What Does Quality Maternal Care Really Mean?

[00:00:00] Jared: Hello, everyone, and welcome to the medDesign podcast. Today, we're honored to host Dr. Andrea Braden. Dr. Braden is a leader in women's health, dedicating her career to enhancing the postpartum experience. She is the founder and CEO of Lybbie a company at the forefront of breastfeeding innovation, empowering mothers through a wearable milk supply sensor and an app.

As the medical director of the Atlanta Birth Center, she champions holistic patient centered care, providing mothers with safe alternatives to hospital births. In addition to her work at Lybbie, Dr. Braden is a board certified lactation consultant and advisor to one of our favorite startups, Couplet Care, where she's helping them bring their over the bed bassinet to a hospital near you.

Beyond her professional life, Dr. Braden is a devoted mother of five, an avid reader, a passionate musician, and a dedicated volunteer in her children's school community. Her multifaceted life and career provide incredible insights into the challenges and triumphs of maternal healthcare innovation. So today we'll delve into her experiences, the story behind Lybbie and her role in supporting the innovative Couplet Care bassinet.

Welcome Dr. Braden.

[00:01:01] Dr. Braden: Thank you so much for having me. It's great to be here.

[00:01:03] Jared: Yes, indeed. We're very happy to have you. And maybe if you could just start us off by telling us what quality maternal care means to you? It's a broad question.

[00:01:12] Dr. Braden: Oh, no, but it's a good one. And so important because, I think a lot of us as OBGYNs were brought up a certain way and to believe that quality is evidence based medicine, end of story, period, full stop.

And I think, especially for those of us in women's healthcare, there's a pivotal point when we finally decide it's time for us to have our own families, when we realize maybe that's not the whole story. And so I think really quality care is yes, evidence based medicine but it's also support of the person that you're taking care of.

And that includes valuing, and I think it's empathy, actually, it's empathetic care and autonomy. I think autonomy is so important. And perhaps that's the biggest piece that's still, we struggle with in the traditional medical system is really honoring the fact that people have, they, have the ability to make choices and inform decisions on their own.

And it is our job to give them that evidence and support them and whatever they feel is right for them. Cause nobody's actually in their shoes. And I think that's a huge change from the way we were all trained over years and years. The doctor knows best. I think the tide has definitely turned and quality care is getting better.

[00:02:21] Jared: I love that. And when you say empathy, I know that Ty, his philosophy is empathy first innovation also. So I think there's, a lot of alignment there with us.

[00:02:29] Dr. Braden: Yes. Yes, values aligned.

[00:02:31] Jared: And so also just if you could tell us a little bit about like your experiences that provoked you to take this on as your life's work.

How did you get to where you are now?

[00:02:41] Dr. Braden: Oh I always say my work as an advocate for women's health care really began in 2009. So 15 years ago, I had my first baby during residency. So training to be an OBGYN. And I was a girl with a mission. I had my whole life planned out. Check check.

I'm going to have a baby. I went into residency planning to have a baby living hundreds of miles away from any support system, any family. At the time, I was married to a surgery resident. But, I had never struggled with succeeding where I wanted to succeed. I had a lot of privilege there.

And I had my first baby, and it really was a wake up call. And not in a great way. I had always put my career first. And, I always said it was my first love. And then I had Annalise. And then I learned what real love was and it was really jarring to try to balance the two things. I thought that it would be so easy and it wasn't.

And it got so difficult for me cause I was used to being, a really great doctor. I started feeling like I was not so great at home because I wasn't home. I was working 80 hours a week and also not so great at work because I was trying to pump and be a mom while I wasn't home being a mom.

And when she was about 10 months old, I actually walked out on the job one day. And I had plans to never come back. My solution was, you know what? This is for the birds. And I choose my daughter. There's no choice here. Obviously this is the right choice. And I'm like, forget all this debt. I'll just figure it out one day, I'm leaving and I stopped. I think I was looking for somebody to stop me. Actually, I had been posting on all these websites, women leaving medicine.com. Please don't look for it, . I hope it's not still there. I think I was looking for somebody to help me. And I didn't know everybody I knew in my field was like, it's so easy, you know, and there's a lot of shame built into that.

And so I was struggling with a smile on my face, trying to be everything to everyone. And I finally found, it was actually my program director and she pulled me into this little closet during residency. And she said, I think you have postpartum depression. And I'm like, Lady, you crazy. I diagnose this stuff.

There's no way that's not me, but I said, I think back to what I told her and I said, I'm not happy as I'm smiling. I'm crying and I'm smiling. And I'm like, I just don't feel like myself anymore. I cry every day in my call room while I'm pumping milk and I just think something's wrong.

And that was what stopped me from leaving medicine altogether. She told me I had postpartum depression. I'm sure you've heard the saying, you have to name it to tame it. I didn't know until somebody pointed it out to me. And then it was like, I was able to forgive myself and move forward. Cause I knew what to address.

And as I came out of it, as I claimed space and accepted that I could be both a mother and a doctor choosing a career in academic medicine, which I did for 12 years until last year, was a real healing process for me actually. I made it my mission to use my platform as an OBGYN to make sure that other people, birthing people, don't suffer the way that I did because it was really bad and I had the privilege of knowing all these things and I still struggled.

And so it turned into this, what are you going to teach? I'm like, I don't know, I'm obsessed with my baby and they're like breastfeeding and I'm like, oh yeah, I could talk about that all day. So I started teaching residents and medical students breastfeeding. I started attending conferences. I got my IBCLC really just trying to grow the reputation in the educational field and try to educate doctors about how to support breastfeeding people.

And that morphed when I came to Emory as a new faculty member in 2015 had just had my third child. By this point, I didn't care. I was like, I'll pump anywhere. I don't care. But it was hard to see other people suffering. There were still a lot of stigma around it. And I'm like, I can only help people so much.

And the issue here is the tools that we have. We can't I can give people all the advice I have all day long and support people, but without the right tools, which did not exist at the time, then it's hopeless. I just feel bad. I'm selling people in a dream that they can't achieve.

And it perpetuates this guilt and shame cycle people stop because they don't feel like they have a choice and then they feel horrible about themselves and flash forward to now, as of last year, perinatal mental health disorders are actually the number one cause of pregnancy related death in moms.

