When Birth Isn’t Joyful: Supporting Postpartum Trauma

Summary

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Advancing Health Podcast Summary

Episode: When Birth Isn’t Joyful: Supporting Postpartum Trauma
Host: Julia Resnik (American Hospital Association)
Guests: Dr. Katie Au & Dr. Catherine Jorda (Oregon Health & Science University Perinatal Trauma Clinic)
Release Date: April 22, 2026

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Episode Overview

This episode tackles the often-overlooked subject of perinatal (pregnancy, childbirth, and postpartum) trauma. Host Julia Resnik speaks with Drs. Katie Au and Catherine Jorda, directors of a pioneering perinatal trauma clinic, about the realities of birth trauma, its mental and physical impact on new parents, and innovative models of trauma-informed care. Their conversation dives into how these experiences are recognized, addressed, and integrated into better healthcare for birthing families.

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Key Discussion Points & Insights

1. Understanding Perinatal Trauma

• Prevalence & Impact

  • Perinatal trauma affects a significant portion of new parents:
    • "About one in three parents end up considering their birth experience to be traumatic." – Dr. Katie Au [01:08]
    • 10% of birthing patients develop perinatal PTSD, which can last years if untreated.
  • Childbirth is often thought of as positive, but traumatic experiences are not rare.

• Societal Silence & Isolation

  • Society rarely addresses birth trauma, leading many to feel isolated and unprepared for complications.
    • "Most people, when they become pregnant, don't anticipate having a complication...and it's hard to prepare for those things." – Dr. Katie Au [01:48]

• Societal Expectations

  • The cultural narrative around birth is overwhelmingly positive, making traumatic experiences feel abnormal or shameful.
    • "Some of the societal norms around pregnancy and birth are very rosy...it can come out of left field for a lot of patients." – Dr. Catherine Jorda [02:54]

2. How Birth Trauma Manifests

• Emotional & Behavioral Symptoms

  • Trauma manifests through fear of repeat pregnancies, avoidance of hospitals, prolonged distress, and even altered family planning.
    • "Patients who've had a traumatic birth sometimes don't even want to get pregnant at all...they might be lost to follow up." – Dr. Jorda [03:38]
  • Perinatal PTSD symptoms:
    • Reliving traumatic events, intrusive thoughts/nightmares
    • Difficulty sleeping and avoidant behavior
    • Trouble bonding with their infant

• Long-term Effects

  • Birth trauma can influence decisions around having additional children.

3. Trauma-Informed Perinatal Care Model

• Origins and Rationale

  • The Perinatal Trauma Clinic originated from the need for coordinated trauma care, especially for patients with prior traumas (e.g., veterans).
  • Traditional medical training did not prepare providers for trauma-informed care in obstetrics.

• Multidisciplinary Approach

  • Clinic brings together OB-GYNs and reproductive psychiatrists/psychologists for a joint, comprehensive patient visit.
    • "Could we get all the same players in the room so that the patient could share their story just one time?" – Dr. Jorda [05:58]

• Benefits

  • Reduces patient stress by preventing the need to retell traumatic experiences.
  • Integrates physical and mental health expertise for better patient outcomes.
  • Creates a safe, supportive space for processing complex emotions and events.

4. Building Trust and Safety

• Approach

  • Non-defensive, open-minded listening—validating both joy and trauma, even in “healthy” outcomes.
    • "You can be really happy about an outcome...and you could at the same time, be very traumatized by the experience. And both of those things can be true." – Dr. Au [10:25]

• Guilt and Patient Experience

  • Patients often feel guilty for feeling traumatized when outcomes are "good"; normalization is essential.

5. Impact Stories

• Memorable Patient Example [11:51]
  • Dr. Jorda tells of a nurse who struggled with birth trauma despite her medical expertise:
    • Felt guilt that her knowledge didn’t help her advocate for herself.
    • With support, was able to plan for and approach a subsequent pregnancy with a tailored, trauma-informed approach.

6. Advice for Other Providers and Hospitals

• Practical Steps

  • Explicitly ask birthing parents about their birth experience in routine postpartum care.
    • "I think it really goes back to naming it, calling it out, recognizing it and asking about it." – Dr. Au [14:53]
  • Include questions about trauma and satisfaction, not just depression/anxiety screens.
  • Ensure patients fully understand their birth events to lower anxiety about future pregnancies.

• Systemic Change

  • The need for systemic protocols to prevent, recognize, and respectfully treat birth trauma.

