The Role of the OB-GYN in Abuse During Pregnancy

Domestic violence is the number one killer of pregnant women, more prevalent than any medical complication or condition.  Domestic violence tends to only escalate during pregnancy, and women experiencing this often need professional help in identifying or escaping their dangerous circumstances.

We know these risks, and yet fewer than 40% of OB-GYNs screen for signs of domestic violence in pregnant patients.  In many cases, even medical professionals believe that screening for domestic violence is not within their realm of responsibility or ability, either because they are not trained specifically to handle domestic violence, or because they believe personal matters are separate from medical conditions.  This is a tragedy because a doctor’s intervention can save the lives of domestic violence victims and their children, and could potentially be received more readily when the patient is pregnant.

While many abused women are isolated from personal relationships, pregnant abused women will often still seek proper medical attention for her baby.  The many required visits with the doctor allows for a trusting relationship to form, and in cases of extreme isolation, the OB-GYN may be the only party able to influence the victim’s situation.

Pregnancy can also be a window of opportunity for helping women escape abusive relationships, because during pregnancy a woman may be more concerned with protecting her baby than her relationship.  What a woman may not do for herself, she will often do for her baby.  However, women often feel more vulnerable during pregnancy because of stress or financial security.  Often, pregnant women feel that leaving an abusive relationship is not an option because of their reliance on their partner’s money or health insurance to fund her prenatal care and the baby’s health after its birth.  For this reason, the same logic that may allow some women the strength to escape may inspire some women to endure her relationship for even longer.  While the intentions may be good, the logic behind this action is flawed.  This is another reason why it is crucial for medical professionals and mandated reporters to screen for signs of abuse.

There are many support systems in place to help pregnant women in terms of finance and stability.  As mandated reporters, we must make it our responsibility to identify signs of abuse, and to provide pregnant women with information on their safer options, such as shelters and programs.  Information about these programs should be placed in all lavatories of OB-GYN offices, where women may privately read or take them without being detected by their abuser.

An OB-GYN can help identify signs of domestic violence by working questions about violence non-threateningly into their examination routine, making safety planning a priority for women who may be being abused, documenting all statements made by the patient that may be indicative of abuse including the name of the perpetrator, and documenting any physical signs of abuse or sexual assault.

Signs of abuse in pregnant women include:

  • Recent history of abuse prior to pregnancy
  • Unintended pregnancy
  • Late entry into prenatal care
  • Poor compliance with appointments and medical recommendations
  • Fetal trauma, particularly fractures
  • Physical trauma, especially to the breast, abdomen, or genitals
  • Poor weight gain
  • STDs
  • Depression
  • Substance Abuse
  • Partner refuses to leave exam room, or answers questions for the patient
  • Adolescent pregnancy.

If there is a history of sexual abuse in a patient, pelvic exams and childbirth may be particularly traumatic.  The doctor should ensure that they are conscious of this when assisting with birth or performing an exam.

To learn more about pregnancy and domestic abuse, refer to our Sexual Assault two-volume set.

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