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Investing in Women Entrepreneurs at Smith College

Much has been written about the need for more women in STEM, women in tech, women in startups, and women in investing. I recently wrote about why women should actively invest their own capital and support each other in changing the ratio in these traditionally male-dominated fields. Although I agree with the research, I’m tired of hearing how more VCs and men should fund women and instead want to see more women supporting each other to walk their own talk. As Madeline Albright once said, “There is a special place in hell for women who do not help other women.” I believe the same holds true in the business world.

That’s why I was honored to participate as a pitch judge at the fourth annual Draper Competition for Collegiate Women Entrepreneurs hosted at my alma mater, Smith College. Forbes recently named Smith College one of America’s top 20 most entrepreneurial colleges. Melissa Draper (Smith ’77) and her husband Tim Draper (a third-generation venture capitalist from Silicon Valley) launched the pitch competition to support innovation and entrepreneurship among young women undergraduates.

Hosted and organized by the Center for Women and Financial Independence, the competition is one of only a handful of startup challenges specifically designed to encourage undergraduate entrepreneurs to start their own business. Entrants in the Draper Competition hailed from more than fifty colleges and included diverse businesses spanning e-commerce, real estate, medical, fashion, services, marketplaces, food tech, beauty, social enterprise and enterprise software. The five winning ventures were awarded more than $20,000 in funding, a generous kick start for the average undergraduate.

draperjudges

As any business owner knows it takes money to make money. Whether founders decide to bootstrap their own startup capital, raise friends and family money, take out a small business loan or alternatively raise venture capital, obtaining funding can be one of the most challenging hurdles to growing a company. Successful fundraising demands not only a viable business plan with a clear path to a sustainable company but also strong founder or founding team capable of delivering a compelling pitch.

I believe building a business (either for-profit or non-profit) can be one of the most satisfying and scaleable ways to impact the world, improve lives, create jobs and enable philanthropy. Now that computers and technology make it possible to launch a business from virtually anywhere targeted at nearly anyone, my hope is that more people become inspired to learn the basics of entrepreneurship to create the economic engines and innovations of the future.

Watch this video by the United States Patent and Trade Office (USPTO) highlighting the importance of women entrepreneurs across the globe, encouraging all of us to empower girls and women to pursue ideas that positively impact the world.

About Smith College
Smith College has a long-standing tradition of encouraging women’s personal and career growth, encouraging its undergraduates to develop their leadership potential and make their mark on the world both while at Smith and after graduation. Today, more than 46,000 Smith alumnae help students take advantage of an “ageless women’s network” to rival the “old boys’ network” across both private and public sectors.

The Center for Women and Financial Independence (WFI) is a resource at Smith College providing women with the skills and knowledge necessary to address financial issues that may arise in their personal, professional, family and community lives. This includes lessons in basic financial literacy, the opportunity to build an in-depth understanding of global financial markets, and tools for entrepreneurs and those seeking skills for successful self-employment. WFI Founding Director Mahnaz Mahdavi was my Economics professor who inspired me to pursue a business career which led to my path as an entrepreneur, for which I am eternally grateful.

Maternal Health Matters: Why the U.S. Ranks Last

Why the U.S. Ranks Last On This Most Important Healthcare Issue: Maternal-Child Health. How We Can Fix It

“Children are our future, and their mothers are its guardians. We must make every mother and child count, because we value every human life.  And they count because healthy mothers and children are the bedrock of healthy and prosperous communities and nations.” Kofi Annan – United Nations Secretary General, 2005

Maternal-child health is the foundation for the future health of any nation. No healthcare policy maker, healthcare provider or employer would deny that healthy mothers are important, or that a healthy pregnancy, a positive birth outcome and a healthy baby are foundational to a healthy population. I would argue that healthy mothers and children are the single most important key performance indicators of public health and of the overall effectiveness of the healthcare system in delivering high quality and cost-effective care. If we were to score the U.S. healthcare system on its maternal health outcomes defined in terms of maternal mortality and morbidity (or reduction in these bad outcomes), the US is failing miserably.

A report by Amnesty International entitled “Deadly Delivery: The Maternal Health Crisis in the USA” provides overwhelming evidence that the US has the worst maternal health outcomes at the highest cost.

Examining Maternal Health Outcomes: The Data

It would likely surprise most Americans to know that the United States is one of the most dangerous Western countries in which to give birth1  American women are more than twice as likely to die in pregnancy or childbirth as women in Canada and at higher risk of dying than mothers giving birth in China, Saudi Arabia, Iran, Libya and Turkey.2  The World Health Organization ranks the US 46th in maternal mortality worldwide and stands among only a handful of countries — including Zimbabwe and North Korea — where the mortality rate has risen since 1990. The US Center for Disease Control (CDC) data show our maternal mortality rate has more than doubled in the past few decades (12 to 28 maternal deaths per 100,000 births)) while more than a third of all U.S. women – 1.7 million women each year – experience a pregnancy-related complication that has an adverse effect on their health.

An expose by CNN and Every Mother Counts titled Giving Birth in America raises the profile and issues of maternal health outcomes in the United States. Produced by Every Mother Counts, with executive producer and founder Christy Turlington Burns, the film chronicles the surprising journey of four women as they give birth in America.

Says Turlington Burns: We face medical-legal, hospital and insurance barriers that are out of sync with women’s needs, like lack of support for vaginal births after C-sections (or VBACs) and mandatory C-sections for conditions that can often be managed safely by vaginal birth. 

Outcomes Data: Complex Reasons for Declining Maternity Outcomes

Dr. William Callaghan, the chief of the Maternal and Infant Health branch at the CDC concedes that maternal mortality rates are too high in the U.S. as quoted in this Huffington Post article on rising mortality rates: Maternal Death Rates Are Decreasing Everywhere But The U.S.

“It reflects, in many ways, the health of our population,” Callaghan continued. “We have a birthing population that is on average older [than before], and more people are coming into pregnancy with obesity, high blood pressure and other cardiovascular risk factors.”

The graph below shows percentages of pregnancy-related deaths in the United States in 2011:

Cardiovascular diseases, 15.1%.
Non-cardiovascular diseases, 14.1%.
Infection or sepsis, 14.0%.
Hemorrhage, 11.3%.
Cardiomyopathy, 10.1%.
Thrombotic pulmonary embolism, 9.8%.
Hypertensive disorders of pregnancy, 8.4%.
Amniotic fluid embolism, 5.6%.
Cerebrovascular accidents, 5.4%.
Anesthesia complications, 0.3%.
The cause of death is unknown for 5.9% of all 2011 pregnancy-related deaths.

Many pregnancy-related deaths and complications are caused by chronic diseases and conditions including advanced maternal age, diabetes and heart disease. More than half of women are above the recommended BMI prior to becoming pregnant. The costs on our healthcare system amount to hundreds of millions of dollars. The cost of pre-term labor and premature infants alone amount to billions of dollars in unnecessary and avoidable healthcare costs and immeasurable adverse impact on the long-term health of mothers and children born too soon.

The National Institute of Health published a study titled “Effectiveness of patient education to reduce preterm delivery among ordinary risk patients” demonstrating that patient education and birth preparation was highly effective in reducing preterm delivery among ordinary risk patients and therefore the costs of maternal-child healthcare:

“In evaluating the outcome of pregnancies in patients not at high risk for preterm delivery (ordinary risk patients) we found that patients who received instruction to recognize early signs of preterm labor had babies with a higher birthweight (3255 +/- 548 gm) than patients who were not so instructed (3200 +/- 599 gm, p = 0.03). Average length of gestation in the instructed and noninstructed patients was 276 +/- 15 days and 275 +/- 18 days (p = 0.12), respectively. The preterm delivery rate among patients receiving the instruction was 9.5% compared with 11.5% among those who did not receive it. We conclude that specific prenatal education about early warning signs of preterm labor is an important component ofpreterm birth prevention programs that can be demonstrated to have an independent contribution to prenatal care.”

