Reproductive Care: A Roundtable Conversation

Few industries are as important, emotionally charged, and life-altering as reproductive care. The degree of change and sacrifice a mother and her family undergo during this time is unparalleled. From fertility and pre-pregnancy to postpartum life, experiences vary greatly, and it’s up to the organizations and brands in the space to listen and provide support that can help as many parents as possible. For us at W+K Lodge, designing tools for reproductive care necessitates the input of multiple voices—dedicated creatives and technologists, expert physicians and caregivers, and the honest input of parents themselves.

To begin our research, we interviewed four individuals close to us at W+K, each with different vested interests and experiences withpregnancy and parenting. We approached this conversation as a starting point for a more diverse exploration of the space.

Ashley Davis-Marshall, Mother and Creative Director at Wieden+Kennedy

Maxwell Folley, Father and Director of Engineering at Wieden+Kennedy

Nicole Marshall, Mother and OB/GYN, Perinatologist at OHSU

Connery Obeng, Mother and Business Affairs Manager at Wieden+Kennedy

Here are their perspectives.

What are a few words that best describe your reproductive journey and experience(s)?

Ashley Davis-Marshall, Creative Director at Wieden+Kennedy
Um. OK. I. Guess. So? I don’t think anything about my reproductive journey has been terribly planned. If it had been, I would have second-guessed whether or not I had the time to balance a career and a family.

Maxwell Folley, Director of Engineering at Wieden+Kennedy
Humbling: As a partner going through the experience, labor was a powerful experience that really made me feel inferior. It’s a moment when the supporting partner, despite whatever control they want to have in the scenario, really can’t control anything and needs to just be the supportive rock for their counterpart in as many ways as possible.

Nicole Marshall, OB/GYN, Perinatologist at OHSU
Anxious: As a medical professional and as a patient myself, I knew all of the potential things that could happen and then translated that into my own experience. Anxiety is also something that I see every day in my patients, especially when they’ve had a bad outcome in the past. There are many points along that pathway that may not go as planned and that may not be what happens. That can be very anxiety provoking.

Frustrating: Pregnancy and early parenthood are things that so many people go through, and yet we still have very little understanding of what is normal and what is within the range of normal. How do we deal with so many of the discomforts, pain, and all the pieces of hurts that go into it? How do we support people who are going through that journey, recognizing what the journey means to patients? It’s not based on your life experiences or anything else that you can control. I have patients who are doing everything according to the books, and they’re running into challenges. I have other patients who are doing everything that society would tell you is horrible, and they have a perfectly healthy pregnancy and a normal baby.

A common narrative we hear is the difference between expectations and the reality of pregnancy, birth, postpartum, etc. What were some stages or areas where the expectation-reality gap is most prevalent?

Ashley Davis-Marshall:
I don’t think I fully realized how much time would be spent FOMO-ing. Juggling parenthood and a career mostly means de-prioritizing the extra (fun) stuff ... I don’t get to hang with moms in the daytime. I don’t get to go to after-work drinks with coworkers. I clock out of one job and go straight to my other. On the flip side, I’m pretty great at time management now. I don’t waste much time. I’m typing this while on hold with my insurance agent.

Maxwell Folley:
I think this gap comes down to our cultural obsession with defining things. We want answers to how the process will go, what to expect, and we want to control it. But pregnancy and labor are moments where you know something is coming but you have no idea how it’s going to play out. We set our expectations based on what we think we can control. But, I think you need to just do your best to control what you’re in charge of, like your state of mind.

Nicole Marshall:
In general, as a society, we still have very much this ideal view of the entire time period, that, “Oh, pregnancy is wonderful,” and, “Oh, isn’t it amazing that you’re carrying a baby?” Especially with breastfeeding: “Oh, isn’t it wonderful and beautiful,” and all of this. Really, the lack of recognition of how much of a demand it takes on our lives, on your body, and on your mind. To go through pregnancy with horrible constipation, heartburn, hemorrhoids, and back pain.

