What is Couplet Care and Why Does it Matter for Moms & Babies?

[00:00:00] Jared: Hello everyone and welcome to the medDesign podcast. Today we're honored to have Dr. Carl Seashore with us. Dr. Seashore is a professor of pediatrics in the Division of General Pediatrics and Adolescent Medicine at UNC HealthCare. With a deep commitment to quality improvement and informatics, Dr. Seashore has been instrumental in advancing newborn care. As the Director of Informatics for Children's Services, he leverages technology to bridge the gap between best practices and practical care delivery. His extensive work with the Perinatal Quality Collaborative of North Carolina has led to significant improvements in care for newborns, particularly those at risk for neonatal abstinence syndrome, and sepsis.

In addition to his clinical and informatics roles, Dr. Seashore is an advisor to Couplet Care, a pioneering startup focused on enhancing newborn safety and care. He's been pivotal in the development of their bassinet, an innovative solution designed to support postpartum mothers after c section to care for and bond with their newborn.

Today we'll explore his journey, the impact of his quality improvement projects, and his role in bringing Couplicare's bassinet to life. Welcome, Dr. Seashore. We're happy to have you today.

[00:01:08] Dr. Seashore: Thank you, Jared. It's great to be here. And thank you, Ty. I'm excited to talk with you all today.

[00:01:13] Jared: Yes, indeed.

So I think just getting started off with the big, grandiose question of what does quality newborn care mean to you?

[00:01:20] Dr. Seashore: Yeah, it's a great question. And it's one we've spent a lot of time thinking about over the years. I was a medical director of the newborn service for about a decade. Really laser focused on that question.

And I think it boils down to two or three things. One is it's, personalized, right? It is individualized and tailored to that family's needs, that mother, that baby and their particular needs. And that involves teamwork, that involves communication, that involves expertise and thought. The second piece is that it's standardized and those might seem at odds with each other, but there's a baseline level of standard of care that we should achieve for all families.

Whether that's meeting their goals around feeding or managing risks for things like sepsis or other perinatal conditions. We should have a minimal standard that all babies achieve that baseline level of care that's rooted in evidence. And accomplished using quality improvement tools at the bedside.

So I think it's those two things primarily where quality of care and then patient experience meet to create the ideal situation for the individual family as well as that public health or population health outcome.

[00:02:35] Jared: Absolutely. And I think we're going to dig into the quality improvement side of things in just a bit.

But I think prior to that, I just want to ask about. What really drove your passion to getting into pediatrics and in particular, and then also informatics, newborn care, just how did you get into this world that you're in currently.

[00:02:54] Dr. Seashore: Yeah another great question and really one that is part intentional part,

the accident of circumstance right so I grew up really enjoying being around children as I emerged into late adolescence and adulthood. I was camp counselor. I did volunteering around things where I was working with children. And so when I went to medical school, like I quickly realized that they were just the most fun population to work with, right?

They're generally pretty healthy. They're incredibly resilient. They tolerate hardship and severe illness and tragedy, even just with a grace that many adults can't muster and, looking at newborns that really gets to the beginning, right?

And being able to get every individual off to the best possible start in life became something I was just really passionate about seeing that there were opportunities to do things better in newborn care from my early experience as a medical student and resident.

And so when the opportunity came to lead that service in my mid career, it was an obvious fit. This all happened as informatics was being born as a field, right? The field of clinical informatics is still relatively young and the use of electronic health records and other digital tools in clinical care was novel and something that was happening over the course of my career as I went through medical school and then residency and then practice.

And so being part of leveraging those tools for success and optimizing those tools for patient care as well as clinician workflows became something I was equally passionate about and excited to make as optimal as it could be.

[00:04:35] Jared: And I think something that we were talking about right before we jumped on is the mother, baby couplet. And for folks that are not exactly aware of just couplet care as a term in general, if you could explain that the origin of it. And what are the benefits of treating the mother and the baby as a couplet?

[00:04:54] Dr. Seashore: Yeah, it's a term that really came out of the nursing literature and the idea that the mother and the baby should be cared for as a unit as a pair, as a dyad is, I think now widely accepted as the standard of care, but 20, 25 years ago when I was in training and emerging into practice, it wasn't, and so my experience as a learner and even early in my faculty career is that the mother and the baby had separate nurses.

The mother and the baby were often in separate rooms during a good portion of the postpartum stay. And in particularly for my involvement, when we would make rounds and see newborns as a team, The nurses would go get the babies in their little roly bassinets and bring them into a central nursery space without their parents for us to do the physical examination, the assessment of the newborn, to talk with the nurses about the care plan, to review the data about any screening or testing that had been done.

And we did this with a little assembly line of babies in bassinets during rounds. And that afforded the experienced senior clinicians opportunities to teach the residents the opportunities to really learn and develop those skills. And then the medical students to get a glimpse of what was happening.

