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The Unspoken Pregnancy Danger

Laci and Scott Peterson seemed like a golden couple. They were young, good-looking, and appeared to be very much in love. And to make their joy complete, after a struggle with infertility, 27-year-old Laci was pregnant with the couple's first child. Scott gave every sign of being thrilled about the impending birth: Neighbors often saw him strolling down the street, hand-in-hand with his pregnant wife. Laci's mom, Sharon Rocha, considered the couple's life idyllic. "I think everyone envies their relationship," she told journalists soon after Laci was reported missing. "This is just the center of her world, to have her baby and be with her husband."

But there was also a dark side to their marriage. During Laci's pregnancy, Scott, a 30-year-old fertilizer salesman, began having an affair. And although Laci was eight months along on Christmas Eve, 2002, Scott says he took off on a daylong fishing trip, leaving her home alone. Laci was never seen alive again: Nearly four months later, her body and that of her unborn son, who was to be named Connor, washed up on the California shore, near the area where her husband claims to have been fishing. On April 18, 2003, police arrested Scott, who had dyed his brown hair strawberry-blond and was reportedly carrying $10,000 in cash. On March 16, 2005, Peterson was convicted for the premeditated murder of his wife and unborn son, and formally sentenced to death.

An Overlooked Threat

Although most of us were shocked by this headline-grabbing case, experts were not. In 2001 a chilling study by the University of Maryland reported that the number one cause of death among pregnant women isn't any of the health problems moms-to-be worry about -- such as preeclampsia (dangerously high blood pressure) or childbirth complications -- but homicide. Violence accounted for 20 percent of pregnancy-associated deaths, more than double the number for blood clots, excessive bleeding, high blood pressure disorders, or infections. The study, which looked at the deaths of women of childbearing age in Maryland between 1993 and 1998, also found that expectant or new mothers are three times more likely to be victims of homicide than women who haven't been pregnant in the previous year.

What kind of person could kill a pregnant woman? Too often, the perpetrator is the very person you'd expect to be the most tender and protective toward her: the father of her child. Overall, about one-third of female murder victims in the U.S. are killed by their husband, boyfriend, or former partner. While fatal attacks on pregnant women are relatively rare, battering is more prevalent. Last March, the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia, reported that 5.3 percent of mothers-to-be are physically abused by their partners. That adds up to more than 210,000 women a year.

Yet most doctors don't ask patients about domestic violence -- even though it occurs more often than some of the medical conditions that pregnant women are routinely screened for, such as gestational diabetes, preeclampsia, or neural tube defects like spina bifida. "Battering is swept under the rug because many doctors aren't comfortable talking about the topic or think women will be offended," says Cecelia Hann, M.D., a member of the medical executive committee of the Henry Mayo Newhall Memorial Hospital, in Los Angeles, and an ob-gyn in private practice.

That's starting to change, however. In December 2002, the Family Violence Prevention Fund recommended that primary-care doctors ask patients about abuse. In partnership with several medical groups, including the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, the group has developed a guidebook that offers doctors tips on how to screen parents and kids for domestic violence and how to respond if abuse is uncovered -- finding resources for the victim, medically documenting maltreatment, and following mandatory reporting laws in the states that have them.

That's a major step in the right direction, since domestic violence poses many dangers for expectant moms and their babies. Studies show that pregnant victims not only have a higher rate of hospitalization for falls and abdominal trauma, but they are also more prone to infections, anemia, vaginal bleeding, and below-normal weight gain. They may also delay getting prenatal care, possibly because their partner won't let them go to the doctor. And to ease the stress of a brutal relationship, they may turn to smoking, drinking, or using illegal drugs, putting themselves and their baby in even greater danger. As a result, they have more delivery complications, require more c-sections, and have a higher risk of giving birth to a premature or low-birth-weight baby. Low birth weight (any weight below 5 pounds, 8 ounces) increases a child's odds of lifelong mental or physical impairment and is also a factor in 65 percent of infant deaths, according to the March of Dimes.

Patterns of Abuse

It's often difficult for doctors, relatives, and friends to tell if a couple has a violent relationship. That's because batterers don't always fit popular stereotypes, says Juley Fulcher, public policy director of the National Coalition Against Domestic Violence, in Washington, D.C. "They're often people you'd never suspect, because they can seem like decent -- even charming -- guys who are well-liked in the community." And they come from a wide range of backgrounds, she adds: "People assume that domestic violence is mainly a problem in low-income families or among people from cultures where the wife is expected to be subservient to the man. The reality is that abuse cuts across all ethnic groups and income levels. Every day I see women who thought that it would never happen to them, but it did."

Whether they're rich or poor, most batterers do share certain personality traits. They're typically men who hold rigid views of traditional gender roles and who have an obsessive need to control their partner. They're usually very possessive and irrationally jealous. Often, they insist on knowing where their partner is at all times: Fulcher knows of a number of abusive men who gave their wives cell phones or beepers, then called repeatedly during the day to find out what the women were doing. While abuse often starts with control tactics like these, then gradually escalates into threats or actual attacks, it's also true that in 15 percent of fatal attacks, there's no history of prior violence, according to the Chicago Women's Health Risk Study, which involved more than 2,600 women. What's more, nearly a third of severe beatings were isolated events, according to the study.