I was at a conference not long ago where someone had put up a picture of an empty candy wrapper. Basically, right now, that is the way we treat mothers. We value them while they’re carrying the baby. Once the baby is out, then we provide no additional support for the mothers. All of the focus, to a large extent, has been on how we protect the baby. How do we get the best outcome for the baby? How do we optimize their care? We really have not acknowledged the role that mothers and women play.

Connery Obeng, Business Affairs Manager at Wieden+Kennedy
Newborn infants are harder than anyone can explain; no one can tell you and no one really wants to tell you the reality. Even brushing your teeth or taking a shower is hard to fit in, let alone leaving the house. You can’t even imagine how absurd it is. There is no model of realistic expectations of new parenthood. The only thing you see is the abnormal. The people who are out of the house and visible within six weeks. What you don’t see is the people holed up in their house.

We don’t have a social system set up where the extended family comes to support new moms. We don’t have the societal/governmental structure to support moms (maternity leave) nor do we have familial structures to support mothers.

Let’s talk about the resources that helped you through your journey. Why did you choose these resources, and can you detail the roles they played for you?

Ashley Davis-Marshall:
La Leche League was a huge help with breastfeeding my first child. I had major latching issues, and a staff member was always available to help. She gave me a great email with step-by-step help that I referenced and even shared with other moms.

Maxwell Folley:
We tried a handful of apps to help track feedings, changes, etc. They all ended up being overbearing. The top resource has been the postpartum nurses. They’re amazing, carry a wealth of knowledge, and are so helpful to you and your partner during the first few days with your newborn.

There are so many questions that pop up and so many anxieties that having a source of reliable knowledge relieves. Googling answers is the most anxiety-inducing thing and is such an easy mistake to make as a parent-to-be or new parent. It’s easy. Having things to counter this with professional and credible advice that is as easy to access as Google is crucial.

Nicole Marshall:
A lot of women turn to online sources and to social media as their main source of answers. There are some resources out there that are very helpful and useful for women. There are others that provide very questionable suggestions and advice. I think [it’s] really hard for women to know where to turn.

There are various apps that seem to be the most popular ones that I hear my patients talking about. Probably BabyCenter is the biggest one that’s out there. It’s one of those that sends out weekly emails of, “Your baby is the size of a kumquat,” and this and that. I think a lot of patients do find value from that.

For some, there’s kind of a love-hate relationship with the medical profession, both from patients who very much value having a physician involved in their care, and others who prefer to turn to other means of care providing rather than hospitals and medical professionals.

Connery Obeng:
Lactation consultants; KellyMom; also talking to my mom and friends was helpful, but it’s tough because that type of network isn’t always easy to find, especially as a working mother.

I’m of the opinion that more information is always better. However, the framing is so important. On Becoming Baby Wise is a book that skewed my expectations. It was not possible to follow the specific and narrow type of schedule that they promoted. But, this book said it would be possible, and I felt like I was failing.

Which digital platforms and apps, if any, do you find most helpful?

Ashley Davis-Marshall:
Babycenter for the first child. I paid no attention to any of this for my second baby. Wonderweeks gives milestones but freaked me out because my second child had developmental delays and she was not on the same trajectory.

Maxwell Folley:
Anything that provides professional advice in a timely manner is key. Calling the pediatrician or OB/GYN can mean hours or even days until you get an answer. Have a reliable hand guide that can answer 99% of your daily questions.

Nicole Marshall:
There’s a variety of fertility apps out there. There’s been a couple of studies trying to look at which ones are good, which ones are not so good, and what kind of formulas they are trying to use. (See the W+K Frontiers article about that here!) For women who are trying to conceive, it can sometimes be very useful to be tracking their cycles and when their period actually started. For patients who are going through fertility treatments, it can be incredibly anxiety provoking. What day is it? Where am I in my cycle? What is my hormone level? How many follicles did I have today? All of those pieces and parts that women are keeping track of until they conceive.

