21. Proactive Pregnancy Care

This episode highlights the ongoing maternal health crisis in the U.S., a troubling reality for such a developed nation. It’s encouraging to see companies like Delfina tackling this issue, especially with a provider-first approach that supports clinicians under pressure. The return of doula support is also powerful—doulas truly can make a difference. For pregnant patients, Delfina offers peace of mind, access to vital information, and early insight into risks like pre-eclampsia.

https://www.delfina.com/

Episode Transcript

(00:12):
All right, hello health heads. Welcome andthank you for checking into this dose of the
healthcare uprising. I'm your producer in theback, Jeremy Carr here with your host in the
front row, Heather Pierce. So why don't youtell them what's on the agenda for today, Heather?
I'm excited that we're bringing on another company and a person representing that company

(00:33):
that talks about maternal health. This is becominga very big theme here. So we have Dr. Isabel
Fulcher who we call Izzy. She's a statistician. Big words don't always work. Lots of syllables.
Yeah. Izzy is a statistician passionate aboutdeveloping data-driven solutions to the maternal

(00:55):
health crisis in the United States. As chiefscientific officer and co-founder at Delphina,
she leads a team that develops, validates, andevaluates predictive algorithms to improve
pregnancy care. Izzy has a PhD in biostatisticsand was formerly a postdoctoral fellow at the
Harvard Data Science Initiative. Yet again,we have another very brilliant person in our

(01:20):
universe. It just keeps getting smarter aroundher. I know. And I can't even say statistician.
That's why we're just the interviewers and notthe interviewees. Exactly. Usually good at
talking. Usually. Me good words. Me good words. So Delphina, this is it. Oh, all right. So

(01:43):
let's get into it then. Here's our conversationwith Izzy from Delphina.
Hi, and welcome to Healthcare Uprising. We'vegot Izzy Fulcher, co-founder and chief scientific
officer with Delphina with us today. Welcometo the show, Izzy. Thanks so much for having

(02:05):
me. Great. Well, as mentioned, you are thechief scientific officer. Not everyone knows
what that means, but tell us a little bit aboutwhat inspired you to be a part of creating
Delphina since you're a co-founder. I'm sorry.I hear chief science officer, think Mr. Spock.

(02:26):
That's my only reference. Oh, Jeremy's like,I'm throwing a Star Trek in there. My mom will
be happy with that one. I'll give it a starword yesterday. That's true. Right. was it
was May the fourth yesterday. It was. Yeah,we're channeling our, you know, our scientific
our love for science. Right. tell us about whatwhat you're doing. for Delfino, why you wanted

(02:52):
to be a part of it. Like I was saying, you'rea co-founder, obviously you're invested into
it. And really what does Delfino do for pregnantwomen, their doctors and the community at large?
Great, loaded question. question. So many. so I started out with a background in research,
so that's where the science comes in. So Ihave a PhD in biostatistics and Now the question

(03:19):
is, what is biostatistics? So biostatisticsis statistics applied to public health. I really,
during my PhD, focused on learning all aboutfun statistical methods, mainly to analyze
electronic health record data. So really messydata and making sense of it. And I took that
and I applied it. I was really interested injust the field of reproductive health writ

(03:42):
large in both the United States. And I wasalso doing a lot of research in East Africa
at that time. So I was working on a big research,not actually research study, it was a digital
health pilot project in Tanzania using communityhealth workers to deploy digital tools to pregnant

(04:02):
people. using these workers to visit pregnantpeople in their home and really help them
get connected to healthcare services in ruraland more urban parts of Tanzania. And so that
really excited me because I saw how they wereable to collect so much data through this as
a byproduct of the program. And I was excitedabout using that data to better understand

(04:23):
the program, help them improve all these womenthat they were visiting in their homes, help
them improve their health for both themselvesand their babies. And then using that data
actually to do some predictive modeling to kindof identify which of those women might end
up with an adverse outcome or which of thosewomen might need some additional care. So that
was kind of my foray into kind of taking thescience research side into like actual implementation

(04:49):
in digital health. And after that, I was kindof hooked. So I stayed in the kind of area
of research. was a data science fellow at theHarvard Data Science Initiative during my postdoc,
doing a lot of different areas of research focused around digital health. That's also
when the COVID-19 pandemic started. So again,really interested in using data to figure

(05:11):
out how we can understand healthcare utilizationagain in the United States and globally. But
by that time I was starting to get a little, I don't wanna say burnt out on the research
track, but I was getting a little antsy. I wantedto be able to start building something and
actually implementing it and being really involvedin that day to day using science to kind of

(05:33):
build a new technology. And that's when I gotconnected with Sanan, our CEO, who was an MD-PhD
at Harvard at the time. He was coming froma medical background. He had unfortunately
witnessed a stillbirth during one of his rotationsat a hospital at MGH. And so he had this brilliant
idea to start using AI and machine learningto actually better predict what patients might

(05:59):
develop complications and actually prevent themfrom occurring. That's where I kind of came
in with the data vision. So we can actuallyuse data to do this, to identify patients and
to create a system of care that really is evidence-based.that's how I got Amazing. Awesome. Yeah. That's

(06:20):
impressive. That was a lot. Yeah. Yeah, that'simpressive. Yeah. And we always say, we get
to meet the smartest people on this show too.You're all from like Harvard and Stanford and
it's just, wow. Brilliant. And going to Tanzaniato do it too, that just adds an extra element
of the humanitarian to it, which is nice. Yeah. I love that. On the, yeah, the, great that

(06:46):
you get to meet people with backgrounds fromHarvard and Stanford. think a lot of people
flock there because there is just so much opportunity. Um, and yeah, I'm grateful for my time there
because I was able to like have some fundingto be able to go to other countries, uh, and
just work on a bunch of different stuff. So.Yeah. I mean, these, these ideas, they, they
need money, right? To, be brought to life. And,know, you put the money together with the,

(07:10):
with the smart, innovative minds and you canget something like Delfino, right? And that's
what the show is about is bringing on the peoplethat are doing the, just the, I feel like a
broken record, like the really cool stuff inhealthcare that is changing lives for the better.
Like that's what it's about. So that's whatwe do here. Yeah. So super, super excited to
have you on today and. And I want to make suretoo, you said public, you know, your focus

(07:33):
was in public health. Delphine is really solvingfor the maternal health crisis. We've covered
this in other episodes most recently with LathamThomas from MamaGlo with the doulas. Episode
11 specifically. Yep. And we interviewed a doulatoo. The maternal health crisis is a real thing.
And to have a company like yours doing somethingvery, very specific and actionable is so huge.

