Latest / The Birth Lounge Podcast / Ep. 468: The Know Your Rights Map: Obstetrical Violence, Birth Trauma, and Patient Rights in the Hospital Birth Room with Cristen Pascucci [Re-Air of Ep. 203]

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Ep. 468: The Know Your Rights Map: Obstetrical Violence, Birth Trauma, and Patient Rights in the Hospital Birth Room with Cristen Pascucci [Re-Air of Ep. 203] · The Birth Lounge Podcast

The lack of accountability with medical boards is absolutely shocking, and I think that people would be so surprised to find out what doctors get away with.
Hello, and welcome back to another episode of The Birth Lounge Podcast.
0:54
You guys, I know that making decisions around your birth can feel so overwhelming.
1:02
And then once you get to a place of having made a decision, you go into your prenatal appointment or you go into labor, and then if you're faced with any sort of resistance or pushback from your hospital team, it can kind of feel like you are coming up against a roadblock or a brick wall or kind of like a WTF moment.
Like, "I feel so informed, I feel so confident.
Why is my medical team working against me?" Well, that's exactly why I have created my scripts for advocacy.
1:39
This is a guide that is jam-packed with the most common objections from your OB that you're going to face in late pregnancy and in labor.
It's gonna cover things like 39-week induction, late term ultrasounds, various interventions, how do you decline things that don't feel aligned to you, and then how do you truly advocate for the things that you do want.
Consent is not a form or a piece of paper that should be shoved in your face.
It's a question.
It's a full-blown discussion.
It's fluid, and not only can you give it freely, but you can take it away just as easily.
You know what I always say, if you don't have the freedom to either say yes or no, then it's not true informed consent.
That would be called coerced consent.
I want you to be overly prepared to advocate for yourself.
I want you to be overly confident in saying no.
I want you to be overly informed about the options that you can request and the discussions that you can have with your healthcare team as your pregnancy progresses and as you labor with your baby.
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Why? Well, because I know that this is the number one crucial key factor in helping you avoid birth trauma and having a birth that leaves you feeling empowered and inspired, not broken and bruised.
Understanding what your options are is one thing, but knowing how to actually achieve them and stand strong in the face of adversity, resistance, and even medical manipulation while you're trying to have your baby is the key.
This guide is completely free, and like I say, it is jam-packed with the most common objections that you're gonna face from your OB.
You can download this guide at thebirthlounge.com/scripts-r-
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for-advocacy.
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Again, that's thebirthlounge.com/scripts-for-advocacy.
3:52
I absolutely cannot wait to help you have the birth of your dreams, and I'm so committed to helping you achieve the birth that you've always dreamed of.
4:03
Grab my free guide at thebirthlounge.com/scripts-for-advocacy
Today is one of the most requested topics that I have ever gotten in my life, and also one of the topics I'm super passionate about.
So this is a conversation I have literally dreamed of.
Please welcome Cristen Pascucci, who is the founder of Birth Monopoly.
Cristen, welcome.
Hi.
How's it going? It is going so well.
I'm like on cloud nine talking to you actually, because today we're diving into obstetrical violence, and I think that you and I both are able to talk about this very heavy and dark and really kind of fear-provoking conversation in a way that is straightforward so we don't like bullshit people, but also we don't scare you.
We just give you the facts, and we say like, "This is something that is happening," and if you're gonna have your baby- Yeah in the hospital, then you need to know about these things so that you know how to prepare.
Mm-hmm.
Because this is something you're gonna face, right? Um, and I think a lot of people try and take birth trauma and use it, almost they weaponize it almost, and they say like, "Well, um, you know, if you don't do this, you're gonna end up with birth trauma."
And birth trauma comes from, oh my gosh, so many places, and that's something I have learned from you.
And so I think that, for me, is where I would like to start the conversation.
In my opinion- Sure birth trauma is really kinda defined by the person who holds that trauma, right? Like, anything can really be birth trauma, but when we're talking about birth trauma in kind of a clinical sense or a very kind of like, you know, specific birth trauma, maybe a legal sense even, what is the definition that we typically use? Oh, for birth trauma? Yeah I don't know that I typically use a definition because I go with, um, I, I really believe in, you know, sort of that principle you mentioned, that it's self-defined.
Yeah.
Um, I think that trauma itself is usually defined as something that overwhelms your system.
