Caroline Malatesta was 32 years old and halfway through the pregnancy of her fourth child when she made a seemingly radical move: She switched hospitals, lured from one that had taken a typically medicalized approach to her three previous births — requiring that she labor on her back, feet in stirrups, with epidurals and episiotomies — to one that used a splashy new marketing campaign to offer women “autonomy,” birthing tubs, cushy suites, and the honoring of any “personalized birth plan.”
But what Malatesta, pictured above, experienced the night she gave birth to her son at Brookwood Medical Center in Birmingham, Ala., in 2012 could not have been further from the soothing, empowering picture the hospital had promised in its ads.
Instead, she tells Yahoo Parenting, she was met with aggressive medical interventions that left her disempowered, permanently injured, and psychologically traumatized. Now she’s in the midst of a lawsuit against the hospital and its huge parent corporation, Tenet Health (which is currently under separate criminal investigation by the Department of Justice for alleged obstetrics-based fraud), for medical malpractice and fraud. And Malatesta is eager to speak out about what she views as the hospital’s “bait and switch” approach to maternity care.
“I’ve been left with a debilitating medical condition, my sex life is gone, I see a therapist, and I’m on medications both for pain and to ward off panic attacks,” says Malatesta, now 35 and a stay-at-home mom to her four kids, ages 9, 8, 5, and 3, with her husband, an attorney. “It has turned our family life upside down.”
Malatesta, with her baby and husband, shortly after giving birth. (Photo: Caroline Malatesta)
Her experience is just the latest example of what seems to be an alarmingly common, yet only recently and increasingly talked-about aspect of maternity care. Often dubbed “obstetric violence” — which is a new but growing concept in this country (and an actual legal term in Venezuela, Mexico, and Argentina) — it entails anything from being condescended to during labor to being forced or coerced into medical interventions, including cesarean sections.
In more and more examples, the women involved have been speaking out — and, in some cases, taking further action: In June, a California woman who says she was given a forced episiotomy by her obstetrician during labor sued him, alleging assault and battery. A New Jersey woman, meanwhile, has sued her obstetrician, saying she bullied her into a C-section. She was one of 45 women to speak out about their horrifying experiences recently for a national photo-essay project, “Exposing the Silence,” and she told her story to Yahoo Parenting in October.
One of the forces behind that project was Cristen Pascucci, a national birth advocate based in Kentucky and vice president of the national Improving Birth organization, who says that Malatesta’s bait-and-switch experience is something she’s been hearing more of from women around the country.
“We’re seeing hospitals, more and more, doing ‘your choice,’ ‘natural’ birth marketing, and there’s no substance to a lot of these claims,” Pascucci tells Yahoo Parenting, drawing on the scores of conversations she’s had with doulas, nurses, and moms around the country. “There’s often no connection between the marketing and the practices. So there might be signs up making promises, but the reality is you’re probably going to be confined to your bed in stirrups with continuous monitoring.”
Michele Giordano, executive director of Choices in Childbirth, a New York based childbirth advocacy group, tells Yahoo Parenting that the bait-and-switch is familiar to her as well. “We have seen that, unfortunately, right here in New York,” she says. “I think the challenge with that type of marketing is that hospitals need to put the evidence behind it — if they’re promising women mobility, informed consent, and access to the provider they’ve been working with, then they need to be able to back that up.”
One of the many ads touting births at Brookwood. (Photo: Big)
The ads seem to be popping up in various parts of the country, including in Indiana, where Christopher Stroud, an ob-gyn who works with midwives, recently wrote a lengthy Facebook response to a hospital’s billboard in Fort Wayne promising “birth your way.” The message has left him with “frustration,” he says.
“To experience your birth your way requires much more than catchy billboards and glitzy marketing campaigns,” he writes in the Sept. 9 post, which has been liked more than 1,200 times. “It requires a birth team dedicated to helping you achieve the birth you desire. It requires a team whose agenda is to serve the laboring woman’s agenda. It requires physicians, nurse-midwives, and nurses, and doulas to put aside what they want or feel is important, and focus solely on what is best for the woman, her baby, and her family.”
Malatesta found that out the hard way. Before switching to Brookwood, she says, she went on a tour of the newly touted Women’s Center, where she saw a birthing-tub suite as well as portable tubs that she was told could be used in any of the rooms. She then met with her new doctor, who was “very supportive” of her desire to have a natural birth without interventions. But when she arrived at the hospital in the midst of labor, her doctor was not on call — and no one else, she says, seemed to know anything about birthing plans, freedom of movement, or anything else she’d requested.
Immediately, Malatesta recalls, a nurse ordered her into a bed and onto her back and hooked her up to continuous wired monitoring (instead of the wireless type she was told she’d have). When the laboring mom asked for the birthing tub she was promised, she says the nurse told her the room could not accommodate one.