(08:01):
What, how does this work? So tell us kindof how Delphina works for providers, works
for the patients. Like what is, what is kindof the big goal? Yeah, you're absolutely right.
So as you already pointed out and you've heardon the previous episodes, there's an ongoing
maternal health crisis in both the U S and inmany other countries. So we're seeing rates

(08:24):
of complications like hypertension during pregnancy,diabetes during pregnancy increase. We see
NICU admissions, so neonatal intensive careunit admissions for babies increasing year
after year. And so there's really a huge opportunityto figure out what's going on and try to kind
of correct for it and prevent that from occurring.So what Delfina does is we are a pregnancy

(08:47):
care platform. We partner with obstetric careclinics, so clinics that are giving prenatal
care to individuals during their pregnancy. So we partner with those care providers to
help them identify patients that will go onto, that might develop complications and then
prevent that from occurring. So as part ofthis platform, we not only integrate within

(09:11):
the kind of electronic health records at thesystem to pull out all of the kind of data
insights that we need, but we also have a patientfacing app that supports the patient throughout
their pregnancy journey. We also have doulasthat connect with the patient throughout.
throughout their journey really make sure thatthey're engaged in their care, that they're
getting any other like social and emotionalsupport that they might need. And then we

(09:34):
also do have some nutritionists and lactationconsultants and mental health specialists
on our team that for those patients that needkind of additional support above the doulas
and above what they're able to get at theirclinics, that they're able to have a telehealth
consultations with them. So we view Delfinaas a system of care. and we are proactive.

(09:56):
So we're trying to identify people kind of beforethe complications occur so that we can prevent
it from happening. Like longitudinal pregnancycare. Yes. Yeah. There you go. I know how I,
that's quite the phrase. I know those healthcarewords, Jeremy, I've been doing this well. Gotcha.
Great, great word. Great word. Exactly. It'skind of end to end, right? It's kind of the

(10:17):
fancy way of saying, um, we've got you from.be getting to end all the way through. Conception
or as soon as you know you're pregnant until,well really kind of postpartum too, right?
All through it, yeah, we go one year like throughthe postpartum period. And that's the, I don't
know if this was covered on earlier podcastsessions, but what really has always motivated
me about like maternal healthcare specificallyin the United States is that you have all these

(10:43):
prenatal care visits when you're pregnant, you'reexpected to go to like 10 to 14 visits. And
then after you deliver, you have one postpartumcare visit when you know you're trying to recover
from this very significant thing that just happenedto you. You come in once at like six to 10
weeks postpartum and kind of all the supportthat you had from the medical system drops

(11:05):
off during that period. And that's also whena lot of complications occur. So that's always
just been kind of mind blowing to me that there'sjust kind of period of silence with the medical
system once you're done. Bye, good luck. Yeah.Hope everything works out. It's like, okay,
probably not. Yeah. Yeah. Yeah. A lot of, alot of crazy stuff happens. So is Delphina,

(11:30):
would you say like your primary is your primaryaudience first, the actual OB GYNs and then
the patients, or do you kind of, can you comeat that at them kind of equally? Like how does
that work in terms of your support there? It'sgreat. Like we think of them both as users
of our system. So I would say everything iseverything we do is to improve pregnancy outcomes

(11:54):
for moms and babies and their entire families. So that's that is the central focus. But in
order to do that, like we really do have toengage the obstetric care providers that are
at these clinics to identify the patients andenroll them in our system of care. of course,
like that is also a key key focus for us. Butwhen we started, like initially started building,

(12:20):
it was very just like building an app that apatient would want to use that was engaging
to them that had educational material that couldbe kind of understandable from a variety of
different people from different cultural backgroundsand different areas of education. And that

(12:43):
was really what we started with building. Andthen we also layer in different types of interventions
that actually do the, that might prevent thingslike hypertension or preeclampsia during pregnancy.
So those interventions again, are very patientspecific. It's things like taking aspirin,
doing some behavioral health counseling. Wehave like a nutrition program and exercise

(13:05):
videos. So those are all very patient focused,but. Again, to get those to the patient, really
want to make sure that their provider, theirdoctor is engaged and also excited about Delphina
and using Delphina. So we definitely are considering the provider as like a main focus as well.
Got it. So what are you just looking at likebiometrics and stuff? How are you doing the,

(13:27):
specifically doing the predicting of the badoutcomes? What's that based on? Yeah, great
question. Um, so there we are. we are usingdata that's standardly available in electronic
health records. So the reason for that is wewanted to make sure this was scalable. And
so I've seen a lot of researchers at like largeacademic medical centers, so like the Harvard's,

(13:52):
the Stanford's doing very complex predictivemodeling where they'll use like thousand different
variables that they have available in theirelectronic health record. And that's great.
That's great if the thing you're building isgonna stay within that ecosystem. But the
moment you take it out of there, like some otherhealth system functions differently. They might
not collect that data. They might store it differently. And so that might not work. So when we first

(14:15):
developed our models, we made sure that to keepthem relatively simple. So we knew that they
could be applicable in most settings. Like whenyou take it out of a large health system that
serves 8,000 pregnancies a year, you can goapply it to a small, rural prenatal care clinic
that might only serve 500 patients a year. So we use just data available in your electronic

(14:36):
health record. And what that means is justit for anyone when listening, when you go to
your doctor, you fill out an intake form thatmight ask you things about your like family
history of hypertension, diabetes, your ownprior diagnoses. So that's all information
we take in. And then any sort of informationon like vitals. So your weight or your blood

(14:57):
pressure or heart rate, things that are takenat a standard clinic visit would also be included.
Okay. Are you thinking about Guava Health as she's talking? That was another interview
we did recently where they pull in all thisdata from, because it's just, the information
is so disparate that it's like sitting in allthese different systems. So Delphina does,

(15:17):
does that, does it pull in the, the, the relevantdata from the various systems and the records?
Yes, exactly. Very cool. Oh, I love that. That'swhy you want the patients and the providers
involved because then you can get all the recordsfrom everywhere compiled. And this, mean, is

(15:38):
a major problem as you probably heard it. Right?Like all of our different data systems, competing
EHR systems, like some places don't even use electronic health record EHR systems yet.
And so really finding a way to centralize allthat information. That's what our team spends
a lot of time doing is like. from all thesedifferent clinics, how do we pull in information

