Tag Archive | depression

What is a Perinatal Mood Disorder?

Recently, the media has reported several stories relating to perinatal mood disorders (more commonly considered to be post-partum depression, but are not limited to depression). Guidelines around who should get screened and when have taken center stage. Despite this attention, many don’t realize what perinatal mood disorders are or whether or not they are at risk for one.

black-and-white-person-woman-girl-mediumQuite simply, a perinatal mood disorder is a mental health concern that occurs either during pregnancy or post-partum. This can include depression, anxiety, obsessive thoughts, paranoid thinking, and thoughts to harm yourself or your baby. While these concerns exist prior to pregnancy for individuals, they can be exacerbated during pregnancy and after for several environmental reasons: changes in hormones and lack of sleep are two prevalent factors. Of course, not everyone who has a baby experiences changes in mood, and certainly, some people seem to be more resilient during this transition.

Common symptoms of a perinatal mood disorder may include:
*Changes in sleep (not being able to sleep at all, even when the baby is or
oversleeping)
*Irritability
*Fears of something happening to the baby (being dropped, not
breathing, etc)
*Concerns (despite weight gain) that baby isn’t eating enough
*Uncontrollable crying
*Disinterest or lack of connection to the babypexels-photo-48566-medium
*A feeling of not being yourself

Nearly 1 in 8 women (and 1 in 10 men) experience a perinatal mood disorder. Treatment is simple and can range from therapy, medication, or both. However, without treatment, there can be long-term consequences that are dangerous for both mother and baby, as studies of depressed mothers have shown difficulties in their children as they age. There is a simple screening that you can opt to take to see if you might be experiencing a perinatal mood disorder and it can be found here. People who are are risk for developing a perinatal mood disorder include those that have experienced depression or anxiety during pregnancy; those that have a family member who had a perinatal mood disorder; those with a history (or family history) of depression or anxiety; those that have suffered a pregnancy loss; those that conceived through infertility; those with a baby that was in the NICU; teenage mothers; those that are having financial/housing/medical concerns; and those that do not have a social support system or a limited one. Certainly, this is not an exhaustive list, but is inclusive of many “red flags”.

 

If you are concerned about you or someone you know that might be having difficultly adjusting to life postpartum, you can contact your OB-GYN/Midwife/Primary Care Physician about a mental health referral. It is important that the clinician you meet with has experience and training in treating perinatal mood disorders as it is not something that most graduate programs cover.

By Julie Bindeman,  Psy-D

http://www.greaterwashingtontherapy.com/

TIME – the Most Precious Commodity of All

breastfeeding momMost mothers are stressed when they have a new baby. I absolutely remember how tiring it is to be a mother – and especially when you’re a breastfeeding mother. Being tired is on my mind right now, because in the midst of working with a new breastfeeding mother of a six-day-old, she flat-out told me that, “this breastfeeding thing is taking way too much of my time.” I was left flabbergasted and flap-jawed. What I wanted to say and what I did say were two very different things. What I wanted to say was “Well, what were you expecting? Did you think you were going to drop the baby in the umbrella stand on the way in and out of your front door?” What I actually said is “Tell me how I can help you.”

The mom went on to explain that nursing every two hours was beginning to grate on her nerves. I went on to explain that babies had tummies the size of golf balls and that breast milk was a “perfect food” that made it digest and move through the stomach very rapidly. I quoted how each DROP of colostrum had 3 million cells (the majority being immune cells). Breastfeeding is as much nurturing as nourishing (hoping the old adage would help). I also described cluster feeding as being analogous to a camel getting ready to cross the desert; feed, feed, feed and then you get the big sleep (maybe 4-5 hours max). In my first book “Start Here; Breastfeeding and Infant Care with Humor and Common Sense” I tried to call the hours between 6-10PM the “arsenic hours,” but the publisher opted for something safer like “the witching hours.” I guess that “every hour on the hour” cluster thing is what put this new mother “over the edge.”

So, here are some suggestions I’ve come up with to help you save time during your busy breastfeeding days.

