The research identified barriers to disclosure remain, often connected to the presence of a partner during consultations or language barriers.
Researchers Professor Debra Salmon and Kathleen Baird, Senior Midwifery Lecturer, from the University of the West of England, working in partnership with the midwifery teams at North Bristol NHS Trust, have been examining this subject since 2004. The latest report, ‘A Five Year Follow up Study of the ‘Bristol Pregnancy Domestic Violence Programme’ and Introduction of Routine Antenatal Enquiry’, has concentrated on three distinct areas; how pregnant women felt about being asked about domestic violence; the experience of maternity care amongst those women living with a violent partner and how the changes in midwifery practice to encourage disclosure have been maintained since their introduction in Bristol in 2004.
The key findings indicate that of the 79% of women taking part who had been asked about domestic violence 94% said they were comfortable with being questioned, 96.6% thought questioning to be appropriate and 95.3% understood the reasons for the questioning. 95% thought that women in an abusive relationship would benefit from advice and support that midwives would be in a position to help with.
Comment from participant who took part in the study:
“I understand why midwives ask about domestic violence, I do not have a problem with them asking me. I believe that midwife should ask about the relationship questions. Midwives have asked me about domestic violence in my last two pregnancies, and I feel it was a good thing.”
Around 300 women took part in the Bristol survey and of the four who said they were suffering domestic abuse only two had told the midwife. Eight women using local domestic abuse services undertook face to face interviews and they unanimously agreed it was essential that midwives asked about violence as they would not have had the courage to bring the subject up if the midwives had not.
Comment from participant:
“I was able to trust them enough to tell them. I was not embarrassed by being asked. I know they ask because they care……Yes the midwife was so helpful, as soon as I told her about the violence and threats she helped me, even helping me fill out the necessary forms. She came to visit me in the refuge when I was no longer staying at my friend’s house. She even arranged for the interpreter to be there for my scan appointment. I felt I could trust her.”
Comment from participant:
”The abuse is worse in pregnancy, he is more verbally abusive when I am pregnant, he makes extra demands on me in terms of looking after the house, he shouts at me and treats me like slave.”
Midwives report a growing confidence in communicating with pregnant women about the difficult subject of violence and stressed that it is important to have at least one opportunity to meet with women without their partner being present.
Comment from midwife: “Yes that is the main barrier if he’s with her at every appointment; you know you have not asked her but what else can you do, as we never ask the question in front of the partner.”
Professor Debra Salmon says, “The study will play an important role informing future policy and practice in this important area. As well as the survey of pregnant women and midwives we also consulted with key stakeholders including Primary Care Trusts, NHS Trusts, social work professionals and young people’s services.”
Ann Remmers, Director of Midwifery, North Bristol NHS Trust, said, “It was great for NBT to be able to collaborate once again with UWE on further important research into ante-natal support around domestic violence. The results of this research show this should form a key part of midwifery practice, which is of huge benefit to women and their families who experience domestic violence.”
The project is funded by Avon Primary Care Research Collaborative.