‘…any violent or abusive behaviour whether physical, sexual, psychological, emotional, verbal or financial, which is used by one person to control and dominate another, with whom they have, or have had, a relationship.'

(Hester et al 1998)

• Includes abuse by parents or other family members: this is especially relevant for younger pregnant women living at home
• One third of domestic abuse begins in pregnancy
• Existing abuse worsens in pregnancy
• Physical violence in pregnancy is most likely to be directed towards the woman's abdomen, genitals and breasts
• pregnancy = time of HIGH RISK: being pregnant is not a protection

Source: Some facts from ‘Why Mothers Die ' (2004; RCOG, London ) also titled ‘The CEMACH Report 2000-2002' (Triennial Report on Confidential Enquiries into maternal deaths in England and Wales (2000-2002). This Report examines deaths during pregnancy and the 12 months after birth.

• 391 women died in this triennium
• 12 women murdered by their partners (13%
• 50% of these were booked for midwife-led care i.e. considered low risk
• Further 43 had reported violence to HCP
• 71% of the women who reported violence were late-bookers / non-attenders; and were not actively followed up
• Some women known to be in abusive relationships were seen at all appointments with partners
• Suicide was the leading cause of death in this triennium's Report Some groups of women were more vulnerable
• Some women are at higher risk - social exclusion, age, language barriers, complex social problems.
• Particular issues with members of some ethnic minority groups. It is important not to stereotype, but need to be aware of this
• Under-use of interpreting services
• Teenage women were found to be at particular risk
• Nine women under 18 died
• Seven of these were in violent, abusive dependent relationships
• Five had experienced sexual abuse
• Five were living in a refuge

In 2004, in Stockport , 2 young women were so badly beaten that their babies died in utero. Both were 17 years old.

Indicators of domestic abuse

• Late booking
• Poor/non-attendance for antenatal care
• Repeat attendance at maternity unit /GP/ A and E for minor injuries / trivial / non-existent complaints
• Repeat presentation with depression, anxiety, self-harm, vague/psychosomatic symptoms
• Minimisation of physical signs of violence
• Poor obstetric history
• Recurrent STIs
• Unexplained admissions
• Unexplained episodes of PV bleeding / abdominal pain
• Non-compliance with care / early discharge from hospital
• Constant presence of partner ‘the cling-on'
• Woman reluctant to speak / disagree in front of partner

Effects on mothers and babies

• DA in pregnancy is a major Public Health issue with profound impact on health of families

Mental health problems

• depression, anxiety, insomnia, self-harm, panic attacks
• increase in drug and alcohol abuse
• exhaustion-staying awake to protect self/children

Life-threatening pregnancy complications – even death

• Antepartum haemorrhage
• Premature rupture of the membranes; premature labour
• Ruptured uterus, liver or spleen
• Miscarriage, stillbirth, IUGR, premature birth, disability
• Babies born with fractures

Recommendations for care: CEMACH and NSF

• Multi-agency working
• staff awareness of DA
• Staff willing to ask
• Routine enquiry at least once in pregnancy click here for more information

For further information please contact Eileen Mahoney, Stockport Specialist Midwife for Vulnerable Groups by email on Eileen.Maloney@stockport-tr.nwest.nhs.uk