Mm-hmm.
Like, it's something that...
It's actually a response and not an event.
So the trauma is what happens inside you.
And it also is why...
I'm eating blueberries while I'm talking to you.
Um, it also is why it's different for everybody.
Something that's traumatic for me might not be traumatic for you, or vice versa.
Um, it also has to do with cumulative experiences.
Like- Yeah and I think that's super important.
Um, because, like for example, um, people who have a history of sexual trauma- Yeah are much more likely to have t- to have what they define as birth trauma.
Um, and that's a, that's a, like, large proportion of people.
Like, there's, there's a lot of overlap between sexual trauma and birth trauma, obviously.
Um, but that's, like, a big part of the population.
It's not...
These aren't, like, small numbers.
Um, so I forgot what your question was, but that is my answer.
Yeah.
No, you answered it.
That's, I mean, yeah.
Okay, so, so much of that comes from obstetrical violence.
Talk to us about that.
Yeah.
So- In a legal kind of sense or a clinical sense, what are we talking about when it comes to obstetrical violence? Okay.
Well, first of all, I wanna say birth trauma is not 100% preventable, right? Yeah.
Like- Exactly birth trauma can come from a precipitous birth.
Mm-hmm.
Like, it just happened fast.
Your body spit the baby out.
You did not have enough time to, like, acclimate to what was happening.
I kinda had this just a little bit with my, with my son, with my, the only baby I've ever had, where it was, like, a fairly fast birth for a first-time mom.
And, um, it was overwhelming.
It was just like, "Oh, my God, I haven't even gotten used to, like, this sensation before this next sensation is happening," you know? Yeah.
Um, and then, like, the next thing you know, you just have a baby, and it's like, holy shit.
What happened? Am I allowed to swear? Yeah, of course.
Okay.
So it's just, like, a really quick transition.
So that's just one thing.
Um, I know it's not an easy thing to talk about, honestly.
It's not at all.
It's a traumatizing subject.
Yeah.
I...
This is part of how I deal with it, is, um, engaging my senses, which means I'm snacking while we're talking.
So I think personally- It's coming out of my head yeah, I think personally I'm able to talk about this topic so, um, freely because I don't have my own birth story yet.
Uh-huh.
So other than witnessing birth trauma, which is very totally different, has its traumas.
I, I have birth trauma, but it's at a witness perspective.
A secondary trauma, yeah.
Definitely.
It is different than I just will never know it until I have my own babies if I were to experience birth trauma, right? And so I do believe that that is- Yeah part of the reason I'm able to hold these, this space so- Yeah easily.
Yeah.
Yeah, for sure, because your trauma isn't, like, pinging up against my trauma.
Definitely.
Yeah.
Now, I do wanna make one little point, though, which is that physiologically the body is really affected by trauma pretty much no matter where the trauma comes from.
Mm-hmm, mm-hmm.
So whether, like, I was in, um, a war zone or, you know, was manhandled by a physician during birth, or, you know, experienced sexual assault or whatever, um, your body, like, your body responds to trauma in the same way.
Does that make sense? Mm-hmm.
Yeah.
Um- It does and some of those symptoms might be things like, um...
And I'm sort of overlapping, like, general trauma and PTSD symptoms, um, because obviously some of this can go to the extreme of being, like, actual PTSD.
Um, so some of those things would be, probably the first thing would be just repeating the event over and over in your head.
Mm-hmm.
Yeah.
Like, not being able to stop thinking about it.
Um, that's one of the most common things that I hear.
Um, having nightmares or dreams about it, where almost, like, you're trying to change the ending of what happened, um, or you're re-experiencing the emotions, um, often, like helplessness, um, hopelessness, grief, fear.
Um, I think invasive thoughts throughout the day is another one.
Um, not necessarily about the actual birth, but just almost like your brain is just kind of, um, not able to keep out, um, the negative stuff.
Um- Mm-hmm or not the negative stuff, but, like, specific, um, things that you're afraid of.
Like, for example, um, dropping my baby, or y- like something really weird, like dropping my baby and then accidentally running over him with my car.
You know what I mean? Mm-hmm.
That is, like, actually really unrealistic.
It's probably not gonna happen, but your brain, like, almost, like, can't identify that as irrational, and it's just, like, just keeps running.
