pregnancy and abuse

Pregnancy and Abuse: How to Stay Safe for Your 9 Months

Pregnancy is a time of change. If you’re pregnant, your life — and your body — starts taking on a new shape as you prepare to bring a little person into the world. Pregnancy can be full of excitement but also comes with an added need for support. It’s natural to need emotional support from a partner, as well as perhaps financial assistance, help to prepare for the baby and more.

If your partner is emotionally or physically destructive toward you, it can make these months of transition especially difficult. Thankfully, there are resources available to help expecting women get the support needed for a safe, healthy pregnancy.

If the Abuse Is Increasing or Just Starting — Why Now?

According to the CDC, intimate partner violence affects approximately 1.5 million women each year and affects as many as 324,000 pregnant women each year. Pregnancy can be an especially dangerous time for women in abusive relationships, and abuse can often begin or escalate during the pregnancy.

Partners become abusive or increase the abuse during pregnancy for a variety of reasons. Since abuse is based on power and control, it’s common that an abusive partner will become resentful and jealous that the attention is shifting from them to the pregnancy. They may be stressed at the thought of financially supporting a child, frustrated at the increased responsibilities or angry that their partner’s body is changing. None of this is the new mom’s fault and none of these are excuses. Nothing is an excuse for abuse.

Abuse of any kind during pregnancy can put a woman and her unborn child at heightened risk, because a pregnant woman is in a uniquely vulnerable position both physically and emotionally. If the abuse is physical, trauma can cause both immediate injury as well as increase her risk for hemorrhaging, a uterine rupture, pre-term birth, complications during labor or miscarriage later in the pregnancy.

What Can You Do?

Approximately 96% of pregnant women receive prenatal care for an average of 12 to 13 visits. These frequent doctor’s visits can be an opportunity to discuss what is going on in your relationship. Whether or not you choose to tell a professional about the abuse, or how much you choose to disclose, is completely your choice. However, their job is focused on the wellbeing of you and your child so this could be a safe time to talk about any concerns.

If your partner goes to these appointments with you, try to find a moment when they’re out of the room to ask your care provider (or even the front desk receptionist) about coming up with an excuse to talk to them one-on-one. The doctor’s office can also be a quiet place to make a phone call to The Hotline. If you’ve decided to leave your relationship, a health care provider can become an active participant in your plan to leave.

Additionally, under the Affordable Care Act, all new and non-grandfathered health plans must cover screening and counseling for domestic violence — considering these to be preventive care services.

If possible, see if you can take a women-only prenatal class. This could be a comfortable atmosphere for discussing pregnancy concerns or could allow you to speak to the class instructor one-on-one.

Here at The Hotline, our advocates are also available 24/7 to help you plan how to stay safe during your pregnancy — both physically and emotionally. Physical safety planning could include tips for when fighting starts, for example, such as protecting your abdomen and staying on the bottom floor in a house with stairs.

Pregnancy can be a challenging time and it can feel hurtful if your partner isn’t being supportive, is putting you down or physically harming you. It’s important to develop ways to take care of yourself during such an important stage of your life — and we can help.

Further Reading and Resources

Safe Pregnancy in an Abusive Relationship

A Safe Passage

power control coercion

From “Broken” Condoms to Pill Tampering: The Realities of Reproductive Coercion

In season one of “Desperate Housewives,” the couple Carlos and Gaby can’t agree on whether or not they should have a baby. Carlos, anxious to start a family, replaces Gaby’s birth control with sugar pills, which leads to her getting pregnant. Five seasons (and some children) later, Carlos has again tricked Gabby, and confesses that he didn’t actually have a vasectomy as he’d told her he had.

While there are a lot of outlandish storylines in the show, this one isn’t far from reality for some couples. Unfortunately, these scenarios don’t just happen onscreen, and there’s a name for them: reproductive coercion. Both men and women can coerce their partners, as seen in Carlos and Gaby’s relationship, into being at risk to have — or actually having — a baby.

Reproductive coercion is a form of power and control where one partner strips the other of the ability to control their own reproductive system. It is sometimes difficult to identify this coercion because other forms of abuse are often occurring simultaneously.