(16:01):
and make it make sense? And then we also getinformation from our patient app. And that's
kind of a, we use that almost as a way to kindof fill in the gaps that exist in these EHR
systems. So you're, they're doing for pregnancywhat Guava is doing for chronic condition.
Yeah. Is basically what that comes down to inmy brain. Yeah. Well, at least well. One part

(16:25):
of what you're doing anyway. Yeah. That's, andyou're obviously doing much more than that.
Well, it expands into other things. Like youwere saying, you are making it scalable too.
So. Yeah. Right. Maybe it's the base, it isthe baseline kind of for everything we do.
Like we need the information on the variouspatients to like be able to figure out what

(16:45):
care pathway they should be on. Kind of carepathway based on their kind of prior risk
factors. So it does form the basis for everythingwe do. And the majority of the patients that
are using this, they tend to be like higherrisk pregnancies or pregnancies that are
at risk of complication, maybe based on likeprevious conditions. Like how does that kind

(17:08):
of play out? So we actually, like Delfinais available for all patients regardless It
could be anybody. Anybody. And the platformby pulling in all this data, collecting data
through our patient app as well, is able tothen identify the patients that are at risk
for certain conditions and then set them ona personalized care journey. So if you're at

(17:31):
risk for hypertensive disorders of pregnancy,you might get a blood pressure cuff and initiate
aspirin. But we're actually not the ones decidingthat. We're giving the information back to
the care providers so that they can better tailor the interventions for the patients. So you're
like serving it up to them. Like, hey, we didall the leg work for you. Yeah, here are all

(17:56):
the insights. And also because a lot of ourpatients are using the app, they're entering
blood pressure, weights, symptoms, moods. We'realso able to show them what the provider is,
what's happening in between visits. Oh, yeah.OK. It comes back to... kind of a running,

(18:16):
another running theme we have here where it'smake the most of your 15 minutes with your
doctor. Cause you only get 15 minutes at a timewith the actual doctor. So if you go in there
and you got everything ready, it's like, here'swhat's going on. And he can take just a couple
or he or she can take just a couple of minutesto, okay, I see what's going on. Then you can
actually use that 15 minutes well, instead ofjust trying to even think of what you're supposed

(18:40):
to be talking about. And I, don't. I'm sureothers have experienced this too. Like even
for the past 10 years of me getting medicalcare, I've had to, like, I had some elevated
blood pressure. And so I actually got a remoteblood pressure cuff, took it home, started

(19:02):
taking my blood pressure and my doctor justasked me to write out my blood pressure on
a piece of paper, take a picture of it and likesend it to them. whereas, so I like showing
up. to my visit with a post-it note. And I wasis there not a better system for this? I think

(19:22):
that like that really a lot of people are stilldoing that today. Like just that sounds very
20th century right there. Right. I need to updatea little bit. think. Yeah. We have the technology
to do it now. Right. Yeah. But it just, I don'tthink like has been disseminated like broadly
to use like connected blood pressure devicesand glucometers and weight scales where the

(19:46):
moment you take the measure, just syncs to yourelectronic health record system for the provider
to do. So. Yeah. It just dumps it right intothe file automatically. Yeah. And with wearables
nowadays, you know, you've got the watch, theor, I got two. I'm like, I don't even know
why I have two, but I do. No, one or a ringand an Apple watch. Oh, that's fine. She's

(20:09):
going cyborg. I do tell everybody, I'm like,trust me, they track different things. I have
them for different reasons. like, okay. Yeah,that's fine. And then the things that they
are similar on, then you can kind of look andsee if they're consistent. I do actually do
that like every day. I'm like, all right, how,which one's right? They're pretty close though.

(20:30):
Yeah, okay. That was my answer. I was goingto ask. They are pretty close. yeah, you know,
with this kind of brings up an idea in my headand I thought about too, like really what Delphina
is about and so much of it is about equitablecare. And I think that is just something that
we need to become more and more aware of. Doyou think that there is a shift in just the

(20:54):
general like medical profession around we can't, you know, I can't deliver care. to every
woman the same way, whether it is a culturalbackground, is a, I don't know, why can't
it, ethnic origins, things that might actuallybe affecting your health as a black woman

(21:19):
or an Asian woman or a white woman or an Islander.Like there's so many different ways of thinking
about it. that a big part of what Delphina is kind of thinking about too? Definitely.
Definitely. I'll take, well, I'll take usback in history to the 1930s. So in the

(21:40):
1930s, that was when the first prenatal careguidelines were published. And it said, okay,
everyone needs to be on this visit schedule.It's the same one I mentioned earlier, 14 visits
at this time point in pregnancy, and then onevisit in the postpartum period. That's it.
It's one size fits all. Like everyone. adoptit and implement it. And that's what's happened

(22:02):
like to this day. Like everyone gets the samenumber of visits. It doesn't matter if you
have to drive two hours for your OB appointmentor you live right next to it. It doesn't matter
if you're a comp, have no risk factors andyou're on your fourth pregnancy versus someone
who is extremely high risk and on their firstpregnancy, right? So it's just kind of one

(22:22):
size fits all approach. And actually like twoweeks ago, the American College of Obstetrics
and Gynecology or ACOG came out with new guidance.So 1930 until 2025, they came out with new
guidance and it's exactly about this tailoringprenatal care. So recognizing that the one

(22:43):
size fits all approach doesn't work for everyone.And actually like taking into account not just
people's like clinical risk factors, but liketheir other social determinants of health.
and their backgrounds and how far away theymight be from seeking care. Could a virtual
care model work for them? Do they really needto come in for 14 visits? And so this was

(23:06):
really exciting that they finally came outand had this recommendation, this new clinical
guideline to really say, hey, it's time thatwe really start tailoring care to individuals.
However, people have been doing this for thepast decade. There's been a ton of evidence
that you should be considering people's. culturalbackgrounds when you're giving dietary recommendations

(23:27):
to pregnant people, consider virtual care anddoing remote blood pressure monitoring for
some individuals, right? And Delphine has beendoing that for the past three or four years
since we've been in existence, doing that tailoredpersonalized care. And there's been other kind
of programs at research centers that have alsodone that. So it's not necessarily new, but

