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Why we need to start prioritising postpartum care

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With some studies suggesting as many as six out of seven women miss vital postnatal visits, FemTech World investigates why we need to change the narrative around postpartum recovery.

Sandra Wirström was working in the digital health sector in Sweden when she had her two daughters. She experienced birth injuries both times and she was surprised by the lack of data and support around post-natal care.

“I had to fight for every single piece of information and every single doctor appointment. I was extremely frustrated that nothing has been digitalised when it comes to the postpartum care,” says Sandra.

Sandra’s experience applies to hundreds of women across the UK. Recent figures show that six out of seven new mothers in England are not getting a check-up of their health six weeks after giving birth, despite such appointments becoming a new duty on the NHS. Of those who attend one, only 15 per cent have a dedicated consultation with a GP to discuss their physical and mental health, according to the National Childbirth Trust (NCT).

Another US study from the American College of  Obstreticians and Gynecologists revealed that as many as 40 per cent of women do not attend a postpartum medical visit after giving birth.

“Nothing has been done when it comes to postpartum digitalisation,” says Sandra. “So, about a year ago when I was on one of my walks with my second daughter, I thought ‘okay, we need to do something about this and change the narrative around postpartum care’.”

Soon after that Sandra met Astrid Gyllenkrok Kristensen, who was as passionate about women’s health as Sandra and like so many other mothers out there, struggled with the physical and emotional recovery process after giving birth.

They decided to set up LEIA, an app co-developed with midwives and medical experts that offers women personalised physical and mental health support during the postpartum months, also known as the fourth trimester.

“There are hundreds of apps to help you during pregnancy and everyone asks you how you feel,” says Astrid. “Post-delivery, you are left on your own in what seems to be the most overwhelming and sometimes traumatising time of your life. Out of 140 million women giving birth each year 90 per cent will experience emotional or physical difficulties, from breastfeeding complications to postnatal depression and pelvic dysfunction.

“When we started looking into this, we found that there were a couple of key issues leading to women struggling in silence,” Astrid continues. “The lack of digitalisation that Sandra mentioned is one of them, along with the lack of medical experts. Women do not get the information they need. They end up self-diagnosing and they have no idea who to turn to. There’s no structure and globally, the healthcare chain is very fragmented.

“There’s also a massive stigmatisation in society surrounding postpartum. The narrative, especially in Sweden, is that you’re supposed to give birth, and then within a week, go for power walk and have friends over.”

A study from the polling company Survation, revealed that 85 per cent of the 893 mothers in England interviewed over a month said their appointments were mainly or equally about the baby’s health and they did not get the chance to talk to the GP about their mental wellbeing.

Astrid says: “One of the problems of women are not getting the health care they need is because the healthcare system is not focused on the women’s perspective and is not based on their needs.

“Studies show us that suicide is now one of the leading causes of death in new mothers, up to one year after giving birth and this is something that shows the acceleration of the problem. The system is broken.”

The pandemic has only amplified this. Research by the Maternal Mental Health Alliance shows that more mothers than usual have been struggling during the pandemic because restrictions on social contact means they have been denied support from family and friends, which has led to more anxiety and loneliness.

LEIA is an app based on science and self-lived experiences of motherhood. Astrid explains that: “Together with both private and public health care, we created a medical advisory board to make sure that we achieve our primary focuses to create a solution and meet the needs of new mothers.”

“Before going into the product, what we wanted to do was to create an app that would help by giving women AI or data driven insights about their emotional and physical health, to help understand what’s going on in their head, what’s going on in their body and what the recovery process in the fourth trimester is.

“But we also wanted to include the partner within that experience, because men are also getting diagnosed with depression. Seeing it as a unit and not just pinpointing the woman, is something that we feel is integral for a healthy recovery.”

Astrid highlights how crucial postpartum check-ups really are when it comes to mental health.

“One of the key things during these visits is to screen women for postnatal depression, which is normally done face-to-face with a questionnaire called EPDS – Edinburgh Postnatal Depression Scale. With LEIA, we’ve digitalised screening models for both postnatal depression, but also pelvic dysfunction, identifying women in risk at a much earlier stage. This means even before giving birth, we’ll be able to identify women at risk of postnatal depression.”

However, changing the narrative around postpartum care is as important as offering women the support they need.

