Abuse & Pregnancy: The Facts

1. The Effects of Sexual Abuse and Domestic Violence on the pregnant/ breastfeeding motherWendy Allmendinger Outreach & Training Coordinator Day One 100 Medway Street Providence, RI 02906 (401) 421-4100 ext. 146

2. Abuse & Pregnancy: The Facts • As many as 37% of patients seen in obstetrics departments are physically abused during pregnancy • Each year about 324,000 pregnant women in the U.S. are battered by the men in their lives • Women abused during pregnancy were 4 times more likely as other abused women to say that they experience very serious violence • Over 100,000 women who were assaulted during pregnancy suffered a miscarriage or internal injuries • Homicide is the leading cause of pregnancy-associated injury deaths (38%)

3. Power & Control Wheel Physical & Sexual Money Threats, Intimidation, & Coercion Cultural & Religious Emotional Minimizing Denying & Blaming Entitlement & Privilege Isolation KIDS

4. The Abuser’s Cycle The tension-building phase... • Abusers nurse their grievances • Spend time collecting negative points about partner • Squirrel perceived faults/transgressions away for future use against partner

5. The Abuser’s Cycle The Eruption phase... Once he's ready to blow, the tiniest spark will ignite him.

6. The Abuser’s Cycle The “hearts and flowers” phase... • He experiences relative calm, catharsis, a feeling of rejuvenation, works to rebuild the bridge he has just burned down. • He says he's sorry. • "Abusers have numerous contradictory attitudes • and beliefs operating simultaneously in their minds."

7. Self-blame Low self-esteem Depression Trauma Labels Resources Fear Love Hope Personal Barriers

8. Offender Tactics • Isolation • Control of finances • Denial • Blame • Manipulation • Children

9. Societal Barriers • Family • Religion • Societal “truths” • Legal systems • Inaccessible social institutions

10. Barriers to Leaving Societal offender tactics personal VICTIM Personal Offender Tactics Societal

11. When is the most dangerous time for a victim of domestic violence? During pregnancy and the first few months after birth. Why? Jealousy Child not the abuser’s Loss of power and control Unplanned pregnancy

12. Sexual Assault: The Facts • Sexual assault is violence not sex. • Offenders want to control, humiliate, and exert power over another person. • Anyone can be a victim and an offender. • Offenders choose vulnerable people to assault. • 1 in 3 women will be sexually assaulted at least once in her lifetime.

13. Relationship between Sexual Assault Victim & Perpetrator 78% were assaulted by someone they knew

14. Sexual Assault Classifications • Stranger Assault • Acquaintance and Date Rape • Marital Rape • Multiple Assailant or Gang Rape • Drug Facilitated Sexual Assault • Incapacitated Rape

15. Humiliation Shame and Self Blame Guilt Vulnerability and fear of people Denial Loss of control over her/his life Grief Sadness and Depression Anger and Irritability COMMON EMOTIONAL REACTIONS TO SEXUAL VIOLENCE

16. For having “caused” the assaultFor not stopping the assaultFor having made “stupid” choices GUILT AND SELF-BLAME

17. POWERLESS, LACK OF CONTROL, HELPLESSNESS • Inability to stop assault • Inability to control emotional reactions • Sense of isolation • Distrust • Questioning own ability to assess situations/people

18. FEAR • Of offender • Of being alone • Of places/ things that remind her/him of the assault • Of loved ones being harmed

19. ANGER At offender At self Misplaced anger at others DISTRUST Of own ability to judge others Of Law Enforcement

20. IMPACT FACTORS Relationship with offender Number of assaults Nature of assault(s) Victim’s support system

21. Effects of Abuse on Pregnant Women • Victims may not get the prenatal care they need because of fear that the health care provider will find out about the abuse. • Stress caused by abuse affects the victims ability to take care of themselves during pregnancy. Victims may continue unhealthy habits such as smoking, drinking alcohol, using drugs, and not eating a healthy diet.

22. Effects of Abuse on Pregnant Women cont. • Dangers to the unborn baby include: • delayed prenatal care • miscarriage • low birth weight • premature birth • stillbirth (death of the baby before it is born) • bleeding from the vagina

23. Other Symptoms Associated with Abuse During Pregnancy • Anemia • Changes in eating and sleeping behaviors • Not enough weight gain • Infection • Depression, anxiety and worthlessness

24. Abuser Tactics • Before pregnancy • When a victim first finds out she is pregnant • During pregnancy • During labor/birth • After pregnancy

25. Before Pregnancy • Abuser may: • Force victim to have sex • Not allow the use of contraception or force the victim to use a contraceptive either to purposely prevent or cause the victim to become pregnant • Refuse to use protection during sex even if the abuser has an STI

26. Once a Victim Finds Out She is Pregnant • Abuser may: • Force victim to have an abortion • Injure victim with the intent of causing her to lose the baby • Force her to have sex • Force her to have an unwanted pregnancy

27. During Pregnancy • Abuser may: • Start, continue or change the pattern of abuse • Concentrate physical assaults on breasts and abdomen • Control or deny the victim’s access to prenatal care • Insult the victim’s body • Deny the child is his • Refuse financial support • Force victim to work

28. During Labor and Birth • Abuser may: • Try and control the medical decisions • Insult victim during labor • Insult the baby during birth • Deny the victim pain medications

29. After the Baby is Born • Abuser may: • Increase the amount of abuse • Deny the victim access to the newborn • Refuse to support or help the victim and the newborn • Demand and force sex • Put down the victim’s ability to parent • Threaten to abduct or harm the baby • Withhold money • Act out abusively when the baby cries

30. Breastfeeding and Abuse • A victim may feel disempowered around breastfeeding her baby because: • Abuser either pressures her to breastfeed or does not allow her to breastfeed. • She may not breastfeed successfully because the abuser has made her feel uncomfortable • Abuser takes away her confidence

31. The Heath Care Provider’s Role • Learn and recognize the signs of abuse • Effectively screen patients for IPV • Listen to what the victim tells you • Document what the victim tells you, history of abuse and injuries in an in depth report • Help victim explore options and provide her with an advocate • Photograph any injuries

32. Documentation • Write legibly • Avoid phrases such as “Patient claims” or “Patient alleges” which implies doubt • Use concrete statements like “Patient states” or “Patient reports” or even use direct quotation (with quotation marks) • Remember…there is always the chance that you could be called to testify-better records make better testimony

33. Victims of Crime Helpline 1-800-494-8100 • Statewide 24-hour telephone support for victims of all types of violence • In-person hospital support for victims of domestic violence, sexual assault, hate crimes • In-person support at police department for victims of sexual assault

34. SATRC Services 421-4100 • Sexual Assault Response Team (SART) • Children’s Advocacy Center (CAC) • Individual and Group Counseling • Prevention Education • Office of Victim Services

35. Domestic Violence Agencies • 24-hour crisis hotlines (telephone support & information) • Safety planning • Shelter • Court services • Counseling • Community outreach

36. Victimization hurts… “You feel stripped naked. You feel as if someone has exposed you totally…You’re powerless…You’re powerless. It’s reminiscent of the kind of helplessness that goes back to early childhood. And I think that’s what makes it so crucially painful. Because you can’t fight back.” (Crime victim quoted in The Crime Victim’s Handbook, Bard and Sangrey,1986)

37. QUESTIONS?