The concept of a pregnancy coach is quite popular in the US, but according to Dr Nandagopal Gopinathan, Co- founder, Naima, an AI-driven pregnancy coaching platform, this idea is slowly picking up momentum in India too. Dr Gopinathan says that his start-up persuades mothers to adopt clinically-proven preventive health methods that help reduce pregnancy-related risks during these times of crisis, and can be a blessing in disguise. In a chat with Raelene Kambli, he reveals more about his concept and his business model
How has the concept of a pregnancy coach picked up in India? Share your personal experience.
I came across pregnancy coaching from a family member who went through it. She claimed that it helped her change her baby’s position. Given my clinical and scientific background, I found this claim difficult to believe but decided to study it. To my surprise, the internet was flooded with clinical research from the US, the UK, India and Australia, highlighting clinical benefits. Today, I regret that in spite of my medical background, I did not know about pregnancy coaching when my wife was pregnant. That was my point of calling, and I decided to use technology to scale this unique service and offer it for free to my near ones and millions of women across the world.
The international versions of pregnancy coaching started in India almost three decades ago but has gained momentum in the past 15 years when more coaching programmes entered the country and trained coaches through their certification programmes. The ayurvedic version of pregnancy coaching known as Garbha Sanskar has been prevalent in India, over centuries. Recently, the state governor of Uttar Pradesh (UP), Anandiben Patel, initiated a Garbh Sanskar diploma programme at Lucknow University to train mothers, gynaecologists and the general public to promote benefits and adoption as a maternity programme. Most pregnancy coaches in India are still unregistered under a single roof and form a largely fragmented market.
Pregnancy coaching is also becoming increasingly popular as a ‘work from home’ career choice. Many mothers are already influencers on Instagram and other mom communities. However, each pregnancy is different, even if in the same mother. A pregnancy coaching certification helps add tremendous career value to anyone who has a passion to help mothers, in a scientific manner backed by the cumulative experience of hundreds of thousands of pregnancies and scientific research.
What exactly does a pregnancy coach do? Does this concept stem from the concept of evidence-based birthing?
A woman’s health primarily comes into focus during her pregnancy. There is not a more emotionally overwhelming period in a woman’s life than giving birth and caring for her newborn. Unfortunately, medical-care providers are already watching out for so many aspects of maternal and child health, for so many mothers at once. The poor doctor to population ratio prevents doctors from providing emotional support and regular advice in the non-clinical aspects of pregnancy. Peer-support and online mom communities have provided a great deal of support. However, today’s research reveals that online mom communities may lead to information overload, followed by information scatter and anxiety.
Pregnancy coaches or assistants are certified professionals who undergo rigorous training to provide clinically-proven preventive health methods to improve the pregnancy experience and reduce risks.
Both the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) have recommended pregnancy coaches as a birth companion.
A pregnancy coach advises and conducts group classes on:
Emotional support: motivation, persuasion, reassurance, encouragement and companionship to reduce anxiety and create a sense of calm.
* Physical comfort: exercises which alleviate pregnancy symptoms, along with movements, and positions that help reduce risk.
* Birthing rights at local and national levels, facilitation of communication between the mother and hospital staff to help make informed decisions.
* Labour procedures and research-validated advice to make choices, manage risks, take precautions for safety,
* Education on breastfeeding, newborn nutrition and new-born response management.
* Guiding and preparing the partner on pregnancy changes.
Pregnancy coaches specialise in non-medical skills and do not perform clinical tasks, diagnose medical conditions, offer second opinions or give medical advice. Coaches are trained to provide caveats asking mothers to check with doctors. They help mothers increase adoption of doctors’ advice and other preventive health practices. Many doctors have doulas (assistants) working with them to increase care for mothers.
So, there are some studies that have been conducted on pregnancy coaching and support that says working with a pregnancy coach can shorten labour, reduce interventions and improve outcomes and satisfaction. How would you justify this claim?
There are hundreds of clinical research reports supporting pregnancy coaching, published in reputed peer received journals across the world including India. Pregnancy coaching is evidence-based. Clinically proven benefits include:
* Reduced anxiety: Anxiety is a precursor to perinatal depression, a silent killer, prevalent in almost 80 per cent of all pregnancies. Studies reveal that up to 70 per cent of this population progress to heart attacks and strokes within five years of deliver
* Reduced chances of induced labour and caesarean.
* Reduced pain
* Reduced labour time
The research literature also mentions that increasing access to pregnancy coaching, in under-resourced communities, can improve birth outcomes. Coach-supported women had lower rates of pre–term birth and low birth weight. They also helped improve communication between low-income, racially/ethnically diverse pregnant women and their healthcare providers.
Can you explain your approach and what women receive working with you?