“I continued asking why I had to be on my back and saying I needed to move around, but she ignored my questions and demanded I obey her, as if I were a disobedient child,” Malatesta recalls through a written description of the birth provided to Yahoo Parenting. “I could sense my husband’s anxiety mounting. As we went back 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.”
When Malatesta’s painful contractions started, she says, she flipped onto the more comfortable position of being on her hands and knees. That’s when her water broke and her baby began crowning. Then, she says, “everything went haywire,” with the nurse physically forcing her onto her back and other nurses joining in. “I desperately tried to flip back to my hands and knees, struggling against the nurses to do so. The nurses held me down and pressed my baby’s head into my vagina to delay delivery as he was trying to come out,” she writes. Staffers physically prevented her baby, Jack, from being born for six minutes, leaving Malatesta with an excruciating, debilitating nerve injury — a permanent condition, pudendal neuralgia, which causes daily pain “much worse than labor,” she says — as well as a diagnosis of PTSD (post-traumatic stress disorder). Pitocin (a labor inducer also used postpartum to prevent excessive bleeding) was given without Malatesta’s knowledge or consent.
Malatesta and her son, Jack, today. (Photo: Caroline Malatesta)
“So that’s how my precious child entered this world,” she writes. “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.”
Calls placed to Brookwood Medical Center by Yahoo Parenting were not returned.
The marketing blitz surrounding the addition of the hospital’s Women’s Center, which launched in 2012, included billboards, TV spots, and local press coverage, using the hashtag #ichooseb and targeting women with phrases like, “We can’t tell you this is the best place to have a baby, but your friends can.” Hospital literature provided to Yahoo Parenting noted, “Our staff works with you and your doctor to create a birth plan designed specifically for you and your baby … [taking] into account your specific medical needs, the needs of your baby, your choice of child-birthing methods… .” On a local television interview with Fox 6 in 2010, the hospital’s Dr. Jon Adcock noted, “We kind of jumped into the area of water birth, and embracing a bit more of the natural childbirth realm.” That caught the interest of Malatesta, who had been hearing about the more alternative labor practices of friends who lived in the Northeast.
After her upsetting experience with Brookwood, Malatesta wasn’t sure where to turn. “I was worried people would think I was being dramatic, because it’s not socially acceptable to complain about your birth if you have a healthy baby,” she explains. She started by trying to find answers about the way she was treated through a hospital patient advocate, but was stonewalled, she says. Though she was hesitant to go the legal route, especially since her father is an internist, she felt it was her only option left, and filed suit in February 2014.
“Several aspects of litigation have been emotionally hard, including having to answer deeply personal and sexual questions in deposition and having my personal emails sifted through by attorneys,” Malatesta explains. “But the hardest part by far is sitting in depositions as a passive spectator, and listening to people try to justify their actions even in the face of my clear refusal. It’s a creepy feeling to hear nurses and hospital administrators who sincerely believe they have the rights over my body.”
The Malatesta family. (Photo: Caroline Malatesta)
In a legal deposition provided to Yahoo Parenting, for example, Amy Beard, vice president of Brookwood Women’s Center, was asked if she agreed that Brookwood should be prepared to deliver on promises made to potential maternity patients. “I would agree as long as it doesn’t compromise the safety and well-being of the patients,” Beard replies. “Some types [of] patients would like to choose things that are not safe for them or their baby, but yes, absolutely, as long as it does not impede the outcome.”
In an opinion piece published in Alabama.com in May, columnist Cameron Smith discusses Malatesta’s case, and how the Brookwood marketing reeled her in. “Most pregnant mothers already want to have a say in the details of delivering their babies, so these advertisements play on that demand. But what happens when the care provided doesn’t match marketing expectations?” he writes, noting that, while his own wife had a positive birthing experience at Brookwood, “that’s the point. … Every interaction with healthcare services is different. There are so many layers, protocols and decision makers that the range of services offered to a single patient cannot possibly be captured in a short television or radio spot. … Before a prospective mother ever voices her preferences, she faces a network of predetermined restrictions that may seriously and uniquely limit what has been advertised to her as a ‘customized’ experience,” he notes. “Add to the mix the fact that the on-call physician may have different rules than the patient’s regular doctor and ‘customized’ might become ‘confusing’ quickly.”
But the bottom-line question in cases like Malatesta’s, Giordano notes, is this: “Why are hospitals saying this when it’s not what they’re doing? Who is holding the hospital accountable? I think that’s been very unclear, and until we know, we will continue to hear these stories,” she says. “And unless a woman takes it upon herself to take the legal route in holding hospitals accountable, there are not a lot of avenues for change.”