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We are the Maternal Health Learning and Innovation Center, a network of maternal health equity experts and organizations working to make real change for women and birthing people in the U.S.
Our podcast is a series of episodes connecting around culture, lifting voices and stories, exploring innovations in maternal care and discussing ways we can center equity in the way we approach our health and wellness.
Learn more about us, explore our resource center and find support for all maternal health professionals at MaternalHealthLearning.org.
For more podcast information and content, visit MaternalHealthPodcast.org.
Venus - 00:00:04:
Welcome to the Maternal Health Innovation Podcast, season three. I'm your host, Venus Standard, Assistant Professor at UNC School of Medicine, the Director of DEI Education and Community Engagement for UNC's Department of Family Medicine. I am also a certified nurse midwife. This podcast is created by Maternal Health Learning Innovation Center. Episodes are released bi-weekly, so please be sure to subscribe. On this podcast, we will listen to maternal health innovators about ways to implement change to improve maternal health in the U.S. This episode, we'll talk about IRTH. Not E-R-T-H, but I-R-T-H. IRTH is the only platform where you can discover real, unfiltered reviews of care of black and brown women created by IRTH. For and by people of color. Today, I'm joined with Ms. Kimberly Seals Allers, creator of the IRTH app, and Ms. Sheridan Blackwell, head of systems change and partnership. Good afternoon, ladies, and thank you very much for taking the time to speak to me today.
Kimberly - 00:01:13:
Thank you for having us.
Venus - 00:01:14:
I want our listeners to understand the what, when, and why about the Irth app. So let's get right into it. So, Ms. Kimberly, the Irth app has often been described as the yelp for black women given birth. Could you give us a brief description on how this app helps black women find doctors who are supportive of their unique needs during labor and childbirth?
Kimberly - 00:01:37:
Yes, people talk about Irth as the Yelp-like tool for Black birth. I think of it as our digital green book for Black birth. And so we know that years ago, our predecessors needed guidance to travel safely throughout the country so that they could arrive safely. And so, I think of Irth as our digital green book for safe birth, because we know that due to the statistics and the prevalence of racism and bias and care that Black and Brown women and birthing people are not having the experiences that they deserve. So, we created Irth, which like you said, is like the word birth, but we dropped the B for bias as a place for users to leave and find reviews of their OB-GYNs, birthing hospitals and pediatrician. So users can go in, they can leave a prenatal review about their OB-GYN experiences. They can leave a birthing review where they'll be asked specific questions about the doctors, nurses, and lactation consultants in that experience. They can leave a review about their postpartum appointment and they can also leave reviews for pediatric appointments for baby up to that first birthday. And so we give our community the ability to share publicly where they're getting good care and where they are not. Birth was always meant to be a communal experience. And through our platform, we're bringing that community back to birth and giving our users this functionality. And they can also search reviews by zip code or hospital name or provider name to see how other people like them have actually rated their care at a particular provider or hospital.
Venus - 00:03:08:
That's amazing. Thank you so much. So let's dive a little deeper. You've touched on a few points that I was going to ask, but could you provide our listeners with a little overview of the functionality and the features? How does it work? How would a woman connect to the information and the resources they need?