Emotional support in a personalised manner is at the core of pregnancy coaching and our offering. Included within it comes the preventive health methods which help reduce maternal health risks. Everyone including technologists in our team see helping mothers as their purpose and profession. Right from outreach programmes to onboarding and service, our messaging packages the language of compassion and care.
Do gynaecologists work with you? How many in India?
We plan to onboard doctors and clinics to complete the service cycle.
We already have leading gynaecologists in India to guide us. Our digital micro-practice programme for gynaecologists has already enlisted 100 in the pre-launch phase of two weeks.
How are pregnancy coaches and midwives different?
In 2013, There were 9,000 registered pregnancy coaches in the US alone. The proportion of American women who reported paid doula service doubled in 2013 and has been increasing since then.
Pregnancy coaches are certified by different authorities after undergoing rigorous training. They fill a gap in the maternal care system by offering motivation, advocacy, and physical and emotional support. They are not medical or paramedical staff and not usually part of the healthcare system. However, this has changed. New York is set to become the third state to provide state insurance for cover pregnancy and birth coaches for low-income women as a way of lowering the maternal mortality rate.
Midwives, on the other hand, are already part of the healthcare system comprising doctors, nurses and paramedical staff. They may perform gynaecological examinations (for example, pelvic exams, and breast exams), write prescriptions, perform clinical monitoring, and provide information about contraception. A midwife is medically trained and qualified to deliver babies. Both the US and Europe require a license to practice midwifery.
In India, nurses and midwives together account for 17 per 10,000 population when compared; 108 for Finland, and 88 for the UK.
Till recently, the midwives in India were Auxillary Nursing Midwife (ANMs) or GNM (General Nurse Midwifes). ANM is a two-year undergraduate certificate-level course in Medical Nursing. In Dec 2018, new guidelines were established with a new programme termed Nurse Practitioner in Midwifery (NPM) in accordance with international standards. These NPMs have to go through another 18 months of training in midwifery.
The pregnancy coach, therefore, fills the emotional, physical and advocacy needs of mothers, beyond clinical service. They offer a more personal and emotional approach customised to the mother’s needs and circumstances. They serve as a companion. Digital pregnancy coaching can cover more of the population with lesser resources.
From a business point of view, how are you fairing so far?
Maternal health is an area with high adoption and lower churn, with lesser clinically effective technologies when compared to any or other medical specialities. With mobile internet penetration, awareness and healthcare decision-making are also increasing amidst women in India and across the world. There is no metric to quantify how self-driven mothers become to seek out the best for their pregnancy. Our segment is therefore never affected by recession or even the current pandemic.
The market and the current situation has increased reception of our offering. Offering this high-priced service at no cost resulted in a viral word of mouth, response, even at the pre-launch phase and we had to build a funnel for onboarding.
From a cost point of view, you say that the Cost of pregnancy coaching in India is around Rs 15,000-Rs 50,000. Don’t you think it is a bit too much?
The median cost for on-premise doula service in the US is $922; in India, the price ranges between Rs 15,000 and Rs 50,000. The online versions range from stand-alone videos to customised care with prices ranging from Rs 3,000-Rs 15,000, respectively.
As a comparable, total cost of an on-premise fitness programme including nutrition and personal coaching, are at higher range both offline and online. However, from a quality of life years (QALY – a statistical measure) perspective, reducing maternal and child health risks has far more outreaching social impact.
In short, combining benefits to mothers, and the effort, care and patience from pregnancy coaches, can justify the cost charged by individual pregnancy coaches.
That said, we intend to disrupt and democratise this service, making it free for mothers. Better care during motherhood should be part of a woman’s right!
What is the response you have received during the lockdown?
Postponement of routine ante-natal visits increased anxiety amongst expecting women. While there were many online doctor and peer communities to provide answers to their questions, emotional support was missing. Our coaches stepped up to address this gap and kept them going with activities and regular advice on diverse topics in a customised, personal manner.
Above that, we came across emotionally sensational acts of mothers such as donating breast milk to a newborn whose mother died during childbirth, amidst the lockdown, endorsed our purpose with motivation. While we are aware of medical professionals and delivery staff taking extraordinary steps as part of their jobs to support our lives; such acts from mothers, even when not required by a job and without any compensation, deserve at least equal praise.
In the post-COVID era, how do you plan to make your services affordable and accessible?
The healthcare trinity includes cost, quality and accessibility. We solved the problem of cost by finding a business model which would help deliver a high-priced at zero cost. We serve the highest level of quality with personalised service and emotional touch. In terms of accessibility, we leverage technology as an enabler to scale rapidly, implement remote AI-driven risk screening and provide engaging user experience by leveraging hyper-reality technology. Our technology roadmap also includes rapid vernacularisation for deployment in multiple languages. We intend to work with governments and policymakers to provide pregnancy coaching as part of their maternity care and insurance programmes.