Domestic abuse in and around the perinatal period is of increasing concern. This is testified in the recent release of the latest MBRRACE-UK Saving lives-improving Mothers’ care report. Speaking on the Maternity and Midwifery hour this week, members of the charity Safelives-Ending Domestic Abuse will be sharing the importance of their work in preventing and supporting those experiencing abuse and those caring for them. Fi MacLauchlan, Practice Consultant, and Ann-Marie Tierney, Lead Trainer and Assessor, for the charity explains more.
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SafeLives’ mission is to end domestic abuse (DA), for everyone, for good. It is an ambitious target for sure but underpinning that goal is a belief that domestic abuse is not inevitable. This is the purpose behind our work- transforming the response to DA in every sector so that no matter who a survivor goes to for help, they will get an empathic response that empowers them with options and considers the risk that is posed to them. Through communicating best practice and supporting frontline organisations to give the best response they can, we want things to change in society when it comes to DA- and all professionals have a part to play.
The UK Domestic Abuse Act 2021 is a landmark piece of legislation that addressed many aspects of domestic abuse, with the view of improving the response to survivors and their families. One of the most significant aspects of the Act was to establish a statutory definition of domestic abuse that sets out the behaviours that come under that umbrella, ensuring that non-physical types of abuse are highlighted alongside physical violence.
This reflects the understanding we have of domestic abuse that has evolved over the years. Controlling behaviour, economic abuse and psychological and emotional abuse are all hugely damaging for survivors and their children and yet these non-physical forms of abuse can be really difficult for professionals to understand, identify and respond to. This in turn means opportunities to intervene and offer support can be missed and survivors feel increasingly isolated, and risk can increase.
Universal health services are in a really key position to be able to have conversations with their service users and patients about DA. Midwifery services in particular have often been a vital part of the multi-agency response, working alongside women at one of the most exciting, daunting and overwhelming stages of their life. We know that around 30% of domestic abuse begins during pregnancy, while 40 to 60% of women experiencing domestic abuse are abused during pregnancy. So unfortunately, this period can also be frightening, isolating and fraught with risk. It is essential we are in a position to respond to expectant and new parents where DA is impacting their household.
Domestic abuse during pregnancy means more than 1 person is at risk- the abuse can have significant effects on the baby including a risk of miscarriage, infection, premature birth and direct injury. And for mum, the increased stress and anxiety of managing risk and trying to remain safe and well can have long lasting physical and emotional impacts.
Knowing the different ways that DA can manifest in a relationship; how a survivor may present in a health setting and how to have appropriate and trauma-informed conversations, is how you can be part of the professional response to abuse. With each question you ask and survivor you are able to engage, you are increasing the chance that that individual will feel safe and supported enough to reach out for support.
An exciting study SafeLives have had the privilege of providing specialist implementation support to is the RIVA study – Evaluating models of healthcare-based Independent Domestic Violence Advisors (IDVAs) within maternity services.
RIVA is led by a research team at Kings College London and the project aims to identify learning from NHS trusts that have implemented the Health Idva programme and evaluate the impact of the implementation activities of Health-based Idva provision with a specific focus on maternity services.
Healthcare-based Independent Domestic Violence Advisors (HIdvas) are an integral part of the multiagency response to DA. They are in an incredibly valuable position to provide practical and emotional support to those experiencing abuse within the healthcare setting. They can provide training about DA to staff across healthcare teams, working collaboratively with staff to provide the right support for victim/survivors of DA at the right time.
SafeLives have delivered practical support alongside facilitating community of practice sessions and open and honest conversations with Health Idvas and NHS staff. Through these engaging discussions, SafeLives consultants have been able to facilitate dynamic workshops to celebrate the valued work of the Health Idvas and open a platform for discussion about the successes and barriers to the implementation of the Health Idva programme.
Several themes have emerged across these workshops; most notably, the need for Routine Enquiry and robust Domestic Abuse awareness training.
It is incredibly important that midwives and maternity staff are supported to recognise their unique and invaluable position in responding to DA. Maternity services are one of the only services where pregnant women are expected to have multiple appointments and there is ample opportunity for routine enquiry about DA and safety at home questions to be asked at each and every appointment.
The impact of Routine Enquiry for survivors of DA can be astronomical; a woman may not choose to disclose when the question is initially asked but feel supported enough to make a disclosure next time, allowing for potentially life saving support to be provided to survivors and their families.
It is imperative that as maternity staff, you feel confident enough to have these often emotional and difficult conversations and use your professional curiosity to ensure the women you are providing care to feel safe, and that starts with robust DA training.
For more information on the RIVA project and Idva’s in maternity services, the following article is available for review:
Forbes, C., Alderson, H., Domoney, J. et al. A survey and stakeholder consultation of Independent Domestic Violence Advisor (IDVA) programmes in English maternity services. BMC Pregnancy Childbirth 23, 404 (2023). https://doi.org/10.1186/s12884-023-05731-1
More information about the charity and resources for Health professionals is available at https://safelives.org.uk/
Fi MacLauchlan,Practice Consultant, and Ann-Marie Tierney, Lead Trainer and Assessor
SafeLives: Ending Domestic Abuse
October 2024