EBB 170 – Addressing Mistreatment in Childbirth Care with Birth Monopoly Founder, Cristen Pascucci

• Learn more about Cristen Pascucci and Birth Monopoly here (www.birthmonopoly.com).
• Access the Complaint toolkit at https://birthmonopoly.com/complaint
• Find out about Mother May I, the documentary, at https://mothermayithemovie.com
• Follow Birth Monopoly on Facebook here (https://facebook.com/birthmonopoly) and Instagram here (https://instagram.com/birthmonopoly). 
• Read the news report about the Annals of Internal Medicine paper about sexually abusive behavior in the operating room here. 

Rebecca Dekker: Hi, everyone. On today’s podcast, we’re going to talk with Cristen Pascucci at Birth Monopoly about what you can do if you experienced mistreatment or unsafe care during childbirth.

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker and I’m a nurse with my PhD, and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. Today, I’m so excited to welcome my friend and colleague Cristen Pascucci of Birth Monopoly to the Evidence Based Birth® Podcast, to talk about hospital complaints and what to do if you experienced mistreatment or unsafe care during childbirth. Real quick, before we get started, just one content warning, we will be talking about obstetric violence and birth trauma in this episode, but we’ll also be talking about what you can do if you experienced those things.

A former communications strategists at a top public affairs firm in Baltimore, Maryland, Cristen Pascucci is the founder of Birth Monopoly and creator of the online course, Know Your Rights, legal and human rights and childbirth for birth professionals and advocates. She is also co-creator of the exposing the silence project and host of Birth Allowed Radio, a podcast. She has run an emergency hotline for birthing people facing threats to their legal rights and childbirth, created a viral consumer campaign to break the silence on trauma and abuse in childbirth, and helped put obstetric violence and the maternity care crisis in national media.

Today, Cristen is a leading voice for women giving birth, speaking around the country and consulting privately for consumers and professionals on issues related to birth rights and birth options. Cristen is now producing a documentary called Mother May I about obstetric violence and the Birth Monopoly. Welcome, Cristen to the Evidence Based Birth® podcast.

Content warning: Obstetric violence, birth trauma, sexual assault in obstetrics. 

Cristen Pascucci: Hey, RD. 

Rebecca Dekker: Hey, CP. We were just saying this morning, it’s coming up on nine years of us both blogging.

Cristen Pascucci: I know, it’s so crazy.

Rebecca Dekker: Yeah, and I write about this in my book, Babies Are Not Pizzas, but it was really fortuitous that Cristen was the first person to leave a comment on my blog, Evidence Based Birth® back when I allowed comments in the old ages. I was the first person to leave a comment where Cristen was blogging at the time and then we discovered that we lived in the same town.

Cristen Pascucci: It’s so funny. 

Rebecca Dekker: I know. And we both had sons named Henry.

Cristen Pascucci: Yeah, we were like two weeks apart.

Rebecca Dekker: Yeah. We’ve both given birth in the same town, two children named Henry in the same kind of difficult birth setting, or birth atmosphere, I would say, at the time, where we were living in Lexington, Kentucky, and then we started collaborating and we haven’t stopped collaborating since.

Cristen Pascucci: Yeah. I think we both had a first birth here that was like, what the hell was that?

Rebecca Dekker: Yeah. I had my second around the same time you had your first and I had opted out of the hospital system because of what I’d experienced the first time.

Cristen Pascucci: Yeah. So, here we are all these years later. It’s funny.

Rebecca Dekker: Yeah. Still working on birthing issues. We haven’t lost the bug yet. I keep wondering, will I get tired of this? So far, not.

Cristen Pascucci: I know, right?

Rebecca Dekker: Yeah.

Cristen Pascucci: I’ll never get tired of it, I don’t think at this point.

Rebecca Dekker: Well, we are so excited to have you back on the podcast. You came about a year and a half ago to talk about discussing difficult topics in the childbirth field. We did that as a preparation for our circumcision article because of your background expertise in communications, and that was super helpful, and we’ve had a lot of requests to bring you back. I’m super excited that you’re a repeat guest on the podcast and you and I were talking beforehand about what we wanted to discuss, and we decided to talk about something that you’ve been working on a lot recently and that’s about hospital complaints.

What can you do if you, as a consumer, experienced mistreatment or unsafe care during childbirth? How do you even address that situation?

Cristen Pascucci: I think it’s really important, just right from the beginning, for people to understand that there is not an awesome, really effective way to report mistreatment, which is disturbing. Something I just sort of discovered doing it hands-on over the years, helping people file complaints and figure out how to navigate what to do after something bad happened, and it was like, over time, I was just like, “This is it. Why is this so difficult? Why doesn’t this seem to work very well? Last year, especially, I started going into a lot more depth about the state boards that are supposed to regulate licensed healthcare professionals, like nurses and midwives and doctors.