An abuser's drive to dominate at all costs can stem from his own prior abuse, perhaps because he grew up in a violent home, according to a study from the University of Cincinnati's School of Social Work. The study looked at men who had assaulted their partners and found that three factors were 88 percent accurate in identifying the batterers: low self-esteem, seeing their dad maltreat their mom, or being subjected to a father's brutality themselves.

Studies by Richard Gelles, Ph.D., dean of the School of Social Work at the University of Pennsylvania, in Philadelphia, also document this vicious cycle: Men who witnessed any abuse of their mother are three times more likely to abuse their wives, while those who saw extreme violence are at 1,000 times higher risk of becoming batterers. "Abusive men believe they have the right to wield power and control over women," says Gelles. "And they'll blame their partner for 'provoking' the beating. They'll tell her it happened because she's lazy, fat, stupid, an awful housekeeper, or a terrible wife and mother."

The majority of women who are assaulted during pregnancy have experienced violence before. The CDC study found that 75 percent of the victims had faced previous domestic abuse. The pattern of attacks, however, may change. The assaults can become more frequent and severe -- and some men will deliberately target the woman's abdomen, Fulcher reports. "It's not unusual for pregnant clients to tell me that their partner said things like 'I'm going to kick that baby out of you.' Abusers will look for a woman's weak spots -- and if she's pregnant, the baby is what she cares about and is trying to protect, so that's where she's most vulnerable."

What about the 25 percent of cases in which beatings begin during pregnancy? This scenario is likely when the baby is unplanned, says Gelles. "Some violence during pregnancy is consciously intended to abort an unwanted fetus. Another risk factor is a man's suspicion he's not the father, whether it's justified or imagined," he notes. And there are other reasons that a pregnancy -- even if it's desired -- can be a flash point for physical abuse. "It's a dangerous time if a man has a potential for violence, because impending parenthood stirs up a lot of tension that can cause him to lash out," adds Gelles. "Maybe the woman has to quit her job or take unpaid time off, which puts him under financial pressure. And as the pregnancy progresses, she may make new demands on him or become increasingly focused on the baby, instead of him. These strains can trigger conflict that turns violent because these men have unresolved anger and little capacity to soothe themselves and resolve problems calmly."

Jealousy of the attention a man's pregnant partner receives from friends, family, or even strangers can also be a trigger. "An abuser wants to keep his victim isolated and dependent so she doesn't get any encouragement or opportunities to leave," says Fulcher. "That makes seeing her interacting with more people -- including doctors -- very threatening to the man, who feels he's losing control of the relationship. So he'll use whatever works to retain his power over her, whether it's threats, manipulation, or punching and hitting."

Why Do Women Stay?

Ending an abusive relationship isn't easy, especially when a woman is pregnant. Not only is the prospect of going through labor and delivery alone scary, but there's a wider dilemma, says Debbie Lee, director of health at the Family Violence Prevention Fund, in San Francisco. "How is she going to raise and support a child on her own, when most families need two incomes to get by? And if you've committed to a marriage, a mortgage, and a baby, it's very hard to say to yourself that you were wrong to fall in love with that person and that your most important relationship has failed. So she may not see any financial or emotional alternatives to putting up with the abuse."

After years of brutality, a woman's self-esteem is often so low that she feels she doesn't deserve anything better, adds Gelles. "I've heard more battered women than I can count say, 'It's not really so bad. The black-and-blue marks go away. I've learned to endure because at other times, he's okay.'" An expectant mother may also blame herself for the violence, thinking that if only she were a better wife, things would change; or convince herself that after the baby comes, the future will be brighter. Since batterers are often quite remorseful between bouts of abuse, their impassioned promises to reform help fuel false hopes.

Even if the victim wants to stop living in fear, she may feel that she has no one to turn to. It's common for violent men to isolate their partners from friends and relatives, cutting off sources of social support. They may also keep a tight rein on the family money, limit the woman's access to the car or phone, and intimidate her with threats like "If you ever leave me, I'll kill you." As a result, victims feel virtually imprisoned in the relationship. But, says Dr. Hann, "if your partner is physically hurting you, forcing you to do things you don't want to do, or making you feel afraid at home, you don't have to take it. Domestic violence is a crime, and there's help available in every community. Talk to your doctor: She can assess your risk and get you help." (See "Do You Need Help?" below.)

And for pregnant women, there's a very compelling -- and chilling -- reason to break the silence that surrounds battering: Up to 60 percent of men who beat their wives also abuse their kids. Even if victims of violence aren't ready to leave their relationship yet, it's still important for them to confide in someone, whether it's their ob-gyn, a battered women's shelter, or a domestic violence hotline, says Fulcher. "There are well-trained people who understand how abuse works, and they can help her protect herself."

Safety planning includes deciding where to go if there's an argument -- it's best to avoid rooms with no exits (such as bathrooms) or ones that contain weapons (the kitchen); preparing a list of people to contact in the event of a crisis and memorizing their phone numbers; establishing a code word or signal to let family, friends, or a trusted neighbor know if they should call for help; and assembling an emergency kit with money, identification, and keys if the woman has to flee her home. But ultimately, the safest thing of all for a battered woman to do is convince herself that she -- and her kids -- have the right to live without terror and violence. As tragic as Laci's murder was, say experts Scott Peterson being found guilty served as a tragic reminder of just how urgent that message is for all pregnant women.

Lisa Collier Cool is an award-winning health journalist from Pelham, New York, and a mother of three.