Abuse during pregnancy

Building Your Case: How to Document Abuse

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If you are in an abusive relationship and are in the process of taking (or deciding to take) legal action against your abusive partner, documenting the abusive behaviors of your partner can be an important component of building your case.

It’s worth noting that each state has different laws about what evidence and documentation can be used in court. Speaking with a legal advocate in your state might better prepare you for your unique situation (our advocates at the Hotline can help locate a legal advocate near you). According to WomensLaw, in most states evidence can include (but is not limited to) the following:

Verbal testimony from you or your witnesses
Medical reports of injuries from the abuse
Pictures (dated) of any injuries
Police reports of when you or a witness called the police
Household objects torn or broken by the abuser
Pictures of your household in disarray after a violent episode
Pictures of weapons used by the abuser against you
A personal diary or calendar in which you documented the abuse as it happened

Below are a few actions you can take to create documentation, if you are able to or feel safe doing so:

Visit the doctor.

More and more, doctors and gynecologists are trained to recognize signs of abuse. Your health care provider could also be a safe resource for disclosing the abuse. If you’re visiting a doctor for an injury, ask them about safe ways they can make notes about the abuse — ex. Some can write “cause of an injury” without it having to go to the police.

Consider outside documentation.

Do you have a trusted friend, coworker or family member who knows what’s going on and would be willing to help? There are many ways they can help document the abuse — whether that’s a coworker making note of times your partner calls you at the office, or a friend holding your journal at her house.

Create a stalking log.

If your partner is stalking you, creating a stalking log can be very helpful to your case. The National Center for Victims of Crime’s Stalking Resource Center has examples of stalking logs (in PDF and Word formats) as well as additional information on stalking.

Learn more about police reports.

ex. Like filing about a lost bike. Ask, “Hypothetically, if there was something that was happening that I would want to report…”

Always ask questions. Call your local police department’s non-emergency number and find out about the protocols and procedures of filing a police report.

This can help you prepare for filing a police report if you need to, which creates a paper trail of the abuse.

Take pictures.

A digital camera or your phone camera may not always be safe. Consider getting a disposable camera. Another option is for someone else to take the pictures and keep them for you.

Let it go to voicemail.

Is your partner calling over and over? Let it go to voicemail once and save the voicemail.

Save digital evidence.

Do you have a smartphone? Most have the “take a screenshot” option. Thirty missed calls from your abusive partner? Take a screenshot of that. Threatening texts? Instead of responding to them, take a screenshot of them. These screen shots get saved in your images folder, so remember to send them on to a friend and delete them. If your partner sends threatening emails, don’t respond to them, but consider saving them in a folder in your inbox.

If you’re not sure if documenting your abuse would be safe, always go with your gut. It’s very important to keep in mind that you are the expert on your situation, and what works for one person may not be a safe idea for another person.

We are not legal advocates at the Hotline, but we are able to offer support and refer you to the local or state resources that might be helpful to you.

Answers shouldn’t be hard to find.

We're here to help!

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Abuse during pregnancy

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Abuse, whether emotional or physical, is never okay. Unfortunately, some women experience abuse from a partner. Abuse crosses all racial, ethnic and economic lines. Abuse often gets worse during pregnancy. The American College of Obstetricians and Gynecologists (also called ACOG) says that 1 in 6 abused women is first abused during pregnancy. More than 320,000 women are abused by their partners during pregnancy each year.

What is abuse?

Abuse can come in many forms. An abusive partner may cause emotional pain by calling you names or constantly blaming you for something you haven't done. An abuser may try to control your behavior by not allowing you to see your family and friends, or by always telling you what you should be doing. Emotional abuse may lead you to feel scared or depressed, eat unhealthy foods, or pick up bad habits such as smoking or drinking.

An abusive partner may try to hurt your body. This physical abuse can include hitting, slapping, kicking, choking, pushing or even pulling your hair. Sometimes, an abuser will aim these blows at a pregnant woman's belly. This kind of violence not only can harm you, but it also can put your unborn baby in grave danger. During pregnancy, physical abuse can lead to miscarriage and vaginal bleeding. It can cause your baby to be born too soon, have low birthweight or physical injuries.

What can trigger abuse during pregnancy?

