In addition to being the month we celebrate moms, May is also Women’s Health Month. Women's ability to give birth and grow a child is a biological attribute. It also presents a slew of health concerns.
A 2023 New York Times article examined a staggering trend of a rise in fatalities after somebody gives birth.
“In 2021, there were 32.9 deaths for every 100,000 live births, up from 20.1 per 100,000 in 2019. Rates for Black and Native American women are two to three times higher than those for white women. In some states, like New York, it is 10 times higher.
But those figures reflect a traditional definition of maternal mortality, deaths that occur during gestation or up to six weeks after birth.
A fuller extent of the problem came to light in September when the Centers for Disease Control and Prevention took a more expansive look at mothers’ deaths, analyzing them for an entire year after childbirth and including fatalities resulting from mental health conditions.
Based on data provided by 36 states on 1,018 pregnancy-related deaths from 2017 to 2019, the CDC concluded that about a third of them occurred during pregnancy or on the day of delivery and roughly another third before the baby turned six weeks old. A full 30 percent happened until the baby’s first birthday. This period had not been a focus of maternal mortality research.”
Only now has the medical community come around to understanding the importance of medical care through all stages of pregnancy and the Fourth Trimester.
Media industry veterans and philanthropists Nana Eyeson-Akiwowo and Marcia Cole already knew there was a staggering need to prioritize care for both baby and birthing parent. They created Fourth Phase, a social impact maternal wellness company that helps mothers heal during their Fourth Trimester by addressing both body and mental well-being.
In celebration of Mother’s Day, we spoke with Nana and Marcia to learn more about Fourth Phase and how they hope the brand changes perceptions of maternal health post-labor.
Enthuse Foundation: Tell us about the Fourth Phase and why there was a need for the brand.
Marcia Cole (MC): Fourth Phase is a social impact maternal wellness company that creates afterbirth care products, mini kits, and luxury gift boxes that help new mothers heal, feel, and be heard during their Fourth Trimester. Every purchase allows us to donate a similar box to new mothers in Sub-Saharan Africa and unhoused moms in the US.
Nana Eyeson-Akiwowo (NEA): The idea came to me during an annual health-focused mission trip to Ghana, where my family originates, and where we were supporting a maternal clinic servicing local women in villages. These women had just given birth, and there was limited Fourth Trimester resources available to them. So often, we focus on the pregnancy and the health of the baby—which is of the utmost importance—but society typically neglects the mental, physical, and emotional well-being of new mothers. Unfortunately, this happens to mothers most in the U.S. and in Sub-Saharan Africa, which both have the highest maternal mortality rates across the globe. This has to stop. I began making maternity to-go boxes and disturbing them at local wellness fairs. During the pandemic, I was helping Marcia with a virtual fundraiser. I mentioned that I struggled to build a website for the new business idea. A digital marketing expert, Marcia, offered to help. By October, it was clear I needed her as a business partner.
EF: What an incredible story! I love that you are using the brand to make a difference as well. How do you define the Fourth Trimester? Who would you say are your core demographics?
NEA: The Fourth Trimester essentially refers to that 12 weeks to almost one year after a woman delivers. When someone says the word ‘postpartum’ [people] often think that the woman is depressed and there is postpartum blues. During the Fourth Trimester, a new mother can experience baby blues, anxiety, or postpartum depression and psychosis, which are at the deeper clinical levels of mental health. There is a wide spectrum that can include some sense of sadness, but it could also include navigating all the things happening in her body as it readjusts from birthing a child. So, it’s just [the] not knowing. Why am I bleeding excessively? Not understanding why my breasts feel this way, and the emotional parts of it.
MC: Our core demographics are expectant and new mothers. The Fourth Trimester is the time when the mother—whether it’s her first or fifth child—is also born. Each pregnancy is different, and each after-birth recovery is different. The understanding of that requires a level of education that has been lost in the U.S. Excessive bleeding is the norm post-natal. But when isn’t it normal? Having a headache is normal for any human. But if a new mother is having consistent headaches, it may be a signal for postpartum eclampsia, a condition that can happen even if you don’t have a history of high blood pressure. For those first 12 weeks, especially, the mother needs to be monitored just as much as the baby because she is also at risk.
EF: Thank you for that explanation. Tell us a bit more about Fourth Phase and its products.
MC: Before we decided on the products, we spoke to more than 200 moms, doulas, and OBGYNs to understand their needs and what our targeted consumer base would want. We knew there was a need for these types of products, but we wanted to make sure what we offered was truly what the mom wished she had when she first went through the Fourth Trimester. And we wanted to ensure that we deliver on that need in a profitable and sustainable way. Customers can shop, learn, and connect with other moms. We offer Fourth Trimester care products, mini kits for on-going postpartum needs, and luxury gift boxes, which make perfect baby shower or push-presents.
