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New clinic recognizes trauma around childbirth, provides specialized care

OHSU Perinatal Trauma Clinic in Center for Women’s Health is one of a few across the country especially for patients with traumatic personal, medical histories
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Katie Au, M.D., and Katherine Jorda, M.D., stand in a patient room at the OHSU Center for Women's Health. The OHSU Center for Women’s Health has developed a unique clinic to provide special care for patients who have perinatal PTSD or perinatal trauma. “I wish every patient could experience this type of support,” Maddie Papke, a patient, said. (OHSU/Christine Torres Hicks)
The OHSU Center for Women’s Health has developed a unique clinic to provide special care for patients who have perinatal PTSD or perinatal trauma. “I wish every patient could experience this type of support,” Maddie Papke, a patient, said. (OHSU/Christine Torres Hicks)

In January 2020, Maddie Papke was thrilled to welcome her first child in the Missouri hospital where she worked as a nurse. Her plan was to have a vaginal delivery — a birth plan she had discussed at length with her provider. But as Papke was in labor, her son’s arm suddenly became lodged in the vaginal canal; before she knew it, she was being rushed to an emergency Cesarean section — a surgical delivery that she hadn’t planned on.

Although her delivery ultimately resulted in a healthy baby boy, Papke was shaken by the experience.

“The way that it was handled was upsetting. I felt disappointed by the initial response and lack of communication from my care team, both before delivery and during,” Papke said. “I felt like something had been done to me, like I had no control over the situation. It really impacted me and my ability to trust the health care system.”

Katie Au, M.D., is wearing a light-colored stripe dress, has shoulder-length dark hair, and is smiling in the garden area at OHSU's Center for Women's Health.
Katie Au, M.D. (OHSU)

Unfortunately, Papke’s experience is not uncommon, said Katie Au, M.D., associate professor of obstetrics and gynecology in the Oregon Health & Science University School of Medicine. That’s why the OHSU Center for Women’s Health established the OHSU Perinatal Trauma Clinic, which Au co-directs. It is one of just a few in the nation providing special support for parents who have experienced trauma around pregnancy and birth.

Au has cared for dozens of patients during pregnancy who experience traumatic childbirth; she remembers being especially impacted by a patient who faced a near-death experience that left the patient terrified to go through another pregnancy.

“We know that patients have traumatic pregnancy and birth experiences. We know that many patients fear pregnancy and the birth process,” Au said. “But what are we doing to change that? And how do we help someone with a history of traumatic birth as they go through another pregnancy?

“As individuals we wonder what we can do differently to improve our care. But it’s rarely about a single clinician, or interaction or moment. As a community and at a systems level, we need to deliver care that is trauma-informed, prioritizes safety and resists re-traumatization.”

Support through perinatal PTSD

Creating that change first began several years ago with the development of a Perinatal Trauma Clinic within the OHSU Center for Women’s Health.

Katherine Jorda, M.D., has short dark hair and is wearing a doctor's white coat while smiling in the garden area at OHSU's Center for Women's Health.
Katherine Jorda, M.D. (OHSU)

“When we initially began planning for the clinic, we did a search to see if there were other institutions offering this care that we could use as a model. We were shocked to see so few,” said Katherine Jorda, M.D., associate professor of obstetrics and gynecology in the OHSU School of Medicine and co-director of the clinic. “We feel honored to provide this care, but on the other hand, we feel incredibly sad because we know how many people need this type of care but won’t have access to it.”

One of only a few of its kind across the country, the clinic provides care for individuals who have experienced birth-related trauma or are at high risk for perinatal post-traumatic stress disorder, or PTSD around the experience immediately before and after giving birth. This could include a stillbirth, premature delivery, emergency C-section or other unexpected obstetric outcome. Perinatal PTSD can also result from a traumatic birth experience or stem from prior trauma like sexual assault, that may potentially be reactivated by a birth-related experience.

The clinic also sees individuals who may have had an uncomplicated delivery on paper, but still experienced perinatal trauma. Their trauma could be related to interactions with the health care system, feeling a loss of autonomy during the birth process, or having a difficult recovery, which can have lasting effects and may cause difficulty seeking care and trusting clinicians in a future pregnancy.

Patients of the Perinatal Trauma Clinic initially meet with Au or Jorda and a reproductive psychiatrist or psychologist for a 90-minute intake session to discuss their history, as well as their goals for pregnancy and birth. In following appointments, they work collaboratively to create a trauma-informed birth plan, which is shared with all members of the patient’s care team.

Some patients engage in one or two sessions to discuss birth planning or better understand their concerns and anxieties, while some require ongoing care and support throughout pregnancy and birth; no matter the situation, each patient receives care that is personalized for their unique circumstances and preferences.

“The feedback has been overwhelmingly positive,” Au said. “We’ve received messages from patients saying they felt broken from their previous birth experience and that we’ve helped them feel healed for the first time.”  

Feeling safe, heard

One of those patients is Papke, who moved to Oregon shortly after delivering her first baby and received care for a subsequent pregnancy at OHSU. After disclosing concerns from her previous birth experience, Papke’s provider referred her to the specialists at the Perinatal Trauma Clinic.

“My experience with Dr. Au and everyone at the clinic was incredible. From day one, I felt known, even though we didn’t really know each other yet,” Papke said. “They took my experience seriously and every step of the way would educate me, take the time to answer my questions and go over all the options.

“I never felt dismissed or pressured into making a certain decision,” she continued. “I wish every patient could experience this type of support.”

Looking forward, the clinic will continue to establish best practices and care guidelines for patients with a history of perinatal trauma, which can be shared with other health systems that wish to apply this interdisciplinary care model. The clinic also hopes to expand care availability, including offering appointments for patients to receive postpartum support following a traumatic birth.

“Our medical system’s gold standard is to have a physically healthy birthing patient and baby, but that’s not enough,” Jorda said. “We must also consider the patient’s emotional and psychological health, both in the delivery room and the long-term.

“While we can’t promise that every delivery will go 100% perfectly, we will make every effort to create a space where patients feel safe and heard.”

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