Caroline Malatesta was pregnant with her fourth child when she made the decision to give birth at Brookwood Medical Center in Birmingham, Alabama. Malatesta and her husband, J.T., made the choice based on Brookwood's promise that their center focused on natural birth and making delivery an empowering experience for women. Unfortunately, the center did not live up to its advertising, and Malatesta was not only left with an incredibly traumatic birth experience, but with diagnosed PTSD and a painful, permanent physical injury as well. In August 2016, Malatesta finally got her day in court, where she was awarded $16 million and the affirmation that her birth experience was not only unacceptable, but a direct result of misrepresentation by Brookwood.

In a country that has a host of issues surrounding maternal and fetal care (as well as a rising maternal mortality rate), Malatesta's victory has the potential to make a significant mark on not only the way we talk about birth, but on how providers market it and follow through on their promises. She spoke to Cosmopolitan.com about her ordeal.

My first three labors and deliveries were medicated, on-your-back deliveries. After my third child, a local hospital opened a new women's center. They had an ad on TV where a doctor was talking about "natural childbirth," and how they were embracing the concept. That added for me a layer of legitimacy that maybe natural birth could be better, especially when you hear a doctor talking about it.

This new hospital [Brookwood Medical Center] started advertising heavily, and natural birth was one of the central themes of their new campaign, including water births. It was all about comfort and choice. It was about getting whatever you want out of your birthing plan. That's what first drew me in and eventually convinced me to leave my longtime ob-gyn to birth at this hospital.

I had interviewed a doctor at Brookwood during my first trimester, just to confirm all of these basic, natural birth services that they were advertising. In our conversation, he confirmed what I had read. He said I could labor in any position, not necessarily on my back, and didn't need continuous monitoring.

I switched to Brookwood around 20 weeks.

On the night of March 11, around 9 p.m., I started feeling tightening and texted my doula that I might be going into labor. Around 11 p.m., the feeling became more consistent, so I called into Brookwood to let them know I was in labor. They told me to wait until the contractions were at least one minute long and five minutes apart. They were really mild contractions, so my husband and I decided to get some rest so we would have energy when my labor would begin to pick up.

Around 2:30 in the morning, I felt a gush and thought my water had broken (it ended up being bloody show), and even though my contractions were still far apart, we went to the hospital. When I walked into my birthing room, the nurse told me to go to the bathroom right away, because I wouldn't be able to get out of the bed for maybe for the rest of labor. I told her that my doctor said I'd have wireless monitoring and that I would be able to be mobile, but the nurse said my doctor wasn't on call. From that point on, it became a back-and-forth of "But my doctor said I could" and "But you don't get to." The nurse treated me like a disobedient child!

I was resisting, but at the same time, I was trying to accommodate because you're vulnerable, you're in labor. I do get into the bed, I do put on a gown (even though the hospital advertised you could wear your own clothes), I do get on my back, even though it was very painful.

Courtesy of Carolina Malatesta

I kept asking, "Why? Why?" but the nurse wasn't answering me. She ignored me, acting almost annoyed with me. As we went back and forth — me asking questions and telling her this was more painful for me, and her getting increasingly irritated — it became very clear that this wasn't about health or safety. It was a power struggle.

Then, suddenly, I felt a big contraction coming on and I jumped onto my hands and knees, and told them that I couldn't be on my back. My water broke and the baby's head started crowning.

The nurse told me to get on my back. I stayed on my hands and knees and breathed, trying to relax, as that is what came naturally to me. But the nurse pulled my wrist out from under me and flipped me over on to my back! Then another nurse held my baby's head into my vagina to prevent him from being delivered. The nurses were holding me down, and I was struggling — really struggling. I grabbed the side of the bed, and at one point, I even put my foot up against the nurse's shoulder and face to try and get leverage to flip back over, but was unsuccessful.

Because of how aggressively the nurses were handling me, my husband's first thought was that something serious was happening. J.T. thought either I was in danger, or the baby was, or even both of us. He was like a deer in headlights. He was at my head, telling me that everything would be OK, and was just trying to comfort me.

Now that he knows the truth, J.T. lives every day regretting that he trusted those nurses.

After six minutes of this, the doctor finally runs in. The nurse lets go of the baby's head and I felt immediate relief, because that deep pressure of her holding the head in against the force of my contractions was finally released. That's why I'm so horribly injured, because she kept holding the baby in.

It all happened so fast. The baby's head immediately popped out and my son was fully delivered a minute later.

