My name is Kate Macdonald and I started The Reproductive Justice Story Project as a place to talk about mistreatment and abuse in reproductive healthcare across Ontario.
I have struggled with the effects of my birth trauma since my baby was born in February 2017. In the days and weeks after returning from the hospital, I began to experience vivid flashbacks of my birth experience. I couldn't even sleep on my back, lounge with my knees apart, or be touched anywhere on my body without having sudden intrusive memories that sent my heart racing with panic. I'd wake up sobbing in the night feeling completely shattered and violated again. The physical sensations felt so real that it was like I was right back at the hospital.
At appointments throughout my pregnancy, my midwives would ask before they touched me, explain what they were planning to do to me before they did it, and let me know that I could ask them to stop at any time. I didn't have to ask for special treatment or disclose my history of trauma in order to receive care that honoured my right to feel safe, have control over, and make informed choices about my own body. I really needed this because of all the times in my life when people haven't asked permission or listened when I told them to stop. I had no idea that as soon as there was a transfer of care to my neighbourhood hospital, the standard of care I'd grown accustomed to would no longer be available to me.
I gave birth at St. Joseph's Health Centre. It's a hospital with a reputation for being less welcoming to midwifery clients than most others in Toronto; one of the last (if not the only) that still forces midwifery clients to have their care transferred to the hospital for inductions and epidurals.
I wrote a letter about my negative experience to the hospital's patient relations department to explain what happened and why it didn't sit right with me. The response I received was disappointing, re-traumatizing, and blatant victim-blaming.
As a result of my complaint, I had three separate meetings with various hospital officials including Elena Holt, clinical program director (women’s/children’s program) and Dr. Sybil Judah, chief of obstetrics.
The way individuals in positions of power respond to patient feedback sets the tone for all care providers working beneath them and informs the culture of the institution as a whole.
In my meeting with Dr. Judah, she shared suggestions of things she believed I should've done to avoid a traumatic birth. For example, I should've disclosed my history of trauma to every staff member so they would've known to give me special treatment. I should've come with a written birth plan. My midwife should've been there. I should've asked for a different nurse to replace the surly and abusive one that I was assigned. That just because a request of mine had been recorded on my file it didn't mean that my nurse would have actually read my chart. She said I should've spoken up at the time and asked to speak with a manager. I should've known to have done all of that while I was in incredible pain, in the middle of the night, in an unfamiliar place, experiencing labour for the first time.
I feel that this response was unacceptable. It should never be the burden of a labouring patient to manage the staff in charge of their care.
My Birth Story
I have a history of trauma. I have experienced intimate partner violence and various forms of abuse so I don't feel safe when any medical care provider puts my sense of bodily autonomy at risk. I don't always feel safe in hospitals because they've been the setting of experiences that were disempowering, humiliating, and dehumanizing in my past. Like many survivors of trauma, I often find it difficult and painful to talk about my experiences and to advocate for myself. During my stay at St. Joe's, my PTSD symptoms were triggered over and over when staff ignored my wishes, minimized and invalidated my concerns, and rushed me to participate in their own plans.
I don't think it happened because the staff were intentionally trying to hurt me. I think it happened because they lacked the skills and training necessary to provide sensitive, trauma-informed care. The culture of the institution itself did not seem to emphasize the importance of accountability and patient-centred obstetric care. Many of the staff members I encountered didn't seem to understand that for patients, labour and delivery can be distressing and overwhelming (even for patients without histories of trauma) and the words and attitudes they choose can have very real consequences in the moment and beyond.
There were many times during my hospital stay when a simple tweak to a staff member's bedside manner could've made a big difference to me. I had been really hoping for a homebirth because of my negative feelings and fears related to traumatic hospital experiences and medical interventions in my past. It looked like I was going to get the birth I wanted until week 41 of my pregnancy.
During a home visit, my midwife took my blood pressure and noticed that it was suddenly higher than it had been for all of my pregnancy. It was too high for a homebirth, she said. I took the afternoon to relax and try to bring the numbers down naturally but when we checked again later, my blood pressure hadn't dropped. It had climbed slightly higher. I headed to the hospital to be monitored and to have some bloodwork done.