Astrid says that: “Most people understand the first three trimesters and the changes in the women’s bodies because that narrative has been established.

“So, we want to establish a narrative around postpartum as well. People need to know that there’s a physical recovery and it takes a year for the body to recover after childbirth. We think that by educating people about the recovery process we can normalise it and start breaking down the stigma.”

Sandra adds: “There’s been a boom in the femtech market focusing on fertility and pregnancy.

“In the past years, there has been a digital transformation in areas such as fertility,  period tracking and menopause. However, there are still a lot of things to do, especially when it comes to postpartum care. We’re still not getting educated enough about what is happening in our body after giving birth.”

LEIA’s data-driven approach aims to influence improvements in public health.

Globally, research data on postpartum care is limited. Amid a lack of awareness of postpartum conditions, however, investment in further studies and in developing options which address postpartum symptoms is also limited, says Astrid.

“We all know that politics is driven by economics,” she says.

“By collecting this data, we will be able to show how the lack of investment and support is actually affecting women. We have to put a number on the problem before they actually start looking into it.”

Sandra agrees: “It’s not only our perspective and our motivation, we are in fact putting the mothers in focus in everything we do by building an app for the mothers out there.”

Clearly, fundamental changes will be required to adequately address postpartum challenges in future. The success of LEIA in starting a conversation around postpartum care is, however, an important first step in driving this change.

Find out more about LEIA here.

 

 

 

 

Sorina Mihaila is the editor of Femtech World. Sorina covers technology, research and innovation in women's health.

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The start-up on a mission to transform metastatic breast cancer management

More than two million women globally were diagnosed with breast cancer in 2022 alone

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One in eight women in the US will be diagnosed with breast cancer in their lifetime and one in 39 will die from it. Could this start-up have the solution?

Nine years ago, Hollywood actress Angelina Jolie announced in a New York Times op-ed that she’d decided to go public about her elective double mastectomy to “encourage every woman” to think about their own risk of breast cancer.

The article went viral and increased breast cancer awareness around the globe, leading to the so-called “Jolie effect”.

But while campaigns like this have changed the way we talk about breast cancer, they haven’t translated into better patient outcomes.

The World Health Organisation revealed that in 2022 the “burden of breast cancer” caused 670,000 deaths globally.

In the UK, one woman is diagnosed with breast cancer every 10 minutes, leading to nearly 1,000 deaths each month.

Survival rates have indeed improved in many parts of the world and diagnostic methods have come a long way in identifying a tumour’s molecular profile. However, questions remain when it comes to choosing the most effective treatment combination for a particular tumour or patient.

“Oncologists consider multiple factors to determine the treatment strategy: the patient profile, the clinical tumour stage, the pathological tumour grade, the molecular tumour profile, treatment guidelines and study results, and patient-specific contra- indications,” Wolfgang Hackl, translational oncology scientist and founder and CEO of OncoGenomX, tells Femtech World.

“But there is nothing to assess whether a certain treatment works in a specific tumour. Oncologists can only be certain about that after the entire treatment journey, which can take months, sometimes years.”

Without a tool to support clinical decision-making, doctors turn to risk-adapted approaches, extending moderate therapies for low-risk cancers and intensive therapies for high-risk cancers. But this doesn’t solve the problem, says Hackl.

“Many patients are still over-treated for fear of being under-treated,” the founder explains.

“In breast cancer, about 60 per cent of women receiving treatment are over-treated. These patients end up having side effects which means they have to stop treatment. When they stop treatment, they are at risk of recurrence.

“This applies to under-treatment too. Under-treating and over-treating patients can both lead to sub-optimal treatment.”

The solution, however, could be closer that we might expect. PredictionStar, a decision support technology developed by Hackl and his team at OncoGenomX, could potentially transform breast cancer drug development, diagnosis and outcomes, facilitating individualised therapeutic decisions at any stage of the disease trajectory.

Wolfgang Hackl, founder and CEO of OncoGenomX

The tool, which uses AI and machine learning algorithms, identifies whether a certain therapy works in a particular tumour and finds the treatments proven to be the most effective for each patient and their specific tumour.

“It harnesses four patent-pending core technologies,” says Hackl.

