Pregnant Women are at increased risk of domestic violence across all cultural backgrounds
Domestic violence occurs across all age groups and life stages. Rather than reducing during pregnancy, expecting a child is a key risk factor for domestic violence beginning or escalating.
Research, published in the journal BMJ Open, found that 4.3% of pregnant women due to give birth in Western Sydney disclosed domestic violence when asked about it by a midwife at her first hospital visit. The study examined more than 33,000 ethnically diverse women who gave birth between 2006 and 2016, and found that these disclosures spanned all cultural groups.
Domestic violence in pregnancy not only causes distress and trauma for the mother and baby, it increases the risk of the baby having a low birth weight or being born prematurely, which is linked to poor health outcomes.
Depending on the state or territory, women may receive a “psychosocial” assessment from midwives when they first book into a public hospital during pregnancy. This screens for depression, anxiety, childhood abuse, domestic violence, support and stress. Using these assessments, the researchers found that 4.3% of women disclosed domestic violence overall, but rates were higher among women having a subsequent baby. The reasons for this were not clear.
Women who disclosed domestic violence in the study were more likely to have a history of anxiety or depression (34%) and have thoughts of harming themselves. The researchers were concerned by this as maternal suicide during pregnancy or following the birth appears to be rising and has now become one of the main causes of maternal death in Australia.
Researchers also found rising rates of pregnant women disclosing domestic violence and being admitted to hospital for bleeding and signs that labour may be starting early (before 37 weeks). When this happens, women are admitted to hospital to try to stop the labour, or to find the source of the bleeding. Sometimes stress can contribute to preterm birth and bleeding in pregnancy.
Regarding what needs to be done: the research states:
- Midwives need to consider cultural norms and acceptability when asking migrant women questions about domestic violence, and this must always be done in a way that keeps the woman safe.
- Partners should not be present when the questions are asked – and this may be done at another time in the pregnancy if necessary.
- Where English is not the first language, interpreters should be used. But this can also present challenges if the interpreter comes from the same community and is known to the woman.
The research also supports continuity of midwifery care as it enables relationships and trust to develop between the patient and health professional. The authors argue for this kind of care to be rolled out more widely in Australian public hospitals.
Read the article here