The abused mothers' age were ranged between 19 to 41 years. Maternal educational levels ranged from illiterate to Doctor of Philosophy degrees. Domestic violence screening score ranged from 11 to 20.
In present study 1568 codes, 20 subcategories, 6 categories and two main themes emerged from the data analysis. Through the data analysis "adopting escape strategies" and "applying situation improvement strategies" were emerged as the main themes. Adopting escape strategies was comprised of three categories including concealment, passive dysfunctional behaviors and neutral passive behaviors. Applying situation improvement strategies was comprised of three categories including positively active self-regulation, protecting family privacy and help seeking (table 2). A more precise presentation of the results is given below. Quotations from the participants are included to better clarified women's strategies for managing domestic violence in pregnancy.
1. Adopting escape strategies
Abused mothers were constantly confronted with the harms and threats posed by violence and had to deal with these harms in different ways. At first, they tried to reduce the psychological stress of violence in various ways such as concealment, passive dysfunctional behaviors and neutral behaviors without directly paying attention to reduce husband's violence.
1.1. Concealment
The special socio-cultural conditions of Iran and various contextual factors caused abused mothers to conceal violence.
1.1. a. Concealment of violence
Abused mothers were initially at a crossroads in choosing to disclose domestic violence or conceal violence. Mostly abused Iranian mothers concealed perinatal domestic violence despite the routine screening for domestic violence during prenatal care. They hided violence from family, friends, the health care system and the legal community and in this manner they manage perinatal violence in their ways. One participant stated:
"In my opinion, all pregnant mothers are abused in some way, but they do not disclose it, they don’t tell this situation to anyone. They hide violence." (Participant 10 – 36 years old- 1 year postpartum)
1.2. Passive dysfunctional behaviors
According to present study abused mothers knew they were being harmed by violence but remained in a relationship due to maternal commitment and lack of support. Usually they used passive dysfunctional behaviors for relief psychological complication as emotion focused strategies.
1.2. a. Emotional release
The study showed that abused mothers initially react to their husbands' violence by crying, getting angry, and even laughing. This quote reflects it:
"When he beats me I shout but he beats more. I cry so much. I can do nothing. What should I do?" (Participant 1 – 37 years old- 36 weeks of gestation)
1.2. b. Retaliatory behaviors
Some abused pregnant mothers utilized retaliation and defiance as emotion-focused coping strategies for dealing with domestic violence. Not submitting to the demands of husband, not talking, self-defense, immorality, fighting back were different ways to deal with violence, which had no effect on reducing violence and sometimes intensified husband's violence. The following quote reflects this:
"When my husband abuses me, I retaliate. I would answer everything he says. He wanted to kick me in the stomach. I stood in front of him, you know, my nail went into his hand and his hand was bleeding so my heart was cooled." (Participant 7 – 36 years old- 17 weeks of gestation)
1.2. c. Abuse to husband and child
In some participants trying to get rid of psychological distress could lead women to sexual disobedience, sexual ignorance and even in a few participants extramarital relationships and thoughts of killing their husbands. One participant stated:
"I got very upset when my husband bothered me. I made my bed and slept in another room. I did not allow him to have sex." (Participant 7 – 36 years old- 17 weeks of gestation)
Under the psychologic stress of perinatal domestic violence a few mothers hit the fetus, harassed their children, beat children and even leaved their children to decrease their distress. One participant declared:
"When I was angry, I would hit the baby in my stomach and empty myself in such a way. I beat the baby because there was no one else at home that I hit him/her to empty myself in that way." (Participant 5 – 25 years old- 10 hours postpartum)
1.2.d. Helplessness and confusion
Pregnancy and postpartum create a sense of isolation for mother that magnified by experiences of domestic violence. Inefficient self-talk, leave spirituality, inattention to herself, self-worthlessness, self-forgetfulness and wish for death were maternal strategy for dealing with emotional effect of perinatal domestic violence. One participant explained:
"I have not prayed for a long time. Previously, nothing could stop me from praying. But I stopped praying for a while now. I'm very sad. Every time I did not pray, I felt as if I lost something. I lost my way." (Participant 2 – 22 years old- 39 weeks of gestation)
1.2. e. Recourse to divorce
A few abused mothers achieved separation belief and decided to divorce as the final solution to get rid of their abusive husband when they could not find another way to reduce the violence. One mother said:
"If my husband's behavior had not changed and he continued to be violent, I would have separated from him, even with a child, because my child would be under more pressure in this stressful life." (Participant 11 – 36 years old- 1 year postpartum)
1.3. Neutral behaviors
The result of present study indicated that neutral passive behavior as placating strategies and diverting attention were of the common strategies used by abused mothers to minimize the recurrence and intensifying of violence in their marital relationships.
