Battered and Pregnant

by Judith Spitzer


Three weeks short of her 20th birthday, Melissa Saldivar died of massive head injuries sustained when she either jumped, or was ejected, from a moving vehicle driven by her fianc & eacute;e -- 21-year-old John E. Lipinski.


Saldivar wasn't breathing when she was dropped off at Sacred Heart Medical Center at 4 am on Aug. 10, 2004, and she was nearly seven months pregnant with Mataya Shanelle, the premature baby her family said she named four days before she died.


Doctors put Saldivar on life support and delivered the baby, who weighed only 2 pounds, 13 ounces, by Caesarian section. The young mother died the next day after breathing machines were removed. Deprived of oxygen before the birth, the baby had been pronounced brain dead several days after her mother's death. She died nearly three months later after being removed from life support machines.


Spokane police, who referred to the deaths as a "DV altercation," at one point called Lipinski a "person of interest" in what they considered a suspicious death. Last week, they turned the case over to Spokane County prosecutors, who then filed two murder charges against him. As of press time, he has not been taken into custody, although police believe they are close to apprehending him.


According to Spokane Police Lt. Scott Stevens of the Major Crimes Unit, Lipinski initially refused to talk to police, and when he did, he offered several versions of how Saldivar was ejected from the car, including that she had fallen down stairs or that she had jumped from the driver's side of the car. Lipinski had earlier been charged with a domestic violence assault against Saldivar in July 2003, Stevens says.


An autopsy reportedly revealed Saldivar died of a fractured skull, but there was also evidence of an injury to her uterus that may have been the result of a punch or kick.


After months of investigation, Melissa Saldivar and her family may see justice done, but Spokane Police Sgt. Joe Peterson says it hasn't been an easy case.


"Some cases are cut and dried," Peterson says. "This is not. It has been difficult from the beginning. This case will have to stand on the evidence alone. Nobody witnessed the crime. But Detective Tim Madsen, who has handled the case throughout, has done a great job in sticking with the case to ferret out the truth."





At Greater Risk


The Saldivar case highlights what has been common knowledge to many domestic violence experts, but what has only relatively recently been the subject of significant research -- that women who are pregnant are at greater risk of violence and/or death by abusive partners.


In fact, the Pregnancy Mortality Surveillance system of the Centers for Disease Control (CDC) reports that homicide was found to be a leading cause of pregnancy-associated injury deaths among women in 1991-99. ("Pregnancy-associated homicide" was defined as a death during or within one year of pregnancy.)


Nationally, estimates for intimate partner violence (IPV, the name the CDC uses to identify domestic violence) are difficult to obtain, public health officials say, because of extensive under-reporting. But they have been able to determine that nearly 5.3 million IPV victimizations occur each year among U.S. women ages 18 and older. This violence results in nearly 2 million injuries and nearly 1,300 deaths (in 2003).


A CDC study that reviewed research literature on the prevalence of domestic violence during pregnancy found that between 0.9 percent and 20 percent of pregnant women reported experiencing domestic violence during pregnancy, with the majority of studies ranging between 4 to 8 percent.


The Washington State Department of Health tracks domestic violence and pregnancy using a pregnancy risk monitoring system called PRAMS.


They say the number of childbearing women who reported physical violence by a husband or partner around the time of pregnancy (12 months prior to pregnancy through three months postpartum) in 2000-02 was about 6 percent -- or approximately 5,000 women per year around the time of pregnancy.


Patty Wheeler, director of the YWCA's Alternatives to Domestic Violence Program (ADVP) in Spokane, says physical violence may begin with a pregnancy and could increase as well.


"Research shows that the incidence of domestic violence increases during pregnancy," Wheeler says, adding that reporting is up during times of pregnancy, too.


"A victim has a connection to outreach," Wheeler says. "The attention is on her during a pregnancy. Plus isolation is part of how her [abuser] controls her. Now she's the center of attention, and the family may be coming back around. It also increases the fear of the perpetrator that he'll be found out. Or, with the increased attention, that she'll find a way to get out of the relationship."


Wheeler says miscarriages are also more prevalent in abusive relationships.


"We've had lots of women here who have lost babies due to stress factors or direct physical assault. It's common enough that we see it probably at least once a month," she says.


Experts theorize the reason for the increase in violence is that pregnancy is a threat to the status quo -- perhaps it's a response to changes in an intimate relationship where domestic violence already exists. A new baby can be perceived as a threat to a partner who will have to share his partner's time and attention with a child. A controlling man may also be threatened each time his mate goes to the doctor, because there are more people who might influence her.





Fatalities


Between Jan. 1, 1997, and June 30, 2004, 281 people were killed by domestic violence abusers in Washington, according to a study released in December by the Washington State Coalition Against Domestic Violence (WSCADV).


WSCADV's Kelly Starr says the study showed at least 28 percent (or 25 women) killed by their male intimate partner had given birth to a child in the previous five years. Of the 25, over half had children age two years and younger.


Still, Starr says, it's both possible and likely that more homicides involved pregnant women -- but they may not have been aware of the pregnancy and didn't have access to medical reports.


"We're aware of at least four women killed by their current or former partner," Starr says. "But for the most part, we don't know if a woman was pregnant because it wasn't reported or wasn't known."


Most of the data collected by the WSCADV is generated from news reports, and because of staffing constraints, only a small number of fatalities are reviewed in depth.


Starr says a pregnancy not only upsets the power and control that an abuser thinks he has over his partner, but it may also catch a woman off-guard.


"Women may think it's going to be a safe, happy time for them and have a false sense of security. And the outside community doesn't realize that [domestic violence] is about power and control and [pregnancy] is not a protective factor by any means," she says.


On the flip side, however, a woman's pregnancy can also provide accessibility to resources, Starr says. And health care providers are a critical source of intervention for victims.


"For a victim isolated by her abuser, this may be the only time there is contact with outside resources and information in the community," she adds. "DHS [the state Department of Health] urges doctors to screen all pregnant women every trimester and during postpartum as part of prenatal care."


According to DHS Perinatal Partnership Against Domestic Violence data, domestic violence in pregnancy is more common than pre-clampsia or gestational diabetes.


"And those diseases are routinely screened for multiple times during prenatal care," Starr says. "It points to the importance of screening for domestic violence in pregnant women."


Several years ago, Wheeler says Spokane's YWCA Domestic Violence program helped train hospital emergency room staff and other health care practitioners on how to screen patients for potential domestic violence.


"You can't ask with [the abuser] standing right there," Wheeler says. "But we taught people how to separate the two and then do the medical screening.


"They will ask the woman if she is currently in a relationship, and then whether it's a safe one -- and just getting them to talk about their relationship. And then have the resources to provide them with support," Wheeler says.