Then I kind of met up with some other advocates who are not in the birth world who had been tracking medical boards, their performances. That was just like a big wow to me, when I realized, it’s sort of like yet another healthcare scandal. I thought maternity care was like one big healthcare scandal, and now I’m like, oh, the regulatory processes are also pretty messed up.

Rebecca Dekker: Can you talk a little bit more about getting involved with advocates in other areas of healthcare? You and I are really enmeshed in pregnancy and childbirth and postpartum, but apparently, there’s obviously this whole other world of other aspects of healthcare where people are also working and fighting against mistreatment and bad care.

Cristen Pascucci: Sure. Yeah, well, so not to get off on a totally different subject, but malpractice is a really big problem. There’s a lot of malpractice. The vast majority of malpractice is never resolved or recourse had, or even reported. That stretches across all of healthcare. In birth, I think we see, we’re obviously focused on this one little slice, and there are unique impacts when we’re talking about pregnancy care. So, there are all kinds of people around the country who advocate, most of whom have had some sort of run in with the healthcare system where maybe they lost a loved one due to negligent care or something like that.

I was actually working with Marissa Hoechstetter, who is a woman in New York State, who was sexually assaulted by her OB/GYN. She’s got her own really super interesting story and years long sort of quest for justice, but she ended up bringing a lawsuit with over 20 other plaintiffs around the hospital sort of covering up what they knew about this doctor, that he was unsafe, and I guess a sexual predator. Marissa and I started corresponding and talking together and collaborating on things. At some point, she mentioned, “Hey, there are other people out there who go at this issue, just not in the obstetric setting.”

I joined this national consumer advocacy group that reviews medical boards around the country and tracks them and keeps statistics on them and does educational stuff. That has been super, super interesting to get kind of a more inside look into how the different boards operate around the country. Some of the people in the group that I’m in have been on medical boards. They’re former healthcare professionals, lawyers, obviously more patient advocates. It’s just been super, super interesting to see how this works in different ways around the country. There certainly is variation, but overall, it’s not very great. It’s not very good, even like the better performing boards, just it’s not that great anywhere.

Rebecca Dekker: Just to clarify, so we’ll mostly be focusing on hospital complaints in the United States, but I think some of the principles we’ll talk about can apply to listeners in other countries, especially when we get to talking about PR and media. But you’re talking a lot about state boards, and I think the average person might not necessarily know what you’re talking about. Can you explain what you mean when you’re talking about state boards and who they are, and what they do, and what power they have?

Cristen Pascucci: Yeah. I’m glad you asked that question because this is something that a lot of people don’t know. Most people, when they have a bad interaction at a hospital, they think, okay, I need to complain to the hospital, right? That would be your first thought. But what I’ve discovered, over time, is that you’re asking an entity to regulate itself. So, you’re asking a hospital to address some sort of issue inside itself, and they sort of get to use their own discretion about whether they take it seriously, whether they take action, how they respond to you, and there’s very little transparency about that.

Now, state boards are supposed to be sort of this more independent third party that they issue the licenses for different healthcare professionals within their states. So, if you’re a nurse or a doctor or certain types of midwives, you’re going to need to get a license through the state in order to practice there. Then the license is supposed to be a way to protect the public to make sure that people who are licensed by the state are competent and ethical and all that stuff that we expect. The recourse that you have as a patient or a consumer is to go to the state board that regulates the license of the person who did whatever thing and ask them to investigate the incident and consider taking disciplinary action against that person’s license. Does that make sense?

Rebecca Dekker: Yeah. So, the state boards are kind of set up by each state legislature, the laws they’ve passed, and they’ve been given the authority to oversee the licenses, issuing licenses, but also maintaining them. So, they require renewal. They can revoke your license. They can discipline you for various reasons. You’re saying, if something happened, if you experienced mistreatment, obstetric violence, unsafe care, negligence, or malpractice, you could complain to the hospital, or you could complain to a state board, are there any other options?

Cristen Pascucci: Or both.

Rebecca Dekker: Or both, you could do both.

Cristen Pascucci: Yeah. Well, and I think the point I was trying to make is that these are supposed to be the bodies that protect consumers from care providers who are acting unsafely or unethically.

Rebecca Dekker: The state boards are supposed to be –.

Cristen Pascucci: Yeah, obviously this inherent conflict of interest when you’re asking a business or an entity to regulate itself, or to tell on itself. It’s like, if a restaurant gives people food poisoning, do you expect that restaurant to go on social media and announced to everyone, oh, hi, sorry. We gave a whole bunch of people food poisoning. We realized that it’s an issue with our policies and our restaurant is really unclean, and we’ve fired these people and we’ve put these new policies in place and we’ve done X, Y, and Z. No, that’s not how businesses operate.