The Impact of Obesity on Maternal Child Health

Science shows overwhelming evidence that obesity affects pregnancy outcomes:

The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic. Source: The Impact of Maternal Obesity on Maternal and Fetal Health. Department of Research, The American College of Obstetricians and Gynecologists, Washington, DC†Department of Psychology, American University, Washington, DC

Callaghan noted that women with lifelong poor nutrition and long histories of type 2 diabetes are also at risk of maternal medical complications — issues Ward attributed to a lack of health insurance.

Examining Costs: Why Do US Births Cost the Most?

A New York Times article from 2013 is one of many articles shedding light on the healthcare dollars spent both out of pocket and by insurance companies including Medicaid in American Way of Birth “The Costliest in the World”. The U.S. has the highest per capita health care expenditures on maternity care (twice that of most developed countries) with hospitalization related to pregnancy and childbirth costs of over US$86 billion per year.

Maternity and newborn care comprise the highest hospitalization costs of any area of medicine and the leading profit-center for most for-profit hospitals. U.S., with costs related to pregnancy and childbirth reaching over $86 billion per year as reported by the New York Times in American Way of Birth “The Costliest in the World”. 

Impact on Fee-for-Service: Money Motivates Doctors To Do More C-Sections

Providers make more money from Cesarean births. The National Bureau of Economic Research and health care economists Erin Johnson and M. Marit Rehavi calculated that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.  An NPR article titled “Money May Be Motivating Doctors to Do More C-Sections” states, “Obstetricians in many medical settings are paid more for C-sections. 

Professor Gerard Anderson of the Johns Hopkins Centre for Hospital Finance and Management says that the fee for service “a la carte” payment system puts more money into the hands of doctors, which drives up the number of tests ordered, “If you can make more money as a doctor by ordering more tests, you are going to order them and therefore patients end up getting more tests,” he says. Patients receiving more tests pay great out-of-pocket costs and cost insurers more money.

Patients Need Education to Reduce Cesarean Birth

Johnson and Rehavi examined the reasons for the increased number of surgical childbirth procedures via an unusual tack: They hypothesized that obstetricians would be less likely to be swayed by financial incentives when patients themselves had significant medical expertise and knowledge. By contrast, the researchers figured, such incentives might play a larger role in medical decision-making when patients knew very little.”

Access to Affordable Maternity Care is Essential

The first step for patients begins with access to affordable preconception and pregnancy care. While the Affordable Care Act has certainly improved access to pregnancy care, there are still millions of uninsured and part-time women who do not get prenatal care. Rachel Ward, the director of research for Amnesty International USA and the author of the 2011 report “Deadly Delivery: The Maternal Health Care Crisis in the USA.” writes:

The way in which the health care system in the USA is organized and financed is failing to ensure that all women have access to affordable, timely and adequate maternal health care services. As a result, women, and in particular women of color, women living in poverty and immigrant women, are more likely to enter pregnancy with untreated or unmanaged health conditions; to receive little or no prenatal care because of delays in receiving coverage; to face crippling debt following labor and delivery; and to have limited access to postpartum care.

Do we value mothers and children so little that we believe that parents should go bankrupt for bringing a child into our society? Does it make sense that parents who lack insurance are subject to higher costs because they don’t have insurance companies negotiating fees on their behalf?

Data Prove Ongoing Birth Support Improves Outcomes

Data shows that proper childbirth education and preparation for birth improves birth birth outcomes. Evidence also shows that labor and birth support from trained care providers such as birth doulas (women that provide birthing women with ongoing emotional, physical and psychological support) improve birth outcomes and reduce costs.

Source: Every Mother Counts, Overdue: Medicaid and Private Insurance of Doula Care

Ongoing Birth Support Lowers Cesarean Section Rates

In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 22 trials that included more than 15,000 women. These women were randomized to either receive continuous, one-on-one support during labor or “usual care.”

The authors concluded (and the evidence shows) that outcomes are improved from doula support, “Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.”

“Overall, women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.”

Providers Should Cover Doula Support to Lower Cesareans and Improve Costs

Why are birth support providers not covered by healthcare insurers who have financial incentives to reduce Cesarean sections and the cost of birth? Why are there no universally available, provider-covered health plans to help women reduce their chances for Cesarean birth? Because doulas are not currently a covered expense, insurance companies have little tracking data on the efficacy and cost-effectiveness of doula support. Because insurers don’t have this data, they can’t justify coverage. A Catch-22 situation.

Access To Doula Services and Income Disparity

“Given the strength of the evidence and the endorsement of doula care by professional associations, it’s important to consider why only 6 percent of U.S. women who give birth have support from a doula. First, hiring a doula is expensive. Most private doulas charge $700-$1,500 per birth, putting doula care outside the financial reach of many mothers.”

Secondly, doulas are not evenly distributed geographically, and many women in rural areas of the United States—where half a million babies are born each year—don’t have a doula nearby. Finally, there is limited diversity within the doula workforce, which can create cultural barriers to access. Most doulas are white upper-middle class women, and most of their clients are white upper-middle class women.

Low-income women and women of color, which are the groups of women at highest risk of poor birth outcomes, are also the most likely groups to report wanting, but not having, access to doula services. The major evidence gap for policymaking is not whether doula care supports positive outcomes but rather how policy efforts can best ensure access to evidence-based doula support and whether and how particular policy strategies more effectively produce value and potentially reduce disparities in birth outcomes.”

The Role of Medicaid in Promoting Access to High-Quality, High-Value Maternity Care: The Case for Medicaid Coverage of Doula Support

More than 50% of births are covered by government-funded Medicaid. A report titled “Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform” published by the Jacobs Institute of Women’s Health states “The Medicaid program is a major source of public financing for health care services provided to pregnant women, infants, and children in the United States.”

Medicaid covers more than 1 in 3 US children and over 40% of births, including infants, as well as a significant number of deliveries across the nation according to the Kaiser Commission on Medicaid and the Uninsured, 2013. With four million births per year, Medicaid covers 1.3 million births.

Medicaid Coverage Reduces Income Disparity

Medicaid is a bedrock source of coverage for children. Medicaid, together with the smaller Children’s Health Insurance Program (CHIP), covers more than 1 in every 3 children and more than half of all low‐income children. Medicaid is particularly important for children with disabilities and special needs. Because of Medicaid and CHIP, the uninsured rate among children has declined substantially over the last decade.” 

Source: Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform

“As states expand coverage to low-income women, women of childbearing age will be able to obtain coverage before and between pregnancies, allowing for access to services that could improve their overall and reproductive health, as well as birth outcomes. Improved birth outcomes could translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.”

Financial Incentives for Medicaid Coverage of Doula Support 

Medicaid has a direct financial incentive to cover doula support as well as national childbirth education to reduce the cost of birth nationwide, which totals more than $80 billion.

The George Washington University School of School of Public Health and Health Services known as the Jacobs Institue on National Health published an abstract titled The Role of Medicaid in Promotion Access to High Quality, High-Value Maternity Care which analyzed and described the role of Medicaid in facilitating access to care for pregnant women and ensuring high-quality maternity care that is affordable:

“Health care reform may provide an opportunity to revisit key issues around access to and quality of maternity care, including the benefit package, the content of services covered in the package, the frequency with which these services should be furnished, and the development of meaningful measures to capture whether women of childbearing age, including pregnant women, regardless of insurance status, indeed receive efficient, timely, effective, safe, accessible, and woman-centered maternity care.”

