Abstract: Abuse of Pregnant Women and Adverse Birth Outcome
by Newberger, Eli H, et al.
Journal of the American Medical Association, 1992, Vol. 267, No. 17, p 2370–72.
Abstract originally published in Midwifery Today Issue 26, Summer 1993.
The prevalence of physical assault of women during pregnancy has been estimated at 8% in a random survey and between 7 and 11% in non-random samples. Pregnant women’s risk of abusive violence was shown to be 60.6% greater than that of nonpregnant women in a sample of 6002 households.
Only a single small study (Bullock, L. & McFarlane, American Journal of Nursing, 1989) has clearly defined the increased risk of low birth weight in women abused during pregnancy. Numerous methodologic problems such as limited descriptions of severity, locus and treatment given for injuries, absence of corroboration with specific neonatal findings, and unreliable inferences of cause and effect combined with false variables, limit the extent to which studies can inform clinical practice and guide future research. These problems as a whole stem from the multifactorial nature of family violence.
Nevertheless, several causal links can be drawn between physical and sexual victimization of a pregnant woman and averse birth outcome. Abdominal trauma can cause abruptio placentae leading to fetal loss, early onset of labor and delivery of a low-weight or preterm infant, or may result in fetal fractures, rupture of the mother’s uterus, maternal hemorrhage, uterine contractions, premature rupture of membranes and infection. The victimization of a woman may lead to exacerbation of chronic illness such as hypertension, diabetes or asthma, which may have negative effects on the fetus. Physical or sexual victimization may also lead to intermediate risks such as elevated stress, isolation and therefore inadequate access to prenatal care, behavioral risks such as tobacco, alcohol and drug use, and inadeqate maternal nutrition, all of which have been extensively identified as risk factors to the well-being of the neotate.
Maternal psychological stress has been associated with depression, and stress and/or depression may have direct or indirect effects on the fetus. Direct effects involve the release of catecholamines resulting in precipitation of preterm delivery or placental hypoperfusion resulting in delayed fetal growth. Emotional distress may also increase the frequency of behavorial risks such as alcohol, drug and tobacco use and decreased utilization of pernatal care.
Implications for practice include giving women the opportunity to speak beyond the confines of the usual medical history to relate their life experiences of victimization. The interview should try to gather insights in their relationships with the battring partners, the women’s fears, and their preceptions of professional responses to their efforts to seek help in the past, and their concerns about their pregnancies, deliveries and the health of their babies. Interviews should be conducted apart from the male partners. Victimized women appear to be more likely to disclose the circumstances of their victimizations to other women and to personnel who offer protection, sympathy and support. Connections should also be made to programs which offer protection, crisis intervention, and support, and the women should be seem as quickly as possible by an advocate or social worker who would provide information about protection, legal rights and shelter.