Rebecca Dekker: I want to clarify that, although hospitals in the US are almost always technically a non-profit, they often operate like a business in terms of they’re about making money, for sure.

Cristen Pascucci: For sure, no question.

Rebecca Dekker: I was thinking, when you were talking about the restaurant, several times I’ve gotten food poisoning from restaurants, which is a miserable experience. Yeah, both times I didn’t call the restaurant. I called the public health department and they sent someone out like that day.

Cristen Pascucci: That’s what you expect. I mean, that’s what you expect, right? That’s what our government is supposed to do. 

Rebecca Dekker: Yeah. I remember they called me back and checked on me a few days later and said, we visited, this is what we talked with them about. This is what the plan is. It was really quite a good experience both times that it happened.

Cristen Pascucci: Yeah. You would sort of expect and hope that, that would apply also to healthcare, that there would be some sort of independent third party that oversees care. Or, I’m sorry, not care, but how providers practice, who have the stamp of approval of the state.

Rebecca Dekker: Now, what about The Joint Commission? Can we talk about that a little bit? That’s the accrediting body for most hospitals, because we’re acting like hospitals are completely unregulated, but they have to go through accreditation. They have to be licensed by the state to operate. So, is going to The Joint Commission an option?

Cristen Pascucci: It is. Yeah, and in fact, there are like multiple options that most people don’t know about. Who would ever know to go to The Joint Commission as a patient. What we have set up for us are these state licensing boards, grievance processes through the hospital itself, and the court system. What I found is we actually have to have all of these other options because those three options just don’t work for most people. Yeah, so The Joint Commission is one that I recommend. I have not worked with anybody who has had any great success getting The Joint Commission to do anything, because you have to remember that The Joint Commission’s customers are hospitals.

Rebecca Dekker: The hospitals pay a lot of money to get accredited by The Joint Commission.

Cristen Pascucci: Yeah. We kind of hit up against that conflict of interest problem yet again.

Rebecca Dekker: Okay. Let’s kind of go back to the beginning. Let’s say I experienced mistreatment or unsafe care for myself or my baby, and I want to do something about it and I reach out to you. What would you tell me to do first?

Cristen Pascucci: The very first thing I would say is collect as much evidence as possible and documentation about your story. Then we would talk about the options for where to go with that. One thing I think that is really helpful is, no matter where you go, you’re going to want to have a solid story organized well with evidence to support what you’re saying if possible. So, it’s good to sort of have that all together in a cohesive way so that you can then get that off to whichever bodies you’re going to send them to.

I definitely tell people like, you don’t do them one at a time, but you want to alert multiple folks about what’s going on in hopes that somebody is going to be able to do something about it.

Rebecca Dekker: By documenting, do you mean getting your medical records, writing down your story?

Cristen Pascucci: Yeah. Definitely ordering your medical records right away and making sure that you get all of them, because a lot of times, you don’t get the full record. When you ask, it can take a little bit of persistence. Documenting your story just as soon as possible so you don’t forget details, and that doesn’t have to be in anything fancy or anything great. Just hurry up and preserve whatever details you can. I even suggest that people make a selfie video as opposed to writing it all down, just because that might be easier to do and you can do that more quickly.

Any witnesses, loved ones, or support people, you can get statements from them. We have a free affidavit form on our website so that you can actually put those statements into a form that is notarized, that says that you swear to the truth of that form. It just kind of gives it a little more weight. Yeah, any photographs or maybe email communications, one example is the big lawsuit in Alabama where the woman got a big jury award for an obstetric violence case. She had multiple personal emails that she had sent out immediately after the birth, or soon after the birth to friends and loved ones that laid out facts about what had happened in the birth, and they corresponded. They perfectly corresponded to each other.

That was good evidence to support her story. Yeah, so medical records, photographs, written testimony, all those things are going to be part of what you sort of consider your evidence.

Rebecca Dekker: I wonder, you’re using the word evidence, are you implying that a lawsuit is a valid option, or are you just talking about documentation?

Cristen Pascucci: Both. Here’s the thing that I sort of discovered about these state boards that is one of the things that I was like, oh, is that they also require evidence, and that’s a real problem because most healthcare encounters don’t have evidence inherent to the experience.

Rebecca Dekker: Like, if a doctor said something verbally abusive during a prenatal appointment, it’s not going to be necessarily documented anywhere.

Cristen Pascucci: Right. They’re not going to put it in the medical records, threatened patient, or whatever, and there’s most likely not video or audio recording of what actually happens, and there’s probably only one to three or four other people who could have witnessed it. Probably most of those people work for the doc, or work for the hospital, or work with that doctor. I know, in California, at least, the board does not have the ability to subpoena witnesses.