Um, definitely, like, avoiding, um, certain triggers, like, um, pregnancy announcements or birth announcements.
Like, you might find that, um, you're starting...
Y- you, you have a different reaction now.
Um, jealousy can be one of those things.
Mm-hmm.
Like, wow- It, it almost like hurts to see someone having a positive experience and like, why couldn't I have had that? Um, um, what else? I'm trying to think.
There was one other that I was just thinking of that was just super common.
Oh, well, when it comes to avoiding, it's like anything can be a trigger, a person, a place.
Um, so I don't know how many people I've- have said to me, you know, I now take a different route to the grocery store or to work or to whatever so I don't have to drive by the hospital, or I don't have to be like near the hospital where, um, that trauma happened for me.
So, um, and definitely avoiding care from your care provider, not ever going back to your care provider or like putting off appointments or, um, yeah, just, just avoiding, avoiding things that might be triggers Sometimes your baby can be a trigger I was just about to say that's exactly what my mind, my mind went to is recognize, you know, even if your baby sometimes triggers you, right? Yeah.
Um, a lot of people will- That's so tough yes, oh my gosh, so tough.
But it's also, um, not your fault, and there's support out there.
So you have resources, but you've got to be able to tell somebody.
Um, and you're really the only one that can recognize that, right? You're the one who kind of knows the thoughts in your head when you see your baby.
So recognize that, um, yeah, that's interesting to hear people have different, take different routes to different places in their, in their life.
That avoidance is really big and disruptive to your life, and I think that disruptive piece is, is the big defining factor of, um, of kind of birth trauma versus, like, navigating kind of through your, your regular life.
When you're, when you are transitioning to parenthood, you have some thoughts that are just like, wow, but your life- Mm-hmm has, has been really turned upside down.
It's when you're not able, and you said this, like, to decipher which ones are, like, realistic that you should pay attention to and which ones are kind of unrealistic, um, and, and might be a problem.
It's when they start to disrupt your life, right, and they start to, like, kind of really impede things that you should probably be seeking some support out there.
So as far as, um, obstetrical violence...
Oh, before I do that, I wanted to say a lot of people will report feeling like actual heaviness in their stomach or knots in their stomach, um, shortness of breath, they'll sweat- Oh, yeah sometimes crying uncontrollably.
Um, sometimes they, they have the, the need to like literally get up and physically move out of the space that you were talking about or- Yeah talk about birth stuff.
Totally.
You know, that, that physical feeling of, um, nausea even, um- Yeah that physical response of either being asked about your birth story, something triggering you about your birth story, or you sharing your birth story, expect it.
Yeah.
Um, it's very normal.
You're certainly not alone in that.
Um, okay.
So for, uh, uh, for obstetrical violence- Hold on one second.
Yeah.
Just real quick before we move on to that one.
Yeah.
I just want to, like, highlight or emphasize what you just said, which is that it's normal.
Um, I think one of the big, um, like barriers to people healing is feeling guilty and feeling alone.
Yeah.
And, um- I, so I, I just wanna, like, emphasize that these reactions are normal in the face of a traumatic situation.
It's, it's a healthy response to have a trauma response, in fact- Mm-hmm um, when there's a traumatic event or, you know, some, some kind of, um, threat.
Um, and so to not feel ashamed about it, to know that, like, there are lots and lots of other people who, um, have experienced that same thing or something similar, and are experiencing it right now, um, and there's nothing wrong with you having that, um, having that reaction.
It's like a human- Yeah reaction.
I was just about to say, it's actually really expected.
We'd be more concerned if you were feeling triggered and not having those things.
We'd be like, "What's, what's going on here? Why aren't they having a bodily response to these things?" So it's, it's expected.
That's why I wanted to talk about it, actually, is so that you can go into this kind of prepared.
Um, and when you have these feelings emotionally or physically, that you, um, you don't feel like something's wrong in the sense of, like, you're in danger.
You know that something is wrong, like you've been triggered and you need some support, but you don't feel like your life is in danger, so that you can stay in control and, and take the necessary steps.
Okay, so obstetrical violence.
Um, I always think about this as any sort of power play, uh, by a medical professional i- in any, any capacity.
Your midwife, um, your obstetrician, your nurse, anyone in there.
The anesthesiologist.
It doesn't matter.
They are in a, um, a position of authority.
