Tag Archive | ambivalence

Love Should Never Hurt

Domestic Violence Awareness Month

Joanne sat bruised and exhausted, hugging her large, pregnant belly. In her mid-30s, blonde and blue-eyed, she was a respected teacher in an elementary school, but tonight she felt like a fugitive. Neither her mother nor her sisters knew how to reach her or where to find her. She was ashamed to say anything to them. But, for the first time in months, she at least felt safe. She would sleep tonight in the shelter. In the morning, she would call the school where she taught and tell them she needed a few days off for a family emergency. If she ever returned to her three-bedroom home, she reminded herself, she needed to change the locks on the front door. Joanne was married to a well-educated man, with a good job. He was also a wife abuser.

Joanne is not alone. One out of every 15 pregnant women in the United States is a victim of domestic violence each year.

WHAT IS DOMESTIC VIOLENCE?
Although even one incident is one too many, domestic abuse is defined as a pattern of behavior of threatened or actual violence committed by a current or former intimate partner. Domestic abuse is not only physical violence. Partners can also be emotionally or psychologically abusive by: failing to show affection or caring for a child; interacting only when necessary; staying emotionally uninvolved and detached. Why? The abusive partner usually seeks to gain power and control in the relationship through fear and intimidation. The abuser tries to control his partner’s behavior by isolating her from friends and family, monitoring her movements, belittling or humiliating her in private or in public or restricting her access to financial resources.

The abuser may force her to have sex or to perform sexual acts that make her feel degraded. He may limit her access to medical care or threaten to hurt himself or take away her children if she does not comply with his wishes. Sometimes women are not aware that they are being abused. They may believe that their partner’s behavior is due to a bad day at work, financial pressures, jealousy, depression or use of alcohol or drugs. Often, the abuser will say he’s sorry, bring her gifts, and promise never to hurt her again. Cultural or religious norms may also play a role in one partner’s response to the other’s controlling or punishing behavior.

WHO IS AT RISK?
According to a report released by the Johns Hopkins School of Public Health and the Center for Health and Gender Equity, “Violence against women is the pervasive yet least recognized human rights abuse in the world…The same acts that would be punished if directed at an employer, a neighbor, or an acquaintance often goes unchallenged when men direct them at women especially within the family.”

A U.S. Bureau of Justice study reports that women of any age and from any racial, ethnic, religious or socioeconomic background may experience physical or psychological abuse from an intimate partner, but that women between the ages of 19 and 29 reported more violence by intimate partners than any other group. In the United States, domestic abuse is also a crime. Although partner abuse exists among same-sex relationships, violence against women is most often perpetrated by a male partner they know and love. Many, like Joanne, are afraid or ashamed to talk about or report it.

VIOLENCE DURING PREGNANCY
Domestic violence tends to begin or escalate during pregnancy. In fact, one in six women reports their first incidence of partner abuse during pregnancy. One study concludes that a woman is more likely to be abused by her partner than suffer from pre-eclampsia, gestational diabetes or placenta previa, conditions for which women are routinely checked. The abuser sees his partner’s pregnancy as a threat; he believes she will care more about the baby than about him. Pregnant women in abusive relationships are at higher risk for medical complications that include bleeding problems, miscarriage, vaginal and cervical infections, high blood pressure and premature labor and fetal distress. Abuse in pregnancy also increases the risk for low-weight gain and low birth weight infants. Once the baby is born, domestic abuse may escalate.

WHAT ABOUT THE CHILDREN?
Young children are often silent witnesses to domestic violence, and many are also the targets of their fathers’ physical, emotional or sexual abuse. Each year an estimated 3.3 million children in the United States are exposed to violence by family members against their mothers or female caretakers. Children exposed to violence at home are likely to suffer from chronic depression and anxiety and may express their sadness and anger through acting out, defying people in authority and through other behavioral problems. Children may become too traumatized to learn or develop normally and may be unable to reach their full potentials as adults. Children who witness domestic violence at home are more likely to repeat the cycle as adults. Experts say young girls are more likely to tolerate abusive behavior from their own intimate partners, and young boys are more likely to become abusers themselves.

