Abuse During Pregnancy — Recognizing It, Getting Help, and Safety Planning

Abuse is not just hitting. It's any pattern of behavior used to control, intimidate, or harm you — and it takes many forms that can be harder to recognize, especially when you're already navigating the vulnerability and emotional intensity of pregnancy.

Physical abuse includes hitting, slapping, pushing, choking, kicking, restraining, or any unwanted physical force. During pregnancy, abusers may specifically target the abdomen, breasts, or genitals. But abuse often starts or escalates in subtler ways.

Emotional and psychological abuse includes constant criticism, humiliation, name-calling, gaslighting (making you question your own reality), isolating you from family and friends, threatening to hurt you, your children, or your pets, controlling what you wear, where you go, and who you see, and monitoring your phone, email, or social media.

Sexual abuse includes any unwanted sexual contact, being forced or pressured into sex acts, being forced to have sex without protection, and marital rape — which is abuse regardless of your relationship status.

Reproductive coercion is a form of abuse specifically relevant to pregnancy. It includes sabotaging birth control (poking holes in condoms, hiding or destroying pills), pressuring you to become pregnant or to continue or terminate a pregnancy against your wishes, and controlling decisions about prenatal care.

Financial abuse includes controlling all the money, preventing you from working, forcing you to account for every penny, hiding financial information, and running up debt in your name.

If any of this sounds familiar, what you're experiencing is real, it has a name, and it's not your fault. You don't need to have bruises to be experiencing abuse.

More common than most people — including many healthcare providers — realize. Research estimates that intimate partner violence (IPV) affects 3-9% of pregnancies in the United States, though the true number is likely higher due to significant underreporting. Globally, the WHO estimates that 2-13.5% of pregnant people experience physical and/or sexual violence by an intimate partner.

Pregnancy doesn't protect against abuse — it often triggers escalation. Abusers may feel threatened by the loss of control that comes with a new baby, jealousy toward the unborn child, or resentment about financial and lifestyle changes. Some abuse begins for the first time during pregnancy.

Certain factors increase risk, though abuse crosses every demographic line: young age (teen pregnancies have higher IPV rates), unintended pregnancy, substance use by either partner, history of abuse in either partner's family of origin, low socioeconomic status, and social isolation. But abuse happens in wealthy families, educated families, loving-seeming families. There is no 'type' of person who is abused, and there is no 'type' of person who abuses.

Homicide is a leading cause of death during pregnancy and the postpartum period in the United States — a sobering statistic that underscores how dangerous this issue is. A 2022 study in Obstetrics & Gynecology found that homicide during pregnancy or within 42 days postpartum was more common than any single obstetric cause of maternal death.

These numbers aren't meant to frighten you. They're meant to validate your experience if you're in this situation and to communicate that you are not alone, this is not rare, and it is taken seriously by the medical community.

Abuse during pregnancy carries real health consequences for both you and your baby. Understanding these risks isn't meant to add fear to an already frightening situation — it's meant to help you understand why getting support matters, and to validate that what's happening to you has measurable physical effects.

For your pregnancy, abuse is associated with increased risk of preterm birth (delivery before 37 weeks), low birth weight, placental abruption (the placenta separating from the uterine wall — a medical emergency), premature rupture of membranes, higher rates of urinary tract infections and other infections, inadequate prenatal care (abusers often prevent partners from attending appointments), and higher rates of cesarean delivery.

For your mental health, abuse during pregnancy significantly increases the risk of prenatal depression and anxiety, post-traumatic stress disorder (PTSD), postpartum depression, substance use as a coping mechanism, and difficulty bonding with your baby after birth.

For your baby, beyond the direct physical risks, growing up in a household with domestic violence affects children's emotional development, stress responses, and long-term health — even when the abuse isn't directed at the child.

This information is not meant to blame you for any pregnancy complications. None of this is your fault. An abuser's behavior is entirely their responsibility, not yours. But knowing the stakes can help you make informed decisions about safety planning and seeking support.

If you're unable to leave right now, any step you take to increase your safety — attending prenatal appointments, creating a safety plan, telling one trusted person — is meaningful. You don't have to do everything at once.

You don't have to leave to start protecting yourself. Leaving is the most dangerous time in an abusive relationship, and only you can determine if and when it's safe. No one should pressure you. What you can do right now is create layers of safety.

Safety planning: identify a safe place you can go quickly if things escalate — a friend's house, a family member, a shelter. Keep a bag with essentials hidden in an accessible location or at a trusted person's home: ID, insurance cards, prenatal records, medications, cash, a change of clothes, your phone charger, and important documents (or copies). If you can't keep physical copies, take photos and store them in a secure cloud account or email them to a trusted person.

Trusted contacts: tell at least one person you trust about what's happening — a friend, family member, coworker, or healthcare provider. Establish a code word or signal that means 'I need help.' This person can check in on you regularly and hold important documents for you.