Um, and anything that is a power play that is meant to throw the room off-kilter and to play that dynamic of them being in charge is obstetrical violence, and this could be verbally, it could be physically, it could be emotionally, it could be fear-based driven.
It could be, um, that they totally just straight up lie to you.
Um, there are just so many examples of obstetrical violence that- I feel like some are intentional, and then I feel like the mass majority is just culture, and it's literally just what our doctors are taught.
Yeah.
And that is the scariest part.
So when we think about obstetrical violence, what's the true definition that we think about? And then also, you've done years of research on this.
I'd love to know what the, like, most mind-blowing couple things that you found throughout your journey that made you be like, "Oh, my word.
What is this?" Yeah.
"What's happening?" Um, okay, there's a lot there.
I think that...
So there, there isn't, like, um, there isn't one definition of obstetric violence right now.
Um, it has been defined in law in certain South and Central American countries.
Excuse me.
Um, I know Venezuela uses the word appropriation of the body, which I think is a really, a really good one.
Um, so it's, um, so part of the definition is that it is appropriation of the birthing person's body by medical personnel, um, which, you know, is kind of what you said, which is where someone else is in charge of your body.
Someone else is making decisions about your body.
Someone else is deciding, um, what's, quote-unquote, best for you and just acting on that.
So they're the decision-maker.
Um, so that, so that might have to do more with sort of like, um, like a, a physical act.
Um- But I, I agree with you that I think the majority of it is, is not, like, outright physical violence.
Um, it is more a, um, uh, coercion, manipulation, pressure, um, just an environment that's set up to, like, um, create a certain outcome.
Or, uh, I shouldn't say outcome.
To create a certain process, you know, um, regardless of who's going through the process.
Um, I u- I like to use the word subordination.
It's where the birthing person is subordinated to literally anything.
Um, whether that's an individual or a system or a, or a whatever, um, where they are not, uh, seen or respected or upheld as the, the decision-maker and the authority in their own birth, over their own body, over their own baby.
Um, so that's, so that's like part of my working definition.
Um, and of course, it can show up in all kinds of ways from, you know, just disrespectful treatment, um, you know, somebody being...
literally just a nurse being snotty, or refusing to answer questions, or being passive aggressive or sarcastic or, you know, anything like that, um, all the way up to, like, full-blown physical violence, you know, getting a court order to make someone have a C-section that they don't wanna have and, you know, don't, don't believe they need.
Um, yeah.
So it's, there's quite a spectrum.
Um, I don't know if you've seen the, that pyramid that I made.
Um, I, I really, I think that's a really helpful visual 'cause it kind of starts at, like, the lowest levels of just, like, um...
You know, one of the lowest, kind of like most benign levels is, like, making jokes about a birth plan.
Like, um, oh, you know, like, "Oh, someone who has a birth plan is high maintenance," or, "That's a guaranteed C-section," or, "That's a, a ticket to the operating room if you have a birth plan."
Um, and it being said, like, in a joking way.
Like, "Oh, my goodness.
No, we're just kidding around.
Like, this doesn't mean anything."
Um, but underlying that is a belief and an attitude, and yes, it does translate into how you're cared for and treated.
Um, and then as you go up that pyramid, you know, it, things get like a little more serious, a little bit more s- confrontational, um, up until you have full-blown- Full-blown violence.
Um, but it's those lower levels that normalize the attitudes and the actions, um, you know, that make up those higher levels of more serious and more physical acts against birthing people.
Okay.
Yeah, you just said, like, full-blown violence.
I think a lot of people imagine, like, doctors slamming your body down on the bed, and it can look like that.
But a lot of times it doesn't, right? Like, they're- Oh, no in the room.
Um- I'll tell you...
Yeah, I think one of the most common ones that I hear of is, um, vaginal exams.
It's- Exactly.
Yeah.
So, like, there's, like, this kinda, like, gray line, right? It's, like, kinda blurry.
Maybe you've said yes to a vaginal exam.
Yep.
And they start doing it, and you're like, "Holy shit, this is so much more painful than I realized.
Stop.
I don't want you to.
Oh, my goodness."
You know, whatever, and the person just doesn't stop.
They keep going.
Maybe it's...
Yeah.
I mean, maybe it's five more seconds.
You know, maybe it's not that much.
Maybe it's just a little bit.
Um- 10 times that's still a violation.