And then we'd go out and we'd visit the parent room separately. And we tell them about their baby who may not even be back yet, right? And it just was, I guess it was efficient from a teaching standpoint, but it was really horrible from a family standpoint. And so over the last 20 years, this concept of couplet care.

We're keeping the mother and the baby together in the same room for the duration of the hospital stay with a single nurse caring for both of them and then a pediatric team or in some cases a family medicine team caring for mom and baby but also an OB team potentially taking care of the mother or a midwife taking care of the mother.

So getting that mom and that baby together in the room became the standard. So when I finished training and joined the first practice, I was part of after residency, one of my responsibilities was rounding on newborns and instead of having an entire teaching service, I had maybe two or three babies on a given day.

And so instead of having the nurses bring that baby to me in the nursery space so that I could examine the baby I just got in the habit early on of checking in with the nurses about what was going on, what concerns they had, looking in the paper chart or what little computer systems we had back then for the information that I needed, and then going into the room and doing all that care in the room.

And I really much preferred that and found it satisfied families in a way that I hadn't experienced when I was learning. And so when I moved to my new position, I really felt like it was important to carry on that practice. And that meant changing the standard of care at an institution, not just changing my own approach to doing something.

And so I think that's my history with couplet care, but it's important for our listeners to know that there's a whole literature they can explore on this that, again, has mostly come out of work done by nurses and leaders in that space.

[00:08:00] Ty: Could you speak to that change in standard of care that happened while you were at the institution?

Because that, in my mind, making that change happen, I know the evidence supported it, but that tipping point where everybody had moms and babies separate to then, okay, now we're going to do this new approach. Do you remember that day that happened or was it a transition or how did that happen?

[00:08:21] Dr. Seashore: Sure. So that was a function of coming to a new institution where I had become accustomed to practicing in a certain way. And that way was accepted and becoming more mainstream to an institution that was still doing it the old fashioned way. And they were still kind of doctor oriented rounds where it was about our efficiency and seeing the newborns and examining them quickly and being able to teach physical examination skills to learners without parents staring at that process.

And so it started with just my own approach to rounding and talking to the nurses when I was on service and saying, Hey, we're going to, we're going to pop through and see all the babies in the rooms if that's okay. And then it evolved as I developed leadership role in the unit to really making that the standard for everybody and then ultimately the nursing staff adopting that couplet care model we talked about earlier, but it was a multi years long process.

But that model remains in place today more than a decade later, which is 1 of the many things I'm proud of in terms of leaving a mark up there. .

[00:09:23] Jared: So this has been established at UNC Health and also, in my own experience with my baby niece, I just experienced this a year ago where I noticed that was also the standard of care in my local Kaiser Permanente.

And I am curious of, is this now just the national standard of care across the board? This is just, there's nobody really doing the, quote unquote, the old fashioned way.

[00:09:48] Dr. Seashore: I think there are probably still people doing it the old fashioned way. Couplet care is certainly the gold standard. I don't think it's yet the standard of care or the default in every institution around the country or certainly the world.

I think one of the projects we worked on was trying to bring that model of care to around a hundred hospitals in the CDC Empower Project that I was part of a number of years ago was really coaching hospitals towards that model of couplet care and keeping moms and babies together during the postpartum stay.

[00:10:21] Jared: And when you talk about like direct health outcomes for the mom and for the baby what have you seen and why was it so compelling, back, 15 plus years ago when you were engaging with this initially?

[00:10:32] Dr. Seashore: Yeah. So this is really outcomes like bonding breastfeeding success sleep.

It's a little bit counterintuitive but families actually sleep better. New mothers in particular sleep better when their newborn is with them. They get a higher quality sleep. We think about a fussy baby, maybe waking that mom up. But the quality of sleep is actually better when they're sleeping when mom and baby are together. That bonding of skin to skin contact that all moms and babies and dads and babies and grandparents and babies can experience helps that newborn transition to regulating their own body temperature, regulating their own blood glucose levels, all these physiologic parameters that change at the moment of birth and the cutting of the umbilical cord, right?

That baby all of a sudden is entirely independent in those operations and that close proximity, learning feeding cues, learning sleep cues, changing diapers in a timely manner, all these different things, learning the baby's sounds, right? What do the different little coos and cries mean?

The parents get much more comfortable in taking care of that baby when they're empowered to do that in the room for the first, 48 hours postpartum while they're still in the hospital. There's been improvements in temperature regulation, improvements in blood glucose, improvements in breastfeeding outcomes, sleep I mentioned have all come with this transition.

[00:12:01] Jared: That's incredible. And being able to see that firsthand to some degree and not knowing physiologically totally what's going on, but just being a part of the experience is just, it's beautiful. It's incredibly beautiful. And so you've part of your work also is with the perinatal quality collaborative of North Carolina.

If you could just delve into a little bit of that for us today, and also just, what are some of the most pressing newborn needs that you've encountered through there? And maybe some of the quality improvements that you've achieved with them.

[00:12:29] Dr. Seashore: Sure. So the Perinatal Quality Collaborative of North Carolina is a state level and funded Perinatal Quality Collaborative.

It's run by a neonatologist and an obstetrician. And like that couplet care model we've been talking about, the idea is to bring the people caring for the mother. People caring for the baby together to tackle problems or challenges that we're facing in really optimizing health outcomes for mothers and babies.

And so each year they typically do one project focused on maternal health outcomes that's led by the OB teams. And one project that's focused on the newborn outcomes that's led by the pediatric family medicine teams. We have representatives from hospitals across the state. All hundred counties, I believe, participate or have participated in the past.

All the larger health systems are active members and we have, again, all level of folks who are involved in caring for babies from nurses and, lactation consultants, midwives, obstetricians, pediatricians, family medicine docs really anybody who might be involved in caring for newborns are present.

We have families serving as advisors on that group and during the time that I was heavily involved with those projects when I was leading our nursery unit we had several newborn projects that I was deeply involved in executing one of those was around improving care for newborns at risk for sepsis.

And so sepsis is a severe infection in the bloodstream. And while it's not extremely common when it happens, it's extremely serious. And so recognizing the risk factors for it and intervening appropriately without doing too much unnecessary care, right? We want to minimize any unnecessary interventions, but we never want to miss a case of sepsis.

And this work grew out of changing national recommendations and evidence based that was evolving around how we should approach risk for sepsis, and some really novel risk calculation work done out of Pennsylvania and California collaboratively. And that really informed a new standard of care at the time for assessing sepsis risk.

And so we decided as a collaborative, I had done some pilot work in our nursery showing that we could safely administer fewer baby's antibiotics in case they had sepsis utilizing this risk tool. And so we scaled that effort to the state. And helped hospitals across North Carolina, implement those tools, understand those tools and in some cases, build those tools into our electronic health record platform.

So there's the synergy between my areas of interest starting to emerge. But at our hospital, we were able to take the percentage of newborns outside of the ICU. So healthy babies, who are exposed to empiric antibiotics. Due to concerns for sepsis from, I believe it was around 10 percent of newborns when we started.

So one in 10 babies was getting a two day course of antibiotics just in case they had sepsis, and we dropped that down to about 2 percent over the course of a six month project. And then at the state level, we were able to have similar success scaling this across the, is it 100, 000 births a year?

No, million births a year that happened in North Carolina. I forget the statistics now. But yeah, we were able to safely reduce that antibiotic exposure, which is associated with adverse health outcomes, right? If you don't need to be exposed to antibiotics in early life, we should avoid that. That project was particularly personal because my daughter was born.

My youngest child was born right around the time that evidence, new evidence came out. And so she was treated under the old guidelines. And now there's new guidelines that would have changed her course. And so I was particularly vested in making that change for future babies to not have to go through the relative trauma we experienced of having to have blood tests and IVs and things like that on the first day of life.

[00:16:39] Jared: Yeah. And also just sticking on the sepsis topic, so sepsis is something that I experienced when I was 16 years old, when I had appendicitis, my appendix burst I didn't go early enough. And so my surgeon was like, you're really lucky. And so she told me how close I was to basically critical care.

And I've had other family members experience it, but my thought is how does a baby, a newborn end up with sepsis? What's the circumstances that surround, that diagnosis.

[00:17:07] Dr. Seashore: Sure. So there's a couple of parameters that drive that risk in newborns. The biggest is prematurity. And so those babies that are born, especially extremely premature, are at the highest risk.

But among term babies, the common risk factors are maternal colonization with bacterium called group B strep. So if you think about strep throat that many people have heard of or experienced, that's a different strain of the streptococcus family of bacterias, but the group B strep is the one that colonizes the birth canal.

And babies born through that colonization are at increased risk for group B strep sepsis are obstetrician and family medicine and midwifery colleagues do their best to decrease that risk by administering the mother antibiotics during labor. And that decreases the baby's risk substantially.

That was work that started back in the 80s. And so now it's, absolutely the standard of care to have antibiotic prophylaxis in the setting of group B strep colonization. The other main risk factor is maternal infection. So if a mother has an infection in the womb called chorioamnionitis, that can increase the baby's risk of, sepsis.

And again, antibiotic treatment of the mother is helpful in decreasing the baby's risk. And then the last is how long the membranes are ruptured before the baby is delivered. So if a mother breaks her water and then doesn't deliver that baby for the next 12, 18, 24 hours, the risk for sepsis increases just from that exposure to that milieu when the baby's sac has been opened to the outside world and they're not yet out. So those are the three main things, and that's what the research group utilized to develop the tool that we used to safely decrease our use of antibiotics.

[00:18:53] Jared: That's really fascinating. Also I've seen a two part lecture of yours on neonatal abstinence syndrome. Yeah, obviously this could be a multiple hour discussion just on this alone. But if you could just talk about the work that you did there for I guess mothers and also babies, because I thought it was really fascinating about how you approached it from the mother perspective.

