“I’ve faced death a lot, so I’m really grateful,” said Denise, 48, who agreed to talk at SafeHomes if she were identified by only her middle name.
Some women were not as fortunate. In a study published Thursday in the journal Obstetrics & Gynecology, a researcher at Georgia Health Sciences University used the Centers For Disease Control and Prevention’s National Violent Death Reporting System to look at women who died in the perinatal period – while pregnant or up to a year after birth. From 2003-07, the study found 94 suicides and 139 homicides, which worked out to two suicides and nearly three homicides for every 100,000 live births. The numbers dwarf the rates of what are thought of as traditional causes of maternal death, such as hemorrhage and infection.
“We’ve been actually making good headway on reducing maternal mortality from traditional obstetric causes of death for several decades now,” said the lead author, Dr. Christie Palladino, an assistant professor of obstetrics and gynecology at GHSU. “The problem is, when you look at (violence) compared to what we might think of as more traditional causes of death, it’s actually much more common.”
Much of it is the result of what the study calls “intimate partner violence.” More than 54 percent of the suicides and 45 percent of the homicides involved violent abuse. Another key factor is depression, which Palladino said bothered her that she was not trained well to address during her residency. Surveys show that 80 percent of obstetricians don’t feel they have the training to treat clinical depression, she said.
“Yet 18-19 percent of our patients during pregnancy or postpartum are going to suffer from a depressive disorder,” Palladino said. “It’s one of those things where the awareness is increasing, and now we are trying to find effective ways to address this.”
THE AMERICAN Congress of Obstetricians and Gynecologists and the American Psychiatric Association recently issued guidelines on treating depression during pregnancy. Part of the problem is the way society portrays pregnancy. For a talk she gives, Palladino went looking for pregnancy images, and a quick search found thousands showing a happy, glowing woman. Looking for depressed pregnancy pictures, “I had to search thousands of images to find one of a woman who looked anything less that ecstatic,” she said. “That’s what providers see, that’s what patients see, that’s what families see.”
That can make it hard for patients to admit to themselves they are feeling down, which needs to change, Palladino said.
“It is a change in mindset and letting people know this is very common,” she said. “It is an illness just like any other illness, and there are ways we can treat it.’
CARE PROVIDERS should also be mindful of the potential for abuse and should screen for that, Palladino said. Denise said she was never once asked by a doctor during her pregnancy if there was anything wrong.
“If someone had mentioned that to me, I probably would have opened up more to my doctor,” she said. “But nobody did.”
An intervention program from the National Institutes of Health found that even a brief respite can help stop the violence from continuing, Palladino said.
“There are just a lot of taboos still around talking about intimate partner violence,” she said. “Yet it’s something that we’re finding ways we can intervene and be effective.”
That’s why providers should collaborate more with groups such as SafeHomes, said Meghann Eppenbrock, the public relations/volunteer coordinator.
“If that victim doesn’t have any options, then you go right back,” she said. “There needs to be a concrete exit strategy.”
Denise is just happy she is on her way to getting a new place and a new life for her and her three children.
“It’s a blessing,” she said.