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. “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. “This all came at a time when more of my friends around the country were beginning to have babies, and I was beginning to realize just how differently birth was handled elsewhere,” Malatesta wrote. “Before then, I didn’t know there were options. I was hearing of friends being allowed to move around during labor, use the restroom, drink water, avoid stirrups, and birth in different positions. I always had been confined to the bed with a bedpan or catheter, only allowed to eat ice chips, and on my back in stirrups for delivery.” “I always was prepped from the waist down with surgical cloths and washed with antiseptic prior to delivery. I just figured that’s how childbirth was done everywhere. Lots of these friends had natural births and talked about them positively. They didn’t have routine interventions and their recoveries seemed faster.” 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. “I was ready!”
But when the time came to deliver the baby, Malatesta says the experience was a nightmare.
Nurses immediately put her in a hospital gown and forced her onto her back, contrary to her wishes; she’d wanted to walk around during her contractions, wearing her own clothes. When she tried to change positions, one nurse physically restrained her. “She grabbed my left wrist and forced it out from under me,” Malatesta wrote. “I pulled back, but couldn’t escape her grip. She pulled my arm and rolled me over to my back. That is the moment I lost control over my birth.” When Malatesta voiced her concerns or objections, she alleges that the nurses simply ignored her. She claims 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 then 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. “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 in any way. “As if birthing a baby isn’t hard enough, I gave birth while engaged in a physical struggle against the people I trusted to care for us,” she wrote. “I kept asking, “Why? Why?” but the nurse wasn’t answering me. 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 condition called pudendal neuralgia. The main symptom of this condition is permanent pain in the genitals, which she said ruined her family life. About eight months after giving birth, she tried to work with the hospital for compensation for this painful condition. “My obstetrician called it the worst injury he has seen in all his decades of practice,” she said. “It has turned our family life upside down. I was a stay-at-home mother of four children, ages five and under, at the time Jack was born, and what happened to me during his birth left me unable to care for them as needed. I endure debilitating pain on a near daily basis—pain much worse than labor.” The hospital wasn’t interested in negotiating. In fact, they didn’t even provide the answers that Malatesta 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. “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. “Brookwood used the idea of natural birth as a way to lure in patients,” Malatesta wrote. “I say that without a doubt. They were not providing the services they advertised.” “I think their marketing department got ahead of themselves because they knew that women wanted these services. Women want to make their own decisions. Hospitals are advertising that women can make these choices like it’s a privilege instead of a patient right. That’s insulting to women!” 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.