It's above hypertension. It's above hemorrhage and nobody's talking about it, and this is like my little piece of the pie. I have sought to try to help in now it's milk supply, and we can get into that if you want, but it's a very long journey, but let's just say I suffered it personally.

I've been breastfeeding on and off for 15 years now with 5 kids. So as a provider and a patient, and a women's health care provider, I have this really unique perspective on how the milk is made and what is needed to support that process for long term goals.

[00:07:17] Ty: I was just, as luck would have it, I was just watching the baby dove commercial they did under pressure.

[00:07:23] Dr. Braden: Oh, I haven't seen it.

[00:07:24] Ty: Oh, it's so good. And it talks about postpartum pressure. And it's just this beautifully shot 90 second video that just talks about the unbelievable pressure that women going through postpartum and breastfeeding and there's just all these sad poignant moments through that.

It's just such a touching. We'll post it in the show notes.

[00:07:43] Dr. Braden: Yeah, I want to see it.

[00:07:44] Ty: Yeah, it's just such a beautiful way of telling the story and raising awareness of just how hard that time period is.

[00:07:51] Dr. Braden: Yeah, I was just telling somebody else today. I'm like, it's the great equalizer.

If a women's health care provider who is trained in pregnancy and postpartum has exactly the same struggles as somebody who knows nothing as the 16 year old, who had nothing ready. What are we doing here? What are we doing here? I have doctor friends all the time calling me asking me for help.

And it doesn't matter how much education is out there. That's not the problem. And the piece of the puzzle that I'm working on, it has a lot to do with anxiety. There's no amount of reassurance that we can do without the right tools to be like, don't worry. It's fine. Everything's going to be great.

Yeah, easier said than done. It's not realistic at all. There is a lot of pressure.

[00:08:32] Jared: Yeah. And another group of people that you've helped also is trans women to breastfeed and

[00:08:37] Dr. Braden: yeah.

[00:08:37] Jared: That was something that I found to be just absolutely fascinating. I couldn't believe that was possible.

And I had to research what you did a little bit, but maybe if you could tell us all just how you came across this issue and how you were able to help so many people.

[00:08:52] Dr. Braden: Yeah. I always say it was like the marriage of my two loves, breastfeeding and, LGBTQ health and trans health.

It started in academia, of course. It was really very random. I tell people, I don't know if you have kids or you've read the, if you give a pig a pancake book series, but that's my entrepreneurship, story. It's I did this and this. If you give a this breastfeeding doctor, this opportunity, all these other weird things happen.

So somebody asked me if I would staff a new gender center at Grady Memorial Hospital that they were trying to start a multidisciplinary clinic. I had no experience in trans health, although I had started the Gay Straight Alliance when I was in medical school, but really didn't know a lot about trans health, but had an interest.

And they said, you're new, you don't have a lot on your plate, would you like to do this? We're going to put it in the International clinic where I spoke a little bit of Spanish. So I was staffing the international clinic and I'm like, great. Yeah, that sounds cool. I'll do that. And nobody really knew anything.

So I had to build it from the ground up, building up gynecological services for this patient population that was really quite marginalized and had a hard time even just getting in and getting normal care. And at the same time I was doing a lot of this, translational research in the lactation space.

So the question came up actually while I was teaching a breastfeeding lecture to third year medical students. And I had this really astute medical student who afterwards became our resident, but she raised her hand and she said did you just say, that it had to do with, I forget the question now.

She asked a question about trans health. I said, Oh, did you know that trans women can lactate too? And she said, where's the study? I'm like, Oh, let me find it. And then I looked it up and I couldn't find it. And I'm like, I know this is out there. I've seen it. And it turns out it was a blog from a trans doctor who like we do in lactation all over the place.

It's peer to peer, everybody's trying things on their own. Nobody's going to physicians. Nobody's doing studies on it. They're just trying things. And so this doctor took a protocol that we use for adoptive parents to induce lactation in herself. And so I really dug into that. And as I dug into that, there was a research project we did through Emory, which was are people seeking this. So we did a study in Argentina at a WPATH conference, the World Professional Association for Transgender Health, to see across the world. Are people being asked about lactation services? Because from my experience, Trans women didn't, they were so excited to have the hormonal changes that they didn't even know it was possible.

But what a feminizing experience to be able to breastfeed your child. It's so affirming. And so we asked, and there were people across the globe who had been approached about this, but nobody knew how to do it. So we found the need and then I became a speaker about this. I did all the research and the people are like, Oh, you need to talk about how this is done.

And there aren't a ton of studies, but what I have found is that it has to do with the estrogen effect on the breast tissue and how it matures almost like puberty later in life. So when you have a trans woman going through that hormonal transition, it does make breast tissue grow, but it grows in a way that is specific to make the physiology of milk making work. So I call it the building blocks of milk making, if you have the right building blocks, including that tissue that has been stimulated by the estrogen, it's possible. And so a lot of people have been trying it. There's still, room for protocols to be built.

A lot of people are still using the old protocols for adoptive parents who want to breastfeed, but super cool that it can be done and it's coming along.

[00:12:07] Ty: I had no idea. That's absolutely fascinating.

[00:12:10] Dr. Braden: Yeah. Yeah. A lot of people don't know, even the trans folks don't know. It's really cool though.

It is possible.

[00:12:15] Jared: Yeah. The human body's incredible. And so I also really want to talk about Lybbie. And what is Lybbie's origin story? What was the unmet need? How did you identify the unmet need that you ended up tackling? And I know you've gone through a couple of iterations of it by this point as well.

And yeah just give us the whole low down.

[00:12:33] Dr. Braden: Ooh, yeah. Okay. I'll try to not bore you too much. It's a very long winded story too. I already said I was a new faculty member at Emory and, when I was taking on all these projects, but this was one of those things. Somebody's Oh, Georgia Tech has this program with students.

And if you have a med device idea, they'll fix it for you. And I was like, sweet. I was pumping with my third kid. I'm like, breast pump sucks. Somebody's got to fix this. I got an email from Georgia Tech saying, Hey, if you have a med device idea, submit it. So I submit and they're like, come on in and talk to us.

So I come in wearing my nerd doctor coat. I was late. I didn't know where I was. All these like glass buildings, very fancy Georgia Tech stuff. Forgot my laptop, but I throw them together some PowerPoint to tell them about the problem. And they were like, this is great. You should do this. You should keep going.

And I'm like, awesome. Where are the students? And they said, What students? You applied to the wrong program. I was like, wait, what? So I thought I applied to the capstone project to be one of those mentors. I had applied for the Coulter Foundation grant funding mechanism, which is like shark tank for grant funding.

And they're like, you're perfect. You'll be great. And I'm like, I doctor, I don't build, I don't business. I don't think I can do this. They're like no, we're going to do this. And but they pulled me in by offering me free classes. They're like, we will sit down with you every Wednesday for a year to prep you for next year's cycle.

Cause we think you have something here. You don't have to get an MBA. We'll just show you. I'm like, hold up. You're going to give me free classes? Okay. So every Wednesday morning at 10 a. m. I just went over there and had, all these lessons about how to commercialize a med device idea, and I just felt so grateful that people cared enough to teach me these things.

It was really exciting. I'd never tapped into that side of my brain before. And that turned it, they would tell me what grants to apply for. I'd never even applied for a grant. And I got all this grant funding, started trying to build a wearable breast pump that was built into a bra.

And the concept behind this was really the pain point that I saw as a breastfeeding medicine specialist was that people knew what to do. The recommendations for increasing your milk supply is to pump more frequently, express more frequently, match the signal to the baby, but for working people that is really impossible because you have to take time and go somewhere and pump and the process is really cumbersome, it's almost impossible to ask people to do that, so I was like, I want it to be set it and forget it, put it on, it's none of your business, people can do it whenever they need to and we went through all that iteration and everything, and then COVID hit and all the grant funding dried up and I was called at the frontline for God knows how long, I didn't know if we'd make it after that.

And we were still under the umbrella of the university. And then Emory was like, Hey we want you to go to Berkeley Skydeck program as a university partner. We're piloting a collaboration here, go out there and see what it's about. And it was virtual. So I was able to do it. It was really intense.

I thought it'd be once a week. It was like every day, lunch and dinner for five months. But it was amazing. And I think it was amazing for two different reasons. One was I went out there looking for a CEO. I was like, I'm a doctor. I cannot be my own CEO. Everybody in Georgia told me that I needed somebody who looked very different from me with a lot more gray hair and different body parts on them, to be able to successfully run a company. And I went out to Berkeley and all the people were there like, I'm sorry, what? Like, why would you not be the CEO of your own company? And it was the first time, I had representation where I actually believed I could do it, which again, shocking, as a successful woman in this field, I felt like I just never thought that I couldn't do things, but I didn't even realize that I had drunk the Kool Aid about being in this world.

I felt very out of place, being an Asian woman who was younger than everybody trying to start a company with no business background or engineering background. And so Skydeck gave me the courage to take this on my own and do it fully and commit to it fully. The other thing I got out of Skydeck was the product market fit.

And what I mean by that was we knew it was a problem with trying to meet the recommendations that people like me give out, but what I figured out there was that it's not just that it's a milk supply issue. Everybody has what's 80 percent of moms have what's called perceived insufficient milk supply, which is I think of it like food scarcity.

You are very concerned that your milk is not going to be enough that you're going to run out and it is almost universal. We've done our own market surveys on this. And there's a lot of research pointing to this is a problem. It's a perceived insufficient milk supply. But the interesting thing is it's not actual insufficient milk supply.

It is the number one risk factor for actual insufficient milk supply. So it's almost a psychological thing that we're trying to solve. So what Lybbie is doing now is we're trying to build confidence, build confident breastfeeders. And I read a book recently that talked about, it was this great quote.

It said, confidence is knowing what's true. And I just, that really resonated with me because I feel like that's exactly the problem. People who are trying to make human milk and make it the only food source for their babies don't know what's actually going on inside of their bodies, so they can't be confident.

And no matter how many times I tell people, come in, let me weigh your baby before and after a feed, and you should be reassured by the number of diapers or the milk that's pumping out, no matter what your stressors are and how that affects your milk supply. It's not working. It's never worked. People are very anxious about their milk supply and they're already investing in it with all kinds of things that don't work.

So we realized that and we said, there's a preventive piece here. So we developed an app to really try to work on the behaviors, like building good breastfeeding habits. And then we decided that we scrapped the whole, breast pumping bra because it was almost like building a dialysis machine.

It was really complicated. And there were lots of pumps and things doing that already. And we're like, what would be more accessible to everybody? What would actually give people the information they need and get ahead of this problem? And that's when we came up with the sensor idea. Like we built a sensor that helps you determine milk production and what's going on dynamically throughout the day, any time of day, almost like an Apple watch with your heart rate, you can check it anytime.

So with Lybbie's sensor between that data piece and building that in, through an AI powered app, we can actually take that data and interpret it and individualize the experience for each breastfeeding user so that you can meet your own goals and really decrease the anxiety around that.

[00:18:48] Ty: Just to dig one more level, like where is the sensor in the whole production process?

Is it like measuring like what's get pumped and expressed or like

[00:18:58] Dr. Braden: In vivo. So it actually sits in they're like dual transducers that sit on the skin. And , the only thing I can think of is like an Apple watch, but it just sits on your skin. You can wear it all day long continuously.

And at any point you can turn on your app and find out where you are compared to your baseline. So there is like a setting period at the beginning to calibrate because everybody's milk capacity is different. And not everybody wants to exclusively breastfeed or can. And so it helps you maintain, maybe you want to be 50%, but

the real problem is the loss of milk supply, that people see, or maybe they don't even build it up to the point because they don't know how frequently they need to empty and it really brings in the maternal health aspect. I think that's been left out of the conversation for a long time.

Obviously, I'm a big fan because that's what I do. I know the person who makes the milk but if you look at the whole lactation field, it's focused right here, it's right here. These two parts should be able to just push them really hard and it should make the milk, which just leaves out the whole person who is trying to make the milk.

And there's been a lot of conversation about the baby, feed the baby, you're a failure if you're not feeding your baby. But what about all of the other pieces that go into the person who's trying to make the milk? So we're able to use technology now to take all these data points and actually do something with it.

So it's not just. anxious tracking of all the parameters and trying to figure out what those things mean, we're giving it to you in the palm of your hands for less than the cost of one lactation consultant visit, which I think brings a lot of value and accessibility to people.

[00:20:24] Jared: That was going to be actually my next question is, does this affect people from various socioeconomic statuses and also for people that are maybe lower on the socioeconomic level area, like what is the outcomes that they typically experience that maybe people in the higher end don't have to experience or they don't have to worry about as much.

[00:20:43] Dr. Braden: Oh yeah. It's there are huge disparities. I've always worked with populations who are underinsured, uninsured and don't have access to a lot of the fancy new pumps or things like that. And maybe don't have maternity leave. Only. 25 percent of people actually get more than two weeks of maternity leave here.

And that's not nearly enough time to be able to build up milk supply. And it's not that they don't want to, I've spoken with my patients about this before and they're like, I know I would love to breast feed exclusively. I believe in it, but I work here. And I'm telling you right now, there is no break.

There's no protective space. There's nowhere I can do this. So I might as well just give up. The other piece that we see, we see very low breastfeeding rates in certain populations. It definitely is amplified and marginalized communities due to medical and systemic racism and social racism. But what we see is, I'll give you an example.

One of the hospitals I worked at, we did a study on, why the breastfeeding rates were so low in this population. And what we found is that, there are lots of factors, but one of the major ones was that we have WIC, which is Women and Infants, Children's Fund. It basically helps provide nutritional supplements for young families.

WIC would give formula so people would get, a pantry full of things and formula. And we know on the breastfeeding side with the WHO and everything that there is this marketing aspect with formula that decreases people's confidence with breastfeeding. It's been played out many times.

And so we know that giving people formula will actually decrease their ability to breastfeed long term. However, here we have this federal system that is giving people what they need, food, if there's food scarcity. But what the patients told us and what they learned is that if they say they're exclusively breastfeeding, they are not able to get any formula and formula is very expensive.

So they don't have any backup plan. And so if it doesn't work out, and let me tell you how hard it is to get in with a lactation consultant. If you don't have a car. You don't have a ride, you have to work, you don't have childcare, there's so many barriers to overcome just to get to see one person and time is of essence, if you don't see somebody in a timely fashion when it comes to milk supply, it adjusts within days.

So if you start losing your supply, it's game over, it can happen very quickly. So what we're trying to do and where we're addressing is giving people access on their phones. Almost everybody has a phone giving them an intervention that is achievable. And, will be covered by insurance someday.

And then, helping people get quality information, evidence based information. So they don't have to ask all their friends and, their mommy groups and everything. You have a trusted source to go to, but ultimately it comes down to choice. And I think at the end of the day, Lybbie is all about giving people choice about how they feed their babies by giving them information about what's really going on.

And I think of it like when I do surgery for people, I do an informed consent, which basically means. I tell you everything you need to know, but you always have a choice to do what you want with that information. And right now, a lot of people don't breastfeed for the long term because they don't feel like they have a choice.

[00:23:43] Jared: You also touched on another thing that popped into my head, which was around reimbursement, or is it going to be covered by insurance at some point? And I feel like that would open up access to a lot of people. Where are you, as far as getting approved for that? And how long do you think that's going to take?

[00:23:58] Dr. Braden: Yeah, it's you know, there is precedent there. However, even with federal law, this is a much bigger problem. We have trouble even getting lactation consulting services covered by some insurers, even though it's supposed to be, many different laws say that, but there is a state regulation.

It depends on the insurance plan. It depends on the size of the employer as to what's covered. So people are really trapped by whatever insurance they have if they have it. That being said, we know that a lot of the high tech lactation companies, Willow, LV, things like that. Came to market first and created that demand before they started seeking insurance reimbursement, which is probably the same path that we will do.

And technically breastfeeding supplies are covered by the ACA which includes breastfeeding bags, but a lot of people don't know this, so any support supplies should be covered. There is of course, a process to go through to, prove that it is a breastfeeding supply, but if the bags are covered, I don't think it's a huge leap, for a monitor but you never know when it comes to breastfeeding.

So I think there's hope. I think one really nice thing is we have access to lobbying capabilities. And we really hope that collecting the data that we'll have, we'll be able to make some really impactful change because there's so much white space in the postpartum space. I think that having this information is showing that this does impact maternal health and infant health as well.

And societal health could help make those changes and get things covered, across the board for lactation.

[00:25:22] Jared: And also just out of curiosity, you mentioned how hard it is to get a appointment with a lactation consultant. Is there a shortage, you could say, like the nursing shortage in a way, but there's just not enough of them to meet the demand that people have.

[00:25:34] Dr. Braden: I'm not sure it's so much a shortage. I think part of the shortage might be a lot of lactation consultants are independent consultants. And so a lot of them are cash pay. It of course takes some off the top and takes away some of their autonomy to partner with groups that take insurance.

So they do have choice as to which clients they take. I would say there is a lot of space for connecting the dots in this postpartum space, even today, I'm asked who's a good lactation consultant? And there's no go to place where there's a clearinghouse of these are good lactation consultants.

These are the people we should go to. It's all word of mouth. We have virtual platforms now too, like the Nest Collaborative, who's one of Lybbie's partners. And they've made accessibility really easy. You can make an appointment same day and they take care of all the insurance paperwork for you, which has relieved a lot of barriers to trying to get somewhere where there is qualified lactation care.

But I'd say it's getting better. But people often don't know where to go. They go to their doctors first. Their doctors may not have a lactation consultant they know to go to. So I would say it's just spread out and all depends on where you live and how much money you have, because depending on where you live, it may be cash, maybe 150, 200 and upwards of that for even one visit. And usually you need more than one. So it's unachievable for many people.

[00:26:46] Ty: One more before is I'm just curious about how you see the like marketing channels for Lybbie. Is it the location consultants or how do you see, cause new mothers, your market is constantly renewing.

So like, how do you see the pathway for it.

[00:26:59] Dr. Braden: Yeah. And everybody asks me that too. They're like obviously you're a doctor. You should go through the doctor channels. Why aren't you B2B? And I'm like, you don't understand. These people do not go to their doctors for this stuff. They go to TikTok influencers.

They go to mommy blogs. We've done some market research on this too. I'm like, what made you make that purchase? And they're like, I was just sitting there and, like this one company said, they'll throw in this product with that one. And so that's how I got started on that brand of breast pads, because there's co marketing with other people in this space.

