She sat in the lecture hall, stunned and in disbelief. Although he didn't beat her physically, her emotional scars had all but destroyed her dignity AND sanity. What was the term the lecturer used? Gaslighting? How many times had he insulted her? Criticized her hair? Her cooking? Belittled her in front of her children and called her a slut when she wanted to take dance lessons? Despite experiencing his abusive behavior, she had no idea that it had an official name: Domestic Violence.
For years, she had endured his bullying, especially during moments when she wanted to nurture her children. He would knock her out of the way when she tried to pin the numbers on their children's uniforms before they ran a competitive race and incessantly berated her whenever she was in the presence of his extended family. Each year his mistreatment and aggression grew worse, like a fire raging out of control. While visiting another state, he forced her to drive a rental car despite her visual impairment and then taunted her each time she missed a turn on the road in full view of their visually frightened children.
When her cup overflowed with abuse and neglect, she filed for divorce and then discovered a man she had been married to for almost three decades but never knew. He used the professional education she had paid for his degree like a nuclear weapon. He took possession of every material asset she owned, in addition to her beloved children through parental alienation, manipulation, and coercion. In the 6th decade of her life, she had to start all over again.
Gratefully, his mental abuse now resides in her rearview mirror. Her children are in college. She lives in her own home. She sleeps peacefully at night, and she has healed.

In a recent medical study, violent deaths of pregnant women outnumber traditional causes of maternal deaths such as post partum hemorrhage or pre-eclampsia . I am not surprised. In September 2010, I wrote an article entitled 7 Reasons Why Pregnancy Becomes a Deadly Affair after an 18 year old college student almost lost her life at the hands of her football-playing boyfriend because she became pregnant. Pregnancy is not a benign act and 50% of them are unplanned.

Dr. Christie Palladino, an ob-gyn physician at the Georgia Health Sciences University and main researcher of the study, looked at data from 17 states and found 94 pregnancy-related suicides and 139 homicides from 2003-2007. Approximately 45 % of suicides occur during pregnancy, often precipitated by a domestic dispute. Palladino addresses the problem by focusing on identification and treatment of pregnant women who have depression by obstetricians or women’s health providers. While it is a noble ideal it only scratches the surface.  There is an association between the “depressed” pregnant woman and relationships that usually involves the father of the baby. It is not enough to put prescribe antidepressants and not provide professional counseling. Most obstetricians do not feel comfortable treating depression if the truth be told. It is neither their specialty nor area of expertise. And God help the patients who are on Medicaid. The challenge to find a psychiatrist that will accept them will be daunting. Palladino mentions more research for future studies. We don’t need more data. We don’t need another American Congress of Obstetrician-Gynecologist (ACOG) task force. We need action plans that include:

1. Formal collaborations between mental health workers and obstetricians for proper referrals and treatments including case management meetings during the patient’s prenatal care
2. Group therapy and individualized sessions conducted by licensed psychologists and social workers
3. Collaboration of social work schools and public health departments or community health clinics that could provide psychotherapy for indigent or Medicaid pregnant patients. Social work students could perform counseling under the supervision of a licensed preceptor
4. Home visits (through the use of Home Visit Grants) for at-risk-women by doulas or community health workers

I would also encourage pregnant women who are in abusive relationships to review the 7 warning signs of a potentially deadly affair.

Suicides and homicides are preventable.  Let’s roll up our sleeves and get busy.