Kimberly - 00:03:25:
Yeah, so when you come into the Irth app, first of all, you can go, you can download it for free in the Google Play or Apple app stores. You download the app, you will have to verify your identity as you do with many apps. You create an account, you answer a few questions around yourself and your demographics. This allows us to get a deeper understanding of the intersections of bias, because we know that it does occur along race, but they could also occur along your insurance type or your sexual orientation or your gender identification or how many other children you have. You'd be surprised at how many Irth app reviews where we see that people feel like they experience bias because they already have three children or four children or whatever it is, which is really nobody's business. But unfortunately, it becomes a point of judgment and a way to make a value judgment on who deserves quality care. So we have some basic questions and then you'll come in and then you tell us why you're here, right? Who are you and why you're here are the two first questions. Are you the mama? We accept reviews from birthing persons, but we also accept reviews from fathers and partners. We accept reviews from doulas because we know that they see a lot. They are our neighborhood watch for birth. And so we actually have a special icon in the app to identify reviews from doulas. We also use this as part of the data that we take back to hospitals to help them improve care. And so they'll tell us who you are. Are you the birthing person? Are you a father or partner? Are you a doula or hospital-based midwife? And then what type of review do you want to leave the prenatal, birthing, postpartum or pediatric? And then you'll be asked a series of questions. I think what's really powerful about Irth is that we turn these reviews into data on the backend to work with hospitals, payers, providers, to really help them learn from the living so that we can help all of our community have more positive birthing experience. So we actually activate the data to do hospital improvement plans. Sheridan leads this work. And so we're excited about being of dual service to our communities, not just giving our community that information, but generating data that can be helpful for hospitals to improve their care. And our vision, reduce and eradicate black maternal mortality and morbidity rates.
Venus - 00:05:42:
Wonderful, wonderful. Thank you. As a provider of prenatal care, I understand that the transparency and accountability is crucial, especially when it comes to the relationship and the trust building that patients should have with their provider, with their doctor or their midwife. How does the Irth App facilitate this, especially when it comes to holding hospitals accountable for the care of women of color?
Kimberly - 00:06:04:
I'll start, I'll let Sheridan add a little bit more. I mean, I think there's been a lot of great work going on in birth equity, birth justice, health equity, but a lot of it is lacking community accountability and transparency. And we have a very simple and basic belief that we will not get to equity without accountability and we will not get to equity without transparency. One of the values that Irth provides is that we do have robust patient experience data. We're building the first national repository of experiences of care of black and brown folks and that actually doesn't exist, right? And on the other side of that, we know that hospitals are actually not getting enough patient experience data from their own surveys, whether they're HCAPs, whether they're Presganes, hospital administered surveys are not getting high response rates from black and brown folks because of that earned distrust, right? And I do emphasize earned. So there's a distrust between communities of color and health systems. And I tell everyone that the only way to repair relationship where trust has been broken is transparency. So we offer transparency as the fastest way to repair and we gain community trust through our process of improving hospital practices and behaviors based on community data and offering that transparency as an opportunity for health systems to repair their relationships with communities of color. Sheri, do you want to add something to the accountability piece?
Sheridan - 00:07:31:
Yes, and I also think the accountability is again, via the transparency through our technology. One thing that's missing within our healthcare landscape is the impact to have real-time data. And when we look at MMRCs and other type of data collection tools, we're looking at data that could be three, four, five, six, seven years old, so it's 2023 and we're still not even through looking at what the effects were from the pandemic. So, the real benefit of Irth is to do things in real time. After you leave a review, it goes through our review panel, which we check to make sure that reviews are accurate and have enough information and then the reviews are posted within seven to 10 days. So we're really looking to eliminate that data lag that is really existing right now within the industry.
Venus - 00:08:14:
That's wonderful, thank you.
Kimberly - 00:08:16:
And I was just going to add, and I think the other piece of that that we really are proud of is that, you know, we expect health systems to be accountable to the communities that they serve, right? And so there are a lot of regulators and a lot of health system bodies. But for me, and in our work, if a health system does not have the approval of the community, if the community doesn't say that they feel seen, heard, respected in that facility, then that hospital hasn't done its job, right? And so we really want to drive community accountability as also being really critical to how we move to a more equitable experience for all Black birthing folks.
Venus - 00:08:53:
Yes, ma'am. So Black women right now are in the middle of a maternal health crisis. I speak on this issue all the time. It's inspiring that the Irth app is empowering women who might otherwise be a victim in this crisis. How does the app give women the opportunity to drive change? And advocate for themselves. And the family members and their community.