Yeah.
Um, and l- I think vaginal exams are a really, a good example because it's easy for people to understand.
Um, and it also, for me, relates, like...
It's so easy to see how that could be a sexual assault, um, feeling for someone.
Um- Sorry, I'm trying to figure out which way to go with this, 'cause there's, like, so many, so many things I can say about it.
Um, but, like, starting from the very, you know, kind of like the setup or the environment around it of, like, the expectation that, like, obviously we're gonna give you multiple vaginal exams or pelvic exams.
Um, yeah, we're gonna check you every hour or every two hours, or, you know, whatever.
Like, that's just, um, the fact that that's- Polity set up.
Of polity.
Yeah, that it's set up- Pol- It's set up as an expectation that you're gonna, like, open your legs for a person to invade your body with their, with a body part.
Um- Like without, without that being, um, an informed consent discussion about like why we might wanna do this and what the potential benefits might be from doing it, and the risks of doing it.
Because, yeah, there are both potential benefits and risks to doing it.
It is not, um, it's not meaningless.
It's not, you know, it's not nothing.
So, um, and then just pile on somebody who's got, who's coming in with sexual trauma.
That's a totally...
That's a possibility for a totally different response if you feel pressured o- or coerced, um, or pushed into letting someone put their fingers in you when you've, you know, maybe had some, some past with something like that.
Um, so anyway, I think that's a really, I think that's a really common one, where it can be really benign, just setting people up with the expectation that this is what's gonna happen.
They don't know that they have a choice.
Everyone might be very friendly to them, very kind, very whatever, but they're never actually given a choice about it happening.
And some of those people are probably totally fine with it and would be like, "Yeah, I don't care, I would've said yes anyway."
But you don't just get to assume that as a provider.
Um, and then, you know, there are the more kind of horrifying stories where people are literally saying like, "No, stop.
Get your hands out of me," and the provider either continues or, um, you know, starts even, um, without asking at all.
Um, I've heard of that with like, with sleeping patients, um, with people who are just like really deep in labor, you know, maybe they're, you know, leaning over the side of the bed or something and they don't even realize what's happening behind them.
Um, yeah, it's, it's non-consensual invasion of your vagina.
Like it's a, it's a thing.
Um, and those, those stories are really disturbing to me because they sound so much like sexual assault.
Like- Yeah I can relate to that so much.
I didn't have a forced vaginal exam, but I, I can totally imagine what that's like, having been, having my own sexual assault history, you know? Mm-hmm.
Um, and this just seems like one of the really common, common things that I hear about, and that people, um, really normalize and blow off and act like, "Well, it's just part of having a baby.
It's just, um, you know, it's part of medical care."
Um, but I think the implications are a lot deeper than that.
So I wanna back up to the conversation where your provider's like sh- you know, sharing all the benefits and the risk.
No matter what, someone should say, should be the provider in this conversation, but if they don't do it, nurses out there, you have a responsibility to say this as a patient advocate.
Someone in the room needs to say, "You can say yes or no to this once you have all this information," right? W- "This is what-" Sure "our suggestion is.
We are suggesting this.
Don't get that wrong.
Like, here's what we think that you should do.
However, here are the benefits, here are the risks, here are the alternatives that you have.
You are free to say yes or no to whatever it is."
Somebody in the room has to say it, and I think that's a big role that doulas play.
Um, it's just really important.
If you don't have a doula, your partner can play it too.
You can, you can kinda like, quote-unquote, "train them" before the birth and say like, r- remind them, have conversations about like their role in the birth room, and this is a great one.
Um, okay, so on a more, more kind of, um, level towards the top of that pyramid, we're talking about something like hospitals getting paperwork from a judge saying that someone has to have a C-section.
Talk us through that.
Well, pregnant women have done a lot of work around that, around like forced C-sections, for example.
Um, there are reports out there, um, you know, journal articles about it.
It's, it's a well-documented phenomenon.
Um, the majority, I think like two-thirds of the people this happens to are people of color.
Um, and, uh, don't, well, don't quote me on this.
I'm on a podcast.
Um, let me, let me reword what I was about to say.
Um, uh, uh, I'll just say like a, a good-sized chunk of the forced procedures were retrospectively, um, uh, bad calls medically, um, which I think is important.
Hmm.
Uh...