One in every five women who seeks medical care in emergency rooms is there as a result of injuries inflicted in a domestic violence dispute

U.S. businesses spend an estimated $5 billion dollars a year on medical expenses related to domestic violence and another $100 million per year for lost wages, time away from work, and employee turnover directly related to family violence.

More than 1 million women a year seek medical assistance for potentially lethal injuries caused by battering.

Approximately 2,000 to 4,000 women in the United States are killed each year by abusive partners or ex-partners.

Making a Safety Plan
When you feel ready to leave your home, it will be helpful to have put aside some things that you will need. It may be safer to keep those items at a neighbor’s or a friend’s house:

Extra set of car keys
Cash, checkbook or credit cards
Driver’s license and social security cards (for you and your children), green card, passport or work permit
Clothes for yourself and your children
Birth certificates
Children’s school records
Health insurance cards
Court papers or court orders
Lease agreements or mortgage payment book

Taking the First Step
Making a decision to end a relationship with an abusive partner is often difficult. For some women, it is the desire to protect their children that brings them to the point of asking for help. Taking action is hard because domestic abuse usually takes place over a long period of time and a woman’s self-esteem and confidence are slowly eroded. She becomes isolated from her community, friends and family. A woman may also remain in an abusive relationship because she is afraid of what family members may say or because she lacks financial resources. She may worry about compromising her partner’s professional status in the community. Often, she still has hope that the abuse will stop and that her partner will come to his senses. Each woman knows when she is ready to leave an abusive relationship. When she does, she can take the first step toward ending the abuse by asking her midwife, other healthcare provider, the police or her employer-assistance program for help.

BREAKING THE SILENCE
Help is available. Call the toll-free National Domestic Violence Hotline: (800) 799-SAFE (7233). From all 50 states, the District of Columbia, Puerto Rico and the U.S.Virgin Islands, victims of domestic violence, their families and friends receive crisis intervention, referrals to shelters, medical care, legal assistance and social-service programs. Trained counselors who speak more than 125 languages are available.

Are You in a Dangerous Relationship?
Your partner may be a good provider, a successful and respected member of his profession, even a caring father of your children. You may still love your partner and he may be sorry for hurting you and may promise never to do it again. However, he may also behave in ways that are considered abusive and illegal.

How can you tell?

Have you ever been afraid of, or felt threatened by your partner?
Do you worry that things you do may cause your partner to get angry, emotionally abusive or physically violent?
Has your partner ever attempted to injure you physically by grabbing, punching, kicking, arm twisting,choking or pulling your hair?
Has your partner ever hurt your pets or destroyed your clothing or other things you care about?
Has he threatened to destroy or take away your home or personal property?
Has your partner prevented you from taking medication, seeking medical care, or insisted on being present at all medical appointments?
Does your partner control your access to financial resources? Decide what and how much you can buy? Control the bank accounts? Refuse to pay bills?
Does he hide deeds to your home, wills, financial savings, and passports?
Has your partner threatened to harm himself or other people you care about? Has he ever threatened to harm or take away your children?
Does he prevent you from communicating with other people by withholding phone calls, keeping you from speaking with or visiting co-workers, friends or family? Prevent you from going to work or school?
Do you feel as though he is constantly checking up on you?
Does your partner often put you down, devalue your abilities, and make you feel guilty,or embarrass you in front of others?
Does your partner demand to have sex when you don’t want to or when you are ill? Force you to perform sexual acts that make you uncomfortable or hurt you? Hurt sexual parts of your body? Insist on unprotected sex or use of pornography?

If you have answered yes to one or more of these questions, know that none of this behavior is acceptable; you don’t deserve it. You may want to seek counseling. If you feel you are in danger, help is available to you 24 hours a day when you are ready to seek it. You can call the National Domestic Violence Hotline toll-free, (800) 799-SAVE (7233) or (800) 787-3224 (TDD). You don’t have to give your name, and your wishes will be respected. Trained counselors who speak several languages are available immediately. They can provide crisis assistance and information about shelters and health care centers, as well as free legal assistance and counseling. If you are in immediate danger, you should call 911.