Sheridan - 00:09:13:
I would say, I think that's one of our main purposes of Irth is to change that narrative that black women do not have to be victims of this crisis and can simply be change agents in just the telling of their own stories, whether positive, middle of the road or negative, that sharing the stories, putting them in a collective place like the app and collecting all of that community feedback in one centralized place drives the transparency and the accountability, but often just builds a community where other people can see that they're not alone in their experience, that something that may have happened to someone else in their community is something that happened to them. And it really just builds that family unit that is built within our communities to color that's already existing.
Venus - 00:09:53:
Ms. Kimberly, I'm curious, how did you come up with this? How did you come up with the idea? Can you share a moment or an experience that made you realize the need for this platform where black women could share their insights and experiences that we may not find on traditional media?
Kimberly - 00:10:08:
Yeah, I think that was exactly my experience. I think one of the seed experiences for me for Irth was my own pregnancy journey where I did do a lot of reading of media and lists and at the time, parenting blogs and really try to do as much as I could to learn about where I could have a safe and empowered birthing experience in my city and ended up leaving feeling really disappointed and didn't understand why the things that I read were standard practices of care that I had to fight for and so I just did not receive right. I think I spent a lot of time in my early days of motherhood blaming myself without realizing that people are just not treated the same way, even in the same place. At the time that I had my first child, I was not yet married and I was in graduate school so I had student insurance and I was treated like an unwed black woman with basic insurance and so I think that experience never left me. It just sat there for years with me kind of holding on to it and then as I got into this work, recognizing that actually I wasn't alone and that there were other people who were being mistreated and often their race, ethnicity, circumstance, insurance type, marital status was impacting the care that they received and so I began to ask myself what if I could have read reviews from people actually like me, right? Whether that meant other black women, whether that meant other black women who were not yet married or people who had my insurance type and so these were the early kind of seeds of my idea. I love to tell the origin story of Irth because it actually really started with the project with my son and I. I have a coding kid who I spent a lot of money sending him to coding camps every summer. I didn't know what he was talking about half the time he came back but I knew I had this idea and quite frankly, my original idea for Irth because I am a journalist by trade was a story bank because I was hearing all these stories in different parts of the country as I was doing this community engagement projects around birth and breastfeeding primarily funded by the Kellogg Foundation and so when I was in New Orleans or when I was in Detroit or when I was on the West Coast, I was hearing the same thing and I'm like, how do these women know that what I heard in Philly is what I heard in San Francisco is what I heard in New Orleans, what I heard in Mississippi and so as I began to iterate on this idea, I thought maybe it could be an app. My son and I started taking app development classes together at NYU. They were offered free to alum and I went there for undergrad and so we really tried to learn. He created the first wire frames for the ideas in my head. He might've been 13 at the time and then we started taking them to pitch competitions and hackathons and other types of places for us to really put this idea out there and so we would practice, we traveled together and we got invited to one at MIT where we literally had engineers turn my son's wire frames into a mobile prototype which I began to use to raise funds and so it was really just the power of stories. I shared it and said, our stories are powerful. I know this deeply and I live this so for me, the opportunity to shift that narrative, to say we are not the victims. We are actually powerful consumers and we can use our consumer power in service of birth equity and justice and that's what we seek to do with the app and the work that we do to improve hospitals through the data we receive from their community.
Venus - 00:13:26:
Fantastic, fantastic. So as an Irth ambassador and doula, you play a pivotal role in supporting women through their maternal journeys. Could you shed some light on the passion for the app and how you transform experiences of women of color during their pregnancy and their birth?
