Abuse during pregnancy: current theory and new contextual understandings

Struggling to survive for the sake of the unborn baby: a grounded theory model of exposure to intimate partner violence during pregnancy

BACKGROUND

Intimate partner violence (IPV) during pregnancy is a serious matter which threatens maternal and fetal health. The aim of this study was to develop a grounded theoretical model of women's experience of IPV during pregnancy and how they handle their situation.

METHOD

Ten interviews with women who had experience of being exposed to IPV during pregnancy were analyzed using the grounded theory approach.

RESULTS

The core category 'Struggling to survive for the sake of the unborn baby' emerged as the main concern of women who are exposed to IPV during pregnancy. The core category also demonstrates how the survivors handle their situation. Also, three sub-core categories emerged, 'Trapped in the situation' demonstrates how the pregnant women feel when trapped in the relationship and cannot find their way out. 'Exposed to mastery' demonstrates the destructive togetherness whereby the perpetrator's behavior jeopardizes the safety of the woman and the unborn child. 'Degradation process' demonstrates the survivor's experience of gradual degradation as a result of the relationship with the perpetrator. All are properties of the core category and part of the theoretical model.

CONCLUSION

The theoretical model "Struggling to survive for the sake of the unborn baby" highlights survival as the pregnant women's main concern and explains their strategies for dealing with experiences of violence during pregnancy. The findings may provide a deeper understanding of this complex matter for midwives and other health care providers. Further, the theoretical model can provide a basis for the development and implementation of prevention and intervention programs that meet the individual woman's needs.

Rural pregnant women's stressors and priorities for stress reduction

Rural residence and maternal stress are risk factors for adverse maternal-child health outcomes across the globe, but rural women have been largely overlooked in maternal stress research. We recruited low-income, rural pregnant women for qualitative interviews to explore their stress exposures during pregnancy, reactions to stress, and priorities for stress reduction. We also used quantitative measures (Perceived Stress Scale, Center for Epidemiologic Studies of Depression Scale-Revised, Posttraumatic Stress Disorder Checklist-Civilian, Lifetime Exposure to Violence Scale) to describe stress exposures and reactions. We interviewed 24 pregnant rural women from a Midwestern US state, who were primarily young, white, partnered, and unemployed. Women's predominant stressor was financial stress, compounded by a lack of employment, transportation, and affordable housing options; extended family interdependence; small-town gossip; isolation/loneliness; and boredom. Quantitative measures revealed high levels of global perceived stress, violence exposure, and symptoms of depression and posttraumatic stress disorder among the sample. Women most commonly reported that employment and interventions to increase their employability would most effectively decrease their stress, but faced numerous barriers to education or job training. Tested maternal stress interventions to date include nurse-case management, teaching women stress management techniques, and mind-body interventions. Pregnant women's own priorities for stress-reduction intervention may differ, depending on the population under study. Our findings suggest that rural clinicians should address maternal stress, violence exposure, and mental health symptoms in prenatal care visits and that clinicians and researchers should include the voices of rural women in the conceptualization, design, implementation, and evaluation of maternal stress-reduction interventions.

Rural mothers experiencing the stress of intimate partner violence or not: their newborn health concerns

Pregnancy and the postpartum period is a time of great physical, psychological, and emotional upheaval. Women who experience intimate partner violence experience more depression and anxiety and a higher risk of adverse pregnancy outcomes (such as those related to the abuse). While the literature supports the presence of increased health care utilization for abused women, there is little information on the way that these mothers seek medical care for their infants. This secondary analysis is part of a larger study on smoking cessation in low-income, rural pregnant women called Baby Behavioral Education Enhancement of Pregnancy (Baby BEEP). Women (N = 616) were classified as abused or not abused based on their answers to the Abuse Assessment Screen. At 6 weeks postdelivery, each woman was asked, "Has your baby had any problems that you talked to the doctor or nurse about?" The abused women (n = 211) sought health care advice significantly more often than the nonabused women (n = 405; Pearson chi(2) = 4.89; P = .027). Stress scores were elevated for all women in the study, but women categorized as abused experienced significantly more stress (P < .001).

Intimate partner violence and its implication for pregnancy

Intimate partner violence (IPV) is a common occurrence in pregnancy and results in an increased risk of adverse outcomes. Homicide may be the most common cause of maternal death. Women who are pregnant and the victims of IPV have high rates of stress, are more likely to smoke or use other drugs, deliver a preterm or low birth weight infant, have an increase in infectious complications, and are less likely to obtain prenatal care. The IPV continues in the postpartum period. Adolescents may be at even higher risk than their adult counterparts. Children raised in violent homes have both immediate and life long adverse health outcomes as a result of their exposure to IPV. IPV adds substantially to healthcare costs both for direct services to treat the injuries and higher utilization of a wide range of healthcare services. Healthcare providers, particularly those who care for pregnant women, are in a unique position to identify these women and direct them and their families to the help they need to end the violence in their lives.