It is an unfortunate truth that women are repeatedly let down by the medical systems that are supposed to care for us. Far too often, concerns are dismissed or minimized, or there's an implication that our physical symptoms are all "in our heads."
Most of us have been in this situation at least once, or we know someone who has. There are many reasons for this lack of appropriate medical care, including a general lack of knowledge about women’s symptoms, bodies and the conditions that disproportionately affect us. That is due, in part, to the legacy of decades of women being underrepresented or excluded from medical research. This continued and deepening erosion of trust between women– particularly women of color– and doctors can have devastating consequences.
We wanted to share the care diary of Marvi Rivera, a Puerto Rican woman based in Washington, D.C., who very sadly lost her baby and experienced mismanagement by her care team before, during, and after her loss. Our hope is that, by sharing, we can get more women's stories into the light and emphasize the critical need to take women's health concerns more seriously.
I went to my first prenatal visit and met with resident Doctor R_. All normal.
I decided to try the midwife approach and had my first appointment with midwife Julie B_. All normal.
I picked up my friend from the airport and noticed a general feeling of pain and discomfort through my body. I remember that when I drove, if I hit a pothole or any sort of bump on the road, I would brace because I felt the impact within my body too.
I tried to contact the midwife group and was unable to get a hold of them. I started my 50 minute drive to work and realized I was in too much pain to bear that drive, so I drove to the Emergency Room instead.
My pain and tenderness was now more evident and specific to the lower left abdominal quadrant. I was assessed in the ER and later sent home with a recommendation to take Tylenol for the pain. I spent the weekend at home with some 99-100 degree fevers and still managing the abdominal pain that prevented me from moving around normally.
I called the midwife group again and was able to leave a voicemail this time. I never received a call back from them. I went to work but was still in severe pain to the point where walking was very difficult. My fevers and pain continued so I decided to return to the ER.
This time, I was able to see one of the doctors from the OBGYN group, Dr. B_, He told me that my pain was due to degenerating fibroids and a urinary tract infection. I was sent home with Indocin, Macrobid and Tylenol.
This was a “routine” prenatal visit scheduled from weeks prior to my incident and now a follow up with my doctor. I saw resident Dr. O_ and we both agreed that I was feeling a lot better. I expressed my concern about the fevers still being persistent, but was told to continue using Tylenol to manage them.
After another weekend in pain and with persistent fever, I called the OBGYN practice first thing Monday morning. I heard back from their Front Desk at the end of the day and went to pick up a second dose of anti-inflammatory medication that evening.
After a week of persistent fevers and pain, I took myself to the ER a third time. At this point my fevers had gone up to 102-103 with uncontrollable and painful shivers. I was starting to get scared about the baby’s ability to survive and my ability to sustain the pregnancy. When I went to the ER, they did blood cultures. The technician taking the cultures lowered his mask and blew air on my arm after disinfecting the area he would use to draw blood. I reacted by just looking at him but was so exhausted that I sat there in quiet shock.
Hours later, Dr. R_ came in with Dr. S_, both from the same OBGYN group. They asked me about the fever and I told them about the 103s I had been dealing with at home. She checked my personal thermometer to ensure it was working correctly by comparing it to the hospital thermometer. She struggled to figure out how to remove the thermometer from the wall hanging unit. First, she checked my temperature with a thermometer set for rectal temperature. Then, she checked my temperature with a thermometer that did not have the required plastic cover. We agreed that my home thermometer was working properly and they proceeded to prepare me for a pelvic exam.
At this point, the doctors realized they had no gel and decided to use sink water for lubrication. That was very odd and extremely uncomfortable, but I admit again that I was so sick and exhausted, I figured it was what I had to do to ensure we were healthy. Dr. R_ recommended a follow up visit and she thought my upcoming visit scheduled for May 4th would be good enough even though it was a bit far out. I was sent home and told to take Tylenol every six hours to manage pain and fevers.
The violent shivers and high fevers worsened throughout the weekend, to the point where my whole body would shake, my lips would turn blue and I would spend hours with cold compresses trying to lower my body temperature. I was hopeful when I got through Sunday without any high fevers.