(23:47):
now there's enough evidence for this large clinicalorganization, ACOG, to come out and say, OK,
everyone, It's time to adjust. Yeah, that'sgood. Yeah, and I think you're right too.
It kind of happens just to happen, but therewas no real guidelines in place before. But

(24:08):
people think about it. Well, think you haveto, right? I I even thought about when I was
pregnant, I had an epilepsy. And so thatwas a big deal for me because my triggers
were like physical trauma, sickness, thingslike that. So pregnancy definitely falls

(24:30):
in that area and particularly childbirth itself.So there was always that, um, like extra oversight
for me. Now that has nothing to do with my culturalbackground. That's certainly my medical, right?
But, um, but that was probably the biggestthing for me anyway, from like my personal
experience was that being acknowledged, like,oh, don't let her go into a seizure, you know,

(24:56):
during childbirth. So like every time I had,I had two C-sections and of course I had to
have like that anti-seizure drip in my IV.So. Were you saying we don't need to go into
your, too much into your medical? Oh, I lovetalking about myself. not mine. I'm just curious
if. In addition to like an OB, were you alsoseeing a maternal and fetal medic, like a specialist

(25:20):
at that time that was helping you just seeinglike your primary OB? So we could go down a
rabbit hole in this one, but this was pre ACA.That might explain a few things. Do I have
to say anything else? There was like very little.Yeah, I was paying. I was like cash pay because
I had no insurance and I was considered a preexisting condition. And, you know, I had to

(25:40):
get like a maternity writer. So it was kindof like bare bones, like whatever I could afford.
at the time because my husband and I were both self-employed and yeah, I could do whole
episode on my first birth. The second onewasn't as bad, but yeah, wasn't great. So
yay for ACA, by the way. I'm a big fan of these government-funded healthcare programs

(26:05):
like Medicaid and ACA and all that stuff. So they help people and they help protect us.
I don't want to, I don't want to spend toomuch time on that. We will get to that episode.
Yeah. Heather's going to stop from talking aboutmyself and the third person. Um, Heather needs
to stop getting too political on her podcast.I look forward to that future episode. It'll

(26:29):
be a good one. It'll be a good one. Um, butone of things I want to ask you about too,
because I saw it, um, the, the big announcement,you just got a series a funding, um, around,
uh, focused on the AI powered maternal. Makesure I'm reading this correctly. 17 million
series a round of funding. Oh my gosh. Big deal.So what is series a, Oh, this is startup world

(26:52):
talk, Jeremy. Can you tell us about that? That'sa, that's like a huge deal. So anything about
money. So I always make this joke. I'm a statistician.Like I deal with numbers all day, but whenever
you put a dollar sign in front of a number,I'm like, I don't do it. I have a similar problem.

(27:14):
So yes, we, so we just raised another roundof funding. Um, so in startup lingo, you, when
you're starting a new company, uh, you'll normally, you might decide to look for venture funding.
And so you would get your kind of first roundof funding. called a seed round. The round

(27:34):
after that is a series a, and then I heard ofa series. He all the way up to that. at. point
you might not need more VC money. And so youmight stop after a series C and go public or
get acquired. But as you keep getting moreand more rounds, so it's just indicating another

(27:55):
round of funding. It's the funds that cameafter the initial. Exactly. Yes, exactly. Thanks
for explaining that. It was a new world tome as well. So learned a lot. But yes, it's
very exciting. So we raised in January andthis is really just going to all of our efforts

(28:17):
to scale. So scaling to more clinics over the next year and beyond. really focusing for
me, like where my head's at is one, hiringa bunch of amazing data scientists and data
engineers to really make sure that we can continueto scale the use of our predictive models and

(28:39):
get all of that disparate data talking to eachother and really invest in our data systems
because it's really complicated as you've alreadyheard before. So yeah, this is really like,
it's super exciting. So scaling, obviouslygetting into more clinics. So, and you mentioned

(29:00):
earlier, I think you have a lot of these biggerclinics, right? That like, that's what they
focus on. And then you've got like, little momand pop kind of OBs like in rural America.
mean, heck in rural America, sometimes these,there's hospitals that are shutting down that
are, that no longer have maternity wards, right?Or NICUs or do they even call them maternity

(29:22):
wards anymore? I feel like that's such an oldterm. We've just learned recently we're down
to one OB in Flagstaff and the whole city. Yeah. One off or yeah, there's one OB in one office
and then there's North country, which is theFQHC up here. Oh, that's right. do have them.
There's only one at the actual hospital. a hugeproblem. That's huge. But then, you know, go

(29:44):
to Phoenix, right? You go to like a big city,you're gonna have those big clinics there.
with the scalability, are you kind of, do youhave like certain areas that you're looking
at? Is it just kind of like, how do you movethrough that? Yeah, great. So we were like
our customers, our health plans. And so we workwith a lot of Medicaid plans. And so those
are mostly like, geographically focused. wherewe have most of our clinics right now is actually

(30:10):
in Texas. That's great. We're able to have our kind of team on the ground going to clinics,
meeting with them, seeing if they would liketo use this solution and really a kind of
targeted geographic approach there. wait, Ihad one other interesting thing to say that

(30:31):
wasn't exactly. Oh. Because I was excited whenyou, well, not excited, but when you talked
about maternity care deserts, that's the formalword for them. The March of Dimes puts out
a report every year on maternity care deserts.So I'd be curious to see if Flagstaff now,
if things are closing now, would actually flagas being a desert or like there's four years

(30:59):
kind of there. That's an interesting questionactually. Yeah. It wouldn't surprise me.
Um, I, you know, I know somebody who's onthe board at March of dimes here in Arizona.
should give her a call. You really, she knowseverybody. That's why she, she was perfect
to start this podcast. Can I ask a little bitof a political question myself? Um, Texas

(31:20):
and pregnancy. Yes. Is it a weird place tobe working with this sort of thing right now?
So I. Originally, when we did our first, had the first clinic that we worked with in
Texas, that like crossed my mind as well.But since we've been working at these like

(31:42):
predominant clinics that serve 70 % Medicaidpatients, they're just like so busy. just
like, I think it's like 50, yeah, 15 minutesa patient just kind of going through that they're.
looking kind of for any support for their pregnantpatients. And so I really, I haven't encountered

(32:04):
any, like really had time to like kind of divein with the doctors about the like kind of
more political landscape there. Yeah, and thelegality side of things there now. And mostly
we're deal, like every patient that's enrolledin a DelphinaCare, like they are entering
through our patient app. have like extreme likedata privacy, settings, we don't share anyone's

