Intimate Partner Violence during Pregnancy

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Introduction   

The World Health Organization defines intimate partner violence as a “behavior within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors.” This definition covers violence by both current and former spouses and partners [1].  

According to the Centers for Disease Control, a staggering 41% of women and 26% of men in the United States alone have experienced sexual or physical violence from an intimate partner (IP) or have been subjected to stalking by an intimate partner. What is even more staggering is that 61 million women and 53 million men have reported being the victims of psychological aggression in their lifetime at the hands of an IP [2].  

Intimate partner violence (IPV) occurs in many different forms and looks different in different relationships. However, there are certain hallmarks and continuities that are present in many relationships where IPV is present. It’s also important to note that many forms of abuse may be and are often occurring concurrently. That being said a nurse should not assume because they hear verbal abuse, that physical or sexual abuse must also be present in the relationship. They should talk to their client and employ assessment tools that will be discussed later in the course. 

Forms of Intimate Partner Violence 

• Physical Abuse: kicking, slapping, punching, pushing, biting, strangling, throwing objects or any purposeful harming of another person’s body. Physical IPV also entails physically withholding someone from going where they want, holding them down or locking them in somewhere against their will. Displaying weapons as a form of intimidation can be both physical abuse as well as psychological [3]. 

• Sexual Violence: Sexual activity is forced by one individual against another. This includes but is not limited to forced oral/anal/vaginal penetration, unwanted touching or fondling, or forcing an individual to touch their genitals, forcing naked photographs or forcing sexual relations with other individuals against their will (or can be considered human trafficking) [3]. 

• Verbal Abuse: constant threats against a person, their property or loved ones, shouting/screaming to cause intimidation and repeated insults [3]. 

• Emotional and Psychological Abuse: This form of abuse can vary greatly in an intimate partner relationship. Intimate partners know their counterpart best and are often able to pinpoint what will be the most psychologically disruptive, whether it be extreme jealousy, ignoring their partner, constantly attacking their self-esteem or self-worth, repeated lying or isolating their partner from family, friends or any support systems [3].  

• “Gaslighting”: According to the Safe Families Justice Center, gaslighting is a” form of psychological manipulation where the abuser tries to make the victim doubt their perceptions and sanity.” When one partner questions their ability to make sense of reality, they become more dependent on the abusive partner, furthering how difficult it is to leave the relationship [4]. The abusive partner may say things like “you’re crazy, that never happened.” Items may be hidden or changed to make the person feel “crazy.” 

• Blaming: Abusers will often blame their partners for their behavior, making it seem that the victim is responsible for their actions. For example, they might say “I wouldn’t have had to push you so hard if you would’ve just cleaned up the kitchen like you’re supposed to.” [5]. 

• Financial Control or Economic Abuse: An abusive partner will want total control over the survivor’s economic standing, leaving them with no financial autonomy. The abuser may steal from their partner, take control of all bank accounts, use credit cards without permission, or incur debt in their name unbeknownst to the survivor [3].  

Again, it is essential to note that the above forms of abuse can vary in relationships. Those forms of IPV are examples of common themes seen and studied over the years but may look very different from relationship to relationship. Some or all areas of abuse may be identified in a relationship with intimate partner violence.  

Power and Control 

Abusive partners exhibit the above behaviors to maintain power and control over their intimate partners. The main goal of the abusive partner is to keep the other party in the relationship. They employ tactics to make the survivor dependent on them and erase any ability to leave the relationship.  

The abuser may be very kind and caring at times to destabilize their partner and offer hope of good times in the relationship. This adds to the gaslighting and confusion a person may feel in an abusive relationship, making it more difficult to leave. Dependence on the abusive partner is the primary goal in IPV.  

Escalation 

The power and control dynamic often starts slowly in the beginning of a relationship and increases with time. Escalation happens when the abuse gradually gets worse and/or the abuser starts to incorporate other types of abuse. Insults may slowly become more hurtful or vulgar, and emotional abuse may graduate into physical abuse.  

