Her ‘Yelp-like’ app holds hospitals accountable for maternal health care

Soon after starting grad school, Kimberly Seals Allers embarked upon another career-defining journey. As she began pursuing a master’s degree in journalism she learned she also would be having a baby.  It was an inopportune time to start a family, some may have whispered. But rather than disrupt her professional life, motherhood ushered Seals Allers into her mission.

Using her editorial skills to produce blogs, books and breastfeeding campaigns to improve maternal care in the Black community, Seals Allers, over the past two decades, has transitioned into a maternal and infant health strategist.

Now, Seals Allers combines her journalism skills with technology to turn the birthing stories of mothers of color into data. Captured by means of Irth, a community-based smartphone app that she launched in 2021, Seals Allers hopes these experiences can be used to fight against the institutional bias that has made giving birth risky business for Black and brown women in the United States.

“It’s “Birth,” but we drop the “B” for bias,” Seals Allers says of the app’s name. “We have a technology platform that’s holding hospitals accountable and puts power back in the hands of the community.”

Seals Allers’ passion for documenting the experiences of mothers of color comes firsthand from the treatment she says she received while seeking perinatal care as a young, professional and not-yet-married Black woman. Despite due diligence, including getting referrals from her white friends who shared stories of their wonderful birthing experiences, her experiences differed considerably. 

“I was completely disrespected, my wishes were ignored and I left feeling traumatized and violated,” Seals Allers said. “I always wondered why a hospital that had treated others so well treated me so poorly.”

Irth came to market as health researchers began to document “obstetric racism” — bias where medical professionals assume pregnant Black women come from low-income families, have multiple children and are dependent on government services regardless of their socioeconomic or marital status. 

Along with the disrespect and dismissal, Black women have described scenarios where they received surgical procedures without warning or consent.

“One of the things that really stands out to me was I had a resident who gave me an episiotomy, and of course, he didn’t tell me what it was he was doing,” recalled Nyasia Countee, a lactation consultant, doula and birthing expert in Detroit about her first childbirth experience. 

“I just remember feeling the sensation. I yelled when I got cut, and I remember being told to shut up.” 

For some women, these traumatic experiences have resulted in them forgoing follow-up care when it is most needed. Nearly two of three maternal deaths in the U.S. occur during the postpartum period — up to 42 days following birth, according to the Commonwealth Fund. 

In 2002, there were 49.5 deaths for every 100,000 Black women compared with 22 per 100,000 live births among all women.

Severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths the first week after giving birth. Cardiomyopathy is the leading cause later during the postpartum period.

There are some cities where having a baby is even more dangerous.

Pregnant Black women in Detroit are 4.5 times more likely to die than non-Hispanic white women and the maternal death rate here is three times the national average, a Michigan Maternal Mortality Surveillance Committee analysis found, adding that almost half of pregnancy-related deaths in the city were preventable. The report also found that Black babies in Detroit are two times more likely than White babies to die before their first birthday. 

Irth is among the first efforts in the last few years to provide qualitative data that help to explain these grim statistics. For Seals Allers, the solution to improving the maternal mortality crisis among mothers of color is to use their stories to force a reckoning. 

“There’s a lot of birth trauma in our community that’s going unaddressed, because we’re only counting if you died or nearly died,” Seals Allers said.

“I’ve been saying this over and over – just because we didn’t die or nearly die doesn’t mean we have the experience that we deserve. So for us, experience is a metric.” 

The Irth platform is powered by the connection Seals Allers has with birthing communities in several cities. 

“This is an app I use often in work,” one reviewer wrote. “Great way to see the real experiences of Black families in birthing spaces and for them to share with other folks. Very easy to navigate and leave reviews on birthing, prenatal, postnatal, and pediatric visits. I would recommend this app for anyone considering a hospital birth.”

As an Irth “Mombassador” in Detroit, Countee introduces the platform to families in her community. 

“It’s about holding healthcare providers accountable,” Countee said. “I help facilitate a connection between Irth app and my local WIC office where Black and brown people can leave reviews for anyone they come in contact with during their maternal time.”

