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Pregnant, but not immune from violence

Recent research has shown that domestic violence towards a woman might begin or escalate during her pregnancy

A hidden crime
When Dr Susan Bewley, clinical director of Guy's and St Thomas's Hospitals, came across US research into domestic violence during pregnancy, she decided the issue needed to be addressed in the UK. 'We knew about the occasional case of abuse and violence - but once we started looking, we simply found more,' she says.

One US study showed that 37 per cent of obstetric patients were suffering abuse, and that 30 per cent of domestic violence actually started during pregnancy. Domestic abuse was identified as a major health issue for pregnant women: a Yale study revealed that abused women were 15 times more likely to suffer a miscarriage.

Accessing abused pregnant women
Together with US criminologist Betsy Stanko, of the Economic and Social Research Council (ESRC), Dr Bewley designed a research programme to examine the issue of domestic violence in pregnancy. The study's objectives were to find out whether domestic violence commonly began or intensified during pregnancy and after the baby was born.

Their worst fears were realised - of the 892 women who participated in the study, 22 reported domestic violence in the course of the current pregnancy. The lifetime prevalence of domestic violence detected during research was 13.4 per cent. In the year before the study, only one case of domestic violence had been detected, and that was because the woman was admitted to A&E.

Acceptable questioning
The abuse was only revealed when midwives asked the right questions. Women are reluctant to admit to abuse without prompting. They feel embarrassed and ashamed, and often think that they are to blame. Partners accompany some women, which further inhibits disclosure.

A crucial element of the study was to find out how acceptable questioning about domestic violence was. Midwives were trained to ask particular questions, and the responses they received were examined to assess effectiveness. This screening was done as part of normal antenatal care at first booking, at 34 weeks and within the 10-day post-partum period.

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