At first, the survivor might feel flattered the abuser wants to spend all their time with him or her and not recognize the abuser is actually isolating them from friends and family. As the abusive behavior continues, the survivor might find themselves without resources due to the isolation. 

Escalation is incredibly dangerous for survivors as the abuser is testing out new tactics to maintain power and control while navigating how far they can go. When the abusive partner feels they are losing power and control over the survivor, their behavior will escalate to reinstate the power dynamic in the relationship [6].  

According to the National Domestic Violence Hotline “The escalation may be intended as a warning or a demonstration of what could happen if their partner decides to become independent” [6]. The abusive partner ultimately does not want the survivor to leave and will go to great lengths to keep them in the relationship. 

Unfortunately, escalation can become lethal. Some perpetrators of IPV will stop at nothing to maintain power and control, including ending their partner’s life. If the abuser makes threats to kill their partner, there is a presence of firearms in the home, or if the abuser has previously strangled their partner, a high level of lethality is involved. Survivors will need help, support, and a solid safety plan to exit the relationship safely [6].  

Risk Factors for Intimate Partner Violence 

Intimate partner violence affects people from all walks of life regardless of gender, socioeconomic status, race, or age. IPV can, unfortunately, happen to anyone; however, certain risk factors increase one’s vulnerability to being both a victim/survivor of IPV and a perpetrator of IPV: 

Risk factors include: [7] 

• Financial stress/limited income 
• Substance abuse 
• Mental health disorders 
• Limited education 
• Previous history of witnessing violence 
• Gender inequality 
• Lack of social support 
• Those with disabilities 
• People of Color and/or Indigenous people 
• Pregnancy 

There is evidence supporting that those in the LGBTQ+ communities are also at greater risk of experiencing IPV than their cis-gender counterparts. Furthermore, LGBTQ+ people of color are at even greater risk of partner violence. They may have less social support, resources and endure more “minority stressors.” Although IPV can happen to anyone, it disproportionally affects women [7].  

Intimate Partner Violence During Pregnancy: Effects on Maternal Health 

According to the National Partnership for Women and Families, 324,000 pregnant people annually are severely abused at the hands of their intimate partner.  However, because so many instances of IPV go under or unreported, the number may be much higher [8, 9]. According to the Emory University School of Medicine, 30% of women who are abused experienced the first episode of abuse during pregnancy and between 4-8% of women are subjected to violence at least once during this time [14]. 

Research indicates that during pregnancy, violence in a relationship may start or greatly intensify. “IPV during pregnancy is defined as any physical, sexual, or psychological harm inflicted by a current or former partner during pregnancy or within the first year after delivery” [9]. 

IPV during pregnancy is considered so damaging due to the adverse outcomes on both maternal and fetal health. The damages inflicted by an abusive partner are far-reaching and can have dire consequences. The abuse patterns mirror those of IPV without pregnancy, however IPV during pregnancy creates unique and different circumstances.  

Physical Injuries 

Those experiencing IPV during pregnancy are at risk for a host of different injuries. They can range from fractures to head injuries and severe bruising. The injuries can be acute or can linger causing chronic pain and suffering, making it difficult to provide appropriate care for a newborn. If a pregnant person sustains a head injury, a traumatic brain injury (TBI) may ensue, causing extreme difficulty in caring for themselves and a new baby. TBIs also greatly impact cognitive function and mental health, increasing risks for depression and anxiety [9]. 

Those who perpetrate violence against a pregnant person are also putting the fetus at significant risk. Pregnant people who suffer physical trauma, especially to the abdomen, may experience placental abruption, hemorrhage, premature labor, or fetal distress. IPV can also cause miscarriage or stillborn birth [9]. 

Mental Health 

Pregnancy can be a very stressful time under the best of circumstances. Those experiencing IPV find themselves immersed in unspeakable trauma and strain while trying to navigate their situation. This kind of psychological trauma can cause depression (feelings of hopelessness/sadness) and prevent the pregnant person from wanting to participate in things that would typically bring them joy [9].  