All the tests came back normal, but the on-call obstetrician Dr. Joseph Daly (who has since had privileges at St. Joe's revoked) came for a consultation anyway. He brusquely recommended that we induce labour and warned of the potential risks of waiting. I'd felt tense and wary of him right away, but when he said he'd need to do an internal vaginal exam, I felt true panic brewing. His bedside manner was already off-putting and it had taken a lot of self-talk and kleenex earlier that day to get me comfortable with the idea of even setting foot in the hospital. I was feeling very uncomfortable with him after just a few minutes and didn't want to jeopardize the calmness that I'd been working so hard to maintain. We asked if my midwife could do the exam in his place but he seemed impatient and asked me incredulously why I wouldn't be comfortable with him performing the exam in the first place. He wouldn't allow my midwife to check my cervix. His tone was condescending and seemed to strongly imply that I was wasting his time if I didn't follow his induction plan without question. I felt that if Dr. Daly was unable to take a moment to help me feel more comfortable before active labour had even begun, his approach likely wouldn't change if I went through with an induction under his care, so I declined and returned home. I found out weeks later that my midwife had actually caught him in the hallway before this exchange and let him know to be mindful that she suspected I had a history of trauma. This was the way he treated me even after receiving that information.
I went home for the night but had to return the next day to repeat the bloodwork and monitoring. Nothing in my condition had changed overnight, but there was a new obstetrician on shift who had a very different attitude. Dr. Paul Davies was on-call that day and he took the time to explain why he too recommended that I agree to an induction. He was much more gentle and respectful when he spoke, and he didn't make me feel like I'd be foolish if I didn't take his advice. He made a point of saying that my midwife was totally competent and capable of doing the vaginal exam herself but that he'd need to perform it if I decided to go ahead with an induction. Overall, he had a similar message that Dr. Daly had had for me the night before; I needed an induction and the doctor must perform the vaginal exam - but Dr. Davies delivered it in a much kinder way. His approach didn't take up more time or resources, but to me, it made all the difference. I decided to take his advice and started an induction that afternoon. He inserted a foley catheter into my cervix and sent me home to let the device do its work. It was a really painful day at home but I was hopeful that this process would kickstart my body to do its thing. I'd badly wished for a homebirth and was feeling very frightened of the possibility of more medical interventions.
My partner and I were told to return to St. Joseph's at 10pm that night ready to check in to a birthing suite and continue with my scheduled induction. Even though we were the only couple in the waiting room, we waited an hour before the desk staff would check us in. We weren't sure of the reason but they wanted to finish all their paperwork at the desk and turn off lights for the night before they showed us to my room. My midwife did not meet us there because, unlike most other hospitals in Toronto, inductions at St. Joe's are still transfers-of-care for midwifery clients. When we were finally settled in our room just after 11pm, the hospital staff were already impatient, I asked to get a glass of water and a nurse told me to "hurry up, we need to get started." A medical student came to take down my information and history. He asked if there was anything I'd like the team to know. I said I did not want to be offered an epidural because if and when I decided I was ready for one, I wanted to be the one to ask for it and would let the staff know. This was important to me.
Earlier that day when the foley catheter had first gone in, the pain was unreal. I was convinced that I needed pain relief right away, but I went home and found that I was somehow coping with the intense contractions in my back and uterus all on my own. When we got back to the hospital, I wanted to feel like I was maintaining some semblance of control when all the hopes and plans I'd had for my birth experience were already feeling out of reach. I thought I'd made my wishes regarding the epidural pretty clear. The student didn't indicate that they'd have any trouble meeting this simple request. He nodded, he smiled, he wrote it down on my file and left.
