment off of mothers whenever possible.

We offer a freemium model in order to ensure that at a baseline, everyone has access to Birth By Us and its transformative power on their perinatal journeys. Parents will be able to benefit from our application by achieving early detection of 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. We have already begun demonstrating willingness to pay from moms and partners at monthly rates ranging from $5-15 and are continuing monetization testing this quarter.

Many employers already contract with digital health and wellness offerings like Headspace to unlock premium versions for employees. By purchasing premium Birth By Us for their employees, businesses benefit from improved productivity, employee engagement, and organizational health since when you take care of people’s health, they are better able to do their jobs.

A subscription contract is also a natural fit for hospitals, physician groups, and birthing centers. With our service, they will be able to have at-home patient monitoring, reduced unnecessary medical visits, decreased operational costs, improved patient communication, and increased practice efficiency by optimizing time spent with patients.

Lastly, for health plans/insurance, 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 later in our operations because we 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.

So far, we have been successful in raising targeted grants around our solution highlighting our current traction and future potential around scalable social impact: MIT Sandbox $12K, MIT PKG IDEAS 2022 $15K Grant Winner, UCBerkeley Haas Healthcare 2023 Pitch Night Winner, 2023 MIT SOLV[ED] Finalists and $20K Award Winner, 2023 UCBerkeley Big Ideas, $10K Winner, 2024 Westly Prize $40K Award, and 2024 Sacramento Kings Capitalize $2,500 Audience Choice Award. These grants have allowed us to prioritize developing our product and scaling our team in meaningful ways and we are excited to continue to seek out opportunities in these areas.

Outside of this, we have conceptualized our subscription model to include a wide variety of payers such as employers, insurance, providers, and community organizations in order to increase access to Birth By Us and be inclusive of moms that do not have the means to pay a monthly cost out of pocket. We have shown traction towards this as we are now contracted under a federal grant through the Office of Minority Health to provide Birth By Us to 250 moms through our partnership with Momentum Park in New Orleans.