Domestic Violence in Pregnancy

Pregnancy is the wondrous time in a woman’s life when she is privileged to nurture new life. She glows with excitement as the weeks pass. The anticipation of meeting her little angel face fills her with joy. Each new kick brings joy and trepidation. There are books to read, support groups to join and a nursery to decorate. “Will I be ready?” “What will labor be like?” “Will he have my nose?” All are normal questions to ponder as her little darling’s arrival draws ever closer. Pregnancy should be a time of peace and safety. 

Amidst the plethora of books and websites offering tips and information on what to expect during this precious time, few help a woman understand or handle domestic violence during her pregnancy. 

Domestic violence is cited as a pregnancy complication more often than diabetes, hypertension or any other serious complication.[i] One out of six women reported the abuse actually commenced during the pregnancy, according to Centers for Disease Control. In the U.S. more than 300,000 women experience some kind of violence from their intimate partner during pregnancy. As the child’s birth approaches, the father feels more stress. This stress leads to frustration. Frustration is directed at his perceived source of stress, the mother and their unborn child. 

When women are abused by an intimate partner, they are at a higher risk for stress, depression and substance addictions. The effects of stress are challenging to isolate. They may include the mother’s general loss of interest in her and/or her baby’s well being during pregnancy and after.[ii]  There are long-term detrimental psychological consequences for the child. Compound this with the fact the child is very likely to witness and experience domestic violence during his childhood. 

It can be easy to stand on the sidelines and critique why a woman stays with her abuser. What many don’t understand are the variety of complex reasons she does. Like everything else in life, you have to walk in those shoes. There are economic pressures as abusers often control the finances. Being pregnant, she may be unable to secure a job. In healthy relationships pregnant women often feel vulnerable and fear being alone. Add domestic violence and she feels helpless and hopeless. Believe it or not there are still religious and cultural pressures to stay; families will coerce the woman. It is a difficult situation where known risks are balanced against the unknown. She will do whatever she can to reduce the damage. Sometimes, that means staying. This is a human conditioning we all do. Some women finally reach a point where the routine risks become intolerable. When this occurs, she needs warm, receptive and loving support. We need to be there, ready and willing to do whatever we can to help break the cycle of violence. She has to know the violence is NOT her fault and she cannot change her abuser. 

Domestic Violence is about power, one person using a pattern of behavior to control another. These include:

• Pushing, slapping, kicking
• Marital rape
• Intimidation, threatening
• Isolation
• Suicide threats
• Degradation 

A few physical effects of violence during pregnancy:

• Insufficient weight gain    
• Hemorrhaging
• Abdominal trauma       
• Ruptured membranes
• Fetal bruising, fractures, hematomas 

If you are in an abusive relationship:

• Have important numbers handy, in phonebook under false names or in some code
• Make a safe plan of escape
• Consider safer places in your home; where there are exits and no weapons. Try to get there when abuse is impending 

When you plan on leaving:

• Plan safe places of escape
• Open a bank account and/or get a credit card in your name
• Try doing things to get out of the house: take out the trash, walk the dog, go to the store.
• Mentally practice how you would leave
• Prepare an emergency bag of everyday things and important documents. Hide it where it is easy to get to. Keep in mind there are situations when all you can do is leave with the clothes on your back. Things are replaceable, lives aren’t. Do what you have to in order to be safe. 

Speak up if you suspect someone is being abused! Are you hesitating, maybe telling yourself “It’s none of my business”, “I might be wrong”, or “She might not want to talk about it”?  When you express your concern you are letting her know you care. You may even save her life and her baby’s! 

Regina Rowley enjoys helping others and living a life where she makes a positive difference. She accomplishes this as a Women’s Group/Conference Speaker, teaching Smartsafe, a reality based self-defense for women, and as a blog writer. 

She may be contacted via her website:

www.ReginaRowley.com 

Please visit and follow:

www.KUTAEmpoweredWomen.wordpress.com for self-defense tips and information. 

 

Resources: http://www.paho.org/english/ad/ge/vawpregnancy.pdf   http://www.kcsdv.org/stats.html

http://www.babycenter.com/0_domestic-violence-during-pregnancy_1356253.bc

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[i] “Battering and Pregnancy” Midwifery Today 19: 1998

[ii] “Abuse of Pregnant Women and Adverse Birth Outcome” Journal of the American Medical Association 267: 1992

What a Doula Can Do for Your Labor Day

By Rebecca Dundore, Gentle Hands Doula Services

The sacred event of childbirth is a defining moment in a woman’s life.  Past accomplishments will be dimmed and future ones will be compared to this day – her labor day.  As a pregnant woman prepares for her birthing day she is met with strong opinions from every corner.   Horror stories come creeping out from the dark corners.  Even people who have never given birth want to tell her what she should do. “Overwhelmed” does not even begin to describe the feeling that a new momma experiences as she is barraged by well intentioned, however misguided, advice.  Even before labor is on the horizon, a doula can become your anchor.  The doula focuses on helping you to get it all sorted out – to dismiss that nagging voice that really scared you or undermined your confidence.

As a doula for over five years, I’ve seen that prenatal support is nearly as important as labor support.  Giving birth is such a huge sacrifice.  It is an ultimate act of love and deserves respect and honor.  Having a doula for your birth is like having a wedding planner for your wedding.  You can have a wedding without a planner, and a birth without a doula, but the right one can reduce your stress level and enhance your experience.  We work together through prenatal visits, phone conversations and emails to bring you peace of mind as you prepare for a day that will be forever in your memory.  Your labor and birth should be something you look forward to, not dread and fear.  Having a doula will help you come to that place of inner strength and confidence where you can confront your fears and press on toward your goal.

When I’m preparing for a birth I always go through my doula bag.  I make sure I have all my massage tools and comfort props and that they are all clean and ready for use.  More importantly, I make sure that I’m rested and that the couple is prepared well.  My goal is to put both parents at ease – I want them to know that I’m on their team and not looking to come between them in any way.  I often show the partner how to use massage and other techniques to relieve pain.  Many partners have thanked me after a birth, stating that they could not have gotten through it without me.  With my encouragement and support, they were able to attend to their partner in a more meaningful way.  Studies have shown that the partner is more emotionally involved in the whole process if they are supported by a doula, even if it is not their first child.

A good doula is primarily concerned with supporting the laboring couple’s needs.  She does not demand that you go all “natural”.  She isn’t there to monitor your health or your progress.  She’s there to be an emotional life-line for both of you.  She’s there to support your wishes, to help you reach your goals, and to provide ideas for laboring well, etc.

In labor, women often find they need a beacon to guide them through the harder times.  A doula can be that lighthouse.  Women who have doula support are far less likely to need medical interventions during labor – and they recover faster too.  Even the baby is less likely to stay in the hospital for a prolonged time when the mother has had a doula!  Women need other women to mother and nurture them into motherhood. Labor is also a major athletic event and warrants the use of a coach and a cheerleader.  To have a guardian of your birthing day is your right.  The doula does not do what your doctor, midwife or nurse does.  Her job is uniquely focused on your emotional well being and your physical support.  You deserve it!

Birth Plan Template

A Birth Plan should be a thoughtful reflection of your values.  It can be a useful communication tool between you and your caregiver. Ideally, this communication starts early in pregnancy. The following is a sample introduction and a list of suggested topics you might want to address in your birth plan. Keep your birth plan simple and no more than one page long. Address only the things that are important to you: 

Best Case Birth Scenario 

We (I) have chosen Dr. ______________  and _______________ Hospital because of their excellent reputation in supporting women through the process of childbirth. We (I) understand that birth doesn’t always go “as planned”, and that’s why we have you on our team, however, barring any situations in which mother’s or baby’s safety is in jeopardy, the following “wish list” represents our best case birth scenario. It is intended not as a list of “demands” but as a tool to facilitate communication between us. We (I) ask that we (I) be included in the decision making process during our (my) birth, and together, we can make this a positive and joyous occasion.

Support 

Presence of coach and/or doula during labor, delivery, etc.

Presence of interns, residents, other personnel

Labor 

Continuous presence of father, doula, mother, etc.