How Medicaid Coverage For Doula Care Could Improve Birth Outcomes, Reduce Costs, And Improve Equity” states

“At a time of growing pressures toward cost-containment within the health care system, the search for solutions to achieve the triple aim (quality improvement and better population health, at a lower cost) [within maternal-child health] is increasingly urgent.”

Efforts to expand Medicaid coverage to include doula services have the potential to improve access to low-intervention, physiologic birth and also to reduce costs of maternity services for all women.

“In 2013, Minnesota passed legislation requiring Medicaid payment for doula services. We (the authors of this post) are currently studying the effects of this law in partnership with community- and hospital-based organizations that provide doula services.

“If states consider this route, Minnesota’s lessons may inform their efforts. It is possible to create policy change that heeds the call of Goldstein to “empower women in their birth experience whenever possible,” and of Glied and colleagues to “improve productivity, producing the same services with fewer, or less costly, labor inputs.”

The Case for Nationwide Financial Coverage for Prenatal Education and Doula Support: Improved Outcomes and Lower Costs

Patient education is sorely lacking for women both before and during pregnancy. There are no nationally-published guidelines for how to prepare for a healthy pregnancy and birth. There is no trusted health or medical authority for pregnancy education in the US that adequately prepares women for the most costly, scary and high-stakes medical event of their lives: childbirth. There is no government-mandated national coverage for prenatal and childbirth education, yet financial incentives exist to adequately prepare pregnant mothers and provide ongoing birth support to reduce costs and improve outcomes, including reduced Cesarean births as evidenced above and below:

“In childbirth, Johnson and Rehavi figured, this meant that obstetricians would perform fewer C-sections when their patients were themselves doctors. 

“We found that doctors are about 10 percent less likely to get C-sections,” Johnson says. “So obstetricians appear to be treating their physician patients differently than [they treat] their non-physician patients.”

“The idea is that physicians have medical knowledge,” Johnson says. “If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician. But that might not be the case for non-doctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them.”

Johnson suggests that one solution to the disparities lies in better patient knowledge and empowerment, which is a result of improved patient education and universal access to childbirth preparation (and therefore financial coverage for childbirth education).

The average childbirth class is about $150, yet the potential reduction in healthcare costs as a result of improved prenatal and birth education and thereby reduced Cesareans is more than the average childbirth class (given Cesareans births cost on-average about $10,000 and in some cases up to $20,000 per birth depending on the hospital).

Prenatal preparation and ongoing, compassionate labor support in the form of birth doulas, which are on-average cost between $500-$1000 provides clear financial incentives for both Medicaid and private insurers to reduce the overall cost of birth, which is phenomenally high and only getting more expensive:

“According to the same Kaiser Family Foundation report, the average hospital delivery cost was $6,520. This cost is steadily rising; it was $3,983 in 1987 and $5,464 in 1997. According to the American Academy of Family Physicians (AAFP) the average costs of a vaginal birth and C-section delivery are:

Without Complications
Vaginal delivery: $6,200
C-section: $11,500

With Complications
Vaginal delivery: $8,200
C-section: $15,500

These are hospital fees only. Doctor’s fees are usually charged on top of this and average $1,500. 

Wouldn’t you rather pay $150 for a childbirth class, even if your payment is out-of-pocket, along with the services of a doula, costing $500-1000 for a total of $650 to $1150, given it’s statistically likely to reduce your chance of a $11,500 to $15,500 Cesarean birth by on-average 22.3% or by 31.5% among Medicaid beneficiaries nationally? The data provides incontrovertible evidence that doula-supported births were 40.9% less likely to result in a C-section compared to births that did not have the benefit of ongoing emotional, physical and educational support not typically provided by obsteticians:

“After controlling for factors associated with high-risk pregnancies and C-sections, such as gestational diabetes, race/ethnicity, hypertension and age, the U of M researchers found that doula-supported Medicaid births were 40.9 percent less likely to result in a C-section.

They also found that states could reap significant savings by paying doulas to support Medicaid mothers during pregnancy and delivery. Minnesota, for example, would have saved $3 million in 2009 by reimbursing doulas $300 to assist Medical Assistance women during childbirth, according to the researchers’ estimates.

Prenatal education and knowledge of basic childbirth procedures, comfort measures and coping techniques can help every woman and mother have a better birth experiment. How can we provide access to these essential health education programs and maternal support services?

Google certainly doesn’t replace the advice of a certified physician, and community health forums are full of misinformation and bad medical advice from women who are untrained in professional birth support and prenatal education.

Access to trained providers such as birth doulas and compassionate, effective, outcomes-driven obstetricians and midwives can and do improve outcomes and reduce costs by the thousands. It is time we provide our mothers the prenatal education support and ongoing birth and labor support that every women deserves.

If you are a first-time pregnant woman, please educate yourself on how to best prepare for childbirth, reading evidence-based guides to childbirth, such as Ina May’s Guide to Childbirth, which follows a midwifery model of care and continuous labor support known to improve outcomes while reducing costs. Childbirth preparation through books and classes provide first-time mothers with inspiring birth stories and practical advice, such as:

  • Reducing the pain of labor without drugs–and the miraculous roles touch and massage play
  • What really happens during labor?
  • Orgasmic birth–making birth pleasurable
  • Episiotomy–is it really necessary?
  • Common methods of inducing labor–and which to avoid at all costs
  • Tips for maximizing your chances of an unmedicated labor and birth
  • How to avoid postpartum bleeding–and depression
  • The risks of anesthesia and cesareans–what your doctor doesn’t necessarily tell you
  • The best ways to work with doctors and/or birth care providers
  • How to create a safe, comfortable environment for birth in any setting, including a hospital

Take a childbirth class at your local hospital, through your obstetrician or midwife or an independent childbirth professional certified through the International Childbirth Association so you are aware of all the various procedures, tests and expertise which will need budgeting for.  A prepared and educated pregnant mother is less likely to make uniformed choices or suffer a negative birth experience.

The  US National Library of Medicine along with the National Institutes of Health published outcomes data showing that “Personal control during childbirth was an important factor related to the women’s satisfaction with the childbirth experience. Helping women to increase their personal control during labour and birth may increase the women’s childbirth satisfaction.”

What pregnant mother and expectant couple does NOT desire a satisfying childbirth experience and a healthy baby?

Find compassionate birth support by finding a doula in your area, available through certifying doula organizations such as Doulas of North America.

If You Cannot Afford the Cost of Health Insurance, Obtain Medicaid or Look Into Reduced-Cost Prenatal Care

The Affordable Care Act offers pregnant women more options and protection. Women in every State can now get help paying for their medical expenses and care during pregnancy.

To find out about the program in your State:

• Dial 800-311-BABY (800-311-2229). This toll-free phone number will connect you to the Health Department in your zip code.
• Dial 800-504-7081 for information in Spanish.
• Call or contact your local Health Department.

For additional information call:

National Women’s Health Information Center (NWHIC)
Phone: 1-800-994-9662

National Center on Birth Defects and Developmental Disabilities
Phone: (770) 488-7150, (888) 232-6789

Smart Moms, Healthy Babies
Phone: (734) 936-4000

March of Dimes
Phone: (914) 428-7100, (888) 663-4637

The Nemours Foundation
Phone: (302) 651-4046

The Financial Case for Postpartum Care

According to data published by Pediatrics January 1986, VOLUME 77 / ISSUEtitled “Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation”, a comprehensive program of prenatal and postpartum nurse home visitation designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status improved outcomes and reduced costs:

“During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies’ fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (<17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P ≤ .05 for all findings.”