Reproductive coercion can be exerted in many ways:

  • Refusing to use a condom or other type of birth control
  • Breaking or removing a condom during intercourse
  • Lying about their methods of birth control (ex. lying about having a vasectomy, lying about being on the pill)
  • Refusing to “pull out” if that is the agreed upon method of birth control
  • Forcing their partner to not use any birth control (ex. the pill, condom, shot, ring, etc.)
  • Removing birth control methods (ex. rings, IUDs, contraceptive patches)
  • Sabotaging birth control methods (ex. poking holes in condoms, tampering with pills or flushing them down the toilet)
  • Withholding finances needed to purchase birth control
  • Monitoring their partner’s menstrual cycles
  • Purposefully trying to pass on a sexually transmitted disease
  • Forcing pregnancy and/or not supporting their partner’s decision about when or if they want to have a child
  • Forcing their partner to get an abortion, or preventing them from getting one
  • Threatening their partner or acting violent if they don’t comply with their wishes to either end or continue a pregnancy
  • Continually keeping their partner pregnant (getting them pregnant again shortly after they give birth)

If an abuser forces their partner to become pregnant, this is not necessarily about the outcome of the pregnancy but rather about the control and power an abuser holds over their partner and their partner’s body.

Reproductive coercion can also come in the form of pressure, guilt and shame from an abuser. Some examples are if your abuser is constantly talking about having children or making you feel guilty for not having or wanting children with them — especially if you already have kids with someone else.

In 2011 The Hotline conducted the first national survey to learn the extent of reproductive coercion. The findings were shocking. Over 3,000 callers participated in the survey and 25% reported that they had experienced this type of abuse.

Safety Plan With an Advocate and Your Gynecologist or Doctor

If you call The Hotline at 1-800-799-SAFE, an advocate can help you develop strategies to address your situation. A gynecologist or health care provider can also be a useful resource, especially in helping you conceal contraceptive methods if this is an issue. Doctors can give birth control pills in plain envelopes for example, or provide less detectable forms of contraceptive. Some of these options include a shot, an implant or an IUD with the strings trimmed.

If you have a positive STI test result and are afraid of how your partner will react, you can speak with your doctor about anonymous partner notification services.

Further Resources

Know More Say More: Futures Without Violence’s awareness campaign around reproductive coercion and domestic violence

finding the right counselor for you

Finding the Right Counselor for You

The idea of sharing personal stories and emotions can be scary, especially if you’re still feeling hurt or vulnerable from a breakup. Delving into these difficult feelings can ultimately be one of the most helpful ways to cope and move on. That’s where counseling comes in. Talking with someone one-on-one in a safe space is a great option for anyone who may need support.

To learn more about the process of starting counseling, we met up with licensed clinical psychologist and motivational speaker Martha Ramos Duffer whose work is centered on trauma treatment, empowerment and personal growth. She provided us with incredibly helpful information on how to choose a counselor.

What are the differences between a counselor, therapist, psychologist and psychiatrist? Who would you suggest for someone who has left an abusive relationship?

That’s an important place to start. The words psychotherapist, therapist and counselor are all used interchangeably. These are people who have received master’s degrees in counseling, social work or psychology. Psychologists have more training because they are doctorate level therapists. Any of these professionals can do a great job providing therapy.

On the other hand, psychiatrists have a doctorate in medicine. In most states they are the only ones who can prescribe medicine and most don’t provide therapy. What most often happens is that somebody who needs medication will see a psychologist or other licensed counselor for therapy and see a psychiatrist for medication.

It’s important to make sure the professional you decide to speak with is a licensed mental health professional. Terms like “licensed professional counselor” are legally regulated, so not just anybody can call themselves that. Words like “counselor” or “coach” are not regulated, so anybody can call themselves that.

What are the steps to take in order to find the right counselor?

The first thing to think about is financial access. Will you try to use insurance to pay? If not, will you pay out of pocket and do you need sliding scale fees? Some therapists offer varying prices based on the client’s income level.

Some communities also have local mental health centers with low fees. If you’re just leaving an abusive relationship and you don’t have access to funds or insurance, see if one of these exists in your area.

