We’re finishing out Black Maternal Health Week with an interview with Erica Chidi — writer, entrepreneur, doula, and more. We talk about issues around Black maternal health, maternal health in general, and possible solutions.

We discuss, among other things, the LOOM app, which will launch in the summer. To stay updated on that, sign up here.

We are also doing a book giveaway with Erica on my Instagram. My book Expecting Better and her book Nurture are often next to each other on the bookshelf. So we’re excited to give away 10 signed sets of both of our books. Head over to Instagram to enter to win!

As always, you can choose to listen to the conversation on my podcast, if you prefer.

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Emily:  Welcome to ParentData. This week in the newsletter, we’ve been honoring Black Maternal Health Week and the issues that face Black women in particular in maternity care. And today I am extremely excited to have Erica Chidi here to talk about these issues and possible solutions. So, Erica, welcome! Thank you for coming.

Erica: Thank you for having me. It’s so fun to be here.

Emily:  So, Erica has a million hats. Let me list a few hats. So you are the founder of LOOM. You’re the author of the book Nurture: A Modern Guide to Pregnancy, Birth, Early Motherhood—and Trusting Yourself and Your Body. You’re a doula, you’re a creator, you do all kinds of amazing stuff. I would love you to introduce yourself a little bit. Tell us who you are and why you do what you do.

Erica: I would say I’m definitely a multihyphenate. I think what takes up 98% of my time these days is LOOM. It’s a health education app that is focused on helping women feel better in their body, through learning about their bodies.

And the key reason for developing this platform is because health literacy is really poor for a lot of folks out there. A lot of people, regardless of their gender, have a basic understanding of how their bodies function and how to take care of themselves in and out of health crises.

LOOM actually was a physical space in Los Angeles from 2017 to 2019, where we taught classes across the female-specific life span — across women’s health, essentially. Everything from period classes to fertility classes, pregnancy classes, miscarriage and abortion support groups, queer-centered family planning support groups… And so, what happened in the physical space essentially was a microcosm of what we eventually wanted to execute on in a tech stack, as they say.

I was a doula and health educator for about 10 years before deciding to raise venture capital and pivot into tech. And I think I spent a good amount of that decade really getting up close to what the pain points were for women and their partners moving through these really important life events like pregnancy, like trying to get pregnant, or starting to move through perimenopause. What I realized is that, regardless of your background, the great equalizer is the fact that most people have the same questions when it comes to these experiences. And I think there hasn’t been a way to solve for this type of health literacy in a way that feels engaging and fun and isn’t so focused on pathology or something being wrong. I think the focus is trying to support people around preventative health.

I got my start as a doula working in the San Francisco county jail, providing childbirth education to folks that were currently incarcerated. And at the same time, I was also servicing the top 1% to 5% of people living in a really fancy San Francisco neighborhood, who also needed doula support. And what I noticed across both of those groups of people is they have basically the same questions about pregnancy and their bodies and the next stage of their lives.

And so that lack of health literacy, that lack of understanding, is what unifies us. And it’s also what’s been my key motivator, in all iterations of my career, is to try and close that knowledge gap.

Emily: I think this knowledge gap is so crucial and so problematic and so confusing. I am a person, like you, who wrote a book about this — and I remember the experience of thinking about trying to get pregnant. And somebody told me, read this book Taking Charge of Your Fertility. And I was like, oh okay, I’ll read that. And there were all of these things in there I did not know. I just didn’t understand how these things worked. And I wonder, what is the deep underlying reason why we are not educating anyone about this?

Erica: I think there’s a couple layers to it. I think, firstly, there is the religious halo that encircles our culture and the fact that talking about these things really leans into this idea of what is respectable and what is okay to talk about. There’s this idea that we don’t want to talk about sex or we don’t want to talk about fertility or the possibility of getting pregnant because it feels shameful. Or at least that’s what we’ve been conditioned to think.

And it also has a lot to do with control. I think for women or nonbinary people that have that anatomy, the more that we know about it, the more control we have over our ability to procreate whether we want to or not. And I think our culture is definitely one of misogyny, one of patriarchy. The desire to relinquish any control to women has been severely undermotivated.

And economics too, obviously. I think there’s a big piece there. Maybe less so now in certain ways, but I think those three pieces are the why.

Emily: Although I think the economics piece matters more sometimes than people think. When we think about, why don’t we know the answers to some of these questions? Why are there so many unanswered questions in women’s health about breastfeeding, about perimenopause? Why is this so poorly understood? And I think sometimes the answer to that is well, there isn’t a lot of money in learning about this.

Erica: Yeah, absolutely. A dear friend of mine, Dr. Suzanne Gilberg-Lenz, talks a lot about this. The fact that physicians are not incentivized financially to practice “slow medicine,” where there is more space for education and non-pharmacological interventions. You’re really thinking about the whole patient. Insurance has really not caught the wave of that being something to bill against in a higher way.

