The Science Behind Coercive Control and Adverse Outcomes During Pregnancy

Republished from the ACECC Journal

In this article, the ACECC Journal discusses prenatal non-physical abuse and the long-term effects on children. We will be discussing the science, data, and urgent need to advance awareness, implement legislation, and empower the victims of non-physical abuse, also known as coercive control, during pregnancy.

A study conducted by Michigan State University published in 2014, found that domestic abuse adversely affects children in the womb. This study was the first to link the abuse of pregnant women with emotional and behavioral trauma symptoms in children within their first year of life. The symptoms displayed within the first year of life included having nightmares, being startled easily by bright lights and loud noises, avoidance of physical contact, and trouble experiencing joy.

The Michigan State University study consisted of 182 mothers ages 18-34, to document their experiences with Domestic Abuse, specifically verbal and psychological traumas. In this study, a strong relationship was linked to prenatal abuse by a male partner which would later develop into postnatal trauma in children.

Alytia Levendosky, a psychology professor and co-author of this study noted that prenatal abuse could cause changes in the stress response systems of the mother, increasing cortisol levels in both the mother and unborn child. “Cortisol is neurotoxic, so it has damaging effects on the brain when elevated to excessive levels”, this information could explain the emotional problems noticed in a baby after birth. Levendosky, a clinical psychologist for nearly 20 years, has counseled many domestic violence survivors. In this study, ProfessorLevendosky found that many victims didn’t think their abuse could affect their child until “later in life”. The link between fetal trauma and the fear of fetal birth defects could help a victim recognize their partners behaviors as unhealthy.

Neuroscientist Tanja Jovanovic, who directs the Grady Trauma Project, a research institute headquartered at Atlanta’s Emory University states that PTSD from domestic violence is high because it’s a “betrayal by someone who is supposed to be a protector.” The issue is further exacerbated by not having a neutral or positive parent who is available, capable of, or willing to intervene when issues arise.

Psychologist Abigail Gewirtz, the director of the Institute of Translational Research in Children’s Mental Health at the University of Minnesota has gone as far as saying domestic violence can feel scarier than war. It’s “one of the most terrifying forms of violence because it happens in a place which is supposed to be safe,” she said.

Knowing that the findings of this study could help medical professionals provide mothers with the help they need immediately, could save not only the lives of countless women, but it could change the trajectory of an unborn child’s life or the future health of a child.

The National Health Service, which proves healthcare for all UK citizens, reported in a study of 489 women with no history of physical abuse during pregnancy but reports of psychological trauma, such as being threatened, screamed at, or insulted, there were adverse effects after birth. In looking at three factors reported by the NHS: maternal stress, uncomfortable living situations, and sounds perceived by the fetus to be loud. Specifically verbal abuse from an intimate partner during pregnancy is associated with immature or deficient auditory function at birth. To the best of our knowledge, this was the first reported statistic that found neurodevelopmental problems in newborns directly linked to verbal abuse in pregnancy.

The fetal auditory system is anatomically mature by the 20th week of gestation. By weeks 28, 29, and 35 the fetus will begin to respond to low, middle, and high-frequency sounds. It was found by the 36th week of gestation, the fetus will typically begin to respond to sounds from the maternal spoken voice, as well as hear and respond to the sounds of the shouting between parents. This study indicated that because both the fetal and maternal heart rate is synchronized, verbal abuse and shouting triggers an increase in both fetal and maternal heart rates. This data clearly suggests that loud, non-maternal sounds which happen in conjunction with an irregular heartbeat or tachycardia, an increased heart rate is likely to stunt auditory function development and does cause discomfort to a fetus.

“The findings reported in this article indicate brain imaging from infants who were exposed to domestic violence, even as they are sleeping, or in utero, showed reduced parts of development. Research found changes in the overall structure of the brain in children of non-physical abuse.”

The best way to protect a fetus in development from the traumas of psychological and verbal abuse is to avoid low-frequency sounds of 65 decibels to sounds over 85 decibels from being directed to the maternal abdomen. Verbal abuse should be avoided during pregnancy in order to protect the newborn’s auditory function.

Because the subject matter is often too difficult for victims and survivors to discuss, over 4,361 mothers included in this study did not respond to the specific questions which examined verbal and physical abuse, Also, these studies were based on self-reporting, where a single question was asked to mothers about abuse. Statistics are based on their recollection of events, without any way of knowing how to determine the severity of the abuse or the frequency. This, along with other limitations, such as babies that were not born within the NHS during the time of the study, did not get to complete the survey. This could account for about 18.5% of all newborns at that time (about 18,125 individuals). Finally, the research does acknowledge and take into account any event in which there is a family history of sensorineural hearing loss and a history of ototoxic medicine, which are additional risk factors of Pediatric Hearing Impairment. This was important to factor into the statistics in order to differentiate between hearing loss due hereditary medical issues versus the effects of fetal stress.

There is a need for improved detection and prevention of domestic violence, with an emphasis on non-physical violence for the better treatment of abuse survivors and their children in the health care system, schools, and the courts. In a 2019 article in USA Today, The startling toll on children who witness domestic violence is just now being understood, finds that most research doesn’t include the psychological and emotional abuse, including gaslighting. Many women say non-physical abuse is far worse for them and their children to live with than the physical abuse because of stigma and difficulty in detection, safe access to reporting and aftercare resources being limited. The findings reported in this article indicate brain imaging from infants who were exposed to domestic violence, even as they are sleeping, or in utero, showed reduced parts of development. Research found changes in the overall structure of the brain in children of non-physical abuse. When the brain is affected at this time, the circuits tend to misfire immediately and continue throughout a child’s lifetime.