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Notable Quotes & Memorable Moments

• "Most people, when they become pregnant, don't anticipate having a complication...and it's hard to prepare for those things." – Dr. Au [01:48]
• "You can really love your baby, and you could at the same time, be very traumatized by the experience." – Dr. Au [10:25]
• "Could we get all the same players in the room so that the patient could share their story just one time?" – Dr. Jorda [05:58]
• "It really goes back to naming it, calling it out, recognizing it and asking about it." – Dr. Au [14:53]

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Timestamps for Key Segments

• 01:05 – Defining perinatal trauma and prevalence
• 03:17 – How trauma manifests in behaviors and decisions
• 05:28 – Origins and design of the Perinatal Trauma Clinic
• 08:02 – Importance of multidisciplinary, integrated care
• 10:25 – Building trust and addressing guilt
• 11:51 – Impactful patient example
• 14:53 – Practical advice for providers without specialized clinics

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Conclusion

Drs. Au and Jorda make a powerful case for recognizing birth trauma as common and deeply impactful. Their clinic's integrated, trauma-informed model reduces patient isolation, builds trust, and normalizes complex emotions after childbirth. Even without specialized clinics, all providers are encouraged to ask about and validate patients' birth experiences—taking the crucial first step toward healing.

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Transcript

[A]

Welcome to Advancing Health. Trauma is not a word we hope to associate with childbirth, but it is a reality for many new moms, and it's time we pay attention to it.

[B]

Welcome to today's episode of Advancing Health. I'm your host, Julia Resnik, senior director of Health Outcomes and Care Transformation at the American Hospital Association. Childbirth is usually a joyful occasion, but. But for some women, it's the beginning of something much more complicated. Even when parents bring home a healthy baby, the birth experience can be traumatic. And when that trauma goes unrecognized or untreated, it can have lasting impacts on both physical and mental health. Today, I'm talking with the directors of Oregon Health and Sciences University's perinatal Trauma Clinic, Drs. Katie Au and Catherine Jorda. We'll explore how trauma shows up during pregnancy, birth, and postpartum, and what it takes to build a model of care that better supports healing and recovery. So let's jump right in. Dr. Au, Dr. Jorda, I'm so happy to be here with both of you today. To start, can you help us better understand what perinatal trauma is?

[C]

Yeah, I'm happy to start. Thank you so much for having us. It's really a pleasure to be here today. So perinatal trauma can really encompass someone that's had a traumatic birth experience, which about one in three parents end up considering their birth experience to be traumatic. So that's a lot of pregnant people and new parents. And about 10% of birthing patients go on to develop perinatal PTSD, which is like a little bit more of a persisting condition that can affect folks postpartum and sometimes years after the event.

[B]

That is a huge proportion of people who give birth. And yet as a society, I feel like we barely talk about this.

[C]

Yeah, I would definitely say that that's true. And if we think about, you know, pregnancy and birth, that is one of the most monumental milestones in someone's life. Everyone remembers the moment that they became a parent or met their new baby. And the majority of pregnant patients are people that are young and that are healthy and have never needed to be in a hospital or have an IV or maybe have never had a surgery before. And many of those things can happen in the childbirth. And so a lot of those things can be unexpected. Most people, when they become pregnant, don't anticipate having a complication or something that is difficult or challenging in their birth. And so it's hard to prepare for those things. And for many folks, it's the very first time that they have interacted in the medical system in this way, and it can be extremely challenging. And when you experience those things at the very same time as becoming a parent for the first time, it can feel really isolating and, you know, be an extreme challenge in the journey. Becoming a new parent.

[B]

Absolutely. Dr. Jorda, anything you want to add there?

[D]

I do think some of the societal norms around pregnancy and birth are very rosy, and I do think it makes it hard when a patient finds that their experience is not rosy. They're like, what just happened? Has this ever happened to anybody else? This was not my expectation. And it can come out of left field for a lot of patients.

[B]

Yeah, I think a lot of people are not prepared that pregnancy and giving birth is really a major medical event. And so when something does go wrong, they feel like it's abnormal when actually it's more the norm. So when we talk about perinatal trauma, it can really look different from person to person. So what are some of the ways that it shows up both during pregnancy and during postpartum?

[D]

Yeah, I think for a lot of patients, it can come up in a lot of different ways. I think patients who've had a traumatic birth sometimes don't even want to get pregnant at all. They don't necessarily want to come back to the hospital or the clinic where they had a traumatic birth, so they might be lost to follow up. And if they do decide to get pregnant, they might be very hesitant to interact with medical system again after a prior negative experience.

[B]

Dr. Au, anything you want to add there?

