By Molly Remer, MSW, ICCE, CCCE

Violence during pregnancy is an unfortunately common experience. Between four and eight percent of women experience domestic (intimate partner) violence during their pregnancies. The incidence of violence increases for women with unplanned or unwanted pregnancies with 26% of pregnant teens experiencing intimate partner violence and 15% of all women whose pregnancies are unwanted being in an abusive relationship. Indeed, murder is the second only to car accidents as the most common cause of injury related death for pregnant women.[1] Sadly, these statistics are likely higher in reality due to underreporting or misclassification.

Despite prevalence and severity, domestic violence is not often addressed in the birth community. Books directed at pregnant women rarely even mention violence in pregnancy (and most do not even include it at all), even though the incidence is similar to the rate of premature births and much higher than the incidence of various pregnancy related complications that generally warrant at least a paragraph in birth literature (such as placenta previa). Likewise, books and training programs for doulas, birth educators, and other birth professionals, generally neglect to address intimate partner violence.

An introduction to the issue of domestic violence during pregnancy requires an understanding of the following dynamics:

• Cycle of Violence—the concept that violent behavior in a relationship tends to occur in three distinct phases. In the tension building phase, the battered partner feels as if she is “walking on eggshells.” The abuser’s temperament and mood becomes increasingly unpredictable and volatile and culminates in the explosion/eruption phase in which an acutely violent incident occurs. Early in a relationship, this phase is often followed by the honeymoon phase during which the batterer is contrite, asks for forgiveness, offers gifts, and assures the woman that, “it will never happen again.” The length of each phase varies by couple and with their relationship. Over time, the tension building or explosion phases may be very prolonged, with little or no time spent in the honeymoon phase.

The cycle of violence continues to repeat and tends to escalate in severity, despite the assurances that the batterer makes during the honeymoon phase.

• Domestic violence is about power and control. It is NOT about anger management, substance abuse (though substances can increases violent incidents), or “nagging” from a girlfriend or wife.

• The abusive partner tends to tell the woman that the violence is her fault and that she provokes or deserves the abusive incidents. He often isolates her from people and situations that will help her know otherwise.

• Abusive relationships may involve physical, emotional, or verbal battering and frequently some combination of the three. Physical abuse includes pushing, choking, kicking, sexual abuse and other means of physical control/harm as well as punching or slapping. Verbal and emotional or psychological abuse involves name calling, insults, berating, shouting/screaming, humiliation, threats, intimidation, destruction of property, isolation, activity restriction, abuse of pets, and withholding of economic, physical, or emotional resources. Women often forget to acknowledge some physical forms of violence like choking or pushing as “real” abuse and will often not consider themselves abused unless they have been punched or slapped by their husband or partner.

• Women stay in abusive relationships for numerous reasons. Battered women often leave their relationships several times before they end it for good. Reasons are dynamic, complex, and individual. Some very basic reasons include hope, love, and fear. The most dangerous time in the relationship is when she leaves—it is then that she is most likely to be severely injured or killed. As a society, we should NOT be asking why women stay, we should be asking how we can stop domestic violence from happening.

 So, what can you do? If you are a pregnant woman who is being abused, please contact your local domestic violence shelter or hotline. Or, call the National Domestic Violence Hotline at 1-800-799-SAFE. Even if you do not feel ready to leave your relationship, many shelters offer “outpatient” support groups and counseling. If you are a prenatal health care provider (midwife, doctor, nurse, physician assistant), please include domestic violence screening questions during your prenatal visits and be alert and responsive to signs of violence. If you are a doula, birth educator, or other birth professional, include a discussion of domestic violence during your classes or prenatal visits and encourage exploration and acknowledgment of these issues during your networking with other birth workers. You may also wish to download and read the Center for Disease Control’s guide, Intimate Partner Violence during Pregnancy: A Guide for Clinicians. If you are a friend or relative of a pregnant woman experiencing abuse, help her develop a safety plan and encourage her to seek the services of a domestic violence shelter.

Though it can be very awkward to address domestic violence issues with women directly and can feel like an intrusion into private lives, if you choose silence, you contribute to a continued culture of fear, shame, denial, and invisibility for the many women experiencing violence during this time in their lives. Acknowledging the reality and prevalence of violence against women in our culture and encouraging open, respectful, and assertive dialog about it is a powerful tool in reducing the occurrence. Strive to help bring violence against pregnant women into public view instead of considering family violence to be private, family business. Women and babies are too important for us to remain quiet.

Portions of this article are excerpted from the booklet Talking to a Battered Woman: A Guide for the Short Term Helper by Molly Remer, MSW, ICCE. This booklet is available as free pdf file on Molly’s website (http://talkbirth.me). Molly is a certified childbirth educator, the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, and a college professor.