IPV during pregnancy can also cause extreme anxiety. The pregnant person can experience feelings of intense dread, worry or nervousness. Anxiety can have physical manifestations, making it difficult or impossible for the abused person to sleep or eat. Anxiety can also cause the inability to concentrate or complete daily tasks [9]. 

Maternal Behavior 

Due to degraded mental health, maternal behavior can also be greatly affected by IPV. A pregnant person may have inconsistent prenatal care or not seek prenatal care at all. This further compromises both maternal and fetal health. Furthermore, basic nutrition, along with exercise or taking prenatal vitamins, may be neglected [10]. 

Stress may also cause the pregnant person to seek stress relief by using tobacco and alcohol or engaging in substance use or abuse leading to low-birth-weight babies or babies born to addicted to drugs [10]. 

Reproductive Health 

“Reproductive health complications are another adverse outcome associated with IPV during pregnancy. Research has shown that pregnant women who experience IPV are at increased risk for a range of reproductive health complications, including vaginal bleeding, premature rupture of membranes, and preterm labor [9].” 

Physical trauma and assault can spur vaginal bleeding which is associated with miscarriage, preterm labor and low birth weight. Physical violence can also lead to premature rupture of the amniotic sac putting the fetus in grave danger. Premature delivery may ensue putting both mom and baby at increased risk of severe infection [9]. 

Pregnant people experiencing IPV may also be at great risk for sexually transmitted infections (STI) as they may not have access to proper protection, be forced or coerced into sexual activity and be fearful to seek out medical care. STIs can harm both maternal and fetal health [9]. 

Maternal Mortality 

Sadly, homicide is a leading cause of death amongst pregnant people and those who have given birth within one year. According to the National Institute of Child and Human Development, in 2020, homicide rates among pregnant or postpartum women were 5.23 deaths per 100,000 live births. Women who were pregnant or postpartum experienced a 35% higher risk of mortality than their nonpregnant or non-postpartum counterparts [11].  

Fifty-five percent of the 189 pregnancy-related homicides in 2020, were non-Hispanic black women. Of these women, 45% were under the age of 24. A staggering 81% of these murders involved firearms and over half took place in the home. Over half of the victims were pregnant at the time of the homicide, while the remaining were within one year of the postpartum period [11]. Of note, deaths related to IPV during pregnancy are far more prevalent than actual obstetric conditions such as hypertension, hemorrhage or sepsis [12]. 

Intimate Partner Violence During Pregnancy: Effect on Fetal Health 

IPV is not only incredibly dangerous and destructive for the pregnant person, but also for the fetus or newborn baby. IPV directed at a pregnant mom impacts her child in a range of ways, from low birth weight to death.  

Low Birth Weight 

Those experiencing IPV during pregnancy may have babies with low birth weight (LBW). LBW is considered a baby weighing less than 2500 g. LBW is not totally understood but could be related to maternal stress, poor nutrition, alcohol or substance abuse, and lack of prenatal care. All of these components can be related to LBW either on their own or combined [9].  

LBW can affect long-term childhood growth and increase the risk for infant respiratory distress, neurological disorders, infections, and developmental delays [9]. 

Preterm Birth  

IPV during pregnancy is not only associated with LBW but also preterm birth, which has far-reaching and detrimental consequences on newborn health. Like LBW, preterm birth in the presence of IPV is not well understood. Stress and traumatic experiences during pregnancy may trigger adrenaline and cortisol, causing preterm contractions [9].  

Also, like LBW, those experiencing IPV during pregnancy may be more likely to engage in tobacco, alcohol, or substance abuse along with absent prenatal care, which influences preterm labor [9].  

The consequences of preterm birth can be devastating, including jaundice, respiratory distress, frequent hospitalizations, long NICU stays, increased risk for cognitive delay, and neurological disorders [9]. 