[C]

I would say that having a perinatal mood issue can be really common, but that can also be common with a birth that goes really well without complications. So for some patients, we see postpartum blues or anxiety or postpartum depression. With perinatal ptsd, we often see patients that have symptoms that last longer than a month postpartum. The perinatal PTSD symptoms often show up as reliving a traumatic event or having some more intrusive thoughts or maybe nightmares. Many folks have trouble with sleep and might have avoidant behavior. And sometimes we see folks that really have trouble bonding with their infant and their child, and those can persist throughout that first year, that first postpartum year of life, but often many years afterwards. And it's not infrequent that. Dr. Jordan? I see patients who maybe have changed plans for their families or have decided to delay childbearing or maybe just have their one child because they're still affected by their symptoms many years out.

[B]

So I know that your perinatal trauma clinic is one of only a few of its kind in our country. Can you walk us through how the clinic works, what it's like for patients who come to you for care?

[D]

Sure. Kind of started a few years ago. Both Dr. Au and I work at the Portland Veteran Administration's hospital. And so unfortunately, a lot of veterans have experienced military sexual trauma. And we had to learn about trauma informed care, which is a framework of taking care of patients, recognizing that prior traumatic experiences might be impacting their current physical and mental health. But we received a lot of on the job training and experience there, and it wasn't really a part of our formal medical student or obgyn resident curriculum. And we took care of a lot of patients and realized, gosh, there is a role for trauma informed care too in obstetrics. Let's set that up. We submitted a grant to start our clinic, and we made the case that patients who've had a traumatic birth need more of a multidisciplinary approach. We are lucky at our institution that we have a robust reproductive psychiatry department. And so patients who've had a traumatic birth would go see our psychiatry colleagues, and then they would see us in obstetrics for either pregnancy care or postpartum. But we found that they were having to tell their story multiple times to different providers. And sometimes patients would ask me about mental health issues that I could try to field but wouldn't have as much experience as my psychiatry colleagues. And then same for my psychiatry colleagues, they'd get questions about their birth and they were like, I just don't feel equipped to answer that. And gosh, could we get all the same players in the room so that the patient could share their story just one time and have both kind of aspects weighed in? And so we started a multidisciplinary clinic where we see patients who have had a history of a traumatic birth or for delivery planning. And we see them in our clinic, both a general obgyn, myself or Dr. Au, and one of our reproductive psychiatrists or psychologists all together in the same room to do a longer, more comprehensive visit. So typically these visits are twice as long as our routine prenatal care, because we found that we needed the time to delve into both an obstetric history and psychiatric history and develop a plan for the future pregnancy.

[B]

That's wonderful, Dr. Au. Anything else?

[C]

Yeah, I would just say that we find that medical care is so siloed, and it's like that in so many different specialties or aspects of care, and that's the same for reproductive health and mental health care. Dr. Jordan. I would frequently see patients postpartum who really wanted to talk about how it felt to have postpartum hemorrhage or to have an unplanned C section. And we're really good at talking about why someone had extra bleeding or what exactly was happening in the room during their C section, but not as well equipped to handle the mental health aspects and help folks process that. Same for a reproductive psychiatrist. They're so wonderful at, you know, accessing those mental health resources and tools and making sure that patients are safe and have a plan for follow up. But they didn't really understand why someone had a hemorrhage or why someone had an unexpected C section and had a hard time answering questions that the patient would naturally have about, will this happen to me again? What would it look like if I got pregnant again? And we just found it to be so incredibly valuable to all be in a room together where we could go through someone's birth experience if or when they feel ready, and answer all their questions about what happened during their labor or their birth or why certain things happen the way that they did, and real time be able to support them best in a mental health capacity. So it just felt really nice to be able to bring those services to patients at the same time. And as Dr. Jordan mentioned, not having people have to relive their trauma multiple times and tell their story to numerous people was extremely valuable. And I think that's been one of the strengths of, of our program, is that we've identified a safe space so that patients know that they can have someone who's both knowledgeable about the obstetric details and then also someone who is attentive to the mental health aspect of care. Because really, birth trauma is all encompassing like that, and we needed a space to be able to address all of those things at the same time.

[B]

Absolutely. And I can imagine that there is a, like, you need to rebuild trust with patients so that they're trusting the medical system again. What does it take to create that trust and sense of safety so you're not just retraumatizing someone with their next birth.

