Postpartum women are neglected despite most pregnancy-related deaths occurring after delivery, according to data
Hallie Bateman tried to ignore the pain that started when she came home from the hospital after giving birth to twins.
The pain, which radiated from her torso to her back, surprised her with its stabbing intensity. But in the haze of having given birth three days prior, Bateman assumed it was normal.
The birth had gone well - both she and her twins left the hospital healthy - but she'd hemorrhaged after delivering.
"This must just be what it feels like to have your uterus contract," she remembers thinking to herself as she tried to focus on her first day home with her newborns.
But the pain wouldn't go away - not with the Advil her doctors advised her to take after the birth, and not after eating some of her mom's butternut squash soup.
By 3 a.m. on March 1, Bateman was paralyzed with pain. Unable to walk or talk, she texted her husband, who was taking care of their twins in the next room, that she needed to go to the ER.
"It was, like I said, worse than childbirth," she recalled.
Hours later, Bateman was diagnosed with severe acute pancreatitis, a potentially fatal and notoriously painful condition associated with high rates of organ failure, at UC Medical Center.
But the hours leading up to the diagnosis were harrowing, Bateman said. Worse, she said, because of how staff repeatedly dismissed her pain.
In a statement emailed to The Enquirer on Aug. 26, UC Health defended the quality of Bateman's care.
"Our review of Ms. Bateman's clinical records reflects that the care provided was appropriate," said Heather Chura-Smith, a spokesperson for the hospital. "The clinical team followed evidence-based protocols."
Bateman, a 35-year-old author and artist, says she's been so frustrated with the response that she illustrated her experience and posted it on Instagram last month.
Since then, her comic has received over 81,000 likes, but Bateman still wants to know why she was treated the way she was.
In the comments on her post, dozens of women shared similar experiences of having their pain dismissed by hospital staff when they were postpartum, despite national data showing that most pregnancy-related deaths occur up to a year after delivery.
"I said 10 out of 10, please help me," said Bateman recalling the level of pain she experienced.
'Absolute agony' before receiving opioids
Bateman arrived at the emergency department of the UC Medical Center at 3:49 am, medical records show.
Because she was three days postpartum, she was wheeled to the obstetric emergency room, which is where she says things went south.
She'd been in excruciating pain for 10 hours already, she said. According to medical records, relief arrived five and a half hours later in the form of hydromorphone, an opioid painkiller at least twice as strong as morphine.
In between, around five medical staff members cycled in and out of the room, Bateman said, each making her feel as if she was being "theatrical."
"Honey, there's nothing I can do," she remembered one nurse saying. "Did you take your Advil?"
Another asked, "'Why would you be in this pain?'" Bateman said. "I felt scared of her."
Reactions from other medical staff ranged from mistaking that Bateman was sleeping when she was curled up in pain and asking her if she needed to use the bathroom.
"I think they thought that I was seeking drugs or that I was just some hysterical woman," Bateman said. "The fact that they constantly offered me Advil tells you everything."
UC Health says administering over-the-counter medications such as Tylenol and ibuprofen, which happened within an hour of Bateman's arrival, was consistent with protocol.
She was presenting as a patient with severe constipation, for which opioids are not recommended as a first step for pain management, said Chura-Smith. Opioids can exacerbate constipation, "which could have worsened her condition," she said.
The fact that opioids make patients "less coherent and drowsy" was also another factor considered during Bateman's care, said Chura-Smith.
Bateman says she understands if there are protocols in place when it comes to distributing opioids. Still, she's having trouble rationalizing the number of hours she spent in "absolute agony."
Suzy Hopkins, Bateman's mother, stayed by her side that night. She described the treatment from staff as "unbelievable." She tried to intervene on her daughter's behalf, to no avail, she said.
UC Health did not provide The Enquirer with a written copy of its pain management policy, as requested.
Following her 9:22 a.m. diagnosis, Bateman was wheeled to another room for treatment for pancreatitis, more than 15 hours after her pain first started and more than five since she'd arrived at the hospital.
In his notes, attending surgeon Dr. Jay Nathwani noted that Bateman's gallstone pancreatitis "posed a threat to life or bodily function," with a "high" possibility of death.
UC Health denies impact of opioid epidemic on pain management care
Bateman, whose pain only began to decrease with the opioid injection, said she wonders whether staff thought she had substance use issues - and whether they discounted her pain because of it.
