1 PAST, PRESENT, OR POSSIBLE VIOLENCE AND ITS AFFECT ON PREGNANCY, CHILDBIRTH, AND POSTPARTUM

CHILDHOOD SEXUAL ABUSE 25 – 40% of girls experience CSA Perpetrators: Males 10:1 80% are known Most are family members (fathers, uncles, brothers, mothers’ boyfriends) 2

POSSIBLE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON PREGNANCY Strong fear of bringing a child into world in which the child could also be abused Feelings that the pregnancy is another abuse or form of victimization or invasion Male fetus or impregnation by abuser can intensify these feelings May experience “wrong gender anxiety” May feel ‘whole,’ okay for the first time, idealize fetus May interpret ‘normal’ pregnancy experiences as dangerous May deny or reject pregnancy (“proof of sexuality”) 3

POSSIBLE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON CHILDBIRTH Unpredictability of labor may be particularly stressful Issues of control Abuse was out of their control if labor is out of their control, could be triggering Withdrawal, dissociation, shame = physiologically stress response Unintentional re-creation of trauma-like experiences by midwives, doulas, and docs 4

POSSIBLE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON POSTPARTUM Difficulty with attachment between mother and baby Fear or angry of breastfeeding Fear of harm to baby by relatives (men) Fear of harming baby by mother Problems with partner (sexuality, trust, etc) 5

ADULT SEXUAL VIOLENCE 1 out of 6 women have been a victim of attempted or completed rape (almost 18 million American women) 80% of rape victims are white BUT racial/ethnic minority have higher rates of rape than whites 6

PREGNANCIES RESULTING FROM RAPE In , 64,080 women were raped. According to medical reports, the incidence of pregnancy for one-time unprotected sexual intercourse is 5%. By applying the pregnancy rate to 64,080 women, RAINN estimates that there were 3,204 pregnancies as a result of rape during that period. The actual numbers may be higher: women who are victims of domestic abuse are more likely to experience rape by their abuser but not likely to report it 7

POSSIBLE EFFECTS OF ADULT SEXUAL VIOLENCE ON PREGNANCY Commonly sexual violence survivors have higher depression, anxiety, and traumatic stress May have extreme personal safety fears May struggle with substance use/abuse May have higher rate of intended pregnancy (survivors more likely to engage in unprotected sex) May disconnect from body and be slow to recognize pregnancy or avoid recognition 8

POSSIBLE EFFECTS OF ADULT SEXUAL VIOLENCE ON CHILDBIRTH Similar to childhood survivors (see previous slide) Women who report sexual assaults generally go through an extremely invasive medical examination and being around medical professionals and equipment can be very triggering Importance of retaining control and minimizing triggers 9

POSSIBLE EFFECTS OF ADULT SEXUAL VIOLENCE ON POSTPARTUM Difficulty with attachment between mother and baby Avoidance of doctors for babies well-being Fear or angry of breastfeeding Problems with partner (sexuality, trust, etc) More later 10

INTIMATE PARTNER VIOLENCE 1 in 4 women will experience domestic violence in her lifetime Estimated 5 million intimate partner violence rapes and assaults occur each year against women Between 79 – 92% of women who experience IPV met the diagnostic criteria for PTSD Young women, low-income women and some minorities are disproportionately victims of domestic violence and rape Women ages are at greatest risk of nonfatal domestic violence 11

POSSIBLE EFFECTS OF INTIMATE PARTNER VIOLENCE ON PREGNANCY If the abuser impregnated the women: He may try to exert extreme control over her pregnancy including medical choices He may be angry that she is bonding with her pregnancy He may ‘force’ her to keep an unwanted pregnancy or abort a wanted one He may try to isolate her (further) from family and friends He may make negative comments about the way her body is changing or her ability to be good mother He may become more violent during this time (feeling out- of-control) 12

POSSIBLE EFFECTS OF INTIMATE PARTNER VIOLENCE ON PREGNANCY She may try to hide her pregnancy from her partner May not want to introduce the midwife to her partner May not want the midwife in her home May be ‘jumpy,’ afraid, and ashamed May try to hide abuse May believe it is her fault May want to leave her partner IF she was recently hurt but often takes the partner back 13

POSSIBLE EFFECTS OF INTIMATE PARTNER VIOLENCE ON POSTPARTUM Safety issues for the mother Bonding and attachment issues 30 – 60% of intimate partner abuser are also child abusers “Neglect” of infant may be related to abuser withholding money for diapers, formula, clothing Abuser unlikely to help with infant care and may impede ability of the mother to provide care May result in greater risk of postpartum depression 14

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DANGER ASSESSMENT QUESTIONS: Has he ever used a weapon against you or threatened you with a weapon? Has he threatened to kill you or your children? Do you think he might try to kill you? 16

DANGER ASSESSMENT QUESTIONS: Does he have a gun or can get one easily? Has he ever tried to choke you? Is he violently or constantly jealous or does he control most of your daily activities? Have you left him or separated after living together or being married? 17

DANGER ASSESSMENT QUESTIONS: Is he unemployed? Has he ever tired to kill himself? Do you have a child that he knows is not his? Does he follow or spy on you or leave threatening messages? 18

DANGER ASSESSMENT QUESTIONS: Has the physical violence increased in frequency over the past year? The physical violence increased in severity over the past year? Have you ever been forced to have sex when you didn't want to? Does your partner use drugs? 19

DANGER ASSESSMENT QUESTIONS: Have you ever been beaten by your partner while pregnant? Have you ever threatened or tried to commit suicide? Is your partner violent outside of the home? Has your partner ever stalked you? 20

SAFE (7233) TOLL FREE IN FLORIDA!

INTERVENTION? On average women in domestic violence situation attempt and fail leaving their partner approximately 7 times Women’s greatest risk for death by abuser is when she attempts to leave What can you do: be supportive, encourage safety 22