Kimberly Turbin thought she was going to be a happy mom. \u201cBut that was snatched from me,\u201d she says, the first time she gave birth.<\/p>\n\n\n\n
Up until then, \u201cI had a perfect pregnancy. I didn\u2019t have any nausea. Nothing was wrong with me,\u201d she says.<\/p>\n\n\n\n
Her water broke while she was at her friend\u2019s house, and she went home to shower before going to the hospital. Once there, she let the staff know she\u2019d previously been raped and asked them to be communicative with her throughout her delivery. She remembers them giving her a pill to help calm her down because she was growing anxious.<\/p>\n\n\n\n
\u201cAnd I did calm down,\u201d she says. \u201cI thought I was going to push the baby out, and everything was great. Everybody was really nice still.\u201d<\/p>\n\n\n\n
But shortly after she began pushing, her obstetrician, Alex Abbassi, told her he was going to perform an episiotomy, or cut into the sensitive skin between her vagina and anus \u2014 known as the perineum \u2014 to widen her vaginal opening. <\/p>\n\n\n\n
Turbin repeatedly objected to the procedure, which the American College of Obstetricians and Gynecologists recommends doing only when absolutely necessary<\/u><\/a>. <\/p>\n\n\n\n \u201cWhat? Why? We haven\u2019t even tried!\u201d she can be heard saying in a video of the birth taken by her mother that she later posted online. \u201cWhy can\u2019t we just try?\u201d<\/p>\n\n\n\n Abbassi said the baby wasn\u2019t coming out and if she continued to try to push, \u201cit\u2019s going to rip the butthole down clean.\u201d When she protested \u2014 more than once telling him no and pleading, \u201cDon\u2019t cut me!\u201d \u2014 he told her he was the \u201cexpert\u201d and that she could \u201cgo home and do it\u201d or \u201cgo to Kentucky.\u201d<\/p>\n\n\n\n He then cut into her perineum a dozen times.<\/p>\n\n\n\n Turbin, who went on to sue Abbassi for assault and battery<\/u><\/a>, says she\u2019s still grappling with the physical and emotional toll of his actions more than a decade later. <\/p>\n\n\n\n \u201cDr. Abbassi snatched my decisionmaking for my body from me because of what he did,\u201d she says. \u201cAnd he left me with PTSD for life and nerve damage.\u201d<\/p>\n\n\n\n Mothers\u2019 mistreatment at the hands of the very health care workers meant to help them through pregnancy and childbirth is a rampant \u2014 and dangerous \u2014 problem in maternity care.<\/p>\n\n\n\n One in 5 mothers<\/u><\/a> in the United States report being ignored, threatened, forced to accept treatment they didn\u2019t consent to, physically abused or otherwise mistreated by their providers during pregnancy and delivery, according to a recent report from the Centers for Disease Control and Prevention (CDC). Among Black, Hispanic or multiracial mothers and those who have public insurance or no insurance, the rates are higher still: closer to 1 in 3. Turbin, who is Latina and was insured through California\u2019s Medi-Cal, belonged to both groups.<\/p>\n\n\n\n And American health care workers are far from the worst offenders. A 2019 study led by the World Health Organization (WHO) in Ghana, Guinea, Nigeria and Myanmar, for instance, found that more than 40 percent of mothers<\/u><\/a> whose deliveries researchers observed were mistreated during childbirth.<\/p>\n\n\n\n These experiences of disrespect and abuse can have a devastating impact, heightening risks for mothers and their children during an already vulnerable period and continuing to affect them long afterward. <\/p>\n\n\n\n Mistreatment has been linked to an increased likelihood of dangerous delivery complications<\/u><\/a>, such as obstructed labor and excessive bleeding, as well as postpartum hemorrhage and abdominal pain.<\/p>\n\n\n\n It can also deal a blow to parents\u2019 mental health, as can the complications and physical pain<\/u><\/a> it contributes to. Mothers who have been mistreated are at greater risk of developing postpartum depression. Their mistreatment can fuel childbirth-related post-traumatic stress disorder.<\/p>\n\n\n\n And when they turn back to health care professionals for help or try to seek justice through hospitals, medical boards or courts, they can find themselves confronting a lack of care or awareness \u2014 if not more disrespect and abuse.<\/p>\n\n\n\n Postpartum depression, the most common perinatal mood disorder, affects about 17 percent of mothers<\/u><\/a> around the world and 20 percent in developing nations. Mothers who have been mistreated appear to grapple with it at significantly higher rates: about 50 percent higher, according to one recent<\/u><\/a> study.