“The first technology is an innovative tumour profiling test, the second one is an individualised prediction model, the third one is a digitalisation tool for information sharing without migrating patient data and the fourth one is a reinforcement technology, which helps the algorithm learn from treatment decisions.”

As far as tumour gene tests are concerned, PredictionStar works with standard, unsupervised, or commercial target gene panels, not only expanding their scope but also raising the applicability of test results from an average 65 per cent to more than 80 per cent.

For the first time, Hackl says, oncologists will be able to understand which treatment combination will work the best for a patient and their tumour.

“PredictionStar takes away the uncertainty around breast cancer treatment decisions and increases the likelihood of opting for the most effective treatment combination without delay and without exposing the patient to the side effects of an ineffective treatment.

“The whole technology is designed as an instrument agnostic which can work with any other existing technologies to allow for seamless interactions, irrespective of the systems that already exist in hospitals.”

The fascinating part is that the tool has a feedback loop which means the technology improves, the more information it gets, refining its therapy guidance.

“This is dramatic if you think about it,” says Hackl. “The US, UK and European countries spend hundreds of billions on cancer treatment every year.

“However, data shows that in cancer R&D, the clinical failure rate is about 30 per cent, which means that one out of three phase three clinical studies fails.

“This is a problem because this is the part of the development which generates 70 per cent of the development cost. Based on the data we have, we believe PredictionStar could reduce treatment expenses by at least 20 per cent.”

At a time when healthcare budgets are being squeezed, this reduction would be significant.

“We tend to believe that healthcare costs are a problem of the poor economies, but richer countries struggle with high healthcare costs too,” Hackl points out.

“This is something that has become very clear in recent years. The way healthcare costs are incrementally increasing over time is not sustainable and needs to be addressed.”

With such impressive capabilities, it seems to be only a matter of time before the availability of robust patient data sets extends the scope of PredictionStar to other cancer types. Hackl doesn’t rule this out.

“Currently, we are focusing on breast cancer, but we are intending to roll this out in other cancer entities,” he says.

If everything goes according to plan, PredictionStar could be ready for use in clinical and translational studies in the next 15-18 months, the founder adds.

“OncoGenomX’s data on file suggest that PredictionStar is leading the game and we have good reasons to believe that it has significant potential to improve clinical and economic outcomes beyond today’s achievements.”

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Could an adhesive device be the answer to perineal tears? This start-up thinks so

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Ditte Marie Fog Ibsen, co-founder and CEO of oasicare

A new device promises to provide midwives with a “third hand”, substantially reducing perineal tears, but could it really work?

“Simply surviving pregnancy and childbirth can never be the marker of successful maternal healthcare”, the World Health Organisation concluded after a damning report revealed that 287 000 women died in 2020 during and following pregnancy.

While maternal mortality rates are down sharply from where they were 20 years ago, research by United Nations shows that progress toward reaching the UN’s sustainable development goal of reducing maternal mortality has stalled.

According to the United Nations Population Fund (UNFPA), every two minutes a woman dies because of complications due to child birth or pregnancy.

But maternal mortality is not the only problem – for every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication.

“Maternal mortality is only the tip of the iceberg when it comes to maternal health,” says Ditte Marie Fog Ibsen, co-founder and CEO of oasicare, a medical device start-up based in Copenhagen.

“Maternal morbidity is the hidden base, predominantly featured by perineal ruptures.”

Perineal ruptures are extremely common and expected complications of vaginal birth. In the UK, about 85 per cent of women sustain some degree of perineal trauma during childbirth.

Multiple studies have found that some women who experience severe perineal lacerations suffer long term psychological trauma and social isolation. However, the stigma around the topic means that many feel too embarrassed to seek help.

“Postnatal care is mainly focused on women with higher grades of perineal ruptures, downplaying the impact of lower grade ruptures on woman’s quality of life,” says Fog Ibsen.

“Short, medium and long-term complications are fairly common but rarely acknowledged or prioritised in the global health landscape.”

‘Women’s tears are not properly assessed’

Fog Ibsen and her friend, Julia Sand, were working as industrial designers creating solutions for midwifes when they realised the scale of the problem.

“We were trying to help midwifes manage their work-related musculoskeletal symptoms when we came across a even bigger problem: perineal ruptures.

“At the time, we didn’t know much about it, but we knew we had to do something about it.”

