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The Gynecologist’s Role in Preventing Intimate Partner Violence 3/3

Part Three: Developing a Safety Plan & Other Considerations

doctor explaining results to patient

Trigger Warning: If you’ve encountered or experienced IPV in the past, please proceed with caution while reading this blog. Furthermore, if you don’t feel safe in your relationship you can take this quiz to determine if your relationship is abusive, call the Domestic Violence Support Hotline at (800) 799- SAFE or contact Catalyst Domestic Violence Services for resources if you’re in Chico, CA.

In the first part of this series, we discussed the cycle of intimate partner violence (IPV) & last week we went over how to identify and respond to signs of IPV. In the final part of this series, we will review how to develop a safety plan, community response, and other considerations.

How to Develop a Safety Plan

Once IPV is identified, a risk assessment must be made to determine if their life is in immediate danger. It’s been well documented that the cycle of violence repeats and escalates over time, therefore increasing the risk of fatality for the victim. Assessing the safety of the victim or victims must be prioritized above almost all else. The health care provider should ask the patient; if their abuser has been physically abusive, if so, to what degree that physical abuse has escalated to, does the abuser have access to weapons in the home, and if they have ever threatened to use them against the victim, to determine the lethality of the situation.

There are frameworks available for health care practitioners to determine the lethality of IPV for pregnant victims (Abuse Assessment Screen) and victims that are not pregnant (SAFE questions.) These resources have been evaluated for effectiveness in clinical settings, they take minimal time to implement, and they demonstrate the professional’s intention to ensure the safety of the patient. After a victim’s situation is assessed for lethality, the practitioner must help them develop a plan to secure the safety of the victim and their children. A proper safety plan will include a strategy for transportation, housing, obtaining necessary items, and essential documentation.

Pregnancy

It isn’t rare for IPV to occur during pregnancy. It’s estimated that 20% of pregnant women are victims of IPV and as many as 25-45% of IPV victims are abused when they are pregnant. The more severe the abuse is before pregnancy, the more probable it is that abuse will persist and/or intensify if the victim becomes pregnant. In fact, 29% of female IPV victims report an increase in abuse during pregnancy, 55% of female IPV victims that were abused the year prior to conceiving will continue to be abused during their pregnancy, and data suggests that a pregnant woman’s risk of abuse is over 60% higher when compared to their nonpregnant counterparts. One out of three of these abused women will seek medical attention pertaining to their injuries during their pregnancy. Despite this data, there is a lack of information on the frequency, timing, and severity of injuries IPV victims endure during pregnancy, as well as, a lack of evidence regarding the impact of demographic variables on this data.

However, it is common knowledge that IPV presents considerable dangers for both the mother and fetus. Negative effects of abuse during pregnancy can result from either direct (placenta detaches from the womb, fetal/maternal fractures, hemorrhage, rupture of the uterus, liver, or spleen) or indirect (maternal stress/isolation, insufficient health care/nutrition, and behavioral risks.) 

For obstetricians, pregnancy provides a rare opportunity to develop a relationship with a patient to identify and assess for IPV. Furthermore, pregnancy can motivate victims to get help to escape their abuser and it may be the only time a victim seeks consistent medical attention. Victims of IPV are three times more likely to reach out for help during their third trimester of pregnancy. 

Medical & Legal Considerations

Health care providers must maintain extensive medical records for all of their patients and if IPV is suspected or reported, that must be documented as well. The health care provider should document the patient’s testimony regarding the abuse, the clinical results, and their opinion regarding the physical evidence. If handled properly, photographs can also be taken and kept in a sealed envelope to be given to law enforcement as well as used in court in the future, if necessary. The health care provider is a mandated reporter and therefore must intervene if children are involved or if the situation is potentially lethal. The specific laws regarding mandated reporting vary between states and even cities. Health care providers are obliged to be cognizant of the specific mandatory reporting laws in their city and state.

Community Considerations

An essential piece of administering care to victims is to determine what resources are accessible to IPV victims within the community. Intervention is much more likely if a victim can develop trust with their health care provider. It’s also essential for the community to be a place that prioritizes IPV victims’ safety and integrity by holding the abuser responsible, providing advocacy for victims, and improving the response to victims. 

Furthermore, each community should have emergency housing, talk therapy, legal counsel, and other support available for free for victims of IPV. In Chico, we have Catalyst Domestic Violence Services that offers; a 24 Hour Hotline (800) 895- 8476, safe housing, a drop-in center, counseling, support groups, and more. Unfortunately, many rural communities don’t have resources like this available for victims. Thankfully there is a national hotline number, 1-800-333-SAFE, that refers victims to the closest domestic violence shelter to their area.

If you’d like to schedule an appointment with Dr. Davis, a leading women’s health specialist, please contact our office at (530) 345-0064, Ext 281. 

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