Online platforms offer scores of stories about poor maternity care

The data we’d analyzed was clear: One for-profit hospital, nestled along the U.S.-Mexico border, had the highest rate of surgical interventions during childbirth out of all hospitals in Texas. 

More than two-thirds of the women who gave birth in 2019 at Doctors Hospital of Laredo underwent a cesarean section or an episiotomy, our analysis showed. C-sections can save mothers and babies, but experts have urged doctors to avoid the invasive surgery when it isn’t needed because of increased risks of complications. But the routine use of episiotomies, an incision made to widen the birth canal and hasten delivery, has been discouraged since 2006.

As a USC Center for Health Journalism 2019 Data Fellow, I partnered with Christian McDonald, a professor who teaches data journalism at the University of Texas at Austin, to analyze hospital inpatient billing data, when it turned out my outlet would not be able to afford the data on our own. A Texas state agency typically sells this data to hospitals and media organizations, and the four years of data used in this analysis normally would cost in-state media $8,500 and out-of-state media $17,000. But as a faculty member at a state university, McDonald was able to obtain the data for free. He just wasn’t allowed to publish or share any of the raw data with me — only aggregates from his analysis.

As we began trying to learn about the factors driving the hospital’s highest rates, I planned to reach out to all of the sources I normally would when reporting on care for mothers and babies — such as midwives, childbirth educators, doulas and lactation consultants.

The only problem, I discovered, was that there were few — if any — of those advocates in the community we were reporting in. 

Webb County is home to 100,000 adult women, but only has about 20 OB-GYNs to care for them — just three of whom are women themselves. When I began reporting, no doulas practiced in the city. There was only one midwife, who caters largely to women coming from across the border and only accepts cash. There are no high-risk pregnancy specialists in Laredo, so one flies from a city 130 miles away every weekday to treat patients with complicated pregnancies. 

I had reached out to WIC clinics and the other two main organizations in Laredo offering services for mothers: the city’s nurse-family partnership program and a nonprofit that provided prenatal care to women living in unincorporated communities in the county. All of the organizations agreed to participate in our reporting, and the WIC clinics said they would allow me and a photographer to spend time in their facilities talking with mothers.

Then the pandemic struck. Finding sources had already been difficult, and now all of our plans to meet people in person were suddenly canceled. All of my reporting would suddenly need to move online. 

Fortunately, we had already known we’d need more than traditional reporting methods to ensure our reporting would serve and reach the women affected by it. With help from the Center for Health Journalism’s Engagement Editor, Danielle Fox, we put together a Google questionnaire in early 2020 asking Texas mothers to share their experiences seeking prenatal care and giving birth. 

With Danielle's help, we heard from 170 mothers from all over South Texas. They told us about their experiences: what was normal, what they wish they’d known before giving birth and the communication — or lack thereof — with their medical providers. We heard from women who felt empowered by their health care providers and others whose questions and concerns were ignored. It was strikingly apparent how many felt like their care had been rushed, or they hadn’t been given all of the information they needed to make informed health care decisions. 

One of the mothers who responded to the questionnaire — who also works as a doula and lactation consultant — lived in San Antonio, nearly two hours away from Laredo. Even though she’d never practiced in Laredo, she’d been asked by women there to help answer questions in a local Facebook group focused on breastfeeding. With her help, I became a member of the group and began posting about what we wanted to accomplish with our reporting.

An administrator of that group ended up introducing me to another Facebook group with thousands of members. Within those online spaces, I connected with sources I probably would’ve never spoken with had I simply reported from local medical clinics. I spoke with multiple mothers who ended up driving 320-miles roundtrip from Laredo to seek care from medical providers in San Antonio in hopes of avoiding unnecessary interventions. I heard from a nurse who pushed back against her doctor but still had an episiotomy performed nonetheless. I met Linda Martinez, who’d become the city’s first doula by the time our stories published. 

Throughout the course of my reporting, it wasn’t the outreach workers or health care providers in Laredo that helped us hold doctors accountable — it was all of the women who’d patiently responded to my Facebook messages and were willing to speak out about substandard care. They guided us through our investigation, and when the stories published, they were also the ones who got the word out by sharing our work. 

The project’s publication spurred community activists in Laredo to call for renewed talks to establish a public hospital system in the city, where the only two hospitals that deliver babies are for-profit. The searchable database showing hospitals’ rates was widely circulated among birth workers and moms’ groups on social media because prior to our reporting, no such tool existed where women could search those measures for hospitals on a centralized website in both English and Spanish.

The stories made rounds on Facebook through Laredo moms’ groups, spurring more than 100 women to comment about their own experiences in the delivery room. Many of their experiences mirrored what happened to the women I wrote about.  Some reached out to tell me about their experiences. Their insight will guide our continued coverage on policy changes and other updates that emerge in the months to come.

“I felt really embarrassed and vulnerable to talk about it, but I just felt like others should know,” one mother told me after sharing her experience. She’d just read the stories after they were posted in one of the Facebook groups. She thanked us for exposing what was happening in the hospital.

If in the future we needed her help in reporting, she was here to answer questions, she told us. She felt empowered to share her voice. 

Tips on using online platforms for sourcing:  

• Think outside the box when connecting with people who interact with those affected by the problem. In my case, that meant talking with hairdressers and leaders of moms’ groups — not just doctors and community health workers.

• Read online reviews and reach out to the people who wrote them. On some Laredo doctors’ Facebook pages, for example, women had written reviews saying they had negative experiences and felt care was rushed. Unlike Google or Yelp reviews, it’s easier to identify and message reviewers on Facebook because their reviews link to their profiles. 

• Search social media platforms for keywords like you would Google. In the early part of the pandemic when it felt like I might never connect with people in real life ever again, I desperately searched for Facebook posts using keywords like “Laredo doula” and “Laredo midwife.” I ended up finding mothers who’d posted publicly about trying to find those care providers, who ended up becoming great sources. Be sure to use Facebook’s filters to further refine your search to a geographic area or timeframe.

• Ask readers to share their experiences and help you with your reporting. After publishing the Google Form asking mothers to share their experiences during labor, we put together a separate form later in the year to learn about postpartum experiences — and heard from 100 more people. Google Forms is a free — and invaluable — tool.