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

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.