Warning: parts of the following birth story may be very difficult to read, especially if you have experienced birth trauma or sexual trauma.
For years, hospitals around the U.S. have co-opted the language of birth centers by quietly renaming their hospital-based maternity wards “birthing centers” in order to appeal to a fast-growing demographic of folks seeking gentler, lower-intervention care. Hospital advertising–using language about “choice,” “autonomy,” and respect for birth plans–has evolved along with the changing demands of a more informed birthing population… but how reliable are those promises?
The Malatesta case in Alabama ripped the lid off a hospital marketing scheme when an injured woman sued the hospital that had defrauded her and potentially thousands of women in her community. That hospital advertised a specific philosophy of care and services (“autonomy,” staff “specially trained” in natural birth) while actually having policies and practices in place that explicitly forbade those things from happening. Caroline Malatesta went to the hospital in labor with her fourth baby having been promised water immersion for pain relief and freedom to birth in the way her body directed, but instead was put in a room with no tub, ordered to stay in bed, and wrestled onto her back–the doctor’s “preferred position”–to push her baby out. Meanwhile, her son’s head was forcefully held in to prevent his birth because the doctor hadn’t arrived yet, and some combination of that force and the physical restraint used on Caroline to keep her on her back resulted in a devastating nerve injury to her, including the permanent loss of her sex life and ability to have more children.
A jury awarded the Malatestas $16 million for what happened to them, even as countless women in the community who will never receive justice came forward to say that they, too, had experienced coercion and abuse at that hospital and others around town.
More Bait & Switch
Today, an ongoing case in California has remarkably similar themes to the Malatestas’. A mother, Jane Doe, alleges that fraudulent hospital advertising led her to give birth in a place she would never have gone to had they been honest about how they practiced. She chose a Sutter Health facility and what it called a “birth center,” which claimed to offer “24/7 midwifery” from “highly trained” Certified Nurse Midwives. The marketing used words like “privacy,” “autonomy,” and “respect.” Jane says she confirmed multiple times in her prenatal care that they supported natural birth and options for natural pain relief, and that her privacy during birth would be respected. Specifically, Jane asked that men other than her husband be kept from the room unless their presence was absolutely necessary and she gave permission.
According to Jane, however, the “evidence-based,” “low-intervention” care she expected did not materialize once she was in labor. Jane describes multiple instances of coercion and procedures being done to her without explanation or permission. She says her birth plan was ignored–the piece of paper was literally pushed back at her when she held it out in her hand. (You may want to skip the following quotes if you are sensitive to birth or sexual trauma.)
This is all from the complaint:
Jane was subjected to many vaginal exams—she remembers as many as five at this point in her labor. . . Jane had no choice about these exams. No one ever Jane informed about the purpose of so many exams or offered an opportunity to decline them.
Jane was directed to remain in the position that Defendant Correa and Defendant Garrett wanted her to be in—on her back—and to spread her legs widely, a position that was extremely uncomfortable for her, even with an epidural. She was told to push. There was no choice. She had to obey. So, she pushed. She pushed while lying on her back, but she kept explaining that she did not want to be in that position.
Jane’s contractions continued, and she wanted to keep pushing. Jane was still lying on her back, still mostly naked, now begging to have more time to push her baby out. Defendant Kachru just stated, matter-of-factly, “Two hours are up.”
At this point, Jane says she continued to beg for more time as she was told she had to decide between a C-section and a vacuum.
Defendant Garrett, who was on the upper right side of Jane’s bed, without Jane’s consent, put a towel over the upper half of Jane’s face, covering her eyes so she could no longer see. Not only was Jane physically restrained and stranded on her back, but she was now rendered blind. Doe Defendant #1 and Doe Defendant #2, who were still restraining Jane by the ankles, then pushed Jane’s legs far, far back toward her shoulders and up past her ears. No one asked for Jane’s consent, and she did not give anyone permission to move her body in this way. She had said “no” to all of this over and over again.
In the midst of all this, an unidentified man entered the room and peered at Jane’s exposed vagina; later, she alleges, he placed his ungloved hand on her buttock, took a “long look” at her vagina, and “grimaced in disgust.”