[00:19:14] Dr. Seashore: Yeah, it's and again, it gets back to that concept of couplet care, right? You're caring for a mother and a baby together. And in the case of mothers with opioid use disorder, right? That baby is born at risk for something called neonatal abstinence syndrome or neonatal opioid withdrawal syndrome.

You'll see it abbreviated as NAS or NAWS, N O W S. And again the approach and treatment of that condition over the course of my career has evolved tremendously from what I experienced in residency when I was learning this field of pediatrics, right? And so when I came to UNC, I was delighted to find that the OB group here had started a program called the UNC Horizons program, which focuses on the treatment of women with substance use disorders and has particular expertise in the treatment of women with opioid use disorders during pregnancy.

And so I was very fortunate to partner with them and work together to think about how we were caring for those mother baby dyads. And how those, how our outcomes were looking based on their novel approaches to treatment of opioid use disorder. And we were able to show really dramatically improved outcomes early on just based on the maternal side of treatment using Suboxone to treat mothers with opioid use disorder during pregnancy, which was novel 15 years ago, and again, is now more of a standard of care.

And we showed that our babies whose mothers were taking that medication rather than methadone had better outcomes, just without any changes in how we cared for the newborns and we subsequently went on with a much bigger team to really rethink the way that we cared for the mother baby dyad in the postpartum period and the way we evaluated the newborns risk of withdrawal and severity of withdrawal And we're able to decrease our use of opioid medications in the newborn during the postpartum period and their length of stay in the hospital.

And I feel very fortunate now to continue to work with the Horizons program and follow many of those babies out the first year of life and sometimes longer while the mothers remain in the program and venture into parenthood in treatment and stable with healthy babies. It's really a treat to be able to do that.

[00:21:32] Jared: Yeah, absolutely. And I wish we could stay on this topic more, but I just, we just got to keep it going. We've got so many more questions for you. And so another part of your expertise is around informatics. You're the Associate Chief Medical Informatics Officer. And so how do you envision technology bridging the gap between best practices and real world newborn care delivery and what are the specific tools for these data driven approaches and I know we talked briefly about AI, and I know you said that's for somebody else in a whole different discussion but I was just very curious about how you operate in that world as well.

[00:22:08] Dr. Seashore: Sure. So like I mentioned earlier, my interest in informatics really evolved with the growth of the use of technology in my job on a day to day basis, right? I grew up with Commodore 64s and TI 99 4As, whoever was around back then. Learning how to program in basic and really simple stuff and went on to having a, reasonably sophisticated computer during college and medical school.

And then all of a sudden those tools being part of clinical care as I went through residency and into my career. And so really looking out for the little guy, right? Developing those tools with an eye towards pediatrics, which is often an afterthought in large health systems became something I really wanted to advocate for.

And I think moving forward the future really is going to be driven by the fact that we have so much more data about what happens during a hospitalization, whether that's for birth or sepsis and a ruptured appendix, right? We have the opportunity to provide clinicians with better tools to help them make better decisions, whether that's about which antibiotic to use in the setting of a ruptured appendix and perhaps an allergy to the first line medication to thinking about rare diseases and to any of those clinical outcomes and so leveraging the power of technology to develop tools that clinicians like to use that make their jobs more efficient rather than less, which is what the EHRs have mostly been blamed for over the last 10 years is really something I think is possible.

And I'm trying to be part of making that happen by, bringing the clinician's perspective to the teams that are building these I. T. tools and making sure what the doctors and the nurses want at the bedside is what we're focused on building and delivering to them. Because ultimately, like any tool you have to know how to use it, and it works best when you know how to use it and so if we can design it to meet their needs, then they'll be able to use it well, and we'll have those impacts on outcomes that we're hoping for.

But I think it's an exciting future for healthcare. It's a little intimidating especially as AI is emerging into the space both healthcare and in generative AI in particular, but it's something that's kept me engaged for a long career at this point, and thinking about what's on the horizon, what does the future look like.

[00:24:29] Ty: I'm just curious about some of the tools that you've worked on and how many of those are outside in versus entirely developed within the health system. Just I'm curious that diffusion of innovation in this space is moving so fast.

There's so many possible outside partners wanting to contribute. Maybe they get it. Maybe they don't. And then you've also got internal constraints. So just if you wouldn't mind to touch on that.

[00:24:53] Dr. Seashore: Yeah, all of the above, I think is the easy answer, right? The electronic health record space is dominated now by larger vendors whether those are, academic health center oriented vendors or community practice or health department oriented vendors, subspecialty oriented vendors.

And then within that ecosystem there's task oriented software, right? There's billing and coding software or there's decision support tools or there's pathway platforms to build decision trees into clinical care. And they all have to interface to allow a clinician to do their work at the end of the day, right?