So that's one way we have already established a lot of partnerships in the postpartum space where, we'll package things together. Of course, the medical piece is there, with that influence, and I'm sure, hopefully by word of mouth and by expertise, it'll go out in the professional fields.

But really, it's a grassroots effort. To be honest we have consumer partnerships. I think there's certainly a role for B2B in the future. Once we have that insurance coverage and it's something we've talked about with some of our partners already, but the initial go to market really is to, find.

The influencers, do lots of social media and get on the rankings and have people talk about it because that's who they're going to, that, and I know it as a mom I, I'm a doctor and I still call my best friend about these things it's the village, it's the village, it's human,

[00:28:13] Ty: yeah, absolutely. It makes perfect sense. We had Dr Goudy on the podcast. Oh,

[00:28:17] Dr. Braden: yeah, I know him.

[00:28:19] Ty: Yeah, and and I think he uses similar channels for his baby product. Absolutely.

[00:28:26] Jared: Yeah, you got to go where the attention is and sticking on the topic of maternal health. You're also an advisor to Couplet Care.

And so how did you get involved with Couplet Care initially and what drew you into their mission?

[00:28:39] Dr. Braden: Yeah, specifically to Couplet Care, they reached out to me. I believe it was on LinkedIn or something. And I recognized the founder's name, Kristen Tully. I'm like, how do I know her? So we had a zoom meeting and when she said her name, I'm like, I think I met you at an Academy of Breastfeeding Medicine conference.

I think it was maybe my first one. I went by myself. It was where I felt like I finally found my people, like I'm not the weirdo crunchy OBGYN anymore. There are many of us out there who care about this. And we got to talking because she was in North Carolina. I knew one of her collaborators there and that was it.

And then when we started talking via zoom and they were, trying to build their advisory board, she told me where she had done her postdoc and it was with James McKenna's lab in Notre Dame. And I about fell out of my chair because I have been stalking that research for so many years. And I, as a mother appreciate the work that she did that nobody else has done around co sleeping and safe infant sleep with, what is physiologic sleep?

And she has that early work. I know it's not what she does right now, but for those of us who care, it was completely life changing for me to not feel like I was crazy for wanting to do what was physiologic. And I think many moms feel that way. It is so hard to, do extended breastfeeding when you're exhausted and you're trying so hard to do all these recommendations and keep your baby on a flat surface with nothing and, but the only way you both can sleep is to be together.

And so her work was about what happens physiologically when a mom and baby or a couplet do co sleep and what are the physiologic things that happen? And she recorded it. And it was so eyeopening and, affirming to me to what my experience had been. So as soon as I realized that was who that was, I was like, Oh, I'm in whatever you're doing.

I am in, I know we believe in the same things. And then she told me about the Couplet Care product and. It just made so much sense and it was so fitting that it was, of course, Kristen Tully developed this. It makes so much sense.

[00:30:35] Jared: Also just real quick what are the physiological things that happen that I don't think we've ever had anyone talk about that.

[00:30:40] Dr. Braden: Oh yeah. Oh my gosh. It's so cool. What they studied was, they didn't give any guidance, they just put cameras in the room and watched as, mom and baby pairs fell asleep and they measured CO2 because, the thought was you're going to suffocate your baby if you sleep. That's the fear mongering that happens with all this public health stuff is, something bad is going to happen is going to be all your fault if you do this, so you better not.

But what they did was they created that safe sleep environment, which, typically is no pillows, blankets. Low surface, and then what they found was the mom formed like a C around the baby. So they almost always slept on their side and that baby sat in the middle of the C.

And what they found was that actually the mom is breathing out CO2 and the baby's breathing it in, which you think would be really bad. The baby needs oxygen, but that actually helped keep the baby more alert. So what we do know about SIDS, we know that exclusive breastfeeding is correlated with a decreased risk of SIDS, but nobody really knows why.

And we know that formula has a slightly increased risk, but we don't really know why, but there's some evidence with pacifier use and with formula. They all kind of point to the heavy sleep that's happening when the baby's in the crib, formula is harder to digest. So one thing with breast milk, it goes through really quickly.

So yeah, you're up all night feeding because it goes through really quickly. That's how it's designed. But the baby's more alert and then the mom's more in tune with the baby. And then the CO2 that the baby's breathing in, the mom's breathing out actually also keeps the baby more alert because they have to breathe it out too.

So it's actually an alert thing similar to pacifier use. So we actually, pacifier use has swung back and forth over the years, but now the stance is it should be offered at sleep times because it was associated with a decreased risk of SIDS. And what we think is happening is that the baby is suckling all night and it keeps them more alert.

And it's very confusing for the public. I remember with my first baby, I was like, I can't, is it bad? It's bad. Passifiers are bad. I'm not going to use them, but I didn't know why. And all of that work came together to really show somebody designed a beautiful study to see what happens.

And the other weird thing about being in the U. S. is other countries don't do this. Why is it okay in another country to co sleep, safely? Why are they educated about this and we're not? It seems like a bit of a disservice and kind of an unrealistic expectation, to be honest. If we are saying you need to breastfeed for the best benefits for you and your baby.

But we take away all the things that would make that possible. What are people supposed to do? They have no choice. And so we're approaching similar problems.

[00:33:06] Jared: That's fascinating. I've got a baby niece in my life and they're going on about the pacifier debate also.

So this is, I'm going to put it there. I'm going to take a little clip of that and show it to her. There you go. You're welcome. And so also if we could just talk a bit about maybe your own birthing experiences and maybe how bassinet could have played a role in your postpartum experience.

[00:33:27] Dr. Braden: Oh, yeah. I actually was talking to a colleague earlier today about this and, every time I meet a new person who's in this field, we have to share our birth stories and, again, I think it's the village. It's normal. But when you hear that somebody also did not have the dreamboat experience, it's really healing to be able to share those stories and understand that it's not just you.

And so with mine, I was a resident. I was making a joke of everything because I was like, Oh, yeah, I'm going to, we were like, Oh, It was awful back then, like we would make fun of people with birth plans and be like, they're totally getting a c section. You bring a birth plan, you're getting a c section.

