“Perinatal Trauma, Part 1” – with Dr. Katherine Jorda

In this episode of Healthful Woman, Dr. Nathan Fox meets with one of his former residents, Dr. Katherine Jorda. Now, she is an attending OBGYN in Oregon and will be discussing perinatal trauma.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN, and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Dr. Katherine Jorda. Kathy, welcome to the podcast. It is so nice to have you on the podcast as a guest. I miss you.

Dr. Jorda: Thank you so much, Nini. I miss you too. It’s been a while.

Dr. Fox: It’s been a while. And you’re all the way on the other side of the country. You’re like the exact opposite side of the country is where I’m sitting right now. So I feel that connection all the way across, but it’s nice to hear your voice again.

Dr. Jorda: Same here.

Dr. Fox: Wonderful. So you reached out to me to say, “Hey, I love your podcast. It’s the greatest thing in the world, and I want to be on it to talk about a really important topic.” And so I appreciate that. It gave me a chance to catch up with you, and it gives our listeners a chance to hear you talk about a really important topic related to trauma. And before we do that, I just want to go into a little bit, who is Kathy Jorda? So you were born in Chicago, right?

Dr. Jorda: Yes. I grew up in the suburbs.

Dr. Fox: Yeah. You know that we’re exactly the same person…

Dr. Jorda: I know.

Dr. Fox: …born in Chicago. What brought you to New York? Why’d you go to New York City? Because that’s where you basically lived.

Dr. Jorda: Yes. Gosh, I loved growing up in Chicago. I was a very loyal Chicago sports fan, so Chicago Cubs, Chicago Bulls. I loved growing up in the Midwest, but for college, I really felt like I wanted to do something different, and Columbia absolutely appealed to me. And I was very lucky to get in, and I was like, “Time to go. Time to pack up and go out to New York City.”

Dr. Fox: Crazy. All right. So far we’re exactly the same, Chicago Cubs, Bulls, Columbia. Fine. And then what led you to go into medicine? I’m curious. I don’t know the answer to this question.

Dr. Jorda: Yeah, my parents are immigrants, and we had no physicians in our immediate family. Whenever we went to medical appointments, it always felt like a world I didn’t understand, a whole new language, and how useful would it be to be a physician and speak that language. So I wasn’t 100% sure but set up some of my college courses to be able to get into medical school if that’s what I wanted to do. And so I was lucky to get in at Mount Sinai in New York City.

Dr. Fox: So you go to Mount Sinai, again, still following in my footsteps, which I greatly appreciate. And you’re at Mount Sinai, and you’re a stellar student, obviously. And how did you choose to go into OB-GYN?

Dr. Jorda: I did surgery first, and I said, “Oh no, I really like being in the operating room but didn’t really see myself being a surgeon.” And I actually thought I wanted to do something a little bit more diverse, like a medicine-pediatrics, I get bored easily, and I thought, “Gosh, with medicine-pediatrics, how diverse a patient population? Why don’t I pursue something like that?” And then I did OB-GYN last, and I did my first delivery, and I absolutely fell in love, like hook, line, and sinker. I said, “This is what I want to do the rest of my life.” Doing deliveries at 3 a.m. was great. It was energizing, was so much fun, even though I’m a complete morning person and being up in the middle of the night is not always my jam, but for deliveries, yes, I could do that.

Dr. Fox: Awesome. Where’d you do your rotation?

Dr. Jorda: I did my rotation at a private hospital in New Jersey.

Dr. Fox: At Englewood or Barnabas?

Dr. Jorda: Not Englewood, Barnabas.

Dr. Fox: Ah, okay. Awesome. Terrific. Then you did do your OB residency at Sinai, and that’s where we basically got to know each other well, I would say.

Dr. Jorda: Yes, absolutely. I don’t know if you remember this, but when I was an intern…

Dr. Fox: Probably not.

