Sadly domestic violence (DV) in pregnancy is a very real and frequent occurrence, affecting women worldwide.
Previous research in the UK has shown research carried out in the UK, 70 of the 295 women who died during pregnancy or in the first 6 weeks after giving birth had a history of domestic violence. 19 of these women (27%) were murdered (CEMACH, 2007) (1).
Unfortunately DV can actually start in pregnancy with international research showing that 30% of women who experience domestic violence are physically assaulted for the first time during pregnancy (1). Women’s Aid (Ireland) highlight some of the harrowing tactics used by perpetrators during pregnancy and in the postnatal period, as well as providing links to some useful resources such as a leaflet.
As part of making maternity care safer, it is essential that we increase awareness of the prevalence of DV and help clinicians to tackle this serious public health issue. Cook and Bewley have produced an excellent practical guide for clinicians on how to approach DV with pregnant women, including how to recognise women at risk, strategies for routine enquiry, and responses to reduce risk in those women that disclose DV. Another very useful practical guide is provided by the Centers for Disease Control in the format of a slideshow.
A number of researchers have looked at the use of screening and intervention for DV in pregnancy care, with a systematic review finding ‘the identification of DV was significantly higher compared to studies that used a non-standardised screen or no screen at all. There was also evidence that recurrent screening throughout the pregnancy further increased identification rates.
There was some evidence that interventions for pregnant women who had experienced DV reduced the amount of violence experienced by these women, but the evidence is very limited by the small number of randomized studies with small participant numbers’ (2). Deshpande and Lewis O’Connor have looked at a number of possible screening tools and highlight pregnancy providing a unique opportunity to identify and screen for patients experiencing DV, particularly given the repeated contact with health care providers and unique opportunity to develop trust between the patient and health care team team.
1) Domestic Violence and Pregnancy. Women’s Aid. http://www.womensaid.ie/campaigns/domesticviolenc1.html
2) O'Reilly R, Beale B, Gillies D. Screening and intervention for domestic violence during pregnancy care: a systematic review. Trauma, Violence, and Abuse 2010; 11(4): 190-201.