Maternity Care Companion, a digital doula for Black birthing parents
A partnership with NYU Langone Health’s HiBRID Lab, leveraging digital health technology toward more equitable maternal health outcomes. Maternity Care Companion empowers Black birthing parents to prepare, learn, and communicate their preferences and needs to the hospital — before, during, and beyond each visit.
Designing for health equity at NYU Langone
As part of NYU Langone’s Healthcare Innovation Bridging Research, Informatics, and Design (HiBRID) Lab partnership, my team of three created a solution for promoting equitable care for Black birthing parents.
Design challenge
How might we leverage digital health technology to achieve more equitable health outcomes and experiences for Black birthing parents at NYU Langone Health?
Why should we care
Black birthing parents in the U.S. are 2–3 times more likely to die from pregnancy or childbirth than women in any other racial group, due to lack of care from medical personnel at the hospital.
The problem
Users are often restrained or hesitant to speak up to the healthcare system, resulting in miscommunications with their healthcare providers — and in being mistreated.
Turning preparation into power
Maternity Care Companion empowers Black birthing parents to take control of their maternity process — better preparing and educating themselves, and communicating their preferences and needs to the hospital efficiently.
Communicate your preferences
Set preferences for every aspect of a hospital visit — including a doctor’s cultural background — to avoid miscommunications and potential discrimination.
Personalized pregnancy readings
Users often feel reluctant to turn to healthcare providers. Reading materials tailored to them let users speak up, or pull through, with more knowledge on hand.
Care companion chatbot
Without much face-time with their doctors, users can ask the chatbot for quick answers, or be directed to resources on topics they’re curious about.
Prepare for each visit
When needs are hard to express out loud, users can record symptoms, questions, and expectations for their doctors to review at the next visit.
The numbers behind the disparity
We looked into the statistics to understand the quantitative context of the possible scope, and researched a variety of potential causes to find the leading ones to start improving on.
Of the 3.74M birthing parents per year, 17% are Black birthing parents.
Of the 1.3K maternal deaths per year, 32% are Black birthing parents.
According to the CDC, 60% of these cases are preventable.
Key findings
The main cause of the high mortality rate of Black birthing parents was racism in doctor attitudes toward patients.
Less accurate diagnosis
Approaching patients with a condescending tone that decreases the likelihood that patients will feel heard, failing to provide interpreters when needed.
Curtailed treatment options
Black people facing more barriers to accessing care, which includes preventive services, acute treatment, and chronic disease management.
Worse clinical outcomes
Systemic racism can be internalized and affect the disproportionate rates of heart disease complications, which take up 40% of the severe maternal morbidity rate of Black birthing parents.
Findings via The New York Health Foundation
How might we serve Black birthing parents with the same high-quality care experienced by all birthing parents?
our refined challenge
Eight in-depth conversations
Semi-structured interviews with users from different medical institutions — a birthing center, a private hospital, a public hospital — helped us understand what works and what doesn’t, and where the opportunity lies.
Stories are often not unique to one person. We heard the same pain points again and again: miscommunications with hospital personnel, and a lack of professionalism and respect from healthcare providers.
I can’t imagine getting pregnant again because of the discrimination. They make you feel like you should leave and not come back at all.
My labor ended up being 24 hours because my daughter hadn’t turned around yet. There weren’t notes in the system, and they didn’t even take the time to look at the ultrasound pictures to see if she had turned.
I asked for a retest to verify, but they wouldn’t back down. If I had believed that wrong diagnosis and gone to surgery, I would have lost my kid.
They insulted me, but I couldn’t tell anyone after all, because all of them who attended to me were white.
Users’ most essential needs, against what today’s medical institutions actually offer
Core insights
Not feeling seen
Users don’t feel seen by healthcare workers, and are often restrained or hesitant to speak up for fear of discrimination when meeting white healthcare workers.
Broken handovers
There’s a degree of miscommunication between users and healthcare workers, due to the lack of user-generated data and of handover between hospital workers.
Feedback goes nowhere
Users think the hospital’s feedback system is unreliable: they never got a call back, and none of their complaints reached management.
What we heard, versus what we know
We tied what we learned from our users to facts we knew about the hospital, and the gaps between the two became our design opportunities.
Users don’t feel educated enough about conditions to speak up.
