Domestic Violence and Pregnancy

Recently, more attention has been brought to the abysmally high rate of maternal mortality and morbidity in the United States. As we work to raise awareness of causes of death during pregnancy and the postpartum period, it’s important that we do not overlook one of the greatest risks to the life, health, and well-being of pregnant women: domestic violence.

Domestic violence exists in every socioeconomic group, among every race and culture. Though it can be an uncomfortable topic for discussion, it’s also an extremely relevant one for this blog, as many women are abused for the first time during a pregnancy or the early postpartum period. Violence by prior abusers frequently escalates during pregnancy and postpartum. Homicide, usually at the hands of a domestic partner, is one of the leading causes of death among pregnant women.

Despite the prevalence of domestic violence, many women are surprised or even offended when they are screened by their care providers for domestic violence during pregnancy. One reason for this shock may be the rarity of thorough screening for domestic violence. While the ACOG currently recommends that all patients–pregnant or not–be screened for domestic violence, in reality, care providers often either ignore this recommendation entirely, do not meet the recommended frequency of screening (at the first prenatal visit, at least per trimester, and at the postpartum visit), or gloss quickly over the questions. Midwives, who typically spend more time with their clients, may in a better position to identify women at risk for domestic violence, but the social stigma and feeling of shame over the abuse keeps many victims silenced, even under more rigorous questioning.

Preventing the first incident of domestic violence or the escalation of previous violence is a necessary step in ending DV-related deaths during pregnancy. Knowing the warning signs of a potential abuser can go a long way to preventing domestic abuse (during pregnancy or at any other time in your life). Warning signs of potential abuse and behaviors of current abusers may include:

• Controlling behaviors, like taking over the finances/limiting your access to money, limiting your contact with friends and family, requiring you get permission to leave the house, or expecting frequent updates as to your plans, location, and who you are with.
• Exhibitions of jealous, including accusations of unfaithfulness.
• Destruction of your property, especially items with sentimental value.
• Hurting or threatening to hurt pets or other animals.
• Threatening to harm you or your loved ones.
• Threatening to commit suicide if you leave.
• Calling you names, degrading you, or humiliating you.
• Forcing or coercing you to have sexual intercourse or engage in sexual acts.
• Blocking doorways/exits or physically restraining you to prevent you from leaving the room.
• Blaming you for angry/violent outburst.

If you believe you are at risk for domestic abuse or if you have already been abused, you don’t have to face it alone. Many larger police departments have domestic violence units, which deal specifically with abuse within a family or living community. The National Domestic Violence Hotline is open 24 hours a day, 365 days a week, providing help to women in the United States, Puerto Rice, and the U.S. Virgin Islands. The numbers for the NDVH are:
1-800-799-SAFE (7233)
1-800-787-3224 (TTY) for the Deaf, Deaf-Blind and Hard of Hearing

Women’s Aid provides a 24-hour domestic violence helpline for women in the UK. The free number is: 0808 2000 247

Canada also has a tollfree National Domestic Violence Hotline: 1-800-363-9010

For more information on domestic violence during pregnancy, please visit the CDC’s page on Violence and Reproductive Health. The Maternal and Child Health Library at Georgetown University also offers a comprehensive list of resources for healthcare professionals, victims of domestic violence, and the families of those affected by domestic violence.

Please look after yourselves, your babies, and your other children. Look after your sisters, your friends, and your daughters. Just as we can work together to improve maternal healthcare, we can work together to put an end to domestic violence through education and awareness.