Content warning: This piece contains a description of a traumatic medical birth experience.
She never set out to turn the world of maternal health care on its head, but local anesthesiologist Dr. Tracey Vogel may do just that.
Working in obstetrics at Allegheny Health Network, she began her career focusing on how to make pregnant people more comfortable during delivery. A well-placed epidural or spinal block can make all the difference during a difficult birth, and she prided herself on being one of the only anesthesiologists that worked solely with pregnant people.
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Vogel, through connecting with patients across Western Pennsylvania, began to notice a critical gap in maternal care for her patients. She was able to ease the physical pain they experienced on the delivery table — but what about the emotional pain they brought into the room with them? Many pregnant people enter the delivery room with a history of trauma related to previous birth experiences or sexual assault, though traditional obstetrics has often failed to acknowledge that.
“Why don’t we think that birth is traumatic?” Vogel asked.
“We are taught a social concept that birth should be beautiful; we should be happy,” she continued in an interview. “It’s always joyous. And we know that it’s not always joyful in the land of obstetrics.”
The rosy image pregnant people see on social media neglects to highlight the trauma and emotional pain that often go hand-in-hand with pregnancy. When Vogel noticed this gap, she began to expand her view of what pain management could truly look like — a novel concept in obstetrics. As her vision broadened, Vogel began to bring trauma-informed counseling into the childbirth process, and then to teach that approach to a growing number of obstetrics professionals.
Maternal mental health care in the United States is abysmal. According to the Centers for Disease Control and Prevention, one in eight pregnant people experiences postpartum depression. Further research, such as a study completed in Texas in 2021 by Mathematica, found that half of the perinatal women diagnosed with postpartum depression do not receive appropriate mental health care, and that number was higher for Black and Hispanic women. A 2011 Harvard Medical School study found that Black women in New Jersey were less likely to receive care once postpartum depression was diagnosed. The United States has a higher maternal mortality rate than any other developed country in the world. Follow-up care is also lacking.
For pregnant people with a history of sexual assault or a previous traumatic birth, this critical gap in the healthcare system often leaves them approaching birth without any consideration given to their trauma history.
Seeing the trauma in birth
With her colleague Dr. Sarah Homitsky, Vogel published a review article highlighting research that found that up to 44% of pregnant people considered their birth traumatic. If this number were so high, it would make sense that more doctors should practice trauma-informed care with pregnant patients. “I find it fascinating that when you look up the ICD-10 codes for birth trauma it’s all about the baby’s trauma,” said Vogel.
“I find it fascinating that when you look up the ICD-10 codes for birth trauma it’s all about the baby’s trauma.”
The first step Vogel took was to complete a 40-hour course for sexual assault counselors at Pittsburgh Action Against Rape. Once she began to understand how much a past history of trauma could complicate a birth, she began to think about how to incorporate trauma-informed care — before and after birth — into regular maternity care.
Vogel envisioned similar approaches whether the trauma stemmed from assault or previous birth experiences. She wanted to help women prepare for their births in a way that acknowledged their experiences and their bodies’ trauma response to those experiences. She began seeing patients in this capacity in 2021 through the Alexis Joy D’Achille Center for Perinatal Mental Health at West Penn Hospital, in-person and virtually. With a tremendously positive response to the fledgling program, Vogel and her team then began to look at sharing what they had learned. To date, Vogel has educated more than 500 medical providers in trauma-informed obstetrical care.
Vogel is now working on curating a reading list and writing a training curriculum. Her goal is to eventually develop a credentialing package for other medical professionals to replicate the same standard of care at their institution. She’s begun to do some training through Allegheny Health Network and some through a company Vogel developed, The Empowerment Equation.
Adding support and respect to birth
Trauma-informed maternal care might sound complex — and it is. At the same time, Vogel found that some very simple steps provide mothers with a sense of control that was lacking in their previous traumatic experiences.
Ta Jané Nolen, a mom of two and a Director of Product Management at a clothing retailer, sought out Vogel after a traumatic first birth in 2019 followed by a difficult ectopic pregnancy in 2020. A series of medical conditions such as placenta accreta, blood clots, and a transfusion-related lung injury that left her feeling like she was drowning led to a long recovery after her first birth. The ectopic pregnancy compounded her trauma.
When she found herself pregnant again in 2021, she was nervous. “I definitely tried to avoid going to the hospital for anything,” she said. “I just didn’t want to, you know, end up back in that position.” She felt powerless over her health.
Her primary doctor connected her with Vogel. Nolen felt, at that point, that she had someone in her corner who not only heard her fears but wanted to prevent another traumatic delivery.
