As birth professionals, we talk a lot about how different interventions can impact the pregnancy and birth process, but many birth professionals fail to speak with their clients on domestic violence and how that impacts the sacred space of the antenatal, birth and postpartum timeframe. This is a complication and stressor that should be taken just as seriously, and incorporated into a woman’s birth plan. When one in four women are experiencing some form of Domestic violence, and women of color experience domestic violence at a 35% higher rate than white women, we need to be talking about this more in the birth community, so it is taken more seriously, and more women get help. In studies done, only 18% of women reported being asked about domestic violence by their provider when they went to triage, and yet, domestic violence is the NUMBER ONE killer of pregnant women. So why aren’t providers asking more, if their primary goals are infant and child protection?
It is not just a matter of dealing with it and getting through. Domestic violence can have impacts so seriously, that it can even lead to stillbirth. And that does not even have to include any physical violence whatsoever.
First of all, what is considered domestic violence or Intimate Partner Violence (IPV)?
Many think of DV or IPV as being physically or sexually assaulted, and that has serious consequences too, but DV is not just isolated to physical acts of violence. It is also includes:
-Throwing away of beloved items
-Controlling social media
& more, that many do not think of as “abuse.”
Take a look at the Power & Control wheel!
Domestic violence causes stress, and luckily, we have lots of studies relating to stress and pregnancy, so this is a no-brainer. Heavy and recurrent stress on a pregnant woman and fetus is not productive and can lead to dire effects. When stress is induced, catecholamine and cortisol levels spike. Increased levels of catecholamines lead to reduced uterine blood flow, which can take away from placental blood flow, reduce oxygen to the baby, and potentially lead to miscarriage or stillbirth. Not only does stress impact the pregnancy, but actually leads to developmental problems for the rest of the child’s life. In this study, testing of the placenta and umbilical cord blood, showed that mother’s who reported stress, including partner-related stress, resulted in higher basal blood glucocorticoid levels and a reduced number of glucocorticoid receptors in the hippocampus. These levels being elevated for an extended period of time can lead to life-long issues such as B-Cell dysfunction (which can lead to leukemia), insulin resistance (increased risk of Diabetes), poor liver function, infertility, depression, and more serious complications.
Domestic violence is associated with increased rates of depression in pregnancy. The risks of depression in pregnancy, come with premature birth, low birth weight, and IUGR. Long-term consequences may present as ADHD, emotional instability, and lack of adaptability in social settings.
Financial control may lead to women not getting prenatal care and nutrition that they may desire. Lack of nutrition and prenatal care can lead to undiagnosed issues and complications. We are firm supporters of self-led and performed prenatal care at HERBAL, but when it is forced, a woman’s intuition is interrupted by the abuse she is experiencing, and she has not been educated on how to do her own prenatal care, there are risks involved! For example, a woman may believe that her untreated anxiety from the domestic violence in her home is causing her to experience head aches, blurry vision and heart palpitations during pregnancy and chalk it up to her “normal,” when she really has pre-eclampsia. The abuser may only allow her to eat/drink a limited amount of things, which does not help the pre-eclampsia, and causes her and baby to be harmed while the pre-e goes undiagnosed and worsens until it is severe.
Due to the nature of codependency and the woman feeling like she routinely submits to her “authority” aka her partner, she is more likely to submit to abusive providers. Perhaps this is the reason that more providers don’t ask, assist and empower women to get out of abusive homes, because they know it gives them the upper hand in controlling their patients birth. Sad thought isn’t it? Victims are more likely to end up in a cesarean section due to complications, low self-esteem, and lack of support.
Domestic violence can also lead to more severe postpartum mood disorders. With stress altering the way a brain behaves, on top of fluctuating postpartum hormones, this may result in a lethal combination that brings a woman to feel worthless as a new mother, lead her to stop breastfeeding even though she does not want to stop, cause her to give up her baby for adoption, or even become suicidal or homicidal.
Domestic violence is more statistically prevalent and risky than pre-eclampsia, placenta previa, choleostasis, and other common complications.
Here is an example of a story in which domestic violence ultimately led to the death of a baby: https://herbaltrainings.com/2019/02/13/the-birth-story-criticized-round-the-world/ Sadly, this kind of story is not rare.
I, Taylor, recently attended a birth in which the partner could not handle the lack of control that he had in his wife’s natural home birth, and called EMS without his wife’s consent, and ended up forcing her to go to the hospital and get strapped down onto an ambulance gurney while her baby was crowning. He refused to even allow her have the postpartum care from the midwife she desired. It was truly horrific to bear witness to. Any birth I have ever attended in which the birthing woman was a victim to ongoing abuse, her labor was long and drawn out, and complications occurred. Even mental abuse, carries to the physical in some way, shape or form. As women, our stress carries directly to our wombs, and impacts our well-being and our babies.
So why are women not talking about it?
