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abuse during pregnancy Definition Abuse during pregnancy is the mistreatment, battering, or abuse of a pregnant woman. The term includes physical, sexual, and emotional violence. Abuse affects women of all ages and from all social and economic backgrounds. Physical abuse is one of the most common causes of complications during pregnancy. It is estimated that one pregnant woman in four is physically abused. This rate is even higher in pregnant teenagers. What are the signs and symptoms of the injury? The physical signs of abuse can include: bone fractures injuries on different parts of the body, in various stages of healing unexplained cuts, head injuries, or bruises The emotional signs of abuse are not as easy to see. The victim may have these traits: depression feelings of anxiety low self-esteem A fetus has very soft, delicate tissues and organs, especially in the head and chest area. Trauma to the pregnant woman's abdomen can cause: miscarriage separation of the placenta from the wall of the uterus, known as abruptio placentae premature labor and delivery of a low-birth-weight or premature infant premature rupture of the membranes infection stillbirth fetal fractures maternal hemorrhage, which can result in the deaths of both mother and baby What are the causes and risks of the injury? The women who are most at risk for abuse during pregnancy are those who have been physically abused before. They may have a history of physical abuse, sexual abuse, or family violence. More abuse is directed toward unmarried pregnant women and those with unplanned pregnancies than other groups. A woman who is abused may not seek prenatal care early in her pregnancy. When prenatal care is delayed, the fetus's early development can have problems. So early prenatal care is very important. Some of the reasons for late prenatal care are fear of the abuser, low self- esteem, and the lack of a support system. The abuser may try to control the woman and keep the abuse hidden from doctors. If the woman has any chronic illnesses, abuse can make them worse. These include high blood pressure, diabetes, and asthma. This worsening can have a negative impact on the growing fetus. Abuse can also increase stress and depression. Stress causes the body to release hormones that can lead to premature labor. These hormones can also decrease the blood flow through the placenta. Decreased blood flow may cause low birth weight. Stress also makes it harder for the woman to take care of herself during her pregnancy. This results in higher rates of malnutrition and poor weight gain. Abused women are also more prone to pregnancy risks such as smoking or using smokeless tobacco, drinking alcohol, or taking drugs during pregnancy. Good nutrition and rest are very important for a healthy pregnancy. What are the treatments for the injury? If a doctor suspects that a woman is abused, she should be given the chance to talk without her partner present. Abused women are more likely to talk about the abuse to other women or to people who offer protection and support. The goal of treatment is to get the woman away from the abuser. If she decides to leave the abuser, she needs a means of escape. Most communities have shelters, counseling services, and other resources to help her leave the dangerous situation. The National Domestic Violence Hotline, 1-800-799-SAFE, offers information and support 24 hours a day. Local crisis shelters can provide a place to stay for women and children on a nightly basis. They provide counseling, legal and hospital advocacy, and community education. Pregnant women who leave their abusers sometimes return home. Money problems or the belief that they cannot properly care for themselves on their own may bring them back home. They may see no other option but to return home to the abuser. It is important to make sure that an abused pregnant woman knows about the options for support and protection that are available in her community. What happens after treatment for the injury? Abuse during pregnancy may leave lasting psychological effects. Sadly, about 70% of men who abuse their female partners will also abuse their children. This supports the belief that a cycle of violence can last for generations.

Author: Gail Hendrickson, RN, BS Date Written: 04/27/00 Reviewer: Carlos Herrera, MD Date Reviewed: 09/19/01 Potential conflict of interest information for reviewers available on request