Pregnant and afraid: When expecting moms suffer at the hands of their partners

As Beth Hovis* lay pinned on her bed, her partner Roger’s* hands tightening around her neck, she had only one thought: He’s cutting off oxygen to the baby.

Beth, who was five months pregnant, flailed her arms and twisted her swollen body in an effort to get him off, but he was too strong, too cruel, too determined to show her he was the boss. He was pissed off that Beth had interrupted him while he was getting high with his buddy, and he was letting her know it. His face was pinched with rage, and his mouth spewed a litany of insults. As the seconds crawled by, Beth became at once weaker and more panicked. Finally, Roger released his grip and left the apartment.

It wasn’t the first time he had physically assaulted her—the violence had begun just after she got pregnant—but his rage was rapidly escalating. Now, Beth feared for her baby’s life.

Expecting a baby is usually an exciting time in a couple’s relationship, but it can be terrifying for the three to nine percent of pregnant women who are abused by their partners. Intimate partner violence, which includes physical, sexual and psychological violence by a current or former partner, puts women at risk for serious physical and mental health issues—and when they’re pregnant, it puts their babies at risk of injury and developmental problems. It can even be deadly: A US study found that about half of all murders and suicides involving pregnant women are associated with intimate partner violence.

Though abuse can occur in any relationship, women are disproportionately affected, and female victims of male violence experience more severe abuse. Research has also found that men who prey on pregnant women are the most violent abusers. But leaving an abusive relationship is challenging, especially when you’re pregnant and face raising a child on your own.

After Beth was attacked, she fled to a friend’s home and called the police. Roger was charged with assault, and Beth stayed with her sister, unsure what to do next. Roger frequently called in tears, promising to change, telling her how much he wanted a family and begging her to come home. After about two months, she did.

“I was so scared to be a single mom. I never imagined I could do it on my own. He took away all my self-esteem,” she says. “I thought if I could just make him happy, if I could give him the love and support he needed, he would calm down. I thought I could change him.”

Unfortunately, abusers rarely change.

Why does intimate partner violence occur during pregnancy?

At its core, intimate partner violence is about power, control and dominance. Through ongoing and often escalating acts of aggression, including threats, intimidation, humiliation and isolation, an abuser attempts to make their partner subordinate and dependent. Men who suffer from personality disorders, depression, low self-esteem and sexual inadequacy are more likely to crave control and therefore act violently in their relationships.

“Men want to control their partners because they want them all to themselves; they think it’s their right to do so,” says Melissa Kimber, a registered social worker and assistant professor in the department of psychiatry and behavioural neurosciences at McMaster University in Hamilton.

Stress and life events, like pregnancy, can trigger a person to be violent toward their partner for the first time or make an existing abuser more aggressive. “Pregnancy is a time of such significant transition and can really intensify the factors that relate to a partner’s choice to use coercively controlling and abusive behaviours,” says Linda Baker, learning director at the Centre for Research and Education on Violence Against Women and Children at West­ern University in London, Ont. “Pregnancy can bring out or amplify that desire to control, elevate insecurities and threaten that person, and the response to that threat can be violence.”

For example, a man may feel his authority is being threatened by healthcare providers who are spending lots of time with the expectant mom and offering her advice that may not be to his liking, such as getting lots of rest when he wants her to do housework. Or a man who controls a woman’s finances may feel challenged when she wants to spend money on prenatal vitamins and baby supplies.

Jealousy can also ramp up during pregnancy, leading to more attacks. A man may irrationally question whether the baby is his or be envious of all the time his partner is spending on baby-related matters, such as going to prenatal classes and setting up a nursery. “Prior to pregnancy, for some women, but not all, possessive jealousy can feel like love,” Baker says. “Then it takes on an intensified tone when the pregnancy occurs.”

Before Beth got pregnant, Roger made proclamations of love alongside some requests she didn’t think were too unreasonable at the time; for example, he asked her to stop bending over because other men could see down her shirt and suggested she avoid certain male friends. He also opened up about his abusive childhood, earning her trust and sympathy. She was thrilled when he said he wanted to start a family, but when she told him she was pregnant, his response was unsettling: “I got you now.”

