VIOLENCE DURING PREGNANCY

Abstract

It is estimated that one in four women will be physically abused during her lifetime.3, 26, 28 Such abuse takes many forms and ranges from minor injuries to major trauma. Unfortunately, the effect of such violence on pregnant women is compounded because there are two victims: the mother and the fetus. Abused women may be unwilling or unable to report their injuries for many reasons. Emergency physicians are in a unique position to help, being often the first and sometimes the only caregivers whom abused women encounter during their pregnancies. Additionally, pregnancy is a time when women's concerns about their own health is heightened owing to their concern for their baby's health. The prenatal period may be a time when abused women will make a change in their domestic environment for the safety of their children which they would not have made for themselves. The prenatal period thereby provides a window of opportunity to begin interventions leading to successful outcomes for at-risk women. This article discusses intimate partner abuse during pregnancy. The population at risk is defined, including risk behaviors, possible identifying factors during presentation to the emergency department (ED) and available outcome data on violence to the fetus and the pregnant mother. Finally, interventions are presented, emphasizing the emergency physician's role in coordinating referrals to social service agencies and helping victims develop safety plans. Intimate partner abuse is one form of family violence and involves assaultive and controlling behaviors imposed on one partner by another. It can encompass or be a combination of physical violence, emotional abuse, and social or economic isolation. Abuse during pregnancy is reflective of intimate partner abuse in general but can also focus on issues surrounding the pregnancy itself. The ED and its emergency physicians are in a unique position to intervene in such abusive situations; historically, however, there has been limited involvement on the part of emergency healthcare providers. The abused pregnant woman presents a complicated and potentially time-intensive case, but the ED may be her only entrance point into a safe support system. Emergency physicians must develop the ability to identify pregnant victims of domestic violence and effectively access available social services and support networks in their communities.

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