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In Harm’s Way

Don't Ask, Don't Tell

For an expectant mother suffering from abuse, her doctor's office might seem like a haven, a place to find help out of a very bad situation. Unfortunately, many health-care providers remain in the dark about domestic violence, says Linda Chambliss, M.D., a perinatologist at Maricopa Medical Center in Phoenix. "People don't want to talk about it. Some physicians still see it as a social worker's problem, or they think it doesn't happen to their patients," she says. But Dr. Chambliss knows differently. Among the 20 to 25 pregnant patients she sees each day, at least one is usually seeking help for injuries received as a result of battering. She recalls checking one patient for preterm labor after her partner threw a telephone at her stomach. In one of the worst cases she's seen, a pregnant patient said her husband had stabbed her numerous times. In the end, the fetus died.

Chambliss and others are working to get the word out. With the American College of Obstetricians and Gynecologists and the American Medical Association, she has developed training sessions to teach obstetrics and gynecology residents to ask about and recognize abuse. And the Centers for Disease Control recently held its first-ever conference on how violence hurts women's reproductive health, including during pregnancy. But it's the March of Dimes that is leading the way. The organization urges doctors to routinely ask every pregnant woman about battering -- especially since the JAMA review of studies suggested that moms-to-be may be more likely to suffer violence than gestational diabetes, preeclampsia, or placenta previa -- conditions for which they are regularly screened.

Even when physicians and nurses ask about abuse, it doesn't mean they'll get an honest answer, of course. When Alvarez's family doctor asked about the fist-sized bruise on her abdomen, she lied, saying she'd slipped and fallen; he urged her to be more careful. Parsons didn't tell her obstetrician about being battered, either, but did ask for help. "I told him I thought I was going crazy," she says; he referred her to a marriage counselor. She called him again. "I told him I felt that my heart was coming out of my chest. It really hurt and I couldn't breathe." He referred her to another doctor, who checked her heart and lungs and told her she was fine. He never raised the prospect of abuse, nor did any of the nurses she saw. "There were signs, but they didn't pick up on them. We were financially well-off, middle-class -- we didn't fit the profile of those they thought they should ask," she says.

Even if a woman doesn't feel comfortable turning to her doctor, it's crucial that she get help somewhere. "Keeping abuse a secret only protects the abuser," emphasizes Judith McFarlane, one of the leading experts on violence against pregnant women and a researcher at Texas Woman's University in Houston.

Real Risks ahead