Improving Maternal-Child Healthcare as a Matter of Public Health

Whether you’re a healthcare provider, a maternal-child health advocate, public policymaker or employer, we have a collective social, moral and financial incentive to improve the healthcare outcomes for pregnant mothers and babies, while reducing the national and out-of-pocket costs of maternal care.This includes cost-effective programs such as national coverage for childbirth education and ongoing labor support.

Don’t we owe it to American children and their mothers to ensure a safe and satisfying birth? Is there anything more important to our society’s future health than the health of our mothers and children?

“It keeps startling me that at the beginning of this 21st century, at a time when we can . . . explore the depths of the seas and build an international space station, we have not been able to make childbirth safe for all women around the world. … This is one of the greatest social causes of our time.” Thoraya Obaid, Executive Director of the United Nations Population Fund

Denise Terry is CEO of EmbraceFamily Health, a digital maternal-child health company focused on supporting parents during pregnancy, baby and the childhood years. EmbraceFamily provides parents with evidence-based education, health education and expert support to enable the healthiest children and families. In addition to her experience as a technology entrepreneur, Denise supported hundreds of expectant parents during pregnancy, birth and the postpartum period as a birth and postpartum doula and licensed childbirth educator. Denise is a mother of twins.

Rock Health’s Halle Tecco, Queen of Digital Health

MY STARTUP GRIND INTERVIEW WITH HALLE TECCO (CEO ROCK HEALTH)

I had the pleasure of interviewing Rock Health’s founder and CEO Halle Tecco before leaving my job as head of marketing and sales of StartupGrind, a global community of entrepreneurs. I left StartupGrind to found my digital health company, EmbraceHer (now EmbraceFamily Health) focused on maternal-child health and women’s health.

As we come to the end of XX in Health week it’s fitting to pay tribute to the woman who launched XX in Health, Halle Tecco.  Halle is co-founder and CEO of Rock Health, a seed accelerator for health tech startups that helps entrepreneurs working to transform healthcare.  XX in Health is an initiative through Rock Health that connects and empowers female visionaries to drive change in healthcare.

I interviewed Halle in San Francisco earlier this month prior to Rock Health’s 4th annual Health Innovation Summit.  We talked about Halle’s journey from Silicon Valley to Intel, Apple and Harvard Business School, where she ultimately founded Rock Health before graduating. We also touched on the joys and challenges that technology entrepreneurs face while innovating in the health space, including the role of ‘healthcare outsiders’ in helping to bring change to a system that’s long needed a little shaking up. We explored the exciting trends disrupting healthcare including mobile, wearable devices, the consumerization of health tech, remote monitoring and more.

We also explored the central role that women play in healthcare as the chief medical officers and caregivers of the family and why more women entrepreneurs would bring a welcome perspective to health tech. Here are some highlights featured in XX in Health’s State of Women in Health Report:

–       85% of women choose their children’s doctors

–       84% are responsible for taking their children to appointments

–       78% of the health industry’s labor force is comprised of women

According to the report, although women play a major role in health purchase decisions, women are still underrepresented as health tech entrepreneurs (a mere 16% of Rock Health founders are women), as CEO’s of hospitals (19%) and healthcare company Boards of Directors (14%). Women entrepreneurs relish a good challenge, however, and I was pleased to hear of the many women innovating health coming out of Rock Health such as Amy Shen of Cellscope, Mikki Nasch and Christine Lemke of AchieveMint, Maria Ly of Skimble, Meghan Muntean ofChickRx, Somaira Pujwani of Medmonk, Rebecca Woodcock of CakeHealth and many more.

As a health tech entrepreneur focused on women’s health and a mother of a young daughter I’m inspired by the example that Halle has set for us. She is empowering both women and men to disrupt healthcare by providing education for entrepreneurs, collaborative access to networks and capital and a positive role model for those who want to affect human health in a positive and truly scaleable way. Are you inspired to shake up healthcare? Apply to participate in the next Rock Health batch and no matter what challenges come your way (because changing healthcare is REALLY hard), keep rocking on!

Here’s a transcript of the interview:

Denise Terry: Halle, why don’t give the audience some background on who you are and your education?

Halle Tecco: Sure, I was born and raised in Ohio, in a very boring town. My mom was a stay at home mom until my parents eventually divorced. Much of my childhood was filled with me entertaining myself because my siblings where much older than me and were more like parents then siblings.

I stayed in Ohio for college and moved to California where I eventually made it to Silicon Valley. I eventually went to Harvard business school while keeping my foothold in Silicon Valley.

I eventually started working for Apple and their App Store, but my passion was in Health Care and I would eventually leave Apple to start Rock Health.

Healthcare is important for everyone. I wanted a way to seek out and inspire others.

DT: What did you learn from Apple that you took with you to Rock Health?

HT: What I learned was that mobile was the future and health care was behind. Healthcare was stagnant. I knew the mobile health revolution was coming.

DT: What were some of the fears or barriers you had when starting Rock Health?

HT: Regulations would be at the top of the list. The FDA specifically is a big barrier. The FDA has not came out with guidelines as to what would make your mobile device a medical device. This can make things hard for people to come out with innovative new tech products.

Selling into large legacy organizations is definitely challenging as well.

Funding is an issue too. There is just more money going into other verticals and not so much into healthcare.

DT: You graduated and came back to Silicon Valley to start Rock Health. How did you getting things started?

HT: While in my 2nd year of business school I met with tons of Boston VCs seeking money and got shut down by all of them. I eventually left and went to Silicon Valley and raised about a half million to get Rock Health started.

We launched at SXSW in 2011 while I still had a few months of school. I was trying to do a lot at once. I had to start with getting the company ready and building a team. The day after I graduated I went straight back to Silicon Valley.

DT: Is Rock Health a for-profit or non-profit organization?

HT: We kind of have a hybrid model going on. We’re a non-profit when we want to work with the hospitals. This was due to how hospitals run. Hospitals said it was easier to partner with non-profit organizations versus for-profit organizations.

We don’t pay taxes with these deals, but it allows us to work well with hospitals and create better programs.

It’s not always about making money, it’s about making good.

We eventually created the Rock Health fund, which allows the company to be a for profit organization away trading for equity. People can invest money for equity.

DT: What do portfolio companies benefit from joining Rock Health?

HT: The program is 4 months long. We like to look for a company with a great team and idea. You have to have more than just a great idea.

We want to see teams that are really passionate, because healthcare is a really crappy road.

DT: What about hardware and wearables? Tell us about that.

HT: I love hardware!

Hardware gets interesting on the consumer side. When you can build something that is traditionally on the hospital side but brings it to the consumers.

The iPhone app, Otoscope, acts as an ear infection detector as a great example.

DT: What is the FDA? What do they do, and why do they exist?

HT: The FDA is set up to protect consumers, in short. There is a lot of bureaucracy involved as well. The FDA has been working in the healthcare space so there are standards, but they are just starting to see more mobile tech and creating a comity to help figure things out.

If your marketing material claims your product can diagnose someone, then it needs to be run by the FDA to make sure your app and advice is legit. We don’t want bogus apps out there giving false advice.

DT: Talk to us about the venture space.

HT: Look up Rock Health on Slideshare we have slides up there.

