Oakland hospital researches problem
In a study presented at the 1997 Clinical Congress of the American College of Surgeons, Lisa Benton, MD, general and trauma surgeon at Highland General Hospital in Oakland, CA, demonstrated that 40% of domestic violence victims in her study group had previous ED visits due to violence. Fatalities were reported for eight mothers and 14 fetuses in the overall study group of 125 pregnant trauma victims.
"With all the pregnant women who died, it was due to violence-related injuries," she says.
Benton looked at medical records of 125 pregnant patients presenting at the ED from 1987 to 1992 and found that of 43 (34% of the group) had violence-related injuries. The eight pregnant women died from either a stabbing, gunshot, or a fall. Of the 14 fetuses killed, nine were due to violence situations.
Benton continued studying pregnant women coming in the ED through 1996, which brought the study group to 215 women. She found 80 women (37%) experienced violence-related injuries. "The percentage had stayed roughly the same - nothing changed," she says.
As a result, Benton established a hospital program to identify at-risk women.
Pregnant women assumed 'untouchable'
"People didn't think to look for domestic abuse because the assumption is you don't hit a pregnant woman," she says. "But a partner's jealousy and rage are often targeted to the pregnant abdomen. We've seen pregnant women who were kicked, stabbed, and shot in the abdomen."
With Benton working at a large urban county hospital, she sees many patients use the ED for primary care. "This gives us the opportunity to identify pregnant women who haven't been getting prenatal care and also identify contributors of them being in an unsafe relationship," she says.
Since pregnant women have special needs and concerns, Benton says prenatal care is an ideal opportunity to intervene for domestic abuse.
"Unfortunately, those in abusive relationships tend to wait until the second or third trimester to see a physician, so we encourage women who come through the ED to get care early," she says.
Pregnant teens more likely to be abused
Many abused pregnant women are teenagers, Benton says, because the 15- to 24-year-old age group, in general, has the highest mortality due to violence. "And pregnant girls happen to be in that violent age group," she says.
To help combat teen violence, Benton serves as a medical advisor to a community violence prevention program called Caught in the Crossfire in which she talks to schools and teen groups.
She also oversees a program the hospital implemented called Teens on Target. Volunteer teenagers - many who have experienced violence first-hand and want to help eliminate it - do peer-to-peer counseling for teens hospitalized for violence-related injuries. The volunteers are trained by hospital social workers and other teens involved in the program.
Benton's tips to health care providers on implementing a domestic abuse program include:
· Get involved in community violence programs. Connect with as many resources as possible. Build a network to help each other.
· Offer information about programs to patients as they come through hospital. Have pamphlets and show videotapes in the hospital's waiting areas, and include information in patient admission packets.
· Women's centers should work closely with EDs to identify victims and serve as a case manager after the victim has been released to make sure she doesn't fall through the cracks.
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