I think there is starting to be a tide shift. Values-based care is really starting to become more and more of the focal point for larger care organizations. And thinking about paying providers for their outcomes, not just paying them for service, which is the really big paradigm shift that’s happening. Because if we’re incentivizing providers to have really strong outcomes, it means that the way that they practice medicine would have to fundamentally change. And I think that there’s some deep alignment there in that change with younger providers graduating and coming out, wanting to practice slightly differently, or having just a different ecology for themselves around how they want to be with their patients and be with the work.

That said — I feel like I can really dive into the numbers here, because it’s you! — the demand for OB-GYNs versus the supply will outstrip each other by 2030. So there’ll just be so many people that need those services and not enough OBs to go around. So I think we’re in this time that’s very interesting, where there does have to be a change, primarily because the foundations are shifting so much in terms of what’s available from a care perspective.

Emily: Yeah and I think it’s going to be very interesting to think about, what are we replacing that with? And how are we continuing to serve people, ideally better, in that kind of environment? And this is where people bring up things like group prenatal care. And I think some of that has been shown to be effective, particularly with Black women, as a way to deliver better information during pregnancy,

Erica: Yeah, absolutely. Centering [group prenatal care] is a long-standing framework in most of the world, specifically the U.K. Centering is a great way to provide maternal care just because there’s less isolation.

And the thing about pregnancy, unfortunately, in the United States is it’s deeply pathologized and it’s very interventionist in terms of how the medicine is administered here. But being pregnant is actually not a pathology; it’s a normal process. Things can happen during pregnancy, but it’s not a disease. So the idea of syncing up with 10 or 15 other people that are going through pregnancy, it is helpful if you’re all around the same time, because you should all be having a lot of the same experiences. And there can be a lot of support gained from being able to touch in and talk about those experiences as well.

But going back to what you were saying about how medicine is practiced overall, given some of the strains that are coming in from a supply-and-demand standpoint, a big part of that is going to be the improvement around health education and health literacy. People need to have a better understanding of their bodies, what’s going on, in order to make better health-care decisions, to advocate for themselves, to help support providers who are burned out and overwhelmed. We know that. And I think there needs to be more equity in the exchange.

And I think, especially when it comes to Black women and Black-bodied people experiencing health care, due to systemic racism built in from the very foundation of medicine, education and a framework of discussion and an acknowledgement of racial anxiety — which is what the New York Times piece that myself and Dr. Cahill co-authored a couple years ago is about — really has to be at the forefront. Which is why I think the values-based care trajectory is so powerful, because it’s about outcomes. So if people are dying and people aren’t making it through and you are now being reimbursed based on how many people you keep alive or how many people thrive, I think unfortunately economics might be the answer to some of the racial disparities that we are experiencing, because people are not going to not want to be paid well.

I mean, obviously ideologically it aligns with me and anybody who is a compassionate human, but I think knowing that economics is what really makes the world go round, it might end up being a key motivator.

Emily: It’s interesting, because that idea, which I am quite sympathetic to, assumes that there is something underlying these disparities in outcomes for Black women in particular, which are extreme. We put some of this data in earlier this week in the newsletter, but the maternal mortality rates for Black women are three times higher than any other racial group and far higher than any comparably developed country. And there’s many things in those data which are deeply concerning.

The idea that providing providers with different kinds of incentives might affect their behavior presumes that there is something that they are doing that we could identify that is changeable. That there’s some underlying issue which is alterable in the behavior of the medical system. I think that would be one interpretation of that. And I’m curious if you have thoughts on: is there something we could point to as, this is the thing that needs to change? An underlying unsolved problem, a misunderstanding, something that we could point to there?

Erica: I would say in health care, the default is speed and volume. If those are the key drivers, they immediately create an environment that is not very compassionate. And I think that when you are not plugged into compassion, you are very, very, very far away from being able to plug into racial sensitivity and cultural awareness and cultural competency, especially for white providers servicing non-white or Black patients.

So I think as we have been saying, because the values of health care and how it’s delivered in this country are already not aligned for good outcomes writ large, it really makes care consistently susceptible to being racist. There’s just not room. Obviously the Hippocratic oath is Do no harm. But again, the framework of medicine was developed by white people. So it’s Do no harm to us, because it’s really just us that are here administering the care. And so it’s a very interesting and very complex problem that probably won’t be solved in our lifetime. I think it’s only right now, real conversations are starting to be had in medicine around race and how it impacts care. We’re just really starting, and so we have a long way to go.