If you have insurance, call and request a list of mental health care providers. After you have a list, you can begin to ask around to see which of these professionals are recommended by others. If you’re coming out of a shelter, ask the people who work there for recommendations. Ask friends and family if anybody has seen a mental health professional who has worked well for them.

If your friends and family members haven’t used mental health professionals, there are other options. Ask for recommendations from other health professionals in the community, like your physician or even other psychologists. Psychology Today is also a useful site where many mental health professionals advertise, allowing you to read doctors’ bios and research more options in your area.

Call several different therapists and talk with them before setting up an appointment. This lets you determine how comfortable you feel and how responsive they are. Ask if they have expertise working with clients who have experienced trauma and domestic violence.

What are some red flags that indicate that a therapist may not understand domestic violence or aren’t a good fit for you?

If a therapist gets defensive when you ask them if they have experience with trauma and domestic violence, then it is likely that they are not well trained in that area.

Another huge red flag is if a therapist wants to begin by looking at your role in the relationship and treats the abuse as a mutual-fault issue. That doesn’t mean that in complex ways we don’t all play a role in every dynamic but that’s not how to treat a survivor of domestic violence. If they start to discuss the situation as if it was a traditional marriage or relationship issue and try to explore your own role in triggering or participating in the abuse, this is a clear sign they don’t understand domestic violence.

If a counselor recommends couples therapy or marriage therapy, this is also a red flag. This is not recommended when there’s battering and violence in a relationship.

How do you know a counselor is a good fit for you?

A good match between therapist and client is one of the most powerful healing factors in a therapeutic relationship. Look for someone who makes you feel heard, understood, safe and comfortable.

If you don’t feel this way, it makes sense to look for someone else. However, it’s important to first ask yourself what is making you uncomfortable. Is your discomfort coming from how difficult it is to talk about this? Of course you’re going to feel badly as you start to talk about what happened. There are all kinds of things that can make a first session not feel good, and you need to discern if your discomfort is because starting the process is difficult, or because you don’t feel heard and understood by the counselor.

Check the blog on Wednesday for the second part of our interview with Martha.

National Domestic Violence Hotline Blog

OB-GYNs, Neurologists Encourage Routine Domestic Violence Screenings

An article released yesterday by the LA Times details the efforts of national OB-GYN and neurological associations to promote routine domestic violence screenings of patients.

In response to the high rates of domestic violence around the nation, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Neurology (AAN) have both called on their members to perform routine examinations of their patients for signs of abuse.

A report issued by the ACOG states that 25 percent of women have been physically or sexually assaulted by a partner. Because OB-GYNs see patients throughout their lives, they are in a unique position to help identify domestic violence victims and intervene to potentially prevent future abuse from occurring.

Neurological professionals are also getting involved. The majority of domestic violence injuries are to the head and neck. Neurologists who are able to identify the cause of these injuries have the opportunity to intervene and offer help to victims.

The involvement of these professionals could help countless victims. This conscious effort to identify abuse signifies the growing trend of a community response to domestic violence, allowing various roles in a victim’s life to do their part to intervene. With a combined total of 80,000 members, these sections of the medical workforce will be able to make a significant impact in many victims’ lives.

National Domestic Violence Hotline Blog

SEEING Beyond Abuse

By Jessica L. Young, O.D. | Pennsylvania Optometric Association’s 2010 Young Optometrist of the Year

Many may think that visiting an eye doctor would be the last place for an abuse victim to go.  After reading this article, you may disagree. One day, a 49 year-old woman came to see me for a routine eye examination. Her vision was getting a little worse and she thought, “Maybe I need a new pair of glasses.” During the examination, I noticed a tear in the iris of her right eye.

Upon checking her eye pressure I found that it was elevated in her right eye. I asked the woman if she had ever sustained any injuries to her eyes. She confirmed that she had in fact been hit many times in her eyes and face years ago by a former boyfriend. I explained how the trauma had damaged her eye and the increased eye pressure could lead to optic nerve damage and vision loss if left untreated. We decided to begin medicated eye drops to lower the eye pressure. So far the drops are successfully keeping the pressure down, reducing her chances of vision loss. This woman very well may have lost her eyesight had she not happened to come for a regular eye exam.