(32:29):
data. And so I was a little worried aboutthat side of things too, just really making
sure that patients feel that their data is protected,especially in this environment. So I think
we had a lot of early conversations about thatin 2022. And as a company coming together
to really make sure that patients felt safeusing Delfina and entering data through that

(32:53):
to support their pregnancy. I, really honestlyhas not come up as like a huge, um, a topic
with patients or providers in Texas to thisday. They're just really looking for help to
support their practices and patients are excitedto kind of use our services and have access
to the mental health specialists. So yeah, that'sgood. That's good. I'm glad it's not getting

(33:18):
in the way. Yeah. And if I can kind of backup a little bit and I come from the Medicaid
University, I spent about half my career inMedicaid currently working in Medicare, but
I know a lot about Medicaid actually did alot of work in Texas for a long time. So,
so I love that you're there. That's a huge market. But in terms of the health plans, so do you

(33:41):
contract first with the health plans beforeyou even go into a market? Like you're not
just going like to any OB provider in anystate saying, work with Delphina. Are you showing
up to their doorstep as a network provider aspart of a health plan first? We won't just

(34:04):
go to any clinic. would mainly be once we'veidentified a geographic region, that's where
we're just we would basically be going to anyprenatal care clinic in that region though,
actually, like once we're like in this city,we would be going to kind of talk to any providers
there. We are not there on like the behalfof the health plan. Okay. It's just based

(34:29):
on the health plan. No, it's just based on geography. Geographical necessity, basically the places
that need it. That's where you go first. Yes.Yes. Okay. That's great. That's a great approach.
Yeah. Give it to the people who need it themost to begin with and then work your way from
there. Right. Yeah. Great. Like every, every, um, we learned so much on the show and just,

(34:52):
you know, having worked in Medicaid, Medicare,I've been on the employer benefit side as well,
like commercial interests. I've kind of seenthe whole industry. So everyone comes about
it a different way. And like, I know that employersare part of your, your target as well, right?
Like an employer's bringing on as a benefitfor their, um, their workforce. Yes. Yes, they
can. So we've designed, so the system was designedto be kind of implemented within a practice

(35:21):
and patients get enrolled through that way andstart using the patient app there. And so that's
how we're able to combine all the data insightsand render the various prediction models. However,
if for employers as well, we're able patientscan just. download and use our app and they're
able to get access to educational materialsthrough the app. They're able to talk to doulas.

(35:45):
They're still able to attend all of our differentclasses that we have, like lactation classes.
We do a cooking class, a yoga class. there'sstill all of that available, even if the provider's
not necessarily in the loop. So even for, I'mthinking mainly of employer health plans where
everyone's spread out throughout the US, thereis still like a lot of value in the Delphina

(36:06):
platform for employers to use. And then employersthat are in a geographic region where we can
go and enroll the various practices, that'salso a great use of the model as well. So we've
made it flexible where there's something thatkind of works for every patient and every
customer that we have. Got it. Okay. Yeah.I saw that. know I saw health plans, I saw

(36:30):
employers, you've got the providers, you'vegot the patients. So you've created kind of
this, yeah, you've created this great kind ofmaternal health support ecosystem, find your
way into the door one way or another, you canget in. exactly, exactly. And I think it goes
back to the just being flexible and like understandingthat, yeah, not every patient's the same,

(36:55):
not every practice is the same, not every provideris the same. And that the other interesting
thing for me is when I've seen our system beused at different clinics that I would think
of the clinics as roughly the same, similarpatient population, like they're even using
the same electronic health record system. Butdepending on the clinic, like they might have
their medical assistants more involved in Delfina. The OBs might be the ones directly reviewing

(37:23):
everything, or the MAs might be reviewing somestuff in the Delfina system before. and the
way the front desk staff also interact. I'vejust been really interested in the dynamics
of a clinic and then how that all like thosedifferent players might interact with Delphina
as well. Got it. And you mentioned too that70 % of your, I guess your patients and or

(37:47):
providers, I guess that kind of go hand in handare on Medicaid. Yes. Which is really interesting.
And of course I'm thinking about This is whathappens because we all of our the people that
we bring on the show, like there's all thisinterconnectedness. That's really cool. I
was thinking about I was thinking about mamaglow, who I mentioned before we actually started

(38:09):
recording, who we interviewed, Latham Thomas.And we talked a lot about the the rising rates
of maternal mortality. And she talked especiallyabout Medicaid and lower income and the underserved,
which You know, that is your Medicaid, yourMedicaid population right there. So what

(38:31):
are the providers saying? Are they just like,this is great. Like this is changing lives.
I mean, even the patients, like what's theword on the street? I imagine this is a big
game changer for folks. Yeah. So again, everypractice is kind of, I've been excited to see
how differently they're engaging with it andthen the different kind of value that's coming

(38:52):
out of it for them. So I think one, major thing is the support of our doulas to help with
the kind of more social aspects of pregnancy.we do like through our app, we collect a lot
of information around social determinants ofhealth. like looking at trend, like availability
of transportation, food insecurity, housinginstability, things like that, that really

(39:18):
help our doulas like tailor their conversationsto patients. And that again, as we mentioned,
like there's a 15 minute window that peopleare getting their visits. So it's nice to kind
of have that supplement, making sure that patientsare feeling supported and like know how to
access other resources. So that's one thingthat we've heard. The other piece is about

(39:43):
being able to, for OBs to be able to see what'shappening in between visits. So again, there's
those 14 visits, but there's kind of. Some ofthem at the beginning are a month apart. so
they don't really, they have to wait for youto come in to bring your little piece of paper
with your blood pressure written on it, to know what's really going on with you. But

(40:03):
with Delphina and other kind of RPM systems,you're able to see like the longitudinal blood
pressure measures over time, the symptoms overtime, and be able to see what's happening in
between those visits. So that's been reallyexciting to some of the, to our users as well.
That's really cool. Yeah. Having the real bigpicture so easily laid out for you. That definitely

(40:29):
sounds like a game changer to me and my layman'sopinion. Well, and data, you know, that's
data tells us so much. And I'm sure from yourperspective, you know, that kind of the scientists,
right? The, the, the, the data focused partof you. I mean, I gotta imagine through,
and I know you said you're not, you're not sharing.health data, obviously, but you're looking

(40:51):
at what you collect, I imagine, right? And sodoes it help you start to see trends? Does
it help you start to see like hot spots of,of like issues and like geographically? I don't
know if you're that far along yet to be ableto get that, but. Yeah. I mean, we, in addition
to the data that we've collected, I also usea lot of national databases and cause those

(41:13):
are great for looking at trends and then kindof isolating the hotspots and the. I mentioned
this at the beginning, but I've just been shockedby how the rates of all of these complications
are increasing. Like the hypertension duringpregnancy has increased twofold over the past
decade. Same with gestational diabetes. Two?Two. In 10 years. That's, Why? I wonder.

