A Dirty Secret : Society would like to think that all expectant moms are cherished. But pregnancy may start--or increase--domestic violence.

She was just 19 and pregnant with her first child. Celerina Vera never expected her boyfriend--the one person who had a stake in her future--to turn against her.

In her sixth month of pregnancy, however, he pushed her down a slope during an argument. Both were distraught at the incident, but for far different reasons.

She was stunned that he would hurt her and risk harming their baby.

He feared being punished.

“He was afraid I’d go into labor and he’d get caught,” Vera says. “Even his mom said this and sensed the need, right away, to cover it up.”

The abuse wasn’t an isolated incident. Vera was battered by the same partner during her second pregnancy, one year later, causing her to give birth to a premature and low-birth-weight baby. It was a long time before she told anyone about the abuse.

“Women are shocked when [the partner] does it for the first time during pregnancy,” says Vera, who now works as an advocate for battered women. “This is supposed to be a happy time.”

The beating of pregnant women may be the deepest secret in the dark world of domestic violence. It is hard to reconcile society’s traditional response to a pregnant woman--pampering and praising her--with the image of a woman cowering in her own home, shielding her protruding abdomen from punches and kicks.

As the facts about domestic violence begin to emerge, among them is the sickening revelation that violence in a relationship often begins or becomes more severe when a woman is pregnant.

According to various studies, a disturbing number of pregnant women is physically abused. When 691 pregnant women in Houston and Baltimore were asked three simple questions about violence during a routine prenatal visit, 17% said they had been physically or sexually assaulted during the pregnancy; almost two-thirds of that percentage reported two or more beatings, according to the 1992 study in the Journal of the American Medical Assn.

And, in a 1994 study of 1,203 women screened on several occasions throughout pregnancy, 20.6% of teens and 14.2% of adults reported abuse. While adult women are most likely to be battered by male partners, teens report physical abuse at the hands of their parents and boyfriends, noted the study, published in the journal Obstetrics & Gynecology.

Another survey of women who had recently given birth found that 6% reported being beaten during pregnancy, according to a government report published last year. A similar Canadian survey found a 6.6% rate.

Research shows that assaults tend to occur later in the pregnancy and that the frequency and severity of beatings appear to be worse for white women compared to other racial and ethnic groups.

Overall, about one in three women experiences domestic violence at some time during her life, according to a recent study in the Annals of Internal Medicine. Given that statistic, it should come as no surprise that pregnancy does not provide a haven against abuse, says Sandra G. Baca, a Los Angeles therapist who works with batterers and their families.

“We still don’t even accept the fact that battering takes place, much less the fact that it involves pregnant women. Our denial system is so great, we can’t make room for that at all,” she says.

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Why would he hurt her when she’s pregnant with his child-to-be?

Although most battered women express intense worry over the baby, neither they nor the batterer may understand the health risks to the fetus.

The few studies that have been done on battering during pregnancy show two typical health consequences: Battered women are twice as likely to deliver a low-birth-weight baby (5.5 pounds or less) than women not abused and twice as likely to seek prenatal care only late in the pregnancy.

Other studies have shown that battering during pregnancy inhibits maternal weight gain, elevates the risk of infections, bleeding and anemia, and may trigger smoking, drinking and drug abuse in the mother.

And in one study of women who had experienced miscarriages, 7% reported being battered at some point during the pregnancy. Physical abuse may also lead some women to choose abortion, according to some psychiatric studies.

“There is so much we don’t know about domestic violence,” says Alana Bowman. This admission, coming from a Los Angeles deputy city attorney in the Domestic Violence Unit, is sobering. Since 1972, Bowman has prosecuted domestic violence crimes, and she says prosecutors must continually challenge outdated notions about the crime in search of a deeper understanding.

For example, prosecutors have learned that abuse during pregnancy--which Bowman estimates represents about 20% to 30% of the misdemeanor cases she handles--often occurs because the pregnancy represents “a threatening change in the relationship.”

“When you talk to the batterer, they say they feel the stress of the pregnancy,” Bowman says. “But we also find that these are excuses or a rationale for men to have a primary position in the relationship. What the baby represents is the moving-aside of the man in his primacy.”

Vera says she hears a lot of reasons why violence occurs during pregnancy, such as financial stresses, suspicion that the baby is not his or anger that the woman is not taking care of herself.