Irth is partnering with hospitals in Detroit; Philadelphia; Sacramento and Long Beach, California. The hospitals are contracting with Irth to receive insights from the patient experience reviews and use that information to improve their services.

“We are honored to be the first hospital in Michigan to partner with Irth to capture community voices from a truly independent source to complement our system-sponsored anti-bias work,” said Paula Schreck, who leads the working group for the pilot project at Ascension St. John.

“Our goal is to assure that our evidence-based Baby Friendly practices are accessible to our Black and brown birthing families in a way that honors their lived experience in the Detroit area.”

Researchers are increasingly recognizing the value of curating patient experience information via smartphone apps to create actionable strategies. Irth aims to help its partners use the data for patient-centered quality improvement projects to better address blind spots and gaps in bias-free patient care.

“We can tell you what percentage of your reviews people use the word disrespected or traumatized,” Seals Allers said. “We can tell you what percentage of people said that they were yelled at – what percentage of people said that their pain levels were dismissed.”  

The top five attitudes app users have reported include requests for help ignored, pain levels dismissed, being scolded, yelled at or threatened. Women also said that their physical privacy was violated and that care teams made assumptions based upon racial stereotypes. 

“This isn’t about taking forever to make changes,” Seals Allers said. “The stories had to be connected to systems change – they had to be connected to making hospitals do better.” 

In addition to working with the partner hospitals, Irth also is seeking reviews from families in other cities with high mortality rates, such as Atlanta and Pittsburgh. 

Over the summer Irth announced its “Drop the B” campaign and encouraged its community to download the app and share birthing stories toward its goal to curate 50,000 reviews by Labor Day.

“We will use public opinion. We will use the power of the community. I will activate every media strategy that I learned in my previous career in service of making sure everybody knows who’s getting five-star reviews in this community.”

Seals Allers’ partnerships follow several years of work in the community as the lead on several foundation-supported maternal care projects as well as her first book, “The Mocha Manual to a Fabulous Pregnancy.”

“I was having a wonderful career in journalism. It would have been a more natural path for me to write about young Black people and money and wealth creation. But no, I decided that I wanted to write a book about pregnancy as my first foray. And, yeah, people could have thought I was crazy.”

During her book tours, she began to see a need for documenting and sharing birthing experiences. 

“Black women, Black mothers and other mothers of color are coming to my book events, and we’re talking about their experiences, good and bad. I’m like, ‘I just heard this same thing in Philly when I was in New Orleans, and I heard it in New York, and then I heard it in Oakland.’ And I was like, ‘How can I let that mama in Oakland know that she’s not alone, and that actually another person in Philly said the same thing – a lot of it around dismissiveness, mistreatment, nearly dying – dying?’”

She participated in community events to share her research about topics in maternal care, which helped her get to know communities across the country.

“I went to a lot of funerals for mamas I did not know, because I simply happened to be in the community during this time, and I was compelled to visit. And I remember being at one where I was just like, ‘I gotta do something.’” 

Seals Allers initially thought that she would create a story bank. Then, the idea for the app came from her own progeny. 

“Irth really started as a mother-and-son project. My son and I started going to app development classes together. It was really a way for me to bridge our world –  for him to see the crazy things that I do –  always talking about breastfeeding, always talking about babies – and that I could actually learn from him and that one of my children could help me be a solution generator for a problem that I learned about becoming a mother,” Seals Allers said. 

She and her son Michael began attending hackathons and pitch competitions. Then, her son created the early-stage design for the Irth app for which Seals Allers thus far has received funding from the Tara Foundation and W.K. Kellogg. 

Now grown up, Seals Allers’ firstborn Kayla works in public health.

“It’s a real joy for me as a mother, not just for them to see me on an entrepreneurial journey, but to see them know that they were a part of identifying the problem [and] also being part of creating the solution,” Seals Allers said. 

“A couple of weeks ago, a woman came up to me. She said, ‘Oh, I’m so inspired by your story. You don’t have a technical background, and how did you find a coder?’ And I was like, ‘Oh, I gave birth to my first coder. He came from my uterus.’”