Allegheny Health Network Opens Trauma Informed Care Clinic for Obstetric Patients

Wednesday, October 13, 2021

Press Releases

Initiative Aims to Better Screen for and Manage Patients Whose Previous Traumas May Impact Birthing Experience and Outcomes

PITTSBURGH -Allegheny Health Network's (AHN) Women's Behavioral Health program, a part of the AHN Psychiatry and Behavioral Health Institute announced today it will launch one of the country's first trauma-informed care (TIC) clinics for obstetric (OB) patients who have experienced a previous traumatic experience. In close collaboration with the AHN Women's Institute, the clinic's director and physician lead, Tracey Vogel, MD, will work alongside OB patients to create optimal birthing experiences by mobilizing clinicians to better screen for and manage the care of women with pre-existing traumatic stress, Post Traumatic Stress Disorder (PTSD), or previous postpartum trauma.

"Obstetric trauma, or a traumatic birth experience, is an issue currently recognized as a significant contributor to postpartum depression and PTSD," said Dr. Vogel, obstetric anesthesiologist at AHN and trauma-informed care specialist. "According to recent studies, as many as 10 percent of women may meet criteria for a diagnosis of PTSD at the time of delivery, and a prior history of PTSD, trauma or chronic stress left unresolved can increase the health risks for pregnant women and their babies."

Respective to the AHN clinic for OB patients, examples of traumatic incidents can range from pre-existing events like domestic violence, physical, emotional or sexual abuse and/or structural/cultural racism; post-birth trauma can include emergency cesarean delivery, major loss of blood at the time of delivery, an extended NICU stay or even perinatal loss.

"It's estimated that nearly one out of four women have experienced some type of abuse in their lifetimes and furthermore, up to 44 percent of women view their childbirth as traumatic. Maternal mortality rates that are due to mental health and PTSD remain at nearly 10 percent, which is staggering when we measure this country against other developed nations," said Margaret Larkins-Pettigrew, MD, OB/GYN clinician and AHN chief diversity, inclusion and social justice officer. "Moreover, there is a significant disparity with Black women dying after childbirth at much higher rates. Now is the time to really look at what we as a health system can do to minimize or eliminate trauma in the obstetrics environment and we're so pleased to collaborate with Dr. Vogel on this important project."

Studies have indicated a correlation between pre-existing trauma with the trajectory of bonding impairment between mother and child. Researchers from the University of Michigan published findings in the Archives of Women's Mental Health (doi: 10.1007/s00737-012-0312-0) which looked at a sample of postpartum women with self-reported childhood abuse and neglect histories. Women with depression and PTSD showed consistently greater bonding impairment at the six-week, four-month and six-month points. In addition, mothers who experience severe trauma are less likely to breastfeed or nurture following birth.

"As this topic becomes more mainstream, I imagine we'll continue to see research-backed evidence that proves providing trauma survivors with positive birth experiences is not only vital to their well-being but also to the relationship between parent and child," said Dr. Vogel.

The TIC clinic is designed to work upstream to proactively identity opportunities to care for and prevent postpartum psychological and physical complications from occurring and/or resurfacing.

Today's launch will involve the implementation of trauma-informed training for AHN caregivers, screening protocols at initial OB exams, customized birth plans where patients have an active role in the decision making and psychological referrals to the AHN Behavioral Institute for ongoing care consultations, if appropriate.

"This will be a truly multidisciplinary effort across several AHN clinical and administrative teams. The goal is to ultimately change perspectives on how we view trauma and furthermore, how we adapt policies to best meet patient needs," continued Dr. Vogel. "For example, if a patient's arms are immobilized during a routine c-section, it could be retraumatizing for someone with a pre-existing history of violence. That's something we would discuss at this clinic and devise an action plan on how best to rework that experience."

According to the American College of Obstetricians and Gynecologists (ACOG), in addition to affecting physical and mental health, a history of trauma can have a profound effect on attitudes toward medical care in general.

"We see previous histories of trauma directly associated with lower care utilization across all specialties," said Sarah Homitsky, MD, psychiatrist and medical director of AHN Women's Behavioral Health division. "This thoughtful clinic presents the opportunity to not only create positive birth experiences but also improve levels of engagement, trust and comfort between patients and the health care system at-large."

In March, ACOG released new guidance emphasizing the importance of OB/GYN providers recognizing the prevalence and impact of trauma on both patients and the health care team, encouraging the implementation of trauma-informed approaches across all levels of practice.

"It's important for clinicians to realize that they have the power to create an environment in which patients feel safe both physically and emotionally through the interactions they have with them every day. Simple things that can help shift or diminish the power dynamic like seeking permission before initiating contact, providing descriptions before and during examinations and procedures and allowing clothing to be shifted rather than removed can cause less anxiety, prevent re-traumatization, and help foster trust," said Colleen McNicholas, DO, MSCI, lead author of the Committee Opinion in the ACOG release.

The new AHN clinic is based out of West Penn Hospital in Pittsburgh but is available across the network via virtual appointments.

For those interested in learning more, please call 412-578-3048 or email [email protected] or [email protected]. For organizations interested in becoming a philanthropic partner for expanded impact through the Trauma Informed Care Clinic, please call 412-578-4427 or email [email protected].

###

Public link

Please use the above public link if you want to share this noodl on another website.