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Abuse during pregnancy is the battering or other physical abuse, sexual abuse, verbal or emotional abuse, or other mistreatment of a pregnant woman. The term includes physical, sexual, and emotional abuse or violence. Abuse affects women of all ages and from all social and economic backgrounds.

Physical abuse is one of the most common causes of complications during pregnancy. It is estimated that one pregnant woman in four is physically abused. This rate is even higher in pregnant teenagers or those women who cohabit.

What are the signs and symptoms of the injury?

• bone fractures
• injuries on different parts of the body, in various stages of healing
• unexplained cuts, head injuries, or bruises

• depression
• feelings of anxiety
• low self-esteem

An unborn child has very soft, delicate tissues and organs, especially in the head and chest area. Trauma to the pregnant woman's abdomen can cause:

• miscarriage
• separation of the placenta from the wall of the uterus, known as abruptio placentae
• premature labor and delivery of a low-birth-weight or premature infant
• premature rupture of the membranes
• infection
• stillbirth
• fractures of the baby's bones
• maternal hemorrhage, which can result in the deaths of both mother and baby

What are the causes and risks of the injury?

The women who are most at risk for abuse during pregnancy are those who have been physically abused before. They may have a history of physical abuse, sexual abuse, or family violence. A pregnant woman is more likely to experience abuse if she is not married, or if her pregnancy was unplanned.

A woman who is abused may not seek prenatal care early in her pregnancy. Early prenatal care is very important in order to catch abnormalities in the mother or unborn child in time to treat them effectively.

Some of the reasons for late prenatal care are fear of the abuser, low self- esteem, and the lack of a support system. The abuser may try to control the woman and keep the abuse hidden from healthcare professionals.

If the woman has any chronic illnesses, such as high blood pressure, diabetes, or asthma, abuse can make them worse. The unborn child then suffers in turn.

Abuse can also increase stress and depression. Stress causes the body to release hormones that can lead to premature labor. These hormones can also decrease the blood flow through the placenta, which, in turn, can lead to low birth weight.

Stress also makes it more difficult for the woman to take care of herself during her pregnancy. This results in higher rates of malnutrition and poor weight gain. Abused women are also more prone to pregnancy risks such as smoking or using smokeless tobacco, drinking alcohol, or taking drugs during pregnancy. Good nutrition and rest are very important for a healthy pregnancy.

What are the treatments for the injury?

If a healthcare professional suspects that a woman is abused, she should be given the chance to talk without her partner present. Abused women are more likely to talk about the abuse to other women or to people who offer protection and support.

The goal of treatment is to get the woman away from the abuser. If she decides to leave the abuser, she needs a means of escape. Most communities have shelters, counseling services, and other resources to help her leave the dangerous situation.

The National Domestic Violence Hotline, 1-800-799-SAFE, offers information and support 24 hours a day. Local crisis shelters can provide a place to stay for women and children on a nightly basis. They provide counseling, legal and hospital advocacy, and community education. Many faith communities have outreaches or crisis pregnancy ministries for women.

Pregnant women who leave their abusers sometimes return home. Money problems or the belief that they cannot properly care for themselves on their own may bring them back home. They may see no other option but to return home to the abuser. It is important to make sure that an abused pregnant woman knows about the options for support and protection that are available in her community.

What happens after treatment for the injury?

Abuse during pregnancy may leave lasting psychological or spiritual effects. Sadly, about 70% of men who abuse their female partners will also abuse their children. This supports the belief that a cycle of violence can last for generations.