And so what we try to do is develop in house the things that need our expertise. And then to partner with vendors to tailor their tools to meet our needs. But it's all of the above. Like I said and that's that's the approach that we're taking to thinking about AI in our electronic health record tools, but just in general, also about, what we're buying versus what we're building.

And there's definitely space for both.

[00:26:04] Ty: It just seems like as you're describing those decision tools, it seems a similar level of consequence to say, like autonomous driving in terms of the unintended consequences, perhaps of a decision tool and like how that's interpreted by a downstream user three years from now.

[00:26:19] Dr. Seashore: Or my favorite example of unintended design flaws was the crash detection on the Apple watch when when they rolled that out, they had floods of automated calls to 911s from amusement parks, from the roller coasters.

And so they actually had to turn that off after the WWDC announcement or whenever they released it for a couple of days to fix that.

Because they were overwhelming 911 centers within a certain radius of amusement parks with calls from people, going down the roller coasters because that sound and velocity and all the stuff that their algorithms were programmed to detect a car crash sounded just like it. Yeah, we have to be very intentional and the stakes are high

[00:27:06] Jared: Yeah, and I know we could keep digging into this, but we really want to talk about Couplet Care and it's clear that you've made a career out of improving the lives of mothers and newborns. And part of that work now is also with Couplet Care. And so I'm just curious of what really drew you to working with Dr. Tully on this in the very early days. Just how did this all really come about? Cause you've really been about this thing since the very beginning.

[00:27:30] Dr. Seashore: Sure. So it's certainly a bit of accidental innovation, right? So I met Dr. Tully through the Carolina Global Breastfeeding Institute at the school of public health, and we were working on a national project with the CDC to improve breastfeeding outcomes.

And part of that was introducing the couplet care model of rooming in, of skin to skin, of not separating moms and babies unnecessarily during the birth hospitalization, of supporting mother's feeding goals, if that was breastfeeding, exclusive breastfeeding, formula feeding, whatever kind of feeding, was working with those hospitals to help them with best practices around optimizing those health outcomes for moms and babies.

And a particular goal of that project was improving breastfeeding outcomes in particular because we know from the literature that many more women intend to breastfeed than succeed in breastfeeding through the first year of life. And much of that is rooted in sort of antiquated hospital practices of separating the mother and the baby.

And of not providing adequate support for breastfeeding in the first few days of life during that postpartum stay. And so I met Dr. Tully as part of that, learned about her work that she had done with the sidecar bassinets, and just got absolutely fascinated with the idea that we could do something better than metal cart with a plastic tub in it and noisy casters and, sticky drawers.

And try to create something that would make the postpartum experience better for moms and babies both just in terms of comfort and safety but also in terms of meeting feeding goals and accomplishing what a mom's objectives were around feeding, right? One of my colleagues jokes that all babies want to breastfeed, right?

Moms are really the ones who are making the choice. Sometimes babies are part of that. But more often than not, it's a maternal choice, but really, making sure that maternal choice was educated, informed, intentional, and then making sure we were doing our best to honor that was really what was at the core of that project.

And it really started there with the realization that we could do things differently. And it evolved from the concept of a sidecar to the bassinet that we have now. And that's been a eight year long process. So to all you aspiring innovators out there, be patient and be persistent, right?

[00:30:06] Ty: Persistence and just grit to see it through, right?

[00:30:09] Dr. Seashore: Yeah, absolutely.

[00:30:10] Jared: And so you and Dr. Tully also have published research together on infant drops and accidental suffocation. And so could you just share a little bit about that, like on how rooming in might be better structured for safety and wellness?

[00:30:24] Dr. Seashore: Yeah. So one of the concerns in the rooming in or couplet care era is that infant falls were potentially becoming more frequent and certainly we're getting more attention. And infant falls doesn't really make sense because they're not walking, under their own power, so drops has become the favored term, at least in the literature.

But essentially the idea there is that the infant makes an unplanned trip to the ground and could potentially hurt themselves, right? With head injury being the biggest concern with rooming in, right? The mother and the baby are together. That bassinet is maybe parked next to the mother's bed.

Moving that baby from skin to skin or a breastfeeding position or a bottle feeding position, or just a hanging out. Talking to grandma on FaceTime position, right? That, that twisting, leaning, getting out of bed motion to put the baby in the bassinet can be painful or even prohibitive for some folks in the post partum period, and if there's not a partner, spouse, grandmother, somebody there to help, then that patient is pressing a nurse call button to summon someone into the room to help them, or perhaps is just falling asleep with the baby in their arms, at which point the baby might drop to the floor, or, really worse fall into the bed rail between the mother and the pillow and the blanket and have an accidental suffocation that's not something I ever saw or have seen in practice, but it's certainly a rare but unacceptable occurrence. And so part of the concept of the Couplet Care design was to allow the mom and baby closer proximity to each other and allow the mother to manipulate the baby even in the setting of a pain limited range of motion.