NEA: We began with two boxes: Vaginal and Belly Birth gift boxes based on the delivery method because the purpose was to take the guesswork out of what to buy. One of the pain points is a new mother doesn’t know she needs these items until she’s had the child. Then she’s going from drugstore to drugstore, googling, and trying to figure it all out. Our gift boxes contain organic skincare products designed for healing from surgical deliveries and stretch marks, lactation-support items, including products for dry, cracked nipples, postpartum underwear, pelvic and perineal care, and mental wellness items, including a journal and digital affirmations. We added the Every Birth Box based on consumer demand when the delivery method had not been determined. We just began selling mini kits and the products found in the box are also now available a la carte.
EF: Maybe it’s a coincidence or a subtle nod to the struggles moms endure, but in addition to hosting Mother’s Day, May is also Mental Health Awareness Month. Can you briefly discuss the emotional component, in addition to the physical healing needed after giving birth?
NEA: Many mothers express losing a sense of self, and some experience postpartum depression, which then comes with the stigma around feeling that way. And many moms have yet to learn what they need post-delivery. The Afterbirth Box is like a big hug for them. In addition to the physical products, we are building a community for new moms. In April 2024, we launched our podcast called Healing After Birth, which features holistic and medical experts and personal reflections from our clientele – those in the Fourth Trimester. Additionally, we are building a list of postpartum care practitioners based on recommendations.
MC: We offer products for both body and mind, which is what came out of the research. The mental health component and the spiritual component to get mom back to center are all critical aspects of the Fourth Trimester healing journey. I don’t think that part is discussed or understood enough. Giving birth places a mother as a bridge between two worlds. Her body will take a certain amount of time to return back to normal—but her mental state may take longer and vice versa. We wanted her to know that wherever she is on this journey, she is not alone. Last year, our Every Birth Box was voted Best Postpartum Kit for Body & Mind by TheBump.com’s team of mom reviewers. That was a great validation.
EF: I think it’s important to note here that not all birthing experiences are the same, and experiences might be different for Black and Hispanic women. According to the Center for Disease Control and Prevention (CDC), Black women are three times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, such as variations in quality healthcare, underlying chronic conditions, structural racism, and implicit bias. Did these statistics impact the idea or structure of your business as Black women business owners?
NEA: [There is] this ideology around Black women being strong. And so often, when Black women go to their health providers, their symptoms and concerns aren’t always taken seriously or given priority. I think for Fourth Phase, what we want to do for women, in general, is advocate for women to be heard. I want them to feel empowered to say: ‘I know what’s happening with my body, and if this doctor doesn’t listen, I will go to another doctor who will be able to help me or find another kind of practitioner or healer.’
MC: These statistics came out exactly when we launched in 2021. The year before, while we were researching and holding focus groups these numbers had not yet been released, so it was not known how dire maternal health—from mortality to morbidity rates--was in the U.S. Nana was aware of what was happening in Ghana and Sub-Saharan Africa, but in America, women of color were suffering in silence. It wasn’t until celebrities like Serena Williams and Beyonce shared their experiences of not being listened to while in hospitals after giving birth that mothers began to understand they weren’t alone—regardless of one’s stature or socio-economic status. Our mission as a social impact business is to sell products that matter to the wellbeing of a woman who chose to become a mom and connect mothers globally. And we want to be able to equip mothers with the knowledge and information they need to advocate for themselves and make more empowered decisions, so they know what’s happening to their bodies after giving birth.
EF: Marcia – Fourth Phase is your third company. How would you describe your experience as a Black woman entrepreneur?
MC: Like many with an idea, I enjoy seeing that idea come to fruition. As a Black woman entrepreneur, I’ve learned that it’s important to take care of myself while on this journey and to be ruthlessly honest about capacity. Some will not see the value of your gifts. But I have to make sure that I see the value of my gifts—take the shots I need to move my business forward, make the difficult decisions needed for the betterment of the company, and believe that the right people will support. As a Black woman leader, my experience is that we open doors for all. History has shown that some go out of their way to close the doors on us. When we began the Fourth Phase, there seemed to be a willingness by many companies to support Black women with their small business ventures. Three years later, that support appears to be dwindling due to very targeted attacks on our demographic, which gets less than 1% of funding. This fact is disheartening, to say the least, as other minority groups are not being targeted in the same way. And I have to wonder why—without amplifying that negativity, and without losing hope. My experience has taught me to be resilient if I want to accomplish something, to keep my eyes on the prize, and not let negative, outside chatter occupy my mind or influence my heart and will.
EF: Thank you so much, Marcia and Nana, for sharing your story and more information about the Fourth Phrase with us. Thank you for advocating for birthing parents and making an extremely vulnerable time less lonely.
It’s possible to make money and a difference. Marcia and Nana’s Fourth Phrase is a brand that provides not only tangible products for those that have just given birth but also a community during a time when everything is new. Check out our other mom-related blog posts Unicorns Do Exist – Five Ways to Overcome Mom's Guilt and Meet My Co-Founder – Mom.
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