My assigned nurse Carmen Gheorghiu arrived a few minutes later. She gave me a hospital gown and told me to put it on. I asked if I could have a second gown to wear like a robe to keep my body covered like I had earlier that day while I was at the hospital. Without looking at me she said no, that I'd just be lying down the whole time so I wouldn't need it. Her response felt too blunt but we'd only just met, I hadn't had a chance to do anything that would warrant rudeness on her part so I brushed it off as a misunderstanding. I was confused, though – I definitely hadn't been planning to lay down all night tethered to a machine until my baby came. I'd been practising breathing and stretches at home and had even packed my exercise mat so I could labour comfortably in different positions on the floor if I needed to. I figured there must be another reason why I couldn't have a second gown so I didn't ask again.
Next, a new doctor (who's name I didn't catch) came in to remove the catheter. She yanked it out of my cervix forcefully, I cried out in pain, but she said it had just been sitting there loose in my vagina, which was not at all what it had felt like. Even after hours of contractions, I'd just barely dilated to 3cm. She broke my water manually saying it looked clear, healthy, and meconium-free. She left and we didn't see her again for many hours.
I sat in a growing pool of amniotic fluid while I was started on an IV for the chemical induction. After a few minutes I asked my nurse if we could change the soaked pads I was sitting on. She said something very curt along the lines of “No. Later. You'll just get them wet again.” I was taken aback. Again, I thought there must be a reason that she responded in this way but it still felt harsh. Maybe she felt it would've been futile to change the bed right away because I'd keep leaking fluids, but I on the other hand, didn't want to sit in pain in a cold pool of uterine goop for any longer than I had to! Instead of recognizing that I was uncomfortable and assuring me that she'd help me feel comfortable again soon, she had just shut me down.
After waiting a little while, my partner helped me out of bed so I wouldn't have to sit in the cold wetness any longer. We asked why the fluid was green. She snapped that it was "just meconium!" as if it were a silly question – the doctor had just assured us that there was no meconium in the fluid, so I thought it was a reasonable thing to ask– but she didn't give any further information and didn't mention it again. Eventually, nurse Carmen reluctantly freshened up the bed but moved around the room without looking at me or acknowledging me. She was distant, peremptory, impersonal. She had poked at me in an unfeeling business-like way when she'd gotten the IV ready in my hand. She was unable to get the needle in on my first hand and had to try a second painful time on my other side. She didn't talk me through what she was doing and appeared impatient and frustrated that my veins weren't cooperating, as if I was urging them to disobey her on purpose.
Due to my high blood pressure, I had to have blood pressure readings taken frequently. It was unusually painful on the automatic hospital machines because I had edaema in my hands from my pregnancy. My fingers were filled with extra fluid, making them swollen and sausage-like. Each time the computerized blood pressure cuff tightened on my arm, it was much more painful than it should have been. The excess fluid was forced into my lower arm, hand, and fingers, stretching my already tight skin to its absolute limit. I felt shooting, stabbing, burning pains in my hands, leaping down to each fingertip. It felt like my skin might actually burst. When paired with my intense back labour, it was unbearably painful. I was literally sobbing in pain every time. Carmen seemed to find this particularly ridiculous. I don't think she understood why it was so painful for me, and she certainly never asked. Once she even snapped that maybe "it wouldn't hurt so much if you'd just keep still!"
Perhaps she noticed that I was trying to stay very still but the pain still kept coming, because later she tried to explain to me that it was painful instead, due to the fact that I hadn't allowed her to rip the small bandaids off of my inner elbows where I'd had blood drawn by my midwife over the past two days. She said that with the bandaids there, the machine wasn't able to read my blood pressure correctly. Even in my distracted state, I knew this made no medical sense and I'd felt just as much pain before the bandaids were there. It felt like she was talking down to me and lying to my face.
At one point while taking my blood pressure, She asked me to rate my pain on a scale of 1-10. I was shocked that she'd suddenly decided to take an interest in my discomfort so I asked her if she meant the pain from my blood pressure cuff. She actually gave a little laugh, saying, “Ha! No! I mean your contractions. I don't care about your blood pressure!” I couldn't believe it. It felt terrible to be spoken to in this way when I was in such excruciating pain. As my contractions became more painful, I told the nurse I'd like to use laughing gas. She said "Okay" coldly and left the room for a while. She didn't return with gas when she came back. I had to ask again a second time before she bothered to take my request seriously.
