Pregnant Women at Risk: Be alert to signs of abuse, and ask questions

10:04 PM CST on Wednesday, February 23, 2005

It is horrifying that Lisa Underwood of Fort Worth, who was seven months pregnant, and her 7-year-old son, Jayden, are dead. It is even more horrifying that, as this case reminds us, violent death is a risk factor of pregnancy.

Researchers in both the United States and the United Kingdom have found that homicide accounts for as many women's deaths during or immediately after pregnancy as any medical complication. In addition, one study published in the Journal of the American Medical Association found that pregnant women were nearly twice as likely to become homicide victims as women of similar ages and races who were not pregnant.
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The Family Violence Prevention Fund has a comprehensive set of "National Consensus Guidelines for Identifying and Responding to Domestic Violence Victimization in Healthcare Settings."

Copies can be ordered at 1-888-792-2873.

The document is also online at endabuse.org/programs/healthcare/files/Consensus.pdf.

Perhaps we shouldn't be shocked. Pregnancy is a stressful event even if it is planned – and even more so when it is not. Unsurprisingly, the incidence of homicide is especially high among women who did not plan their pregnancies.

What matters is that we face the fact that not all relationships and not all pregnancies conform to our romanticized notions. Doctors, nurses, other medical personnel and even just those of us who know a woman who is pregnant must be alert to signs that she is in distress or being abused.

It's never easy to ask delicate questions, but that's another thing research has shown: Women are far more likely to disclose domestic violence if they are asked than if they must screw up the courage to make the admission on their own.

Nevertheless, another study found that only one in 10 gynecologists routinely asks patients whether their partners are abusing them. That's not to blame the doctors – medical schools have not traditionally recognized domestic violence as a public health issue.

But a few simple questions – "Is someone hurting you? Is someone threatening you?" – asked by a doctor or a concerned co-worker could save the life of the next Lisa Underwood.
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