(BIRMINGHAM, Ala.) -- She delivered a healthy child, but left the maternity ward traumatized and ashamed.
"The most happy moment in my life is at the same time the most terrible moment in my life because of what they did to me," said a California mother who alleges hospital staff physically restrained her against her will and coerced her into accepting interventions to expedite her delivery at a hospital last year.
"I said, 'No, I don't want to. I'm full of energy,'" said the woman, who spoke to ABC News only on condition of anonymity to protect her family's privacy. "I said, 'No.' Nobody cared."
This patient is one of a growing number of women who advocates say are challenging a culture of silence and stigma around mistreatment during pregnancy and birth. The Centers for Disease Control and Prevention says the experiences are not uncommon and may contribute to the nation's maternal mortality rate -- one of the highest among the richest countries in the world.
Earlier this year, the agency launched an awareness campaign with a notice to American health systems to be more respectful in providing maternity care. ABC News spoke with a number of women across the country who said the guidance was overdue.
"If the CDC has to tell you to respect patients' rights and to respect the medical ethics of autonomy, I think we've really gone off the rails," said Julie Cantor, a women's rights advocate and attorney who is representing Doe.
The CDC analysis of a recent survey of 2,400 new mothers includes reported cases of ignored requests for help; being shouted at or scolded; violations of physical privacy; and threats to withhold treatment, or made to accept unwanted treatment.
"This mistreatment is very troubling," said CDC Chief Medical Officer Dr. Debra Houry in an interview. "This is why we need hospital systems, providers and communities to really be aware of this, because there's many things we can do."
Houry says cases of mistreatment are especially concerning at a time when maternal deaths in the U.S. are on the rise, especially among Black and Hispanic women. In 2021, the latest year for which data is available, 1,205 women died of maternal causes in the U.S. with a rate of 32.9 deaths per 100,000 live births -- up from a rate of 23.8 in 2020 and 20.1 in 2019, according to CDC data. Black and Hispanic women had higher rates in 2021, at 69.9 per 100,000 and 28 per 100,000, respectively. That's compared to 26.6 per 100,000 for white women.
"Potentially, in a stressful moment, there can be unconscious bias that comes out," Houry said. "This is why we need to be more cognizant of it and make sure that women feel empowered to come forward as well when they're experiencing this."
Mistreatment in maternity care, while not a new phenomenon, has historically been underreported and unaddressed, advocates for pregnant persons say. Some women say they are reluctant to raise concerns with providers, especially after an otherwise successful pregnancy.
"Cases are generally very hard to litigate and they're expensive, and so one of the issues that is a cultural phenomenon is, 'Well, if the mom's harmed, but the baby's fine, why is that worth any money?'" said Cantor. "It's a system that's built around moving money, not just fixing problems."
In 2016, the case of Caroline Malatesta of Birmingham, Alabama, helped put mistreatment of birthing persons in the national spotlight.
A jury delivered Malatesta a landmark $16 million judgment in her favor after claims of medical negligence and reckless fraud against Brookwood Baptist Medical Center, where she delivered her fourth child.
After devising a natural birth plan with her doctor that emphasized autonomy and freedom of movement, Malatesta said she was subjected to physical restraint.
"They pulled me to my back, flipped me over, and I remember the pressure on my back being so intense that I lifted my right leg and even pushed against the nurse's [hair net], just trying to fight to get back over," she said in an interview.
"The hard part came after, when everything's quiet, everyone goes away, and there's a sense of betrayal," Malatesta said. "I know that sounds unusual, but you have put your trust in these doctors, into this -- these people who are supposed to be looking out for your care."
In the months that followed, Malatesta says numbness turned into debilitating pelvic nerve pain and PTSD. All of it taking a toll on her ability to parent and on her relationship with her husband.
"One of the biggest roadblocks is that women feel like, 'Well, if I talk about what happened to me, it shows I'm just selfish because I wanted my birth to be a certain way when really I should have been thinking about the safety of the baby,'" said Malatesta. "Women have these birth plans because they care about the safety of their babies."
The jury's decision in Malatesta's case might have been rare, but instances of birth trauma are not, public health experts and pregnancy advocates told ABC News.
"I've heard thousands of those stories," said Cristen Pascucci, a birth advocate in Kentucky who supported Malatesta through the trial and whose site, Birth Monopoly, archives stories of mistreatment nationwide.
"There's a lot of gaslighting that goes on when anybody has anything to say about their birth other than 'it was beautiful,' 'it was wonderful,' 'it was great,'" Pascucci said. "But the bottom line is mistreatment is not necessary for safety."
Kimberly Turbin of Los Angeles, whose traumatic 2014 hospital delivery of her son has more than a million views on YouTube, said each woman's experience is unique.
"A lot of obstetric violence can be very kind. You don't even know you're being done a disservice because obstetric violence doesn't always look like my horrific birth video," said Turbin.
As her own mother recorded the scene with a cellphone, Turbin is heard questioning the need for an episiotomy, a cut made to the vaginal area to ease delivery, which she says her doctor then performed against her will.
"He doesn't tell me what my options are. He never mentions that the baby or I am in distress," Turbin said. "I'm getting a contraction. He comes near me with the scissors and starts slicing up my vagina 12 times."
After speaking with more than 80 attorneys who declined to take her case, Kimberly filed a lawsuit against her doctor on her own; she settled her case in 2017 and now helps other women seek justice.
The American College of Obstetricians and Gynecologists (ACOG) says a pregnant patient's autonomy should be a doctor's top priority, saying "it is never acceptable" for a provider to use "duress, manipulation, coercion, physical force or threats" to compel a recommended treatment for a patient or unborn child.
While life-or-death emergencies often require urgent medical intervention, ACOG says "it is imperative that pregnant and postpartum patients feel comfortable communicating" their wishes.
"Listen to your patients when they tell you they have questions. Listen to them when they have concerns about what's going on. And, listen to them when they say 'no.' You cannot force care on people," Cantor said.
The CDC says women should feel empowered to speak up about concerns with their experience in the maternity ward and that providers should be more sensitive to them.
"Certainly training helps to understand what are some of those biases that we all have," Houry said.
Training medical professionals is something Pascucci, the CDC, and women's health advocates are working to expand, but many say there also needs to be a fundamental shift in how society thinks about birthing persons at their most vulnerable moment.
"We can't keep saying, 'Well, this is just, you know, this must just be how it has to be.' It doesn't have to be this way. It does not have to be this way," Pascucci said. "It's just a matter of making the decision to change what we do."
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