Physical assault resulting in trauma to the eye can have both immediate and lasting effects. If trauma to the eye occurs, urgent medical attention should be sought to treat any immediate damage. Visiting an eye doctor is prudent for anyone who has ever sustained trauma to the eye at any time. This is because a form of glaucoma, called traumatic or angle recession glaucoma, can occur months or even years after an eye injury.

Glaucoma is the second leading cause of blindness in the United States. But what is glaucoma? The eye contains fluid, which is constantly being produced and drained. This fluid creates a pressure inside the eye (intraocular pressure) and helps the eye keep its shape. If this pressure becomes too high, it can damage the nerve inside the eye (the optic nerve), which can result in permanent vision loss. This is glaucoma.

When the eye undergoes trauma, the damage that occurs can lead to glaucoma. The fluid in the eye is drained where the cornea (the front clear window of the eye) meets the iris (the colored part of the eye); this is called the angle. This drainage angle can be damaged during a traumatic event such as a strike to the eye. When the angle is damaged, the fluid may not drain properly, which can cause the eye pressure to increase and can then lead to glaucoma. This is a special type of glaucoma: angle recession, or traumatic glaucoma.

In the United States, over 1 million Americans experience eye injuries each year. Blunt eye injuries account for over 60% of these injuries, and over 10% of all eye traumas are due to assault[1]. Damage to the eye angle (called angle recession) is one of the most common complications after a strike to the eye[2].  Though infrequent, damage to the eye angle can lead to angle recession glaucoma. This can occur weeks, months, or even many years after the trauma to the eye has occurred. As with most other forms of glaucoma, symptoms of vision loss are not noticed until the glaucoma is advanced and the damage is extensive. In fact, glaucoma is often called the “sneak thief of sight”. Since traumatic glaucoma can occur long after the eye has been injured, it is very important not only have an initial eye examination, but also regular visits to an eye doctor.

At the first visit to an eye doctor, it is necessary to mention any previous eye or head trauma so the eye can be properly evaluated for angle recession and glaucoma. The doctor will check the eye angle with a special lens, measure the eye pressure, and evaluate the optic nerves for any signs of damage. If angle recession is found, regular follow-up visits will be needed to monitor the eye for angle recession glaucoma. If glaucoma is detected, the doctor will likely start prescription eye drops to lower the eye pressure and try to prevent further damage to the optic nerve.

The Centers for Disease Control and Prevention estimate that 1.3 million women are victims of physical assault by an intimate partner each year. One in every four women will experience domestic violence in her lifetime. Domestic violence is a serious problem and a common cause of injury.

I urge anyone who has ever sustained an eye injury, especially victims of domestic violence or child abuse, to schedule an examination with an eye doctor. Please mention your history of eye trauma so the eyes can be properly evaluated

[1] American Academy of Ophthalmology.  2009 Eye Injury Snapshot Project Results.

[2] Sullivan, Brian R.  Angle Recession Glaucoma.

* It’s rare to get an eye doctor’s perspective on domestic violence. We thank Dr. Young for reaching out to us and sharing this important piece of information. *

National Domestic Violence Hotline Blog

Domestic Violence: Medical Records Can Sound an Early Warning

The following blog entry is written by Nancy Fliesler. It originally appeared on Thrive, Children’s Hospital Boston’s health and science blog. It is being featured on our blog with permission.

Domestic abuse often goes undiagnosed until too late — yet medical records often contain subtle clues that doctors often lack the time to fathom out. Now, researchers from the Children’s Hospital Informatics Program and Division of Emergency Medicine demonstrate that tapping commonly available electronic health records could help doctors spot abuse early. This display, designed for physicians, pulls a patient’s diagnostic history into one view, sounding an alert when the pattern of visits suggests possible domestic abuse.

Each colored bar above represents a diagnoses recorded in the patient’s chart, grouped by category, during the four years before her abuse diagnosis; the most recent diagnoses are shown at the bottom. The color coding denotes the degree of abuse risk, calculated using data from the study (green, low risk; yellow, medium risk; red, high risk). As indicated by the blue “detect” arrow, the system would have sounded an alert as early as 34 months before domestic abuse was actually diagnosed.