After delivery, I think there are women who are turning to different apps to keep track of, “OK, when did the baby feed? What side did they feed on? When did they change the diaper? How long did they sleep?” Various apps try to keep track of all of those different things. I did with my son and it was just as frustrating trying to get him to latch and figure out, “OK, which side was that on?” and then to start the timer on the app, and then to turn it off. It was not nearly as useful as it theoretically could have been. I knew what I was doing with the second one, so I didn’t turn to any of that. I didn’t feel like I needed any of it.

How did it feel to bring, or choose not to bring, brands and products into this journey?

Maxwell Folley:
During pregnancy, most of it was purchasing for post-pregnancy—stuff for the child and for child care. I trust brands that hit that sweet spot between safety and utility. Nuna is a brand I trust. They focus on ease and safety and their products are simply designed. Also, 4 Moms does a decent job. Black Wagon in Portland is a store I love because they’re small and carry a selective catalog of stuff focused on ease and safety. I find comfort in knowing every product they carry is high quality.

Nicole Marshall:
It’ll be interesting to see how the market changes. Babies “R” Us was such a huge driver. New parents could create a registry and walk around this ridiculously huge store with aisles and aisles of all of these essential baby products. So, it’ll be really interesting to see if someone steps into that void, [or] if it’s all going to be Amazon baby registries.

Target has increased their market share. That’s been very controversial, because they used a variety of marketing techniques that they were able to figure out, based on what people were buying, when they were pregnant. They started sending specific coupons to women realizing it. There’s a couple of interesting stories that came out. A dad was upset that his 15-year-old was getting all of these coupons, and it turned out she actually was pregnant.

What was the role of family and community support in your experience?

Ashley Davis-Marshall:
My mom and mother-in-law came to stay with us for a week each and that helped. Somewhat helpful. But also somewhat annoying. One time I was complaining to my husband about the lack of help from his mom and didn’t realize that I was being picked up by the baby monitor and she heard. Whoops!

Maxwell Folley:
Everyone is willing to provide endless amounts of advice and opinions. You have to be selective with this because every parent is so eager to dish it out unsolicited.

Not everyone is willing to help though. My partner and I don’t live by family, so we mostly rely on friends when in a pinch and most are friends who do not have children. So there was a learning curve with our friends, but they’ve been a huge help and our kids are growing up with our friends as a big part of their lives. It’s been great to see how our friendships have adapted with changes in our family.

Nicole Marshall:
I specifically chose not to go to the prenatal yoga classes or the prenatal swimming classes. I was like, “Why would I want to do that?” That was not what I wanted to do.

When my son was about a month old and we had really been struggling with breastfeeding, I had found a lactation support group that I had started going to. That ended up being a huge source of support, and really made a big difference in that early postpartum journey. My son is now almost four and a half, and our group is still good friends. That worked out to be a really neat source of support with folks, so I’ve encouraged my patients to really think about being a part of a group like that. There can be something very reassuring about saying, “Hey, my kid’s doing this. Is your kid doing this?” or, “I’m struggling with this. Have you had this?” or, “How did you deal with this?” That can, at times, be very useful to get that support.

However, it can also be very toxic if it’s a super competitive environment. It’s like, “Oh, my kid is walking. Why isn’t your kid walking?” Motherhood’s a very complex area. That balance between supporting women in their choices, encouraging them, and not tearing each other down is a very fine line, both during pregnancy with what choices people are making, and in the postpartum. Whether it’s about breastfeeding, whether that’s cloth diapers versus disposable diapers, whether that’s starting solid foods — all of those things end up becoming potential battlegrounds.

How did you choose what care options to prioritize? Healthcare systems? Online forums? Friends and family? Products and brands?

Ashley Davis-Marshall:
I Googled key phrases. It would be nice to have perspectives from less extreme cases, particularly in my situation of having developmental delays.

Nicole Marshall:
To some extent, it was a lot easier for me during the pregnancy side of things, since that’s what I do every day. I did end up having complications with both my pregnancies, so I had to relate my experience to theory and studies. There were times that I looked online for different things or asked both my colleagues and friends various things about different experiences.

Where were there gaps in support for your journey? How did you attempt to work around or fill these gaps?