1.3. a. Placating strategies
Placating and acceptance of violence were recommended by most of participants as one of the best ways of minimizing the recurrence of perinatal domestic violence. Placating such as silence, tolerance, burning and building, patience, submission, obedience, indifference, waiver and violence normalization were of the best ways of keeping peace in the house. The following quote reflects it:
"A woman may face the worst insults and behaviors in her husband's house, but she must be silent. The man does whatever he wants, insults, disrespects ... but the woman should be quiet and calm at the house." (Focus group discussion- 35 years old- 1 year postpartum)
1.3. b. Diverting attention
Diverting attention from the issue of violence and forgetting and justification mechanism were another emotion focused maternal strategies for dealing with domestic violence. The following statement confirm this:
"Despite violent behaviors of my husband, I tried to calm down, I was involved with my baby in my womb. This made me not to think about violence." (Participant 2 – 22 years old- 39 weeks of gestation)
2. Applying situation improvement strategies
Some mothers, while believing in the necessity of covering up violence with regard to individual decision-making and individual abilities, and in the shadow of high self-esteem and self-confidence or by disclosure violence and seeking support tried to improve their situation by active self-regulation, protecting family privacy and help seeking.
2.1. Active self-regulation
The result of present study indicated that maternal urge to protect the unborn baby and protect marital life were of the most important impetus for try to reduce violence by focus on it.
2.1. a. Self-actualization
Some abused mothers used the maternal active strategies for dealing with domestic violence In order to be able to protect the privacy of the marital life without causing psychological harm. These strategies included create a good mood, self-relaxation, return attention through enjoyable activities, positive mental imagery and maintain authority, skills and empowerment. These quote reflects it:
"Every time my husband was beating me, the baby in my womb was in a bad mood, her movements were slowing down, but I was making fun of myself at home. I was entertaining myself. Sometimes I watched TV programs because of my fetus to see colorful pictures in my stomach and have a positive effect on her mood in this way. Every day, as soon as my husband left the house, I would do the housework and go for a walk with my children to calm down so that we would feel better. "(Participant 6 – 41 years old- 1 month postpartum)
2.1. b. Comprehensive self-care skills
The mother acquired Comprehensive self-care skills through physical self-care, emotional psychological self-care, social self-care and spiritual self-care. The following statement approve this:
"I was prioritizing for myself. I made time for myself. I even went to the park so that the baby in my womb could hear the sound of the babies in the park. I was talking to her and I was saying that there is a park here, there is a slide, it is swinging, look how beautiful it is, the children are swinging, see what they are screaming and shouting. I controlled myself, I calmed myself down." (Participant 6 – 41 years old- 1 month postpartum)
2.1. c. Promoting positive self-concepts
Maintaining and promoting self-confidence, self-esteem and self-control are the strategies that the mother uses to promote positive self-concepts. The following statement confirm this:
"I see in my friends have lost their self-confidence during pregnancy. They think that their husband is no longer interested in them, because their appearance has become ugly and they have become fat so their situation is getting worse day by day. I never spoke in front of my husband that I was ugly during my pregnancy and after that. I always said I am very good in every way and I have no problems." (Participant 11 – 36 years old- 1 year postpartum)
2.1. d. Resilience
Despite the increased risks associated with domestic violence during pregnancy, many women effectively navigate their experiences and come to display adaptive outcomes, such as resilience. Resilience included promote individual growth, being purposeful, source of internal control, flexibility, independence, realistic look and thinking positive. One participant stated:
"I think a part of the husband's violence is because of economic issues. Some mothers understand the pressure on their husband in life. They think it is fair to tolerate verbal violence occasionally but no other types of physical, sexual and emotional violence, especially during pregnancy so that the fetus stays healthy and is not harmed." (Focus group discussion- 38 years old- 6 months postpartum)
2.1. e. Strengthening spirituality
Abused mothers endorsed strengthen spirituality as a form of adaptive coping strategy they adopted in dealing with perinatal domestic violence. Relying on God, appealing to the Imams and submitting to the divine destinies were strategies that formed based on the mother's religious beliefs and resulted in maintaining her peace and reducing her vulnerability and ultimately increasing the mother's ability to protect the privacy of the marital life. This quote reflects it:
"No one can help me. Only God can help. Only God can create an opening in our lives and improve our situation. Only Imam Reza can help." (Participant 3 – 29 years old- 40 weeks of gestation)
2.2. Protecting family privacy
The result of present study showed that protecting family privacy by purposeful effort to correct spouse behavior, supportive efforts and maintain maternal commitment were the active maternal problem solving strategy for dealing with domestic violence.