Fetal Injury or Death 

When a pregnant mother experiences physical trauma from IPV, the risk to the unborn child is always present. This can, unfortunately, lead to severe fetal injury and, sadly, death. Physical assault can lead to placental abruption which can cause fetal demise and warrants immediate medical attention [9]. 

Physical trauma of the mother can cause fetal injury, including head trauma, fractures or internal injuries. This can have grave consequences for the unborn baby. Injury or death of a baby can be devastating for the pregnant person, and appropriate psychological resources and support should be provided [9].  

Long Term Health Outcomes 

Babies who survive maternal IPV are at risk for long-term, negative health concerns. They may experience mental and behavioral health challenges such as anxiety, depression or antisocial behaviors. They may be at increased risk of suicide as they get older [9]. 

Developmental and cognitive delays may also be present. Caregivers may notice the child has decreased socialization skills and has trouble with memory or appropriate language development. This can have lasting impact on the child’s ability to perform in the school environment leading to behavioral disturbance or negatively impact self-esteem [9].  

If the child is still living in the home where violence is occurring, they are at increased risk of experiencing physical, emotional, sexual or psychological abuse themselves. Children who witness IPV may be at increased risk of perpetrating violence themselves or becoming victims of violence later in life [9].  

Why Don’t They Just Leave? 

For those who have never experienced IPV or known anyone who has, it can be perplexing to wonder why the abused person doesn’t just leave the relationship, especially if physical harm is befalling them and their unborn baby or newborn. It can be confusing for onlookers and easy to blame the person who is experiencing the violence for not stopping it by leaving the abusive partner. 

The reasons an abused person cannot just leave a violent relationship are complicated, not to mention leaving can be fatal if not done safely and with care. When responding to those in IPV situations, nurses must be cognizant of the barriers to leaving an abusive partner. The following discussion is not exhaustive of all the reasons why people remain in these situations but provides insight into why “just leaving” isn’t always an option. 

Financial Abuse 

Many people who find themselves in abusive situations become financially dependent on their abusive partner. This is by design, making it incredibly difficult for those experiencing IPV to leave. Without financial resources, an abused person may not be able to access food, shelter, or other everyday resources for themselves or their newborn. Abused persons have the difficult choice of enduring abuse or forgoing the safety of having basic necessities in order to survive [13].  

Children 

Survivors of IPV may have other children who love and are dependent on the partner perpetrating the violence. The abuser may be integral to childcare and providing necessary resources for children in the home. The partner experiencing IPV may decide their children having basic necessities and having both parents/guardians in the home outweighs the risk of the abuse. Children also, much of the time, love their parents/guardians despite abuse in the home [13]. 

Religious/Social Beliefs 

Abused partners may belong to a religious institution that does not condone divorce or leaving a spouse. Survivors of IPV may rely on their faith for support and community and fear being excommunicated should they leave the abusive relationship. Without access to their religious community, survivors of IPV may be further isolated [13]. 

Lack of Support 

When those in an abusive relationship want to leave, they may not have any support systems to help with finances, childcare or other resources making leaving possible. Like financial abuse, this is by design orchestrated by the abuser. The abused person is isolated from friends and family, leaving them dependent on the abusive party, with no alternatives for help [13]. 

Abusive Partner Promises to Change 

After abusive episodes of any kind, the abuser may exhibit contrite behavior. This includes apologies, promises of improvements on their part and gift giving. This can “honeymoon” phase can be maintained for some time, leaving the IPV survivor to feel hopeful the abuser will no longer engage in such destructive behavior. Unfortunately, the abuse begins to continue again following this pattern [13]. 

Divulging Personal Information 

The people we share intimate relationships with know the most about us, and unfortunately, abusive partners will weaponize information to maintain power and control over the survivor. For example, abusers may threaten to “out” someone if they are part of the LGBTQ+ community and others may not know. Or abusers may threaten to call authorities over immigration status or report a history of substance abuse. The survivor feels compelled to stay to protect their personal information or shield themselves from serious repercussions legally or socially [13]. 

