Undated file photo of Oregon Health & Science University.
Courtesy of Michael McDermott / OHSU
The birth of a baby is often celebrated as a joyful and natural process, but it can also be physically and emotionally traumatic. The Perinatal Trauma Clinic at Oregon Health & Science University is one of only a handful nationwide that aims to support parents who have experienced trauma around birth or pregnancy. Patients work with both mental and physical health care providers at the Center for Women’s Health to develop a plan that fits their personal circumstances.
Katie Au and Katherine Jorda are both associate professors of obstetrics and gynecology at OHSU. They co-direct the clinic and join us with more details about the care they provide.
Note: This transcript was computer generated and edited by a volunteer.
Geoff Norcross: This is Think Out Loud on OPB. I’m Geoff Norcross. The birth of a baby is often celebrated as a joyful and natural process, but it can also be physically and emotionally traumatic. The Perinatal Trauma Clinic at Oregon Health & Science University is one of only a handful nationwide that aims to support parents who have experienced trauma around birth or pregnancy. Patients work with both mental and physical health care providers to develop a plan that fits their personal circumstances.
Katherine Jorda is an associate professor of obstetrics and gynecology at OHSU. She co-directs the clinic and joins us now with more details about the care that the clinic provides. Katherine, welcome to Think Out Loud.
Katherine Jorda: Thanks so much for having me.
Norcross: So birth is often portrayed as an exciting and natural process. And of course it is that, but people also swap horror stories about the experience. Can you talk more about how the physical aspects of birth or pregnancy can result in trauma for some patients?
Jorda: Absolutely. I think trauma can have many definitions. But the one I like the best is fear that doesn’t turn off. In childbirth, it can show up in fear for the pregnant person or their baby’s physical safety, or it can show up as emotional or psychological fear, like not being listened to.
Norcross: Is there a line between a normal birth and a traumatic birth? I mean, giving birth is a hard thing, of course. When does it spill over into something that can lodge in the body like a traumatic event?
Jorda: That is a great question because the line can be really different for everyone. I think it’s really important to note that trauma is truly defined by the person experiencing it. It is in the eye of the beholder. So patients may have a traumatic birth experience, even if the infant and the birthing parent themselves are considered healthy. Delivering a physically healthy baby can be traumatic if the patient’s experience was painful, if their concerns weren’t addressed or if they felt unsupported. All of those things can lead to long-standing negative effects.
Norcross: I think our understanding of trauma is evolving and changing, and now we understand it as something that lives in the body. And it is something that you can chart and it can have all kinds of effects. Is that true for this particular type of trauma too?
Jorda: Absolutely. I think it can manifest for individuals in many different ways. Patients can find that after a traumatic birth experience that they relive the event, that they may get physically sweaty or nervous about thinking of the event, and find that they might even have nightmares or disruptions in their sleep as a result of a traumatic birth experience.
Norcross: You mentioned the lack of support possibly playing into this as well. Pregnancy can bring you into frequent contact with the health care system in America which can be difficult and stressful to navigate. How might that result in its own trauma?
Jorda: Patients bring all sorts of experiences with them when they come into our office, when they come to the hospital for delivery. And we in the medical profession are starting to have an increased and enhanced understanding of the effect of prior traumatic medical experiences that patients may bring with them. And for that reason,
we’ve started asking individuals when they come in for their visits about prior experiences that might have been traumatic for them as a way of opening up a conversation of what we as medical professionals can do to mitigate that potential response.
Norcross: You are the co-director of OHSU Perinatal Trauma Clinic. Can you describe that for me – what is perinatal trauma?
Jorda: Yes. So perinatal trauma can basically be surrounding the birth experience. It can arise to a disorder of PTSD, or post-traumatic stress disorder, arising after a traumatic birth. And technically that can be diagnosed anytime from getting pregnant to six months after delivery.
Norcross: How common is it?
Jorda: The numbers can vary. But one in three parents consider their birth experience traumatic and about 9% to 10% of birthing patients go on to develop perinatal PTSD specifically.
Norcross: Is it confused often with postpartum depression or what we might sometimes call the baby blues?
Jorda: Absolutely. Postpartum depression is a separate diagnosis, but there can certainly be an overlap in symptoms.
Norcross: What puts people at high risk for perinatal PTSD?
Jorda: So patients can be at higher risk of perinatal PTSD if they come in with some pre-existing PTSD from other experiences, as we discussed before, prior traumatic medical experiences or other forms of PTSD. They are also at risk for developing perinatal PTSD after poor obstetric outcomes such as the loss of an infant, or if they had an obstetric emergency occur during their birth such as heavy bleeding, or needing an emergency C-section or emergency operative vaginal delivery.
Norcross: How often do women seek or receive treatment for perinatal PTSD? How common is it for women to seek this out?