As I got ready to head out the door for work on Monday, I felt lightheaded and sat down to gather myself. Almost instantly, another fever of 102 kicked in with violent shivering and I called the OBGYN’s office with the details. They called me back about an hour later asking me to come in for an appointment on the 27th. I thought, after my recent history, they would know best so I remained in bed with my cold compress and Tylenol.
I headed to the OBGYN’s office for my follow up. Dr. O_ saw me first and we talked about how the baby was usually very low which always made it hard for them to find his heartbeat. I told him I was used to that and was more concerned about my persistent fevers. He called Dr. B_ in and confirmed that he could not find a heartbeat. They told me to go to Labor & Delivery and drew me a map of how to get there. I still have that lame map. They also gave me time to call my boyfriend and after a few minutes, I was on my way to L&D alone.
It would take Brad 40 minutes to get to us. I think I called my boss to tell him I would not be able to go to work that day. I think I called my dad after that and started crying uncontrollably in the parking garage. After talking to him for a couple of minutes, I got in my car and started driving to L&D. I called my coworker and best friend to tell her I could not get to work because the baby had no heartbeat. We both cried as I frantically drove around trying to find L&D. I honestly don’t remember how I found it, but I did.
I walked myself to Clatanoff Pavilion and checked in. They put me in a room to wait for the doctor. Brad arrived. Dr. S_ did the first ultrasound — no movement from the baby that had been an active wiggle worm days earlier. She explained that a second ultrasound had to be performed by a different provider to confirm the findings.
We waited for about 20-30 minutes until Dr. Ra_ came in. She apologized as she did not know we were waiting on her to move forward with my plan of care. She confirmed there was no heartbeat and then explained my options. I could do a D&C, go home and miscarry on my own, or deliver the baby at the hospital. At that point and with limited info, I just wanted to be done with the pain of carrying my dead baby so I was leaning towards D&C. Doctors decided I needed to go to Maternal Fetal Medicine first, in order to perform an amniocentesis. Dr. S_ said she’d call MFM and let them know I was headed that way.
When I arrived at MFM about 15 minutes later, the Front Desk did not have a clue as to why I was at their office. Now I had to explain, in a lobby with other patients, why I was there, on top of having to manage the last series of events.
Dr. G_ performed the amniocentesis —she was remarkably kind and so was her staff. Immediately after the amniocentesis, I noticed I was spotting and told Dr. G_. I waited for instructions and was told to go home, pack a bag, and return to L&D since I was now actively bleeding. I went home to pack my things and received a call from Dr. S_ wondering if I was indeed going to come back to the hospital.
Upon arrival, the hospital’s visitor desk staff demanded I check in, but I told them I was bleeding through my pants so they figured it would be best if I just continued walking to L&D. Once at L&D, I decided I would deliver my baby, but I was terrified of the option to hold him because I did not want to have my last memory of him be a bloody mess of a misshapen human. I did not voice this concern to anyone because I did not know who to talk to or when to talk to them.
They did test me for COVID for the first time at this point, despite my current visits to the ER in the last two weeks. They induced labor and what I now think was contractions, started. Since I was only 19 weeks along, I had not made time to familiarize myself with what to expect during labor. The nurses did tell me to be careful when I went to the bathroom. At some point, someone asked me if I wanted an epidural. To be honest, I had vaguely thought about having an unmedicated birth without knowing its implications one way or another. After all the pain and fevers I had been feeling for the last few weeks, I thought the epidural would be a welcome relief. The anesthesiologist, Dr. F_ blew us all away when he came in as empathetic and kind as ever possible. I will never forget the way he explained everything, cared for me and expressed genuine concern for what we were experiencing.
About a half hour after my epidural was in, Dr. F_ came back to tell me he had to remove it. They had just realized that I had an infection that had spread to my blood. I don’t think I even understood the seriousness of what he said, but I trusted him and allowed him to remove it. My contractions quickly became more evident and I remember the nurses asking me to rate the pain level from 1-10.
The last time they asked me that, I gritted my teeth and waited a few seconds for the pain to wear off before I verbalized “nine?”. She left the room. During the following contraction, I felt like something dislodged around my pubic area and I told my boyfriend to call the nurse. I was crying at this point… I think it was mostly fear of not knowing what was happening and the pain being so severe. My next contraction was my last one and I felt a slippery, warm whoosh of a mass exiting my body. I cried and told my boyfriend that something had come out; I asked him to call the nurse again.