Documentation: if it's safe to do so, keep a record of abusive incidents — dates, what happened, any injuries, photos of injuries (you can email these to yourself or a trusted contact). This documentation can be important later for legal protection, custody decisions, or restraining orders.

Digital safety: if your partner monitors your phone, use a private browsing window to look up resources and clear your history. The National Domestic Violence Hotline website (thehotline.org) has a quick-exit button. You can also call from a friend's phone, a work phone, or a public phone.

Prenatal care: keep attending your prenatal appointments if you can. Your healthcare provider can be an ally — many clinics screen for IPV privately and can connect you with social workers and advocates.

Your safety and your baby's safety are the priority. There is no wrong way to survive.

Help is available 24 hours a day, 7 days a week, and it's confidential. You can reach out in whatever way feels safest for you.

The National Domestic Violence Hotline: call 1-800-799-7233 (SAFE), available 24/7, in over 200 languages. If you can't speak safely, text START to 88788 or chat online at thehotline.org. Trained advocates can help you create a safety plan, find local shelters, understand your legal options, and connect with resources — all without pressure to leave before you're ready.

Local domestic violence shelters provide safe housing, legal advocacy, counseling, support groups, and help with basic needs like food, clothing, and childcare. Many have specific programs for pregnant women and new mothers. To find your nearest shelter, contact the National Hotline or search at domesticshelters.org.

Your healthcare provider: OB-GYNs, midwives, and nurses are trained to screen for domestic violence and can provide referrals, document injuries for legal purposes, and connect you with hospital-based social workers. If you're uncomfortable disclosing in person, you can call your clinic's nurse line.

Legal resources: many communities have legal aid organizations that provide free assistance with protective orders, custody issues, and divorce proceedings for domestic violence survivors. The National Network to End Domestic Violence (nnedv.org) can help you find legal resources in your area.

If you're in immediate danger: call 911. If you can't speak, many 911 centers accept text messages, or you can call and leave the line open so dispatchers can hear what's happening.

You deserve to be safe. You deserve to have a pregnancy free from fear. And you deserve support that meets you where you are, without judgment.

If you suspect someone you care about is being abused during pregnancy, your instinct to help is important — but how you help matters. Well-intentioned interventions can sometimes put a survivor at greater risk if not done carefully.

Do: express concern privately and without judgment. A simple 'I've noticed some things that worry me, and I want you to know I'm here for you — no matter what' can be more powerful than you realize. Listen without interrupting, advising, or expressing shock. Believe what she tells you. Validate her experience by saying things like 'That's not okay' and 'It's not your fault.' Let her make her own decisions about what to do — autonomy is central to healing from abuse. Offer practical support: 'I can hold a bag for you,' 'You can come to my house anytime,' 'I'll go with you to an appointment if you want.' Keep the door open even if she's not ready to accept help right now.

Don't: confront the abuser — this can trigger escalation and put her and the baby in danger. Don't give ultimatums ('If you don't leave, I can't help you'). Don't share what she tells you with others without her permission. Don't call the police without her knowledge unless there is an immediate life-threatening emergency. Don't judge her for staying — leaving an abuser is a process, not an event, and it typically takes multiple attempts.

Educate yourself about the dynamics of abuse. The National Domestic Violence Hotline (1-800-799-7233) is available to friends and family members too — you can call for guidance on how to support someone you're worried about.

Your steady, non-judgmental presence may be the most important thing she has right now.

This is one of the biggest barriers to disclosure, and it's important to understand the landscape. The short answer: in most situations, what you tell your healthcare provider about domestic violence is confidential and protected by the same privacy laws (HIPAA) that cover all your medical information.

Healthcare providers are not generally required to report domestic violence against competent adults to law enforcement. Your provider will not call the police simply because you disclose that your partner is abusing you. They can document your injuries (which may be helpful later if you pursue legal action), provide medical treatment, offer referrals to domestic violence resources, and help with safety planning — all confidentially.

There are exceptions. Mandatory reporting laws vary by state, and some states require providers to report injuries that appear to result from weapons, injuries that appear intentionally inflicted (in some jurisdictions), or suspected abuse of minors, elderly adults, or adults with disabilities. If you have other children in the home, your provider may have obligations related to child welfare reporting — not because you've done anything wrong, but because witnessing domestic violence is considered a form of child exposure.

If you're concerned about mandatory reporting in your state, you can ask your provider about their reporting obligations before disclosing. You can also contact the National Domestic Violence Hotline (1-800-799-7233) for guidance on the laws in your state before speaking with your provider.

Many prenatal clinics now screen all patients for domestic violence during private moments (when partners have stepped out of the room). If your provider asks you screening questions, they're not singling you out — it's a routine part of care recommended by ACOG for all prenatal patients.

Do not let fear of reporting keep you from getting medical care for yourself and your baby. Your provider is on your side.