Roger started constantly criticizing her and telling her she was going to be a bad mom. He insulted her friends and family in an attempt to isolate her from them. And he was so jealous, he threw out all the photos she had with other men, grilled her daily about who she spoke to and accused her of cheating on him. It wasn’t long before his attacks turned physical: He grabbed her roughly, slammed her against walls, threw her on the bed and restrained her painfully. The physical violence stopped when she returned home after the choking incident, but the emotional abuse was relentless. Still, there were glimmers of the man she loved. He would tell her she was beautiful and rub her belly, hoping to feel the baby kick. “He would treat me like gold one minute and a piece of dirt the next,” she recalls.

Roger’s jealousy peaked in the delivery room. When a male nurse tried to insert a fetal monitor in Beth to check the baby’s heartbeat, Roger lost it and demanded a female nurse. When their baby, Elliot*, was born via C-section, and the doctor held him up for his parents to see, Roger leaned over and whispered in Beth’s ear: “Doesn’t. Look. Like. Me.”

Though abuse can happen to anyone, it’s more likely to occur in relationships in which the couple is separated or common law, as Beth and Roger were, rather than married. Having low socio-economic status, abusing drugs or alcohol, being under 20 years old and being exposed to violence in childhood are also risk factors for becoming a victim or a perpetrator of abuse. Studies have found that up to half of low-income women are abused during pregnancy, often because poverty creates stress that precipitates violence, and women lack resources to leave the relationship. And Indigenous women are up to three times as likely as non-Indigenous women to be victimized, in large part due to racism and intergenerational trauma rooted in the residential school system.

If a pregnancy is unplanned or unwanted, women are four times as likely to experience increased rates of abuse, according to one study. “The father of the unborn child can have a distorted perception that ‘she did this to me; she wanted it; we’re not ready,’” Baker says. “There’s a lot of anger that’s targeted at her, and it can be directed at the fetus as well, in terms of injury to the abdomen.”

For some women, pregnancy offers a respite from violence, although it almost always starts again once the infant is born. A man who’s already abusive may halt his violence because he doesn’t want to hurt his unborn baby, but when physical abuse is reduced, emotional attacks often get worse. “A father may really want that child and see it as an extension of himself,” says Baker. “He may have a line where he doesn’t see it as wrong to coercively control and assault his partner, but he does see it as wrong to do it while she’s pregnant.”

In some cases, the pregnancy itself can be a form of abuse—a woman may be sexually assaulted, coerced into pregnancy, prevented from using birth control or lied to about condom use. “Pregnancy can be a tactic to keep a woman in the relationship,” says Kimber. “It’s a way of holding on: ‘You’re pregnant. You can’t leave. You’ve got my kid.’”

Gayle Dante* suspects her abusive ex, Brent*, used this strategy when he lied about using a condom and got her pregnant just weeks into their relationship. He was excited and supportive at first, but after a couple of months, the abuse became apparent. “It was like a complete 180,” she says.

Brent started criticizing Gayle, saying she was too emotional, calling her lazy, even getting angry if she brought home what he deemed the “wrong” bag of chips. He isolated her from friends by excluding her from activities and tried to hide her pregnancy. “It started with what seemed like very small and minor things, then it became a pattern,” she says.

Once their son was born, Brent questioned whether the baby was his and even told people he had paternity tests done, which wasn’t true. The abuse escalated and got physical, with Brent sho­ving her and pinning her to the wall to yell in her face.

The couple went on to have a second child and then split up. When Gayle started dating other people, Brent’s jealousy went into overdrive. “He followed me places; he called me at all hours of the night; he showed up at my doorstep unannounced,” she recalls. They got together for a night, and Brent again lied about using protection. Gayle wound up pregnant with their third child. She wonders whether it was an intentional act to keep her busy with another baby and away from other men.

As with her previous pregnancy, the abuse abated when she found out she was expecting, albeit temporarily. “He was great, he was supportive, he was super happy—and then it tapered off,” she says. “There was criticism. There were threats. He would disappear.”

It’s a predictable pattern, Kimber says. “If the partner coerced the woman into becoming pregnant or forced that experience on her, there can be a honeymoon period where that mission has been achieved.”