Throughout our time together, nurse Carmen made a point of telling me quite often that I should just get an epidural already. I thought I'd made it pretty clear when I arrived that I had no interest in receiving these types of offers, but they kept coming. A lot. She repeated it often without a shred of concern or empathy in her voice. She didn't seem to be sympathizing with my painful labour and offering a kind suggestion to help me cope. Each time she told me to get an epidural it was as if she was complaining to the room itself. Sometimes she'd be typing at the computer, absorbed in the screen. Sometimes facing away from me towards the privacy curtain. Sometimes she'd just say it as she moved to exit the room. It didn't seem to ever be while looking at me, facing me, or actually having a discussion with me. It felt very weird and petty, as if she was annoyed that I wasn't labouring in a way that was convenient for her.
My partner and I both agreed after talking about it later that it felt like maybe she was pushing an epidural so hard because I was causing extra work for her. We thought she must've had many other patients to check on, given the way she seemed so busy and so inconvenienced every time she had to come back into my room. It was the night shift after all, and it would've been a lot less work for her if I'd been heavily medicated and sleeping. We found out after that the ratio of patients to nurses in the birthing rooms is actually 1:1.
Throughout the night, my contractions were frequent and intense. I had back labour so my whole lower body was consumed with pain. I would breathe into the mask attached to my laughing gas as I felt a surge coming on. Sometimes in between contractions, my back would spasm again or my baby would kick forcefully inside me causing more intense little spasms in the front of my belly. I would try to relax and take a single deep breath in my mask. My nurse didn't seem to like how often I used the gas. At one point, she poked her finger roughly into my belly saying, "You're not even having a contraction! Don't use the gas!"
I started to get the feeling that maybe my nurse was not on my side. She was not providing even the bare minimum labour support I had expected. It didn't feel like she was there to help me get through this experience at all. I hadn't paged my midwife yet because my cervix had made very little progress and I guess I'd thought I'd have lots of helpful and supportive people around between hospital staff and my partner.
The fetal heart rate monitor that was strapped to my belly was losing the heartbeat often as my baby and body moved. This would make the machine beep, even though there was nothing wrong with my baby's heartbeat. It seemed like my nurse found this very frustrating, as she had to come in and silence the machine each time it happened. Every time I had to be unhooked to waddle to the bathroom she'd wordlessly undo the monitors without looking at me. I was in a ton of pain, experiencing labour for the very first time, it was the middle of the night and I had barely slept for days. I remember feeling very strongly as if I was in her way, like just by being there was causing frustration for her.
The last straw was when Carmen strode in with the doctor around 3 am to tell me (not ask me, not discuss with me) that they'd now be putting a heart rate monitor on my baby's head to eliminate the inconvenience of the beeping belly monitor I'd been wearing. It happened so fast, I didn't feel prepared or like I had any say at all.
My partner and I were exhausted and bewildered. Carmen lowered my bed down flat. I felt very exposed and vulnerable, being on my back like that with my knees apart while a pushy stranger was doing an extremely painful thing that I didn't quite understand. The process involved the doctor reaching right into me to attach a wire onto my baby's scalp. It was absolutely excruciating. After two failed attempts to attach the monitor, I sobbed for the doctor to stop. She told me in a condescending tone "No one is trying to hurt you, Kate!" which felt so cruel and dismissive. Was she implying that it shouldn't hurt as much as it did, or that I should be able to handle it? She did not seem empathetic at all. She did not acknowledge that what she was doing was very invasive and very painful. It was one of the most dehumanizing parts of my hospital experiences. For months since, I've woken up in tears after dreaming about it, or been interrupted while going about my daily routines by vivid physical flashbacks of the feeling of her fingers twisting inside me.
So many of these staff interactions left me feeling like I was getting in the way of them doing their jobs, not like I was a person who they could've worked together with towards our common goal of bringing out a healthy baby.