So not only did this disproportionately impact people of color, but they were also almost all of them were unnecessary? I'm not gonna say all, 'cause I can't remember the proportion.
I, I wanna say it was either one-third or two-thirds.
Still a large- But that's like a very general number.
Yeah.
Um, but yeah, like, like a not insignificant number of them were definitely found to be, you know, basically errors, like medical errors.
Kinda negligent, huh? Yeah.
I mean, just feels like negligence.
Okay, so yikes.
That's, that's absolutely incredible.
Okay, let's talk about the violence that comes from a provider, either a nurse or a, a doctor or a midwife that, um, heh, pulls the card of, "Well, I've been a nurse for 30 years," or, "I've been doing obstetrics for 42 years.
You should just trust me."
Yeah.
That's very- Yeah sly.
It doesn't feel like obstetrical violence, but it is, absolutely.
Mm-hmm.
Yeah.
There are a lot of really subtle ways that it shows up, and the...
What you just described is someone saying, "You're not the expert.
I'm the expert."
That really firmly takes you out of the center of the decision-making and makes them the decision-maker.
Um, or at least someone who has a lot of influence over that decision as, um, as if they have a right to the decision as opposed to a responsibility to advise you, support you, um, you know, care for you.
I think that's, I think that's really important.
And I, and there's, there's a power dynamic involved here, too.
Um, a couple minutes ago when we were talking about, um, you know, someone being, someone saying, "You have a choice to say 'yes' or 'no' to this thing," the...
I can see how someone who doesn't, who isn't really familiar with the internal workings of a hospital or, um, a- an L&D room might be like, "Huh, that's weird."
Like, why would you need that? And that just seems so obvious.
Like, of course, you know you can say no, right? Um, that doesn't, that, that perspective doesn't take into account the power dynamics that are happening there.
There's already this assumption that the physician or, um, you know, other, other personnel in the room are, are experts- Mm-hmm in what's going on, and the patient is sort of the receiver of the expertise and is meant to follow the advice and decisions of the experts in the room.
Like, this is already set up.
We know this.
I mean, it's, it's been researched.
People do what their doctors tell them to do.
That's just how it goes.
Mm-hmm.
Um, so for someone to...
So, so for someone in a position of authority to make a recommendation, that's different from your sister saying, "Maybe you should consider a C-section right now," or, you know, whatever the thing is.
Um, so that's sort of like a, like an invisible component of it, um, that I think we need to really talk about more, is that, is that inherent power differential, um- That makes it harder for patients and their loved ones to, to communicate with, with the rest of the people in the room Does that make sense? Do you think that makes sense- Yeah to people? I think so.
I mean, I'm just seeing so much of it play out in my head because it- it's almost...
I was just talking to, um, actually Mandy Irby, the birth nurse you guys- Oh um, I was just talking to her.
We were recording our episode of, um, the Pulse Check podcast, and I was telling her, "I just got back from a really wonderful birth," but the OB was a- amazing.
She was great.
But in a hospital, it can only be so good, and I think that is it, is that a hospital birth, no matter what, will have these underlying kind of things happening because it's in the hospital, and it's just part of the culture in the hospital.
So when we come across this obstetrical violence, Cristen, we can do something with it.
We can report it, right? So let's talk about that.
A lot of times, I'm sure so many people out there are rolling their eyes being like, "Yeah, I've reported it, and this is my story."
So a lot of times we report it, and we get this nice, uh, email back that says like, "Thanks for reporting," and that's literally it.
Or you get a, a sentence in there that says like, "It's been investigated and deemed a non-issue."
Perfect.
So dismissive.
Or you get a phone call that's super cold, um, and they say like, "Okay, we looked into it and it was nothing.
Bye," essentially.
Um, or the best is when you get nothing.
You take the time to tell this hospital they traumatized you, they fucked you up, and they're going to respond with absolutely nothing.
Talk to us about what it looks like when we report something.
Is there repercussions for these doctors? I know the answer, but I just am gonna leave it to you to share the, uh, share it with people.
Bust the bubble.
Um, what, what's it look like on the inside, um- Okay when you report things? Okay.
Well, okay, so I'm gonna back this up to one of the things that I used to hear so often, which was, "If things were really this bad, people would report it," right? Um, I don't hear that quite as much anymore, but it used to be, like, every day where people were arguing with me about, you know, obstetric violence existing or not existing.