Exposure to emotional trauma can also impair learning, according to Alissa Huth-Bocks, a child psychologist at University Hospitals in Cleveland. Huth-Bocks stated the “most damaging time” is during pregnancy and the first three years of life when development “takes the biggest hit at the brain level.”

Research shows Post-Traumatic Stress Disorder, similar to that of soldiers returning from the war, is found in babies born to mothers who experienced non-physical trauma during pregnancy. The study of PTSD found in children has not been researched as significantly as it has in veterans returning from war. Psychologist Kathleen Kendall-Tackett, past president of the American Psychological Association’s division of trauma psychology, said “babies are like a blank slate… If a mother is beaten while pregnant, there is a chance the baby will be injured, delivered prematurely, and there is a stack of other things that can happen – including physiological programming of the hyperactive stress system that leads to inflammation as an adult,” she said while comparing it to Veterans, “It’s like when a soldier comes back from combat, hears a click and hits the ground.”

The Japan Environmental and Children’s Study referred to as JECS, conducted an ongoing and nationwide population-based study that will follow pregnant women from early on in their gestation periods until the child reaches 13 years of age. This study is being conducted to assess the correlation between verbal abuse, and intimidation, elements of coercive control, during pregnancy. The JECS studied pregnant women living in 15 specific areas of Japan, from an array of socio-economic standings. The JECS did find that because verbal abuse and other elements of coercive control, do not rise to criminal actions as physical abuse. Additionally, the decades of connecting non-physical abuse to adverse childbirth outcomes are less widely known despite the findings that there are negative effects on unborn children.

Participants were asked to answer questions either in a document given to them at their obstetrics appointment or received in the mail. In the second/third trimester, the questions were asked:

• Have you been verbally insulted or yelled at by your partner during pregnancy? (Verbal Abuse)

• Have you been physically abused, such as being slapped or beaten, resulting in unjust because of a quarrel with your partner during pregnancy? (Physical Abuse)

Each response had to be in one of the four predefined categories

1. Never

2. Rarely

3. Sometimes

4. Often

In conclusion, the data obtained by the JECS study, of the 79,985 pregnant participants, 10,786 or 13.5% experienced verbal abuse during pregnancy. There was a reported 978 or 1.2% of victims who were physically abused during pregnancy and 810 experienced both verbal and physical abuse from their partners. Socially disadvantaged women made up a significant percentage of the women who were being verbally abused, many were from low-income houses, with other mitigating factors such as drugs, alcohol, or smoking. This same demographic consisted of younger mothers, who had poor mental health. The data finds that in Japan, women of means and with higher education levels and living situations were less likely to be victimized during pregnancy.

Increasing studies have been conducted in order to better understand the association of postpartum mortality and IPV, Intimate Partner Violence. Dr. Diana Chang, an OB/GYN, and Isabelle Horon conducted a study in 2001 on maternal mortality in Maryland. During this time, they uncovered the medical reasons behind death after birth were typically associated with hemorrhaging, hypertensive disorders, infection, and embolism. The actual leading cause of death during pregnancy and within the year following is homicide. Two out of three homicides were perpetrated by intimate partners.

A National Institute of Health (NIH) study conducted in Spain from February 2010 – June 2010 studied a cluster sample from patients seeking out obstetric services and trained midwives who reported that pregnant women experienced non-physical abuse more than physical abuse.

Scoring 0 -100 (Higher score means more severe IPV)

• Physical IPV: 10

• Psychological IPV: 25

Associated with the study, they found that Psychological IPV is directly linked to:

• Urinary tract infection reported

• Vaginal Infections

• Spontaneous Preterm Labor

Obstetricians, gynecologists and midwives are all mandated to report this abuse if it is made aware to them. The emphasis on their screening abilities and the need to take psychological IPV seriously is undervalued. This study also took into account the socio-demographics of the patients. They state there is a 95% confidence rate in their scoring system.

Statistics from Japan and Sweden show that physical and sexual abuse has decreased over the last ten years, whereas verbal and emotional abuse has remained the same. While Domestic Violence became a mainstream conversation in 1973, Psychological and Verbal Abuse only began to gain exposure after the groundbreaking work of Dr. Evan Stark, in 2007, with his book Coercive Control: The Entrapment of Women in Personal Life. It is well documented that physical abuse during pregnancy can cause harm to both the mother, fetus and baby . However, the threat of violence, psychological abuse, emotional abuse, and intimidation their adverse outcomes have less exposure to the broader medical community.

Mothers who face mental or psychological trauma during pregnancy have babies that show three times the amount inflammation in their bodies as a baby born within healthy circumstances. Inflammation can be the root of poor health later in life. Furthermore, the likelihood of depression is significantly higher in children who suffer in the womb.

Unfortunately, aside from medical journals, you will find very little acknowledgement of the effects of long term mental trauma of children who are born during an emotionally and psychologically tormentous pregnancy. It is likely that with exposure to this subject, we can raise awareness to the needs of the victims and hopefully provide them with the resources and information on how to safely remove themselves for the betterment of their own lives and that of their unborn child in the years that follow.