If you had, say a nurse … If you had four nurse witnesses, if they decided not to talk to the board, they just cannot talk to the board and kind of leave you in a, he said, she said situation with the doctor. But I think this is one of the things that I discovered that I was just sort of like, oh, this is a little disturbing, is that you’re expected to have evidence for something that you wouldn’t necessarily … That doesn’t actually produce evidence on its own, if that makes sense. You would almost have to go into the encounter expecting to create evidence in case you needed it, which is unrealistic.

I think that’s one of the sort of built-in flaws to some of these systems, is that there’s this expectation that you’re going to be able to prove your case when no average person walking into a healthcare encounter is walking in thinking, I need to be able to document every detail in case I get hurt or … You know what I mean? In case I come out of this with some kind of harm. Yeah, but what you can do of course, is just preserve every little bit of evidence that you possibly can right away. Again, I’m talking about evidence as if, whether you’re talking about a lawsuit or you’re talking about going to a state board to report an incident against someone’s license.In both cases, you want to have evidence.

Rebecca Dekker: Okay. Let’s talk about complaining to the hospital first, because that seems like the easiest thing to do. How would you go about submitting a complaint to the hospital?

Cristen Pascucci: You can contact the hospital. Usually, they have a formal process. The tricky thing about the formal process is that it’s generally an internal process, and you may not actually participate in an investigation. Whatever you send to or complain to the hospital, that might be the only information that you ever get the chance to share with them, and that’s not necessarily true. Like, they might reach out to you later and say, we need more detail on X, Y, or Z, but you can’t make that assumption.

Ideally, how it works is you file a grievance with the hospital. They take that, they look at it, they do an internal investigation. They might have a peer review or some kind of internal review where the provider’s colleagues would look at what happened and they might have to answer questions about what happened, and then they decide what kind of action to take at that time, or to take no action. However, as a patient, it’s unlikely that you would really have many of those details, and I think mostly for liability reasons, the hospital is not likely to be very forthcoming about their investigation and the results of the investigation.

You might get something kind of vague, like, thank you so much. We’re investigating this. Then later, thank you so much, we’ve closed our investigation. We feel like it was resolved. So, especially when we’re talking about birth, that can feel really unsatisfactorily to someone. If they have trauma from an event and they’re looking to get some closure from following up and reporting it.

Rebecca Dekker: I think what I’m hearing you say is that it’s typically a pretty unsatisfactory process. When you complain to a hospital, they should receive your complaint, but they often don’t communicate anything else other than that they received it, and maybe that they investigated it. But if you’re looking for any kind of recourse, like we’ve made changes to this policy, or this doctor is no longer with us, or anything like that, it’s unlikely that they’ll do anything like that, and even if they did, they probably wouldn’t tell you.

Cristen Pascucci: Yeah, it’s too bad because I know that providers do get in trouble and have actions taken. It’s just not very likely that you as a patient are really going to be told about it.

Rebecca Dekker: Because they’re thinking liability, they’re thinking, oh, patient Cristen, she requested her medical records, red flag for them. Right?

Cristen Pascucci: Sure. Yeah.

Rebecca Dekker: She submitted a complaint and it was pretty serious. Another red flag. All right, we’re going to cut off communications with Cristen because we don’t want to act like we’re at fault or that we did it anything wrong.

Cristen Pascucci: Yeah. Why would we say to her, my goodness, you’re right, our doctor, whatever –.

Rebecca Dekker: But the funny thing is, is it’s like exactly the opposite of what consumers are looking for. If a consumer experiences a trauma and they reach out to the hospital and the hospital shuts the door and refuses to admit wrongdoing, then you kind of have no other recourse except to pursue further complaints with the state board or with lawsuits.

Cristen Pascucci: Yeah, which I think is a really good point, because I think everybody I’ve ever worked with who’s pursued a lawsuit has said, “I’m only doing this because the hospital would not talk to me. I had no intention-“

Rebecca Dekker: It’s the only they could get information or get any kind of closure.

Cristen Pascucci: Yeah. I had no intention of suing anyone. I immediately went straight to the hospital and was just like, can I please talk to someone about what happened? After being stonewalled by the hospital, I got mad and was like …

Rebecca Dekker: Nothing’s going to change unless I pursue this.

Cristen Pascucci: Yeah.

Rebecca Dekker: Because I think a lot of times what people want is they don’t want this to happen to somebody else. They want it to stop for the future. If a hospital refuses to address it and doesn’t say, you know what? We’re going to make sure this doesn’t happen again, it would be very upsetting. It would make me very angry too. I can see how people would then go on to sue. So, it’s almost like hospitals are cutting off communications to lower their liability, and in fact, it kind of increases their liability.

Cristen Pascucci: Yeah. Diana Snyder, who’s a lawyer, formerly in California in Massachusetts, and I think she’s in Wisconsin now. She does birth law stuff. She gave a talk a couple of years ago that I attended that was she … It was all about basically, if you want to lower your liability, you need to increase your communication as a provider, which is the opposite of what they are advised to do, generally by legal counsel or by the institution. Like you said, it’s usually like, let’s shut the door. Something bad happened, we better shut the door.