<\/p>\n\n\n\n Information on the relative prevalence of childbirth-related PTSD following disrespect or abuse is harder to come by. But researchers have identified mistreatment as a significant risk factor<\/u><\/a> for the condition, and poor experiences with health care workers loom large in descriptions of traumatic deliveries: One widely cited study found that roughly two-thirds of mothers who suffered birth trauma<\/u><\/a>, regardless of whether it resulted in PTSD, said their providers\u2019 actions were what made the experience traumatizing.<\/p>\n\n\n\n Childbirth-related PTSD, like other forms of the disorder, usually stems from a person \u201cexperiencing an event as a real threat to their life, or potential threat,\u201d says Sharon Dekel, an assistant professor of psychology at Harvard Medical School and the founding director of the Postpartum Traumatic Stress Disorders Research Program at Massachusetts General Hospital. That feeling could arise from physical complications during labor, she says, or from \u201csomething psychologically being violated.\u201d<\/p>\n\n\n\n Dekel and her colleagues have found that roughly 5 percent to 6 percent of mothers<\/u><\/a> develop PTSD after a \u201csuccessful\u201d birth, while as many as 17 percent display clinically significant symptoms. <\/p>\n\n\n\n The effects of traumatic births aren\u2019t limited to the mothers at their center, either. People who bear witness can be traumatized as well, Dekel says, and parents with PTSD can experience difficulties caring for their babies, whom they may associate with their trauma.<\/p>\n\n\n\n PTSD, postpartum depression and other perinatal mental health conditions have been found to negatively affect parenting quality and early relationships between parents and children<\/u><\/a>, which in turn can impair childhood development. Research has also indicated that trauma can reverberate through generations<\/u><\/a>, possibly even leaving a tangible mark on families\u2019 genes.<\/p>\n\n\n\n This is something Turbin thinks about: how her mistreatment and its lingering effects may impact her children.<\/p>\n\n\n\n \u201cI would cry a lot, or maybe I would scream more than I would like to,\u201d she remembers. \u201cI had to get hypnotized to stop screaming at my kids.\u201d Years after her traumatic delivery, she says everything she feels \u201cis raw,\u201d and at times, she experiences panic or shuts down. Sometimes, when her children are screaming, she just ignores them.<\/p>\n\n\n\n Because of Abbassi\u2019s actions, she says, \u201cI never became the mom I wanted to be.\u201d<\/p>\n\n\n\n Parents affected by childbirth-related PTSD may feel like they\u2019re reliving the birth through intrusive thoughts or flashbacks, try to avoid reminders of the experience \u2014 including pregnancy \u2014 and grapple with depression and \u201cnegative alterations in mood and cognition,\u201d Dekel says.<\/p>\n\n\n\n They may also be gripped by guilt and shame, she says, believing they\u2019ve failed their children or that their bodies have failed them. The same feelings often plague parents with postpartum depression<\/u><\/a>, along with helplessness, hopelessness, restlessness, sadness, anxiety and emptiness. Some have suicidal thoughts. Some translate those thoughts into suicide attempts.<\/p>\n\n\n\n And if they reach out to professionals for help, parents already struggling with their mental health again face the risk of mistreatment \u2014 with potentially dire consequences.<\/p>\n\n\n\n \u201cWe see and hear of many cases of care that we could characterize as mistreatment when individuals are seeking help for mental health during pregnancy, postpartum and post-loss,\u201d says Wendy Davis, the executive director of the nonprofit Postpartum Support International. \u201cThat often takes the form of belittling, demeaning, blaming the individual, sometimes really overt name-calling.\u201d<\/p>\n\n\n\n Davis, who previously worked as a psychotherapist and specialized in perinatal mental health after recovering from postpartum depression and anxiety herself, says this kind of treatment from health care professionals can have a dangerous effect.<\/p>\n\n\n\n \u201cTheir existing mental health symptoms have already made them think they can\u2019t do this. \u2018I shouldn\u2019t be a mom\u2019 and, at worst \u2026 \u2018my baby would be better off without me.\u2019 That thought is already swirling around in somebody who\u2019s dealing with a perinatal mood disorder,\u201d she explains.<\/p>\n\n\n\n \u201cSo if you go to a professional, and if they give the same message,\u201d she says, \u201cperinatal patients have an extremely high risk of suicide.\u201d<\/p>\n\n\n\n Mental health conditions are the leading underlying cause of maternal mortality, according to the CDC, accounting for more than 20 percent of pregnancy-related deaths<\/u><\/a> in the United States. Most of these deaths are determined to be preventable.