“I think what was really significant is that it wasn’t just, ‘We’ll make a plan. We’ll figure it out. It’s gonna be fine,’” said Nolen. “It was really that she put me at the head of the table, right? And said, ‘This is your pregnancy. This will be your child’s birth. How can we help you feel more comfortable about it?’” She had not experienced that type of autonomy before in her medical care.
Her daughter was born without complication — a redeeming experience for Nolen and her husband. “I didn’t want my previous story to be the end,” she said.
Amy Walsh, a hypnotherapist and mom of two in Kennedy Township, also sought Vogel’s care for similar reasons. “I saw her in preparation for my second birth, but it was actually about getting over the trauma from my first.”
Despite what she describes as a detailed birth plan, Walsh found all of her expectations quickly go out the window when she delivered her first child two years ago. Instead, Walsh found herself, withheld from food, on a forced Pitocin drip for five days. A rotating string of doctors managed her care but all of the focus was on delivering the baby — not on Walsh’s quickly deteriorating mental health.
At the end of five long days, her son was delivered via C-section. Due to an epidural error, Walsh’s legs continued to move involuntarily. She was strapped down. “I wanted to have this special bonding experience with the baby, but instead my head was spinning with fentanyl.”
Walsh and her husband both had PTSD after the birth of their child, but because the baby was healthy, the birth was considered a success, said Walsh.
For her second pregnancy, Walsh’s doctor connected her to Vogel. The experience, she said, was night and day.
“If I wouldn’t have had Dr. Vogel talking to my care team, I don’t know what would have happened,” she said. “Because of that, I got flagged as a trauma patient and they really made sure everyone was respectful from start to finish.”
Vogel acted as an intermediary between Walsh and the delivering doctor. Having someone in her corner changed the entire experience. “My primary emotions the first time were feeling unsupported, disrespected and abandoned,” she said. “My second birth was healing.”
Walsh’s second delivery reflects many of the experiences Vogel strives to create. “We
keep everything calm, quiet,” the doctor said. “We don’t have trainees. We don’t want beginner folks doing epidurals or spinal [blocks] for people with a history of trauma.”
She also advocates for the use of anti-anxiety medications — traditionally withheld from patients — during delivery. “There’s plenty of really solid research studies out there looking at various types of anxiety medications. And at low doses, they are very safe for the baby. That seems to be what everyone’s afraid of, but they’re not considering the mother’s psychological health at these times.”
Sharing the knowledge
Armed with data and the positive experiences of patients since the inception of this program, Vogel said she believes a shift can occur. The medical community is finally looking more closely at maternal health care.
“My underlying thought is that western medicine has stripped so much away to make it a medical procedure, to make it convenient and fast and physical, rather than the emotional experience that it is,” she said. She’s calling for “a shift back to treating women with respect in terms of birth.”
If you or someone you know are struggling with mental health symptoms related to birthing or mothering, reach out to your PCP or one of these organizations:
Postpartum Support International
UPMC Magee-Womens Behavioral Health Services
AHN Alexis Joy D’Achille Center for Perinatal Mental Health
As Vogel and AHN work to spread what they’ve learned to other hospital systems, there are a few key things that they want to focus on. First, patients need a practitioner to listen to their fears without judgment — they need for their experience to be validated.
Beyond that, Vogel is working to develop more comprehensive screening tools and questions for patients. The Edinburgh Postnatal Depression Scale, today’s most commonly used screening tool, has come under criticism recently for missing key signs of postpartum depression, especially in low-income patients. The tool does not screen for trauma — just depression.
There’s also a need for trauma-informed gynecological care as a whole. Vogel has been asked to consult with patients with a history of sexual trauma to talk through various gynecological procedures, such as having a polyp or fibroid removed. For a person who had sexual trauma, being strapped down and placed under anesthesia can feel like being assaulted all over again.
“Some patients won’t have their surgeries unless they have this kind of service, and the surgery is really indicated for their particular condition,” Vogel said.
She’s been called in for trans patients — another overlooked population in obstetrical care — who are delivering babies so that the entire team can be respectful of their unique birthing needs.
“It’s very odd for an anesthesiologist to work just in obstetrics,” Vogel said. “But it puts me in a very unique position to see things differently every single day.”
Correction: Dr. Vogel and Dr. Homitsky wrote a review paper highlighting studies on trauma and childbirth, including research finding that up to 44% of pregnant people consider their births to be traumatic. A previous version of this story mischaracterized their role in that research.
Meg St-Esprit is a freelance journalist based in Bellevue. She can be reached at megstesprit@gmail.com or on Twitter @megstesprit.
This story was fact-checked by Dakota Castro-Jarrett.