The hospital has a library of comprehensive informational resources to provide.
Doctors have tight schedules and don’t have much availability.
Patients are willing to learn and seek out answers on their own time.
Users don’t want to just be a number — they want their doctor to know who they are, even when they’re assigned a different one each visit.
Hospital file transfers carry no information or input from the user, other than the previous doctor’s diagnosis.
Users have choices pushed onto them — painkillers they’re against taking, a c-section when they want a natural birth.
Doulas exist to explain options, so users are prepared to make informed decisions during their pregnancy.
There’s a general fear of discrimination around the white healthcare workers they interact with.
The hospital also offers bookable visits with doctors from different racial groups.
Four areas of design
After identifying the opportunities, we articulated design goals that acted as guiding principles for the project.
01 ・ Improve information transfer
Between patients and doctors — so what the patient knows, needs, and prefers actually reaches the people treating them.
02 ・ Provide tailored resources
Education and reading materials matched to each patient’s background and conditions, not a generic pamphlet.
03 ・ Empower patients
Help patients take control of their own pregnancy process instead of having choices pushed onto them.
04 ・ Extend beyond visits
Extend healthcare past the walls of the hospital, into the weeks between appointments.
Ideation
A pretty intense brainstorming session, sketches of the prioritized ideas, and laid-out concept details gave the team more context and established common ground.
Lo-fi wireframes, tested with 3 users and 2 clinicians
After ideating features and building the IA, we created low-fidelity wireframes and tested them with three users and two hospital clinicians.
Testing insights
Having information like patients’ preferences communicated outside of hospital visits is the highlight of the app.
Guided decisions
I especially like My Plan, the birth plan, and readings — they not only let me set preferences but also guide me about certain choices a birthing parent might need to make.
— User 1
Feeling safer around the system
This is putting mom and baby’s healthcare and their wishes first — it shows they’re listening, and I can expect them to follow my wishes. I also like that I can choose a doctor’s cultural background.
— User 2
Better-spent visits
Doctors have limited time, and there isn’t any digital birth plan right now. Seeing the maternity preferences they set lets us know their expectations quickly, so each visit can focus on the more important parts.
— OBGYN clinician, NYU Langone Health
The final user flows
We designed key user flows to construct the core experience, concentrating on communicating preferences with healthcare providers (My Plan) and on educational materials that empower decisions. Journaling turned out not to matter as its own feature, so it became a lighter place to write down critical information to pull out during a visit.
Final user flow
My Plan / communicate preferences with providers
Serving as a digital doula: users set preferences for every aspect of their care, including choosing a doctor with a cultural background or ethnicity similar to theirs.
Care Companion / real-time answers from a chatbot
Users get quick answers to basic questions, or are directed to resources on topics they’re curious about — so information flows outside of hospital visits too.
Readings / personalized materials that empower
Drawing on the demographic data users share at sign-up, Black birthing parents get resources tailored to their background and related health conditions.
Pre-visit notes / optimize each session
Patients record symptoms and questions for their doctors to review at the next visit — an additional space to communicate needs and expectations.
Winner of the strategic innovation pitch competition
Maternity Care Companion won the Strategic Innovation in Product and Service Design pitch competition, and was shared at the NYU Langone Health Center for Digital Health Equity and the FuturePractice lab’s Innovation Room.
They did such strong work! Really cool to collaborate with them. It’s like it’s ready to pitch to the stakeholder and ship.
Kerilyn Tacconi, Innovation Manager of the NYU Langone HiBRID Lab
The data and insights are very confronting. It’s very important that the solution is based off of that.
Roger Madar, Managing Partner of AMPERSAND.vc
What this project taught me
Delve into the universe where the users are
Being an Asian woman, I was especially aware that I had to fully immerse myself in the complexity of race-based health disparities in the United States. Understanding it on a systemic level, and hearing people’s stories, is what surfaced their real needs.
It’s ok to start small
An app is small, but it can make great impacts. Talking to our NYU Langone Health sponsor, I realized that although a better solution might tackle the root of racism in healthcare, we designed an experience that works well for most of their users in the short run.
Keep your users close, your teammates closer
Attentively listening to users matters, and so does communicating with your teammates. It improves the quality of the work, and sharing your take on the progress can shift the direction of a whole project. A team works best when their hearts are together.