Threats of Bodily Harm to the Survivor and/or Loved Ones 

After abuse has escalated in IPV, the abuser may resort to threatening to kill their significant other if they leave them and these threats should always be taken seriously. Abusers may threaten to hurt or kill not only their partner, but also their partners family, children or pets. This allows the abuser to maintain control and keep the abused partner with them out of deep fear for their safety and the safety of their loved ones.  

People who manage to leave the abusive relationship are often stalked, harassed and targeted by the abuser even after the relationship has ended. According to the Emory University School of Medicine, amongst multiple other sources, the most physically dangerous time for a woman involved in IPV is when they leave. The abusive partner has lost control and uses increased levels of violence to try and exert control again [14]. 

More than three women are killed daily in the United States by husbands or boyfriends, making separation a very dangerous time [14]. 

The Importance of Screening for Intimate Partner Violence During Pregnancy 

Medical visits may be the only opportunity an abused person has to divulge that abuse of any kind is occurring. This may be the only time they are independent of the controlling partner and can discuss what is happening to them 

Due to the severity and devastating outcomes of IVP during pregnancy, the U.S. Department of Health and Human Services has formally recommended that IVP screening and counseling should be a central part of women’s preventative health visits. Nurses and physicians in a variety of healthcare environments are in a unique position to screen and educate clients about IPV (15). 

The screening process should take place frequently and/or whenever a healthcare provider (HCP) sees fit. The current recommendations on IPV screening during pregnancy include during obstetric care on the first prenatal visit and again each trimester. Screening should then continue during the postpartum period. It should be noted that it may take clients several visits before they feel comfortable speaking up so continuous, gentle screening is advised [15]. 

Nurses and other HCP should watch for signs from clients that might indicate IPV is occurring. “Signs of depression, substance abuse, mental health problems, requests for repeat pregnancy tests when the client does not wish to be pregnant, new or recurrent STIs, asking to be tested for an STI, or expressing fear when negotiating condom use with a partner should prompt an assessment for IPV” [15]. 

According to the American College of Obstetrics and Gynecology safe screening by HCP’s should be done in the following ways [15]: 

• Ensure the client is independent of any friends or family members before discussing any IPV related issues. Ask to speak to the client alone as is “protocol” if needed. 

• If an interpreter is necessary, only use medically sanctioned services and not someone associated with the client such as family, friend or coworker. 

• Make the client aware that IPV screening is universal and not only directed at them. “We’ve found it really helpful to discuss healthy relationships with all of our clients, especially those that are seeking prenatal care.” *Be sure to discuss physician/client confidentiality but what is considered mandated reporting in your state. 

• Screening for IPV should be integrated into routine health screening for every client. 

• Staff should receive regular, routine training on IPV and screening for IPV. 

• Make information such as hotlines, signs of IPV and other resources available to clients in private areas such as the exam rooms or restrooms.  

• Use non stigmatizing language during screening. Avoid the use of words such as “rape,” “battered” or “abused.” Instead ask “Has your partner ever physically hurt you?” or “Does your partner support this pregnancy?”  

Screening Tools and Questions 

There are several tools used to screen for IPV during pregnancy, however the most commonly used are The Woman Abuse Screening Tool-Short (WAST-Short) and Abuse Assessment Screen. 

The WAST-Short has been an effective tool for screening pregnant clients seeking ongoing prenatal or postpartum care [16, 17].  

The WAST-Short focuses its questions on tension in the current relationship, and respondents can choose answers from a scale ranging from “no tension” to “great difficulty.” For example, “Do you and your partner work out arguments with (1) a lot of tension or great difficulty” to (3) “no tension or no difficulty.” Scores of WAST-Short can then be determined, dictating what further interventions may be needed [16, 17].  

The Abuse Assessment Screen was created to administer to women during antenatal care but focuses on emotional, physical and sexual abuse at any time during a person’s life. Questions include: 

• “Have you even been emotionally or physically abused by your partner or someone important to you?” 

• “In the last year have you been hit, slapped, kicked or otherwise physically hurt by someone? If so by who and how many times?” 

