When Leslie Driggers Hoard entered Providence Memorial Hospital in El Paso, Texas in 2012, she felt prepared for the birth of her first child. “It should have been the happiest day of our lives,” she said. Hoard and her husband were not, however, prepared for an experience she calls physically and verbally abusive, medically flawed, and deeply traumatic.
Hoard recalled nurses giving her extremely painful vaginal exams, refusing to remove their hands from inside her even when she screamed and begged them to stop. She said nurses inserted an IV without permission; attempted to administer the labor-enhancing drug Pitocin without consent; and as the hours passed, refused to let her drink water or leave her bed—even to use the bathroom. Although her labor had progressed steadily apparently without medical complications or fetal distress, Hoard said the on-call obstetrician berated and yelled at her for not pushing correctly and began violently pressing on her vagina while she pushed. Finally, Hoard remembered the doctor telling her he was going to perform a C-section, and stating that this was not because he just wanted to finish his shift and go home. Although Hoard had signed a blanket consent form on arrival, there was no further paperwork or discussion to make sure she was aware of risks and benefits. Without any information about the procedure, Hoard found herself having C-section surgery, which she believes was medically unnecessary.
“During the C-section, I actually felt myself leave my body,” Hoard said. “I’ve never been raped, but I know what rape victims mean when they say that. I really wasn’t there. Finally, I heard a cry and thought, ‘Oh, that must be my baby.’”
Caring for her newborn in the following months, Hoard said, “I was not in a healthy place.” She struggled to breastfeed and bond with her baby. She describes feeling constantly on high alert, having anxious visions of terrible things happening to her son, and frequently breaking down in tears. A therapist later suggested that Hoard had PTSD. Her anxiety returned with her two later pregnancies, along with anger and fear; she worried that having had a C-section could permanently impact future deliveries.
In the year after her son’s birth, Hoard tried to report her experience to the hospital. When she was discharged, she was told that an external company would be calling her for patient feedback, but the call never came. She contacted the Labor and Delivery department, but found it incredibly difficult to figure out how to file a complaint.
Finally, she was able to schedule a meeting with hospital administrators where she said they minimized and dismissed her concerns, promising only to conduct an “internal investigation.” Hoard received a letter two months later informing her that a review of her case had been concluded. The letter said the hospital was “truly sorry” and stated that staff would receive education around informed consent and customer service. It did not address Hoard’s specific allegations or mention any disciplinary action. The letter stated that her complaints about her obstetrician would be reviewed by medical staff, but she heard nothing more about them.
Providence Memorial Hospital declined VICE’s request for comment on these allegations, citing patient privacy laws.
Left with no recourse to protest her treatment, Hoard became one of over 250 women who have posted on Birth Monopoly’s Obstetric Violence Stories Map. The web page, which went live in January 2019, is the first worldwide, public database of abusive maternity care stories. Birth Monopoly is an advocacy group focused on exposing abuse in the US maternity care system, and the page allows both obstetric violence survivors and “witnesses,” like nurses or birth doulas, to share information and experiences. Tiny triangles mark the submissions on the map, which are not independently verified, painting a global picture of women who feel abandoned by health care systems and medical professionals who appear uninterested in their trauma.
A woman named Elizabeth from Maine said her obstetrician administered Pitocin to induce labor without her consent. Otherwise, she reports the doctor complaining, “We could be here all night.” Lesley, from Wisconsin, describes her labor and delivery nurse grabbing her ankles and forcing a hand inside her body to break her amniotic fluid, although she said she explicitly refused the procedure. Diana in Ontario, Canada recounts how her obstetrician began stitching up her vaginal tear after delivery without anesthetic; when she screamed in pain, she said he told her to "Stop moving. You get what you deserve."
Birth Monopoly also provides information and support for parents on how to claim their rights in childbirth settings. Founder Cristen Pascucci said the concept for the map came from years of responding to women who contacted her with obstetric violence stories, and helping them make complaints to hospitals with frustratingly few results. “I am just at my breaking point with feeling like it's a waste of time,” said Pascucci about the complaint process. “It can be therapeutic for people who have had traumatic experiences, and it can definitely give someone some closure, but as far as accountability, it's almost nonexistent. I have an inbox full of people's stories and so finally I said, ‘Okay, we're going to document this once and for all.’”
Holding abusers accountable has been an elusive goal for parents and maternity care advocacy groups, who point to indifferent reactions from hospitals and the scarcity of lawsuits. Unless infants have suffered permanent injuries, lawyers very rarely take on obstetric violence cases, which may claim malpractice, medical negligence, battery, and even fraud. The lawsuit of Alabama mother Caroline Malatesta remains one of the few successful civil cases, which proved in 2016 that her hospital had fraudulently advertised its childbirth options. Malatesta never had an option to bring criminal charges against the labor and delivery nurse who allegedly held her son inside her vagina during his birth in 2012, causing her permanent nerve damage and chronic pain.
Many in the childbirth field draw parallels between the growing number of parents speaking out about obstetric violence and the #MeToo movement. Like the Obstetric Violence Stories Map, #MeToo has also given rise to online databases that name perpetrators. In choosing to publish their stories, many obstetric violence survivors feel they are standing up against a similar culture of silence and normalization within an industry. When Leslie Driggers Hoard posted about her birth on social media, she saw a familiar attitude of victim blaming. “There are plenty of people that defend the doctor and say ‘It was probably a misunderstanding,’ or ‘I’m sure he was just trying to give you a healthy baby,’” said Hoard, “which is a lot like saying, ‘You shouldn’t have been there. You shouldn’t have been wearing that.’”