In the future, the researchers hope that their models can detect when a person is at risk for abuse before abuse even occurs. Although the study, published in the British Medical Journal, was done in adults, the plan is to validate the model in children, too, and to develop similar models for conditions that are often missed, like depression and early-stage diabetes. According to Ben Reis, PhD, who led the project, such “intelligent histories” are an important step toward the larger goal of predictive medicine — helping busy physicians not by making diagnoses for them, but by offering a decision support tool that can flag patients who merit specific screening.

National Domestic Violence Hotline Blog

Domestic Violence Training in Hospitals

The following entry is written by Maria Phelps.  Maria is a survivor and blogger. She uses her website  to share her personal experience with DV, address current DV issues and advocate for victims’ rights. Maria was kind enough to give us permission to reprint her latest entry and share it with you all.

Two years ago I was brought into St. Lukes Hospital in Orange County NY for a severely injured left leg. I was carried in on a stretcher by EMTs, followed by my abuser. I was given a room and got immediate attention by the staff, and the team of medical personnel did a wonderful job in stabilizing me and taking care of my injured body. With my abuser at my side, I was asked questions by the staff members, questions like “how did this happen?”. My husband answered for me, naturally, he wanted to hide the abuse and conceal the truth. I was afraid, in shock, and immobile, and I lied that night in the ER. For a few moments, I was taken out of my small hospital room and was wheeled off to get X-rays. I was alone, finally. Nurses tried to make conversation with me and asked what had happened, and I told them “my husband did this to me”. The conversation was over at that point, and everyone became uncomfortable. I got my X-rays not too long after the conversation and found that I had three breaks in my left leg, and I needed surgery. I went home with my abuser that night.

Today was court. Today I was prepared for a trial for my order of protection in Rockland County NY, under Judge Christopher. While preparing for my trial, I realized that the way a scene of a domestic violence crime is handled by law enforcement and medical personnel is critical for the victim. In my case, I was never once separated from my abuser the day of the injury, not when the police arrived, and not when I got into the ER. This changed everything. I was too afraid to tell the truth about what had happened to me to the officers when the injury took place, and I was too afraid to tell my Dr. what happened to me at the hospital because my abuser was hovering over me the whole time. My abuser was at my side the entire night, helping the police file a false police report, his version, and telling the Dr. that my injury was a result of “playing around/wrestling”. Looking back on this situation, both at my home with the police and at the hospital, I’ve realized that had the hospital staff been trained in recognizing the signs of DV, my case against my abuser would have been stronger today. It is critical to have accurate accounts of what happened at the scene of any violent crime, especially DV crimes, because too often, battered women are too afraid to report abuse to the police. In my case, even though I sustained severe injuries, there are no reports stating that the injuries stemmed from abuse. Thankfully, I did file an amended police report about the abuse at a later date, but I was lucky.

Although the scene of my domestic violence incident was not handled properly, I was still prepared for court today. I was prepared to tell my story of brutal violence, and I was prepared to tell the whole truth, nothing but the truth. I was prepared to explain why I couldn’t tell the police the real story that day, and I was prepared to explain why I couldn’t tell my Dr. the real story either. The truth is, I was never left alone with any member of law enforcement and I was never left alone with my Dr. long enough to tell the truth that night. When I arrived at court, I was ready to give my testimony and I was ready and eager to hear my husband’s testimony. But, I never got to testify because my abuser consented to the permanent restraining order and I was able to walk out of court today with my order of protection (1 year OP).

Although I was able to get my order of protection, I am still disturbed about something. Today I phoned St. Lukes Hospital in Newburgh NY and asked to speak with someone in the hospital that would know about staff member domestic violence training. I am certain that there are hospitals in Ulster County, Rockland County, and Westchester County that have local shelters train hospital staff members about recognizing the signs of violence. But after I asked the question, no one knew of any “DV training” in the hospital, and I wasn’t surprised considering I was a victim of violence and no one saw the signs two years ago when I was brought in on a stretcher. So, I left a message with the Education Department and I emailed my question directly to the hospital. I am waiting for a reply, but this is an issue I want to address. It is critical for victims of domestic violence to have at least one accurate record about the abuse on the day of the injury. These documents are critical for the courts and hospitals should be trained to recognize the signs of abuse and they should be following a protocol, possibly making a confidential DV file for the patient, and giving victims safety plans.