Kimberly - 00:13:44:
So I'm not a doula, but I'm sorry, that's okay. So, I wanna just correct that I'm not a doula, but we do activate doulas and Irth ambassadors in service of our mission. And so, one of the things that we realized early on in Irth was that, you know, our community needs support around sharing their experiences. You know, many times black folks expect bad things to happen, they're not socialized to actually believe that things that happen to them matter, as I believe white women are often socialized to feel like they always have a voice and they should always express their voices, which is great. And so what we found was like our community needed some handholding. And so, we activate birth workers into our Irth ambassador program. It's something we're incredibly proud of. We are committed as an organization and as a brand to take care of those who are taking care of black and brown birthing people. So, we've created a wraparound support program for Irth ambassadors, birth workers, whether they are doulas, whether they are lactation consultants, childbirth educators, pelvic floor therapists. There's so many. And so we bring them into our program. We give them a monthly stipend. We give them access to a therapist because we had deep knowledge and understanding from our piloting of this process of the emotional stressors that they are carrying with them every day that they have no way to process. And if we are going to tout doulas as important to black women, we have to take care of them as people so that they are sustained in this work or else as we're learning already, the burnout rate for them is getting to the 18 months, two years. So we provide stipends, a therapist. We reach out to brands to send them nice things. We create a curated speaker series focused purely on their professional development and their needs. And we invite them into an opportunity to represent Irth in their community, attending community events, helping us get reviews, leaving their own reviews as doulas and really being our eyes and ears on the ground. And so, we're excited about the ways that our Irth ambassador program is growing. I think we're now in eight cities, Sheridan will correct me. And then all of that work is really done in service of the doulas being a part of the systems change in their neighborhood, right? So that review collection supports the work that we do to improve a hospital or identify the hospitals that need improvement, right? And so that is really the purpose of the work. And then obviously helping our community have more access to information that they can use to wield their consumer power and exercise their rights within the healthcare system as also part of how we push for systems change.
Venus - 00:16:17:
Absolutely amazing.
Sheridan - 00:16:18:
Not only do the Irth ambassadors help us out with that patient engagement, but they help us with doula engagement as well, as we see all across the country, like doulas are being spoken about. There's all these new doula training programs. States are thinking about doula reimbursement, but the information that the doulas are able to provide, number one, both help us on patient side, but with them as well, about how hospitals are treating them when they're going in to support their clients, about what types of things that they need and able to sustain themselves and able to help us continue to provide those services to our community. And so a lot of that feedback that we get can be used for all of those things as well.
Venus - 00:16:54:
That's wonderful. That actually is a great segue into my next question, Ms. Sheridan. As the head of systems change and hospital partnership, how has the Irth app impacted the maternal health care landscape?
Sheridan - 00:17:05:
Yes, we have a bunch of different hospital pilots across the country right now. We're working with the hospital in Philadelphia. We have a hospital pilot in Detroit. We'll be starting our three year program in California. So we are working in a number of different levels, whether working directly with hospital pilots, we are working with some city and health departments. And then we also are working with the March of Dimes really as a data complexion tool, really to help them with some of their initiatives that they're doing on the back end. So really excited about the different case uses for the Irth app. But number one, our information is always available and there to collect on that black patient experience that can be used to work through other quality improvements that are being developed. So a lot of the information that we're being seen is being able to be shared with that hospital to help them develop whatever type of improvement plans they need to develop. I would say a lot of them have been around some things with nursing and empathy training. We've seen a lot of comments based off of anesthesia and the way that pain management is dealt with in the labor and delivery process and how important and crucial that is to have those involved. And, you know, we're really looking to develop from our feedback some specific metrics that we can add within the quality metrics within the hospital system around OB, thinking about how they're looking at health equity in the maternity care space. So there's so many different impact lanes and we're really proud of all those things that are coming to fruition. Each process, I would say, is a learning process, but we continue to grow our volume through our reviews and that those things really help us with our learnings as we go forward.
Venus - 00:18:36:
What challenges have you faced fostering these partnerships with hospitals?
Sheridan - 00:18:40:
We are a disruptor to the industry. And this is really the first time that hospitals are not directly in control of their data. When we are really out there in the community, we are doing this at an arms distance from hospitals. As Kimberly mentioned, there is that earned distrust that exists between communities of color and at hospitals. And when we are out in community, you know, we are looking to always maintain our independence as a community based organization. And so I would say there's some tension there with the hospitals in that regard. But we do have some hospital partners who are very open to learning what they don't know. The hospital based administered surveys and some of the other things that have been in existence for the last, however long, hundred years, are not able to really touch upon the things that need to be worked upon. And so they're not even able to really manage the things that they need to work on because they can't measure it. And so much of those surveys really are focusing on, you know, facility needs and, you know, was the temperature of your food hot? Was your room quiet? Did you have the things you need? They are not really able to go into the levels of what is respectful as a to you as a patient and what you need as far as from the care from your provider. And so I would say it's both a learning experience. It is a lot of tension, but we're really excited to continue to disrupt that, to really provide some different types of angles to that learning that really hasn't existed before.