• Since being pregnant, has anyone forced you to have sexual activities? If so, whom? How many times? 

A positive response to any of the questions warrants further follow-up and may denote the client is experiencing IPV and the nurse should respond accordingly with resources and education to maintain safety [16,17]. 

Additional Screening Questions nurses can use to discuss IPV during pregnancy include [18]: 

• “Did someone cause the injuries you have? Can you talk to me about who it was?” 

• “Do you ever feel afraid for yourself or your baby when your partner is around?” 

• “Do you feel it’s safe for you and your baby at home?” 

• “Has your partner or former partner ever threatened to hurt you or your baby? 

What To Do if Intimate Partner Violence is Suspected 

If a nurse or other HCP suspects that IPV is present after screening a pregnant/postpartum client, immediate safety of the client and their child/ren should be determined. Nurses should bear in mind that previous incidents of non-fatal strangulation, being threatened with a firearm or the presence of a firearm in the home, and physical violence put the client at increased risk of lethality [15]. 

Clients should be offered the opportunity to create a safety plan while they are away from the abuser. Nurses should never force the client to report the abuser or secretly give them written resources. This can increase violent behavior, putting the abused partner and baby at greater risk [15]. It’s essential to allow the client to make their own decisions as they know their partner best and how to navigate what they believe will keep them safe.  

When assisting clients in safety planning, offering resources and referrals is critical. If a client is at risk for IPV during pregnancy or is already experiencing it, the nurse should have an armament of resources available. This includes local and national resources for domestic violence shelters and programs, legal aid, contact for local law enforcement, and counseling services [15].  

OBGYN services should maintain a relationship with local domestic violence agencies to help them manage situations that may arise for clients. They often have referrals for pregnant people specifically to help ensure safety and coordinate their unique needs. Clients should also be offered a private place with a landline to make phone calls to ensure the abuser can’t access calls made from the client’s cell phone [15]. 

If needed, many victim/survivor advocates from local programs will meet clients in a safe environment such as an emergency department or healthcare provider’s office, to discuss options and offer resources. These experts have the ability and tools to connect clients to the appropriate programs and provide ongoing support in ways nurses may not be able to.  

Safety plans are so important because it gives the survivor an opportunity to make a plan of action in advance should a situation become dangerous, or they need to leave their home quickly. With advance planning and navigation, survivors may be able to better protect themselves and their children and feel more empowered to leave a dangerous situation. Safety plans for pregnant people experiencing IPV is not limited to but should include some of the following [19]: 

• Keeping items such as purse/keys/wallets in a place where they are easily accessible should I need to leave in a hurry 
• Teaching children to call 911 in case of emergency 
• Having a suitcase/diaper bag prepared to go should leaving a situation quickly need to happen 
• Ensure access to medications for myself and my child should I need to leave home 
• Talking with a trusted neighbor or friend who could help during a dangerous situation/develop a code word for “help.” 
• Is there a place I can keep copies of important documents or money that I can later access if I need to leave my abusive partner? 
• Discuss ways to maintain safety when behavior is escalating or becoming violent. What has worked in the past? What made the situation worse? 

Nurses and other healthcare professionals should never put themselves in dangerous situations to help their clients. IPV can be disruptive and dangerous for bystanders so appropriate safety measures should be taken.  

Nursing Considerations 

Responding to IPV during pregnancy is critical, and nurses play a key role in this endeavor. Nurses should receive the proper education and tools to respond and support their clients. 

This includes appropriate training to be able to identify signs of IPV during and after pregnancy, such as depression, anxiety, bruising, etc. They should be specially trained to screen and assess pregnant people at regular intervals. This will help recognize those at risk for IPV during pregnancy or those already experiencing it [16, 17].  

Communication 

Nurses should also understand the importance of communication when addressing clients. Nurses should be offered tools to broker important and difficult conversations about IPV during and after pregnancy. They should understand the importance of sensitivity and fostering trust between client and nurse [16]. 