Domestic violence is not biased, it crosses all socioeconomic backgrounds. Stop it now. IT may save you and your family’s life.

Other Resources:
National Coalition Against Domestic Violence: http://www.ncadv.org
The National Domestic Violence Hotline: http://www.ndvh.org

Article by Nicette Jukelevics, Childbirth Educator certified by the International Childbirth Education Association
Presented by Angel J. Miller, MSN, CNM, CEO, WomanPlace, Inc.

Depression in Pregnancy

Depression occurs almost as commonly in pregnant women as it does in non-pregnant women. While the increase in hormones is often blamed for many of the mood swings and other emotional and psychological occurrences in pregnancy, they are only one part of the puzzle when it comes to pregnancy and depression. For some women the stress of pregnancy brings on depressive symptoms, even when the pregnancy is planned. These feeling might intensify if the pregnancy is complicated or unplanned, or if life itself is stressful.

What factors increase my risk of being depressed in pregnancy?
• Having a history of depression or PMDD
• Age at time of pregnancy — the younger you are, the higher the risk
• Living alone
• Limited social support
• Marital conflict
• Ambivalence about the pregnancy

What is the impact of depression on pregnancy?
Depression can interfere with a woman’s ability to care for herself during her pregnancy. You may be less able to follow health recommendations, and sleep and eat properly; jeopardizing proper nutrition, sleep habits, exercise and following prenatal care instructions from your healthcare provider. Depression can put you at risk for increased use of substances that have a negative impact on pregnancy (tobacco, alcohol, illegal drugs).

Depression may interfere with your ability to bond with your growing baby. A baby in the womb is able to recognize the mother’s voice and sense emotion by pitch, rhythm and stress. Pregnant women with depression may find it difficult to develop this bond and feel emotionally isolated and detached from their unborn child.

Many of the signs of depression can mimic pregnancy symptoms. It can be hard to determine what is normal fatigue in pregnancy and what is depression. This can lead to an underreporting of the problem to their healthcare provider. There is also a tendency of people to ignore depression in pregnancy simply because this is supposed to be “a happy time in their life,” and this includes the pregnant woman herself.

Signs of Depression
• Problems concentrating
• Problems with sleeping
• Fatigue
• Changes in eating habits
• Feeling anxious
• Irritability
• Feeling blue

How does pregnancy impact depression?
• The stresses of pregnancy can cause depression or a recurrence or worsening of depression symptoms.
• Depression during pregnancy can place you at risk for having an episode of depression after birth (postpartum depression).

Are there any other things I should know about?
Treatment during pregnancy involves several avenues. Developing your support network is extremely valuable. Having yourself surrounded by supportive individuals that you know can be beneficial, particularly if they have experienced the same feelings. Talking to a professional or psychotherapist can be very helpful, particularly since there are major physical, mental and emotional changes occurring during pregnancy. Medications can also be used during pregnancy under the care of a practitioner who has experience with using antidepressants and other medications during the course of pregnancy and breastfeeding.

So what are my options if I’m depressed during my pregnancy?
• Preparing for a new baby is lots of hard work, but your health should come first. Resist the urge to get everything done — cut down on your chores and do those things that will help you to relax. And remember, taking care of yourself is an essential part of taking care of your unborn child.
• Talking about the things that concern you is very important. Talk to your friends, your partner, and your family. If you ask for support, you’ll find that you often get it. If you are not finding relief from anxiety and depression by making these changes, seek your doctor’s advice or a referral to a mental health professional.

The key to preventing problems that stem from depression in pregnancy, which may also increase the likelihood of postpartum depression, is getting the support and help you need as soon as you realize that you are experiencing a problem. With more than two out of three pregnant women having depressive symptoms it’s important to recognize that you are not alone and that help is available. Talk to your healthcare provider if you are in need of help. Be open and honest with your concerns and realize there is help.

Angel J. Miller, MSN, CNM