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Domestic abuse

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Domestic abuse is associated with many negative outcomes in pregnancy such as premature birth, low birth weight, fetal injury and fetal death. However, abuse does not just have to be physical, a psychologically controlling partner that appears to make all the decisions for the pregnant women can be just as harmful.
 
How do you cope with the domineering partner? Should midwives do more to help these beleaguered women find their voice?

Topic created By - Guest (30 October 2008 - 15:21:36) Domestic abuse is associated with many negative outcomes in pregnancy such as premature birth, low birth weight, fetal injury and fetal death. However, abuse does not just have to be physical, a psychologically controlling partner that appears to make all the decisions for the pregnant women can be just as harmful. How do you cope with the domineering partner? Should midwives do more to help these beleaguered women find their voice?

Responses

Submitted By - Guest 02/11/2008 23:04:50 Midwives could empower these vulnerable women through educating. Most women in this predicament lack knowledge on the rights they have as a human being and also the help available. In addition, some women seem to think this is normal. I live in an area where teenage pregnancy is very high. Most of these girls think it is normal for their partners to hit them. Being young myself, i remember the time when i used to be impressed by tough men and never wanting to have a weak boyfriend. Luckly for me, i have grown out of this through education and being a student midwife have made me realise how abnormal domestic abuse is. In contrast, other wome are still accepting such behaviours from men because they do not know any better, especially those who lack further support from family members. In this case they feel that they have no choice but to stay with the man. This is where health professionals, especially midwives take on the role of educating women and giving them informed choice of the help availabe. For example, women's refuge.
Submitted By - Guest 04/11/2008 13:43:05 I agree that midwives have a role in educating women about what support and help is available to them.It is a difficult area as a domineering partner will attend most antenatal appointments,making it difficult to allow confidential exploration of domestic abuse issues.The midwife also has to try to understand that for some women they make the choice of staying with an abusive partner.Women may have many different reasons for making this choice and midwives need to respect this.The midwife is not in a position to judge,only to voice her concerns for the woman and for her baby and to give them support in a difficult situation.The few times that I have been physically and verbally intimidated by abusive men their women have sat quietly watching another woman get the treatment that they usually get.I was shaken by the experience but got support from my colleagues and friends.The midwife has 10 months or so to show  a woman in this situation kindness and support but I am not sure that she can change it if the woman chooses to stay.You can only help women who want to be helped.
Submitted By - Guest 07/11/2008 14:04:31 Educating girls about domestic abuse, in all its forms should be commenced at school, so that a knowledge base is provided prior to commencing the “dating game”.

Boys should also be educated about what is acceptable behaviour – within the full-time education curriculum.


This may also support those who live within an abusive environment and have normalised such behaviour.


As midwives we have encouraged men to participate in the pregnancy and birth processes – to the detriment of some women. Perhaps we should be looking at formalising processes which enable us to meet with women on their own? It will at least provide an opportunity to the woman to discuss such issues.


It is difficult for women from all groups of society, including some midwives, to discuss domestic abuse. However, in the current climate we do have to accept that raising awareness and listening are the key areas supported. It will take more than just education and finance to change the culture that prevails – this will take time!

Submitted By - Guest 31/01/2009 09:39:13

I entirely agree with all the respondents and accept that domestic abuse is very difficult and frustrating to deal with as the woman/man will only leave when they are ready.


I heard a very disturbing report on radio 4 which reported an increase in violence/intimidation from teenage boys to girls. The stories of these young girls and the threatening way they were treated by their 'boyfriends' was very disturbing. In view of this I feel that education must be the key. Interestingly the latest research did not support that the "boyfriends' of these girls did not come from homes where their mother was abused.

Submitted By - Guest 11/11/2008 11:01:38 When is it the 'right' time to discuss domestic violence? Is there a 'right' time?
Submitted By - Guest 02/12/2008 20:19:09

I agree Midwives should empower women in this case through all the right sources available. Most women in this situation DO have knowledge on their rights, Domestic Abuse affects All Women across the social sector. Midwives need more insight into this problem.  Women's refuge can be successful in re-housing women, but not successful in keeping the woman away from the abuser. It's a toughie and one I would like to educate myself more on when I start to be a student Midwife.


One question, do midwives visit refuges where vulnerable pregnant women are placed?

