Caroline Malatesta is a mother of four who lives in Alabama.
For her fourth child, she had a very specific birth plan in place. She wanted a natural birth—a departure for Malatesta, who had epidurals and episiotomies while delivering her three other children.
The mother decided she wanted to give birth in a more natural way; she wanted to forgo the medicine and avoid laying on her back. Her birth plan was unconventional by modern standards, so she chose to have the baby at Brookwood Health Center, which explicitly advertised that they would follow any birth plan.
“They were using phrases like ‘personalized birth plan,’ ‘It’s about that birthing plan…whatever you want out of your birthing plan,'” Malatesta wrote later for the advocacy blog BirthMonopoly.
“No other hospital in town so much as mentioned such progressive concepts (and it should be noted that assisted out-of-hospital births aren’t legal here in Alabama).”
The Brookwood facility offered “autonomy,” according to advertisements, and even had birthing tubs on hand to accommodate mothers’ wishes. Malatesta spoke to the doctors at the medical facility who assured her that they would do everything possible to meet her needs. It seemed like the perfect place to bring a new child into the world.
Malatesta’s out-of-state friends introduced her to the concept of natural birth, and she was fascinated by the idea of being able to move about the room during labor, avoid drugs during the birth, and use a traditional birthing position rather than lying on her back with her feet in stirrups.
She made up her mind: She’d switch hospitals and give birth in a more natural way.
“I carefully made a birth plan based on best medical research, approved by my doctor,” Malatesta wrote in her BirthMonopoly piece. “I was ready!”
But when the time came to deliver the baby, the experience was a nightmare, Malatesta said.
Nurses immediately put her in a hospital gown and forced her onto her back, contrary to her wishes, she said; she’d wanted to walk around during her contractions, wearing her own clothes. When she tried to change positions, one nurse physically restrained her, according to a blog post by Malatesta’s lawyers.
“Caroline had no freedom of movement,” the post reads. “Instead, she was restrained, sometimes forcibly. Caroline was offered no choice; it was the nurses’ way or no way.”
When Malatesta voiced her concerns or objections, she alleged that the nurses simply ignored her. She claimed the nurses actually seemed annoyed that she would object to their instructions, despite the fact that she’d gone over a specific birth plan with her doctor.
Then, the situation somehow got worse; the baby began crowning, but the doctor wasn’t there. The nurses reportedly began physically holding the baby in place, preventing Malatesta from pushing the baby out. This struggle lasted for six minutes until the doctor finally arrived.
The medical records showed Malatesta’s struggle.
“Unfortunately, the patient was not able to [behave] in a controlled manner,” the records read, as reported in Malatesta’s piece on BirthMonopoly. “She was pretty much all over the bed.”
The baby’s head immediately came out and her son, Jack, was born a minute later. Fortunately, Jack was perfectly healthy, but Malatesta certainly doesn’t credit the medical staff for that positive outcome.
“I kept asking, “Why? Why?” but the nurse wasn’t answering me,” Malatesta wrote. “She ignored me, acting almost annoyed with me. As we went back and forth—me asking questions and telling her this was more painful for me, and her getting increasingly irritated—it became very clear that this wasn’t about health or safety. It was a power struggle.”
But unfortunately, Malatesta continued to suffer. She says that the ordeal left her permanently injured, suffering from a chronic pain condition called pudendal neuralgia. The main symptom of this condition is permanent pelvic pain, which she says ruined her family life.
About eight months after giving birth, Malatesta tried to work with the hospital for compensation for this painful condition. The hospital wasn’t interested in negotiating, Malatesta claimed. In fact, they didn’t even provide the answers that she asked for.
“I grew up in a medical family,” she wrote in a piece published by Cosmopolitan. “My dad is a doctor; my granddad was a doctor. Litigation, medical malpractice—it’s not something we take lightly. When the nerve injury really revealed itself, I wasn’t planning to file a lawsuit. I just wanted answers.”
Soon, however, Malatesta was reconsidering that stance. She filed a lawsuit against the hospital, and two years after filing, she went to court. Even during the lawsuit, Malatesta’s pain affected her; she wasn’t able to sit for more than a few hours a day, so she couldn’t spend much time in the courtroom.
But something incredible happened: Other women began to come forward with other stories of obstetric violence.
“I became acutely aware that this wasn’t just about me,” Malatesta wrote in Cosmopolitan. “This became a cause for me, almost. To bring the truth out on behalf of so many other women. I was surprised how much it meant to these other women that I was filing a lawsuit.”
