Widespread disrespect, abuse in maternity care leave mothers with lasting trauma

Kimberly Turbin thought she was going to be a happy mom. “But that was snatched from me,” she says, the first time she gave birth.

Up until then, “I had a perfect pregnancy. I didn’t have any nausea. Nothing was wrong with me,” she says.

Her water broke while she was at her friend’s house, and she went home to shower before going to the hospital. Once there, she let the staff know she’d 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.

“And I did calm down,” she says. “I thought I was going to push the baby out, and everything was great. Everybody was really nice still.”

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 — known as the perineum — to widen her vaginal opening. 

Turbin repeatedly objected to the procedure, which the American College of Obstetricians and Gynecologists recommends doing only when absolutely necessary. 

“What? Why? We haven’t even tried!” she can be heard saying in a video of the birth taken by her mother that she later posted online. “Why can’t we just try?”

Abbassi said the baby wasn’t coming out and if she continued to try to push, “it’s going to rip the butthole down clean.” When she protested — more than once telling him no and pleading, “Don’t cut me!” — he told her he was the “expert” and that she could “go home and do it” or “go to Kentucky.”

He then cut into her perineum a dozen times.

Turbin, who went on to sue Abbassi for assault and battery, says she’s still grappling with the physical and emotional toll of his actions more than a decade later. 

“Dr. Abbassi snatched my decisionmaking for my body from me because of what he did,” she says. “And he left me with PTSD for life and nerve damage.”

Mothers’ mistreatment at the hands of the very health care workers meant to help them through pregnancy and childbirth is a rampant — and dangerous — problem in maternity care.

One in 5 mothers in the United States report being ignored, threatened, forced to accept treatment they didn’t 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’s Medi-Cal, belonged to both groups.

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 whose deliveries researchers observed were mistreated during childbirth.

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.

Mistreatment has been linked to an increased likelihood of dangerous delivery complications, such as obstructed labor and excessive bleeding, as well as postpartum hemorrhage and abdominal pain.

It can also deal a blow to parents’ mental health, as can the complications and physical pain 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 (PTSD).

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 — if not more disrespect and abuse.

The reverberations of trauma

Postpartum depression, the most common perinatal mood disorder, affects about 17 percent of mothers 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 study.

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 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, regardless of whether it resulted in PTSD, said their providers’ actions were what made the experience traumatizing.

Childbirth-related PTSD, like other forms of the disorder, usually stems from a person “experiencing an event as a real threat to their life, or potential threat,” 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 “something psychologically being violated.”

Dekel and her colleagues have found that roughly 5 percent to 6 percent of mothers develop PTSD after a “successful” birth, while as many as 17 percent display clinically significant symptoms.

The effects of traumatic births aren’t 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.

PTSD, postpartum depression and other perinatal mental health conditions have been found to negatively affect parenting quality and early relationships between parents and children, which in turn can impair childhood development. Research has also indicated that trauma can reverberate through generations, possibly even leaving a tangible mark on families’ genes.

This is something Turbin thinks about: how her mistreatment and its lingering effects may impact her children.

“I would cry a lot, or maybe I would scream more than I would like to,” she remembers. “I had to get hypnotized to stop screaming at my kids.” Years after her traumatic delivery, she says everything she feels “is raw,” and at times, she experiences panic or shuts down. Sometimes, when her children are screaming, she just ignores them.

Because of Abbassi’s actions, she says, “I never became the mom I wanted to be.”

Parents affected by childbirth-related PTSD may feel like they’re reliving the birth through intrusive thoughts or flashbacks, try to avoid reminders of the experience — including pregnancy — and grapple with depression and “negative alterations in mood and cognition,” Dekel says.

They may also be gripped by guilt and shame, she says, believing they’ve failed their children or that their bodies have failed them. The same feelings often plague parents with postpartum depression, along with helplessness, hopelessness, restlessness, sadness, anxiety and emptiness. Some have suicidal thoughts. Some translate those thoughts into suicide attempts.

And if they reach out to professionals for help, parents already struggling with their mental health again face the risk of mistreatment — with potentially dire consequences.

“We 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,” says Wendy Davis, the executive director of the nonprofit Postpartum Support International. “That often takes the form of belittling, demeaning, blaming the individual, sometimes really overt name-calling.”

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.

“Their existing mental health symptoms have already made them think they can’t do this. ‘I shouldn’t be a mom’ and, at worst … ‘My baby would be better off without me.’ That thought is already swirling around in somebody who’s dealing with a perinatal mood disorder,” she explains.

“So if you go to a professional, and if they give the same message,” she says, “perinatal patients have an extremely high risk of suicide.”

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 in the United States. Most of these deaths are determined to be preventable.

Davis says perinatal mental health care has taken “baby steps” toward improvement in recent years. “At 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,” she says.

