Pregnancy is supposed to be a time of peace and safety. A time where the family turns its thoughts towards raising the next generation and growing a healthy baby. Unfortunately for many women, pregnancy can be the beginning of a violent time in their lives.
Effects of Domestic Abuse on Pregnancy and Labor
Domestic abuse and violence against pregnant women have immediate and lasting effects. While some of the complications you might suspect are present, such as immediate injury to the woman or her baby, there are also other effects on the pregnancy.
Many women who are battered during pregnancy will continue unhealthy habits due to stress, such as smoking, resorting to drug use, and improper nutritional habits. These also affect the pregnancy.
Immediate effects on the pregnancy can include:
Abuse, both in the past and in a current relationship, particularly sexual abuse, has been shown to have effects on laboring women. There is even some speculation as to whether or not previous history of sexual abuse can delay the baby from dropping into the pelvis, make the pushing stage longer, etc.
The constant pelvic exams by multiple people, the lack of privacy, the increasing sensations in the pelvic area from contractions and the baby, and the potential for a feeling of lost self-control all contribute to potential triggers for the women with these histories.
Counseling prior to labor, involvement of the primary midwife or doctor can help lessen these sensations for the abuse survivor in the labor scenario. Precautions taken to ensure fewer vaginal exams, pain relief of the choice of the woman, and reduction in the number of extraneous personnel at the birth are all ways to reduce the incidence of problems for these women.
Screening for Domestic Abuse
It is estimated that one in five women will be abused during pregnancy. As homicide during pregnancy now surpasses the previous leading causes of death (automobile accidents and falls), it is more important than ever that we know the signs and properly screen women for domestic violence.
The good news is that many women have a relationship with a health care provider, particularly during pregnancy and well baby visits, after the birth (even for lower income families). This allows more opportunities for screening and prevention.
What we still need to work on is making sure that the care providers and emergency room workers know the signs of abuse and what to do about them. Currently about 17% of all routine health care providers screen for domestic violence at their first visit, with only 10% screening at subsequent visits.
Abused women come from all backgrounds and socioeconomic areas. There are barriers to determining who has suffered abuse because of fear of reprisal from the violent partner, lack of knowledgeable viable alternatives to money and housing issues, and embarrassment that she is even in this situation. Practitioners need to be sensitive to these issues.
Common signs might be: