Domestic Abuse in Pregnancy: Risks, Signs & How to Get Help

Key Takeaways:

1. Homicide is the leading cause of death for pregnant individuals, with intimate partner violence (IPV) being a significant factor. The risk of homicide is especially high among young Black pregnant individuals.
2. Pregnancy can escalate domestic abuse as abusers feel threatened by the shift in priorities, leading to increased control tactics like physical violence, financial manipulation and reproductive coercion.
3. Abused pregnant individuals face serious health risks, including preterm birth, miscarriage and developmental delays for the baby, as well as an increased risk of future abuse.

Pregnancy can be an exhilarating and joyous nine months for most parents-to-be. This is likely a time when they’re picking out baby names, test driving strollers and washing teeny tiny clothes in preparation for a new family member. 

But the dynamic changes drastically when one of the soon-to-be parents is abusive and controlling toward their partner. Every year in the U.S. perpetrators of intimate partner violence (IPV), or domestic violence, abuse as many as 324,000 pregnant people from every age group, religion, ethnicity, socioeconomic level and educational background. And that number is likely much higher, as most incidents of IPV are never reported, according to CDC research. 

Pregnancy Doesn’t Cause Abuse, But It Can Make Abusers Escalate

Pregnancy doesn’t cause a partner to be abusive—that’s a choice they make. Renowned domestic violence researcher Jacquelyn Campbell, PhD, RN, professor of nursing at Johns Hopkins University School of Nursing, says that in the research she’s done, pregnancy doesn’t necessarily increase the risk of domestic violence either. 

“What we found in various studies dating back to 2008, the most common pattern was there may be physical abuse before pregnancy but during pregnancy it becomes only psychological abuse,” says Campbell. To some survivors, this gave them a sense of false hope that having a baby together was improving the situation and their partner was become less abusive. 

Unfortunately, in the vast majority of cases, this was not a permanent change. Many women said pregnancy didn’t have anything to do with their partner’s abuse. He hit me whether I was pregnant or not pregnant, Campbell says she’d hear from survivors.

Survivor Amy told DomesticShelters.org that the first time her abusive partner hit her was when she was pregnant. 

“He came home one night and he smelled like perfume. When I questioned him, he laid me down on the bed and started calling me names, slapping me over and over.”

From there, his abuse escalated to not just being violent and controlling toward her.

“​​He was abusive to the children also. When I tried to stop him he would become more abusive with me. I would literally keep my children behind me and say, ‘Please, do anything to me. Just don’t touch the kids.’ He would threaten to abuse the children more if I intervened. Toward the end, if he wasn’t hitting our children or me, he was being emotionally abusive. I felt like a prisoner of war, just trying to survive and protect my children. It was six years of hell.”

Another survivor shared that her abusive partner refused to let her seek prenatal care for the entire nine months of her pregnancy, relegating her to just one room in the house. Domestic violence during pregnancy isn’t always physical violence. Sometimes, power and control looks like degradation, neglect, sexual violence or financial control.

“Pregnancy itself can be used as a power and control dynamic,” says Dr. Rachel Miller, PhD, LMFT with Hold the Vision Therapy in Chicago. As a survivor of domestic violence herself—she endured 17 years with an abusive partner—she now counsels other survivors, helping them understand abusers’ tactics and heal from their effects. Pregnancy doesn’t often cause abuse to start out of nowhere, it is usually an escalation of abuse that was already present. If a survivor had an inkling before getting pregnant that their partner was controlling, they may see a sharp uptick in that control, which can include physical violence and stress that affects both baby and mom-to-be.

Abusers are used to being the center of attention in a partner’s life. They’ve orchestrated it that way. A pregnancy introduces a shift in priorities, and abusers may find that they’re no longer a top priority. 

“The abuser is thinking, ‘Do I lose some of my power and control over this person when there’s someone who I’ll have to compete with for attention and resources?’” says Miller. 

As a result, abuse may start or escalate during pregnancy in order to retain the abuser’s perceived place of top priority. The pregnant partner suffers, of course, by neglecting any of their needs in order to keep the peace at home with their abusive partner.

“Being pregnant can create greater tensions,” says Miller. Financial strain is another factor that can exacerbate abuse, she adds, though correlation isn’t causation. Financial stress experienced by a couple with a healthy dynamic won’t result in the pregnant person being beaten. Financial pressure in a relationship where abuse is already present will likely make things worse. 

This stress on the pregnant individual greatly increases their risk of preterm birth, meaning prior to 38 weeks, as well as low birth weight. In pregnant people who are abused, the risk of preterm birth doubles. 

As a result, says Miller, pregnancy may be the time when pregnant survivors begin to rethink their situations more seriously. What was tolerable on their own may seem far scarier with the thought of a baby or child enduring the same. 

“Resistance or retaliatory violence can happen,” says Miller. “Power and control escalate to where the survivor becomes violent themselves as a protective nature.” Far too often, survivors are named as primary aggressors in situations where abusers convince police that they are the victims, a tactic called DARVO, or deny, attack, reverse victim and offender. A pregnant person behind bars is not the prenatal care that OB-GYNs suggest. 

Pregnancy also brings with it a loss of isolation, something that abusers aren’t keen on. 

“When someone is pregnant, you start dealing with people outside ‘the bubble’ of your relationship, so if isolation was part of that dynamic, all of a sudden you have family getting more involved, there are doctors who are paying attention. There’s that loss of isolation that can trigger a panic [from the abuser] so they heighten their ability to use their violence to keep [the survivor] isolated,” says Miller.

Many pregnant individuals who are also being controlled by an abusive partner do not receive adequate prenatal care. An abuser may try to convince them they don’t need prenatal care or outright forbid them from going with threats of violence. For those pregnant individuals who do see a doctor, the abuser may stay by their side continuously in order to ensure the survivor doesn’t disclose what’s actually happening at home. 

Homicide is the Leading Cause of Death of Pregnant Individuals

It’s almost too unbelievable to be true—the leading cause of death of pregnant and early postpartum individuals is homicide by an intimate partner, most often by a firearm. Yet depending on where you look for this statistic, homicide might not be listed as a prevalent cause of death at all. 

“Right now, the definition of maternal mortality does not include death by homicide. I’m not sure this is correct — being pregnant or postpartum significantly increases the risk of death by homicide, and more pregnant women die of violence than any individual medical cause,” says Hooman Azad, MD, MPH, a fourth-year resident in the Department of Obstetrics & Gynecology at New York’s Columbia University Irving Medical Center. Azad was one of the researchers of a new study released this year at the Society for Maternal-Fetal Medicine’s annual meeting. 

“Part of the reason violence is not recognized as the leading cause of death during pregnancy is because we don’t include homicide and suicide in the definition of maternal mortality,” Azad says.

The study also found that Black pregnant individuals ages 18 to 24 have a risk of homicide by an intimate partner at four times higher than the national average. 

Strangled While Pregnant

A concerning number of pregnant individuals are strangled by their abusive partners while pregnant. Sometimes, victims identify being “choked” by a partner, even though this is a misnomer—choking refers to an obstruction in the throat while strangulation is when pressure is applied to the throat, restricting air and blood flow. Strangulation is known as the highest predictor of future homicide by that partner.  

This past May, a Fort Lauderdale, Fla., police officer was arrested for strangling his pregnant girlfriend. Even though police noted the strangulation was not done with “extreme force,” this doesn’t mean the assault was any less serious. Advocates argue that any number of seconds of cutting off blood flow to the brain can result in long-term injuries. Survivors may not lose consciousness while being strangled, though some do. Some survivors even seemingly feel fine after the strangulation, but then experience sometimes serious symptoms hours or days later. Delayed death can also occur after strangulation for reasons including stroke, irreversible brain damage and swelling of the airway that can lead to respiratory distress. 

Often, there are no physical indications of strangulation, a fact abusers exploit in order to use it as a tactic of abuse while also being able to deny it later. However, survivors should always seek medical attention after a strangulation, especially while pregnant, as there can be serious health risks to both the survivor and baby. 