Kimberly - 00:20:02:
I was just going to add that I always like to remind folks that power is also at the root of racism. And so hospitals have, and health systems have exerted power. They've held power. We meet these folks all the time, not to mention those funders who are afraid of hospitals. They have power in this country. And so it is really important for us that we use technology to give power back to our community so that we can deal with some of these power imbalances that have really contributed to not just the distrust, but the poor birth outcomes. The reasons why people aren't going back to hospitals, but then they get blamed for not going back to the hospital. We have to understand it. If we truly want to address it, you can't change what you can't see. What we offer hospitals who are often very resistant to the transparency, they would love to just buy our data, which we don't do. The only way to access IRF's data is to agree, legally sign our MOU, and agree to an improvement plan based on what we learn. But if we were willing to just sell our data, give it to hospitals for them to keep hold, and I don't know, do what with, we would never have a funding gap. And so our intentions are clear. And we are unapologetically disrupting power dynamics, because that is often and as well at the root of racism. And so what we want hospitals to do is to actually benefit from our process, view, or if not just having valuable data, but an opportunity for them to repair their relation with the community, measure something that it's supposed to matter, to put them to walk the talk, as it were. But this is a work that results in a lot of no's. And this is something that I think the industry needs to accept. Accountability and transparency is coming to everybody. It's coming to every industry. We expect it. Consumers are demanding it. And it's also something that we're leveraging in service of the Black moms who continue to disproportionately die under the current system.
Venus - 00:22:01:
Right, absolutely. Have you noticed an improvement in the care of marginalized communities as a result of the collaborations that you formed?
Kimberly - 00:22:10:
Well, I think one of the biggest powers of Irth is just knowing that it exists, right? So when folks know that we're in their community and they know that there is a platform for folks to leave their feedback and it's going to be public, that in of itself is a nudge for behavior change. And so we view the transparency and really our presence as something that we have seen hospitals respond to, whether they're nervous about it, upset about it, angry, that's fine. For me, that lets me know that we're doing good work because if you're not getting resistance then you're not disrupting hard enough. And so we find that our presence in and of itself requires folks to pay attention.
Venus - 00:22:52:
Absolutely. So, looking ahead, where is Irth going? What is your aspirations for the app and how do you envision it involving and creating lasting change in the landscape of maternal and infant care?
Kimberly - 00:23:05:
Our vision for Irth is that it becomes our good housekeeping seal of approval for birth, that our community will demand that their providers and local hospitals are Irth approved, and that actual hospitals will desire to be Irth approved, that they will be proud that they have earned a badge of recognition, something that is possible for all hospitals that go through our improvement plan and the work that Sheridan will do with them and her team. So, we want them to be proud of that, so we're here to drive desire and demand and you know also that we move up work upstream to see who else should be requiring and demanding that Irth app reviews are part of how they are being monitored or regulated. So that is our vision that we have created something that our community wants and wants providers to have and that hospitals see the value in going through a process of listening to the community, responding to the community, implementing those changes, because actually community accountability and that badge of recognition that says you have listened for us, that's the most important accreditation that you could ever earn, right? And so that is part of our vision and I'll let Sheridan talk about our vision for systems change.