At some point during this time, the doctor's attention was drawn to the medical tape on my inner thigh that had been used to secure the foley catheter earlier in the day. I had chosen not to tear it off myself yet because it was very stuck and would've hurt very much. It wasn't in anybody's way. The doctor wanted to rip it off for me now but I asked her to not to because it still felt very stuck and was pulling at my sensitive skin and leg hair.
A few minutes later, without any warning, Carmen reached over and started to tear the very same tape off my skin. She had not asked permission and she did not check-in or warn me first. She had clearly not listened to me tell the doctor just minutes before that I didn't want the tape to be pulled off right now. I had no idea why she would think that was an appropriate thing to do. I was already crying and yelled at her to stop. She did, but then (again without a word of warning) she started moving my bed position with the controller. I was having a contraction and was in a lot of pain. I wanted to remain in the same position until the pain subsided. I sobbed for her to "stop, stop, STOP!" But she would not. The bed continued to move. My partner had to tell her to stop again and physically reach over to place his hand on her arm before she took her own hand off the controls. All she said in response was a flat, "oh, I didn't know you were talking to me."
At this point I absolutely lost my cool and began yelling through my tears at her. I felt she hadn't been listening to me all night. I told her how frustrating it was that she refused to honour my request of not pushing the epidural on me. I told her everything I'd been politely keeping to myself, hoping not to cause a fuss, since I'd arrived. I sobbed until the room cleared out. I paged my midwife right away to say things were not going okay without her and I'd be needing some support after all.
I don't remember the nurse coming back into my room after this. Another nurse appeared in her place who was much more reasonable and I laboured through the rest of the night with the help of my midwife and partner. I filed a complaint against nurse Carmen Gheorghiu with the College of Nurses of Ontario. She will be required to appear before a panel to be formally cautioned. She still works at St. Joseph's Health Centre.
Everything was easier once my midwife arrived. She gave me sterile water injections in my lower back which eliminated my back labour pains for hours. She was not bothered by my beeping belly monitors. She was there helping me through every contraction and offering gentle encouragement and physical support. By morning, I had been pumped full of pitocin all night was definitely ready for an epidural. I chose to have one. When the shift changed over, I was very lucky to be assigned a competent nurse who was gentle, kind, and communicative.
She actually looked at me when she spoke to me, listened, answered my questions, and even explained what she was going to do before she touched my body but it should not be a matter of luck whether a labouring patient is given a nurse who is sensitive to their needs.
That morning, right around this same shift change, a stranger came into my private birthing room. I'm not sure if she knocked, but once she was inside she didn't acknowledge me or introduce herself, it felt invasive and confusing. I didn't know who she was though she stood right beside my bed wearing her winter coat and speaking to my nurse. My midwife had to explain that this stranger in street clothes was actually an OB here at the hospital before she bothered to introduce herself to me.
My midwife left and I was able to relax for much of that day with the epidural doing its work. My cervix progressed very slowly, but by early evening, it was finally time to push. The shift changed, I was grateful to be assigned another caring and kind nurse. My midwives arrived, I started to push with their help.
The next few hours were a blur but my midwives consistently kept me in the loop as to what was going on when they touched me. They'd warn me before they inserted their fingers, saying things like “you're going to feel me touch you now” or “here I am, push against my fingers”. When they stepped out to have a quick break, the on-call obstetrician Dr. Beata Grygowski appeared and took over for a few minutes.
She did not talk me through what she was doing or warn me. She worked as if I wasn't in the room with her at all. I couldn't feel the full extent of the pain through my epidural, but I felt the extreme, alarming pressure of her pulling me apart using both hands. I had no warning and had no idea what was going on. My trauma response was reactivated. I was completely frozen and unable to call out to her in the moment. It was far more forceful than anything the midwives or nurse had been doing so far. I was fully convinced that she had physically torn my flesh with whatever she'd been doing without an explanation or my consent. I've felt extremely violated and upset by this ever since. I had to talk about it with my midwives later before I could begin to accept that maybe she hadn't actually ripped me with her gloved hands. For months after, I would often wake up sobbing in the middle of the night from flashbacks and nightmares of her fingers inside me, trying to tear me apart.