(41:40):
It's a great question. It's a great question.And then I've also... at the clinics we work
at, like I'll look at their retrospective data,sorry, their historical data to see what the
trends look like over time. And it's the same.Like, yeah, it might be 1.8 times or 2.5 times,
but it's still in that direction. Like thingsjust across the board seem to be getting worse.

(42:03):
I think it's a combination of factors. thinkit's definitely has to do with a lot of like
social factors, like food insecurity, diet, access to healthcare before you get pregnant,
because a lot of the patients that we serveget on Medicaid once they become pregnant.
So they're not getting healthcare before that. I think it's also potentially like other

(42:31):
rates, like rates of type two diabetes and chronichypertension increasing. I have some early
suspicions that it could be due to pollutionlike wildfire smoke. There's been some studies
done that showed during those big fires in California,the rate of preterm birth increased and potentially

(42:53):
connected to COVID like as a prior infection as a risk factor. Cause we also see that COVID
increases the rates of complications. So I thinkit's, yeah, a combination of all of those things.
And so, yeah, you mentioned. not having healthinsurance before you get on Medicaid where

(43:14):
you then qualify for it because you're pregnant.Yep. And like I was saying, you know, pre ACA,
right, was my world. And I just, it's a greatopportunity to say that, like we need to take
better care of our people. Like we shouldn't,we shouldn't be showing up at the 11th hour,
you know? So. Exactly. And this is what I'veheard also from our health plan partners is

(43:37):
they feel so reactive, like to be proactive.So they want to be able to prevent these things
from happening or know, know who doesn't havetransportation to their medical appointments
so that they can get it to them or know whoexperiencing food and security so that they
can help plans do have a lot of resources toconnect patients to, but they feel like they're

(44:00):
always reactive, like, Oh, the baby's in theNICU. Okay, now we have to react and try to
like, you know, improve outcomes from that point.But if the care had started before all of this,
maybe you could have prevented that NICU admission.So I think that's why health plans are excited
about Delfina because we were like that asour whole thesis is being proactive, avoiding

(44:24):
being reactive at all costs. And I think that'swhere we need to go with healthcare across
the board. really focus on prevention insteadof like waiting for something bad to happen
and then treating someone. That is a commonthread on our show, is that kind of getting
out ahead of things before they get worse becausehistorically, health insurance payers were

(44:49):
kind of the only player in the sandbox, so tospeak. And now we've got all this tech enabled,
these apps, right? Like we're getting diagnosticsat home, the wearables, right? Like all the
things and the value-based care, the conceptof Value-based care, started around, I want
to say around 2010, that's when I got involvedin it. And it was kind of like this fledgling-like

(45:14):
idea. Nobody knew what value-based care meant.Now it's everywhere. And it is that proactive
care, like let's stop the bad things from happeningby actually taking care of people. And, well,
at least trying to, right? Ultimately, we haveto make the decision about what we're willing
to do as an individual. What about 300 yearsago, Ben Franklin said an ounce of prevention

(45:38):
is worth a pound of cure. There you go. It onlytook us 300 years to catch up to his thinking.
And we're not there yet though. Yeah, me I guess we're approaching that hopefully. We're
getting there. Well, and ironically, so manyof these greatest ideas, right? Like the apps
and the technology and the AI. It's like everyonewas sitting at home during COVID going, well,

(46:01):
what should I do? I'm going to. I'm going tobuild a company. Right. there's, there's a
lot of really cool things and just pushing everybodyto virtual, right? Like that completely catapulted
that stuff too. So there's been a lot of goodthat has come out of that. into podcasting.
We all found something to do more pod for apps.Yeah. It's true though, actually podcasting

(46:23):
did kind of take off. was a tour guide beforeCOVID and as soon as the COVID hit, I'm like,
well, guess I'm not doing tours anymore. SoI started a podcast. Pivot. Exactly. Well,
yeah. Well, so here we are, you know, andthen you've got, you know, Delphina and you've
got, you know, so many other great companiesout there that are getting into this proactive

(46:43):
kind of delivery of care, which is amazing.So I'm excited about it. That's actually the
coolest thing to me about this entire podcastis how much of it is about that. People aren't
trying to treat you once you're already sick.It's so much about not. letting you get sick
to begin with, if you can. That it makes somuch more sense to me that way. for pregnancy

(47:08):
specifically, it also is just such a short window.Um, when things could go totally fine, but
things you could also develop a lot of differentcomplications. And so like, you really need
to be fast at doing the preventative thingsto have a healthier pregnancy at the end of
it. Yeah. That's yeah, we're here for it. Um, you know, want to touch base really quickly

(47:33):
on the doula piece of what Delphina does. getlike the clinic, the PR know, you've got all
these predictive analytics, the data, theserelationships with kind of all the people that
are part of, know, making sure these babiesare born healthy and the mom is healthy. Um,
dual as we know are a big part of, uh, delivery or, you know, the maternal care, you know,

(47:55):
kind of that. Um, I think we should have a doulafor everything, quite honestly. Um, we should
all have a doula. I agree with that. Yeah.Just a doula for getting by every day. I think
that's called an executive assistant. Emotionalsupport is what emotional support is, right?
So the doula piece of Delphina, is that virtual?Yes. So it's virtual doulas, but we hired a

(48:21):
doulas from the same like geographic region. Um, and a lot of our Patients are also Spanish
speaking, so we also have bilingual doulas.So most of our doulas right now, major focus
on Texas, going elsewhere now, but a lot ofour doulas live in the Houston and Austin areas
where we are and represent the patients thatwe also serve. And what's your perspective

(48:49):
on doulas being a part of a woman's maternity?experience and the actual birthing experience.
Because, you know, we've talked about this alittle bit on a couple other episodes I already
mentioned, I'm a big fan of the doula and howthat has helped actually lower the maternity
or sorry, maternity mortality rate. Am Isaying that right? It's end of the day. can