<\/p>\n\n\n\n Davis says perinatal mental health care has taken \u201cbaby steps\u201d toward improvement in recent years. \u201cAt this point, in the 21st century, the resources do exist for social support, peer support. We have more and more informed perinatal mental health providers, and we have more and more informed OB and primary care providers,\u201d she says.<\/p>\n\n\n\n Dekel, too, sees progress. She points to the growing body of research on the subject and notes that the National Institutes of Health, which supports her work, has made maternal mental health a high priority. \u201cWhich is terrific,\u201d she says, \u201cand I think is raising a lot of awareness among the scientific and also critical communities.\u201d<\/p>\n\n\n\n But both caution that there\u2019s still work to be done, specifically stressing the need to better educate and train providers.<\/p>\n\n\n\n \u201cThe gap that exists that we really need to close,\u201d Davis says, \u201cis the gap between the resources that exist and medical care.\u201d<\/p>\n\n\n\n As well as exacerbating both physical and mental health risks, mistreatment can fracture mothers\u2019 trust in health care workers, making them leery of receiving treatment in the future.<\/p>\n\n\n\n \u201cWhen somebody experiences mistreatment of any kind from a medical provider, really specific things happen,\u201d Davis says. \u201cThere\u2019s now a decrease in trust. There\u2019s a decrease in confidence on the part of the individual. They second-guess themselves. They might blame themselves for problems that are going on. Mostly, they don\u2019t want to have the same negative experience they had before.\u201d<\/p>\n\n\n\n This can cause people to stop going to appointments, she says, or to \u201cput on a mask to try to appear better and healthier and \u2018less weak\u2019 to avoid the terms of the experience before\u201d if they do return to a provider.<\/p>\n\n\n\n Mothers who suffer mistreatment have been found to be less likely to seek care<\/u><\/a> throughout their pregnancies and in the wake of giving birth, a critical period for ensuring the long-term health, and even survival, of both mothers and their children. Medical mistrust can also contribute to women of color in particular eschewing perinatal mental health services<\/u><\/a>, and it can cause people to put off care or decline to take medical advice<\/u><\/a> for health issues extending far beyond maternity and postpartum care.<\/p>\n\n\n\n \u201cTo this day, I really don\u2019t feel comfortable going to hospitals,\u201d says Sebrena Tate, citing the ways her doctors treated her during labor and postpartum care in the pandemic. \u201cI always have this sense of, whoever walks in, is everyone going to be able to walk out? I\u2019m always questioning medical providers.\u201d<\/p>\n\n\n\n After Tate went into early labor roughly six months into pregnancy, the doctors at the hospital she was admitted to \u201cweren\u2019t answering\u201d her \u201cquestions and were brushing the situation off,\u201d she says. She remembers being told \u201cthese things just happen\u201d and \u201cwe just have to wait and see.\u201d<\/p>\n\n\n\n One doctor from the neonatal intensive care unit (NICU) told Tate, who is Black, \u201cDon\u2019t worry about it. Black females are the strongest babies in the NICU,\u201d she recalls. The comment made her think about the harmful biases<\/u><\/a> surrounding Black women\u2019s pain that have long affected their medical treatment. It made her worry what else her providers might be thinking.<\/p>\n\n\n\n Due in part to implicit and structural bias in the medical system, Black mothers in the United States face deadly disparities<\/u><\/a> when it comes to pregnancy and childbirth. They\u2019re three times as likely<\/u><\/a> as their white counterparts to die due to pregnancy-related causes, according to the CDC. They\u2019re also about 50 percent more likely<\/u><\/a> to give birth preterm \u2014 one of the leading causes of infant mortality.<\/p>\n\n\n\n \u201cI just remember being in that hospital room and being like, \u2018I don\u2019t feel safe. I feel like none of these people have my best interests at heart right now,\u2019\u201d Tate recalls. \u201cLike either myself or my daughter\u2019s not going to make it out of this hospital.\u201d<\/p>\n\n\n\n She decided to leave and went to another hospital the following day. The care she received there was \u201ctotally different\u201d and more attentive, she says, but her daughter ultimately passed away.<\/p>\n\n\n\n The last time Tate went to a medical provider was her six-week postpartum checkup, during which a midwife \u2014 who had not read her chart \u2014 asked her, \u201cHow\u2019s the baby?