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Homicide and Suicide: An Unacknowledged Cause of Death for Pregnant Women

 

In a recent Science Daily report, “Homicide, suicide outpace traditional causes of death in pregnant, postpartum women”, caught my attention.  Outpace traditional causes of death in pregnancy and postpartum?  What about all of our concern regarding mortality rates as a result of C-section?  I bought the study.

According to Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K. J. (2011), in the November issue of Obstetrics & Gynecology:

In total, we identified 233 pregnancy-associated violent deaths, yielding an overall pregnancy-associated violent death mortality rate of 4.9 per 100,000 live births; 64.8% of the pregnancy-associated violent deaths in our sample (n = 151) occurred during pregnancy (compared with the first year postpartum).  The overall pregnancy-associated violent death rate was fairly stable of the study time period, ranging from 4.3 to 5.4.  In addition the rates of pregnancy-associated homicide and suicide were each higher than mortality rates attributable to common obstetric causes. (Palladino, et al., 2011, p. 1059)

Mortality Rates Higher than OB Complications

The rate of death for pregnant women due to homicide, or suicide is higher than hemorrhage, eclampsia/pre-eclampsia, and amniotic fluid embolism.

Hemorrhage/placenta previa: 1.7  deaths per 100,000 live births2
Eclampsia/pre-eclampsia 1.7 deaths per 100,000 live births2
Amniotic Embolism 1.1 deaths per 100,000 live births2
Homicide 2.9 deaths per 100,000 live births1
Suicide 2.0 deaths per 100,000 live births1

 

 

 

 

Suicide:

  • 45.7 percent of suicides occurred during pregnancy
  • 51% of suicides occurred during postpartum
  • Victims were significantly more likely to be Caucasian, or Native American, and unmarried
  • Women ages 40 and over represented 17.0% of suicides
  • Suicide rates between states did not differ
  • 54.3 percent of suicides involved intimate partner conflict contributing to suicide

Homicide:

  • 77% of homicides occurred in pregnancy (not postpartum)
  • 45.3% of homicides were associated with intimate partner violence
  • 53.9% of victims were under 24 years of age
  • 44.6% of victims were African American
  • Homicide rates did not differ between states

 

These findings suggest that effective prevention methods aimed at perinatal psychosocial health are imperative.  Unlike some obstetric complications, violence is potentially preventable.

With continued focus on maternal violent death and a continued push toward the development of effective psychosocial interventions…we may be able to reduce the effect of this unfortunate killer on American women, their children, and their families. (Palladino, et al., 2011, p. 1062)

As birth advocates, intimately involved with the health and well-being of pregnant and postpartum women, what do we do?  What is our part in addressing this unfortunate killer of American women?

Posted by:  Walker Karraa, MFA, MA, CD(DONA)

 

 

References

  1. Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K. J. (2011). Homicide and suicide during the perinatal period: Findings from the National Violent Death Reporting System. Obstetrics & Gynecology, 118(5). 1056-1063. doi: 10.1097/AOG.0b013e31823294da
  2. Berg, C., Callaghan, W. M., Syverson, C., & Henderson, Z. (2010). Pregnancy-related mortality in the United States, 1998 to 2005. Obstetrics and Gynecology,116:1302-9.
  3. Homicide, suicide outpace traditional causes of death in pregnant, postpartum women. ScienceDaily. Retrieved October 21, 2011, from http://bit.ly/qCN06m

Maternal Mortality, New Research, News about Pregnancy, Perinatal Mood Disorders, Research , , , , , , ,

  1. October 29th, 2011 at 12:33 | #1

    I would love a follow-up to this on what are some things we can do, what signs can we look for?

  2. avatar
    Walker Karraa, MFA, MA, CD
    October 29th, 2011 at 13:14 | #2

    Dear Elizabeth,
    Thank you for your comment. I think there are several layers of answers. For the immediate questions, here are two resources.

    Warning signs: http://www.suicidepreventionlifeline.org/GetHelp/SuicideWarningSigns.aspx

    National Partnership to End Interpersonal Violence
    http://www.uncg.edu/psy/npeiv/

    Regarding things we can do–first is what you have done, ask. Secondly, add good information to your website, and educational materials. I still don’t understand why Lamaze, among all of the other birth organizations have no resources listed on their website. Stigma? Fear? What do you think?

    I think the burden, truly, is on our organizations. They are failing us, and putting women at risk by refusing to address perinatal mental health in curriculum. We must continue to look to the leaders in our field to educate us. If those leaders are not providing the evidence-based information, we must ask them to. We must ask them to educate us, train us, within the scope of our practice, address these issues. Continuing education hours for online modules would be great. http://www.mededppd.org has several.

    One good way to start would be to ask our organizations to create position papers on maternal mental health. ICEA has just done so, and is the first childbirth education organization in history to do so. Lamaze, CIMS, ICAN, DONA, CAPPA should as well. Educators should never be left to not know how to recognize signs, and refer appropriate resources. And women and families should never leave a childbirth education series without knowing the facts, and resources in their hands.