For many families, pregnancy can bring about feelings of stress, which is normal. But it's not okay for your partner to react violently to stress. Some partners become abusive during pregnancy because they feel:

Upset because this was an unplanned pregnancy
Stressed at the thought of financially supporting a first baby or another baby
Jealous that your attention may shift from your partner to your new baby, or to a new relationship

How do you know if you’re in an abusive relationship?

It's common for couples to argue now and then. But violence and emotional abuse are different from the minor conflicts that couples have.

Ask yourself:

Does my partner always put me down and make me feel bad about myself?
Has my partner caused harm or pain to my body?
Does my partner threaten me, the baby, my other children or himself?
Does my partner blame me for his actions? Does he tell me it's my own fault he hit me?
Is my partner becoming more violent as time goes on?
Has my partner promised never to hurt me again, but still does?

If you answered "Yes" to any of these questions, you may be in an unhealthy relationship.

What can you do?

Recognize that you are in an abusive relationship. Once you realize this, you've made the first step towards help. There are lots of things you can do.

Tell someone you trust. This can be a friend, a clergy member, a health care provider or counselor. Once you've confided in them, they might be able to put you in touch with a crisis hotline, domestic violence program, legal-aid service, or a shelter or safe haven for abused women.

Have a plan for your safety. This can include:

Learn the phone number of your local police department and health care provider's office in case your partner hurts you. Call 911 if you need immediate medical attention. Be sure to obtain a copy of the police or medical record should you choose to file charges against the abuser.
Find a safe place. Talk to a trusted friend, neighbor or family member that you can stay with, no matter what time of day or night, to ensure your safety.
Put together some extra cash and any important documents or items you might need, such as a driver's license, health insurance cards, a checkbook, bank account information, Social Security cards and prescription medications. Have these items in one safe place so you can take them with you quickly.
Pack a suitcase with toiletries, an extra change of clothes for you and your children, and an extra set of house and car keys. Give the suitcase to someone you trust who can hold it for you safely.

Remember: No one deserves to be physically or emotionally abused. Recognize the signs of abuse and seek help. You might feel very scared at the thought of leaving, but you've got to do it. You and your baby's life depends on it.

More information

National domestic violence hotline: (800) 799-SAFE (7233) or (800) 787-3224 TTY

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Psycho-emotional support during pregnancy

Clinic of Gynecology and Oncogynecology

Moscow, st. Shchepkina, 35

Moscow, Spiridonievsky per., 5/1

Moscow, st. Pravdy, 15 building 1

Write to WhatsApp

January 11, 2017

Loginova Olga

Obstetrician-gynecologist, Ph.D.

Pregnancy is generally assessed as a prosperous emotional period for the woman and the family as a whole. At the same time, in some women, the period of pregnancy and the state of motherhood increase the risk of developing or progressing mental disorders. Numerous studies have shown that pregnancy does not protect against the development of severe depression or the worsening of existing problems. Women who stop treatment on their own or reduce drug dosages are at high risk. Women are twice as likely to be depressed as men. Not surprisingly, depression is one of the most common medical complications during pregnancy and the postpartum period.

Postpartum depression

Risk factors for depression in pregnancy:

daily stresses, including adverse events,
lack of social support,
domestic violence,
history of depression in previous pregnancies,
maternal anxiety,
unwanted pregnancy,
ambivalence towards pregnancy,
low income,
low level of education,
smoking,
absence of spouse/partner (single mother),
a history of postpartum depression and dose reduction or self-refusal to take antidepressants.

Potential complications of depression during pregnancy

Mother

Difficulties in childcare.
Smoking, alcohol or other drug abuse.
Decreased appetite and low body weight.
Sleep disorders.
Alarm.
Aggravation of depression.
Suicidal thoughts or attempts.
Not breastfeeding.
Disruption of communication mother-newborn.
Postpartum depression.

Effect of depression on fetal development - possible negative effects:

teratogenic effect,
spontaneous miscarriages,
preeclampsia,
intrauterine growth retardation,
premature birth,
low birth weight.

During pregnancy, many women experience increased levels of anxiety and emotional lability. In the first 3 months after childbirth, the risk of a mental disorder increases several times. Depression occurs in 80% of cases. Most mental disorders occur in women of childbearing age, in connection with this, pregnancy often occurs while taking psychotropic drugs. Abrupt withdrawal of psychotropic drugs often leads to relapse of psychiatric illness - a careful assessment of the risks and benefits to mother and fetus of medication and relapse of psychiatric disorder should be carried out. In women of childbearing age and pregnant women, psychotropic drugs that are as safe as possible for the fetus should be used. In some cases of mild to moderate anxiety and depressive disorders, cognitive behavioral therapy is the first choice.