–Fear of CPS/DCF
This is a very scary and valid concern, that if women disclose domestic violence to their care provider, friend, family member or another person, that CPS or DCF will be called, and the children will be taken away from not just the abusive partner, but the mother as well. The mother often believes it is better for her to just remain in the situation without saying a word, short-term or permanently, so that the children remain in a home with both their parents, and not risk the involvement of CPS/DCF. In American DCF standards, women that are victims are not receiving the benefit of the justice system that allows her to keep her kids until DCF proves that “beyond a reasonable doubt” that she is guilty of neglect or abuse, but instead DCF relies on “preponderance of the evidence” meaning they can take away a child for just the ASSUMPTION that she failed to protect her child from harm. And often, the reunification plan, if her children are removed, includes COMMUNICATING AND INTERACTING with her abuser. How sick is that?! It’s no wonder that women are not communicating about the abuse they are enduring, with a system set up like this. If you are victim considering leaving, I strongly recommend finding a family lawyer that can represent you and guide you through the proper steps before DCF gets involved. Domestic violence shelters often have family lawyers that specialize in victim representation, that work completely pro-bono for victims.
-Fear of being alone, not having support, being homeless, etc
Depending on the area women are in, there may be a severe lack of resources available for the woman to receive housing, food vouchers, transportation, and more, that is being provided at home by her abuser. When there seem to be no good options for her to continue to have the basic needs met that she should have, why would she want to leave? Domestic violence shelters can usually provide shelter, food, bus vouchers and more, but sometimes even they are full with others or have a limited amount of funding available to be able to adequately provide. It is a good place to start though, if you are looking to get out of the situation you are in, and if the one you call cannot assist you, they may have resources that can. 211 is also an excellent resource to connect you with local resources.
-Fear of death
Some home situations are so threatening that even if a woman gets out safely, gets a restraining order, and moves forward with her life, that she still faces a risk of death. The day that she leaves is the riskiest day for homicide to occur, because if she is caught, it will trigger the abuser to use whatever means necessary to prevent her from leaving him/her, including murder. After that, the victim is still at an increased risk of the abuser tracking her down, and seriously injuring or killing her.
–Hope that it will get better
Did you know, that even when a woman leaves her abuser, she returns an average of 7 times? There is something called the Cycle Of Violence that has several phases of how abuse works, how women develop codependency, forgive an abuser, and continue to remain in a relationship with such a terrible person. The Honeymoon Phase is extremely toxic for a victim, as this makes them believe that they are truly loved, that things will change, and this makes them attached, and even want to return to their abuser after they left during violent outburst, hoping that things can get better. Most victims are empaths, or have childhood memories growing up of this cycle of violence, and remember their parent staying with that parents abuser, and associate this abuse, with love, as sick as it is, this is their normal.
-Lack of opportunity for a safe space, away from the partner, to disclose the issue
Even if a woman is ready to leave her abuser, and to find resources to help her and her growing baby, she may have a lack of opportunity to tell someone and get help. Some abusers have so much control that they do not allow their partner to even shower by themselves, work, see family/friends, go to appointments alone, drive by themselves, or have control of their own phone. Anything that gives the victim an opportunity to leave or to figure out that the abuser is in fact, abusive, the abuser will forbid.
How can we help these women suffering in silence, for any of the above reasons?
-Make yourself a safe place for women to come talk! Develop a resource list in your community and keep it on your phone notes, a file on your computer, a binder that you keep in your home, ready to aid a woman that only has very little time to take action.
-Host woman support groups, that are not specific to domestic violence. Make it something about menstruation, breastfeeding, cervical fluid, what have you, something that an abusive partner would typically have no interest in attending or learning about, and no suspect of there being a presentation on domestic violence. Don’t center your support group solely on domestic violence, as this is false advertising, but do make a point to talk about it, and provide resources that women can easily remember, as it isn’t likely they will be able to take it home. Be sure they have your contact information that they can save in their phone if they have an opportunity to reach back out to you, should they find themselves in an abusive situation!
-Place information cards in boxes of breast pads, menstrual pads, wherever only an expectant or postpartum woman might look for the most part, on resources for DV support/assistance.
-If you suspect that a woman you know is in an abusive relationship, the worst thing that you can do is to call DCF or the cops on her, in attempt to help. This is LIFE-THREATENING for her and her children. DO NOT EVER DO THIS. You can provide her resources, but getting authorities involved without her knowledge can get her and her kids killed. This is the dumbest thing that anyone trying to help, can do. Also, do not try to personally insert yourself between your loved one and her partner, ever. This will lead to you never being able to speak to your loved one again, and may even lead to you getting directly harmed yourself. The best thing that you can do for your loved one is speak to her, directly, alone, and let her know you will help anyway you can. IF a woman is leaving an abusive relationship and you are helping her, however, it is best that authorities are on stand-by around the corner or make a plan to show up at a specific time and assist you and your loved one in gathering her belongings and leaving safely, just in case the abuser shows up or is home at the time that this is planned.
-Providers can help by requiring that all partners leave the room during certain procedures and using that opportunity to ask questions about the safety of the woman’s home, making it clear that they will not call DCF or the police if the woman indicates that she does not want to, but let the woman know that they are a safe resource when and if they want help.
If you have been in an abusive relationship and got out, what helped you to leave, stay gone, and protect yourself and your baby? It may help others for you to share your story!