The duo began researching the issue and came up with a single-use medical device designed to protect the perineum and reduce uterine ruptures.

The product, which is currently being tested in several hospitals in Denmark, is adhesive and acts like a protective layer that prevents ruptures during childbirth.

“We are essentially trying to replicate the skin so we can prevent ruptures, which tend to happen when the vagina and perineum stretch during birth,” explains Fog Ibsen.

“We’ve made it very simple so that it can be easily applied and easily taken off.”

The interesting part, she says, is that women don’t actually notice it.

“That’s a quite good thing because there’s a lot of attention on the birth. The midwifes were a bit worried initially about the adhesive and whether it could last and stick to different types of skin, but so far it’s been great.”

The midwifes have played a crucial role in the product development process, helping the oasicare team identify issues early on and improve the device.

“We relied on their knowledge to get the balance right so that in the future we can give the product  to people who don’t have the same level of experience, but can still use it to prevent ruptures.

“The product is very easy to cut in, for example, so that midwives can adjust it easily.”

Currently, the team is not allowed to disclose any details about the efficacy of the product but a study, which is expected to conclude later this year, will establish how much the device could reduce ruptures.

“If all the studies go well and we get good data from the hospitals we work with we could see the product on the market in 2025,” says Fog Ibsen.

Her goal, however, is to launch the device outside Denmark where, she says, women desperately need it.

“In Denmark, I think, the midwives are doing a great job, but in other parts of the world the situation is very different. Women’s tears are not properly assessed, which means that despite having suffered serious tears they are being told that everything’s just fine.

“Our goal is to make the product available in countries like India, where a lot of women would benefit from it. It’s a simple device, but it can have such a big impact.”

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Could this app change the way we live and work?

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Imagine a tool that could help women align their daily schedules around their menstrual cycle – it exists thanks to two passionate tech entrepreneurs and start-up co-founders.

Elina Vale, chief executive officer and Rustam Galiev, chief product officer, are on a mission to dismantle society’s 24/7 work culture and replace it with an “evidence-based” approach where women can thrive – regardless of the menstrual phase they are in.

The concept, also known as cycle syncing, is a way by which women adapt their health and lifestyle habits to fit the four phases of their menstrual cycle, namely menstruation, the follicular phase, ovulation and the luteal phase. During these phases, it is thought, women experience changes in key hormone levels that can affect their mood, energy and productivity.

The idea isn’t new. In fact, the practice was introduced by nutritionist Alisa Vitti in her book WomanCode in 2014.

What is new, however, is the way Vale and Galiev adjusted the method to suit women’s needs in the workplace. The founders developed an employee benefits platform that claims to combine science, coaching and artificial intelligence to help female employees improve their productivity and performance by working with their menstrual cycle. 

The app, they say, combines a to-do list, habit tracker, period tracker and mindfulness app in one tool.

“The way women’s menstrual cycle works is very different from the common nine to five routine that we, as a society, tend to prioritise. That’s what we are challenging at Essence,” says Vale.

“We aim to provide women with a tool that allows them to think [of what they could do] based on the phases of their cycle and not just in the traditional work routine.

“We are looking at things such as the type of activity that you do, the intensity, your workload and what your needs are to balance your performance and wellbeing.”

While there aren’t many scientific studies to support cycle syncing, evidence does show that hormone fluctuations affect energy, mood, appetite and sleep.

Vale says there is some research on how each phase of the menstrual cycle affects the types of activities women do. “We know, for example, that in the follicular phase it’s better to start new projects and in the luteal phase it’s better to wrap them up.”

She also says there is evidence to suggest that cultivating an inclusive workplace and actively supporting employees could improve their wellbeing and unlock their full potential.

“An inclusive workplace has been shown to improve motivation and engagement. The problem is that currently, everything in the workplace is structured in a ‘gender neutral way’, which is, by default, very male-focused. From our research, we know that most women don’t know much about their menstrual cycle, so they don’t look at the month through the four phases of the cycle.

“However, we are trying to change this perception and help women think differently.”

The end goal, the founder says, is to make employers prioritise menstrual health in the workplace and take women’s needs seriously.

“Most companies have mental health and wellbeing programmes in place – we think menstrual wellbeing should be a part of that too.”

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