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In Harm’s Way

Lynn Parsons* will never forget her first pregnancy. One memory in particular stands out: the night her moody husband, Mark*, sat in front of the TV watching a violent cop show. Parsons, 6 weeks along, was upset by the images of a terrorized woman flashing across the screen and asked him to turn off the set. His response: a swift kick toward her abdomen with his steel-toed boot. That was the first time Parsons realized exactly how much danger she and her baby were in. She managed to dodge that blow, but as the months wore on, she wasn't always so lucky.

Parsons married her husband because he was tall, handsome, and quiet. "That was one of the things that attracted me," says the forthright, intelligent 35-year-old woman. "I had grown up with an awful lot of yelling in my house." But during their long courtship, Mark broke the stillness twice by striking and choking her. To woo her back, he once drove a carload of gifts and stuffed animals to the restaurant where she worked to tell her how sorry he was. Though Parsons had doubts about marrying him, his persistence finally won her over. "When you've fallen in love with somebody, you believe it when he says it won't happen again."

In the three years they were married before she got pregnant, Mark never raised a hand to her, so Parsons considered the violence a thing of the past. However, with their baby on the way, the violence not only resurfaced -- it returned with a vengeance. "There was this sudden change," she says. "Instead of months or years between incidents, it was just constant." Tensions erupted almost daily, leading to arguments and tears. More and more, Mark's sarcastic streak was directed at her. He hit her and pushed her off the bed. He choked her against a wall and punched out the plaster near her head. He drop-kicked a hot iron at her.

These are scenarios that most of us find nearly unfathomable. We expect husbands to shower their pregnant wives with love and attention, protecting them against harm -- not causing it. How can we begin to comprehend repugnant images of a woman fending off punches and kicks from the father of her unborn child?

But these assaults happen far more often than we realize. A review of 13 studies published in the Journal of the American Medical Association (JAMA) concluded that between 3.9 percent and 8.3 percent of pregnant women are victims of domestic violence. That translates into a staggering number: Up to 332,000 of the 4 million American women having babies each year suffer physical abuse. And it isn't a problem that affects only low-income families. "Batterers come from blighted neighborhoods and pricey ZIP codes alike," says David Adams, Ph.D., a Cambridge, MA, psychologist who cofounded one of the nation's first batterers' programs. One in five men who enter Adams's program is a professional, he says. "We've had psychologists, doctors, and lawyers."

*Names and some identifying features have been changed

Profile of a Batterer ahead

Profile of a Batterer

Men who abuse their pregnant partners often blame money pressures, stress, and the added responsibilities of having a child. But all expectant fathers face these pressures. What makes batterers different? Often, they are emotionally immature, self-centered men obsessed with controlling their partners, says Sandra Baca, Ph.D., a Los Angeles psychotherapist who counsels batterers and survivors. They use ridicule, sarcasm, and threats before resorting to the ultimate control tactic -- beatings. "Violence gets results," says Baca.

Rhonda Alvarez's* husband followed the pattern of a typical batterer. Early in their marriage, he hurled insults. Then, when Alvarez was six months pregnant with their first child, an argument flared out of control and he slapped her, pulled her hair, and left her with a huge bruise on the side of her abdomen. Alvarez wept because her stomach ached; he accused her of faking the pain. She stayed up all night brooding over the beating. "I blamed myself. I felt that I shouldn't have said what I did." She tried harder to be a good wife, but more beatings followed, usually after her husband's weekend drinking binges. Like many women living with violent men, Alvarez saw two sides to her husband. "He's very funny and friendly and sociable, but when he drinks, his personality gets aggressive," she says.

For a man prone to battering, his partner's pregnancy can trigger deep fears of losing the spotlight in a relationship and losing control over someone who caters to all his needs, says Adams. "They're bugged that they're not the center of attention anymore." It seems astounding, but some abusers are so jealous of their own baby that they focus attacks on the pregnant abdomen. And they often resent the attention outsiders lavish on mother and child. Says Parsons, "You're carrying the child, so people are more happy for you than they are for him."

Abusive men also tend to see gender roles in black and white. Instead of pitching in around the house, they expect their partners to do "women's work" and they have little patience when fatigue or morning sickness gets in the way of cleaning and cooking. Alvarez's husband called her a slob and berated her for neglecting the house. Even though she worked the graveyard shift during her pregnancy, she scrambled to keep their home tidy. "I had to make sure everything was perfect, just right, the way he wanted it. His dinner had to be ready and the house had to be clean," she recalls.

Some batterers get upset over their partners' changing appearance. Instead of seeing a wife or girlfriend as nurturing their growing child, they only see her putting on weight. When these twisted dynamics are added to the emotional and financial stresses future fathers experience, abuse can escalate quickly, as it did in Parson's case. Because pregnancy brought about so many changes beyond her husband's control, she says, "the only thing he could do was make it worse."