Principles of therapy

Involving prospective parents in decision making.
Use of the lowest effective doses.
Use of the safest preparations.
Do not administer multiple drugs at the same time.
Adjust dose during pregnancy.
Provide adequate screening for fetal development.
Inform obstetricians and gynecologists about possible changes in mental status.
Assess the development of withdrawal syndrome in a newborn.

Breastfeeding and drug therapy

All psychotropic drugs pass into breast milk. The concentration depends on the psychopharmacological properties of the drug.
Since most psychotropic drugs are metabolized by the liver, and in newborns up to 2-3 months. insufficiency of liver enzymes, then premature babies and newborns have an increased risk of toxic effects.
The concentration of antidepressants and tranquilizers in mother's milk is quite low, especially when using low doses. When planning a temporary breastfeeding regimen, it is possible to minimize the ingestion of the child, but it is impossible to exclude the toxic effect.
The concentration of normotimics (lamotrigine, carbamazepine, lithium preparations, valproic acid) in breast milk is very high (20-50% of the mother's serum concentration).

Psychotherapeutic techniques

Cognitive behavioral therapy.
Interpersonal psychotherapy.
Supportive psychotherapy.
Family counseling.

At the European Medical Center, all pregnant women in need of psychological support are accompanied by qualified obstetrician-gynecologists together with psychiatrists.

As part of the EMC School of Moms, you can ask any questions that concern you to our psychiatrists.

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Clinic of Gynecology and Oncogynecology

Moscow, st. Shchepkina, 35

Moscow, Spiridonievsky per., 5/1

Moscow, st. Pravdy, 15 building 1

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Dear Vladimir Borisovich! Thank you from the bottom of my heart. You are truly a doctor from God with a capital letter. Thanks to your professionalism, kindness, tact, charm and talent, I believed in the success of the upcoming operation immediately at the first meeting at your appointment, you explained everything so intelligibly and convincingly that there was complete confidence in success. The operation you have done is fantastic! The very next day it was possible to sit, get up and groom, and on the third day I was discharged home. Just great. A month later, I completely forgot about the problems that I had before the operation. Once again, many thanks to you and your team, God bless you with health, well-being and success. You are a miracle doctor!!! Best regards, Antonina

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Effect of drug abuse on pregnancy

The article has been translated and adapted.
See original article here www.drugrehab.org

Anyone can experience drug use and abuse. According to the Centers for Disease Control and Prevention ( Centers for Disease Control and Prevention - CDC), one in ten US residents over the age of 12 has used illicit drugs (substances whose use is prohibited) at least once in the past year. Another 2.4% were taking non-medical prescription psychotherapeutic drugs that were either not prescribed to them or were previously prescribed to them.

12.9% of women claim to have used illicit drugs in the past year

These figures are slightly higher for women. According to the National Institute on Drug Abuse ( National Institute on Drug Abuse - NIDA), 12.9% (or 15.8 million) of women over the age of 18 have used illicit drugs in the past 12 months. Prescription drug abusers are also higher at 3.8% or 4.6 million women.

Illicit or improper use of drugs can be harmful to a woman's mental and physical health, but this behavior can have even more serious consequences when it comes to an unborn child.

Pregnancy and Drug Use or Abuse

According to NIDA , drugs taken during pregnancy affect the mother and the growing fetus because these substances "cross the placenta easily."

The National Institute of Child Health and Human Development ( National Institute of Child Health and Human Development ) explains that the placenta is “a temporary organ that connects mother and fetus [that] delivers nutrients and oxygen to the fetus and removes harmful waste and materials". It performs the same functions as many still completely unformed organs, such as the lungs, liver and kidneys, and if problems arise, they can create lifelong difficulties for mother and child.

What problems could these be? The answer to this question largely depends on what drug or type of drug is being used.

Illicit drugs

According to the American College of Obstetricians and Gynecologists ( American College of Obstetricians and Gynecologists - ACOG), one in 20 pregnant women uses some form of illegal drug, also referred to as a recreational drug. This could lead to to a number of problems , among which the following are possible:

Miscarriage,
Premature labor, ie. the onset of labor before the 37th week of pregnancy, or premature birth,
Stillbirth.