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. “Which is terrific,” she says, “and I think is raising a lot of awareness among the scientific and also critical communities.”

But both caution that there’s still work to be done, specifically stressing the need to better educate and train providers.

“The gap that exists that we really need to close,” Davis says, “is the gap between the resources that exist and medical care.”

Broken trust

As well as exacerbating both physical and mental health risks, mistreatment can fracture mothers’ trust in health care workers, making them leery of receiving treatment in the future.

“When somebody experiences mistreatment of any kind from a medical provider, really specific things happen,” Davis says. “There’s now a decrease in trust. There’s 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’t want to have the same negative experience they had before.”

This can cause people to stop going to appointments, she says, or to “put on a mask to try to appear better and healthier and ‘less weak’ to avoid the terms of the experience before” if they do return to a provider.

Mothers who suffer mistreatment have been found to be less likely to seek care 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, and it can cause people to put off care or decline to take medical advice for health issues extending far beyond maternity and postpartum care.

“To this day, I really don’t feel comfortable going to hospitals,” says Sebrena Tate, citing the ways her doctors treated her during labor and postpartum care in the pandemic. “I always have this sense of, whoever walks in, is everyone going to be able to walk out? I’m always questioning medical providers.”

After Tate went into early labor roughly six months into pregnancy, the doctors at the hospital she was admitted to “weren’t answering” her “questions and were brushing the situation off,” she says. She remembers being told “these things just happen” and “we just have to wait and see.”

One doctor from the neonatal intensive care unit (NICU) told Tate, who is Black, “Don’t worry about it. Black females are the strongest babies in the NICU,” she recalls. The comment made her think about the harmful biases surrounding Black women’s pain that have long affected their medical treatment. It made her worry what else her providers might be thinking.

Due in part to implicit and structural bias in the medical system, Black mothers in the United States face deadly disparities when it comes to pregnancy and childbirth. They’re three times as likely as their white counterparts to die due to pregnancy-related causes, according to the CDC. They’re also about 50 percent more likely to give birth preterm — one of the leading causes of infant mortality.

“I just remember being in that hospital room and being like, ‘I don’t feel safe. I feel like none of these people have my best interests at heart right now,’” Tate recalls. “Like either myself or my daughter’s not going to make it out of this hospital.”

She decided to leave and went to another hospital the following day. The care she received there was “totally different” and more attentive, she says, but her daughter ultimately passed away.

The last time Tate went to a medical provider was her six-week postpartum checkup, during which a midwife — who had not read her chart — asked her, “How’s the baby?”

“I just feel like they don’t really care,” Tate says.

She did see a therapist in the wake of her experience, whom she’d already been connected with when she previously dealt with postpartum depression. But she says she “wasn’t really able to find a lot” 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.

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’ invisibility in conversations surrounding maternal mortality.

“My advocacy just keeps on growing, because I have a lot of work to do,” she says.

The fight for awareness and accountability

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 World Health Organization and the United Nations, and explicitly outlawed by several Latin American nations.

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. And efforts to combat providers’ disrespect and abuse or hold them accountable for their actions are an uphill battle.

Storm O’Brink seeks to do both as a full-spectrum birth worker and advocate with the University of Iowa’s Rape Victim Advocacy Program.

O’Brink, 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.

They describe mistreatment they’ve witnessed firsthand: patients being coerced or forced into pelvic exams or treatments they didn’t want; providers “completely trampling on” patients’ boundaries.

“As a doula and as an advocate, it’s my job to amplify the survivor’s voice when they’re not being heard,” they say. In the case of mistreatment, “I try to intervene. I try to speak up as much as I can. But there’s only so much I can do before the providers will attempt to kick me out of the room.”

O’Brink also works to help people who want to “seek some form of justice” for their mistreatment complain to the hospital or state medical board, and will occasionally assist them in finding a lawyer if they think they have grounds to sue.

But they say most of these efforts end in disappointment, and it can “open a wound” for people as they navigate months- or even years-long processes that often involve hospitals, providers, courts or other entities “invalidating the experience they had and basically saying it needed to happen this way.”

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, acknowledging “physical and mental deterioration” related to his age. He and Turbin later settled her lawsuit out of court.

She hopes she set a precedent with the case, in which a California judge ruled Abbassi’s actions could be tried as potential assault and battery. But at the same time, she says she doesn’t recommend other people follow in her footsteps.

“The psychological and the mental anguish isn’t just from the assault. It’s from everything, along with the assault that happened to me. For me, I wasn’t just assaulted. I was also part of a movement to spread awareness. And yeah, I didn’t have to be — but then I had to be. There was no going back,” Turbin says.

“I always said, ‘I’m going to do it.’ And I did,” she says. “But I’m telling you, I paid the price for it. My kids paid the price for it.”