As a mother of three, Caroline Malatesta thought she knew what she was letting herself in for when it came to the birth of her fourth baby.
But rather than the natural experience she had planned, the birth of her fourth child in 2012 left her with post-traumatic stress disorder (PTSD) and a serious injury.
Caroline and her husband, JT, chose Brookwood Baptist Medical Center in Birmingham, Alabama, specifically because of its heavily advertised natural birth philosophy, including water births, individual birthing plans, and freedom of movement.
However, from the moment she arrived at the hospital and was told her doctor wasn't on call, things started to go wrong.
"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," she wrote for Cosmopolitan.
She said it was clear that the nurse's concerns weren't regarding her health or safety. Instead, she says, "it was a power struggle."
Although Caroline was comfortable labouring on her hands and knees, the nurses allegedly pulled her wrists out from under her and flipped her onto her back.
"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," Caroline wrote.
At this point Caroline's baby was crowning, but rather than allowing her to push through her contractions, one of the nurses held the baby's head in her vagina, preventing her from delivering the baby.
After six minutes, a doctor came in to assist and the nurse relented.
"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," she wrote.
"So that's how my precious child entered this world. As if birthing a baby isn't hard enough, I gave birth while engaged in a physical struggle against the people I trusted to care for us."
The time spent holding the baby in led to Caroline developing the debilitating nerve condition pudendal neuralgia.
According to the Pelvic Pain Foundation of Australia, the primary symptom of the condition is pain in the genitals or the anal-rectal area. The immense discomfort is usually worse when sitting and can become permanent.
The condition left Caroline in constant pain and unable to have sex even months after the birth. Then things got worse.
"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 non-functional for six months."
When Caroline chose to sue the hospital, she said she didn't take the malpractice lawsuit lightly. In fact, she says she just wanted answers over the way she was treated.
The hearing was difficult for the mum of four in many ways, including "having to answer deeply personal and sexual questions". But at the time, the worst part was listening to the excuses given by the medical team who worked so hard against her choices during the birth.
"But the hardest part by far … [was] listening to people try to justify their actions even in the face of my clear refusal. It's a creepy feeling to hear nurses and hospital administrators who sincerely believe they have the rights over my body."
Finally, two years after filing the lawsuit, she was awarded AU$20million (US$16m) dollars. The jury awarded $10 million in damages for the pudendal neuralgia, $1 million to her husband for loss of consortium, and $5 million in punitive damages for reckless fraud related to an ad campaign promising that the medical centre was a place for natural child birth.
In a blog post, Caroline's attorneys at Marsh Rickard Bryan wrote that the win came down to the medical centre not following through on their ads' promises, which emphasised a mother's choice.
"The so-called natural childbirth experience at Brookwood turned out to be a nightmare for the Malatestas," according to the blog. "Caroline had no freedom of movement; instead, she was restrained, sometimes forcibly. Caroline was offered no choice; it was the nurses' way or no way. "
Caroline was overwhelmed by the verdict. "I was shaking. I was crying. I couldn't believe that all these years of fighting for the truth to come out – it was finally over," she said.
"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.
"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."