(49:20):
just decreasing that decreasing that and doulais playing a pretty pipped up. critical role
in that. Cause it's way higher here than anyother developed nation. Right. Yeah. Yeah.
Um, and also significantly higher among blackmoms too. I think, um, doula, mean, doulas
are amazing. So my perspective is they're amazing. also, Um, and I've also, yeah, the stuff,

(49:46):
I mean, studies, there's been a lot of researchstudies that have shown that they do reduce
the incidents of C-section and preterm birth, and then patient satisfaction is significantly
higher. And they actually encourage patients.I think there was one study that showed a pretty
big, maybe 50 % increase in the number of patientsthat were going to that postpartum care visit

(50:11):
that's six weeks after. So they're still encouragingcare utilization with the traditional medical
system. If any other therapy showed that kindof reduction, positive benefit, it would kind
of be everywhere. And so I think there's a revolutionhappening now because people are like, whoa,

(50:32):
it really does improve like clinical outcomes for people. And I think a lot of that has
to do with culturally competent care. I thinkthere's a lot to be said about not being...
stressed during pregnancy and they can definitelylower that stress level. They can help you
connect you to resources again back to likefood insecurity or needing transportation.

(50:54):
They can help you navigate some of those challengesas well. So I'm all for doulas. I've seen
the science as the chief science officer. I'veseen the science and yeah, I think I'm all
for it. Yeah, but the irony is though is thatdoulas always were like, oh, it's some like
hippie-dippie like you know, crunchy granolamom thing. And it's like, no, no, no, they

(51:15):
actually have clinical data supporting the factthat a doula should be a part of your, of your
pregnancy and delivery. Something that's stuckin my brain from Latham Thomas's episodes is
28 % reduction in surgical births. Yeah. Yeah.Just from having a doula in the room. Lowering
the C-sections. More than a 20, you know, 28% decrease in C-sections and whatnot. Yeah.

(51:39):
And remember, Latham also told us there isa federal program that if you fill out the
right paperwork, you can get a free doula. Yeah.You can get your doula paid for through a federal
program and they were already funded beforethe new administration took over. they have
the money. Yeah. And now you have Delphinatoo, So yeah, keep that, all those listeners

(52:00):
out there who, you know, want to go that route.Yeah. I don't know how to find the paperwork,
but I know there's a program out there. backand listen to episodes 10 and 11. Latham told
us all about it. to Google it. That's awesome.And I would also advocate for postpartum doulas
as well. So during that postpartum period whereyou're, yeah, you have that kind of care drop-off,

(52:22):
like having that, again, support and someonethat you can kind of reach out to during the
postpartum period is also, I think I've seenpatients really benefit from it. Yeah. Oh,
I'm sure. Yeah. That's a tough time, right?Like, yeah, you've got everyone, yeah, they're
all hanging around you. It's almost like overwhelming.then, and then you're just alone out there

(52:44):
in new mom land saying, do I do? How doesthis work? Sleep when the baby sleeps. That
never works. There's nothing else to do, right?Yeah. Yeah. That's crazy. Yeah. Well, I love
this has been such a great conversation forus. What is next for Delphina? Like where,
where are you going? What are the next kindof like big, big milestones for the company?

(53:08):
Big milestones. yeah, try scaling. We're movinginto other States now, picking up more clinics.
I'm really excited to, we've passed the 5,000patient Mark. I'm excited to start kind of
digging into our data more to look at. As youalready mentioned, you were reading my mind,
like hot spots, geographic hot spots, like new,cause a lot of the national data I mentioned

(53:33):
comes out like two years late. So you're alwayskind of behind. So I needed to start being
able to kind of come up with those own trendswith our data and really, really looking forward
to kind of emphasizing the impact of Delphinaand like digging into even like specific, like
here's how we're seeing the doulas drive changein outcomes. I'm sure it'll echo other sentiments.

(53:59):
Here's how we're seeing our nutrition interventionlook at changes in outcomes. So I'm just excited
to be getting to the point where we have enoughdata to really show the value of the specific
components of Delfina, which I think also justhelps everyone that's working in this space,
doing research in this space, people tryingto... make their own maternal health programs,

(54:21):
OBs, like trying to figure out what works inmy clinic that they could also kind of take
evidence that's being generated by us and byother researchers to implement things that
work. Yeah, that's exciting. Lots of stuff.mean, you know, the world is kind of your oyster.
I think about when I was pregnant, you know,the last time I was pregnant was 2013. And
then before that was 2008, 2009. And it's amazinghow far we've come in that. Gosh, if I asked

(54:48):
my mom, who's 83, she'd probably be like, whoa. Imagine what it was like delivering a baby
in the 70s compared to like 2009. And I'm like,wow. And I think it's just we've gone light
years ahead in a really short amount of time. very cool. Delphine is, think, is definitely
playing a big part in that. advancing our technologyand how we take care of ourselves. Exciting,

(55:17):
exciting stuff. It's very Mr. Spock. Oh yeah.Back to that. Hey, that's very nice bookend
there, Jeremy. I like to go full circle. Yeah,he does. So before we let you go, um, what
is the best way for someone to find you, whetherthey're a provider or a patient or a health
plan or an employer? Yeah, you can reach outto us at, um, by email partner at delphina.com

(55:40):
would be a great email to reach us at. We'realso on. Tick tock Instagram. X and LinkedIn.
And I am personally on LinkedIn and Blue Sky.So I post a lot of scientific findings related
to the stuff we're doing, but then other excitingthings in the field of reproductive health
there. And because we are scaling, we are alsohiring. So definitely go to our website and

(56:05):
look at the careers page. I'm sure we will stillbe hiring whenever this airs. I love it. Yeah.
Well, I always say hashtag startup life. Um,if you want to work in healthcare, I say, and
I've been in healthcare for, Oh God, since 2002,I don't even know. that 23 years? I am not
a scientist. Um, so my math is poor, but 20some odd years. And I will say right now is

(56:33):
the most exciting time to work in the healthcareindustry. So for anyone that is looking for
a career change or just getting in, you know,starting their careers, like. get into healthcare,
get into a startup. It's super exciting. I loveit. So yeah, come along for the ride. think
it's been so much fun. Yeah. I've learnedso much in the past three years. So I agree

(56:58):
with that statement. Yeah. Yeah. It's a whirlwind,but you know, strap in, buckle up the whole
thing, but it's like riding the crest of thewave and it's a really, really cool way of
to be riding. So that's my take. That's whyI jumped in. So, well, with that, thank you
Izzy so much for coming on. This has been anothergreat conversation and just, we really love

(57:23):
digging into the women's health space and definitely the maternal pregnancy, all that
kind of stuff is definitely a big space forus to be talking about. So a lot of big things
happening. So we're here for it. Thank you forhaving me. I'm here for it too. Awesome.
It was great to chat with you both. Thanks somuch.