That can really have the opposite effect because people don’t feel heard, they feel like you’re trying to cover something up, they feel invalidated, and they certainly feel like nothing’s going to change. That’s a really unfortunate feature of our system, because I do know that there are places where they do take grievances and complaints really seriously, and they do, do something about it, but we’re just never going to know.

Rebecca Dekker: Oh, I see what you’re saying because you don’t get the communication. All right, so let’s move on to complaining to state boards. How does that process, what does that generally look like?

Cristen Pascucci: I actually have a really good resource on my website about this, that it’d probably be easier to just point people there. We have a bunch of basic information about it and a directory, a state-by-state directory for the different boards if you wanted to say, report a nurse in New Hampshire or a doctor in California, or a midwife in Texas, you can go to our state directory and find the link to the online information from that board.

Rebecca Dekker: How can people find that information on your website?

Cristen Pascucci: Birthmonopoly.com/complaint.

Rebecca Dekker: Okay, birth monopoly.com/complaint. And that is each state probably has its own process then for submitting a complaint. Typically, people complained to the medical board for a physician, the nursing board for a nurse, etc. Okay, midwifery board, if there is one or find out who they’re housed under.

Cristen Pascucci: Yeah. It’s different in different places. If you go to that directory, you can just look at your state, and then you can look at the credential of the person. If it’s an MD, for example, then it’ll say which board administers that license and which one that you’d want to go to. Does that make sense?

Rebecca Dekker: Yeah. Most of the time when you submit a complaint to a state board, you actually hear back from them? What are the pros and cons of doing that?

Cristen Pascucci: Yeah, they usually acknowledge receipt at least. Then there’s usually sort of similar to the hospital grievance process, there’s often some really minimal communication about, okay, now we’re investigating, or we have concluded our investigation, or we decided not to investigate further. Sometimes it might, if it goes all the way, it might be, we’ve decided to, or we have taken appropriate disciplinary action. You may or may not know what that is. There’s a lot of detail I don’t want to go into, because it would be kind of tedious, but we have a really good resource for that on the website that kind of walks you through the process from, I think I might have been hurt, or disrespected, or whatever the thing is, to filing a complaint with your state board.

Rebecca Dekker: Have you seen people have success from complaining to state boards? Or do you feel like, in general, most of the time nothing comes of it?

Cristen Pascucci: In general, most of the time nothing comes of it, but there have been a couple of bright spots. What I realized was people don’t even know the basics about doing this. It’s kind of sad for me to think that someone would go through all the trouble and the trauma of submitting a complaint without even realizing, for example, that they need to include evidence because it’s not always obvious. There’s a way to do it, I think, that increases the odds of having your complaint taken seriously, and so that’s why I started working on this resource so that people could make a really good effort with filing those complaints.

Then I’m hoping we’ll see a little bit more of a response. We’ve created a tracking system so that people who submit complaints can let us know that they have done so and we can sort of track the outcome or the response to that complaint by the state board, because we know that, in general, the system is not really awesome for patients, whether we’re talking about maternity care or other areas of healthcare. So, we want to get some data on that. Also, that helps us perfect the information that we can give out to consumers about how to do this most effectively, is by sharing that information as people go through the process themselves.

Yeah, and I think also, there are other reasons to do it. One is, if at any point you want to file a lawsuit, you want to have this document, you want to have this documentation together. It sort of makes sense if you’re going to file a lawsuit that you would have reported the provider. It doesn’t make so much sense that you would go before a court and say, “Oh, I didn’t bother reporting them because I didn’t think anything would happen.” It is just sort of something you need to go through and get that documented.

Although I will just add to that, that if you’re planning a lawsuit, that I would definitely consult with a lawyer before submitting a complaint because whatever the facts are on there, that documentation will be included in your lawsuit. So, you want to make sure you’ve got it written the way your lawyer would advise.

Rebecca Dekker: Okay. We’ve talked about hospital complaints, complaining to the state boards, and you’ve got a whole page on your website with all kinds of resources to walk people through these steps at birthmonopoly.com/complaint. You mentioned lawsuits briefly. Is that something that … What are your thoughts on using a lawsuit as recourse for a really bad, or I don’t know how you would judge it, but unsafe care or mistreatment or abuse or obstetric violence. 

Cristen Pascucci: Yeah, well, they are sort of the long shot, long-term. I don’t think they’re practical for most people, especially when I would say the majority of the harms that the people that we work with, it’s a lot of psychological harm, which is really hard to get courts to place value on, like financial value on it. Also, many of these claims are temporary physical harms. Most likely someone didn’t die as a result of obstetric violence. Most likely, it was something like an episiotomy done without consent, and the resulting, maybe that person has PTSD, and they might have pain for six months, but in the US, our legal system is really set up more to address permanent and dramatic harms like a death, or an impairment, or a disability.

