W&J graduate assists in creation of innovative clinic for women dealing with traumatic child delivery
For women, pregnancy is expected to bring feelings of joy and excitement.
But that’s not always the case.
Up to 44% of women view their childbirth as traumatic – the result of an emergency cesarean delivery, major blood loss during delivery, or a long NICU stay for a baby, for example.
And for women who have lived through something awful – domestic violence, physical, emotional or sexual abuse, or another traumatic event – pregnancy can be stressful.
“There is this idea that birth is a pretty and joyous occasion, and that you have to be happy. But the picture society is painting isn’t reality,” said Dr. Tracey Vogel, an obstetric anesthesiologist at Allegheny Health Network and trauma-informed care specialist, noting the United States has one of the worst maternal mortality rates among developed countries. “Women find themselves in the position where they are holding themselves to some unrealistic expectation of pregnancy, and it makes them feel like a failure, like you get a grade on childbirth and you’re failing.”
To address the needs of obstetric and postpartum patients with a trauma history, Vogel collaborated with AHN’s Women’s Behavioral Health program to launch one of the country’s first trauma-informed care clinics, which is based out of West Penn Hospital.
It’s the culmination of a decade-long journey that started at West Penn Hospital, where Vogel – who earned her undergraduate degree at Washington & Jefferson College before completing medical school at the University of Pittsburgh – began working with pregnant women as an anesthesiologist.
She started to notice obstetric patients were sharing surprising fears and concerns that caused anxiety during their pregnancies.
Then, about five years ago, Vogel became certified as a sexual assault counselor, and had what she calls “an aha! moment.”
“Now I understood what survivors or trauma looked like, and I could see the same patterns in my patients in obstetrics, how something triggered in them from a previous trauma and caused acute stress responses,” said Vogel. “It was kind of a revelation for me, and I started studying about it. It changed my life and my perspective about what trauma is.”
The outcome is a clinic that provides customized birth plans for obstetric patients with pre-existing traumatic stress, PTSD, or previous postpartum trauma, and creates an environment where patients feel safe, both physically and emotionally.
“Every single person is so unique in their trauma and what they need. The common denominator is the development of trust, and they all need to feel safe and feel in control,” said Vogel. “If a patient’s arms are immobilized during a routine c-section, it could be re-traumatizing for someone who was a victim of sexual assault. For a woman who experienced a perinatal loss, it’s a whole other type of trauma and they need an approach that allows them the earliest possible connection with their newborn, so if it’s a c-section, I make sure they have a clear drape so they can see the baby the moment that baby’s born. Those are things we discuss at the clinic and devise action plans.”
The clinic also provides trauma-informed training for AHN clinicians to better screen for and manage their patients’ care.
Research shows unresolved trauma or chronic stress an increase the health risks for pregnant women and their babies.
And patients with pre-existing trauma, or a traumatic birth experience, face a higher risk of postpartum depression and PTSD, and are more likely to have trouble bonding with their newborn.
For Aubrey Johnson, Vogel played an important role during and after her second pregnancy.
Johnson, of Peters Township, had a fourth-degree vaginal tear – the most severe – when she delivered her son, Hendrik, three years ago, and required a transfusion after suffering major blood loss.
The experience left Johnson physically and emotionally traumatized.
“I healed slowly, I couldn’t hold my son, and you start to beat yourself up,” she said, adding she developed postpartum depression, and later, postpartum psychosis.
She was hospitalized, and began treatment at AHN’s Alexis Joy D’Achille Center for Perinatal Mental Health, which is named after a young mother who died from suicide six weeks after she gave birth to her daughter in 2013.
“I owe my life to the center. If not for the center, and the support of my family and friends, I would not be here today,” said Johnson.
In 2020, Johnson, who owns Moxie, a Pilates studio with locations in Mt. Lebanon and the city, became pregnant again.
But she was frightened she would have a recurrence of the physical and mental complications.
Her therapist at the Alexis Joy Center recommended she contact Vogel.
“From the first minute I talked with Dr. Vogel, I felt like, ‘Oh my God, she hears me.’ She helped me develop multiple birth plans for whatever could happen,” Johnson said. “She gave me a sense of peace and calmness.”
In April, with Vogel serving as her anesthesiologist, Johnson was induced and delivered a healthy baby girl.
“It was amazing. It was a smooth delivery, completely different from my first,” said Johnson. “And having Dr. Vogel there made for a better birth experience. She ordered tests to make sure my iron levels were good and she was the one who administered the epidural and gave me the lowest possible amount of medication for it. I felt safe with her.”
Following the birth, Johnson developed postpartum depression, but she said it was mild and, with the help of Vogel and continued therapy, she “nipped it in the bud.”
Today, Johnson practices self-care and has found balance in her life.
And, she’s learned that she can overcome adversity.
“I learned how strong I really am. I regained confidence in myself,” said Johnson. “I know now that asking for help is a strength, not a weakness. I trust myself now. I have self-compassion and I give myself grace and love. I’m grateful for the experience, and I hope that what I went through can help me help other women.”
It’s outcomes like Johnson’s that motivate Vogel.
“I want women to know that they are enough,” said Vogel. “It’s all right for them to not only feel joy, but to feel frustrated, angry and upset. It’s OK to feel both. Always know, you are enough.”
For more information on the TIC Clinic, call 412-578-3048 or email tracey.vogel@ahn.org or liana.verzella@ahn.org. The clinic is based out of West Penn Hospital, but is available across the network via virtual appointments.