That was just the culture. I would like to say that I've changed my mind about that. I had a birth plan with my last baby, but back then it was like, not cool, for us. So I was like I'm going to have a birth plan and I'm going to say only med students can come in the room.

Like I made this big joke. Everybody has to do a cartwheel to come in. I don't want Enya. I want salt and pepper. I want Push it. I need energy like a pep rally, and I was having a blast. So I, even though I said, I'm, I'm too cool for a birth plan. I had expectations.

They were not the woo, Enya expectations, but I had expectations for birth experience that were not met and It took me about a year to talk about my birth experience with a healthy mom healthy baby Everybody was fine to be able to talk about that without crying. It was so hard and I didn't know why you know, everything on paper was great.

I came in, broke my water. Everything went really smoothly, but there were little things along the way, little bitty things. And when you're in that vulnerable place and it's the first time you've been hospitalized and you're scared for your life and your baby's life, everything is magnified.

You remember every single little thing somebody says. And there were a million little things that happened that made it, overall, I'm like, I have a beautiful, healthy baby. Why am I so sad about this experience? So if I take Couplet Care's bassinet, that would have been huge. I think one of my big.

It's interesting being a physician, having a baby, because I guess everybody assumed I already knew what I was doing, so I didn't. The miss there was that nobody educated me, and they're like, oh, that's wrong. And I'm like, I've been breastfeeding for 12 hours, and now you tell me I'm doing it wrong?

Like, why didn't anybody teach me this? I was just flabbergasted at the lack of support, that everybody assumed I knew what I was doing. And I, felt really guilty that I should have known what I was doing. And, I remember when Kristen told me about the videos she took coming up with Couplet Care and she showed me some, she's one of these ones was just, Oh, we all feel it.

Those of us who have been there, we feel it when the mother is calling for the partner in the room to help her. And she ends up taking a pillow and chucking it across to hit the person because she can't wake them up. The expectations we have for birthing people to just bounce right back. We take care of the pregnant person like nobody's business.

Soon as that baby's out, you better get back to work and you better, suck it up. Your pain is not real. All of those things. And I think a lot of us have felt that. If I think of my postpartum experience, I was reeling from that. I did this wrong already. I'm a terrible doctor and a terrible mom.

Great. Started off on the right foot. The bassinet itself, the way it's designed. It makes so much, I don't know if your listeners already know the design, it swings over the bed, just like the food tray, like we've had food trays forever that are accessible to people sitting on hospital beds, but the bassinet, I'm really short, I'm 4 foot 11, like trying to get myself up with my ice pad and then, the little meshy undies and just mess everywhere and I can't even walk, my epidural's wearing off and, but I gotta pick this baby up that I can't even reach.

And put her on me, but God forbid you fall asleep with her in the bed with you. Which is where she wants to sleep because she's crying over here and I can't comfort her. And the hospitals really freak out about having a baby in the bed. It's a huge liability. Or you could drop the baby if, like I've had friends who've dropped their babies.

It's horrible, but you're on these medications, you're exhausted and nobody's really talked about what can we change to actually support people who are going through this versus this is, I feel like this is a women's healthcare overall. I could have a whole podcast on this one, but we are just like, this is just how it is.

We're women. And this is just how people take care of women. And we've accepted it for so long. And public care has come around and been like, nah, there's a better way. And how about. Why not? Why can't we make this a little bit easier and more physiologic? A lot of people have to deliver in hospitals and don't have the option to deliver outside of a hospital.

But how are there ways that we can help people who are struggling with getting their bodies back and, understanding how, learning how to work with this baby. And yeah, I, all of that to say, it would have been really nice that teeny bit of extra support with my first baby.

[00:38:03] Ty: I'm glad you used the food tray analogy, because, that ease of being able to bring the bassinet to you, I think we've made it easier than a food tray.

[00:38:13] Dr. Braden: Oh, yeah. That thing's clunky, and you gotta adjust it up and down. It's, maybe there are fancy ones that are easier, but Not in my experience.

[00:38:20] Ty: Once it's positioned next to the bed, hopefully mom can just easily access, be able to access her baby and then set aside or cuddle with it as, during our formative testing, we saw a lot of different just like possible configurations to make it just that much more accessible and easy.

[00:38:36] Dr. Braden: Yeah, I love it. Great. Great work.

[00:38:38] Jared: You brought up an interesting point also just about like how the mother's pain is discounted to some degree. And I remember with my sister in law and she had a C section and the nurses were just totally downplaying like her, like the pain that she was in.

And in my mind, I'm like, how is she not in pain? The incision is just incredible. Like how are these nurses like, Oh, just, like it just was, it felt so toned down. And I'm like, how is this? I'm not seeing outsider and I don't understand it. It's a big surgery.

I feel like I'd be in tons of pain. I don't know.

[00:39:10] Dr. Braden: It's culture is hard to change. And, I think there is this whole other conversation. It's coming up in the conversation of systemic racism in the healthcare system because it affects people of color more than, white people traditionally.

And so we have seen over and over again, the evidence of how people are treated when they say they have pain. And there are a lot of biases, implicit biases that come into play about, people will make that snap judgment about you. And all of us, I think it's been really hard as an OBGYN to understand that I was complicit in this.

I think we're all grieving that we were taught this and we believed it as fact. And we didn't even realize we were doing this, but it's a huge piece. And I think it requires a lot of rewiring of brains of people in the healthcare system, a lot of consistent training year after year about bias and systemic bias and how this affects the care of patients.

And, for me, it's, I guess my approach is more like you, of course you're in pain and to not try to tell people what they're feeling. And as physicians, some of that was in our training. We were trained to be like, we're the doctors we know best. tell them what they're feeling.

And it's very cringy now to think that was the mindset. Even as a woman, I did the same thing to myself. I remember one day being at the nail salon and, they put the little hot towels on your legs and my legs were, my skin was burning and I did not want to inconvenience that person by telling them, that they were burning my legs and it was a very eye opening moment.

I'm like, what is wrong with me that I would much rather suffer in silence than to feel like I'm inconveniencing somebody I don't even know, but it's not just me. It's a lot of people. And time over time, this is just how it is. Look at a lot of in office procedures for OBGYNs.

There's a lot of conversation on TikTok about that, about minimizing women's pain. But it's real.