2.2. a. Constructive purposeful efforts
In the initial exposure to violence, some of the mothers tried to control violence by using purposeful effort to correct husband's behavior such as turn disputes into positive negotiation, building trust, create intimacy, promote husband information, maintain the authority of the husband, meet the sexual needs of the husband, encourage her husbands for psychological counseling and trying to change the destructive behavior of the husband. The following statements indicate it:
"I tried to maintain my husband's authority and I did not do anything without his information. When the fetal movement was reduced, I endured a lot of anxiety from morning to night, but because I had to coordinate with my husband and then leaved home, I didn't want to go to the hospital without my husband's information to control the fetal heart rate." (Participant 11 – 36 years old- 1 year postpartum)
2.2. b. Supportive efforts
Some mothers supported their husbands in economic and emotional status. Although supportive efforts did not reduce the husband's violence, it could improve the mother's psychological states and it affected the mother's sense of satisfaction with her ability and empowerment.
One educated mother stated: "I was teaching at university before I got pregnant, I had projects, I had some savings. I paid for my prenatal care and screening tests because I felt my husband was resisting paying for them, and I was so happy to be able to pay for perinatal care." (Participant 10 – 36 years old- 1 year postpartum)
2.2. c. Maintaining maternal commitment
The result of present study revealed that maternal commitment such as efforts to maintain fetal health, trying to keep the children calm and priority the comfort of the fetus and children to maternal liberation from violence made mother to stay in abusive relationship and didn't think about separation. In fact mothers sacrificed themselves and put their children’s needs ahead of their own to keep their family from breaking up. One mother explained:
"When you become a mother, the feeling of motherhood makes you look at life differently, you are responsible for maintaining the health of your child, and the most important thing is to be patient and tolerant. Patience and endurance in the face of all the violence of the husband, for the sake of keeping the fetus healthy because of the duty of motherhood." (Participant 1 – 37 years old- 36 weeks of gestation)
2.2. d. Preserving marriage
Some abused mothers tried to save their marital life despite their husbands' violence because of their interest in cohabitation and their husband's satisfactory commitment. One participant stated:
"Although my husband sometimes abuses me, but my marital life is good. I love my life very much. I think my life is better than my sister's and my mom's. I love my husband. My husband is a man who has been standing on his own feet since he was 15 years old. I am very satisfied with my life, I do not want to lose my life." (Participant 5 – 25 years old- 10 hours postpartum)
2.2. e. Avoiding social judgments
Avoiding social isolation and preventing the stigma of divorce, the stigma of remarriage, preventing the lack of financial support after divorce and the lack of a supportive family prompted the abused mother to try to protect the privacy of the marital life. One participant described:
"I was born and raised in a small town. If a woman divorces, society and her family look at her with pity and her life will destroyed. These are the things that make a mother stay under any circumstances and try to save her common life." (Focus group discussion- 28 years old- 35 weeks of gestation)
2.3. Help seeking
The result of study revealed that some abused mothers finally tried to generate solutions by disclosure violence and gain formal and informal support.
2.3. a. Disclosure of violence
Some abused mothers finally disclosed domestic violence following the failure of previous strategies used and the intensification of violence. Maternal empowerment and familiarity with individual rights, the ability of the health care system to identify violence, the presence of supportive families and supportive systems and the intensification of violence have been factors that facilitated the disclosure of violence. The following statements confirm this:
"Men should know that they have no right to violence against pregnant women. They have no right to harass a pregnant woman. Pregnancy is sacred, now I came to forensics, I want to make it clear to my husband that he no longer has the right to hit a pregnant woman"(participant 9 – 28 years old- 8 weeks of gestation)
2.3. b. Looking for network support
Domestic violence reduced maternal social network and the result of present study demonstrated the importance of formal and informal support and seek help from these support system in facilitating dealing with domestic violence. Formal support were included health system, psychological counseling, use of welfare services, forensic medical center, social worker, relief committee, the police and Justice. Informal support were included friends and family. Abused mothers formed friendly alliance and asked help from formal and informal support system. The following statements confirm this:
"Abused mothers should be informed about which systems support them. What services can they receive from health centers? Where can they go for psychological counseling? How can they complain about their husbands?" (Participant 27- 37 years old- key informant).