Dr. Jorda: When I was an intern, you were moonlighting at Elmhurst as an attending, and one of my first deliveries with you, you said, “Have you done forceps delivery?” And I said, “Of course, not. I’m an intern,” and you said, “Go get forceps.” And I ran to go get them, and my hands are shaking. I’m so excited. And the patient didn’t end up needing the forceps delivery, but I was so excited to be able to do an operative delivery with you as an intern.

Dr. Fox: But it didn’t happen.

Dr. Jorda: It didn’t happen, and I was like, “I’m here.”

Dr. Fox: The patient flouted our efforts. All right.

Dr. Jorda: “I’m ready.”

Dr. Fox: Yeah, that was a great time. First of all, you’re part of a really, really good class of residents. It’s a good year for you guys. There are better years than others, and yours was definitely one of the better years. And, yeah, that was a lot of fun, I remember, so I guess that was like 2005, 2006, 2007, 2008-ish, somewhere in that range, I guess. I don’t know what year you were in.

Dr. Jorda: 2007.

Dr. Fox: Yeah, so I was a fellow, and I was doing a lot of moonlighting at that time, because I had four kids and no job, so it was kind of rough economically for the Fox family. So I did a lot of moonlighting. But, no, it was awesome. I mean, Elmhurst Hospital is the best. I mean, it’s just the best place on Earth in so many ways, and it was great. All right, so good. So you’re a stellar OB-GYN, and you finish, and then you go out to Portland, like, Portland, Oregon, not Portland, Maine. What brought you all the way out there?

Dr. Jorda: Correct, correct. Well, my husband went to medical school with me, and that’s where we met, and he had a job opportunity out in Portland. He was doing a one-year fellowship, and at this point, I had been in New York for 12 years, and I absolutely loved it, but I was thinking it was time to try something new, and we thought, “Gosh, let’s try Portland, Oregon for a year.” And I joined the faculty at Oregon Health and Science University for a one-year position, and I ended up loving it, so did my husband. And so we both ended up staying here.

Dr. Fox: That’s amazing. Now, did you realize that you still maintained your very strong Midwest accent through all this?

Dr. Jorda: I had not.

Dr. Fox: I hear you, and it sounds so peaceful. I love listening to my own kind speak. It’s just…it’s the dialect. I get it. It’s like speaking your own language, so that’s great. So what’s it like out there? I’ve been to the West Coast, but I’ve never been to Oregon, although I should go. I know there’s a lot of runners out there and there’s a lot of vegan food. What else do I need to know?

Dr. Jorda: Yes, it is very naturally beautiful. Growing up in Illinois, it was always a two-hour drive or three-hour drive through corn fields to get to a different environment. And here in Portland, you basically can drive an hour and a half in any direction and get to the coast, you can get to mountains, desert plains. When you step off the plane, the air is so incredibly fresh. So when I have people visit from New York City, they’re like, “Gosh, it really does feel like a breath of fresh air,” and I absolutely agree.

Dr. Fox: That’s amazing. So you’re in Portland, you’re an OB-GYN. What’s your practice like or what was it like and how has it evolved over these years?

Dr. Jorda: I started as a generalist in 2011, and this was my first job out of residency, and I was thrilled to be at an academic center. I absolutely love teaching, wanted to keep that going, and I loved being a general OB-GYN. One of my favorite surgeries is a vaginal hysterectomy, and I was also at the Portland Veterans Administration Hospital doing benign gynecology, and I unfortunately worked with a lot of veterans who had military sexual trauma. And so learning more about trauma and the impact it can have on patients and their lifelong health really became important to me. I was also on the obstetrics quality safety committee, and so we would review cases, and I often saw how communication breakdowns played a role in challenging outcomes for patients. And so I combined a little bit of my gynecology experience with the obstetric quality case review to develop a new clinic for patients who have had a traumatic delivery in their past.