The suit, filed in 2014, took two years to litigate. A jury deliberated for nine hours, then returned a stunning verdict, awarding the Malatesta family $10 million in compensatory damages, $5 million in punitive damages for “reckless fraud,” and $1 million for loss of consortium.
While the jury’s decision will go a long way towards holding the perpetrators of obstetric violence accountable, Malatesta says that she’ll likely live with horrific pain for her entire life. She hopes that her struggle will help to prevent this type of scenario from playing out the same way in the future. The good news? Malatesta is not alone in this mission.
Taking on Obstetric Violence
Obstetric violence, which took such a terrible toll on Malatesta’s health, lies at the intersection of institutional violence and violence against women, says the advocacy group Women’s Global Network for Reproductive Rights. The mistreatment affects women who are pregnant, in labor, actively giving birth, or in the postpartum stage. Women may be denied treatments, have their requests ignored, endure verbal humiliation, and receive forced, coerced medical treatments. They may even experience physical violence, invasive practices, and other dehumanizing, humiliating treatments.
Women face this abuse at the hands of the healthcare industry far too often, says Jamie Yates, a seasoned New York City doula and childbirth educator.
“Unfortunately, these types of situations are all too common in hospitals,” she tells HealthyWay. “Most incidents of dissatisfaction go unreported because women are guilted into believing that because they have a healthy baby, that they should be happy, even thankful, that unnecessary procedures were performed on them.”
“The absolute most important decision every pregnant person must make is who they choose to be their care provider.” —Jamie Yates
“The absolute most important decision every pregnant person must make is who they choose to be their care provider.”
This seems to be a uniquely American problem, Yates explains.
“Our current maternal care system ranges from the deeply flawed to downright dangerous for moms and babies,” she says. “The U.S. has one of the worst maternal mortality rates in the developed world, and the maternal mortality rate is four times higher for black women.”
(Actually, Yates is the slightest bit off here. The U.S. doesn’t have one of the worst maternal mortality rates in the developed world—it has the absolute worst, by a wide margin. She’s close enough on the racial disparity though; the Centers for Disease Control and Prevention tracked a mortality rate of 12.7 perI a 100,000 live births among white women in the years 2011 through 2013. During that same period, black mothers passed away during childbirth at a rate of 43.5 per 100,000.)
Ending the Epidemic of Violence
The solution to obstetric violence isn’t simple, but it starts with women being in charge of their bodies and their choices during pregnancy, says Yates.
“The absolute most important decision every pregnant person must make is who they choose to be their care provider,” she says. “Most low-risk women would be better served by a midwife. Midwives, on average, spend more time with their patients and have a greater understanding and acceptance of a pregnant person’s ability to birth their own babies. If, for whatever reason, a midwife isn’t an option, it’s important to choose an obstetrician who listens and is willing to answer questions from the beginning.”
Plans can change, but there should be one constant throughout the experience—respect. Birthing people deserve to be participants in their own labor and, most of all, deserve all of the information so they can have true informed consent or refusal of intervention.” —Jamie Yates
Plans can change, but there should be one constant throughout the experience—respect. Birthing people deserve to be participants in their own labor and, most of all, deserve all of the information so they can have true informed consent or refusal of intervention.”
Of course, the luxury of multiple health care options isn’t always possible. Regardless, women should be on the lookout for red flags. Some doctors won’t even discuss birth questions until the last trimester—that’s not good, says Yates.
“If your doctor is unwilling to have conversations about options and provide clear evidence-based information at your appointments, switch providers,” she advises. “If they are unwilling to listen prenatally, they are unlikely to respect your needs during labor.”
Even with a supportive doctor or partner, navigating hospital policies can be overwhelming. This is where Yates suggests enlisting the help of a doula.
“While a doula can’t ‘save’ a person’s birth, a good doula can help them get the information they need in order to make informed choices about their birth,” she says. “Doulas can be the eyes and ears in the labor room along with helping the laboring person and their partner feel supported.”
It’s also important to realize while having a great support system and a rock solid plan is a great start, anything can change in an instant once labor begins. Being flexible is just as important.
“Plans can change, but there should be one constant throughout the experience—respect,” says Yates. “Birthing people deserve to be participants in their own labor and, most of all, deserve all of the information so they can have true informed consent or refusal of intervention.”
Malatesta, it’s clear, paid the price for an unresponsive health care team. By speaking out, she’s helping to ensure that the next mother won’t face the same tragic experience.