But it doesn’t last.

The dangers of violence during pregnancy

Despite the significant stress they underwent, Beth and Gayle’s pregnancies were without complications and their children were born healthy, but many women and babies aren’t so lucky. Research shows that pregnant women who are experiencing intimate partner violence are twice as likely to skip prenatal appointments and delay prenatal care until they’re in their third trimester, both of which are associated with preterm birth and low birth weight. Abuse is also associated with poor nutrition and inadequate weight gain, as well as higher rates of smoking, and alcohol and drug use.

“Abuse makes women less able to care for themselves,” says Patricia Janssen, professor and co-lead of maternal child health at the University of British Columbia’s School of Population and Public Health in Vancouver. “Maybe she’s not getting the food she needs because she doesn’t have the money to buy it. Or maybe she’s prohibited from going to doctor’s visits in case she says something. Or she’s self-medicating to manage her stress.”

Janssen, a former labour and delivery nurse, did the first population-based study in Canada looking at adverse pregnancy outcomes associated with exposure to intimate partner violence and found a threefold increase in poor fetal growth, a nearly fourfold increase in hemorrhaging during pregnancy and an eightfold increase in perinatal death, which includes stillbirths and deaths within the first week of life. Her findings, published in 2003, have since been replicated over and over again.

Janssen says a lot of the physical abuse is trauma to the abdomen, which can tear or detach the placenta, potentially reducing blood flow to the baby and causing the mother to hemorrhage. “If the placenta is no longer able to deliver enough blood to the baby, the baby will die,” she says. “There can also be congenital malformations from trauma. You can break babies’ bones in utero.”

A large body of research supports a strong association between intimate partner violence and preterm birth and low birth weight, which are among the leading causes of infant death. And the more frequent the violence is, the greater the risk.

Abused women’s mental health can also suffer: about 40 percent experience depressive symptoms and up to 84 percent suffer post-traumatic stress disorder, according to a 2015 review article published in the Journal of Women’s Health. This can inhibit a woman’s ability to bond with her baby, which can in turn affect child development in various ways, from emotional regulation to educational achievement. A woman’s stress from experiencing abuse can also impact her unborn baby on a biological level. Emerging research suggests that stress stimulates hormones in the mother, which may reduce fetal growth and lead to early labour.

Sometimes the abuse leads pregnant women to take their own lives. Suicide is one of the leading causes of death during pregnancy, and data from the World Health Organization shows that intimate partner violence is one of the most consistent risk factors for suicide attempts.

Tragically, some women and babies are killed by their abusers. There are no comprehensive Canadian statistics on how many lives have been lost during pregnancy, but about every six days, a woman in Canada is killed by her partner.

In April 2017, Arianna Goberdhan, who was nine months pregnant, was stabbed to death inside her home in Pickering, Ont. Her baby did not survive, and her husband has been charged with first-degree murder. The couple, who were in their mid-20s, had only been married for a few months.

Less than four months later, Raja Ghazi, a mother of two, was stabbed several times in her Montreal apartment when she was eight months pregnant. She had an emergency C-section, but the baby died. Her husband has been charged with attempted murder and first-degree murder of the infant.

And in May 2018, an expectant mother in her third trimester was shot in the belly at a Vancouver print shop, where she was hiding in fear of her ex-boyfriend. The woman survived, but the baby did not. The man charged, identified by print shop staff as her ex, had previously spent time in jail for the attempted murder of another ex-girlfriend.

The challenges of leaving an abusive relationship when pregnant

Research shows that women are at the highest risk of extreme violence, including murder, when they are preparing to leave an abusive relationship and soon after escaping, often because the abuser feels their control slipping away. Women may stay in abusive relationships because they are concerned for their lives, and pregnant women also have their babies to worry about. “The fear of reprisal or punishment by the partner is intensified because it’s no longer just you who might be hurt—it’s your child,” Baker says.

Lack of access to resources, such as money and housing, is another key reason women may feel trapped. This is especially true for pregnant women who are unemployed or in precarious work situations, but even going on maternity leave can cause financial stress. Women may also be worried about uprooting their lives and having a baby in a shelter.