Jorda: It can be very common that patients experience a traumatic birth. But I would say that patients don’t always formally receive medical care. They may recount their birth experience or share their birth story with loved ones or friends. But they may not necessarily seek medical care moving forward, which is one of the reasons we developed this clinic. I run the clinic along with Dr. Katie Au.
Norcross: Well, we actually have Katie Au, co-director of the Perinatal Clinic at OHSU.
Katie Au: Hi there.
Norcross: And I apologize, Katie. We had some connection issues earlier, but we were able to bring you on and it’s good to have you.
Au: Thank you so much for having me.
Norcross: Katie, there are a lot of factors at work here – poor healthcare, difficult birth, difficult pregnancy, developing PTSD. I’m wondering what that might mean for future parents? How does all of this impact a patient’s experience with a future pregnancy?
Au: Yeah, it really, truly has a profound effect. And one of the ways that we define trauma is that it has a lasting effect on an individual’s functioning and physical, social, emotional and spiritual well being. The reality is that one in three parents consider their birth experience traumatic – that’s a really high number. And about 9% of birthing patients go on to develop perinatal PTSD.
So it’s a lot of birthing patients. It’s a lot of partners, it’s a lot of couples. And we know that if someone experiences a traumatic birth, the patient is much more likely to potentially delay childbearing in the future, to change their family plans, to experience postpartum depression, anxiety. And that can absolutely impact whether someone becomes pregnant again in the future or how they interact with the health care system in a future pregnancy.
Norcross: Does the health care system acknowledge this as a problem?
Au: I think we’re starting to. I think we can do so much better in this arena. And this is one of the reasons why Kathy and myself have decided to focus and bring attention to this area.
Norcross: Katherine, how are patients actually referred to the clinic? When do you see them? And how does that happen?
Jorda: Patients are referred to our clinic usually at the first obstetric visit by any of their providers. And they will often, at that first visit, delve into a prior obstetric history. And if the patient deems that experience as traumatic, any of those providers can refer patients to be seen in our clinic for an initial consultation. And that is with myself or Dr. Au, as well as a reproductive mental health specialist.
Norcross: Do you get a lot of first-time patients or do you mostly focus on those who have already been pregnant before?
Jorda: It can be a mix. I would say the vast majority of our patients are those who have experienced a prior traumatic delivery, but we also see first time parents.
Norcross: And what can they expect when they come to see you?
Jorda: So we can see patients both in the office or virtually, and we like to give patients as much voice and choice as we can. Whether they are seen virtually or in person, we offer the patient to have a support person with them in order to be an extra ear, an extra source of support for patients as they share their stories. Their prior traumatic delivery experience can be really hard to share. So we invite patients to share as little or as much as they would like to with our team.
Norcross: Katie, have you heard from patients about their experience with the clinic? What are they saying about it?
Au: We have. I think that’s been one of the most gratifying parts about our work. We’ve had several patients who we’ve now helped through their pregnancy and subsequent delivery. Many of them have expressed the sentiment that they feel healed, and that their birth experience the second time or third time around was far different than the first time. And I think the common thing is that people feel heard and that they feel safe.
Norcross: And how would you like to see this clinic at OHSU grow in the future?
Au: My hope for the program is that patients who have a traumatic birth end up feeling less alone. And that as a health care system, we can better support patients by providing trauma-informed obstetric care along with mental health care support. We know birth can be life changing and is unforgettable for most people. And we know patients deserve to feel empowered, seen and safe in their pregnancy and birth experiences. So my hope is that this clinic is one part of bringing this issue to the forefront.
Norcross: Yeah, and as we mentioned, there are only a handful of similar clinics around the country. Are you talking with other health systems around the United States about how to get a similar clinic off the ground? Is there interest out there for more of these?
Au: There’s definitely interest. Yeah, there are a few nationally but not many. And we are working with colleagues across the country, both to present and disseminate our work and to also learn from others who are interested in having similar types of clinics available to their patients.
Norcross: Katherine, anything you want to add to that?
Jorda: I would agree. We know there are so many instances during pregnancy that can be hard for patients. So one of the things we want patients to know is if you are struggling, you are not alone, please reach out. Our clinic is just one resource that can be helpful, but there are a lot of others. And patients may not know that there are support groups with other parents facing challenges. They may not be able to access mental health care for themselves. We in health care would just like to do a better job of supporting each individual patient.
Norcross: Katie Au, Katherine Jorda, thank you so much for your time.
Au: Thank you.
Jorda: Thank you.
Norcross: Katie Au and Katherine Jorda are both associate professors of obstetrics and gynecology at OHSU and they are co-directors of the OHSU Perinatal Trauma Clinic.
Before we go, I want to make a clarification about something I said yesterday during our conversation about electric scooters in Portland. On average, there are 3,600 e-scooters being used a day in Portland. Each scooter on average is being used to make roughly three trips a day.
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