There is no one specific way to discuss IPV with pregnant and postpartum clients and communication style should be determined on a client-by-client basis. Studies indicate that some pregnant clients receiving antenatal care would prefer their midwife to be able to articulate the different kinds of violence that can occur along with the consequences to maternal and fetal health. The same study indicated that some women preferred to be directly asked about experiencing violence, while another cohort stated they would want information about IPV first [20]. 

This clearly illustrates that nurse communication about IPV during pregnancy is dynamic and should be guided by the client. However, “Spending enough time with a woman, simply facilitating unhurried communication and a client-centered care approach were identified as important factors for improved communication” [20]. 

It’s also imperative that medical staff engage in cultural competence during communication and education sessions. Nurses should understand the cultural background of their clients and take this into consideration. For example, in some cultures violence against women is accepted and clients may not know how dangerous it can be to them and their unborn baby.  

Furthermore, attitudes around pregnancy and childbirth significantly vary among different cultures. Discussing both of these topics should be approached gently and nurses should be open to their client’s unique perspectives. Ultimately, it is up to the nurse to behave with cultural sensitivity to promote safety for their client [20]. 

Legal Implications 

Nurses nationwide are mandatory reporters should they suspect, child abuse, elder abuse or neglect. Pregnant and postpartum clients experiencing violence from their significant others are in a difficult position when it comes to trying to maintain safety for themselves and their children. Nurses need to be acutely aware of reporting laws in their area when responding to IPV.  

According to Futures Without Violence the central role of HCP’s is to provide survivors of IPV, with ongoing access to medical care, resources and referrals, and a continuous support system. Due to an abusive partner’s desire to maintain power and control, reporting abuse of a client may increase the risk for violence or lethality. “Unfortunately, applying mandatory criminal injury reporting laws to domestic violence cases is most often not helpful to domestic violence victims and may actually jeopardize their safety” [21]. 

Limits of confidentiality should be made clear and up front to clients before discussing IPV. Be clear that if you learn of abuse directed against children or vulnerable populations, it is your obligation to report to law enforcement or other appropriate agencies. Then allow the client time to determine what they share with you. When in doubt about reporting check with facility policy, state laws, risk management and supervisors [21].  

Nurses Making a Difference 

Intimate partner violence is an overwhelming and difficult issue to address, especially when someone is pregnant. The good news is that nurses are in a remarkable position to make a difference by identifying and supporting IPV survivors. 

The Domestic Violence Enhanced Home Visitation Program was developed by Phylllis Sharps PhD, RN, the associate dean of Johns Hopkins School of Nursing, along with other researchers.  

Through the initial DOVE research study, pregnant people worked with a nurse where IPV was discussed, and screening tools were administered.   

Clients in the study met with the nurse or community health worker 4-6 times during pregnancy and then received 6-12 visits from them in the postpartum period. The nurse was then able to continue to use IPV screening tools, discuss safety planning, and risk of homicide throughout these visits. 

The results of the study were very positive. Women who were in the DOVE group experienced 20-40 fewer episodes of violence than those not in the study. Many of the women reported feeling more confident and able to leave the abusive relationship and those who couldn’t leave still reported less instances of violence and better coping skills.  

Despite the prevalence of IPV and its far-reaching negative health outcomes on pregnant people and children, nurses are in the powerful position to combat this epidemic and advocate for their clients.  

Conclusion

Intimate partner violence is a dangerous and insidious epidemic affecting countless people and families every day. Through power, control, and manipulation, an abusive person can make it nearly impossible for their partner to leave. Pregnant people can experience significantly worse violence, which leads to long-lasting maternal and fetal health outcomes ranging from bruising to death.  

Nurses and HCPs are in a unique position to screen their clients for IPV during pregnancy and the postpartum period using several different tools while employing sensitivity and cultural competence. Nurses are able to offer a variety of resources to their clients including safety plans and referrals to several different agencies.  

It has been proven that through nurse training and ongoing support of pregnant and postpartum clients, decreased homicide and violence can be achieved.  

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