But I think in terms of what you were saying around behavior change and identifying what behaviors are problematic, there’s just so many steps that are creating the problem that we have. And a lot of it has to do with before someone even starts medical school. It has to do with just how we’re socialized and how we are socialized to see each other. And so the outcomes focus is an economic lever that I think will help support this more foundational, ideological DEI work that is now in medical school and in the day-to-day for providers. If we can have economic incentives coupled, and then political incentives too like the Momnibus… I would say all of these pieces have to compound for there to be actual systemic change, because it’s a systemic problem. So we can’t just look at providers only. We’ve got to look at payer, we’ve got to look at politics.

Emily: What you said about the speed is really interesting, because we know when we look at implicit association tests that most people perform in a way that suggests significant racial bias on implicit association tests. And some of those are about what happens, the first thing you see, what is your first instinct. We also know that with enough moments of time, people can redo their first instincts and they can have a second instinct, and that may be a better one. And so this idea of: you need more time to be able to have these larger cultural conversations and to recognize the other factors other than the first thing that comes into your head when you start trying to do something. And that you know is potentially bought by time.

Erica: Exactly, yeah.

Emily: So I was going to ask where you see hope, but I’m going to ask a more specific version of the question of where you see hope, which is: Do you see hope in policy change? Do you think that there are, at the political level, policy changes that are feasible and would be helpful?

Erica: I think I do see hope. The people that I know that are going up to Washington, having the conversations, are seeing some possibility show up more so than ever before. However, I don’t look to politics being the only answer just as much as I don’t look to doulas being the only answer for Black women either.

I think, again, in order for there to be systemic change, all of these things need to work together. And you know, I think even this conversation that we’re having right now is also a part of it. It is a collective shift that is going to have to happen over a number of decades. However, I do think change is happening, but it’s happening really slowly.

Emily: So let’s talk about your part of the solution, your change. Let’s talk about LOOM. We alluded to this at the beginning, but tell us, what are you building?

Erica: Well, as I was sharing, it’s a health education app, but what makes me the most excited about it is I think what we’ve figured out over here is how to make learning about your body fun. And one of the real reasons why we wanted to solve for fun in the experience is just because oftentimes when we are focused on the body, it’s usually because we need to fix something. Something is wrong or we’re trying to optimize something. I think what we’re trying to solve for with the app is just this idea of micro-learning and compound learning over time about things that you need to know.

One of the key tenets of LOOM, and really just of my body of work, is this idea of biological empathy. Which is, what would happen if you had enough health education to be able to have a sense of empathy for an experience that you haven’t gone through yet? So really what’s happening in the app is we’re serving you up education about menopause regardless of where you are in your life span, information about IUDs even if you don’t use one.

Because really what we noticed in a lot of our user research is that women, or nonbinary people, want to share health information with people that they love or their community. It’s like if they find out information, they want to share it. In many ways, I would say it’s kind of the genesis of your work. It’s like: What’s happening? I want more people to know about this. It’s a very natural inclination, actually, and it’s pretty ubiquitous. But not everybody has the means or the time or the access to be able to leverage that information that they have found in a way that feels supportive.

And so the app is about you getting to learn, you also getting to share what you’ve learned, and then also amplifying voices of women’s health from around the world. There is an audio component there, where you’ll be able to listen to stories from people you know, people you don’t know, to learn. And we did that because there’s a really huge gap in women’s health research. Again, the economics of researching women is not super-lucrative, apparently. Maybe that’s going to change. But that currently is how it is. And so what I learned when we had our physical space for LOOM is that women’s stories are actually anecdotal evidence that other women can cling on to make sense of their own bodies, even though there’s not an article in a journal about this thing. If three or four women are experiencing it, more than likely there’s probably more, and there’s something to cling onto there.

And so the app really brings together this factual, evidence-based information so that it’s easy to consume, so that women have more visibility into what is the latest information that could be helpful for them. And then there’s actual stories from real women that can also help connect the dots if there isn’t something in the research. And so we’re bringing those pieces together, and it’s exciting.

Look — it’s not a panacea. It’s not like rocket science. It’s not a wearable. But it’s pretty important, because what happens is something’s going on and you end up on WebMD or you end up down some rabbit hole. And we’re really trying to be a home base for women throughout their life to get this information, to share it, and we look forward to being able to really iterate and do more with the platform as it grows.

Emily: I love the story aspect of the platform, but I also love this connection of: there’s an evidence space between one story and the gold-standard medical journal where shared experiences can be quite informative. And there are often things that come up in the work that I do where many people will share: I have had this experience and it’s not really very well covered in any medical literature, and occasionally I’ll mention it to a doctor, and they’ll say, I don’t know really know anything about that. But yet I can see it is clearly something that many people are experiencing and I think that just that feeling of being able to connect with someone else who’s having the same emotional experience, the same physical experience, or whatever it is, it can be very relaxing.