Being in an abusive relationship can destroy a woman’s self-esteem and isolate her from friends and family, and she may not feel she can raise a child on her own. Women may be afraid to seek assistance from the police or a shelter for fear of being reported to child protection services and having the baby taken away at birth, although it’s rare for this to happen. Indigenous women in particular may have a distrust of child protection services due to the legacy of the government separating Indigenous parents and children, and the disproportionate number of Indigenous children in the child welfare system today.

Abusers often oscillate between being cruel and kind, and women may love their partners and maintain hope they’ll change. A woman may think the birth will end the violence, especially if it abated during pregnancy. And she may feel her child needs a father. “I’ve spoken to many women over the years who hate the abuse, but they love their partner and believe that love will eventually transcend and cause the abuse to end,” says Baker. “The hope might be that it will stop once that adorable little munchkin arrives because he will love the baby and then, by extension, realize how important his family is.”

But the newborn stage can be stressful, and a Canadian study found that 95 percent of women who experienced violence during pregnancy said it increased after the baby was born. Abusers may target their children too. Studies have found that 30 to 60 percent of men who abuse their partners also abuse their children, and even just witnessing violence can lead to behavioural and psychological challenges for the child, including mood and anxiety disorders, trouble making friends and difficulties in school.

Gayle’s middle son, now 14, has generalized anxiety, and she wonders if it stems from the significant stress she endured during pregnancy. Also, while Brent was careful to protect his image in front of his kids, there were times they witnessed his abuse. Once, when Gayle came home from an evening out with the kids, who were then three, five and seven, he yelled at her for keeping them out late, calling her a bad mom and threatening to beat her up next time. The children were in hysterics. “I told him he needed to calm down because he was scaring them,” she says. “That was about the time I was like, This is not OK.”

When she told Brent she was leaving, he threatened to kill himself and said she was destroying their family, but she knew she was doing the right thing. She persisted and found a new home for her family. Brent actually helped her move—but then said he had nowhere to go and refused to leave. “It was hell,” Gayle recalls. Finally, after six months, he left for good.

Children who are exposed to violence are more likely to abuse their future partners and children, and to be victims of intimate partner violence, perpetuating an intergenerational cycle of violence. So it’s important that women get help, not just for themselves but also for their children.

How abused pregnant women can get help

If you’re experiencing abuse during pregnancy, you can discuss it with your midwife or doctor, who will be able to connect you with resources and closely monitor your pregnancy. Doctors have a legal and ethical obligation to keep the information patients share with them confidential, except in cases that they’re required by law to report, such as child abuse. It’s not mandatory to report intimate partner violence to the police, although a bill to change this had its second reading in the Senate in October 2018. Guidelines from the Society of Obstetricians and Gynaecologists of Canada recommend that physicians routinely ask women about violence as part of their prenatal care—but research suggests they rarely do.

Across Canada, there are nearly 600 shelters for women seeking safety from violence, and women don’t have to leave their homes or their relationships to get help. Counsellors at shelters don’t pressure women to leave, and they provide services on an outreach basis, so women can make an appointment to discuss their needs or call the crisis line at any time. “Shelters offer much more than a roof over your head,” says Marlene Ham, executive director of the Ontario Association of Interval and Transition Houses. “Shelters are 24-hour support systems for women and their children.”

One of the key things counsellors do is help women create safety plans, whether they’re ready to leave or just considering it. These plans include deciding where to go in an emergency and how to get there, how to talk to friends and family about the situation, how to build a support network and how to take legal action if necessary. Counsellors often advise women to practise an escape route from their home, to pack a bag of important items and documents and leave it with a trusted person, and to create a code word to notify friends or family members if they’re in danger and need help.

Many women worry about the legal implications of leaving a man when they’re pregnant with his baby. While a man doesn’t have a legal right to be involved in the pregnancy, he does have rights once the baby is born, including having contact with the child. However, the mother can apply through the courts for a protection order to keep her ex away from her and her child. Women may have to go to court to get sole custody.

Counsellors can help women access legal aid services, trauma-informed counselling, housing support, child and youth programs, and healthcare, including prenatal care and access to abortion services and supports. “Shelters are pro-choice and support women in whatever decision they make related to their pregnancy,” says Ham.