[00:41:00] Ty: I was wondering if you could react to a statement that was made that, like the existing bassinets are fine because women who have had a c section, we need them to get out of bed anyways. For part of the recovery. So this isn't really an issue.

[00:41:14] Dr. Braden: Like many things in medicine, I'm like, but why not make it easier?

[00:41:18] Ty: Yeah.

[00:41:18] Dr. Braden: I feel like this is how we get stuck in our ruts in the way we do things. And this is why change is so hard because everybody immediately says no, because it disrupts the flow.

But a lot of these fears, I feel like, could be just turned on their heads when you, how about let's think of, instead of thinking of all the reasons why not, change our mindset to, how could we make this better? There's so many ways to improve it. And just because you have a bassinet, that makes it easier for you to, to postpartum, doesn't mean that your patient's not going to get out of bed.

Our container is big enough for both. We can do both.

[00:41:51] Jared: Sticking on the postpartum care side of things. And so one of the big pieces of the bassinet is being able to reach in and see, grab their baby and establish breastfeeding. And so maybe if you could talk to why that's actually so important.

[00:42:06] Dr. Braden: Yeah, this has existed in NICUs for a long time, the ability to reach in to the bassinet, for babies that are separated from their parents for long periods of time, and maybe they're too small to even do kangaroo care, but we have documented data saying that the physical touch the touch is so important for regulating the baby system as they're transitioning to this world that we're in and we know it in the NICU setting.

It's not something new, but for whatever reason, it has not translated into, everybody's we'll just do it. Pick up your baby, but don't sleep with them. Pick it up. And so as far as establishing breastfeeding, I think in the immediate postpartum period, there are a lot of studies that came out showing that there were many things that we were doing in hospitals that were unintentional barriers to establishing breastfeeding.

And that's where the 10 steps to breastfeeding care came out several years ago, probably two decades now. And they came from the WHO, the 10 steps to breastfeeding. And a lot of them had to do with protecting that time right after the baby's born. And one of the things is skin to skin. And so what we know about skin to skin is that when the baby first comes out, it regulates their heart rate.

It regulates their blood sugar. It colonizes their skin with the mom's skin microbiome, if you will. And the same thing with breastfeeding, you're colonizing the gut with that microbiome. So you're getting the baby into physiologic space. Think about it. Babies have been born for a long time.

This is how it's done. You watch any mammals, this is how it's done. There's a deep connection that has to be there and it helps with the mom. There's so many cool ways that having your baby on your chest actually helps with the healing in the postpartum space. So one of the things, if you've ever seen the videos of the breast crawl, you have to watch it.

It is the coolest thing. The breast crawl in a normal term, healthy infant is something that in some communities, as a tradition, everybody stands around and watches the baby find its food, just like a little puppy. It is the craziest thing, but it is so cool. So babies can't see a lot, but they can see the dark and light, the contrast of the nipple areolar complex and the rest of the breast tissue.

They also can smell. And so when they're laying skin to skin they physiologically adapt that and they start getting hungry. So you'll see signs that they're ready to feed. One of them is you'll see them start to drool and then you'll see them tongue thrusting. And then what's my favorite part is that they actually crawl.

So their little feet line up perfectly with the fundus or the top of the uterus, which is, expanded cause the baby just came out. So one of the jobs that we have in the hospital or anybody who's had a baby, we massage that muscle down and try to get it to involute to prevent postpartum hemorrhage.

The baby's little feet are also designed to do that for the moms. So when they're laying on their bellies, their little feet kick on the fundus, helping to involute and prevent postpartum hemorrhage. Likewise, nursing can decrease postpartum hemorrhage as well because it releases oxytocin, which is the medication we give to cramp the uterus which decrease, and when there's a postpartum hemorrhage, we give oxytocin, but the baby is able to give that to the mom.

And then the crawling piece, they have just enough musculature in their necks to pick up their heads and they bounce. You have to aim them a little bit, but they bounce until they get right there. And they can get really close and try to nurse on their own if you let them. So the videos are cool because nobody really touches the baby.

They're just watching and waiting on the baby to go find its milk. And many people do this in other countries. It is, I've done it with a few of my kids because it's just so freaking cool. And that babies know to do this, but it's very instinctual. And back to Couplet Care, the closer we can keep that bond, the easier it is to regulate those systems.

You've got a brand new baby who's new to this world. You've got a brand new parent who also is new to this whole sleepless. We have to sync up the sleep cycles. We have to, figure out hunger cues. This is another 10 steps to breastfeeding is rooming in. And so rooming in is the practice of back in the day, back in my day when I was a baby, there was a nursery.

And you would send your baby off to the nursery and stay there overnight. And they would give formula because we thought that was better back then. And then you'd come back when it was convenient. And now there's been, especially in baby friendly hospitals. You room in the nurse takes care of both mom and baby and the nurseries, a lot of hospitals have gotten rid of the nurseries and there is some interesting historical context there too, because I don't know if the nurseries were invented by the formula industry.

They would come in and fund the redesign of labor and delivery units. To build nurseries so that people could feed formula to the babies. And it's pretty disturbing actually, if you look way back in history, like a hundred years ago, when this started it's really impressive how that marketing has affected.

For this long, how it has affected our ability to get back to physiologic feeding. So rooming in as a way that we can help. And this bassinet helps regulate and help the mom and baby be able to get their systems synced up because it's that supply and demand that keeps, it gets the milk supply built up and regulates and make sure that you're feeding your baby enough.

And so it does make that process a little easier. If you just, I call it the open buffet. When you're trying to build your milk supply, open buffet. Just let the baby have it. You are the pacifier. And that's, it does all the work for you. You don't have to pump. Like the baby will do all your work for you and get your body caught up if you let them, but we have to remove all the barriers that are in the way to the baby doing what it needs to do.

[00:47:21] Jared: I appreciate this masterclass you're putting on right now.

[00:47:23] Dr. Braden: Thanks for coming to my Ted talk.

[00:47:26] Jared: Definitely planning on having our family in around three years or so. And so we're going to be going back to this episode, taking notes.

[00:47:33] Dr. Braden: Yes. Yes.

[00:47:35] Jared: If you could boil down the benefits of essentially integrating the bassinet as a standard of care to what's the main benefit for the mother, the main benefit that you would say for the baby, and then the main benefit for the hospital system also, because I think like this probably benefits the hospital to some degree.