Sheridan - 00:24:17:
Yeah, I think all of our systems change work is done through all of the initiatives and activities that Kimberly mentioned something we're also really excited to start doing is really publishing and acknowledging both those leaders and laggards or reaching a few data thresholds in some of our major cities where we'll have enough data to really release some lists on, you know, the top approved hospitals for maternity by black and brown people in each city, which will also really help drive that transparency, that accountability and that competition that really exists within the healthcare industry. Everything right now within healthcare landscape is really about, you know, different systems and collaborations and things like that. And once we see that one hospital is acknowledged and another is not, I think that will also really drive that work that needs to be done really to hold everyone up to a certain par. But within the hospital work that we do, you know, I'm really just excited about again showing the data that is missing. When we work with hospitals, I think, you know, we asked the hospitals to create a working group, which is the group that we work with throughout the part of the 18 month process. That is members of the maternity team from physicians, midwives, residents, nursing, lactation, as well as some supporting departments like patient experience, quality and safety, and then an executive sponsor to really help drive some of the things, but they're really just excited half the time to see what that data is. Because again, they don't even know sometimes it's like it's called unconscious bias for a reason. So I don't even know what I'm doing as provider that may be, you know, affecting our patient outcomes, especially if it's never been shown to me or I've not even thought about what I'm doing. We're seeing that a lot of, you know, writers, no one's really going into this work with the objective to hurt anybody or to upset anybody. But if they're only having these generic trainings that maybe, you know, an hour, 30 minutes every year that are not really touching upon anything deeply or something that is hyper local to their community, there's a lot of missed opportunity for those learnings. So really just showing them that data that exists is the best learning experience and really is a self reflection on what am I doing to provide to that. And then we help them really come up with some improvement plans, implement those improvement plans and always again using the Irth app as an accountability system. Because again, new patients can always come in and say, I didn't really see that. I didn't feel that plan when I was there. So our goal is always to make sure that the community is aware of what we're doing. And so they can always contribute their experiences back to keep that revolving door going open.
Venus - 00:26:38:
Ladies, this has been amazing. Do you have anything else that you want to add that we didn't touch on?
Kimberly - 00:26:43:
Well, one thing that I wanted to say, because we're in the space of maternal innovation, this idea that who we are innovating for remains at the core of what's happening. And so a lot of times, particularly in health tech, we're seeing new technology platforms that are giving individuals or birthing folks or that mama more things to help her in her desire to have a joyful birth experience. So you can do concierge services. You can talk to doulas on technology. You can talk to midwives on technology. You can take your blood pressure. You can monitor, you can listen to your baby. But who's holding the system accountable? And so for me, innovation is not just around creating new technology for people to save themselves, because technically that's not their job. So we're excited to see more innovation and the ways that we're innovating around holding systems accountable. And we're really proud that our innovation actually serves a dual market, providing something to the community, but using that to be of service to systems change, because ultimately these are the systems that are being paid to help us at this very vulnerable, should be joyful time of our lives. So that's something I think is important when we're talking about innovation, to always ask innovating for whom, and actually to ask, are we innovating for equity if we're not actually dealing with systems change and trying to address power structures that cause harm?
Venus - 00:28:05:
Man, how awesome. Thank you so much. And thank you for taking the time today to talk to us and to share with our listeners what Irth app is, why the Irth app is, and how it's gonna help moving forward. And for you listeners, I wanna thank you all for tuning in today. For more podcasts, videos, blogs, and maternal health content, please visit Maternal Health Learning Innovation Center's website at maternalhealthlearning.org. We wanna hear from you, so please share what you heard, if you like it, what you wanna hear more of, the review of our podcast, share it with your friends, your colleagues, and like-minded innovators. We have some great topics and episodes that are coming up, so please subscribe, tag us, and share us at hashtag maternalhealthinnovation. My name is Venus Standard, and we'll see you again next week on Maternal Health Innovation Podcast. Thank you so much for joining. This project is supported by the Health Resources and Service Administration, HRSA, of the U.S. Department of Health and Human Services, HHS, under grant number U7CMC33636, State Maternal Health Innovation Support and Implementation Program Cooperative Agreement. This information or content and conclusions are those of the author and should not be referred by HRSA, HHS, or the U.S. Government.