Signs that may show up after a strangulation can include:

• Changes in one’s voice
• Neck pain
• Difficulty swallowing or breathing
• Ear pain
• Vomiting blood
• Vision change
• Tongue swelling
• Bloodshot eyes
• Lightheadedness 
• Petechial hemorrhages (small little red spots on the neck, face, or head)
• In the case of pregnant victims, miscarriage
• And long-term physical, emotional, and mental health consequence
  

What Is Reproduction Coercion?

Another factor that can come into play is reproductive coercion. This is when an abusive partner forces or coerces a survivor to abort a pregnancy against their will, or forces or coerces a survivor to become pregnant or continue a pregnancy that the survivor does not want. Bringing a child into a relationship where there is abuse by one partner can be a way to keep the survivor trapped indefinitely with that abuser. 

To see other examples of what reproductive coercion can look like, read “A Guide to Reproductive and Sexual Coercion.”

Health Complications of Stress, Abuse During Pregnancy

Besides an increased risk of preterm birth, these are some of the other health complications abused pregnant individuals are at risk for:

• Spontaneous abortion, or miscarriage. More likely with sexual abuse or abdominal trauma.
• Preeclampsia, high blood pressure during pregnancy that can severely damage the pregnant individual’s brain, liver and kidneys, as well as increase the risk of stroke.
• Placental abruption, an emergency condition where the placenta detaches from the uterus prematurely, potentially resulting in maternal hemorrhage, a hysterectomy or the death of the fetus.
• Negative maternal care, meaning abused pregnant women are more likely to smoke, drink, avoid staying active or neglect sleep.
• Developmental delays in babies, as well as emotional reactivity and behavioral issues as they age.
• Increased risk of homicide and suicide.
• Increased risk of abuse in future pregnancies. 
• Increased risk in abuse of children in the home. 
• Higher incidence of ACEs, or adverse childhood experiences, in a child which can lead to health issues later in life. 

How to Escape Abuse Before It’s Too Late

Pregnant survivors may hope that once the baby is born, the abusive partner will soften. After all, who doesn’t immediately fall in love with an adorable newborn? Survivors may think that sharing the task of raising a child will bring them closer together. 

Unfortunately, this isn’t how abusers work. They’re not wired like normal, caring, selfless individuals. There may be a lull in their abuse—the cycle of abuse graphic can help survivors see this pattern more clearly— but likely, the survivor (and baby) will find themselves in more danger the longer they stay. 

Granted, the thought of throwing your life into upheaval by leaving your partner during pregnancy is no small undertaking. It’s important to find support. The abuser may try to stop you from doing just that by isolating you as much as possible, but there are ways to reach out. 

1. If you can’t call a domestic violence hotline at home (i.e., you or your phone is constantly being monitored by the abuser) schedule a doctor’s appointment at a time when the abuser can’t attend (they’re working or out of town). A survivor may try to sneak away to an appointment, but be aware that many abusers track their victims using smartphones or other devices. 
2. Ask your doctor if you can contact your local domestic violence organization from their office. Create a safety plan for leaving. Remember, only you, the survivor, knows when it’s safest to leave. Survivors face an increased risk of danger when the abuser feels like they’re losing control, so having a plan in place is vital. 
3. Think of a place you can go where the abuser won’t be able to locate you—a relative the abuser hasn’t met before, a coworker’s house or a domestic violence shelter. 
4. File for an order of protection. Consider whether filing criminal charges is right for you. Be aware that many abusers manipulate their victims into recanting after they’re arrested. 
5. If possible, seek the advice of a lawyer with experience representing domestic violence survivors. A prebirth custody agreement may be an option. 

IMPORTANT: Read This Before Having a Baby

Sometimes it’s hard to spot abuse even when you’re in it. Abusers can disguise power and control as care and survivors may not realize how much danger they’re in until something seriously scary occurs. If you have any doubts about whether or not it’s a good idea to have a baby with your current partner, read, “Ask Amanda: Questions to Ask Yourself Before Having a Baby.”