Dr. Fox: So explain that to me. You have background, I guess, in your practice in sort of trauma in general because you’re dealing with veterans who had, I guess, sexual trauma or abuse of sorts in the military. And you’re also an OB-GYN doing gynecology and doing deliveries, and you somehow come up with an idea that you’re going to take trauma and sort of a different kind of trauma, I guess I would say, related to a delivery and sort of work with those patients. How did you even come up with that idea? Because it’s the same word, but it’s so different.

Dr. Jorda: Yes, absolutely. It started with a conversation with a colleague. We were in clinic late on a Friday afternoon doing our charting, and she was talking about the great lengths that she went to provide care for a patient who had had a traumatic delivery. The delivery itself went really well, but the patient ended up with a spinal headache after the fact, and the patient made the comment of, “Gosh, actually the spinal headache was one of the most traumatic parts of my delivery because it brought up events and thoughts of my prior delivery that was really scary for me,” like going under general anesthesia for her first C-section. And so the anesthesiology team unfortunately did not know this history from the patient. And when they had their conversations about treatment for the spinal headache, it brought up a lot of bad memories of her prior delivery.

Dr. Fox: So you decide to start this new clinic. What did that entail? What did you have to do in order to do this?

Dr. Jorda: Yes. At my institution, there is a yearly grant that you can apply for to start new clinical initiatives. So I had to do a literature search and see what was out there and write a grant application.

Dr. Fox: And then basically they approved it. And this is something novel, right? There aren’t a lot of these floating around.

Dr. Jorda: Yeah, when I had the idea with my colleague, we thought, “Surely, this must exist at other places. We can see what they’ve done to set up their clinic and learn some lessons from them.” And we did not come up with much at all in our literature search.

Dr. Fox: Wow. So did you have to do any formal training yourself in trauma or counseling or psychology or anything related to that? Or did you just decide you’re going to bring in mental health professionals to partner with you? How did you do that logistically?

Dr. Jorda: We did a little bit of both. So we absolutely had a behavioral health team with us that was partnering with us to guide the treatment principles that would do. And we also did some continuing medical education. So all of us as a team went and did some training at Harvard Medical School, and there’s a psychiatrist there named Dr. Alisha Moreland who started a trauma-informed systems change course. And so my behavioral health colleagues had a little bit more formal training in taking care of patients with a history of trauma, but we did the course together to get a baseline.

Dr. Fox: And so what happens at this clinic, just for our listeners? Who would go… What happens there that’s different from maybe their own prenatal visits or their family or friends’ prenatal visits? How would they sort of understand what you’re doing over there?

Dr. Jorda: Yes. So our patients come to us through a variety of different ways. They can refer themselves or their prenatal care provider can talk about their prior obstetric history and realize, gosh, this person had some elements of a traumatic delivery in their past and get referred to our clinic. Typically, we do an intake visit together, so one general OB-GYN along with a behavioral health specialist, so either a reproductive psychiatrist or a psychologist, to the initial intake visit together so that we can explore both elements of the obstetric history as well as the behavioral health impact.

Dr. Fox: And I would imagine that doing it together is also a real service to the patient because she doesn’t have to tell the same story twice.

Dr. Jorda: Exactly.

Dr. Fox: So she basically just tells you both. And you may ask more questions on the medical side, and the other person may ask some more questions on the behavioral health side potentially. You could obviously both ask about both, and then it comes together. So that happens at the initial visit. And what kind of traumas would, I don’t want to say qualify because I imagine you turn a lot of people away, but would typically bring someone in to your clinic?

Dr. Jorda: Yes. We have a really broad definition of trauma in terms of what brings a patient into our clinic. It often relates to a prior delivery, so either an obstetric emergency, like an operative vaginal delivery or an emergency C-section, a challenging maternal outcome, like postpartum hemorrhage, or having a prior history of trauma from medical care in their past.

Dr. Fox: Okay. And then after the initial visit with you guys, do you follow them? Is there sort of primary providers for the whole pregnancy, or do you function as consultants while they stay with their own doctor, or is both an option? How does that work?