Rebecca Dekker: So, being forced into a surgery or pressured or coerced, for example, on cesarean when it wasn’t necessary, that probably wouldn’t be considered a harm by a judge or a jury because it’s not … Most people don’t see a C-section as a harm, unless there was additional harm that occurred with the surgery.

Cristen Pascucci: Right. A good example is Rinat Dray, who’s a mother in New York who did bring a lawsuit for a forced cesarean, and lots of people have forced cesareans, unfortunately. The only reason she was able to bring a case was because the doctor actually nicked her bladder in the surgery, and so that was an additional harm. They didn’t consider the C-section itself to be a harm, which is a problem. We have a long way to go, and I think it’s embedded in a lot of cultural beliefs and biases and misperceptions about childbirth, about women, about birthing people. Yeah, we have a long way to go because you have to remember, the legal system reflects in cultural norms, and beliefs. You can only expect so much out of that, right? 

Rebecca Dekker: Yeah. So, it’s not a very commonly used option in your experience and so a difficult option to pursue.

Cristen Pascucci: Yeah, and the very first barrier is just finding a lawyer who will take the case. A lot of times, what people get is yes, I see that you were harmed, yes, this was wrong, and no, it is not worth it for us to take your case because there’s just not enough money in it to make it worth paying to bring a case. It’s expensive, and it takes a long time, and it’s traumatic, which gets us into, okay, well, what else can people do? 

Rebecca Dekker: Yeah, so what else can people do if the hospital doesn’t do anything, if you never hear back any resolution from the state board, or they don’t take any action, and you don’t want to, or don’t have the resources or a situation to file a lawsuit? What other options do people have? 

Cristen Pascucci: One of the things about the options that we’ve already discussed, the hospital complaint process, or a grievance process, the state board complaint process and lawsuits is that, almost like giving away your story to someone else and asking them to make an assessment of it and then make a judgment on it. That can be the antithesis of what a trauma survivor can handle or wants. I think it’s really key to keep that in mind as you’re going through this process is, what do I want to get out of this? Can I only heal if I get recourse, if I get this validation from this other party that I was wronged, or can I take this on myself and use it to tell my story and own my story and heal around my story?

I think that’s actually probably the best value that someone can get out of it. So, how can you tell your story? Sometimes I think the most important thing is to own your story and to get it out on your own terms. You have to remember that these systems that we have set up are generally closed systems. They’re internal processes. You’re, like I said, sort of handing off your story, and then someone else is doing something with it. Who knows what that outcome is going to be? I think that there’s a lot of value in speaking your story with your own words on your own terms, in the forum that you choose.

I also think it takes a whole lot of leverage away from whoever, the system that so effectively covers up a lot of this misconduct when you just go straight to the public and say, this is what happened. Hospitals do not like bad press. Getting your story in the media can give you all kinds of leverage that otherwise you would have absolutely none of. I have worked and do work with people in figuring out, what is the best option here? How do we get this out there? How do we get eyes on this? How do we actually see if we can make some change in a way that we’re leading that charge more than handing it off to someone else and hoping they do something with it?

This could be as simple as making a Facebook post that says, this is what happened to me. Here are the facts. Here’s the impact it had. Or it could be, actually something I’m working on right now is gathering statements from different individuals who have suffered harm at one particular institution, and then putting those, sort of loosely organizing those, getting complaints filed, and then also taking all that in a package to the local media to say, this is a real problem at this hospital. Yes, we filed a complaint, but our previous experiences with this hospital and this system lead us to believe that it’s not going to be taken seriously. So, can you talk about it?

That’s a way that you can get out of that sort of closed system model that really allows this stuff to … That perpetuates the problem. 

Rebecca Dekker: I love that suggestion of just like, don’t be silent about it, and instead, use your power, your voice. Your power lies in your voice in telling your story and being public about it, if possible. I think there’s other ways to do that as well. Instead of just posting on social media, you can also leave reviews on different public websites, correct?

Cristen Pascucci: Yep. You can do that.

Rebecca Dekker: Finding everywhere that doctor is reviewed and leaving your own review. Yeah, using the IRTH app, which we’ve featured a few episodes ago, IRTH on the App Store to leave a review. Using the media, if that’s something that you decide to go for. I love that idea though, of using your voice and getting out there publicly. That’s assuming, of course, that you’re the consumer or the patient. What if you witnessed mistreatment as a nurse? Because I feel like nurses are often on the front lines. We have a lot of labor and delivery nurses who often feel trapped because they witness unsafe care, but they feel that it can be dangerous to speak up as well.

They risk possibly losing their job, losing social status at work. What advice do you have for nurses who may be in the room when unsafe cares is being delivered or when there’s mistreatment? 