“If she has a drink, for example, he may beat her,” Vera says. “It’s not OK for her to hurt the baby, but it’s OK for him to hurt the baby.”

Vera, who separated from her boyfriend when her children were young, agrees that the violence centers on who holds the power in a relationship undergoing a fundamental change.

“The pregnancy is a threat to him because she has to go to the doctor every month; there are more people who can influence her. The baby is the focus of her life now, not him. She is getting attention from more people.”

Battering may be triggered later in the pregnancy when the man begins to dislike the appearance of his partner’s changing body, Baca notes.

“A lot of these men place emphasis on how their partners look. And, rather than looking at their wives as beautiful during pregnancy, they see their wives as looking disgusting. They’ll say, ‘Why are you so fat?’ It’s almost like the woman is a trinket, and if she looks fat and unattractive, that makes him look bad.”

Some women who are battered before the pregnancy are aghast that the pregnancy makes matters worse.

Peggie Reyna began suffering beatings shortly after her marriage and prayed that a baby would change things.

“I thought it would stop as soon as I got pregnant. But my abuse increased during pregnancy,” says Reyna, now a member of the Los Angeles Commission on Assaults Against Women. “Then, I thought it would stop after the baby was born.”

Battered women soon pin their hopes on just trying to survive from day to day, experts say.

“There is this bewilderment among women that this grown man feels jealous of his own baby,” Bowman says. “The women I’ve talked to are absolutely shocked that it happened. But I think there is a sense of shame too. . . . There are so many things that point back to her doing something wrong.”

In an attempt to absolve a woman of that feeling, the March of Dimes, Southern California chapter, is launching a campaign on battering during pregnancy. At a recent meeting of its advisory committee, members discussed using the theme “Daddy Don’t” to raise awareness of the plight of the fetus, says Linda Lange, who is directing the March of Dimes campaign.

It’s typical for people to ask an abused woman why she “just doesn’t leave” the home, Lange says. Victims of domestic violence know that the answer isn’t simple. And it’s even more complicated for a pregnant woman.

“Women are so much more vulnerable at that stage in their lives, it’s a lot harder for you to leave,” Vera says. “There is also a big stigma against being a single parent. And they worry about how to support the baby. They worry about being alone during labor and delivery.”

Reyna says fear immobilized her for many years.

“If you knew that you didn’t do exactly what you were told, when you were told, [and] that the [fetus] would be the target of violence, how intimidated would you be?” she says.

For some women, the choice is between being battered or being homeless, Bowman says.

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The consequences of pregnant women being battered often escape the notice of health professionals.

“When I [speak] about this to physicians’ groups and health-care providers, they are always surprised to hear battering is common during pregnancy and that it sometimes begins during pregnancy,” says Dr. Elaine J. Alpert, a Boston University medical school professor and author of a recent article on domestic violence in the Annals of Internal Medicine.

Pregnancy should provide an opportunity for a doctor to detect abuse, however, “since most women see a doctor at least once.”

Alpert says that all women should be asked about domestic abuse during prenatal care and again before they are discharged from the hospital after delivery.

Although doctors often hesitate to ask a patient about her relationship with her partner, women welcome the inquiries, says Dr. Michael Wilkes, co-founder of a domestic violence course for medical students at UCLA.

“It is still a very strong taboo to talk to patients,” he says. “Doctors are reluctant to talk about what couples do when they fight: ‘How do you guys resolve conflicts? Do you have bad fights? Tell me about a bad fight. Does your husband drink? What happens when he drinks? Does he get nasty?’ ”

Both Alpert and Wilkes report that patients are rarely offended by those kinds of questions; rather, it is considered a sign of a caring physician.

Nevertheless, people are sometimes unwilling to speak up. Experts say the batterer will often accompany the woman to the emergency room or doctor’s office and will try to answer questions for her or curtail what she says.

Physicians need training to pick up on signs of domestic violence, says Wilkes, whose program at UCLA is one of only two domestic violence programs taught at U.S. medical schools.

Wilkes says that about half of the domestic violence cases he has seen in patients “I picked up on just because I raised the issue and listened between the lines.”

Detecting the abuse during pregnancy may save a woman from a future that will imperil her and her children, experts note. Although some beatings stop after pregnancy, more often abuse continues, involves the children and is sometimes a precursor to homicide.

“This is a father who is willing to risk the health of his partner and his child,” Bowman says.