Like many abuse survivors, Hoard said posting on the Obstetric Violence Stories Map has been an important part of recovering from her childbirth trauma. She finds it healing to read similar experiences and feels comforted by the potential to protect other women who may be researching maternity care providers in their communities. “I just feel like it’s a moral obligation to tell the truth,” she said. “If I were pregnant, and I was thinking about going to [this doctor], I would want to know.”
Believing that women have the right to know also inspired maternal health advocate and author Kimberly Seals Allers to create the “IRTH” app, which she describes as “Yelp for experiences of bias and discrimination in maternity care.” The app, which recently received a development grant from the Tara Health Foundation, will allow users to publicly post their experiences with hospitals and providers. It will also include participant information like race, ethnicity, religion, class, gender identity, and sexual orientation, so reviews can be filtered to help identify biased care.
“For me it is very important that a Black woman particularly, but also a same sex couple or a transgender person, has a resource to see what people just like them have said about a particular hospital or physician,” she said. According to Seals Allers, the stakes couldn’t be higher: Systemic racism has been linked to the increasing maternal mortality and morbidity rates in the US where Black women are dying from pregnancy or childbirth-related causes at three to four times the rate of white women. But despite the data, she said women’s stories are frequently explained away or rejected as “one offs” by hospitals. “You may try to dismiss one of us or two of us, but you can not dismiss a thousand of us,” she said. “That's a much stronger story than one just centered around individual women, many of whom have already died. We can't keep telling this story from the grave.”
Individual tragedies , like the deaths of Shalon Irving and Kira Dixon Johnson, have captured public attention, but there is little research that directly connects discriminatory or abusive maternity care to maternal health outcomes. The first national study on mistreatment in maternity care was released in June 2019 and found that one in six women in the US had experienced abuse during pregnancy and child birth. Rates were even higher for women of color, women giving birth in hospitals, and those with social, economic, or other health challenges. The World Health Organization has called for greater global action on this “important public health and human rights issue.” When creating her map, Cristen Pascucci consulted with researchers to ensure the data collected could be used as empirical evidence.
Both Pascucci and Seals Allers said health care providers and hospitals have no place on these patient forums, and that allowing them to dispute unverified accounts would defeat the purpose. While some reviews could be exaggerated or false, Seals Allers said consumers can decide for themselves whether a low rating was justified or not. She also plans to provide “low-performing” hospitals with their relevant data, as well as offering targeted anti-bias training and other services. Pascucci agrees, and defends the idea that women’s stories should be considered evidence of a widespread problem. “Stories are all we have,” Pascucci said. “We just saw the #MeToo movement literally take down perpetrators by just the power of storytelling. So, do you believe women or not?”
But the question of whether hospitals will use patient narratives from outside sources to address abuse and discrimination is unclear. In a statement to VICE, Dr. Barbara Levy, Vice President of Health Policy at the American College of Obstetricians and Gynecologists wrote:
“Most providers or systems do not pay much attention to the online rating websites like RateMDs, HealthGrades, DrScore, because the data are questionable. Also, I am unsure how the hospital or providers will integrate the data from [an] online forum into their own quality improvement processes. It is important that the women who post their information publicly are also contacting their provider directly, as well as the hospital administration or leadership … so that their feedback is actionable. … The American College of Obstetricians and Gynecologists is very much in favor of incorporating the patient and caregiver voice as quality improvement systems are developed.”
However, many maternity care patients who have filed complaints are skeptical that their feedback will produce any change. In Toronto, Canada, Kate Macdonald filed a complaint with St. Joseph’s Health Centre about her traumatic birth experience in 2017 and also had several meetings with administrators. Macdonald said her labor and delivery nurse insisted that a doctor insert an internal fetal monitor without Macdonald ’s consent. She said the invasive procedure was very painful, and that the doctor and nurse refused to stop even when she screamed in pain. Macdonald’s nurse disputed her account of the incident.
When her efforts to report her experience yielded no results, Macdonald tried an evidence-based approach. She created an online survey of patients who had given birth at the hospital and shared it in several social media groups. Over 400 people took the survey, and while some responses were positive, a significant percentage answered negatively to questions about respect, compassion, bodily autonomy, and informed consent. After presenting the survey data to the hospital, Macdonald received a letter from St. Joseph’s, which she responded to publicly.
“They typed up a PR response about how much they love and value feedback,” Macdonald said, “but they addressed almost nothing. In the survey, one of the final questions was ‘what changes would you suggest?’ So, it was all laid out for them.”
In a statement to VICE, St. Joseph’s Health Centre stressed that it does use patient feedback to improve care, citing their Patient Relations team, community engagement council, and patient advisors who encourage comments. “We appreciate every effort to hear from the 3,400 women who choose to deliver their baby with us every year,” the statement read, “and the survey is another important input that we will be using to find ways to improve our program and overall experience for laboring women.”
Macdonald plans to expand her survey to other hospitals and cities. In 2018, she launched The Obstetric Justice Project, a website for patients in Canada to share stories of obstetric violence and abuse in reproductive healthcare. She said most people who have submitted stories also struggled with reporting their experiences, finding it difficult to give feedback to providers, or getting no response after filing a complaint. But even if complaint channels are flawed, Macdonald thinks people should still file them, and she saw a direct parallel with reporting allegations of sexual assault or harassment, which are too often rejected or ignored. "The system is rigged against you,” Macdonald said. “Of course it is. But you do it anyway."
Leslie Driggers Hoard is also determined to speak up about the abuse she said she suffered, and she saw it as evidence of outdated misogyny in maternity care. "I grew up in a generation of women where we were told we could do anything; we could be anything," said Hoard. "And then you have a baby, and walking through the doors of the hospital is like stepping back into the 1950’s. They don’t treat you like an equal at all."