For women who continue their pregnancies and want parenting support, there are a few programs designed to help survivors of violence, including Mothers in Mind, which is available throughout Ontario, and Connections, which is offered at 25 locations across Canada, including Aboriginal Head Start sites. Both of these programs help women understand how their experiences with violence may affect their parenting, how they can manage the impact and how they can foster healthy relationships moving forward. They also allow women to connect with other moms who have had similar experiences.

“Intimate partner violence is quite isolating,” says Mary Motz, the clinical psychologist at Mothercraft’s Breaking the Cycle program in Toronto, which runs Connections. “One of the ways women can be empowered is to be able to have an opportunity to reflect on and talk about their experiences and realize they’re not alone.”

There’s also a program for men who have abused their partners, which is available in more than 40 locations across the country. Caring Dads helps men understand the harm they have caused and work toward having healthier relationships with their children and their children’s mothers.

Beth was hopeful Roger would change after Elliot was born, but he didn’t. One time, he came home from work and screamed at her because the curtains were open, claiming neighbours could see her breastfeed. Another time, he pushed her onto the bed, stretching her stitches from her C-section.

Then one night, when one-month-old Elliot was sleeping, Roger told Beth he had killed three people who had wronged him, recounting each crime in excruciating detail. As Roger wrapped up his last story, he said his victim was crying for his mother in his final moments. Beth thought of her baby in the next room. She wasn’t sure whether Roger was telling the truth, but it didn’t matter. “The bubble burst,” she says. “It was all of a sudden crystal clear that I was going to die by this guy’s hands.”

After Roger left for work the next morning, she packed up her possessions and called her dad to pick her and Elliot up. Beth went into hiding, first at her father’s and then at a women’s housing society. “My whole family had to put up a wall. We didn’t give him an inch,” Beth says. “It was hard because part of me still loved him and we had a child together.”

A year after leaving Roger, she fell in love again and rebuilt her life with a kind, supportive partner, who became Elliot’s step-dad. When Elliot was three years old, Beth went to court and got full custody. Roger left town and hasn’t seen Elliot since he was a baby, but has made several attempts to contact Beth over the years, often calling her family members and making threats. “I had a lot of guilt about taking my son away from his father,” she says. “I had to keep telling myself I was doing the right thing.”

Today, Elliot is 17 and Beth knows she made the right call to raise him in a home free of violence. For years, she struggled with how to tell her son about his biological father and could never bring herself to do it. Elliot knew nothing about him until very recently, when Roger tracked him down via social media. When Elliot told Beth, she cried as she explained why she had to leave and how hard it was. It was a lot for Elliot to take in, but as she spoke, he nodded with understanding. “Thanks, Mom,” he said when she finished. “You did good.”

*Name has been changed.

Where to find help

• 
If you are in immediatedanger, call 911.
• For a list of victim services providers, domestic abuse centres and helplines across Canada, visit endingviolencecanada.org/getting-help.
• To find a shelter in your area, go to sheltersafe.ca.

How to help a friend who is being abused

• Start the conversation: If you suspect a friend, relative or colleague is experiencing abuse, ask open-ended questions, such as, “Are you OK? Is something going on in your life?” Tell her you care about her and you’re concerned. It’s best not to ask directly if her partner is being violent or abusive, as she may not describe the behaviour in those terms or she may be ashamed or in denial. You may have to check in several times before she confides in you. If she reveals what’s going on, listen to what she has to say, and tell her you believe her and it’s not her fault.
• Offer support: Let your friend know she can talk to you any time, and try to spend time with her to show you’re there for her. Don’t pressure her to leave her partner or criticize her for staying. Focus on building her confidence so she can make her own decisions. You can do this by highlighting concrete examples of her strength. For example, “Just opening up about this shows how brave you are.”
• Provide her with next steps: While you can’t tell your friend what to do, you can research the services available in your community, share the information with her and offer to accompany her to appointments. If she decides to leave her partner, help her make a safety plan in consultation with professionals. Invite her to stay at your home or leave some important items there in case of an emergency. Since she’s likely worried about having a baby or an abortion on her own, you can offer to act as a support person.