Dr. Jorda: Yeah, we give patients both options. So if they are with a prenatal care provider that they really like, that they’ve established with and want to continue with them, we can do a one-time consult, and we try to come up with a really concise plan that anyone who’s taking care of the patient can access. So we identify what is something that didn’t go well or that they’d like to improve upon from their last delivery and identify anything that went well from their last delivery that they’d like to continue and really clarify what their goals are for this next delivery.

Dr. Fox: And then what if they want to stay with you entirely?

Dr. Jorda: Yes, some patients will want to stay with us entirely, and we will take them on as patients and follow them.

Dr. Fox: I’m just trying to get a sense. Is it mostly on the sort of mental health side, or is it mostly on the obstetrical side? Meaning when they talk about what happened last pregnancy and it was traumatic, and you mentioned let’s say a postpartum hemorrhage. Is most of what you’re doing, how do we prevent another hemorrhage, what’s your risk for a hemorrhage, a workup for a hemorrhage, those types of things versus you had a really difficult delivery and difficult experience, how are we going to make the next one a little bit better for you? Again, whether you hemorrhage or not. I’m just trying to get a sense. What part of it are you guys focusing on? Unless it’s both equally.

Dr. Jorda:Yeah,it can be a little bit of both. I often think of, “Gosh, if you had a postpartum hemorrhage, what can we do as obstetricians to stack the odds to minimize that chance of that happening? And I can’t 100% guarantee that that won’t happen again. But what can we do medically to improve those odds that that experience won’t happen again?” And then we also play devil’s advocate. So we say, “Okay, I know you don’t want to have a postpartum hemorrhage happen again, and we’re absolutely trying to minimize that risk for you, but what if it does happen again? How can we communicate better? What can we do moving forward?” And communication is often a hotspot for prior traumatic deliveries.

Dr. Fox: In terms of that that was part of the reason it was traumatic?

Dr. Jorda: Exactly, exactly. So some patients will say, “Gosh, I was afraid I might die when I had a postpartum hemorrhage. Nobody was communicating with me. Nobody was telling me what was going on.”

Dr. Fox: And so when you’re meeting with them, is it a lot of counseling to process that, or is it sort of on the practical and, “Okay, we’re going to be sure to be very clear on communication, or we’ll recommend to your providers, like, be very clear about communication”? Do you understand my question about what part of this is happening during the prenatal care?

Dr. Jorda: Yes. Yeah, I will often rely on a behavioral health specialist to kind of process a little bit of how that went. But in my plan, I try to be really concrete, communication was very challenging in the past, and they want involvement or very clear communication about what is happening.

Dr. Fox: And how long have you been doing this clinic for?

Dr. Jorda: About three years now.

Dr. Fox: And what has been the response to it? Just I guess your own sense and maybe if you have any numbers or anything like that?

Dr. Jorda: Yeah, the patients are very grateful that this service is happening. Unfortunately, I wish I wasn’t as busy as I am. I would love to get this message out there and not be as busy because I don’t want anyone to have a traumatic delivery.

Dr. Fox: And do you think that it’s more an issue that there are traumatic deliveries that can be avoided or people have traumatic deliveries but their providers aren’t typically able to, for whatever reason, serve them in the next pregnancy well? Do you know what I mean?

Dr. Jorda: Yeah, I think it’s absolutely the latter. I don’t want anyone listening thinking like, “Oh my gosh, a traumatic delivery is going to happen to me,” or be very fearful of birth. But as a obstetrician, I can’t 100% guarantee that a patient will have a good outcome, that a patient will be completely healthy and they’ll have a normal healthy baby. And I absolutely wish that were the case, but in the absence of that, if someone has a bad outcome, how can I show up as a physician and support them? And if I can’t guarantee that they’ll be 100% healthy and that their baby will be healthy, and they do have a bad outcome, what can I do to mitigate that experience for them?

