Pregnancy and birth should be a time for women to prepare for motherhood — to have autonomy and control over their experiences and to choose the experience they want to have (barring medical emergencies, of course). But for too many women, that’s not the case — they report medical mistreatment during pregnancy and birth that results in birth trauma that can last long into motherhood. Now, a bombshell analysis from the Centers for Disease Control and Prevention (CDC) has begun to compile reports of mistreatment and birth trauma and explore its relationship to maternal mortality rates, which are much higher in the U.S. than in any other developed nation in the world.

The CDC’s recent analysis of 4,200 new mothers found cases of “ignored requests for help; being shouted at or scolded; violations of physical privacy; and threats to withhold treatment, or made to accept unwanted treatment.”

“This mistreatment is very troubling,” CDC Chief Medical Officer Dr. Debra Houry told ABC News. “This is why we need hospital systems, providers and communities to really be aware of this, because there’s many things we can do.”

Houry said the CDC’s findings were especially troubling as maternal mortality rates rise in the U.S., particularly among non-white women. In 2021, the latest year for which data was available, 1,205 women died of maternal causes — 32.9 deaths per 100,000 live births — up from 23.8 in 2020 and 20.1 in 2019. For Black and Hispanic women, the rate was 69.9 and 28 in 2021, respectively, compared to 26.6 for white women.

“We need to be more cognizant of it and make sure that women feel empowered to come forward as well when they’re experiencing this,” Houry said. 

But while cases of birth trauma and mistreatment of women during pregnancy and birth are not new, there’s historically been a stigma around talking about them. Caroline Malatesta gave birth to her fourth child at Brookwood Baptist Medical Center in Birmingham, Alabama, in 2016. After working with her doctor to devise a natural birth plan that emphasized autonomy and freedom of movement, Malatesta was physically restrained against her will while giving birth.

“They pulled me to my back, flipped me over, and I remember the pressure on my back being so intense that I lifted my right leg and even pushed against the nurse’s [hair net], just trying to fight to get back over,” she said. “The hard part came after, when everything’s quiet, everyone goes away, and there’s a sense of betrayal. I know that sounds unusual, but you have put your trust in these doctors, into this — these people who are supposed to be looking out for your care.”

In a landmark case that helped spark a national conversation about maternal mistreatment, Malatesta sued the hospital for medical negligence and reckless fraud and was awarded $16 million. But that doesn’t erase the months she lost to PTSD and debilitating pelvic nerve pain, both of which took a toll on her relationship with her husband and her ability to parent her newborn.

“One of the biggest roadblocks is that women feel like, ‘Well, if I talk about what happened to me, it shows I’m just selfish because I wanted my birth to be a certain way when really I should have been thinking about the safety of the baby,'” Malatesta said. “Women have these birth plans because they care about the safety of their babies.”