Mm-hmm.
And they would always say, "Oh, give me a break.
If it were really that bad, people would be reporting it, and there would be all these lawsuits and, you know, et cetera, et cetera."
Um, so that is, like, completely a myth.
Um, that's just not, uh, that is just not an accurate analysis of what's going on.
Um, so, uh- uh, just to like give you a super general, very, very general, um, kind of an overview- When something like this happens, you have, you have a few options for reporting.
Um, one is to go directly to the hospital and say, "This is what happened in your facility.
I'm not happy about it.
Um, you know, whatever.
I want something done."
Um, another would be to go to the state board that, um, carries the license of the type of provider who you, um, had, had a problem with, whether, you know, a nurse, a midwife, or a doctor.
Um, and then another way is to go through our legal system, which would be to bring a lawsuit.
Um, from years of doing this, I can tell you that none of those is very effective.
Um, I have done a ton of research on medical boards, so that's, um, mostly physicians.
Um, and, uh, i- it's, like, it, I feel like this is, like, a whole, um, rabbit hole.
Uh, the The lack of accountability with medical boards is absolutely shocking, and I think that people would be so surprised to find out what doctors get away with.
Um, what is- Well, it's doctors judging doctors, right? Like, the medical board is made up of other physicians, and so we're asking physicians to judge their peers, and it just doesn't work like that.
You cannot have something like that.
These people view themselves as equals, and doesn't work like that.
There's got to be a board that's made up of a variety of people that know different perspectives and that aren't majority physicians.
It- there- a huge issue with that.
Yeah, and a lot of it is, um, a lot of these state boards are political appointees.
Um, there's not a lot of care paid, like, or attention paid to the makeup of...
Like, like a thoughtful makeup of a board, where you'd be like, "Okay, it makes sense to have- Yeah you know, this type of a person and this representative and this whatever."
Yeah.
It's like, okay, we're gonna have, you know, six physicians and three, you know, whatever.
Six, six OB, or, no, not OBs.
Um, like six physicians and two hospital administrators and, you know, whatever, somebody else to, like, break a tie.
Um, and they just, they just kind of, like, essentially police themselves.
Um, when you look at the numbers, because every board, I, I, well, I shouldn't say every board, but the vast majority of state boards, um, produce annual reports.
And when you look at the numbers of the complaints that are filed versus the disciplinary actions that are ultimately taken by the board, um, it's usually in, it's, like, in the single digits of percentage points.
Um, it's really Uh, you know, and that alone doesn't necessarily mean anything, but it does when you start breaking it down and you start looking into, you know, what kinds of things are people reporting? Um, what is the investiga- the investigatory process like? Yeah.
Who's doing the investigating? Who gets to be heard? Who, um, who can be heard as witnesses? Like, what evidence can you bring? Um, and when you start breaking down all these pieces, it's just like, oh my God, there are just so many gaping cracks of where things can, um, can really easily fall through.
Um, so you know, you get a place like California where you have 10 or th- 11,000 complaints filed in one year, and about 1% of those gets disciplinary action taken.
Um, yeah.
So, uh, that, I think, is the most accessible for people.
Like, that, to me, that is the, um, that avenue is the one that makes the most sense.
Like, that, that there should be a state board.
It is a state board.
It is not a professional board.
Um, but it should be representing the people, right? It should be about, um, protecting the public.
Um- Which means- And that, unfortunately, is really dysfunctional in the majority of places.
That means on those boards, the public has to be present.
It makes no sense to have a board that's representing the public and there are no actual patients on that board.
Yeah.
It's not a possible- Or there might be, but they don't have voting rights, or, you know.
I mean, every state is different.
Um, but there's no place where there's a majority of patients or patient representatives or patient advocates, um, making decisions about the people who are serving the public in a medical capacity.
That doesn't happen.
Um- But there's work being done on that front.
Um, so then the, so then the other avenue I mentioned was complaining directly to the hospital.
And, um, the best way I can describe that is, you know, it's a, it's a complai- it's a customer service, like, complaint issue like anywhere else.
If you went to the mall and you slipped and fell, and you went to them and said, "Hey, um, you had water on the floor and I slipped and fell," and you completely left it up to them to decide how they were gonna respond to you.
Do you think they're gonna say, "My goodness, I can't believe we did that.