The nurses showed up, cleaned everything up and took my baby to a different room. I remember wondering where my mom was and desperately trying to get her to hurry to the hospital. She made it to the room about 30-45 minutes after I delivered. They let us see and hold the baby. He was born en caul, weighed 9 oz and measured 9 in. At some point after the delivery, I went to the bathroom and an alien-like long mass fell out of my uterus. Three nurses were unable to explain what it was so they called Dr. S_ and she dismissively stated it was just membrane remains.
The nurses explained I could ask to see the baby whenever I wanted to, I could shower independently once I was cleared from the epidural, I could have all the visitors I needed and that they could come and go as needed. So we did just that.
I remained in the hospital for observation due to the infection and the staff started to get so confused about my plan of care that one of the nurses asked me which antibiotics I was receiving. I asked her to stop and make sure she had the right antibiotics and treatment. I think this was the first time I asked to talk to someone in charge because my entire experience with the hospital and the practice had been a chain of “drop the ball” moments. A patient advocate representative came to see me the following day.
I slipped stepping out of the shower and hit my head on the bathroom floor. I had to get a CT scan and stay for an extra day. The technician transporting me told me I should be thankful I was not as sick as most of the people in the hospital — not the most reassuring words I needed to hear at that point. A week later, when I was reading the medical reports, I found out that the nurse that filed this lied about it. Her report said I went to the toilet, tripped on a towel, jumped in the shower and refused care. Both my mom and Brad can confirm that is not what happened.
Dr. A_ from Infectious Disease came to visit and asked me what was preventing me from going home. The staff had been telling me that Infectious Disease was the deciding factor that would allow me to go home. The fact that he asked me that question was confusing, but I explained that he was the deciding authority on whether or not I went home. This made it very evident that the medical providers were not communicating with one another.
Finally went home with antibiotics. When I got home, I called my pharmacy and they told me that they would not have my antibiotics until May 3rd. I frantically called around to find a local pharmacy that had the antibiotic, that took my insurance and that was open long enough for me to pick up the prescription. The last thing I wanted to do was to further put my health at risk by not taking the required antibiotics and increase my stress levels after such traumatic events.
At some point around 5pm, I received a call from the OBGYN, asking if I wanted to chat with him on the phone prior to my scheduled May 4th appointment. He knew I was disappointed in the way he told me to drive myself to L&D. I thanked him and explained that I was not physically or mentally ready to chat because it was still all too recent and I did not feel well. He told me that if my fevers went above 101.4, I needed to come back to the hospital.
Shortly after we hung up, my temperature went up to 102. I called the OBGYN’s office but got their after-hours recording which prompted me to reach out to the OBGYN on call. I called twice and it rang forever so I eventually hung up and called 911. I arrived at the ER around 7:30pm. My mom waited alone in the waiting room while I sat on the stretcher on the ambulance entrance side of the ER. My boyfriend called the OBGYN’s after-hours number and finally talked to an operator who told him a doctor would call me back within the next 20 minutes. I never heard from them so I called and asked to see how much longer it would be until I heard back from a doctor. The operator told me in a very irritated and sarcastic tone that she did not know because the doctor could be in the middle of a delivery. I understood and thanked her.
Shortly after that, a doctor called me and without any introductions asked me about my concern. I explained my situation and she abruptly interrupted to tell me she’d talk to the ER. She hung up without a goodbye and I never heard from her again. I was finally admitted to the ER and reunited with my mom around 10:30pm. Mom and I spent the night in the ER and around 6:30am, they came to pick me up for an MRI. I would be admitted and go to a room where they did not allow visitors so my mom had to leave. Both of us were confused and exhausted, so we did not understand why my support person was now suddenly being sent home. Mom went home to wait until they allowed visitors again at 9am.
After my MRI, I was transported to my new room through the hospital basement to my new room. I was dropped off, greeted by a nurse eventually, and left alone until my boyfriend and mom showed up at 9:30am. My technician told me I should be thankful my miscarriage was not a hit-and-run accident where I lost all my kids — not sure of the context and not sure those where the words I wanted to hear at that point. I asked to shower and they told me I needed a shower order which was new to me since I never heard of it during my stay 4/27-5/2.