[C]

I think it all stems with having an open mind and not being defensive about the care that someone has had or the outcome that someone has had. You know, I can't tell you how many times Dr. Jordan and I will see a patient and they feel really guilty saying that they had trauma related to their birth or that they were disappointed in their experience because maybe Their baby was perfectly fine and very healthy. And they were perfectly fine, too. But that doesn't change the fact that the C section was really hard or really traumatic. And someone feels guilty for sharing those thoughts or feeling like it was a traumatic experience when, you know, family members will say, but you're healthy and your baby's healthy and your baby's fine, and you guys are both alive, so it's okay. It just brushes off those complex feelings that people have, because you can be really happy about an outcome, and you can really love your family and really love your baby, and you could at the same time, be very traumatized by the experience. And both of those things can be true. And I think it just starts with acknowledging that and letting patients know that those things can both be true. And you recognize that, you understand that,

[B]

and you're here to help them really normalizing their experience. Hopefully that helps with some of that guilt. So I'd love to talk a little bit about the impact that you've seen, either through data you're collecting or patient stories that really illustrates the difference about what this type of care can make for patients.

[D]

I can think of one patient who is a nurse by training and had a traumatic birth and delivery. We were seeing her for postpartum care and kind of processing all of that, and she had so much guilt about it. She's like, I'm part of the medical field. I thought that knowing how the medical field works, I should be able to advocate for myself. And I'm a nurse. I advocate for patients all the time. But when you're a patient and you're laboring and you're trying to push out a baby, I mean, those are a lot of identities colliding. And it can be really hard to advocate for yourself, even if you know what the medical system is like and you are a patient. And our patient population often doesn't necessarily interact with the medical system unless they're giving birth. And so I think it can be a really unfamiliar position for patients that can be very, very challenging to navigate. There's also the element of, during my pregnancy, I had control. I could exercise, I could optimize my health in preparation for this process, pregnancy and birth. But now I'm trusting these individuals in this hospital that I may or may not know the delivery team to help me get through this. And so when things start to go sideways or, gosh, this C section for this reason wasn't part of the plan or expectation. It can be very difficult for patients. And so as we talked about this person's experience. We tried to normalize and share that, yeah, maybe you are a nurse, but you're not a nurse and you're a patient at that time, right? Like you can't have such high expectations for yourself and try to kind of lift that guilt and kind of put it in a perspective. And so we were able to talk and plan for the next pregnancy. And when patients see us, they can continue seeing us for routine prenatal care or it can be a one time consultation to develop a trauma informed care plan. So this patient continued on with us and we were able to be there for this patient's delivery and see them postpartum. And it was just really nice for her to have that shorthand of, hey, I've shared my experience with this team. They know what were the activating factors, they know what was hard for me as a nurse, and here's what we did as a team and here's a plan and here's how we can kind of mitigate some of those things that had come up in her prior delivery.

[B]

That is a really powerful example of, you know, what happens when you can integrate behavioral health and physical health. It's better for everyone. So not all hospitals are so fortunate to have a perinatal trauma clinic like yours. So for those who don't, what are some practical ways that providers can recognize and respond to trauma?

[C]

You know, I think it really goes back to naming it, calling it out, recognizing it and asking about it. So I mean, if, you know, one in three birthing patients is experiencing some amount of trauma or dissatisfaction with their birth, that's many of the patients that we're seeing. So we need to ask about it. We need to, you know, it's pretty routine to do, you know, anxiety, depression, mood screening and postpartum visits. But I wouldn't say that it's routine for everyone to be asking how a patient's birth experience was. Like, how satisfied were you with your care? Are you having trouble sleeping? Does it make it difficult to think about a next pregnancy? But I think we should be asking those questions and making sure that patients questions are answered about their birth experience as well. I can't tell you how many times we've seen a patient who is scared to get pregnant again. But if someone had just explained what it was that happened to them last time and that that's not likely to recur again or even just understand what it was that they went through, their mind is sort of blown in a way that they're like, wow, I had no idea that that was, you know, something that likely wouldn't happen to me again. And I think about pregnancy in the future in a completely different way. So I think talking about it, you know, recognizing it, I mean, it's something that's just so common and, and yet there are so few people addressing it. It's a disservice to birthing families. And we really need to be addressing these things and from a systemic perspective, thinking about how do we prevent birth trauma and how do we treat it in a respectful and compassionate way.

[B]

And I am sure if there are any new parents who are listening to this who have had a traumatic birth experience, they will feel less alone. And hopefully providers will hear this and realize that there are some straightforward things they can do to help their patients feel safer, to create better birth experiences for everyone. So, Dr. Au and Dr. Jorda, thank you both so much for the work that you do for your patients, for sharing your expertise with us. This has been a really great conversation and I just appreciate both of you.

[C]

Thank you so much.

[D]

Thank you.

[A]

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