Meet 'Irth,' the App That Asks Black and Brown Women to Rate Their Birth Experience

Kimberly Seals Allers was in graduate school when she gave birth to her first child. Going into single motherhood as a woman of color with student health insurance, Allers said she "did the work."

"I felt like I did so much research," Allers said. "I was really trying my best." 

Instead of the birth she'd prepared for, Allers said the providers assisting in the birth of her daughter were dismissive of her questions and her choices after delivery. To this day, she "can't fully explain" why she had a C-section because her medical team never adequately explained it to her. She felt her pain levels were dismissed in labor and her desire to breastfeed, instead of her baby being fed formula in the hospital, was also ignored.

"It really marred my initial experience," Allers said of her beginning experience in motherhood. "It really impacted those early days."

Stories like Allers' are not uncommon in the US -- in fact, social media platforms like TikTok have provided a new engine for people of color to shed light on their birth experiences, sometimes inspiring debates about home birth, medical school training and more. While stories like Allers' outline a lack of transparency or poor care, others involve much worse outcomes, including the preventable death of the parent. 

To address these problems and help improve pregnancy and birthing care all around, Allers developed Irth, an app for women and parents of color to rate their experiences with a hospital or doctor so other parents have more information to inform their choices on where, and how, they give birth. 

Here's how it works, why it's important and why Allers includes the input from the often-forgotten -- yet powerful -- role of the doula.

Racial bias and maternal mortality

Maternal mortality refers to deaths that occur while someone is pregnant, during childbirth or in the 42 days after pregnancy ends. Globally, the vast majority of these deaths occur in lower-income countries where people have less access to health care, including prenatal care. But among wealthy nations, more women die during pregnancy, birth or postpartum in the United States than in peer countries, including Canada, Australia, South Korea, Germany, France, Sweden and others, according to information from The Commonwealth Fund, which collects data from the Organisation for Economic Cooperation and Development. 

In 2021, the latest year for a maternal deaths report by the US Centers for Disease Control and Prevention, the US beat its bad record: Roughly 33 people died for every 100,000 live births, compared with approximately 24 the year before. Black women were more likely to die than their white peers -- nearly 70 deaths for 100,000 births. 

The reasons for this disparity are multifactorial. It can't only be explained by the existence of health conditions that make it more likely someone experiences a pregnancy complication, such as diabetes or a high blood pressure. And it's not all accounted for in differences in access to resources: Wealthy Black women and their babies are still twice as likely to die as wealthy white women and their babies, according to a California study reported in The New York Times. 

These types of racial disparities in health care are not new, nor are they limited to the birth experience. A small study from as recently as 2016 found that about half of a pool of white medical students surveyed held false beliefs regarding biological differences between white and Black patients, potentially perpetuating old beliefs in the medical setting that Black people feel less pain. 

An app like Irth is one tool for individuals to work together to navigate these disparities in care.

How to use Irth 

Irth is a tool for parents of color to find hospitals or doctors for care before, during or after their delivery. Past patients can leave reviews for hospitals, and those considering giving birth at a certain location can use the app to read reviews of others' experiences. 

To use Irth, you'll first need to download the app and create an account. Then, you're given an option to leave a review or search reviews. If you're searching for a review, you'll use your ZIP code to find reviews near you. You can read others' experiences, including an overall rating, the name of the doctor and whether or not the user thinks race was a factor in the care they received, or if they're unsure. 

If you're considering pregnancy or are still in the process of choosing a hospital to give birth or a pediatrician, for example, there's also an option to get notified of new reviews near you that are posted on Irth.

To leave a review of a hospital or doctor, go to the home screen and select the "review" option. Most people leaving reviews so far appear to be the person who gave birth, but partners, nurses, midwives and doulas (more on them below), are also able to leave a review. 

When leaving a review, you'll be prompted to share whether you were given prenatal, postal, birthing or pediatric care. Then you'll fill out location and date details, notes about the staff involved in your care, as well as your overall experience. Irth notes that your race, gender, sexuality, age and other personal details will be displayed to other users on the app.

The power of the doula 

The role a doula plays in childbirth is a powerful one that's often overlooked, according to Allers, and she welcomes their reviews on the Irth app. A doula is a labor assistant, but Allers says the real role of a doula is to prepare mothers and birthing parents on what to expect, which questions to ask and what you should be aware of when you leave the hospital -- a time in which risk of stroke, excessive bleeding and other health risks remain high and many of the maternal deaths reported occur. 

Essentially, Allers says, doulas "fill the gaps" in care that aren't standard in the US, but are expected and routine in countries like Australia. 

Because research shows the presence of a doula increases healthy outcomes for Black women, as outlined in an article on Irth, some community programs exist to provide doula support at low or no cost, including New York City's no-cost doula service, for example. 

The education and support doulas provide, especially for those at historically high risk of being harmed in a medical setting, is paramount. The information gap in pregnancy and childbirth is a country-wide problem, Allers explained. "We have been removed from knowledge about how our bodies work." 

What's next for Irth

Irth is currently looking for more community partners in order to add more reviews and flesh out the experience. Irth is also partnered with some hospitals in select US cities, including Philadelphia, Detroit, Sacramento, Calif. and Long Beach, Calif. Future partnerships in New Orleans and Atlanta are coming soon. 

The goal of Irth establishing these hospital partnerships is to help each medical system develop better tools or programs that better-serve their communities, which includes maternal care for Black and brown patients.