The share of patients with substance use disorders who visit the ER solely to obtain drugs range from an estimated 12% to 20% of ER patients. A study published in the Journal of Emergency Medicine in 2012 found that drug-seeking patients were much more likely than others to report 10/10 pain.
UC Health firmly denied that the opioid epidemic - or drug-seeking stigma among medical staff - was a factor in Bateman's care.
"Pain management is personalized to every patient's care plan," said Chura-Smith. "Every patient has the right to appropriate assessment and management of pain."
The Enquirer also asked whether the hospital had a different pain management protocol for postpartum individuals or patients with a substance use history. UC Health did not provide a specific answer, instead providing the same response it did to The Enquirer's question about the opioid epidemic.
Jenifer Fahey, division director of midwives at the University of Maryland, has researched and treated postpartum pain in her 24 years of being a midwife.
Amidst the opioid epidemic, she said that health care providers face a "hard balance between managing the pain and not creating an increased risk of addiction."
This is especially true of emergency room staff, because they're accustomed to seeing patients who are "trying to treat their addiction by getting pain meds."
Still, in Bateman's case, Fahey says that the first sign that something was unusual should have been the fact that Bateman wound up in the ER just days after delivery.
"We would not expect someone to be coming back to the hospital for pain following a vaginal birth," Fahey said, especially an uncomplicated one. "So the first red flag that would go up with me is anyone returning after they've been discharged."
Pain is an expected part of giving birth, she said. "But that's for a laboring patient."
"I expect 10 out of 10, or 12 out of 10, for someone who's in labor. I would not expect it for someone, whether they're pregnant or postpartum, who's not."
In her 2017 paper on postpartum pain, Fahey found that unmanaged pain can lead to long-term mental health conditions like depression, which last beyond the postpartum period.
Being unable to manage postpartum pain effectively "can interfere with ability to parent in those early days," said Fahey.
UC Health apologizes: 'We are very sorry'
Bateman's pancreatitis was found to be caused by a gallstone that eventually passed. But due to the risk of pancreatitis recurring, her gallbladder was surgically removed a month later.
It was only when she recovered from the surgery that Bateman found the time - in between nap time and feedings for her twins - to contact UC Health and express her concerns about how she'd been treated.
Phone conversations with the hospital's patient relations office, which conducted a review of Bateman's emergency care, proved unhelpful.
"Your records determined there were no inappropriate care issues with the care provided," read the July 30 letter Bateman received following the review, also noting that her pancreatitis was "discovered fairly quickly."
Finally, feeling unheard, Bateman took to Instagram, where her post garnered thousands of likes. Following the post, she received a call and a letter from Ronald Rohlfing, UC Health's system director of clinical support services.
Rohlfing wrote, "We are very sorry for the trouble you experienced during your stay."
He continued, "While our reviews show that the proper diagnostic and intervention pathways were followed, we did not meet your pain management needs."
Rohlfing did not reply to The Enquirer's requests for an interview by phone or email.
Health care neglects postpartum women despite increased risk of death
Fahey was unsurprised that commenters to the Instagram post described having pain dismissed by hospital staff. She describes this treatment of postpartum moms as "tradition" in health care, because it's easy to pay less attention to moms after they deliver their baby.
"That's exactly the reason that I chose that as my area of concentration," Fahey said of the postpartum period, which she describes as "one of the moments of peril" for new moms.
Data from the Centers for Disease Control and Prevention shows that 65% of pregnancy-related deaths in the U.S. occurred up to a year after delivery, compared to 22% during the pregnancy and 13% on the day of delivery.
This is why the American College of Obstetricians and Gynecologists, the national professional association that writes guidelines for health care providers who treat pregnant and birthing people, revised their postpartum care guidelines in 2018.
The new guidelines were published "with the recognition that yes, absolutely, that time period" has been a neglected period, said Fahey.
Similarly, in recognition of the danger the postpartum period poses, especially to Black and Native American women, the CDC launched a national campaign called Hear Her in 2020.
The campaign emphasizes that 80% of all pregnancy-related deaths are preventable and that communication between pregnant people and health care professionals can be "life-saving."
One thing Bateman learned is how many people can relate to her experience or through their loved ones.
"I don't think that this went viral because my story is especially unique," she said.