Screening for Domestic abuse in pregnancy is an expected role of the midwife. Jeannine Marie Webster, midwife in Dublin, shares some thoughts on this role and the new screening guidance for Ireland.
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Midwifery is a holistic profession, we view the woman treating the mind and the body, not only witnessing their physical and emotional transition to motherhood but being conscious of the impact of social conditions and background that may also impact on their journey to motherhood. The mother/midwife relationship is built on trust and partnership seems to offer a safe space for women to disclose their history, some for the first time.
In 2017, I was midway through my master’s degree in health and social care when at an antenatal clinic I met a woman whose healthcare record at first glance caused concern, repeated nonattendance at clinics, and specifically those that focused on her alone rather than routine antenatal assessments, I also noted that she disclosed a history of Domestic Violence with her ex-partner. I undertook to sit with her and talk her through what might be going on for her. What emerged from that discussion was a story of fear, confusion, anxiety, and frustration alongside physical exhaustion. That visit we set upon a plan that might support her, aligning all her non routine and routine appointments to one day ensuring that they coincided with childcare etc. I also contacted the secure accommodation she was living in to inquire if there were any practical supports, they could offer her and her family. Afterwards I liaised with the maternity medical social worker who was happy to support the plan.
From then the focus of my masters changed, I wanted to explore the whole area of domestic violence in pregnancy and role of midwives in the care of women with a history of domestic violence.
In my master’s thesis I researched the background and incidence of domestic violence, its impact in pregnancy and to capture the views and experiences of midwives screening for domestic violence in pregnancy. My findings showed that, overall, midwives seemed to welcome screening, feeling they did have a central role to play in identifying women experiencing domestic violence. However, the literature determined that there were many areas that midwives felt were lacking, namely education, structural/organisational deficits, and support for midwives themselves.
Now five years on from my masters, I find myself presenting our new national guidance on screening for domestic violence in pregnancy at the All-Ireland Maternity Festival. In 2021 I was invited as an advisor onto an external expert committee advising Women’s Aid regarding establishing a training program specifically for allied healthcare professionals caring for women in pregnancy and development of a maternity outreach worker to liaise between maternity hospitals and Women’s Aid. Stemming from my involvement in this project, I was asked to join a working group in the National Women’s and Infants program who were in the process of developing a new guideline on screening for Domestic Violence in pregnancy.
The new guideline is due to be published soon in 2024; central to the guideline are the 3 R’s, Recognise,Repond and Refer, the key recommentations are
- Mandatory antenatal screening for domestic violence for all women attending public care, semi-private care, private care and all community settings.
- All domestic violence screening should only be undertaken by trained staff.
- Appropriate domestic violence training is provided to all staff in maternity settings.
- Domestic violence screening takes place face to face with the woman in a private setting where safe to do so.
- At least one individual consultation without the woman’s partner present should be offered to all women during pregnancy.
- Professional interpreters/translators are used to screen for and discuss concerns relating to domestic violence.
- The introduction of the electronic healthcare record system to all maternity hospitals/units would ensure consistency in screening for domestic violence in pregnancy. It is recommended that a woman who makes a disclosure of domestic violence should be offered a referral to a Medical Social Worker. Best Practice
- Child protection concerns relating to domestic violence are a mandatory referral to Tusla.
- GardaÃ/ Sexual Assault Treatment Units should be contacted with the woman’s consent following a physical/sexual assault.
- Clear plans documented in the healthcare record for the woman’s care including intimate care.
- That all services have pathways in place to ensure the safety of the woman and of the staff taking care of her.
- Postnatal screening of domestic violence for all women takes place prior to discharge from hospital, or community and domiciliary services.
- Discharge packs should provide information on domestic violence, including information on local and community supports as well as supports in the maternity unit.
- Disclosures of domestic violence are notified with consent to GPs and PHNs in discharge letters to ensure further and ongoing support for women.
- Medical Social Workers in all maternity hospitals/units.
- Medical Social Workers are involved in the provision of multi-disciplinary training of and support for hospital staff.
Reflecting on my own experience and the research I undertook, I am hopeful that, the combination of the publication of the new guidance and the introduction of robust training of midwives and all other allied health professionals by Women’s Aid, we will see an increased awareness and Recognition of the importance of screening for domestic violence in pregnancy and  a confidence in our Response and Referral.
Jeannine Marie Webster
April 2024
2024