Nicole Marshall:
Some of it is the lack of knowledge that we have. How do we help women be more likely to get pregnant? How do we make them less likely to miscarry? How do we decrease the risk of preeclampsia? All of those could potentially be areas where different brands and technology could play some kind of a role. The challenge is, right now, we don’t necessarily have the direct advice to give.

I would love to be able to take a woman on her first visit and say, “OK, based on these analyses” — whether it’s body composition, glucose levels, or whatever it is — “here’s what I think is the optimal plan of care for your pregnancy. Here’s how I want you to exercise. Here’s the diet that I want you to have. Here’s how much sleep I want you to get. Here’s the stress release I want you to do.” Being involved to assist women throughout pregnancy and have a mapped-out plan of care —[ it] would be great to have that kind of thing.

Connery Obeng:
Coming back to work was absolutely terrible. I still was getting up three or four times a night and nursing, the baby was exhausting, and the daycare that we had to send her to was horrible. And daycare is so expensive in this country. Why is it not subsidized? Daycare workers get terrible pay. It’s so interesting, in this country where we prioritize finances, everything maternity- and child-related has no resources.

What technological innovations in this space would you wish to see?

Maxwell Folley:
Easier access to affordable donor milk. My second child we needed to supplement with donor milk. It is incredibly expensive, something like $3 to $5 per ounce. It’s mostly expensive because of the steps involved with processing donor milk. Milk banks are nonprofits and take many steps to ensure the milk is safe, but they have to charge to cover these steps. It would be great to see innovations that help accelerate the donor-screening process, reduce costs of shipping for the bank, and make milk processing easier.

There is a lot of promise in AI and machine learning research for prenatal assessment and labor processes. Particularly for solving problems like delivery technique assessment. Predicting the appropriate delivery can help to prevent excessive operative techniques. Research is also being done to predict premature birth with obstetric and pregnancy data. Finally, ML research is being done for prenatal risk assessment, which, when applied, can reduce the number of invasive and expensive prenatal tests.

What does the next frontier of reproductive care look like to you? How do you imagine that healthcare providers, companies, nonprofits, governments, and innovators can work better together to protect and support women and families?

Maxwell Folley:
I hope it will introduce ease and access. Innovation should be targeted at providing utilities that reduce steps, reduce risk, and introduce transparency. Introducing efficiencies through innovation into processes can reduce costs and increase access in turn. It’s a matter of shifting the dynamic because today’s biggest players in the innovation space are private agencies that keep healthcare data, and this is essentially IP to them. If access to high-quality data is open, innovation in AI and ML thrives. Patients should be given the ability to donate their data for research purposes in the same way they can donate organs, milk, or blood. Access to this data can save millions of lives.

Nicole Marshall:
We should minimize the burden of what we’re asking women to do right now. Women who are diagnosed with gestational diabetes have to check their blood sugar four times a day. If they do need to start medication, then they’re typically coming in twice a week for fetal monitoring. They’re changing their diet. They’re increasing their exercise. We’re asking a lot of women, so even trying to figure out a way that we could automatically have a blood sugar [reading] transmitted to the hospital so that they don’t need to come in [would help].

Are there ways that they could do fetal monitoring at home and transmit it to the doctor’s office, so they don’t have to leave work and come in all the time? For women who have hypertension in pregnancy, could they do blood pressure checks at home that are automatically sent to the doctor’s office to keep track of things, rather than having to call in and check in? We need to decrease some of the burdens on patients and help with care.

Connery Obeng:
Individualized attention is really great. Doctors are so busy they have like 15 minutes to meet with you one time a month. How else are you supposed to know anything? It’s weird to me that you have to do your own research on pregnancy and parenting. Some people like that and it works for them, and I don’t know what the alternative of that is. There has to be a better way than, “Oh just do an internet search!”

Illustrations by Loris Lora.

In this Reproductive Care series of W+K Lodge Frontiers, our team of designers and engineers explores how brands can create better products and experiences for women, children, and their partners. Join us as we consider what it means to deliver not just utility but care along the reproductive journey. If you’re interested in collaborating on any projects or learning more about W+K Lodge, email us at frontiers@wklodge.com.