  • If you have an exceptionally sleepy baby (or just have to get the show on the road once in a while), I find that you can feed on one side while you simultaneously pump on the other: Tarzan Pumping (at least that’s what I call it). That trick alone can save you up to a half hour per feeding and maximize your milk supply. Your body will react as it you’re feeding twins (because both sides are going at the same time) and perhaps even increase supply a bit. It will also expedite your feeding and have your baby feel as though a bigger, stronger twin was on the other breast helping him or her out. Now you’ll want to feed that milk to your baby at some point (perhaps during cluster feeding time), as when I previously instructed another mom to do this, she was giddy with her new frozen stash; problem was the baby hadn’t gained any weight in a week…whoops; I should have been more clear with my instructions.
  • Anyone who tells you to sleep when the baby sleeps probably doesn’t shower, do laundry, use the bathroom, open the mail or eat; I never understood that suggestion. I mean, that’s the only time you have to do ANYTHING, isn’t it? So, ALLOWING others to do things for you will help put time back in your day. You shouldn’t feel as though you’re not a good mother if you don’t do everything and do it well (do as I say, not as I do/did). I remember 28 years ago how I came creeping out of my house to get the mail and was spotted by my neighbor. She promptly sent her “nanny” over to my house with instructions to “help that poor woman out.” Problem is that I wouldn’t let the well-meaning nanny in! As I look back on it, I was afraid that I’d be found out; that I’d be “exposed” and my neighbor would know how I wasn’t really holding things together as a mother “should.” In my experience, many mothers feel that same way. They’re overwhelmed but think that they’re the only mother experiencing that. I’m here to tell you that MOST mothers feel overwhelmed in the beginning and if they tell you otherwise, I’d be wary.
  • Remember the saying “time is fleeting,” so are these stages!  Many times these cluster feeds will pass quickly and after a couple days you’ll have an entirely new baby.  It’s important to keep in mind that babies patterns change quickly and you won’t always be feeding around the clock. 

When I heard this mother complaining about time, as I think more about it, I’m suspicious there might be something else going on. Is she depressed? Is she lonely and needs to get out of the house for companionship, does she simply have cabin-fever, or are her expectations unrealistic as to how much time infants take out of a mothers day? What do you think?

Blog written by  Kathleen F. McCue, DNP, FNP-BC, IBCLC-RLC, 

Owner of Metropolitan Breastfeeding

Grief and Self-Care

This blog was originally published (by the author) on Reconceiving Loss in July 2015.

It’s the time in your life when the hardest thing to do is to be selfish. Yet, that is how you might feel in terms of your emotions. The sadness, tears, heaving sobs that are unrelenting threaten to unhinge you. You yearn to stop, but you can’t. Those around you try to offer you comforting words or platitudes. Sometimes they help, but often they don’t. This is what grief can look like, particularly the soul-crushing grief of losing a pregnancy or baby.

Through this grief, you often feel alone. Friends and family don’t seem to understand that one month later, you haven’t “snapped out of it” and “moved on.” Your partner is also at a loss for words or actions that might be comforting as he embraces you for the hundredth time. Perhaps he sees the loss differently. Or maybe more time has passed and you even have another baby, yet you still feel some numbness that this new baby hasn’t been able to fully eclipse.

This is the time when you just want everything to disappear. Or you throw yourself back into your life, willing the everyday motions to undo the feelings. You want to be cared for, but all of the attempts of asking aren’t helpful. Perhaps there are a few people that get it, but you don’t want to burden them. The temporary salve they provided in just talking and listening has worn off, and reaching out seems too hard.

A compounded loss in grief is the temporary loss of your sense of self and the idea that you have a semblance of control in your life. Taking this back and reclaiming you can be important and healing through your grief journey. But how? Taking tiny steps to care for yourself. Yes, take care of yourself.

In the throes of grief, it can be difficult to even get out of bed in the morning and go through your hygiene routine. Even past this phase, doing anything pleasurable can seem like plodding through molasses. Often, grieving mothers fear that if they start to engage in life again, that somehow this means that they are forgetting the baby that died. There might be continued focus on trying to achieve a new pregnancy (from yourself or from those around you) as if this is the answer to healing. Ultimately, at the end of the day, you are your own best resource. You are your own best advocate. To do either, you need strength and perhaps the permission that it is OK to matter. It is OK to indulge. It’s OK to ask for a break and to take charge of your needs.

What might self-care look like? It can be as minimal as taking time to journal, take a bath, go on a walk, or sing. Self-care doesn’t have to cost money (as the previous examples suggest) but it’s also fine if it does. Examples might be: a manicure, massage, a weekend retreat, signing up for a class or learning a new skill.) The only limit is you. And you are the only one who is fully able to care for yourself in the way that feels best.

by  Julie Bindeman, Psy-D, Co-Director of Integrative Therapy of Greater Washington

http://www.greaterwashingtontherapy.com/

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.

Madness and Mental Illness: As society we didn’t step in, couldn’t help, and we are the ones who lost.

thebipolarbastille.

For Williams, we dropped the ball. As society we didn’t step in, couldn’t help, and we are the ones who lost. We are the ones who were lucky to have known such a brilliant artist, and we are the ones heartbroken in the loss.


803c9153a6e8387832c02a67695c6cb5  

     I am sure by now we have all heard about the devastating loss of actor Robin Williams. Williams, who had suffered from depression, committed suicide after years of battling a crippling foe some of us know all too well. Depression, a component of many mental illnesses, is hard for some people to understand. How could someone just throw away everything? I have heard individuals close to me even say they could never forgive someone who committed suicide. “It’s the most selfish thing in the world.” These individuals understand suicide to be the easy way out. And in some cases it is selfish. But it…

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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

Love Shouldn’t 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 hermovements, 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’S 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 most 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, LLC