So being able to take the baby from here to here or to be able to just have your hand on the baby, right? And sleep, knowing that you can feel your baby's breathing, you can feel their warmth, you can feel if they move, or start to squirm, or they might, start making noises, and you're right there with them, and you're not having to twist.

And Ty, I'm sure you recognize this as a parent, but you do a crunch if you're in bed, and lunge a little bit to get up and respond to a crying baby. Especially in the early days. And if you've had a C section, that's a pretty miserable thing to go through. Even just a vaginal birth, that can be hard.

And so really designing something that allowed the mother more autonomy and in her ability to interact with the baby for safety reasons, for diapering reasons, for comfort reasons, for feeding reasons, for all of those is what went into the design process for thinking about this better mousetrap that we strove to create.

[00:33:10] Ty: Yeah, I was talking to Sarah Hopgood. She's one of the nurses has been supporting this and she just described without Couplet Care, that's we're asking mothers to do something that's very natural in an environment that's very unnatural. You've got all these hard surfaces that are good for the hospital experience, but not necessarily safe.

And then trying to get access to this, bassinet where your arms are having to bend the wrong way, there's just, yeah, there's a lot of impediments in kind of the current structures.

[00:33:38] Dr. Seashore: Yeah, and I've seen different solutions to that in different hospitals across the country and some have gone as far as to put, retractable big flat beds that are designed for examining a newborn into the furniture, right?

So that when the doctors or the nurses come in and they need to see the baby, they can bring out this big, work surface with a mattress to examine the baby, a heat source if they need it, oxygen coming from the wall if they need it. Which is an immense investment in infrastructure and I don't think would be very comforting to a family to see this sort of large medical apparatus coming out of the wall just so that I can look at a baby, right?

So yeah, we thought about

[00:34:21] Ty: the postnatal warmer, like the giraffe. They're just standard on that sort

[00:34:26] Dr. Seashore: of a fold up version, a Swiss Army knife version of that in the wall furniture. And then, again, that assembly line of bassinets for examining that I talked about it at the onset versus something that, I can interact with this bassinet and I can just barely move the baby or the unit, the tub and do my exam right there next to the bedside.

Much more comfortably and raise and lower it. So if I have a short medical student working with me or a really tall resident working with me I can height adjust it to meet their needs. And again it's ability to come over the bed, I can just pass that baby right back to the mother in the bed after examining and point things out or just regain that closeness that is ideal in the postpartum stay.

[00:35:13] Ty: You just said there clicked for me of the first bassinets you saw that integrated motion just had height adjustment associated with them. I guess that's the primary use case that was addressing there of like just different heights of physicians that were coming through to inspect.

[00:35:27] Dr. Seashore: And nurses. Yeah. And that's again, a very clinician oriented design element. And we really, tried to capture both the clinician needs, but also the parent needs. And we thought about, again, all types of new parent situations, whether it's mom with a support person, without a support person, different delivery complications needing to be in that hospital type bed and really, create something that answers all of those challenges, not just what I need.

[00:35:56] Ty: Yeah. That's like kind of a consistent thing when you have multiple stakeholders looking at the design of something, because there's points in time where this feature benefits one stakeholder and this feature benefits the other, and you have to make a choice between those two, you can't have it both ways in a design process and like making that intentional decision of which direction to go with that.

That's a design decision and you have to balance those factors.

[00:36:21] Dr. Seashore: Exactly. Yeah.

[00:36:22] Jared: And that kind of begs the question of how does the current gen five bassinet sort of meld those two needs of the clinicians being, I think obviously secondary to the mother and newborn needs of course, but how did you meet the needs of everybody involved here. Or did you not? Did you just say we're tossing out the, you could say, quote unquote, needs of the providers. But how does it meet the needs of everyone involved? We haven't even talked about the needs of the providers and all of this.

[00:36:47] Dr. Seashore: Yeah, I think, again my bias was to think about this from the lens of a new parent first. But to always have the provider needs in mind and before Gen 5 we certainly had models of this that were too clunky for a provider to really use sensibly. And we learned from that.

And it's why we're not, on Gen 1 anymore. But we favored the parents experience and safety really overall, and then we worked towards that provider comfort as we were able within those constraints, I think is a fair way to summarize it like any tool, right?

It has a little bit of learning, right? The first time someone opened a drawer, they had to learn how to do that. Oh, wow. Now I can access all this stuff without having to reach down or whatever. And the first time someone uses this bassinet, they'll need to know, Oh, I, I need this lever or this motion to accomplish what I'm doing, or if the wheels are locked versus unlocked.

But we took a lot of design elements from existing medical equipment that people are familiar with in a hospital setting. If we go way back, Ty, to the graduate seminar, where we first iterated these ideas you know we gave them examples of hospital equipment to inform their decisions from tray tables and existing bassinets and giraffe units and the rest of it.

So we were really intentional and trying to make it feel intuitive with features and functionality that, weren't out of an airline cockpit or something like that.