In addition, if a child is born to a mother who used illicit drugs during pregnancy, there is a risk of low birth weight, small head size, heart defects, and other birth defects. Then, as the child develops, there is also an increased risk of stunting, learning and behavioral problems, and even sudden infant death syndrome (SIDS).

Opioids

ACOG explains that the recreational use of opioids such as heroin puts a pregnant woman at risk of various complications, including placental abruption (a condition where the placenta separates from the uterine wall prematurely), premature childbirth and stillbirth. It can also disrupt the normal development of the fetus.

While pregnant women are advised not to use opioids at all, ACOG emphasizes that if there is dependence on such drugs, "the drug should not be abruptly stopped without medical supervision. " This is argued by the fact that withdrawal symptoms often lead to relapse, which puts both the mother and the unborn child at risk.

ACOG adds that there are drugs to help stop opiate use, such as methadone or buprenorphine, which have not been linked to birth defects. In some cases, the baby may experience withdrawal symptoms if the mother has taken any of these drugs, but these effects can be alleviated by, for example, swaddling, body contact, and certain medications.

Stimulants

This category includes drugs such as cocaine and methamphetamine. According to NIDA, the effect of such drugs on fetal development is somewhat unclear, mainly because pregnant women who use them often also use other drugs.

NIDA further explains that in some cases, women who take stimulants do not properly care for their diet and health during pregnancy. As a result, it is difficult to determine whether a child is born with problems due to the mother's use of stimulants, or whether the problems are related to one of these other equally important factors.

For a future mother, the use of this category of drugs can have the following consequences:

Migraine,
Seizures,
High blood pressure or pre-eclampsia,
Premature rupture of membranes,
Placental abruption,
Spontaneous miscarriage,
Preterm labor activity,
Difficult childbirth.

Babies born to mothers who used cocaine during pregnancy may also be smaller than usual. They may be irritable and hyperactive, they may have tremors, high-pitched crying, and excessive sucking. These symptoms may be related to withdrawal symptoms or may be due to the fact that cocaine is still in the baby's body, where it can remain up to seven days after birth.

Studies have shown that children born to pregnant women who use the stimulant methamphetamine - approximately 6.7% of all people seeking treatment for this drug - are often impulsive or hyperactive . They are also often more depressed, restless and have cognitive problems.

Marijuana

Marijuana is legal in some states for medical and/or recreational use, but it is listed as a recreational drug because it is illegal in many states.

Some pregnant women use marijuana or cannabis to relieve the discomfort they experience from pregnancy-related morning sickness. However, marijuana use during pregnancy can often lead to unintended consequences, such as a 2.2-fold increase in the risk of stillbirth, according to NIDA.

Some studies have linked marijuana to various health problems in children after birth. For example, the Alcohol & Drug Abuse Institute (ADAI) at the University of Washington shows that although researchers do not have a clear understanding of all the effects of marijuana on the fetus, some studies have shown that children exposed to this drug during fetal development, may potentially be born with a hole in the heart . Also, as they grow older, they may experience cognitive problems related to memory and thinking, concentration, impulsivity and hyperactivity.

According to ADAI, sometimes these negative effects continue into adolescence, when they can be exacerbated by depression, anxiety, and learning difficulties. Marijuana use during pregnancy can also lead to an increased risk of marijuana use by the child when they reach adolescence.

ADAI researchers add that sometimes marijuana use during pregnancy can lead to physical problems in the baby, such as childhood cancers. For these reasons, ACOG recommends against using marijuana during pregnancy, even if it is prescribed for other purposes. Instead, alternative means should be considered to treat the underlying condition without harming the fetus.

Socially acceptable, prescription and other “licensed” drugs

A pregnant woman and her unborn child can be negatively affected not only by the use of illicit drugs, but also by some “permitted” substances. Many of them are socially acceptable or even prescribed by a doctor, but can be quite harmful to the mother and the growing fetus.

Caffeine

Approximately 54% of Americans drink coffee daily. Around the world, about 2 billion people consume at least one cup of tea daily. Thus, it is reasonable to believe that pregnant women will want to continue the habit, although some health experts believe that the cons may outweigh the pros.

The American Pregnancy Association ( American Pregnancy Association -APA) is one such expert, stating that caffeine can increase blood pressure and heart rate, which may not be good for a pregnant woman. It also has a diuretic effect, which can potentially lead to dehydration. According to the APA, caffeine can also harm the fetus by interfering with normal movement and sleep, which can also interfere with the mother's sleep.