Submitted By - Guest 03/01/2009 04:10:01 I am a midwife now and have suffered domestic abuse in the past. No amount of education could help me, I didn't leave because I loved him and stupidly thought that I could change him. The only way I could leave was when I had finally had enough and realised that he wouldn't ever change not for me or anyone else. So my advice to other midwives is to be a listening ear, offer the help and hope she's had enough and will take it. If it was your idea for her to leave and not hers then she will go straight back to him the minute he shows remorse.
Submitted By - Guest 08/01/2009 11:42:19 Absolutely never stop believing that things can get better.  I too lived with domestic abuse for years, and finally got away when I accepted I couldn't protect the family anymore.   What kept me going was the certainty from those around me that I deserved better, and needed the energy to make that possible.   It's never OK whatever form the abuse is!
Submitted By - Guest 17/01/2009 19:15:46 It is a very difficult subject to approach, as many women will not talk about it, as they have been made to think it is their fault. They feel they are "bad" wives, girlfriends, mothers, or so their partners make them think they are. We can not tell women what to do, we can only tell them what we know. If abuse has taken place before a pregnancy then it can very often escalate during pregnancy, with the pregnant abdomen being the target. We can only let them know what could possibly happen during their pregnancy, and the dangers to their unborn child. We can also let them know that there  is help available to men or women with this problem. We must remember that women can be abusers as well, especially in the context of lesbian parents. I have always advised women to do what they think is best for them and their children or unborn child. I try and get them to talk about how they feel and try to get them to get the support they need from their family and friends. Failing that then giving them information on woman's refuges if the situation is very violent can help.
Submitted By - Alifie Jones 26/05/2009 11:16:49 I am a student midwife and have worked in the community with my mentor. I have completed a few booking appointments and avoided asking the question on domestic abuse.  When I hear my mentor ask the question 'in your relationship have you ever experienced domestic violence', I cringe. I feel so uncomfortable at asking the question.  How do you pose this question and get over feeling like your being interfering? 
Submitted By - Guest 07/10/2010 09:47:30 I was a community midwife for 18 years before transferring to the area of child protection. You have to find a way of asking the question that is comfortable for you. I found that something along the lines of incorporating it into 3 things that all midwives should ask. The mental health screening tool, trigger question regarding pelvic floor function and domestic abuse. I used to explain that these questions are asked of all women, so that they do not feel singled out and started by saying something like ‘We know that domestic abuse can begin in pregnancy and if it is already happening, can increase in severity. Is this something that affects you?’ 
 
I am a little perturbed by some of the comments that have been made about the women who experience abuse. To understand why they stay in an abusive relationship, one has to understand the cycle of abuse and the control that these perpetrators hold over the women. As far as education is concerned, I agree that all women who experience abuse need to understand their options, but having sat on our local MARAC (multi agency risk assessment conference for high risk domestic abuse cases), three of the most severe cases that we have discussed have included a senior nurse (and her husband - also a nurse), a social worker (and her partner a social work manager) and a teacher (and her husband a head teacher). 
 
Domestic abuse does not only occur within lower socio-economic groups, where educational attainment is below average. These 3 women were intelligent, professionals who understood that domestic abuse is wrong, but who (for whatever reason) felt unable to leave the relationship at that point. One problem for more affluent women is the cost of refuge accommodation, which in my area is currently £580 per week (free if the woman is in receipt of benefits). 
 
I would suggest reading ‘Pregnant women, violent men: What midwives need to know’ by Sheila Hunt and Ann Martin in order to have an understanding of the way perpetrators act and think and the way that the victims respond. 
 
Submitted By - Guest 16/02/2009 22:42:43 I am touched by the personal experienced shared by those of us who have had or have abuse in our lives. The common theme appears to be 'to listen to the woman' ...'do not judge her for not leaving or for not being able to decide what to do' . My most recent 10 years of experience is with teenagers and they have taught me so much about listening. They want someone to care for them and also to care about them. Ways of helping to raise a woman's self esteem is also vital to learn....my midwives spent much time in the clinic complementing young women on their beautiful pregnant bodies etc.
Submitted By - Cheryl Taylor 02/05/2009 14:18:55 Domestic violence has always been a topic that has provoked many a heated debate, should they leave? Why don't they leave? and of course the midwife's role.  As a midwife I have encountered many situations where domestic violence has been suspected, but not confirmed.  However, it brings to mind a situation where a patient reported the fact that she was being abuse by her husband and as the pregnancy advanced the abuse worsened. 

I discussed this with my line manager, and was advised to complete the relevant paper work, and inform the patient that i had no alternative but to report what had been disclosed to the relevant agencies.  Although initially reluctant for me to do so she understood that it would be in her best interest, and the interest of her older child for Social Services to be informed.  I also gave contact details of women projects and the local domestic violence bureau.  Following referral I was contacted by the child protection team and informed that because abuse had not been aimed at the child, they were unable to intervene.  This highlighted the plight that we as midwives encounter routinely, all we can do is empower women by supporting them and informing them of their rights, however, frustrating this may be.