Cristen Pascucci: Well, first of all, you’re supposed to report it, as a nurse, but we know, in reality, there can be blowback. There can be all kinds of repercussions for doing that. I think, unfortunately, we’re in this stage in this sort of phase of solving the problem where there’s still this silence that gives this system so much power. I think, at this point, nurses figuring out ways to use their voices is going to be the only thing that sort of pulls back the curtain so that other nurses can come forward. It’s going to take a number of voices.

Right now, what we typically get is one nurse who’s willing to make a complaint at a facility, and then everybody else is scared to back that person up. It’s going to take more voices. It’s going to take some solidarity among professionals to make something happen. I work with a couple of nurses, specifically, one in West Virginia, and one in California who have sort of taken this on and gotten pretty public about, as soon as I spoke up, things started kind of going badly for me at my job, and then eventually, I had to leave the facility.

The thing is, people don’t know that. People literally, the public, doesn’t generally know that, that’s an issue, and they’re not going to, and I don’t think anything’s going to change until there’s more just general awareness that, that’s a thing. So, it’s going to take sort of like a tipping point number of people coming forward to talk about that being a problem. Then we can start demanding accountability and solutions from bodies, like The Joint Commission or government bodies that are supposed to be overseeing any of this stuff, but it’s going to be at least partially a result of public demand. 

I think it’s just sort of a general principle with nurses like we were talking about is that visibility is your protection. So, in some cases, it’s like, the more visible you are, the more protected you are. It’s not always true of course, but if we can push forward and organize on this a little bit more, it would totally change the dynamic to have multiple people saying, there’s a flaw in the system, versus one poor person with a target on their back at a random facility somewhere. I think we’re getting there a little bit, but that’s just something that we have to keep pushing on.

I think another thing nurses can do is raise this with their union. Unions do offer some protection and support. I think the more we make this an issue, more systemic solutions will follow from that. It’s something I wish that we were talking about publicly at annual conferences for obstetricians and nurses. There were journal articles out there about it, because well see, you tend to see policy follow public outcry or awareness or educational campaigns. 

Rebecca Dekker: Yeah. Sadly, we don’t see a lot of national leadership at all on this issue in terms of national organizations actually addressing this with their own members. 

Cristen Pascucci: Yeah. I’m thinking back to a few years ago when, I don’t know if you remember this, Rebecca, there was an article came out in a medical journal, where I think it was, I want to say it was maybe students were reporting really egregious disrespect and misconduct. I think it was even in the obstetric setting, although I’m not totally sure. They were basically saying like, hey, there’s a really bad cultural problem here. This is really pervasive in what we’re seeing in care. Hear some of the comments that have been made about patients.

Here are some of the things that we’ve seen. It was like, it created this big, uproar and for a little while, it was a topic, and leadership was having to address it. It was like, do you remember when that happened?

Rebecca Dekker: Yeah, I do remember. I think it was in a major medical journal.

Cristen Pascucci: Yeah. 

Rebecca Dekker: We’ll have to find the link and post it in the show notes, because that was a fascinating article, and I agree. I think it’s like what you said earlier though. It’s like, when you bring things out into the light and you talk about it and when people use their voices and enough people speak up, it becomes too big of a problem for the people in power to ignore anymore. 

Cristen Pascucci: Yeah, and to some extent, it’s not always authentic, but I think anything is-

Rebecca Dekker: The response, you mean?

Cristen Pascucci: Yeah. I mean, yeah, anything is better than nothing. Over time, you do create more social pressure. We saw that with that article that we’re talking about, where there was a huge response. People were like, yeah, I’m so glad someone’s saying something about this finally. Then, after a while, it just faded away and it didn’t blaze, explode.

Rebecca Dekker: Create lasting change.

Cristen Pascucci: Yeah, but it could have. I wonder if today something like that happened, if the response would be even more robust than it was.

Rebecca Dekker: Yeah. After the Me Too Movement and the heightened awareness of the maternal mortality crisis in our country. Exactly. Cristen, any tips for self-care healing if somebody’s going through this process of trying to complain?

Cristen Pascucci: Yeah, and I almost wish we hadn’t left it toward the end because it’s something that I really suggest that people prioritize from the very, very beginning, is having a lot of trauma awareness. I think you’ll find that at every step along the way, you’re having to revisit some trauma. If you’re not really aware of that and prioritizing your own health, and mental health, and self-care, you might find that it overtakes any actions that you’re trying to take. So, it can just be too emotionally difficult and too overwhelming and too triggering to follow through all these steps of this process.

I mean, it’s a lot to ask someone who’s been harmed and most likely traumatized to prove their case to some strangers. It’s a lot. So, I always suggest that people have enlist loved ones, or nonjudgmental support, compassionate support as much as possible, especially at moments like receiving your medical records and reading your medical records for the first time, receiving and reading any communication from either a hospital or a board or whomever. It can be super triggering. 