Mobility

Fluids and food

Ambience of environment (i.e. quiet, dim lights, music, interruptions, etc.)

Medical interventions:

IV (this is usually required if dehydrated, GBS+, desire epidural, or need pitocin)

Amniotomy (breaking bag of water)

Monitoring (continuous or intermittent, external or internal?)

Vaginal exams (important to limit if bag of water is broken; also consider the psychological effect of learning you’ve not made as much progress as you thought)

Pitocin

Pain medication/epidural

Delivery 

When to start pushing (waiting for urge to push, station of baby, etc)

Birthing positions (squatting, hands and knees, side-lying, etc)

Breathing during pushing stage

Support and encouragement

People in room, ambience

Mirror to see baby emerge

Episiotomy

Perineal massage, warm compresses

Baby delivered to abdomen

Dad or Mom deliver baby?

Who cuts cord and when (allow to continue pulsating?)

Placenta (keep or see?)

Donate or bank umbilical cord blood

In the event of cesarean delivery:

Desire to be fully informed of all interventions

Coach and/or doula present for birth

Type of anesthesia (epidural or spinal)

Lowering of screen prior to delivery

Holding baby after delivery (by coach and/or mother)

Sedatives after see baby? (sedatives are associated with maternal amnesia)

Baby brought to recovery room for feeding

Immediately After Delivery 

Hold the baby until…..

If baby must be taken away from mother for any reason, father accompanies

Skin to skin

Initiation of breastfeeding

Baby’s medications (Vitamin K, Erythromycin eye ointment, Hepatitis B)

Postpartum Period

Rooming In

Breastfeeding, bottles, glucose water, pacifiers

Circumcision—yes or no (if yes, request anesthesia?)

My Birth Stories

It seemed a fitting way to start this blog by sharing my own birth stories.  In this way, you will learn my personal history with birthing, which certainly has impacted my philosophy on the subject.

Now, mind you, my first birth was 35 years ago!  You may say that birth has really changed in those 35 years.  You’d be right. Some changes have been good.  Some changes have been not so good.  And some things have not changed at all.

My first birth

With my first labor,  my contractions were irregular, and not really painful. I wasn’t sure I was in labor, but the contractions were persistent. After 12 hours of laboring at home I went to the hospital.  It was difficult to walk from the parking lot into the hospital because I was shaking so badly. Labor had become systemic! I was four centimeters.  I remember my nurse telling another nurse, “this one will go fast”!

You always remember your labor nurse. This one was about 104 years old, starched white uniform and cap, and continually offering me drugs. I had decided long before this day that I was not interested in a medicated birth, but despite my refusals, she kept pushing me to take the drugs. Back then, all that was available was a shot of Demerol intramuscularly. This is a narcotic, it goes into your bloodstream, and to the baby, resulting in groggy mom and groggy baby. And, by the way, everyone got a shave and an enema. The only advantage to the enema is that they had to let you get up to the toilet (which is a great place to labor, by the way)!

Back in 1977, you labored in one room, delivered in another, recovered in yet another, then spent the remainder of your postpartum stay in a “ward”, where there were two to four women to a room. After six hours of laboring, I was completely dilated and was moved to the delivery suite, which felt much like an OR–cold, stark, white.

My legs were strapped into stirrups and I was flat on my back. I remember thinking how awkward and inefficient it felt to push while on my back. My baby was occiput posterior (OP). This means that the back of his head was against the back of my body. We also call it “sunny side up”. It’s not the optimum fetal position for birthing. After about 30 minutes of pushing, the doctor pulled out the forceps and cut a womping episiotomy (more on this later). He rotated my baby, and pulled him out. At the time, I was convinced he was going for my tonsils.

Ravi was 8 pounds and 15 ounces. He had a couple of forceps marks on his outer eyebrows. I saw him for a moment, then they wisked him away to the nursery, where he spent his first two hours of life away from me.

I had wanted to deliver at home with a midwife, but my husband was leery about that. After Ravi was born, I thought, “thank God I was in the hospital”. Because he was OP and had meconium (baby poop in the amniotic fluid), I concluded that it was safer for him to be born in the hospital under the hands of a skilled obstetrician. I made a correct observation, but drew the wrong conclusion. Research suggests that, for a healthy woman with and uncomplicated pregnancy, it is safer to birth at home (more on that later).