[00:38:15] Ty: Yeah, and just being able to learn from what works in other contexts, so you're not having to go from complete scratch, but rather can pull from the best of what works in other industries.

And I just also want to just compliment you, Carl, because like when we were dealing with the third generation bassinet and there was a mechanical issue, the lock that we had designed worked great for bedside with mom, but you get ripping down the hallway and the lock couldn't handle it. And just, I just was so impressed.

You were very mechanically adept. And we had the lid open and we were trying to fix it and everything. Ty, what did you get? We do it this way. Oh, of course.

[00:38:53] Dr. Seashore: Yeah. I remember that was a fun day. Those were like, how do we break this? That was the design phase of, what happens when a toddler climbs on this?

What happens when it's an emergency situation and I'm booking down the hallway with this contraption to get the kid to a higher level of care. And that really helped us again, work out those bugs in the earlier versions. But no, I'm a tinkerer, right? I think just having a little bit of a, how does it work?

Mindset has helped me in thinking about the elements of design here and working with you, of course and the expertise that, Trig brings just brings that to a whole new level and helps me realize how little I know in the tinkering space, but at the same time, how much that sort of collaboration can be really powerful.

[00:39:33] Ty: I think it speaks to, like none of us have it all figured out and we can all learn from each other. And that's the fun of collaboration too, in pursuit of a worthy goal.

[00:39:42] Dr. Seashore: Yeah, absolutely. Yeah.

[00:39:44] Jared: Yeah. So Dr. Seashore, you've been a part of updates of standards of care.

And so I'm curious of what it's going to take for the Couplet Care bassinet to be implemented as a new standard of care. And also just how does the bassinet as it's designed align with best practices for newborn care?

[00:40:02] Dr. Seashore: Yeah, it's there in the name, right? We believe that this bassinet that we've designed helps, achieve the quality goals that the evidence is telling us are important right now.

That those are breastfeeding and bonding and recovery and just newborn regulation in the postpartum period. They're safety oriented around the drops and accidental suffocation questions, and they're family centered, right? They're really what parents want and need. There's so many gadgets and gizmos for sale to prospective and new parents, right?

None of them are really necessary, right? You really don't need anything in Babies R Us. They're all wants. They're all luxuries. In the hospital setting for home use, right? I mean, some form of diaper will make your life better, right?

[00:41:00] Ty: But the diaper genie, it's just a con on first time parents.

[00:41:03] Dr. Seashore: A hundred percent. Yes. We use that for the first three months with our first child and gave it away. And so many other things but in the hospital setting, there are certain things that we need for that standard of care that I mentioned at the outset. And there are things that we want, but there's a minimum standard that we need for safety and for just delivering evidence based care.

And I think this bassinet fits into that space perfectly, right? You need a bassinet for a newborn during the postpartum stay. They can't be in a hammock. Mom can't carry them around the whole time. They can't be in dad's lap the whole time. Grandma sometimes does try to hold them the whole time.

That can happen, but even grandma has to sleep, right? And so you need a place to safely put the baby to sleep to model what safe sleep looks like at home and so to make that as functional as possible for the recovering mother after birth and for the team of people involved in taking care of the baby is just what makes sense.

And so I think, for the small learning curve of figuring out how to use it that we'll all have to overcome the benefits to families will be tremendous, and I'm excited that there are folks out there who've expressed interest in studying those outcomes who aren't us with the bias of being its creators, hey, how can I study this with regards to breastfeeding or falls or neonatal abstinence syndrome, infants at risk for withdrawal.

And I'm super excited to see where that leads in terms of evidence based care in the future. And, if we can contribute to that with this bassinet then it'll be a success.

[00:42:35] Jared: Absolutely. And I hate to call you out, Ty, but you are the most up to date on where things are with the bassinet currently today.

So I think also just maybe could we have a status update on where are things at and what's going on with it and what can people expect from couplet care in the future. Maybe six months to a year out timeline.

[00:42:55] Ty: Yeah, sure. So you've heard reference to multiple generations of prototypes.

And that's been an extensive process of really trying to make sure we're balancing all of the user needs that really go into an interesting and complex space. So currently where we're at is we've got three units that are being fabricated that are manufacturing level prototypes that are the final tooling that allow for like lower cost manufacturing methods.

So those units are being ready for a year long clinical study at Johns Hopkins, which and then we're going to be fully expecting that to deliver next month and then be getting kicked off for this kind of a final phase of this as part of the phase two SBIR grant. And then with that, we've got some other units that we'll be taking through summative final usability testing, all of the verification and validation steps that we'll need to go through in order to have the final filing to then be ready for sale. The ultimate goal for this is that the production units are ready to take orders and then we'll be shipping to hospitals that have placed an order, expected delivery early 2025.

So it's been a long road to get here, but we can see it and it's awesome and it's cool to see that come together. So anyway, that's a quick update there.