[00:47:51] Dr. Braden: Okay let me start with mom because that to me, that's the most obvious one and probably the area we have the most need, maternal health. It's maternal health month. We have a lot of work to do. There's a lot of funding going there, but nobody even knows where to begin, and I think the gap that people are seeing now is the postpartum space, and it starts right there in the hospital, or wherever, you would need a bassinet and any little extra bit of support to make it an easier transition for a mom and, it seems so simple, but it's actually simple and elegant to just make it easier for her to hold and touch her baby.

That's huge. Yeah. Think of c sections, one of the huge traumatic pieces for people sometimes when they have an unexpected c section is they don't get to bond with the baby immediately after, that they don't get to do that skin to skin and it's an access issue. They just can't.

Or, maybe they can't hold the baby on their chest. I could even see this in the c section room, bring the baby over so the mom can touch the baby while she's finishing her c section, but there are so many little things that would help with the experience. And I think it's come to light that the experience is very much wrapped up in maternal mental health. And even if you're like me and you think the experience is a joke and that you don't need one. I also needed one and I didn't realize it until after the fact. So I think the 1st maternal change would be honoring that experience and if this is something that would help, why not?

And then for the infant side, I think it's a little fuzzier there because, it's in a bassinet here or there, but I think it comes down to the physical touch, the calming the baby piece can be really difficult if you're like trying to go over a bassinet. And I think I would probably have to raise my bed way up to even be able to reach the baby.

But anybody who's had an infant knows that trying to get the baby to sleep when they are brand new to this world and, try a swaddle and they can't even pull their hands out. It's to be able to touch the skin of your parent and hold that hand is huge. That goes a long way. And even if the baby's not hungry, you just fed the baby, trying to get the baby to sleep in that bassinet can be really challenging and without any, fluffy things in there because those are not allowed either, but that hand, huge, that human touch is huge for regulating the baby's nervous system. And then as far as the hospital systems go, what I'm seeing now as a hospitalist is people are going to where they feel more supported.

And I'm seeing a huge wave of change where moms and birthing people are like, yeah, I don't care about what insurance you take or don't take like they will sometimes get their prenatal care completely with a practice, but they don't want to deliver at that hospital, and they will go to another hospital, just to have the better birth experience.

And I think the word is out. People are saying no to these rules that we've put on them from the insurance companies and they're like you know what I don't care, because if I come in through the emergency room, I know you can't send me home, but people are doing that. They're choosing places to deliver because of the reputation, because of the support that they're getting, and I know it's not just my hospital.

I am seeing it, throughout the country at other hospitals too there's a movement for people who have to deliver in a hospital. There's also a movement towards community birth, but for those who want to go to the hospital and don't want to go to the hospital where their doctor delivers. This could be a huge benefit to those hospitals.

Like people who are trying to market the space and that they are the most supportive of moms and babies. That's a huge selling point.

[00:51:11] Jared: Yeah. That's a way to back up the brand promise of saying that we are a baby friendly hospital. We'll prove it that,

[00:51:17] Dr. Braden: yeah, exactly. Baby friendly really should also be mom friendly.

And that's been the critique all along.

[00:51:22] Jared: And I guess, we're really up on time here. And so just to finish things off, just what excites you about the future of care for mothers and infants and, throughout your career, I'm sure you've seen quite a bit of change. And so what excites you about that direction and what's driving your passion today and then also what's next for Lybbie.

[00:51:40] Dr. Braden: Yeah, the thing that excites me most, I think I can feel the change coming, I told you 10 years ago, I was like the weirdo, like I was the only person who actually really cared about a birth experience and I had to keep it quiet. And I feel like more and more women who are entering the medical field actually are coming together and sharing their stories and their voices and normalizing the fact that this needs to be a priority in healthcare. And so the more of us who move up into leadership and into the medical field, the more supported the birthing people are when they come in to have their babies. What excites me? I think this year this fund out of the white house from, there's the women's healthcare sprint that just came out.

Jill Biden pushed it through the white house for so long. It's been a real problem getting investors on board with funding women's health because they're like, Oh, there's no data, no research. But nobody would fund the data or research. So everything would go towards, Viagra and things like that.

But the white house recognized this and they partnered with a fund that is giving out a hundred million dollars to startup companies to try to make these companies, de risk companies enough so that they can improve women's health. So I love seeing. You know the priority behind that. The NIH is announcing a new, arm of the NIH for funding in this space.

So I think once we get the government on board, hopefully investors will follow. I'm seeing a lot more interest in the investor space as well. And I forgot your last question, ,

[00:53:01] Jared: I don't know if you remember it, what's next for Lybbie? And it also is relevant to a quick question we got in the q and a, which is what are the next steps do you see for the app and sensor?

And how long do you use the app after weaning?

[00:53:11] Dr. Braden: Yeah so next steps for Lybbie. We have just, we're actually getting the final wireless prototype today. And so we do have a provisional patent. We are about to start our next race again. So June 1st, we are starting an angel round. We have also applied for the ARPA H funds.

So that would be 3 million. If we get that we're good. We don't need any investor funding. If we get that we can go to market. We're looking at a 12 to 18 month runway. Basically we need to duplicate the device where it is, so we can get to a design freeze. We anticipate with enough funding, it really shouldn't be that long.

We don't have to go through 510k clearance fortunately for a wearable and then as far as how long you would use the app. We are guesstimating and all of our projections are based on, current breastfeeding usage rates, which, we're guessing people would use the app about six months.

But I anticipate that once this gets out there, we'll probably see a lot more interest in long term use because there are a lot. We've normalized breastfeeding for longer periods of time and at six months when people are introducing solid foods. That brings up a whole new slew of questions of what is normal with my milk supply?

So I personally think there's utility past the first and second year. Now AAP has recommended, that people can breastfeed two years and beyond and have lined up with the WHO recommendations there. And so more and more people are doing it. So I think there is utility past the six months. I'm just being a little conservative with my projections.

[00:54:32] Jared: Absolutely. Dr. Braden, thank you so much for joining us. Thank you for being a catalyst of change in a space that desperately needs it. And just good luck to Lybbie and also Couplet Care in the future as well. Thank you so much.

[00:54:44] Dr. Braden: Thank you for having me. Have a great day.

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