Although studies on whether it can lead to birth defects or miscarriages show conflicting and inconclusive results, the APA suggests that 150-300 mg of caffeine per day is considered relatively safe. One cup of coffee contains approximately 95 mg of caffeine, but it can be more than 500 mg, for example, in a large serving of coffee from Dunkin Donuts (517 mg), so it is recommended to monitor the exact amount.

It is also important to understand that caffeine is present in other foods, such as chocolate and various over-the-counter headache and migraine medications.

Alcohol

Drinking alcohol during pregnancy can cause the unborn baby to develop fetal alcohol syndrome (FAS), partial FAS, neurodevelopmental disorders, or alcohol-related birth defects.

The National Institute on Alcohol Abuse and Alcoholism ( National Institute on Alcohol Abuse and Alcoholism - NIAAA) considers that the risk of developing such conditions increases if a pregnant woman consumes excessive alcohol, i.e., by their definition, consumes more than three servings of an alcoholic drink at a time. This is especially important during the first trimester. According to the NIAAA, the frequency with which a pregnant woman consumes alcohol is also a factor.

Children born with FAS often experience emotional problems as well as difficulties with understanding, attention, memory and communication. All this can affect their academic performance and, in the future, may create problems with employment. Thus, FAS has both short-term and long-term effects.

For these reasons, heavy drinking during pregnancy is not recommended, but the NIAAA emphasizes that "the safe level of drinking during pregnancy is not known." Therefore, pregnant women are advised to completely abstain from alcohol.

Nicotine

According to NIDA, approximately 16% of pregnant women smoked during part of their pregnancy. In addition, the nicotine content "in the blood of the fetus can be up to 15% higher than that of the mother." ACOG adds that nicotine, just one of the thousands of harmful substances found in cigarettes, constricts blood vessels. This allows less oxygen and nutrients to be delivered to the growing fetus, which can lead to permanent damage to the brain and lungs.

CDC adds that smoking also increases the risk of birth defects such as cleft lip or palate, preterm birth, miscarriage and low birth weight. It may even contribute to SIDS. The risk of stillbirth is also 1.8-2.8 times higher if a woman smokes during pregnancy, according to NIDA, and is considered a contributing factor in more than 1,000 infant deaths per year.

Even "passive consumption" of nicotine can have negative consequences. Exposure to environmental tobacco smoke can increase the risk of stillbirth in an expectant mother by 2.1 times. It can also lead to preterm labor or low fertility, as well as an increased risk of asthma, respiratory problems, ear infections, and cavities in the baby after birth.

Some moms-to-be are switching to e-cigarettes in an attempt to lead a "healthier" lifestyle, but NIDA warns that they also contain nicotine, so their effects may be similar. ACOG agrees, stating that there may be issues related to propellants and flavors found in e-cigarettes. With this in mind, they recommend quitting smoking altogether during pregnancy.

Prescription painkillers

What happens if a woman gets pregnant while taking prescription painkillers such as codeine, oxycodone, hydrocodone and morphine? According to CDC , these opioids increase the risk of the fetus developing brain or spinal problems. They can also cause a baby to be born with a heart defect or with the intestines protruding from the abdomen through an opening near the navel.

In some cases, opiate use during pregnancy can lead to preterm labor or stillbirth, with NIDA reporting that prescription pain medications can increase this risk by 2.2 times. However, as with recreational opiates, the CDC does not recommend abruptly stopping such painkillers, as doing so may cause more harm than good. Instead, it is recommended that you consult with your doctor to determine the best course of action for you and your unborn child.

Effect of addiction on the newborn

If the drug is taken regularly during pregnancy, the baby may become dependent on it, leading to a withdrawal effect after birth. This is called neonatal withdrawal syndrome (NAS), and is most common if the baby is born addicted to opiates. In the presence of NAS, hospitalization of the child is usually necessary for effective treatment of withdrawal symptoms.

According to NIDA, withdrawal symptoms may occur up to 14 days after birth and often include the following:

Irritability,
Excessive crying,
piercing cry,
Sleep problems,
Increased heart rate,
Diarrhea and other gastrointestinal problems,
Slow weight gain,
Vomiting,
Convulsive attacks.

The long-term effects of maternal drug use during pregnancy can also lead to long-term effects on the baby, such as those resulting from birth defects, preterm birth or low birth weight.