Finally, a vacuum was used to force her baby out of her body.
Jane was left with debilitating Postpartum PTSD and a pelvic nerve injury–just like Caroline Malatesta.
Reading Jane Doe’s story, I can’t help but wonder how many other families have experienced obstetric violence and preventable birth trauma at Sutter Health facilities calling themselves “birth centers.”
What birth centers are meant to be
Birth centers emerged in the 1970s and ‘80s as alternatives to hospitals for birth, and “professionalized” by 1985 with the establishment of national standards, a national membership organization, a national accreditation body, and a national research study showing impressive benefits from their use.
Birth centers are midwife-run facilities, usually with a low volume of births, serving women and birthing people who desire support and options (like water immersion, birth balls, privacy, freedom of movement) for physiologic (natural) birth. Women who need or want epidurals or Cesareans must transfer to a hospital for those procedures.
According to the American Association of Birth Centers (AABC), a birth center is “a home-like facility” providing “family-centered care for healthy women before, during, and after normal pregnancy, labor, and birth,” guided by “the wellness model of pregnancy and birth” and “principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness” (read more here). Nationally accredited birth centers are subject to certain standards (read them here) that govern everything from how they operate to whom they serve.
Probably the single most important characteristic of a birth center is that it follows a Midwifery Model of Care. This is a “wellness model” that means pregnancy and birth are treated as physiologic processes, with medical intervention only when necessary. The person giving birth is the center of care and the decision-maker, with an emphasis on informed consent by a care provider whose role is one of support rather than management. (Read more here.)
Recent high-quality national research done specifically on accredited, freestanding birth centers shows excellent health outcomes and high patient satisfaction. Superior outcomes include a 6% Cesarean rate, compared to a 27% national rate for low-risk women, with no increased risks for mothers or babies (read more here).
According to the late Kitty Ernst, midwifery pioneer and co-founder of what is now the American Association of Birth Centers, birth centers are meant to be “maxi-homes, not mini-hospitals.”
Birth Centers: “Few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety.” – From the National Birth Center Study, published in the New England Journal of Medicine (12/28/89)
Bait & Switch is Obstetric Violence
Bad-faith promises around sex and reproduction are violence against women.
A “sailors promise” is an oath you don’t intend to keep, named after the men who sailed from port to port getting women into bed with promises of love and marriage. Once they got what they wanted, the men would sail on to the next destination free from consequences. The consequences for the women, however, could be devastating in many ways. You might be considered “ruined” and unmarriageable… You might feel violated to learn that you consented to sex on the basis of deception… And, of course, you might be left with a lifelong commitment to the child of man who will not be your husband.
Likewise, hospitals lying to birthing women in order to “get what they want”–our business–is violence against women. It is luring women into a sense of safety and support, to leave them at least disappointed, but at worst severely traumatized around a singular life event. In cases like we’ve described here, the physical injuries these women received, on top of the psychological injuries, permanently altered courses of their lives.
How many more of us are out there?
Our Stories are the Evidence for Bait & Switch Practices
It’s difficult to prove bait & switch because it is simply a story about what we were told versus what we got. When women express that they feel lied to, we are often gaslit by being told we heard wrong, our expectations were too high, or we just can’t understand the complexity of the circumstances that ended up happening. Yet, there are tens of thousands of stories out there about bait & switch in maternity care, especially around promises made to support “natural” or low-intervention birth and vaginal birth after Cesarean (VBAC).
Our stories are the proof.
Interestingly, when I shared about the California case with my friend Rebecca Dekker of Evidence Based Birth, she instantly remembered a podcast interview she had done with a family who mentioned they’d been forced to labor in an awkward position at a Sutter Health facility (here) and another who went to one of their “birth centers” but were required to submit to continuous fetal monitoring (here). Since Sutter Health is now being sued for misleading the public about their services, I wonder what other stories are out there?
Have you experienced or witnessed bait & switch tactics like what Caroline and Jane have described?
Birth Monopoly’s Obstetric Violence Map is a place to share your story, anonymously if you like.
Collectively, our stories have the power to advance medical research and legal advocacy.