Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Tracey Vogel, MD’s presentation advocates for Trauma-Informed Care (TIC) as a necessary universal precaution in maternal health, moving the focus from physical safety to include psychological safety. TIC is a cultural paradigm shift that re-frames clinical interactions from “What is wrong with you?” to “What has happened to you?” The goal is to realize the high prevalence of trauma, recognize its behavioral symptoms, and respond by implementing policies and practices that resist retraumatization. For anesthesia providers, this means actively giving patients a sense of choice and control and preventing avoidable psychological harm, such as unnecessary physical restraint during surgery.
Key Points:
- Definition of Psychological Trauma
Psychological trauma is rooted in feelings of powerlessness, helplessness, and loss of control/connection [03:38, 04:05]. Trauma is in the eyes of the beholder, meaning an event is traumatic if the patient perceives it as such, regardless of physical complication severity [06:58, 07:49]. - TIC as a Universal Precaution
Trauma-Informed Care should be employed as a universal precaution, a cultural shift that views the “difficult” or “non-compliant” patient as symptomatic of an underlying stress response rather than problematic [01:43, 11:37]. - Core Principles of TIC
The Substance Abuse Mental Health Services Administration (SAMHSA) identifies four R’s (Realize, Recognize, Respond, Resist Retraumatization) and the CDC identifies six principles for TIC, including Safety (physical and psychological), Trustworthiness/Transparency, Collaboration/Peer Support, and Empowerment/Voice and Choice [13:01, 15:09]. - Risk of Birth Trauma
Negative events around childbirth now meet the criteria for a traumatic event (birth trauma). Traumatic experiences are associated with increased risk of postpartum mental health issues (e.g., PTSD, depression), altered pain thresholds, and impaired maternal-fetal bonding [05:49, 24:57]. - Anesthesiology’s Primary Prevention Role
Anesthesia providers are key to primary prevention by ensuring physical and psychological safety. Practices like physically restraining conscious women for Cesarean delivery are psychologically harmful and must be changed to prevent retraumatization, particularly for patients with a history of sexual trauma [27:22, 22:38]. - Secondary Prevention Strategy
Playing Tetris (a visual-spatial task) for 15 minutes within six hours of a traumatic experience has shown data suggesting it can decrease the incidence of PTSD symptoms at the six-week mark [28:48].
ABOUT THE SPEAKER(S)
Tracey Vogel, MD
Obstetric Anesthesiologist
Director of the Perinatal Trauma-informed Care Clinic,
Pittsburgh, PA
Tracey Vogel, MD is an Obstetric Anesthesiologist, trained sexual assault counselor, and the creator and Director of the Perinatal Trauma-informed Care Clinic in Pittsburgh, Pennsylvania.
She received her MD degree from the University of Pittsburgh and finished her anesthesia training, including a fellowship in obstetric anesthesiology, from Stanford University in California. She speaks nationally and internationally on the topic of birth trauma and the need for trauma-awareness in obstetrics and actively promotes medical “centers of excellence” in providing trauma-informed care for obstetric patients. She offers full-day training sessions on trauma-informed care principles throughout Pennsylvania as an initiative through the PA PQC (Perinatal Quality Collaborative). Her hospital based work also includes involvement with quality assurance processes, education and training of nurses, residents, and medical students, and creation of specific care plans for high risk obstetric patients including those with prior sexual trauma, opioid tolerance and substance use disorders, and mental health concerns. Beyond her work in hospital settings, she is part of the governor’s HEAL PA Taskforce seeking to make Pennsylvania a trauma-aware state.