There were 180 investors in the digital tech space, 80% only invested in one startup. There are no angel investors in the digital health space. This really hurts the eco system of companies trying to make a name for them in this space.

DT:  Some people say that the use of doctors is going to decline in the coming years, what are your thoughts on that?

HT: Tech can help with standard things around a doctor’s office. If a kid keeps coming in with an ear infection, a doctor doesn’t need to look at it, a machine could do it. This frees the doctors’ time to do things that a machine can’t.

DT: What are some things you haven’t seen and would like to see in the tech health care space?

HT: I’m personally into remote continuous monitoring. Things you can wear in the home to help consumers understand their bodies and health. We currently have a few companies like that now.

DT: Tell us about women in health.

HT: There aren’t a lot of women in the healthcare generally, so we started an initiative to support more women in digital health. Women make most of the health care calls in the home anyways, so getting them involved allows the industry to get a new perspective.

I was really disappointed to see very little women applying and getting involved in Rock Health.

DT: Explain Obamacare.

HT: I don’t understand all of it, but I see the main goal is about access. There are 50 million uninsured Americans and this is one of the reasons why healthcare costs so much.

Healthcare can be expensive because people who don’t have insurance cost taxpayers money to help pay their bills.

Pretty soon insurance companies will start to compete with each other with price and quality. This will bring innovative new plans and ideas into the hands of consumers. This should get more entrepreneurs involved into the health space too.

Insurance providers really need to reduce their costs and overhead. Insurance companies are also buying up smaller companies to get a competitive edge over their competitors. Planning for the future.

DT: You have an amazing health summit coming up, Tell us more about it.

HT: It’s the 3rd annual health innovation summit in SF at the W hotel. It’s sold out, sorry.

We want to try and live stream it, but not sure yet.

John Sculley, who has been investing a lot in the industry, is speaking about building an iconic health company. And Steve Blank will also be speaking about the Lean-ish healthcare startup.

We want to make our conferences more geared toward tech with more positive vibes compared to the negative type of vibes that health conferences have. We want people to have fun and learn.

DT: What do you see the next 10 years is going to be like in healthcare?

HT: I hope remote continuous monitoring takes off to help reduce visits to the hospital for general checkups.

Baby boomers are creating a big market, so I’d like to see some stuff there too.

DT: Well that’s it for tonight. I’d like to thank Halle Tecco for coming out and speaking to everyone.

halle-rockhealthHalle is responsible for building partnerships and overseeing Rock Health’s strategic direction. She previously worked for Intel and Apple, and founded YogaBear.org. She earned a BS at Case Western Reserve University and an MBA at Harvard Business School. Halle was named one of CNN’s “12 Entrepreneurs Reinventing Healthcare” and Forbes “30 under 30″. Follow her on Twitter @halletecco

 

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Why Women Investing in and Championing Women Makes Sense

Read my post on the importance of investing in women in technology and supporting women pursuing careers in STEM and technology on Startup Grind.

Building an Ark Company and The Myth of the Unicorn

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‘Well, now we have seen each other,’ said the unicorn, ‘if you’ll believe in me, I’ll believe in you. Is that a bargain?’ — Lewis Carroll

There’s been much talk in Silicon Valley lately of building Unicorn companies. Thanks to Aileen Lee’s 2013 “Unicorn Club” post in Techcrunch, the term Unicorn no longer means a mystical one-horned horse-like creature. It now means a Billion-dollar company, or to be more precise, “U.S.-based software companies started since 2003 and valued at over $1 billion by public or private market investors”. Everyone in Silicon Valley wants a Unicorn now. VCs want to find them and fund them. Founder/CEOs want to start them. Engineers want to build them. Service providers want to cater to them. We are in the golden age of Unicorns. Never in the history of software have more companies risen to a billion-dollar+ valuation as quickly as in the last 5 years. It took companies like Oscar and Zenefits only 2 years to reach Unicorn status, faster than even Uber, Facebook and AirBnB.

All this insanely rapid wealth creation is making Silicon Valley a weird place to live. There are dozens of billionaire founders and VCs within a stone’s throw of Sand Hill Road just down the street from me. There are more Teslas per capita within a 10 mile radius except for maybe downtown Las Vegas thanks to Tony Hsieh. Whether all this wealth creation is actually doing good for humanity remains to be seen. Sure, Uber is keeping thousands of drivers gainfully ’employed’. AirBnB lets normal people make money by hosting guests at their dwellings. Facebook is keeping the world more open and connected. They are all touching billions of lives.

And yet is market valuation and money the most noble and important metric for measuring ‘value’ to humanity and society? Who wins when companies are worth billions? Founders and early investors. Maybe some lucky early employees, as with Google, Facebook, Paypal…Perhaps those hard-working and lucky individuals will go on to found and fund even greater companies that impact millions and billions of lives in a positive way. Maybe not. Maybe they’ll just buy more Teslas and houses and private planes and hang out on billionaire row at Burning Man. Fewer than a dozen Silicon Valley billionaires have joined Warren Buffet’s Giving Pledge.

What about the billions of people on the planet who aren’t so fortunate to share in these spoils? Isn’t there some better measure and higher ideal that we as entrepreneurs and company-builders can aspire to that isn’t solely measured by the dollar signs? Where are all the companies committed to enhancing the value of human life? Ones focused on optimizing lifespan, solving for premature death, curing unnecessary disease, unlocking our personal DNAmapping how we’re all connected, or improving the state of humanity in some large way? Do we really need another social network or gaming company or hookup app? Why is this work left to foundations like The Gates Foundation? Where are all the brilliant minds solving the big, important human-saving problems?

Among the thousands of paired creatures saved on the Ark, there was the Unicorn. Apparently the Unicorn did not make it on the Ark due to hubris. Let’s not make that same mistake with the companies we create.unicornnextone

One of my favorite poems and songs by Shel Silverstein recounts this story of the unicorn literally missing the boat because he was too busy playing silly games. Oops, I digress…

A long time ago when the earth was green,
There were more kinds of animals than you’d ever seen.
They’d run around free when the world was bring born,
But the loveliest of them all was the Unicorn.

There were green alligators and long-necked geese,
Some humpty-backed camels and some chimpanzees,
Some cats and rats and elephants, But sure as you’re born
The loveliest of them all was the Unicorn.

Now God seen some sinning and it gave him pain.
And he says, “Stand back, I’m gonna make it rain.”
He says, “Hey Brother Noah, I’ll tell you what to do,
Build me a floating zoo.

And take some of them green alligators and long-necked geese,
Some humpty-backed camels and some chimpanzees,
Some cats and rats and elephants, But sure as you’re born,
Don’t you forget my Unicorn.”

Old Noah was there to answer the call.
He finished up making the ark just as the rain started falling.
He marched in the animals, two by two
And he called out as they went through.

“Hey Lord, I got your green alligators and long-necked geese,
Some humpty-backed camels and some chimpanzees,
Some cats and rats and elephants,
But Lord, I’m so forlorn, I just can’t see no Unicorns.”

Then, Noah looked out through the driving rain,
Them Unicorns were hiding, playing silly games,
Kicking and splashing while the rain was pouring.
Oh, them silly Unicorns.

There were green alligators and long-necked geese,
Some humpty-backed camels and some chimpanzees,
Noah cried, “Close the door cause the rain is pouring,
And we just can’t wait for those Unicorns”

The ark started moving, it drifted with the tides.
Them Unicorns looked up from their rocks and they cried,
And the waters came down and sort of floated them away.
And, that’s why you’ve never seen a Unicorn to this very day.