Dr. Fox: So let’s get a little bit into trauma. We’re using this word, and it has different connotations for different people and different definitions for different people. So when you talk about this, if you lecture about it or if you’re talking to patients about it or just if you think about it, how do you even define trauma?

Dr. Jorda: Yeah, I think of trauma as a fear that doesn’t turn off. It doesn’t matter whether the threat is perceived or real. Basically, the fear response is turned on all the time.

Dr. Fox: And then there’s this idea that there’s different parts of the trauma, I think you call it or I read about the three Es.

Dr. Jorda: Yes. So the three Es of trauma are the event itself, the experience, and the effects.

Dr. Fox: And so what are the difference between those three?

Dr. Jorda: Basically, I think an example here could be really helpful. So say someone gets in a car accident, and that’s the event. One person’s the driver, and they likely had a concussion, but they didn’t have the resources to access medical care afterwards. They felt responsible for the accident since they were the driver, and they began to feel guilty about the accident. When people ask if they want to talk about it, they choose not to. So their experience of the event is challenging because they feel isolated and ashamed, and they become fearful of driving and have physical deficits from their untreated head injury. So that leads to the longstanding effects. So the event is the car accident, the experience is challenging, and the effects over the course of that person’s life are negative. So you have another person in the exact same accident. So they have the same event happen to them, but they were able to access medical care treatment. They were upset about the accident and shared what happened with some close friends. And after some time, they felt supported by their community and even felt a renewed sense of gratitude for their life. So their experience of that event is really different and changes their longstanding effects.

Dr. Fox: And so based on that, it would seem that the trauma is really more related to the experience of the event than the event itself.

Dr. Jorda: Absolutely. And the experience is really impacted by the supportive relationships that that person does or doesn’t have.

Dr. Fox: It’s really interesting when you mention that. We have a sister podcast that we actually rolled them together. It’s called “High Risk Birth Stories.” And, basically, in that podcast, it was devoted to people telling the stories of their birth, some happy, some sad, some traumatic, some not, a full range of what went on. And we sort of rolled that into this podcast, and now we just do them here. But one of the recurring themes that came up in this podcast specifically related to trauma is it really was that, it was the experience more than the event, meaning we had some people talk about, I mean, horrible things that happened, stillbirths and miscarriages and really, really terrible events that happened to them. So sad. But at the time of the event, they felt that they were taken care of, they were listened to, they were sort of at peace.

Obviously, they’re very sad about it, and their memory of it is very sad, but they don’t describe trauma from it. They don’t have those manifestations, like you said, the effects from it, whereas other people with maybe even a much less concerning outcome, so whatever it might be. So they had an emergency C-section. Obviously, that’s not on the same level as a stillbirth, but because that emergency C-section produced so much fear at the time, or uncertainty at the time, or maybe disappointment at the time, whatever it might be, that was never really properly addressed either by their doctors or maybe internally in their family or themselves, they still feel a tremendous amount of trauma from that, which sort of, if you look at it, you’re like, “Wait, that doesn’t make any sense. How could someone who had a stillbirth have less trauma than someone who had a C-section?” But it really isn’t… I mean, the event obviously has something to do with it, but it isn’t principally the event, it’s the experience of it

Dr. Jorda: A hundred percent. And that is what I have found in my clinic, is that something that on paper looks fine, healthy parent, healthy baby, but their experience was awful, that is what can lead to that persisting trauma.

Dr. Fox: So what have you learned in the past three years of doing this? Obviously, you’ve learned that, right? Or if you knew it before, you learned it a lot more, right? You definitely are knee-deep in it now. So what would you say to… I’m going to ask this question twice, first, about sort of patients themselves, women themselves going through birth and, second, about the people taking care of them. So the people themselves going through it, what lessons have you learned that can help people who have an event, again, whether it’s wherever it falls on the scale of horribleness, what are the things they can do at the time or right afterwards that might lead to not having trauma from it that might help them get through it in a way that allows them to not feel the effects later?

