I didn’t mean to post all the heavy stuff back to back but this is important. October is Domestic Violence Awareness Month. It is a time to bring awareness to something that is often hidden behind closed doors, behind carefully chosen words, and behind the smiles of people who may be struggling in ways the rest of the world cannot see. When we talk about domestic violence, we usually imagine visible bruises, police involvement, or a woman desperately trying to escape a dangerous situation. But abuse doesn’t always look the way we expect it to. Sometimes, it looks like a partner who answers every question for her. Sometimes, it looks like someone who is not allowed to attend an appointment alone, who seems anxious about what she says, or who constantly worries about upsetting the person beside her. Sometimes, it looks like nothing at all from the outside. And sometimes, the person experiencing abuse is preparing to welcome a baby into the world.

Pregnancy can be an especially dangerous time. We typically think of pregnancy as a season of anticipation, preparation, and new beginnings; and for a lot of families, it is. But for women experiencing intimate partner violence, pregnancy can be a time of increased danger. Abuse may begin during pregnancy, or an already abusive relationship may become more dangerous as pregnancy progresses. An abuser can feel threatened by the changes happening in the relationship, attempt to exert greater control, or use the pregnancy and baby as additional tools of manipulation. Abuse can also involve reproductive coercion, sexual violence, emotional intimidation, isolation, and financial control…the list goes on and on. The statistics are sobering. According to the CDC, approximately 5.4% of women who had a live birth in nine U.S. jurisdictions between 2016 and 2022 reported experiencing intimate partner violence during pregnancy. The CDC also reports that, in 2018–2019, the homicide rate among women ages 15–44 was 16% higher among those who were pregnant or within one year of pregnancy than among those who were not pregnant or postpartum. Intimate partner violence was involved in nearly half of the homicides of pregnant and recently pregnant women examined in one study. These numbers represent real women, real babies, and real families. Pregnancy and the postpartum period deserve particular attention because violence during this time can have devastating consequences for both mother and baby. It can cause physical injury, pregnancy complications, preterm birth, low birth weight, and lasting emotional trauma.

A woman should not have to choose between protecting herself and protecting her baby. She deserves safety, support, and compassionate care for both.

This puts midwives in a unique situation. Midwifery is deeply relational. We aren’t simply seeing a woman for a brief appointment, check a measurement, and sending her on her way. We often walk alongside families through months of pregnancy, the intensity of labor, the vulnerability of birth, and the transition into parenthood. We learn about their hopes, their fears, their relationships, and their lives outside of a clinical setting. We visit their homes, sit at their kitchen tables, share difficult conversations, and become a familiar, trusted presence during one of the most vulnerable seasons of their lives.That closeness can be incredibly powerful.A woman who has been isolated, controlled, or made to question her own judgment may find that having someone listen without judgment is a meaningful first step toward recognizing what is happening to her. A midwife may notice changes in behavior, signs of fear, or a partner’s attempts to control conversations and decisions. She may be one of the few people with whom a woman has regular contact outside her immediate household. Sometimes, the most important thing a midwife can offer is a safe opportunity to speak honestly. Not every woman will be ready to disclose abuse. Not every woman will identify her experience as abuse. And not every woman who discloses abuse will be ready or able to leave. That doesn’t make the conversation a failure. Our responsibility isn’t to demand answers, pressure someone into leaving, or make decisions on their behalf. It is to listen, take concerns seriously, affirm that abuse is not her fault, and help her understand that support is available. A woman deserves to retain her voice and her autonomy, especially if those are the very things someone has been working to take away from her.