You’ll see green alligators and long-necked geese,
Some humpty-backed camels and some chimpanzees,
Some cats and rats and elephants,
But sure as you’re born,
You’re never gonna see a Unicorn.

– Shel Silverstein

I propose adding a new breed of company to the lexicon of Silicon Valley: the Noah’s Ark company. Removing the religious teaching of the Ark story for a moment, let’s just focus on the parable: The Ark saved humanity from the flood. Whether you believe the Great Flood happened or not, history is rife with flood myths. The Ark lifted humanity to a greater state of existence – apparently the human race had become so wicked, evil, violent and corrupt that it was not fit to go on living. Does this sound a little bit like the sad state of affairs in the world today? Where is the compassion that inspires smart entrepreneurs to solve for humanity’s greatest problems? Not the ones that affect the 1%, those that touch the 99% — poverty, hunger, disease, death, lack of education, lack of access to water, basic healthcare and proper nutrition. The list goes on…

A Noah’s Ark company can be a not-for-profit like Internet.org, which aims to connect the two-thirds of the people on the planet that don’t have Internet access. Or a company that crowdfunds healthcare to people around the world who could not otherwise afford it. Or companies that give humans access to clean drinking water, the vital ingredient that sustains life.

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Most all of these companies focus on some aspect of human health and quality of life improvement. These are noble, humanitarian-focused, life-enhancing companies with the power to improve billions of lives and impact the next several generations. Look at Counsyl and 23andMe, which gives everyone access to know their own personal DNA. These are Noah’s Ark companies.

If you are an entrepreneur, a technologist, a consumer, an investor — I implore you to devote your time and your dollars to help build the Noah’s Ark companies of the future. Being a unicorn and a Noah’s Ark aren’t mutually exclusive – but how about let’s aim to build Noah’s Arks before unicorns.

My aim is to build both, then to join The Giving Pledge to give it all back to humanity and pay it forward to the next generation. My company focuses on healthcare innovation and on technology solutions that improve health outcomes. Our first focus is on the health of mothers and children (maternal-child health), because as a mother I believe there is nothing more important to a parent than the health of your own children. If you want to improve the health of humanity and the health of future generations, I believe we should start with the beginning of life — where the greatest lifelong impact can be affected proactively and preventively.

In the end, on your deathbed, when you perform your life review before those you are leaving behind, will it really matter how many zeroes are at the end of your bank account? Will your kids be better humans because you left billions behind for them? Do you truly believe that she who dies with the most money “wins”? I don’t. Those with the most toys when they die, still die. Money can only solve for certain things and enhance your quality of life so much beyond the basics. Ultimately, money doesn’t buy happiness. It also won’t save humanity from itself. But just maybe if a few hundred of us build a few hundred more Ark companies, we can lift the tide for all of humanity by the billions.

From a Ukranian Folktale:

All of the beasts obeyed Noah when he admitted them into the ark. All but the unicorn. Confident of his strength he boasted ‘I shall swim!’. For fourty days and fourty nights the rains poured down and the oceans boiled as in a pot and all the heights were flooded. The birds of the air clung onto the ark and when the ark pitched they were all engulfed. But the unicorn kept on swimming. When, however, the birds emerged again they perched on his horn and he went under — and that’s why there are no more unicorns now.’

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Clarity Brings Compassion

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I recently experienced what I will call an ‘awakened moment of clarity’ a few weeks ago. It is the closest thing to an enlightened state of being that I have had in my lifetime. It hit me out of nowhere, completely unexpectedly. I was literally standing on my balcony looking out at the trees in our backyard. In an instant, I felt an expansion in my heart and a flood of great joy. The feeling reminded me of the first time I saw my babies after giving birth. It was unconditional love. However, this love was directed at no particular person or thing. Those of you who are mothers and fathers might relate to this feeling. Until you welcome your own children into the world, you have no idea of your capacity to love so immensely, to feel so deeply connected to something or someone. It all changes in an instant, and life is never quite the same again.
There’s a saying that having children is “deciding forever to have your heart go walking around outside your body.” That’s how I felt in that moment. Although I have meditated for nearly fifteen years, this was unlike any meditation experience. I felt hyper aware of my surroundings, my bodily sensations, my breathing and the lack of thoughts in my mind. It was, for the first time in many months, extremely quiet in my head. I was at peace. I felt connected to everything and could viscerally sense the interconnectedness of all living things. I felt an overwhelming sense of gratitude for being alive and a simultaneous awareness of my own mortality. I felt very raw and vulnerable. I still do.
When I next saw my children, I saw them not as my children, but as a part of our collective future and humanity. Our children. As their mother, I’ve been entrusted to nurture them, keep them healthy and safe, help them mature into the best possible humans. I have always enjoyed helping people grow to their full potential. I’ve been blessed with boy-girl twins, which makes the experience of motherhood doubly joyful. I realize now how precious and limited my time with them is. As the saying goes, the days with children are long but the years are short. It’s over in the blink of an eye. Ask any grandparent. longshort That Saturday I felt as though I had fresh eyes on the world, like I was seeing the world and the people in it with the unbiased and innocent eyes of a child. I turned on the news (bad idea when one is feeling vulnerable and open-hearted) and felt at once the pain, suffering and anger in the world. People dying, children starving, humans killing each other over beliefs of the mind that may or may not be true. We now have the power to destroy each other, our species along with all the other species on the planet, thanks to the evolution of our technology. Our technology evolution has far outpaced the evolution of our own humanity. We are now the most dangerous animals on Earth. And although we have the technology, human capital, financial capital, and intellectual capital to eradicate poverty, ensure no person dies of hunger, or preventable disease….where is the collective motivation from those who can help to do so?

Consider these statistics:

  • There are 842 million malnourished people in the world; 1 in 9 people on the planet remain hungry every day
  • Every four seconds, a human dies of hunger — usually a child
  • Millions of children live in poverty, affecting their long-term health, development, and economic future
  • There are over 200 million child laborers in the world. Many of them produce the goods you and I consume every day, from toys to clothes to carpets to sports equipment. More than half of the World’s 200 million working children are working under hazardous conditions.
  • More than 702 million people have no access to a safe source of drinking water
  • More than 2 million children under the age of 5 will die this year, over 3 million are undernourished
  • More than 300,000 mothers will die in childbirth this year
  • More than 10 million women will suffer injury, infection or disease from childbirth this year
  • Over 140 million girls and women suffer from female genital mutilation, a barbaric, preventable, medically unnecessary procedure
  • Over 225 million women who want to avoid pregnancy lack access to safe and affordable birth control, contributing to a cycle of poverty among young girls who get pregnant too soon, die in childbirth, and leave school before getting a full education.  Most of these women live in the 69 poorest countries on earth. Why can’t we give them free contraceptives?