Dr. Jorda: Gosh, I think there’s a couple things that I’m thinking of, but I would boil it down into three things, so education, communication, and expectations.

Dr. Fox: Wow. And you also picked three things that rhyme. That’s very impressive, by the way.

Dr. Jorda: Oh my gosh. I know. I’m a fan of that alliteration. So the education piece, I think of obstetric emergencies, so an emergency cesarean section or an operative vaginal delivery, so using forceps or vacuum, are big hotspots for perinatal trauma. And I feel like patients should know going into delivery that that’s a possibility. Now, is it very rare and the vast majority of time deliveries go off without a hitch and no issues? Yes, that’s 100% true. But if you find yourself in an obstetric emergency, I would love for you to have some background knowledge before going into labor and delivery that that’s a possibility. So I like to talk to all of my patients in prenatal care to review obstetric emergencies, like an emergency C-section, like general anesthesia for an emergency C-section. And I also like to tell patients about the use of forceps or vacuum deliveries and why they might be indicated and have that conversation in a more calm environment in the office setting rather than on labor and delivery in the midst of an emergency situation.

Dr. Fox: So that’s education beforehand. Is there any education someone can do afterwards potentially to sort of mitigate the possibility of trauma?

Dr. Jorda: Yes, I do think talking to your obstetric provider if possible is going to be very helpful. And if you don’t want to continue care or don’t feel comfortable with that provider, reaching out to anyone in the medical field to review the details of your last delivery, because getting some of those questions answered about what happened here, what was going on, why was this recommended after the fact can be very helpful. And then education in terms of knowing that other people have experienced hard deliveries and reaching out for peer support can be very helpful.

Dr. Fox: Okay, so that’s the education part?

Dr. Jorda: Yes.

Dr. Fox: What was the next -ation? Was that communication?

Dr. Jorda: Yeah. The next one was communication. And I think of that with your prenatal care provider because, from what I’ve heard from patients, they talk frequently about communication breakdowns. So either there was no communication and somebody was left in the dark. So back to our postpartum hemorrhage, they were afraid of dying because of the extent of the bleeding. Or I’ve had spouses say, “I was terrified that my partner would die because they got whisked off to the operating room and nobody told me what was going on.” So either no communication or what little communication did happen was presented in a disinterested or rushed way. And so developing that relationship with your prenatal care provider and asking questions can be incredibly helpful. I think one thing I’ve learned from taking care of patients with a traumatic delivery is everyone has a different communication style. Some people are like, “Give me all of the information. If I’m having a surgery, I want you to narrate exactly what step on the surgery you’re in.” And others are like, “Gosh, just give the need-to-know information. Just give me the highlights. Actually hearing more medical information is going to be overwhelming.” So trying to figure out patient’s communication styles in advance can be very helpful. And you as a patient can tell your provider, “Yes, I want a lot of information,” or, “No, give me the highlights.” And I find that information to be very useful.

Dr. Fox: Awesome. All right, what was the third?

Dr. Jorda: Expectations?

Dr. Fox: Expectations. Love it. So what’s that?

Dr. Jorda: Yes. So I think the vast majority of the time, again, I want to stress people have amazing and healthy deliveries. The human body can do amazing things, including the miracle of birth. I truly believe that. But if someone has a bad outcome and the only narrative that you’ve heard is that birth is amazing, trust your body, it opens up the door to shame and isolation. So if you don’t have an amazing birth, what happened there? Did my body fail me? Am I the only one who hasn’t had a good outcome? And so knowing in the back of your brain that not all pregnancy outcomes end 100% well, I think that can be useful because if you fully believe that 100% of the time things work out and you’re in that small percentage, it really leaves you in an isolated state.