A lot of this stuff can feel really invalidating, which is the last thing that a traumatized person needs. Just like a first, super basic step, if there’s someone in your life who’s willing to be your sounding board and support you and just listen more than anything and be compassionate, I really encourage people to pair up with that person and get have their presence, even if it’s via Zoom or Skype, or whatever, at these sort of key moments in the journey, including when you are writing your story or documenting your story. That can be really difficult.

If you have access to professional help, I say absolutely avail yourself of anything that you have access to. There’s also DIY therapy out there, which I think is a really fantastic, more accessible option for a lot of people. Whatever self-care looks like to you and to whatever extent you can do, and I know kind of how ridiculous it is to say that during a pandemic, when kids are home and people are stretched so thin already, but just setting a few minutes aside for yourself on a day when you’re going to be working on your complaint, or you’re going to be thinking about it.

Just being really gentle with yourself and giving yourself whatever you need. I mean, it might be as little as not waiting to pee, go take care of it when you feel like it. If you need water, go get water. If you want to stretch your legs, stretch your legs. Just these really, really simple, basic ways you can show yourself that you’re taking care of yourself. All of that will help a little bit. Any quiet you can get can be helpful. Of course, some people want to avoid quiet because of the trauma.

But yeah, you, whoever you are, is really the best person to figure out what you need psychologically and what your body needs. So, just pay attention. Even the littlest things can really create a little bit of a sense of comfort and a little bit of safety, really simple stuff, like I said. Listening to your body, eating when you’re hungry, going to the bathroom when you need to go to the bathroom, washing your face, washing your hands, stretching your legs, walking around a little bit, taking five minutes to just close your eyes in some quiet. Put some headphones in. Whatever you can get to during this pandemic when we’re all like crowded in together in close quarters. 

Rebecca Dekker: Yeah. I’ll never forget when you were working with Caroline on the legal case in Alabama, and you told me that one of your requirements were for working with anybody on a legal case, because you do this almost like legal doula, helping people through the emotional and PR aspects of filing a lawsuit. One of your requirements is you require people to have therapy if they’re filing a lawsuit. Is that still the case? 

Cristen Pascucci: Yeah, for sure. No, but I will say, and I don’t want to sound so like kind of elitist about it, because I’m not saying like, oh, you need have to have professional therapy in order to work with me, but there’s so much you can do. For example, if I’m working with someone who’s pursuing a lawsuit, I make it really clear that they have to prioritize their mental health, and if they don’t, it could totally derail their case. I’ve seen it happen way back when I saw it happen enough, that I was like, oh wow, this is something I have to be really upfront with people about.

Because a lot of people have trauma around these situations, one of the urges, sometimes traumatize people get, is to take action, immediate action, and you feel like that’s where your healing is going to come from. So, manically, pursuing legal options, for example. Then after a while, as your trauma sort of processes more, you might find that you don’t have any energy for all of that stuff that you started. In fact, your trauma is sort of hitting you and you have the opposite effect. You’re actually completely depressed, completely exhausted.

Rebecca Dekker: And you want to avoid thinking about it or talking about it. 

Cristen Pascucci: Yeah. I think it’s important. It’s something that I make sure that I talk to people about, is having some real awareness and attention around how your trauma is figuring into how you’re moving forward. Because if you’re hanging your healing on this process, that’s probably not going to be successful. You have to really actively work on your own healing and use this process in a thoughtful way. Does that make sense? 

Rebecca Dekker: Yes, it does. Cristen, thank you so much for coming on the podcast. I know people can follow you at birthmonopoly.com and on Instagram and Facebook @birthmonopoly. Are there any other projects or resources you want to tell people about before we go? 

Cristen Pascucci: I just want to remind people about the complaint resource that we have multiple pieces of that coming out. A bunch of it’s out, a bunch of it’s coming out more, but mostly, we’re working on this documentary called Mother May I. That’s sort of my big gamble to get all this stuff out in the public eye. It’s about obstetric violence and birth trauma, and it’s also about the business monopoly on childbirth that keeps people inside abusive institutions and systems where we don’t even have options outside of abusive institutions.

We’ve been working on that for a few years now. We’re kind of coming towards the end of the process, and anybody can check that out at mothermayIthemovie.com, and feel free to contribute to the cause. It’s a movie, it’s expensive, and we can always use more funds and more support. So, thank you for having me on Rebecca. 

Rebecca Dekker: It was our honor to have you, Cristen. Thank you so much for joining us. Today’s podcast was brought to you by the Evidence Based Birth® Professional Membership, the free articles and podcasts we provide to the public are supported by our professional membership program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members at EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, and exclusive library of printer friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories.

We offer monthly and annual plans, as well as scholarships for students and for people of color. to learn more, visit ebbirth.com/membership.