    As you can tell, it is a passion of mine to create a paradigm of inclusion for the new generation of birth advocates, and more importantly–for women, that encompasses the whole woman, not just her reproductive life events.

    Bottomline, we need to do what you have done…ask what we can do. Thanks, Elizabeth.

  3. October 29th, 2011 at 14:38 | #3

    Hi Walker – thanks for bringing this study up at Science & Sensibility. It is well known that domestic violence often peaks during pregnancy and postpartum. I am very intrigued by this population, and work with many women who report that their partners substance abuse, verbal abuse, and physical abuse intensified during pregnancy and right after birth. I’m very interested in knowing the reasons why this is, I love to see some studies about this. My own personal theory is that the partners are triggered and unconsciously dealing with the demons of their own abandonment and abuse issues from their families of origin, are triggered by the normal dependency that that pregnant women need, and the fear of their upcoming expanded responsibilities and needed maturity.
    This is an issue I’m quite interested in and deal with often in my private practice. thanks again for the info, you’re the bomb!

  4. avatar
    Walker Karraa, MFA, MA, CD
    October 29th, 2011 at 14:55 | #4

    Hi Kathy,
    Thank you for this valuable perspective. Violence against women is at the core of so many of our personal and professional passions. Hopefully these conversations will encourage birth professionals to look beyond and include all types of violence, not merely obstetrics. We have nothing to gain by only advocating for lower C-section rates, if women have violence in the home, or an un-diagnosed depressive disorder. There is so much to lose.

    I would love to have you offer your thoughts about how birth advocates, childbirth educators, doulas and lactation consultants might address these issues.

    Thanks for reading and commenting…

  5. November 1st, 2011 at 07:39 | #5

    @Walker Karraa, MFA, MA, CD
    Hi Walker – Hmm, well I have a lot of thoughts about how birth advocates and childbirth educators might address these issues. It would take a really probably longer type of forum for me to really pull my thoughts together and come up with some suggestions. One thing I’ve noticed is that there is a lot of concentration on on having an optimal womb and birth experience….I think that this kind of information is very valuable, but it’s not that useful to people actually experiencing domestic violence. It’s surprising to me that some allied birth professionals are unaware that pregnancy is one of the triggering periods for increased DV….there is certainly a disconnect between the mental health arena and the childbirth educator arena. I think you’re doing the job good job of trying to bridge that gap. I also think tho, it is difficult for unlicensed professionals to delve into areas of domestic violence with her clients. I suppose a psychoeducational approach would be best. You pose an interesting question, what types of interventions can be made that aren’t threatening? one thing I can think of is having some information about DV & pregnancy on some of the childbirth education websites. That could be a beginning, and then maybe slowly introducing information to childbirth educators about DV…..perhaps just having a pamphlet out during a childbirth education class….need to think about this some more, thanks Kathy

  6. avatar
    Heather
    November 14th, 2011 at 16:12 | #6

    A large number of suicides happen in postpartum – perhaps childbirth educators can help, but in my part of the world, not many women attend private childbirth classes. Hospital birth classes are more attuned to making sure women are aware of the hospital regulations, and expectations revolving around what will happen during the 24 hours or so leading up to the birth of the child.

    Pregnancy is revered, the women are excited and prepared (in what ever way) for the birth. Mothers taking Bradley classes typically have 2-3 hours per week for a number of months, talking with other pregnant moms, sharing their feelings and excitement. When that baby is born, suddenly these mothers are alone with a “demanding child.” Not only are they isolated, the focus goes off the formerly pregnant woman and onto that oh-so-cute baby. While ever mother appreciates her baby being noticed, not ever mother can adjust immediately to the focus coming off her overnight.

    There are some parenting groups, and La Leche League used to have a lovely network of mothering through breastfeeding, but even that is almost gone from our quilt of America. While many parents may prepare for childbirth, there is little to no preparation for parenthood, and very little support as well.

    The American society contributes to violence in the media and in games. It is a common thread throughout our society. Most parents feel uncomfortable watching a sexually-oriented show with their children, but many don’t mind the violent tv shows.

    As a nurse, and former birthworker, I cannot help but notice the disconnect between baby/parents and the at-risk status of the same dyad. Living in a rural, poor, uneducated area, I see babies taken from their mothers immediately at birth, and basically held hostage in the nursery. Medical professionals often feel they do a better job of feeding and changing the newborn, which can be true, because they do it frequently. However, the medical professional is supposed to be teaching: teaching the parents how to feed, teaching the parents how to change, showing gentle care by example. Instead, we have understaffed hospitals rushing to fill in all of the blanks on the chart, and at-risk parents going home with unattached babies to a home that has no idea what to do with this child.

    I believe we have a societal issue. It’s not an organization who can take full responsibility, it’s not a facility that can take full responsibility. It’s not the full responsibility of the teen mother who was mothered by a teenager, and is doing the best she knows how, with the tools she was given.

    Our society needs to embrace the family, the child, the mother, the father. We need to put people before things, and until we do, we will continue, as a society, to undervalue people. As we undervalue people, we will put women last, because they are last in our society. And as last in our society, women will continue to take their lives because they “just don’t matter.”

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