There were a pair of medical students who showed up periodically. They consistently left my door ajar and left my privacy curtain slightly open so that when I looked towards the door, I could see people moving through the hall. They'd stand at the foot of my bed while I was totally exposed with my feet in the stirrups and smile. I had no idea why they were there or what their role was. I had to ask for others in the room to close my curtain and door every time they left. It was totally infuriating but in my confused state I wasn't able to make it clear that I wanted them to stay away, so they kept coming back. Carelessly leaving me exposed to the world each time by not bothering to leave my door and curtain as they'd found them.
During this time, two unwelcome family members showed up at the hospital. I had not told them my room number myself because they were not invited to the birth but they were directed, no-questions-asked, to my private birthing suite by hospital staff. There was a knock at the door and I looked over, through the curtains the medical students had left open to see the unwelcome guests in the doorway, peering in. I was half-naked with my feet in stirrups. I felt so humiliated and violated once again.
A couple hours after I began pushing, my baby was finally born. My midwifery student carefully massaged my belly while interacting with me to help squeeze all the extra fluids out. I remember Dr. Grygowski reaching up without warning to push down very sharply on my gut as she said “Midwives are too gentle!” I heard a big gush of blood and fluids splash out. It was a shock for her to touch me so roughly without warning and I wondered later why she wasn't able to let me know or help me prepare by counting with me, for example. She and the medical students stitched me up, ignoring my request for more freezing in my perineum. I was sure I felt the sting and tug of the needle each time. I was beyond relieved when the three of them finally left me to relax with my new baby and my partner.
I'm very happy with my baby, and I'm so glad he was born safe & healthy but I wish my experience at the hospital had been less negative and disempowering. Although there were some caring and capable staff members that were part of my care, what stands out the most when I look back on my experience are vivid recollections of moments in which my consent was absent and right to dignity and compassion was ignored.
After I came home from the hospital, I just couldn't shake the negative feelings about my birth. I needed the hospital to know what had happened and why it was not okay, so I wrote them a letter. It took me six difficult weeks to get it all on paper. I wrote and rewrote, often breastfeeding my newborn with one hand and typing with the other. I remember crying to my partner about how, even when it was all written down, on ten typed pages with every detail I could remember, I still hadn't captured how terrible it felt.
I began posting in online forums and talking to new parents at drop-ins and groups, wondering if others had had similar experiences to mine. I learned that although many report having had really positive experiences, so many others leave the hospital feeling disappointed or hurt by the way they were treated. I am not alone. This is not just a problem at one hospital, it's happening all over.
If stories like mine are not uncommon, why are so few patients speaking up? Why is it so hard for us to express ourselves in the moment or return to share our feedback once we've had time to process it?
During these conversations, the reports given by community members ranged from small cruelties, to acts that in any other setting would absolutely be considered sexual violence. Why do so few survivors of sexual violence come forward? The parallels here are too strong to ignore.
Given the response I received from St. Joe's regarding my concerns, it's no wonder more people don't talk about their own. It's absolutely crushing to be told, implicitly or explicitly, that what you went through was somehow your own fault. That if only you'd done or said something differently, things might have been okay. That you should just be thankful it wasn't worse. That maybe it wasn't that bad after all. That you should just put it all behind you now and quietly slink away into parenthood.
It's time we speak up about mistreatment and abuse at the hands of healthcare professionals in Ontario. It's time we held our care providers accountable. We need to start talking about what respectful, dignified, compassionate care looks like and how to make it a reality for every patient, not just the lucky ones.
I know from experience that it's hard to speak up. It is so, so hard. I'm hoping that The Reproductive Justice Story Project can help make it a little easier.
If any part of my story resonated with you, please consider getting in touch to share your birth or reproductive healthcare experience anywhere in Ontario.
Change can happen if we all speak up together!