The American healthcare system is full of software. It is not always full of care. That was one of the clearest lessons from my conversation with Melissa Hanna, the co-founder and CEO of Mahmee, a company that provides prenatal and postpartum support through doulas, lactation consultants, nurses, mental health providers, and nutritionists. The services are bundled together and, in many cases, covered by insurance. The support begins during pregnancy and continues through a child’s first year. At first glance, Mahmee sounds like a healthcare startup built around coordination. In one sense it is. But Hanna’s story is really about something harder. She started with the belief, common in startups, that a broken system could be fixed by better software. Over time she found that software mattered, but it was not the thing standing in the way. The original problem that pulled her in was simple and disturbing. The United States has some of the worst maternal and infant health outcomes in the developed world. For Black women, the numbers are far worse. Hanna said Black women face maternal mortality rates three to four times higher than peers with similar clinical and economic profiles who are not Black. Native American and Indigenous women also face sharply elevated risks. These are not small gaps at the margins. They are structural failures. Hanna began by treating the issue as a data and communications problem. Why were patients falling through the cracks. Why were providers not sharing information. Why were systems not talking to one another. Those are reasonable questions, especially in American healthcare, where fragmentation is a defining feature. Patients move between doctors’ offices, hospitals, insurers, specialists, and community providers, often with little continuity between them. So Mahmee’s first life was as a software company. For roughly five years, the company built tools to connect providers and surface information that was not being captured elsewhere. Hanna and her team focused on the providers who often sit outside the formal medical stack, doulas, lactation consultants, nutritionists, nurses, and mental health professionals working in communities, private practices, or local nonprofits. Those providers often knew a great deal about what was happening with a patient. A doula might hear details a patient never shares with an OB-GYN. A lactation consultant might see warning signs that never make it into a medical record. A mental health provider might understand a patient’s risk in ways that do not show up in a standard clinical workflow. But much of that information was effectively invisible to the larger system. Mahmee built software to change that. The company created electronic health record tools, care management systems, communications features, and scheduling and billing software aimed at these community based providers. In doing so, it found real demand. Thousands of providers signed up across 44 states. The footprint was broad. The product was useful. But scale did not follow. That was the hard part. Each provider might only serve dozens, or perhaps a hundred, clients a year. The software worked, but the market around it was too small and too fragmented to produce the kind of reach Hanna believed was necessary. She used an analogy from The Founder, the film about Ray Kroc and McDonald’s. You can have a very good milkshake machine, but if the burger stands are too small to use it at scale, the machine alone does not solve the problem. That was the pivot. Hanna realized the real barrier was not simply that community based maternal health providers lacked software. It was that they lacked a place inside the formal healthcare economy. Insurance often did not cover their services. Payment models were broken. The people who were often best positioned to support mothers before, during, and after birth were sitting outside the system that paid for care. At that point Mahmee stopped being a pure software company. It became a tech-enabled healthcare services provider. Instead of just selling tools to doulas and lactation consultants, the company employed them and built a coordinated care organization around them. The software remained important, but it became infrastructure for a services model rather than the product itself. This is a more interesting kind of startup story because it runs against a habit in tech. Founders often want the clean answer. There is a messy industry, and software will organize it. Hanna found that the mess was deeper than that. The system was fragmented not just technically, but financially and institutionally. Data could not solve a funding problem. A dashboard could not make insurers reimburse the people who were doing essential work. That matters because maternal care is not a niche. Hanna put maternal and infant healthcare in the United States at roughly a $200 billion market. Yet for something that large and consequential, the experience is often poor, costly, and isolating. Many women move through pregnancy and birth without enough support, without clear information, and without much sense of agency over what is happening to them. One of the strongest parts of our conversation came when Hanna described a patient story that made this concrete. The woman was in her early twenties, already had one child, and lived in a rural area with limited hospital and doctor access. During her first pregnancy, she felt judged throughout the process. She was young, a woman of color, and she came away from the experience feeling that she had no control. Labor was difficult. The care felt harsh. She was in pain, asked for help, and felt talked down to rather than supported. When she became pregnant again, she was afraid. She wanted the baby, but did not want to relive the first experience. Through Mahmee, she learned something basic that had been missing the first time. She had choices. She could ask questions. She could slow a conversation down. She could say no. She could ask about pain management options beyond the narrow set that had been presented to her before. She could participate in the process rather than just endure it. That may not sound radical, but in practice it often is. The modern medical system moves quickly, especially in high stress environments like labor and delivery. If a patient is not informed and supported, decisions get made around her rather than with her. Hanna’s point was not that doctors and nurses do not matter. Quite the opposite. In high risk pregnancies, they matter enormously. Her point was that support, education, and continuity of care change the experience and often the outcome. This is also where her critique of the system is most useful. She does not reduce everything to one cause. Systemic racism and bias, she said, are real and they amplify disparities. But she also pointed to two other drivers, fragmentation and the chronic underfunding of preventive care. If support is only available at moments of crisis, then people will continue to arrive at those moments without the preparation, context, and trust they need. Hanna also spoke frankly about the difficulty of funding a company in this area. Building in healthcare is hard. Building in women’s healthcare is harder. Raising venture money for maternal health can mean explaining the problem to investors who have never had to think about it in concrete terms. Part of the job, she said, was reframing the opportunity so people could understand it as both a human problem and a business one. Another part was finding investors for whom the issue already felt personal, because they or someone close to them had been through a birth experience that was worse than it should have been. What stayed with me most was the shape of the lesson. The original thesis was not wrong. Technology does matter. Mahmee still builds software. It still uses connected tools and remote monitoring. It is now looking at how AI might fit into care delivery. But the mature version of the thesis is more grounded. Better care does not come from software alone. It comes from software plus people, software plus payment systems, software plus trust, software plus someone who is actually there when a patient needs help. That is not as neat as a pure software story. It is more true. There is a tendency in startups to assume that every broken institution is waiting for the right app. Sometimes what is actually missing is a workforce, a reimbursement model, and a way to bring overlooked people into the center of the system. Mahmee’s story is about discovering that the missing layer in maternal care was not just information. It was support that had been treated as optional, informal, or outside the reimbursable core of medicine. Hanna’s company now tries to make that support part of the default package rather than a luxury add-on. The goal is not only to improve outcomes, though that is clearly part of it. It is also to change what pregnancy and postpartum care feel like for the person going through it. That may be the real measure here. Not whether a startup found product-market fit in the usual sense, but whether it found a way to make a system less cold, less fragmented, and less likely to fail people at a moment when failure carries enormous cost. — Transcript John Biggs (00:00.161) Welcome back to Keep Going, podcast about success and failure. I’m John Biggs. Today on the show, we Melissa Hanna. She’s the CEO and co-founder of Mahmee M-A-H-M-E-E, which is a fascinating startup. You guys work with doulas and you work with care during birth, right? So why don’t you tell me about that? Welcome. Melissa Hanna (00:30.561) Thanks, yes. Well, Mahmee provides wrap-around prenatal and postpartum support. We do that with a team of doulas, lactation consultants, registered nurses, mental health providers, and nutritionists. And it’s all included in one bundle. that’s actually covered by insurance. In most cases,