Don't Ask, Don't Tell ahead

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

Real Risks

Perhaps nothing motivates a woman to leave an abusive situation more than knowing that her child might be in danger. And the risks for a battered mother-to-be and her baby are substantial. The range of injuries inflicted on fetuses includes skull and femur fractures, early separation of the placenta, and death; the mother's uterus may be lacerated as well. Battered women who are undernourished -- a significant number are so depressed or anxious that they fail to gain enough weight during pregnancy -- are more likely to have a low birth weight baby (under 5 1/2 pounds). This is especially worrisome because these babies are 22 times more likely to die before their first birthday. A malnourished mother-to-be increases her odds of becoming anemic, of having a difficult recovery from childbirth, and of suffering from vaginal and urinary tract infections, bleeding and spotting, and miscarriage. Her chances of preterm delivery go up, too, in turn increasing the odds that her baby will have breathing and feeding difficulties. Bonnie Dattel, M.D., a professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, says research indicates that the risks to children may go well beyond infancy to include developmental and learning problems at school.

To make matters even worse, many women turn to cigarettes, alcohol, or drugs to numb depression, anxiety, and suicidal feelings. "They use the substances to cope with the violence," says McFarlane. And because battered pregnant women are twice as likely to delay prenatal care until the third trimester, they place themselves and their babies in even greater danger. They may be too depressed to take care of themselves properly, or afraid a doctor or nurse will ask about their injuries. Some batterers even stop partners from getting care. Dr. Chambliss's patients have confided to her that husbands or boyfriends had taken away car keys or bus fare to prevent them from seeing a doctor.

Expecting the Worst ahead

Expecting the Worst

Why does an abused woman stay? There are any number of reasons, of course, but during pregnancy a woman is particularly vulnerable. She may dread the thought of going through labor alone; she may need help from her partner after the baby is born; and she may feel more financially dependent on him while she's expecting and after. What's more, like many women who are battered, Parsons wanted the violence to end -- not her marriage. She clung to the dream that she and her husband could still build a life together. She fantasized that after the baby came along he would return to being as attentive as he was during their early courtship. "In the beginning, it was wonderful. It was flowers and taking me out to eat. I was treated like a queen," she says. "I was holding on to the hope that it would get back to that someday."

To an outsider, her wish might sound naive, but battered women often lose perspective. Jealous, possessive husbands or boyfriends control their actions and keep them from using the phone or seeing friends and family. They cut off a woman's emotional support so she becomes entirely reliant on him. Parson's husband drove away her friends; Alvarez's wouldn't let her accept rides to work from a male coworker who thought it was too dangerous for a pregnant woman to ride the bus late at night. "These women are truly isolated," McFarlane says. "They are prisoners in their own homes."

Many tell no one about their crisis. When patients confide in Dr. Chambliss, her advice is compassionate but clear and direct: "I tell them that no one deserves to be hit, and that probably this will get worse."

She also reminds them that domestic violence is a crime. Laws vary from state to state, but California, Minnesota, Rhode Island, and Wisconsin are among the states with the strongest domestic violence laws. Recently, the Arizona legislature passed a law allowing the court to increase penalties if the victim of abuse is pregnant. And California gives the baby what amounts to legal rights against its batterer; a batterer can be prosecuted for murder for killing a fetus.

Some abusive men do stop after an arrest lands them in a court-ordered counseling program. But success rates for such programs are low. For many women, safety for themselves and their children means leaving -- and that means confronting the paralyzing fears of ending up homeless or facing the batterer's wrath. Leaving is risky because an enraged batterer might step up the violence. But staying can be worse. McFarlane's reminder is chilling: "A man who hits a pregnant woman is unusually violent -- even for a batterer."

Parsons and Alvarez say their husbands threatened to kill them if they ever tried to go. Still, Alvarez left not long after her husband choked her breathless one day. "He almost killed me. He had that anger, that fire in his eyes," she recalls. She called a women's shelter, which helped her plan an escape and find a place to live where her husband wouldn't find her. She secretly stashed away money, then filed for a restraining order before moving with her three kids to a hidden location. Today, she is legally separated from her husband.

Lynn Parsons, too, eventually found a way out. At just 29 1/2 weeks along in her pregnancy, she gave birth to a 4-pound boy with serious neurological problems. When she returned home from the hospital, her husband resumed the abuse. She first tried to leave when the baby was 2 months old. She came back after her husband promised that he'd change; he didn't. She left again when the baby was 8 months old, but returned because she was afraid she couldn't support herself and her son. When her son was 22 months old, Parsons reached her breaking point. She worried that it was only a matter of time before a hurtling plate hit her son, and she hated to see the boy cower at his angry father. "He loved his dad, but when there was yelling and screaming, he'd refuse to look at him," she says. That was when she got a restraining order, forced her husband to move out, and filed for divorce. "My self-esteem was so low, I didn't feel like I deserved better," she says. "But I wanted something better for my son. I didn't leave for me -- I left for him."

Katherine Kam is a freelance writer living in the San Francisco Bay area.

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