[00:44:10] Jared: That's incredible, eight years in the process. Finally, you're all here and congratulations to all of you that have been instrumental in all of this.

And I know that we're coming up on time a little bit. I want to maybe broaden back out. And so Dr. Seashore, I'm just very curious, like you have been a part of a lot of positive improvements for care for mothers and care for newborns. And often when folks talk about the state of healthcare in the U. S., it's not always such a bright outlook, but going into sort of your career and all the successes you've had, it seems to be that the future of healthcare is pretty bright with people like you involved in sort of things like this. And so just what's your outlook on the future of maternal care, newborn care, and I guess also what's just on your mind as far as what else is ripe for innovation and improvement for care for these populations?

[00:45:05] Dr. Seashore: I think that mindset that you outline is key, right? If you approach things as being problems, it's really easy to get mired down and bummed out about the state of affairs. If you approach them as challenges I think they call that a growth mindset in business school. I don't know, or somewhere it's more exciting and you can figure out ways to overcome them or make things better.

I think patient engagement is one of the areas we need to really do more work in terms of improving folks health literacy and their ability to access care. And for that access to be equitable, right? Whether it's a language barrier or a cultural barrier or a systemic barrier. I think we need to make sure that all this good work that we're doing is reaching every patient, right? And that means lowering the bar to entry to getting health care, making it easier to get health care, making our patients more informed about what they're going to experience during a birth hospitalization. What is that like? If you've never experienced that before, you did as an uncle recently for the first time, it's a little overwhelming.

And if you don't know what, to expect going in, it can be scary. And so how can we better reach our patients where they are at home in a hospital bed, wherever that is, and involve them in their health care? I think that can help bring a lot of the joy in practice back that some people have lamented is missing over the last 10 or 20 years as health care has, evolved into its current state.

But I think approaching problems as challenges to be solved and in need of a solution rather than just enduring doing it this way, because that's the way we've always done it, is what it will take. I think one of the really positive things is that the dogma that I was taught, which is that it takes 10 years for something published in the literature to reach the textbooks, right?

Very few medical students are studying from textbooks anymore, but I think we do have the possibility for innovation in how we deliver care to reach more patients more quickly as those developments happen at scale, right? And we're seeing this with the novel therapeutics for cancers and in all sorts of other spaces.

We're seeing this in treatment of sepsis, not just in newborns, but all comers. We're seeing this in so many different areas of health care. We're working hard in the field of pediatrics right now to think about that with the current mental health crisis we're seeing in young teens, preteens, and adolescents.

And what are the best ways to screen for, identify, treat, and improve outcomes with anxiety and depression? So I just think there's tremendous opportunity and for the innovators out there, for the curious out there, for the clinicians out there, pick something that excites you and you feel passionate about and the work doesn't get boring and drag on.

And you don't even mind it when you get a ping from Ty, late at night or something like that with the question because it's a passion project. It's something I tell all the residents and students I work with that if it's a passion project. You won't mind the extra work that's required to put into it to succeed.

If it's just trendy or if it's something that a mentor kind of fed you to work on and you're not excited about it, it's going to be really hard to see it through. And, this bassinet has been as much grit as anything else. Like Ty said earlier, really, just seeing the challenges through to something that's going to work.

It takes a long time, takes a lot of effort. But I think in the long run it pays off.

[00:48:42] Jared: And, somebody once had a tagline when they came on the show that their mission in life is to change the millions of peoples of lives that they've never met. And I feel like that tagline tends to apply to somebody like you also where you've had an instrumental role in changing standards of care.

There's all these people across the world. And that. are essentially benefiting from work that you've done, and you're never going to get to meet them, so that must be a wonderful feeling, but you've had such a high impact in your career so far, and I'm just curious of what's next for you in your career, and also just what's driving your passion today.

[00:49:15] Dr. Seashore: Gosh, that's complicated. If you had asked me 10 years ago, would I be involved in designing a novel bassinet for newborns, I wouldn't have been able to answer you. I don't know. Or if I was going to be in clinical informatics, it would have been hard to say that journey started just about exactly 10 years ago.

And so I think I will be where the challenges take me, where the evolution of the field of pediatrics and the field of clinical informatics go. Yeah. And I hope I'll be still doing it in an environment where I can teach and work with learners at all different levels while still providing care to patients and families on a routine basis.

But I don't think I could tell you exactly where it would be more specifically than that.

[00:50:01] Jared: Absolutely. Dr. Seashore, thank you for joining us today. Thank you for the work that you do, especially as somebody that gets to experience the benefit of your work very downstream. And thank you for your time today.

[00:50:10] Dr. Seashore: You're welcome. And thanks for having me. This was a really fun discussion.

[00:50:14] Ty: This was really cool to see you again, Carl, and fun to reminisce on our journey together.

[00:50:18] Dr. Seashore: Yeah, it's great to catch up Ty. It's been a, it's been a fun one and maybe there'll be more in the future.

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