Perhaps it’s considered a dirty little secret in many families, but the fact that according to Curry, Perrin and Wall’s 1998 article “Effects of abuse on maternal complications and birth weight in adult and adolescent women.” in Obstetrics and Gynecology 92, 530-534, an estimated 1 in 6 pregnant women experience abuse from an intimate partner needs to be considered and assessed for during prenatal visits.
In assessing a pregnant woman, there are certain behaviors that should be considered as risk factors for abuse, such as those identified in the study by Berenson, AB, Stiglich NJ, Wilkinson, GS and Anderseon GD published in the American Journal of Obstetrics and Gynecology, 1991, June; 164, pp 1491-6 titled, “Drug abuse and other risk factors for physical abuse in pregnancy among white, non-Hispanic, black and Hispanic women”. They determined that abused women were “more likely to be divorced, admit to illicit drug use, use alcohol and smoke compared to nonabused females in their study.” In the study 501 pregnant women attending a public clinic were interviewed, 20% of the women reported physical abuse. Another study cited in the text by Huth-Bocks, Levendosky and Bogat in 2002 titled, “The effects of domestic violence during pregnancy on maternal and infant health” in Violence and Victims, 17, pp 169-183 found that “abused women were more likely to have public insurance, be single, have less than a high school education, and to have medical or obstetrical complications.” Another “risk factor” identified for the pregnant woman “frequent alcohol abuse by the male partner has been found to be associated with the likelihood of violence in the home” (Wilt,S & Olson,S, “Prevalence of Domestic Violence in the US”, JAMWA, Vol. 51, No. 3; pp 77-82, May/July 1996.) In JAMI, Vol. 267, No. 23, June 17, 1992, McFarlane,J., Parker,B., Soeker,K. and Bullock,L.’s “Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care” the conclusion was that “a simple clinical assessment screen completed by the health care provider in a private setting and with the male partner absent is effective in identifying abused women.”
Once the potentially abused pregnant woman is identified, there are certain interventions that have been proven to be most effective in helping to reduce the incidence of continued abuse to the woman. McFariane,J., Soeker,K. and Wiist,W.’s study published in Public Health Nursing Vol. 17, Issue 6, pp. 443 in November / December 2000 titled, “An Evaluation of Interventions to Decrease Intimate Partner Violence to Pregnant Women” found that “violence scores at 2 months post-delivery were significantly lower for Outreach groups compared to counseling only, but not significantly lower than the Brief intervention group.” Another study that McFarlane,J., Parker,B. Soeker,K., Silva,C., and Reed,S. did was published in Res Nurs Health 22, pp 59-66 in 1999 titled, “Testing an intervention to prevent further abuse to pregnant women” 132 pregnant women received 3 counseling sessions designed to decrease further abuse. A comparison group of 67 abused women were given a wallet-sized card listing community resources for abuse. Using repeated MANCOVA with entry scores as a covariate they were followed at 6 months and 12 months post delivery. The study found that “significantly less violence was reported by the women in the intervention group than the women in the comparison group.”
As startling as the statistic is, “1 in 6 women are abused during pregnancy”, it is incumbent upon those medical professionals providing care for pregnant women to have an effective screening tool to identify those women at risk for abuse, to do a comprehensive assessment of the woman without her partner present, and to have an appropriate referral base for intervention that will help to reduce the incidence of abuse in the woman’s life.
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Forensic Nursing Chronicles 