\u201d<\/p>\n\n\n\n \u201cI just feel like they don\u2019t really care,\u201d Tate says.<\/p>\n\n\n\n She did see a therapist in the wake of her experience, who she\u2019d already been connected with when she previously dealt with postpartum depression. But she says she \u201cwasn\u2019t really able to find a lot\u201d when she searched for other support resources. Not wanting other parents to experience the same loneliness she felt, she has worked to become a resource herself by going through bereavement doula training, building her own doula service, and becoming a birth trauma group leader at Postpartum Support International.<\/p>\n\n\n\n Turbin, too, has sought to help other parents. In the years since her traumatic delivery, she has plunged into advocacy on medical board reform, maternal mortality and mistreatment. While discussing her own experience, she speaks passionately about the cases of several other women who suffered mistreatment or died in childbirth and about Latinas\u2019 invisibility in conversations surrounding maternal mortality<\/u><\/a>.<\/p>\n\n\n\n \u201cMy advocacy just keeps on growing, because I have a lot of work to do,\u201d she says.<\/p>\n\n\n\n The fight for awareness and accountability<\/p>\n\n\n\n Disrespect and abuse in maternity care, also in some cases referred to as obstetric violence, has in recent years been recognized as a human rights violation by international organizations, including the WHO<\/u><\/a> and the United Nations<\/u><\/a>, and explicitly outlawed by several Latin American nations.<\/p>\n\n\n\n Most countries still have no laws expressly prohibiting it, however. In fact, the law sometimes serves as an instrument for mistreatment, as in the case of court-ordered cesarean sections<\/u><\/a>. And efforts to combat providers\u2019 disrespect and abuse or hold them accountable for their actions are an uphill battle.<\/p>\n\n\n\n Storm O\u2019Brink seeks to do both as a full-spectrum birth worker and advocate with the University of Iowa\u2019s Rape Victim Advocacy Program.<\/p>\n\n\n\n O\u2019Brink, who uses they\/them pronouns, provides counseling throughout the perinatal period and accompanies survivors of obstetric violence and sexual violence to medical appointments and procedures, among other services.<\/p>\n\n\n\n They describe mistreatment they\u2019ve witnessed firsthand: Patients being coerced or forced into pelvic exams or treatments they didn\u2019t want; providers \u201ccompletely trampling on\u201d patients\u2019 boundaries.<\/p>\n\n\n\n \u201cAs a doula and as an advocate, it\u2019s my job to amplify the survivor\u2019s voice when they\u2019re not being heard,\u201d they say. In the case of mistreatment, \u201cI try to intervene. I try to speak up as much as I can. But there\u2019s only so much I can do before the providers will attempt to kick me out of the room.\u201d<\/p>\n\n\n\n O\u2019Brink also works to help people who want to \u201cseek some form of justice\u201d for their mistreatment complain to the hospital or state medical board, and occasionally they assist them in finding a lawyer if they think they have grounds to sue.<\/p>\n\n\n\n But they say most of these efforts end in disappointment, and it can \u201copen a wound\u201d for people as they navigate months- or even years-long processes that often involve hospitals, providers, courts or other entities \u201cinvalidating the experience they had and basically saying it needed to happen this way.\u201d<\/p>\n\n\n\n Turbin filed complaints against Abbassi with the hospital and the Medical Board of California, in addition to suing him. Two years after performing her delivery, he surrendered his medical license<\/u><\/a>, acknowledging \u201cphysical and mental deterioration\u201d related to his age. He and Turbin later settled her lawsuit out of court.<\/p>\n\n\n\n She hopes she set a precedent with the case, in which a California judge ruled Abbassi\u2019s actions could be tried as potential assault and battery. But at the same time, she says she doesn\u2019t recommend that other people follow in her footsteps.<\/p>\n\n\n\n \u201cThe psychological and the mental anguish isn\u2019t just from the assault. It\u2019s from everything, along with the assault that happened to me. For me, I wasn\u2019t just assaulted. I was also part of a movement to spread awareness. And yeah, I didn\u2019t have to be \u2014 but then I had to be. There was no going back,\u201d Turbin says. <\/p>\n\n\n\n \u201cI always said, \u2018I\u2019m going to do it.\u2019 And I did,\u201d she says. \u201cBut I\u2019m telling you, I paid the price for it. My kids paid the price for it.\u201d<\/p>\n\n\n\nThe reverberations of trauma<\/strong><\/strong><\/h2>\n\n\n\n
Broken trust<\/strong><\/strong><\/h2>\n\n\n\n