Erica: Yes, yes. And we also did something else with the platform that I feel like you will resonate with. This idea of time poverty — not having enough time to do really anything and women holding the brunt of that.

One of the things we really wanted to solve for as well, knowing everyone is so busy, is how do you get a lot of value and not necessarily have to spend a lot of time with us. And so I really feel like the app does that. Like you can get a lot, but you don’t have to live there. Which is I think sometimes the definitive feature of a lot of social apps; they want to take as much of your time as possible.

Emily: So everyone should just go download the app, because it’s great.

Erica: Yeah, it hasn’t come out yet; it only comes out in July. So your folks are hearing about it first.

Emily: So in July, go download the app. But one of the things that my sense is the app will do is these little pings of information: Here’s a fact that you might be interested in about perimenopause and you don’t have to spend a lot of time reading it. It’s short. It comes, you read it, that’s interesting. Or you don’t read it today and you read it tomorrow. And I think that, I mean, it’s just interesting. It’s an enjoyable way to learn. Going back to your underlying idea of: this should be fun, and not something that you’re doing because you know something is wrong. And then you’re ready.

Okay. So I want to end by coming back to this New York Times piece from several years ago, which I think is a really fantastic and important piece. But some of it is really focused on, from the perspective of a Black woman, how can you advocate for yourself in these settings? So do you want to take two minutes and talk a little bit about what advice you would give to Black women who are going through pregnancy in this space that we know has these underlying issues and want to be in a position to best advocate for themselves?

Erica: So, one thing I want to say before I dive into it is, when the piece came out, the majority of the feedback was overwhelmingly positive. There was some feedback, which I really resonate with, that shared: why does the burden have to be on Black women to do any kind of advocacy for themselves in this environment? Because we already take on so much. Shouldn’t it be the provider’s responsibility? So I really just want to acknowledge that and hold that, because I do understand that and it does make sense to me. Again, I don’t have an immediate solve for that, but I just think it’s worth acknowledging — there is an inherent power dynamic. There is an inherent challenge in that environment.

That said, my recommendation is really reminding the provider that you are Black. And how that impacts your outcomes in your care, based on what you know. Because again, going back in our conversation about some of the key mandates in health care, it’s speed and volume, right? Obviously it’s care — but it’s care, speed, and volume. The speed is what creates a big part of the problem in the patient-provider rapport. And so when I say remind the provider that you are Black and your outcomes and how that impacts you, it’s really just slowing the provider down to take you in and take a beat and to be cognizant of that reality. Because it is very much like, I got 15 minutes with you, what do you need?

Both my parents are clinicians, and so I’ve always really come to this space with a very humanistic approach. Like, they’re overwhelmed too. They have a lot that they’re holding, especially, inside of the pandemic that we’ve been moving through. So it’s bringing them into your story, bringing them into your experience, and really trying to ask them to be collaborative with you about avoiding these possibilities based on what you know.

And then I think on the other side of that, my other recommendation is for Black women to have a care buddy — have a partner, friend, family; bring somebody with you that can help to be a second set of eyes and ears that can help remind you of what you need inside that appointment. Because, I mean, even for me, I’m coming with all the things, but depending on how long I had to wait for the appointment, depending on how I’m feeling, there’s all of these components that can make it very difficult to optimize an appointment. So having a care buddy would be really important.

And then thirdly — I like to call them “speed bumps” for the appointment to slow it down — is actually to bring in written questions on a piece of paper printed out, or on your phone; put an alarm in the middle of the appointment to get your phone to go off, to be like, oh, I have this question. Those speed bumps, I think, can help provide a little bit more clarity or a little bit more space so the information can metabolize better or more before you’re already out the door, right? Those are important things as well.

And I think the last thing, too, I think for pregnancy: consider bringing your own robe to your appointment, if possible, that you use for your appointments. Because that’s another way to, again, differentiate yourself and also to keep you feeling less like a patient, more like someone who’s well. Those are things that we sometimes would recommend when I was a doula working in the hospital for labor. It’d be like, bring your own labor gown that can put all the leads and everything in. It doesn’t interrupt the intervention or medical process that’s happening, but it’ll make you feel more comfortable. And that might be also a conversation point for your provider. They’ll be like, oh, that’s a nice robe. They’ll be like, this person’s different, they’re doing something different. Again, I wish we didn’t need to do small tactics like this, but I do feel it’s: every little bit helps.

Emily: I love that. Just to really go back to this idea of slowing down, which feels very key to a lot of what you’re saying.

Thank you so much, Erica. This was really a fantastic conversation. And I know everybody will be learning a lot more about themselves come July. But I just really appreciate you being here.

Erica: Thank you so much for having me. I love chatting with you always.