Domestic violence escalated during Hayley's pregnancy — a time when women are at greater risk
Intimate partner violence during pregnancy brings increased risk for the mother and her baby. (ABC: Kylie Silvester)
When Hayley was pregnant, her husband insisted on attending her medical appointments.
But his motivations were not supportive in nature.
Warning: This story talks about experiences of abuse.
"He would watch me in examination rooms and then ask me after if I liked what the doctor had done to me, and I would often get accused of cheating with professionals I had to see for my pregnancy," recalls Hayley, not her real name, who has since escaped that abusive relationship.
It's just one example of the control and abuse Hayley experienced during all of her pregnancies.
"Pregnancy was a time for escalated abuse for me. I felt trapped. Not only in my house, but also in my body.
"I didn't want to be pregnant, I didn't feel safe, and I felt alone."
The risks of intimate partner violence during pregnancy
Research suggests women are at greater risk of intimate partner violence (IPV) during pregnancy and postpartum.
IPV increases the risk of mortality in pregnancy as well as physical and mental health issues for the mother, explains Deirdre Gartland, senior research fellow at Murdoch Children's Research Institute.
"Women who experience IPV are more likely to experience chronic disease, pain, drug and alcohol problems, post-traumatic stress disorder, depression and anxiety symptoms in adult life compared to women not experiencing IPV," she says.
IPV also increases the risk of a baby having a low birth weight or being born prematurely, says Hannah Dahlen, professor of midwifery at Western Sydney University.
Those risks to babies can be linked to jaundice, anaemia and respiratory distress in infancy, and diabetes and heart disease later in life.
Because many instances of violence go unreported, it's difficult to measure the true extent of IPV during pregnancy.
According to the 2021-22 Australian Bureau of Statistics Personal Safety Survey, 27 per cent of women have experienced violence or abuse by a partner.
Of these women, 42 per cent experienced violence during their pregnancy, including 17 per cent who experienced violence for the first time during their pregnancy.
Women's preoccupation with their baby can pose a challenge to partners using abuse, experts say. (ABC: Kylie SIlvester)
Research by Dr Gartland involving 1,507 first-time Australian mothers found 5 per cent reported being afraid of their current partner during their pregnancy.
She says this captures "the more severe end of partner violence where it is very clear to the women that things are not right".
However, when researchers asked participants about specific behaviours of their partners, which included physical, emotional or sexually abusive behaviours, Dr Gartland says the rate of IPV was much higher, with almost one in five women reporting partner violence in the year after having their first baby.
In that same cohort, 29 per cent of mothers reported partner abuse in the first four years postpartum.
Professor Dahlen's research from 2018 found that over 10 years, 4.3 per cent of pregnant women due to give birth in western Sydney disclosed domestic violence when asked about it by a midwife at their first hospital visit.
"We knew that was really low [because] we also know it's very vulnerable sitting in front of a stranger … so women will often not disclose," she says.
Why intimate partner violence increases during pregnancy
Pregnancy has been identified as a time of greater autonomy and self-awareness for women, according to the Australian Institute of Family Studies.
Women's preoccupation with their baby and their lesser physical and emotional availability during pregnancy may also limit their ability to perform expected traditional homemaker roles, leading to an increase in violence.
Alina Thomas is CEO at Engender Equality, a not-for-profit that supports people affected by family and domestic violence in Tasmania.
She says because domestic violence is about power and control, a pregnancy can challenge that for the person who is using violence.
"They might be seeing the baby as competition for time, for attention," she says.
"They might be seeing the additional medical intervention as a threat, as they might not like other people connecting with their partner and supporting them."
Ms Thomas says when the person using violence feels they're losing control, that is often when the abusive behaviours escalate.
During her pregnancies, Hayley says she was monitored and controlled more intensely, including not being allowed to leave the house.
"He would take my keys, throw things around the house, throw things at me, chase me if I tried to leave, even to the point of jumping on the car.
"He'd slap me, send me to my room, follow me if I went for a walk, check my phone constantly and check my bank account."
Professor Dahlen says the person using violence may also view their partner as more vulnerable because she "will do anything to protect the baby".
Dr Gartland says IPV can also include reproductive coercion, a type of domestic violence where someone is stopped from making their own choices about pregnancy and having children.
What intimate partner violence in pregnancy can look like
Intimate partner violence during pregnancy, birth and postpartum will look different for every victim-survivor, says Ms Thomas, but includes physical, sexual and psychological abuse.
Willa, not her real name, says her ex-husband forced her to work long hours and deprived her of adequate nutrition during her pregnancy.
"I was forced to work for our business, even up to and during labour," she says.
"I had miscarriages and I believe they were a result of overwork, lack of folate and poor nutrition.
"He didn't allow me to eat decent meals due to long hours at work."
During labour, Willa says her ex disrupted birth plans she had made, including controlling what pain medication she could opt for.
Ms Thomas says victim-survivors report an increase in jealous and possessive behaviour as well as accusations of infidelity by their partners during pregnancy.
Hayley says the financial abuse she experienced became even more difficult while she was pregnant.
"I had a budget on what I could spend on myself for necessities for pregnancy," she says.
"I would even get into arguments about nappies and what I could put in my hospital bag."
During postpartum, she was not given time to recover and was expected to shift her attention to her partner.
"It was up to me to do everything: change nappies, feed kids, change them, clean the house, shop, cook, clean the yard … it didn't matter if I was pregnant or just had a baby," she says.
"I was discouraged constantly from breastfeeding for more than two months as [he believed] my breasts were for him."
Identifying intimate partner violence and getting help
Both Hayley and Willa say they did not recognise they were experiencing intimate partner violence at the time.
"I have been through sexual, physical, psychological and economic abuse from an early age. I just assumed this was normal," Hayley says.
"When I did say something, I was often told to leave, it was my fault, and that it takes two to tango.
"It was hard to explain to others what I was going through because I felt ashamed and blamed myself for what was happening to me.
"I also carried the guilt of exposing my children to the abuse, which took an emotional toll on me as a mother."
Escaping a violent relationship is complicated.
Even for those who decide to leave the person who is abusive, it can be logistically challenging and extremely dangerous.
Ms Thomas says there are extra layers of complexity for pregnant victim-survivors, including societal expectations.
"If somebody falls pregnant and they are wanting to leave a relationship, that would feel almost inconceivable for friends and family.
"There is all this pressure — you can't be pregnant on your own, you are better off staying, a child needs two parents and male role models — all of these myths."
Ms Thomas encourages victim-survivors to disclose what they are experiencing to someone they trust, such as a close family member or friend.
It may also be a professional involved in supporting the pregnancy, such as midwives, GPs, prenatal yoga teachers, antenatal educators, women in mothers' support groups or lactation consultants.
Professor Dahlen says midwives play a crucial role in identifying abuse and connecting victim-survivors with specialist services.
If you or someone you know is experiencing abuse, experts recommend contacting 1800RESPECT to connect with a service local to you.