Finally was able to speak with the Perinatal Grief Counselor, after being told she had retired and that option was no longer available. This was an overdue but welcome visit.
I requested to change my IV since it had become occluded and my hand was starting to swell. Staff removed it and attempted to set up another IV. One nurse tried three times, two technicians tried three times each and by the end of that I was in tears. They finally allowed IV therapy to come in and I realized then that I will never let anyone fish for my veins ever again. That experience was probably one of the most painful and clear memories out of my entire stay at the hospital - I still get flashbacks of how much it hurt and how much I tried to sustain the pain.
I was able to go home, but to prevent the same stress from last time, I asked the nurse to check with the pharmacy prior to my departure. My mom drove us to the pharmacy and they told us they did not have a prescription for me. I had to call the hospital again and wait for the pharmacy to check again to make sure they had the right prescription. After a few calls, everything got sorted out.
I had requested a one-to-one appointment with the OBGYN that told me to drive myself to L&D. He explained a plan of care moving forward and apologized for not “meeting my needs”, which seemed like an odd apology to offer, but I took it.
I went to the bathroom at home and passed out. Did not call 911 because I was terrified of going back to the hospital that mistreated me.
I received a scheduled follow up call from my OBGYN. After explaining what happened the day before, he provided a prescription and asked me to call if anything changed.
Brad and I met with Directors and were given a thank you for speaking up pep-talk. I was allowed to voice my concerns about the hospital staff being dismissive, lacking personal and communications skills, blowing on my skin prior to taking blood, not being able to correctly use hospital thermometers, performing a painful pelvic exam with sink water, sending me off to drive myself to Labor and Delivery, not telling me what to expect regarding labor, not knowing which antibiotics to give me after delivery, not providing adequate grief support, not having clear and practical guidelines on support person vs. visitors, abusing my body with the “let me see if I can get your vein this time” approach and overall inadequate patient care skills.
They explained their attempts to update protocols and clarify visitor rules with their staff. They also explained they took every logical step regarding my care, so clearly, there was no way to prevent the death of my baby.
This was a scheduled post-hospital stay appointment. Saw two doctors I had never met before, they were both women and were very nice. The simple act of offering a hand to help me sit up from laying flat on the exam bed brought me to tears because it made me realize how much I had been both covertly and overtly mistreated.
This was my scheduled postpartum appointment. The staff member that checked me in went through the normal gamut of questions and checks, but forgot to read my chart because she asked me if I was breastfeeding. If I had any hope of staying with this practice (and I considered it), she took care of making it clear this was not the place for me.
I finally had some time to clear my head and gather some objective thoughts about my experience with the doctors. I reached out to the Director of Patient Advocacy to see if I could schedule quick one-to-one meetings with 6 providers to tell them how I felt and how I genuinely hoped some things they said/did would no longer be a part of how they treated future patients. I was naive enough to think they would care or want to hear my thoughts.
I followed up with the Director of Patient Advocacy because I had not heard from them. She replied the following day to confirm receipt of my email.
The Director of Patient Advocacy emailed me and told me the hospital had already provided time for me to voice my concerns. Since they had no new information to provide at this time, they would not schedule any meetings. I proceeded to email the providers directly via MyChart. My remarks were short, direct and respectful. I received a message from Dr. S_ and we agreed to chat the following day at 3pm.
The midwife had read my MyChart message and left me a voicemail apologizing for the fact that she did not reach out to me when I lost my baby. She seemed to genuinely care but by the time I had a free moment to call her back as offered, I had received an email from the Director of Patient Advocacy asking me to make no further contact with their staff members about my complaint.
That is the timeline of my experience with the OBGYN and hospital I fully trusted with my life and my Andres’ life. I blame my blind trust in medical providers and my blatant lack of common sense for the fact that I lost him and put my life at risk. I believe that the doctors had a chance to be more proactive, more cautious and more thorough regarding our care. They dismissed me, they lied in their reports, they treated me poorly and eventually, I got so sick that my baby’s heart stopped beating.
Going through this changed me and changed my perspective as a patient. I will question every doctor’s suggestion, read and understand reports and doctors' notes, and respectfully request a better option if I do not think what they are offering is in my best interest.
I will advocate for myself and encourage other women to do the same.
artwork: carrie moyer