Dr. Fox: And so I guess that’s sort of rolled up with education, but it’s like a subset of it, that it’s not just knowing what might happen but realizing that it’s almost a sense of we don’t always have control over what happens to us. I mean, we can do our best, obviously, and it’s good to do your best to try to, like you said, make the likelihood of an adverse outcome as low as possible, but, ultimately, there’s some things we just can’t control. And that’s very difficult for some people, I think, to buy into. For others, it’s easier. I don’t know, again, what leads someone to be like that versus the other is very…that’s deep. I don’t know, but it really is true. And for some people, it’s just very hard to come to grips with that.

Dr. Jorda: Yeah, I think we bump up into the limits of modern medicine here, right? People are like, “What are you talking about?” I’m like, “That could happen.” And, absolutely, unfortunately, that can happen, but it doesn’t mean you did something wrong or your doctors did something wrong. Sometimes that is the case, right? And we need to get into that. But sometimes it doesn’t have anything to do with you may or may not have done because I find a lot of patients blame themselves for the bad outcome, right? Or if there’s poor communication, “Gosh, I should have pushed my doctor more. I should have asked more.” Sometimes that’s the case, but oftentimes it’s not.

Dr. Fox: Yeah. Well, first of all, I just want you to know I’m loving this. I’m totally drinking the Kool-Aid, and these themes come up so often. I mean, when you talk about education, it’s so poor, unfortunately, the education that’s out there. I think Google has made it very difficult because people just…they’re bombarded with information, and it’s hard to distill sort of what makes sense, what’s appropriate for them, sort of what is applicable to them. And so it’s not that easy, unfortunately, to be educated in advance. I think it really does take some effort either to get it directly from your doctor or midwife or to get what are the sources that they recommend, whether it’s a specific book or specific website or a podcast. I mean, literally, it’s like the reason we do this podcast is to try to give people normal, reasonable, accurate education on the front end, but on the backend, it’s so helpful to do that debrief, like you said.

I would encourage it to be with your own doctor, midwife, whoever delivered you as part of you. Again, none of us want patients to have bad outcomes or to have traumatic births, right? People don’t go into medicine to harm people, right? That’s not why we do this. And so I get it that sometimes when there’s a bad event, you feel like you don’t want to talk to the person who was there because either you feel like they failed you, or either they didn’t communicate with you, or whatever it is. But I think I would encourage people to have conversation with them because, number one, you may get your questions answered, number two, you may have a different view of them afterwards, and if you have the same view of them afterwards that you feel like, again, they failed you, they misled you, whatever it might be, all right, then you leave, you see somebody else. But I think that more times than…I would probably say it’s more likely than not when you leave the conversation, you’ll feel better about the situation compared to worse or the same. And, like you said, if you can’t do that or don’t want to do that, the other option is just to do it with somebody else as possible or do both. But there’s so much that can be gained from that. I think medically, educationally, and also emotionally, part of processing these events is to talk about them and to share them and not to keep them bottled up.

Dr. Jorda: Yes, 100%. I absolutely do agree that patients seek out their delivering clinician because they can give the most accurate update of what was going on at the time from a medical standpoint, right? Because they had all of those details in front of them. It is much harder to go back into a chart and look at what was written to figure out what happened. But that doesn’t mean you have to do it right away. If you’re not emotionally in a spot where you can have that conversation, you can wait six weeks, you can wait two months. But I have found that having that experience of getting the opportunity to have your questions answered from whoever was there for that delivery is the most impactful.

Dr. Fox: Totally. Kathy, we’re going to end this podcast here, but we’re still in the middle of this, and we got a lot to talk about, so I’m going to bring you back. We’re going to do this again next week, and we’re going to do Part B next week. So thank you for joining me. I’m going to have you on again. We’re going to finish this conversation, and for all of our listeners, this is really amazing stuff, and stay tuned for Part B next week with Dr. Katherine Jorda to talk about trauma related to pregnancy and delivery.

Dr. Jorda: Thank you.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.