Now consider the fact that a handful of our population (1%) controls more than HALF the wealth in the world. Let me repeat, 1% of the world’s population owns more wealth than the other 99%. The wealthiest 80 people in the world own the same amount of wealth as more than 3.5 billion people.  Screen Shot 2015-04-11 at 9.38.29 AM I realized the gross inequity and income disparity in our world today with a lens of awareness I had not held before. There is no lack of resources, whether human, capital or technological that could be applied to solve these problems. The billions in wealth from dozens of “unicorn” companies here in Silicon Valley could immediately make a dent in these problems. Yet why are all these talented minds trying to build the next hook-up app, or gaming distraction, or disappearing social messaging tool….as though these are the most pressing societal problems to solve? Screen Shot 2015-04-11 at 10.26.08 AM

I live in the heart of Silicon Valley, five minutes from Sand Hill Road — the Land of the Midas List. There are no fewer than ten billionaires living within a one mile radius of my home. I am not one of them. If ever that happens, I will swiftly join Warren Buffet’s Giving Pledge to give all of it away. A la Warren Buffet, Tim Cook, Bill & Melinda Gates. Kudos to Mark Zuckerberg, the youngest to pledge so far. Because seriously, who cannot live, love and be happy with a mere half-billion dollars or a few hundred million? What could you possibly buy with that much unproductive wealth? How much do you really want to spoil your children and your grandchildren, and would they be better human beings from it (or rotten?). How many humans could you feed, vaccinate, educate, empower with technology tools to create economic engines to alleviate the problems above and below? There is so much hard work to be done, with so many brilliant minds in our backyard who could hack solutions for these eight problems…maybe not in a weekend, but perhaps over a year’s time with only 10% of their time devoted to it during working hours. Give your money, give your time, give both. givingpledgeOne startup near and dear to my heart called Watsi, built out of Y Combinator just a couple of years ago. I was one of their first donors because they crowdfund donations for medical treatments for underserved people all over the world. My $100 donation helped a seventeen-year-old mother from Kenya receive maternal healthcare to ensure a safe delivery. After a smooth delivery with no complications, she and her new baby did well. She was comforted by having a skilled attendant by her side during the birth and is grateful to have delivered in a hospital. Most women in the developing world are not so fortune. Many women walk miles to a hospital during labor to deliver their babies. This woman received maternity care for $100, the price of a nice meal out with my husband. It puts things into sobering perspective. I can never look at a hundred dollars in the same way again. Could you spare some of your money to fund life-saving, life enhancing treatments for those who cannot afford it? My heart broke open over and over.

I wept like I have never wept before in my life. It was as though the floodgates of grief and suffering experienced by these billions of people…the women, children, elderly, war-torn, displaced, underserved and forgotten…came pouring through me.  I returned to work the next Monday with a renewed sense of perspective on my calling in the world. I remembered the quote by Mark Twain, “The two most important days in your life are the day you are born and the day you find out why.” I had re-discovered and re-affirmed my “why”. Why am I here? I will never look at the world the same way again, nor my part in it. I believe we get one, limited lifetime on this planet Earth. No do-overs, no “try again next time” second chances… ONE shot. Better make it count. What will I do with the precious time I have left on this planet? Come back and visit for what happens next… P.S. Why are you here? What is your calling? Have you found it or lost it along the way? I did, but got it back. Would love to hear from you. You’re not alone.

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On Being a Woman, Wife, Mother, Founder, CEO and Woman in Tech

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It’s been nearly two years since I gave this blog any attention. I’ve been running full speed as cofounder and CEO of my digital health startup, EmbraceHer Health. I’ve raised seed money after bootstrapping for over a year, started generating revenues through sheer sweat and sales hustle, and hired an awesome team of women to help me get it done.

I’ve faced many of the same challenges most entrepreneurs face and it’s been a lonely and hard road. It’s hard to admit this to non-entrepreneurs who can’t quite relate to the 24/7-ness of it all. I’m a mom of twins – the work is not double, especially when they are babies – it’s exponentially harder than having one child. My husband is a tech CEO who makes the best possible startup partner, but despite all the Lean In advice to split household duties 50/50 I am still CEO of our household (which means hiring and managing all the amazing people who make it possible for us to work in our respective startups). We devote much of our waking hours to running our companies while still remaining devoted to each other and our children. It’s something that most women entrepreneurs rarely discuss or complain about because let’s face it, we have enough female bias to deal with without being labeled complainers about our home life.

There is a working mothers’ dilemma that many dads do not face, namely who is going to run the caring for the children when someone else is helping to care for them (e.g. daycare, nanny, au pair, babysitter network, grandparents, etcetera)? It sounds nice in theory to ‘divvy up the home work 50/50’, but we didn’t even attempt that because practically speaking, your nanny or childcare person just cannot answer to two bosses (just like have co-CEO’s is generally not a good idea). There needs to be the one ‘Person Clearly In Charge’ and that default setting is assigned to moms.

In our household the running of the house and minding of the children is my second full-time job (e.g., CEO of Our Home). To do this job well means outsourcing housework and childcare to trustworthy experts, but first and foremost it means being able to (1) Hire exceptional people and be able to manage them well, and (2) Let go of control and trust others with your children and your home.  If you cannot imagine saying yes! to #2, you will not be able to scale yourself successfully. Believe me when I say it truly takes a village to raise a child, a family, and grow a business. You cannot and should not do it all alone.

Note that I have one of the most loving, involved husbands in the co-parenting journey, which makes the added household responsibility somewhat workable for me. He’s home before tuck-in time, super attentive on weekends, and (lucky for me) isn’t addicted to distraction on social media or his iPhone. He prefers old school communications like (gasp!) picking up the phone to talk to people. So when he’s with our children, he is 100% fully present. As studies have shown, quality of presence with your children is much more important and impactful than quantity of time spent. Working mothers, take note! One more reason to feel less guilty for working while someone else cares for your kids. While I don’t agree with 100% of the advice Sheryl Sandberg shares in Lean In, I do agree that whom you choose to partner with in life will impact your success at home, at work, and in life. This fact cannot be overlooked any longer: the man (or woman) you choose will affect your professional success. Make sure you choose someone who will support your decisions when it comes to having children (if, how many, and when?), maternity choices (how long to leave work, will you return to work, full-time or part-time or stay-at-home?), paternity choices (will dad help? if so how long and how much?), and working while raising children (who “minds the children” or the childcare for the children?)….etcetera.

Then there’s Mommy Guilt. I have not met a working mother who hasn’t felt pangs of mommy guilt. Beginning with the first day back at work from maternity leave to the sometimes heart-wrenching ‘drop off’ at daycare we are constantly reminded that our choices come with tradeoffs. It’s not the same for working dads. First of all, there is no such phrase as a ‘working dad’. There is no battle of ‘stay at home dads’ vs. ‘working dads’. The default setting of traditional parenting is mom stays home and dad earns the income. Or both parents work but mom is still in charge of the caretaking in addition to her job. I know dozens of women who wish this were different. Many of my friends would opt to work part-time if there were more flex-time options for women with children. Sadly, there are few. Especially in tech startups where everyone is expected to work more than 45 hour weeks (mine are typically 60 hour weeks) and not leave the office for a 2:30pm school pickup. So what are we women to do if we want to ‘lean in’, make an impact at work, create something fabulous with our time outside of children, flex the creative parts of ourselves that have nothing to do with caregiving, give something back to the world, or create something for ourselves?

I’m speaking at the Girls in Tech conference on this very topic. How can you create a life that doesn’t entail choosing one path or the other? How can we bring our whole selves to the world so we are not forced into a ‘default setting’ because society and employers expect us to play by their rules? How do we create meaningful partnerships, marriages, friendships, support groups, mentor networks and collaborative workplaces that enable women like us to work, play, mother, love, create, care, and bring our true gifts to the world?

One of the reasons I started a company after working at nearly a dozen companies (mostly startups) is because I wanted to set my own terms for how my work and family life could support and enhance each other. I also wanted to create a culture that was proactively supportive of women of all ages and career aspirations. I am tired of working for men who don’t quite get what it’s like to be a woman in tech, who can’t empathize with the extra BS we have to deal with that we silently ignore or shrug off as the ‘default setting’ for behavior in the workplace. You won’t believe the number of times I’ve said exactly the same thing as a male colleague only to have it repeated in a different (and often louder) way to greater accolades from other men.