Ravi is more than okay. He is a grown man with a wife and four children, and a brilliant career as a neurosurgeon. But, I feel gypped that I was not allowed to push instinctively and missed those precious first couple of hours with my son.

My second birth

Vijay’s birth was completely different. He was born in the hospital, but everyone was relaxed and patient. I labored, delivered, and recovered all in the same room. He was also OP, but  my doctor was content to wait for him to rotate. My labor nurse (I will always remember her fondly) laid a hand on my belly and prayed for my baby to turn! After an hour of pushing, and a little manual encouragement from my doctor, he turned and came right out!

The doctor delivered him onto my belly and I will never forget how Vijay looked up at me and reached for my face. Although everyone, at the time, told me that it was just reflex, it is now known that this is a purposeful phenomenon that we see in the first hour of life (see Your Amazing Newborn in my book list).

His dad gave him his first bath in the delivery room. In those days (1980) the Leboyer Method was very popular, and he encouraged this practice. (Check out his book on my book list).

Vijay never left my side. In fact, he slept on my chest all night long, nursing intermittently. Although I love all my children, I have a special bond with Vijay that, I believe, began with his gentle birth.

My third birth

My third labor began early in the morning. Contractions were irregular and tolerable. But, they never quit. I finally called my doctor, and he told me to come to his office. My husband came home from work, we dropped our other two off at a friend’s home, and headed for town. We lived in coastal California at the time, and although it was only 11 miles to town, we had to travel over a mountain grade to get there. At around the top of the mountain, I felt my baby was coming. I FREAKED OUT! When we got to the doctor’s office, I was 8 centimeters dilated. My doctor told us to go straight to the hospital and he’d meet us there.

That was 2:00 pm. At 6:00 pm, I was still pregnant. After breaking my water and starting pitocin, I finally progressed to complete and delivered my third son, Ramesh, at 8:30 pm. Guess what? He was also OP. If he hadn’t been, I might have had him on top of that mountain grade!

But, that’s not the only thing that held him back. Our psyches are powerful! My fear (the “freaking out” part), literally stopped my labor. I was fortunate to have a patient doctor. Most others would have cut me at around 5 pm. Check out the book, Birthing From Within, by Pam England, to learn more about the power of our thoughts related to our births.

My fourth “birth”:

My story would not be complete without telling you how my daughter, Charissa, came into our lives.

I first dreamt about her when I was seventeen years old. I met a little brown girl who called me “Momma”. Because I was so drawn to her, I called her “Charisma” (we modified it a bit to work with the last name).  When I met and married my first husband, who was from South India, I figured I was going to give birth to her. Well, after three boys, I decided to start a different search for her!

Charissa was born in South India in 1985. Abandoned in the hospital by her birth mother, she was taken into guardianship by her paternal grandparents, who lived in South India at the time. She came to us when she was 6 months old.

The wait for adoption is ever so much more “uncomfortable” than pregnancy. The uncertainty, the helplessness. But, finally, she arrived, after an unbelievable amount of paperwork.

I will always remember the feeling when she was placed in my arms for the first time. Although I’m tempted to call it “instant motherhood”, it’s really not–I had been waiting for this moment for 6 months…it’s not unlike waiting for the birth of your biological child for several months. I had started a bond with her from the moment I saw her pictures…that’s MY baby!

Hello world!

Welcome to my blog! My background is in fitness and nursing and motherhood.  I teach yoga, welcome new babies into the world as a labor & delivery nurse, educate new nurses as an assistant professor in the College of Nursing, and love on my grandbabies!

My passion is to educate and empower expectant moms and their partners to take an active role in their birth experiences.  When women are included in the decision making process, they experience the rite of passage that gives them the strength to be mothers.  I have found it extremely rewarding to observe this transformation in women when they realize that they have choices in childbirth and, more importantly, when they become stewards of their own health care, they become strong, empowered women.

Here at my blog, you will find information and opinions about things related to pregnancy, birthing, and motherhood.  I welcome your feedback and questions!