There is another side to this conversation that also deserves acknowledgment.The same personal nature of midwifery that allows us to build trust can also create vulnerability for us. When care takes place in a family’s home, the midwife may be entering an environment in which she has limited control over who is present, what is happening around her, or how another person may respond to the care being provided. A controlling or abusive partner may view the midwife as a threat. Not because she has done anything wrong, but because she represents an outside relationship, an independent source of information, and someone who may recognize the control taking place. A partner may become suspicious of private conversations, resent the time and attention given to the mother, interfere with appointments, or attempt to intimidate the midwife. In more dangerous circumstances, a midwife may face threats, harassment, stalking, or physical danger herself. This is a difficult reality to acknowledge, particularly in a profession built around service, compassion, and willingness to show up for families. We want to be available. We want to be approachable. We want women to know they can trust us.But caring deeply about our clients doesn’t mean we are immune to danger, and being called to serve doesn’t mean we are to ignore our own safety. Midwives need appropriate safety protocols, professional boundaries, and support systems. Home visits should be approached with thoughtful risk assessment, clear communication procedures, and plans for responding when a situation feels unsafe. When there are concerns about violence, safety planning must consider the well-being of both the client and the provider.These precautions are not a lack of compassion. They are part of practicing responsibly.**We cannot pour ourselves into caring for families while pretending that the safety of the person providing that care does not matter.**

So what does supporting a woman experiencing violence actually look like? It doesn’t require us to have all the answers. It requires us to approach her with care, humility, and an understanding that leaving an abusive relationship can be complicated and dangerous.It may look like speaking with her privately, away from a partner or family member, when it is safe and appropriate. It may look like asking compassionate, direct questions about her safety rather than making assumptions about her relationship. It may look like listening without judgment and avoiding language that blames her for what is happening. It looks like respecting her decisions and recognizing that she understands many of the risks and complexities of her situation better than anyone else. It looks like helping her connect with domestic violence advocates and other appropriate resources when she is ready, while considering whether written materials, phone calls, messages, or referrals could be discovered by an abusive partner. You may end up developing a safety plan that fits her individual circumstances, including the needs of her baby and any other children. It’s important that we understand our professional obligations around confidentiality, documentation, and reporting, including any legal requirements. These conversations should happen in a way that protects privacy and does not inadvertently increase danger. A phone call, a text message, a printed resource, or even a conversation overheard by the wrong person can create risk in some circumstances. And we need to remember that domestic violence is not limited to physical assault. Threats, coercion, humiliation, isolation, sexual abuse, financial control, and interference with reproductive decisions can also be forms of abuse. A woman does not have to wait until she is physically injured to deserve help.

If you are pregnant, newly postpartum, or raising children while living in a relationship that leaves you afraid, controlled, or unsafe, I want you to know something. You do not deserve to be hurt. You do not deserve to be threatened. You do not deserve to have your choices taken away from you. Abuse is not your fault. You may love your partner. You may hope things will change. You may be worried about your children, your finances, your housing, or what will happen if you leave. You may not be ready to make a decision, and you may not know what your next step should be. You do not have to explain everything today, and you do not have to figure everything out alone. If you are concerned about your safety, a domestic violence advocate can help you explore options and develop a plan. You deserve support that respects your choices and takes your safety seriously. If you are in immediate danger, contact emergency services if doing so is safe. In the United States, the National Domestic Violence Hotline is available at **800-799-SAFE (7233)**, by texting **START** to **88788**, or through [thehotline.org](https://www.thehotline.org/). Consider whether your device or communications may be monitored before reaching out.

Domestic violence is not just a private family matter. It is a community concern, a public health concern, and a maternal health concern. We need to create communities where women are believed, where abuse is recognized beyond its most visible forms, and where support is available without shame or judgment. We need healthcare providers who are willing to ask difficult questions, listen carefully, and respond thoughtfully. We need to protect the people who provide care, too, so that they can continue serving their communities without being expected to disregard their own safety. For those of us in midwifery, this responsibility is especially personal. We are often invited into the most intimate parts of a family’s story. That invitation carries both privilege and responsibility. We may not always know what a woman is experiencing behind closed doors. We may not be able to change her circumstances ourselves. But we can make it clear that she deserves to be safe, that her voice matters, and that she does not have to face everything alone. And sometimes, being the person who sees her, hears her, and treats her with dignity is an important place to begin. Every woman deserves to experience pregnancy, birth, and motherhood with safety, dignity, and the freedom to make decisions about her own life. That is something worth advocating for this month—and every month.

*If you or someone you know is experiencing domestic violence, confidential support is available through the National Domestic Violence Hotline (https://www.thehotline.org/), at 800-799-7233 or by texting START to 88788. If there is immediate danger, contact emergency services when it is safe to do so.*