(57:49):
And there you go. Our conversation with Izzyfrom Delphina. And, uh, it does officially
keep getting smarter around here. Uh, she, shecould be my Mr. Spock any day. Well, she's
certainly smart enough. That makes sense. Wasthat too suggestive? I don't know. I didn't
mean anything by it. So what are our main takeawaysfrom that? So like, as I said, at the top

(58:11):
of this maternal health, there, we have a maternalhealth crisis in America of first First world
or first, no. First, first world. I do not,I do not have a PhD clearly. Supposedly first
world. Supposedly. Um, and it, it can literallycontinues to maze me because this keeps coming

(58:33):
up on the show that we have pretty significantissues around maternal health and outcomes
and the health and delivery outcomes of babiesand mothers and all these things. I mean, I'm
glad that companies like Delphina exist for like solving for this issue, but it's still

(58:55):
like bonkers, right? To me that we havethese problems to begin with. Like we should,
we should be better. Why are we not betterguys? Yeah. I mean, it's a question for so
many facets of our society these days, honestly,but. you know, women's rights and especially

(59:15):
women's rights when it comes to healthcare and just the focus, the lack of focus, I should
say on women's healthcare for forever beforenow. Yeah. Another common topic. And the
fact that all these great innovations that we'recovering on this podcast that are now finally
addressing women's health in a proper way,who's bringing it to us? It's all women. All

(59:38):
our guests are women who are starting thesecompanies. I am woman hear me roar. You know,
if, no one's going to do for you, you got todo for yourself. That's what my sign said actually
at the woman's March protest, by the way, whenI did my first one, it did, it actually said,
I am woman, hear me roar. So instead we havea hippie. I'm such a hippie. So instead I
have this podcast now and I like to give theplatform to all of the ladies saving the day.

(01:00:04):
Also another thing I love that, um, Delphinahas doula support. and that Dulis is making
an appearance again. We've done a couple ofepisodes around Dulis and midwives. Dulis can
save the world, guys. They seem to be becomingmore ubiquitous throughout the pregnancy world

(01:00:24):
or whatever you want to call it. I hadn'teven heard of Dulis before, but now it's like
every time we talk to somebody who's in thepregnancy realm, word comes up. So that's
pretty cool. Yep. Instead of saying there'san app for that, we should be saying there's
a doula for that. And there's the other dualisttoo, like the, uh, well, the, the infertility
dual ends and the death doula and like we'rehearing of these other applications of it as

(01:00:48):
well. We're going to have to get into it somepoint. all need a doula for everything. Um,
so I'm stoked that they have that as part ofthe program. So there's the technology piece,
right? Like there's like these predictive algorithmsand the AI and the technology, but then there's
like, and you also have access to like a. likea virtual doula essentially, which is, you

(01:01:08):
know, amazing because technology is great. We all want it. We need it. It's making healthcare
more consumer friendly. It's making us havemore control over our healthcare, but that
in person that, that human connection is stillreally, really important. So I think that's
a really nice balance that they're bringing. And also too, it is, I would say it's, provider

(01:01:33):
first platform, but is also very much for thepatient. So I think that's a really, because
often what you find is that these, um, thesenew technologies in healthcare are typically
built for primarily one audience, but, I'mseeing more and more that they're built for
not just the provider, not just the patient,but for both. And so that's a really great

(01:01:56):
way, especially if, um, when you're, when you'repregnant, if you get diagnosed with like, I
don't know, like preeclampsia or like one ofthese things that can be very dangerous to
be able to have an app to track everything andwhat's going on. And when you walk into your
doctor's office and your OB is seeing what you'retracking, it not only helps you, it helps

(01:02:18):
them. And so it's just this whole idea of likeexpediting the entire healthcare process. Right.
Because we only have 15 minutes with our doctor. So let's make it efficient, you know? So
anyway, I think it's great. And clearly we havea, you know, a maternity health crisis in this
country that needs addressing and Delphina isjust doing their, um, you know, playing their

(01:02:40):
part. happy to have them on. only so-calledfirst world nation that doesn't have socialized
medicine. Yeah. And supposedly the richest countryin the world at the same time. explain that
to me. Houston, have a problem. Yeah. Big problem. Anyway, we're here to, we're here shining
light on those problems and, let's start fixingit. Yep. And show you the way to the solution.

(01:03:00):
That's why it's called an uprising. That's right.Let's go. All right. Well, if you like what
you hear, hit the like, subscribe, auto download,all those sorts of things on whatever platform
you're on. If you have a minute, maybe leaveus a rating and review. That's always most
helpful for the feedback and the algorithm andall kinds of things. We are on all the major
listening platforms. Audio wise, we are on YouTubevideo wise. We got a Patreon that is also video.

(01:03:26):
platform, can join the community, support thepodcast for as little as a dollar a month.
Uh, what else we got to tell them here, Heather? You can visit us online at healthcare, uprising.com.
And also if you, um, are out there on the socials,you can find us on just about every platform,
Facebook, Instagram, LinkedIn, and blue sky.We don't do the X though. Nope. We don't do

(01:03:49):
that. We're blue skyers. And I don't even knowif that's how you call it, but that's what
I'm saying. I've made sense to me. Cool. Sogo find us out there. Just search healthcare
uprising podcasts and you will find us. We postout there regularly. Um, when our episodes
are dropping, we share our, um, intervieweesposts. So lots of good information to stay

(01:04:10):
up to date on healthcare. Um, also we're alwayslooking for people to come on the show. Um,
people from actual organizations, companies, startup founders, et cetera. And also for
our human stories series, just, you know,regular Joe, Joe and Joanna's on the street.
However you identify, if you have a healthcarestory, we would love to hear from you. So

(01:04:36):
give us a shout at healthcare uprising at gmail.com and reach out and we'd love to bring you on
the show. So I believe that's all I've got. So with that, Keep looking for the good in
the world, because sometimes it's where youleast expect it.

(01:05:50):
This has been a Shut Up