Intimate partner violence and pregnancy

Written by Daniela Francavilla, Child Protection Educator at Sydney Local Health District   

Given the prevalence of intimate partner violence, health professionals will inevitably come into contact with women whose physical safety, as well as emotional and psychological wellbeing, are being placed at ongoing risk by their partner. This means we are uniquely positioned to respond in ways that promote the safety and wellbeing of women and their children by addressing the violence being experienced. The impacts on women and their children have become increasingly better understood over recent years but it can still be a challenge to identify.

There are various factors that can increase risk for women and one of these is pregnancy. Women are at increased risk of experiencing violence from an intimate partner for the first time during pregnancy. If violence already exists, it is likely to increase in severity during pregnancy. Young women, aged 18-24 years, are more likely to experience domestic and family violence during pregnancy and unintended pregnancy is often an outcome of an existing abusive relationship.

We have known for some time that poor birth outcomes (such as low birth weight and premature birth) and post-natal depression are associated with domestic and family violence during pregnancy. However, the long-term effects of exposure to domestic and family violence in utero are just emerging and point to significant compromises in brain development with ongoing negative consequences.

There are a number of indicators of possible intimate partner violence that health professionals should be aware of when coming into contact with pregnant women. These include, but are not limited to:

  • late entry into antenatal care
  • unwanted pregnancy or STI through coerced sex
  • poor weight gain
  • increased rates of miscarriage, neonatal death, late trimester bleeding, infection, placenta abruption and premature delivery
  • increased rates of spontaneous and induced terminations
  • stress, anxiety and depression
  • unexplained or multiple injuries or where explanation is inconsistent with injury
  • injuries and/or pain are minimised
  • substantial delay before seeking treatment
  • repeat after hours presentations to ED
  • woman describes self as ‘accident prone
  • sleeping and eating disorders
  • increased use of tobacco, alcohol, drugs and antidepressants
  • higher attempted suicide rates
  • more frequent hospital admissions
  • socially isolated
  • frequent absences from work
  • references to partner’s anger or temper

If intimate partner violence is suspected then we need to be able to start a conversation with the woman that is non-judgemental. If it is suspected but not disclosed, a direct approach should be used. Examples of specific questions linked to clinical observations include:

  • "You seem more anxious and nervous today. Is everything alright at home?"
  • "When I see injuries like this I wonder if someone could have hurt you."
  • "Is there anything else that we haven't talked about that might be contributing to this condition?"
  • "I can see that something has changed here. Do you want to talk about it?"

Some important principles to adhere to are:

  • Talk to her alone and never with her partner
  • Listen to the risk to her and her children
  • Take her seriously
  • Provide non- judgemental support and tell her it is never her fault
  • Understand her limited choices
  • Have information re relevant resources and referral options to offer

Domestic and Family Violence (D&FV) services and resources

Further resources

  • GP Learning have a series of on-line learning modules dealing with family abuse and violence - know how to respond when you suspect violence.
  • RACGP Whitebook (4th ed) – Abuse & Violence
  • It Stops Here - NSW government D& FV Framework for reform