We're 100% at fault.
Here's $500 for your broken leg, and, um, every time you come back here after this, please let us know you're coming and we'll give you VIP treatment"? Or are they gonna be like, "Hmm, you probably should've watched your step"? Bye.
Because why would they admit fault and help you out if they don't have to, if you don't have any way to enforce that on them? Now, in like the slip and fall example, um, you might have another way to enforce that on them, which would be by filing a lawsuit, right? But it's really hard to file a lawsuit in, with medical malpractice, and specifically with birth injury and trauma cases.
Really hard.
The very first barrier is just finding a lawyer who understands the issues, um, because birth is different from most medical malpractice, and it's almost a, you have to get somebody to represent you who understands that, who's willing to be educated about it or to educate themselves, um, who probably is willing to work with experts in, you know, experts in that field and be sort of like humble enough and like smart enough to acknowledge that they need, you know, additional expertise.
Um, and that's like a really, that's a really hard thing to find.
Um, if you look at the bigger picture of medical malpractice, y- the vast majority of med mal, there's never a lawsuit brought.
The vast majority of medical malpractice just sits on the shoulders of the public.
It's like, you know, um, a, a- an older lady at home taking care of, um, her own mother who, you know, had, had some preventable adverse event in a hospital that the hospital won't, you know, admit to, and she's stuck at home, you know, caring for this, caring for her mother for the next, you know, for the rest of her life.
Um, that's where most med mal actually lives, um, as far as, you know, like the long-term consequences.
And that's another thing where there's this sort of myth that it's so easy to bring lawsuits, it's so easy to sue people, and that's absolutely not the case.
And of course, it, it depends, you know, state to state.
Um, but I mean, like just off the top of my head, I can tell you California has a $250,000 cap on these kinds of cases, medical cases.
So any, so any lawyer who's gonna be helping you out, they're...
your award is gonna be capped at $250,000 no matter what.
So they're, that lawyer is gonna be doing that analysis in their head of like, "Is this worth me doing?" Which in a lot, a lot of times comes down to how easy is this case.
Yeah.
Is this a slam dunk? Can I get in there, get our, get our payout and, and get this through the system and out? Um, 'cause if it's a more complicated case, like why would they do it? They don't have to.
There's, you know, 100 people behind you lined up looking for a lawyer.
Um, yeah, it's a really And, and it's also a traumatic process.
Yeah.
You've...
The whole thing is people questioning your story.
Yeah.
Calling you a liar or crazy.
Yeah.
Yeah.
It's, um, you know, patients, consumers in a really hard spot.
It's like you're damned if you do and damned if you don't, and there's literally, hmm, uh, not anyone on your side.
There's no one on your side.
There's no one there to fight for you, um, except, you know, lawyers and to go through the court system, which is gonna be draining time-wise, emotionally, hard on your family, financially.
There's just so many, um, cons to that, that I think a lot of people, it's gonna stop them from, um, actually going through that, that, that route.
So man, Cristen, thank you so much for joining me today.
You're welcome.
This has been an awesome conversation.
I think a lot of people probably know that, that there is obstetrical violence out there and that trauma happens during birth, but I think a lot of people don't get this inside look.
So if they wanted to learn more, can you share, um, your Instagram or your website? Where can people find you and connect with you, um, if they wanted to learn more about that? Um, so my website is birthmonopoly.com.
I'm on Instagram at the same, you know, /birthmonopoly.
And on my website at birthmonopoly.com/obstetric-violence,
um, there's a whole resource page, including an international map where people have submitted their own stories of either experiencing or witnessing obstetric violence.
So there's some real, real stories there, and your audience is welcome to submit there as well.
That's amazing.
That's my favorite resource of Cristen's, you guys, is that obstetrical violence map.
I share it probably one time a day at least, um, actually.
Wow.
I share it all the time.
I always...
I share it with so many people, whether it be people sharing their story with me and me saying, "You need to report this here," or it be people looking to how to share their story, whether it be anonymous or they're okay being named.
That is it.
I mean, we just have- Mm-hmm so many people who are asking for this, or it could be someone who we've supported and we're encouraging them to, uh, ad- um, submit whatever they have experienced.
So all right, you guys, we will see you next time on the next episode of the Birth Lounge Podcast.
Until then, take care.
Bye, y'all.
Thank you so much for tuning in today.
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