And then I just focused on my baby, my son, Jack — the best part of all of this.

Courtesy of Caroline Malatesta

Over the following weeks, I expressed my frustration over the birth to my husband, to some close friends, and even to the hospital.

I just wanted to know why. Why did they force me on my back? But I never really got a direct answer. I got corporate runaround answers, and at the time, I didn't really push hard enough because I didn't realized I was permanently injured from the birth.

Signs of an injury started from right after the delivery, and over months, developed into a full-blown nerve injury. I was having abnormal nerve sensations: pins and needles, numbness, burning. I knew something was wrong. I kept going back to my ob-gyn and he kept reassuring me, because he didn't know anything was really wrong.

Then, in November, my injury flared up. I already wasn't able to have sex at all but had been managing through the pain. But, eight months after the birth, the worst of it came on suddenly. I was so debilitated that we had to move in with my parents and receive full-time help for me and my children. It's a very, very, painful, debilitating condition. I was completely nonfunctional for six months.

Despite the fact that Jack was a perfectly positioned little 6-pound, 14-ounce baby, and that I've delivered bigger babies at faster speed with no problem, I was injured badly. Because of the trauma I sustained from fighting while birthing, I now suffer from a permanent and debilitating nerve condition called pudendal neuralgia.

I grew up in a medical family. My dad is a doctor; my granddad was a doctor. Litigation, medical malpractice — it's not something we take lightly. When the nerve injury really revealed itself, I wasn't planning to file a lawsuit. I just wanted answers.

I tried to reach out to hospital administration. The patient advocate referred me to the vice president of the hospital, who referred me back to the patient advocate, but nobody was able to give me any answers. The patient advocate finally agreed to set up a meeting but then called me back and said, "Risk management and several key individuals have declined your request for a meeting. I'm truly sorry from the bottom of my heart for all you've been through." She ended the call abruptly by telling me that somebody walked into her office and she had to go. She told me to have a good day and then hung up the phone on me.

It was at that moment that I realized that despite not wanting to go through litigation, I had no other choice but to file a lawsuit, because they weren't going to listen otherwise.

The hospital made it very clear they were uninterested in settling. I don't think they took me seriously. I think a lot of times hospitals think it's just "silly women" who want their "silly birth experience." But it's more than that. These women that are making these choices are making real, medical decisions!

Two years after filing, we went to court. I wasn't at court all that much actually, except for only a couple hours a day, and even that was hard. I just couldn't sit that long in a chair. The jury took over nine hours to deliberate. I was an anxious mess.

When I heard the verdict, I was shaking. I was crying. I couldn't believe that all these years of fighting for the truth to come out and to get validation — it was finally over.

When I first filed the lawsuit, I had no idea what to expect. As litigation unfolded and after some early media, women from all over started contacting me about their own stories. I became acutely aware that this wasn't just about me. This became a cause for me, almost. To bring the truth out on behalf of so many other women. I was surprised how much it meant to these other women that I was filing a lawsuit.

Courtesy of Caroline Malatesta

This verdict is a wake-up call for hospitals that don't take women seriously. It's a wake-up call that they need to review the way they've been doing things and make changes. Sadly, I think it took this verdict to make them wake up.

Brookwood used the idea of natural birth as a way to lure in patients. I say that without a doubt. They were not providing the services they advertised. I think their marketing department got ahead of themselves, because they knew that women wanted these services. Women want to make their own decisions. Hospitals are advertising that women can make these choices like it's a privilege instead of a patient right. That's insulting to women!

So many women are told, "It's best to be flexible because birth is unpredictable," but I think that it's just a blanket excuse for anything that happens during a birth. I believe that's the most abused phrase in childbirth, especially when it comes to railroading a woman's choice.

I'm doing better today, but life is very different. I sleep a lot more. I have to rest in bed a lot more. I go back and forth between using ice packs and being in hot baths for portions of the day to help with pain. I am just in chronic, real, nerve pain in the most sensitive area of the body. Some days I'm a lot of pain, some days are better. You just take one day at a time. I'm still on a lot of medication, I still only do a fraction of what I used to do, I still can't have sex. I have to reserve my energy for the important things. The nerve has to stay quiet. It would have to be a major medical advancement or a miracle for it to get better. I refuse to say never. I have to hold out some hope.

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Related: Millions of Women Are Injured During Childbirth. Why Aren't Doctors Diagnosing Them?

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