Then there are the interruptions. Has this ever happened to you? First of all, breathe. Count to 3. Repeat after me: “Stop interrupting me. I just said that. No explanation needed.” Repeat again, in case he didn’t hear you.

I am no longer the only female in my company (it was a lonely two years!). My cofounder is an amazing doctor, but he is not my full-time co-pilot and while he has often been called a ‘midwife in obstetric scrubs’, he is also not a woman in tech. So I’ve hired an amazing director of engineering and product who has been yearning to work with a female CEO. My Chief of Staff is a fellow mom at my children’s school who happens to be a pediatric nurse. I have a team of amazing interns who are all our target audience, which is great for customer empathy (we build health products for women). We offer flex-time schedules, remote work along with co-working a few days a week. Our ease of communication, collaboration and ability to get shit done is unlike anything I’ve experienced in any of my ten other startups (all led by male CEOs with predominantly male teams). Let me just brag here – it is AWESOME. #GirlBrag  By the way, I’m hiring awesome people. Please spread the word.

I’m using my startup as a real-life experiment for what a women-centric workplace and female-oriented company culture can achieve and inspire. As my good friend Tony Hsieh has written, building a great company culture is essential to creating a great company, period, “There are companies that focus on work-life separation or work-life balance and at Zappos we really focus on work-life integration and at the end of the day it’s just life.” I believe this with all my heart, because achieving work-life balance is the Great Myth that keeps us dissatisfied. There is no such thing as balance or “having it all”.  Everything comes with tough tradeoffs and work-life integration will look different for everyone. But if you think you can split your work from the rest of your life you will eventually be disappointed with either your work or your life. If you want to separate your work from your life in the first place, you probably aren’t loving your work so much. So make sure you’re doing something you love, something that you truly believe is worth doing with your entire being. Because it will probably take up a large part of your life, emotionally and mentally — consciously or not.

I’ll be back with more thoughts to share on my journey through startups and tech while being a woman and then a mother, and my experience of motherhood while being a woman in tech. I have some work-life lessons I’ve been yearning to share with other women, especially millennials and younger GenXers who are reading books like Lean In, are blessed with more family planning options like egg freezing, and are still being told by everyone that they can ‘have it all’.

The path I chose definitely hasn’t been easy. Oftentimes it’s been quite lonely. Sometimes I’m amazed I’ve made it this far. But now that there are more of us talking about this, here is our chance to band together and collaborate in making the world, starting with our work, the way we want it to be: female friendly.

#ShesTheReason I Went to Smith College

I had never planned to attend a women’s college. Far from it. I wanted to join the big boys at Georgetown and pursue a diplomatic career getting my bass-ackwards country back into shape. I never realized that women’s colleges existed until I approached my AP English teacher Mrs. Timoney for recommendation letters. “I am extremely disappointed that you have not considered Smith College,” she said in her most dignified and disappointed voice. “Huh? Where is that?” I asked. [Look of utter shock from my most respected teacher!] Ooops. Wrong response. “Please, tell me more, I’m interested!” I said.

“It is a most impressive academic institution, and you would be doing yourself a disservice not to consider it,” she told me. She told me of her own daughter who had graduated Smith and more recently, Harvard Law School. She raved about the class size, the focus on academics and teaching over publishing, and the women who were “simply brilliant”. She talked about the amazing network of successful women who would act as lifelong mentors and advocates for my professional success. Who were these magical women and how could I be like them?  It all sounded so amazing. I applied that same week and was accepted a few months later, in no small thanks to the glowing recommendation Mrs. Timoney wrote me (I saved it for sentimental reasons, and it still makes me tear up more than 20 years later).

After spending a weekend on campus during my round of college visits, I realized that I owed Mrs. Timoney a great deal of gratitude for pointing me down a path I never would have considered otherwise. For many reasons, Smith was the right choice for me. I probably wouldn’t have pursued economics or graduated early or entered the mostly male-dominated field of technology and startups, had it not been for my Smith education.

Today, on International Women’s Day, I thought I would take a moment to thank my first true mentor Mrs. Rosemary Timoney. She helped shape my life in the most meaningful way, she’s the reason I went to Smith College and why I’m so passionate about supporting women on their journey to success.

Be Thankful for Your Startup Partner

Startups aren’t for the faint-hearted, as anyone who has survived more than one will tell you. Startup life can be crazy, lonely, exhausting, and even heart-breaking at times — while also being exhilarating and fulfilling in the same day! Startup stress accumulated from long hours, all-nighters and ‘always on’ work pressures can challenge even the most solid relationships with family, friends and loved ones. Unless you’re actually in a relationship with your co-founder (like Eventbrite co-founders and husband/wife team Kevin and Julia Hartz) or with someone who is also in a startup or has been before, you may feel like your boyfriend/girlfriend/partner/lover/spouse just doesn’t understand you. If you’re lucky enough to be with someone who ‘gets’ you and your startup life, be thankful and be sure to let them know how much you appreciate them.

Before I met my husband (thank you founders of Match.com), I had already been through the ups and downs of five startups. Some successful, several failures. He was a serial entrepreneur who had also founded several startups, had succeeded and failed and understood my passion for launching ideas that could disrupt the world. We found a kindred spirit in each other, someone who could empathize with the other’s passion while also providing emotional camaraderie after a hard week’s work in the startup grind. Neither of us ever felt neglected when we pulled an all-nighter or jumped out of bed at 2 in the morning to put out a work fire. That’s just what you do when you’re committed to making your startup successful.

Perhaps the craziest test of our relationship came when we decided to launch our family (and give birth to twins!) in the same year my husband became a startup CEO. We are lucky that we can both function on very little sleep, as we barely got any for two years. Our motto back then?: “Sleep is for the weak”. We survived that rough stretch with a lot of help from grandparents, hired helpers and our own resolve to keep our marriage together, no matter what work or babies threw (up) our way.

Our weekly date nights saved us from being too baby- or startup-focused and gave us at least a couple of hours each week to reconnect.  If there’s one non-negotiable to keep your romantic relationship from flaming out while you’re in startup mode — keep your date nights sacred and make time for connecting one-on-one, just like you would with your co-founder, investors or team mates. After all, your team mate on your life journey is probably (and hopefully) more important than any of the people you’re working with, with greater impact on your lifelong happiness than whether your startup is successful – read Clayton Christensen’s How to Measure Your Life for more insights.

Our twins are now five years old and my husband and I have both been through three startups each since they were born. We couldn’t have tackled the challenge without a whole lot of empathy for each other’s passion, plus collaborative team work to manage our household, childcare and taking care of ourselves as well as our kids as true partners.

On this Valentine’s Day, I’m feeling most grateful that my life partner is also my greatest startup partner and supporter of my professional dreams.

Being a Jerk Won’t Make You More Successful

Silicon Valley VC Vinod Khosla wrote an insightful post on TechCrunch asking the question ‘Do You Need to Be a Jerk to Be a Successful Entrepreneur?“. He contrasts Steve Jobs’ ‘jerk-like’ behavior with his phenomenal success, while explaining that being successful and treating people fairly are not mutually exclusive. While entrepreneurs are not always the easiest people to love, there are thousands of successful entrepreneurs who are not jerks. Take Richard Branson, Marc Benioff, Mark Zuckerberg, Aaron Levie, Sarah Blakely and Oprah Winfrey to name a few.

You don’t have to choose between success and being nice, good, fair or treating people well. “It’s a false choice,”says Khosla.

I agree!

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