Domestic Abuse in Pregnancy

Warning

TARGET AUDIENCE: All Maternity and Neonatal Staff Groups.

PATIENT GROUP: Unborn babies, neonates and children.

  • Outline indicators of abuse, incidence and types of abuse as well as key agencies who may become involved.
  • Provide staff with supportive information to recognise and respond appropriately to anyone experiencing domestic abuse within maternity services.

Domestic abuse can affect men and women, straight and gay relationships, regardless of culture, religion, age or class. Domestic abuse is carried out by partners or ex partners and includes a variety of different behaviours such as:

  • Physical – hitting, punching, kicking
  • Emotional – threats, humiliation, criticism, name-calling, isolation, coercive control (discussed further below)
  • Sexual – rape, sexual assault
  • Financial – withholding money, financially dependent, not allowing work
  • ‘Honour based’ violence, forced marriage, female genital mutilation (FGM), ‘honour’ crimes

(Scottish Government, Equally Safe, 2017).

Domestic abuse is a form of Gender Based Violence (GBV) which means the violent and abusive behaviour carried out predominantly by men is directed at women because of their gender.

Domestic Abuse (Scotland) Act 2018 came into force on 1st April 2019. The legislation criminalises domestic abuse and coercive control. In the first 12 months since the legislation was introduced there were almost 1700 offences recorded by Police Scotland. Under the act, domestic abuse is understood as behaviour that is violent, threatening or intimidating towards a partner, ex-partner, and/or child. Examples of but not selective to the following:

  • making them dependent on their partner
  • Isolating from friends, family or other sources of support
  • Controlling, regulating or monitoring daily activities
  • Restricting freedom
  • Humiliating, degrading, punishing them
  • This includes abuse within the home, in public places and also online/social media.

Research suggests that pregnancy is an additional risk factor for domestic abuse occurring, therefore professionals in maternity services have a duty of care to respond and recognise appropriately.
Regular contact and continuity of care are crucial to support women and families experiencing domestic abuse.

Prevalence of domestic abuse can be difficult to determine as many women will not report the incidents and therefore are likely to be much higher than data we are able to collect.

Calls to the national domestic abuse helpline soared by 66% during the lockdown period.

SafeLives (2020)

60,641 incidents of domestic abuse were recorded by Police Scotland between 2018-2019 and it accounts for 20% of all police business.


88% of reported domestic incidents take place within the home, however they can happen anywhere.


35% of domestic abuse incidents occurred at the weekend.

Police Scotland figures reflect that the gender of people involved in domestic abuse incidents were: 82% male abuser, female victim, 16% female abuser, male victim, 1% male abuser, male victim, 1% female abuser, female victim.

Police Scotland (2020)

MMBRACE (2024) report shows 72 out of 625 deaths attributed to domestic abuse; 12% of the women who died during or up to a year after pregnancy in the UK between 2020-2022 were at severe and multiple disadvantage. The main elements were issues regarding mental health, substance misuse and domestic abuse.

Around a third of women’s records (31%) had missing information on routine enquiry being offered which remains a significant proportion of women not being asked regarding domestic abuse at booking or throughout pregnancy period.

MMBRACE (2024)

Initial disclosure:

  • Carry out routine enquiry in a safe, quiet and private space.
  • Respond sensitively and enable the woman to talk openly.
  • Provide an interpreter for a person who is hearing impaired or person where English is not their first language (ensuring this is not a family or friend).
  • Ask non-threatening but clear questions, e.g. do you feel safe at home? Have you ever been fearful for your safety or the safety of your children? Are you currently frightened of your partner or someone close to you?
  • An instinctive response to hearing someone is experiencing domestic abuse is to tell them to leave the abusive partner. However, advising someone to leave their relationship is not always good advice. Separation can be a time of heightened risk for people experiencing domestic abuse and for their children. The majority of domestic homicides occur during or just after separation. Stalking and harassment is also more likely during or just after separation.
  • Discuss a safety plan with the woman; refer to point 11 for more details.
  • Offer useful contact information.
  • Document accurately in Routine Enquiry page on woman’s Badger record ensuring detailed information is recorded regarding type of abuse disclosed, dates, agreed plan and discussions had with the woman and further actions taken.

Further actions:

  • Regular monitoring of the health and wellbeing of victim and unborn baby, additional appointments which suit the woman and encourage her to be seen alone where possible.
  • Sharing of appropriate information with health visiting/FNP services, any additional professionals involved in woman’s care.
  • Seek guidance on adult and child protection procedures (point 7).
  • Ensure staff safety and wellbeing (refer to Lone Working Policy).
  • Further routine enquiry opportunities at a later date to identify potential increasing risk.
  • Speak to line manager, senior midwife team for support.
  • Make senior inpatient staff aware prior to delivery if specific plans are in place, e.g. no sharing of information in ward setting, make clear in maternity notes.

Often there are no external signs of domestic abuse. However, there may be potential indicators which may alert midwives to domestic abuse without a disclosure such as:

  • Late booking.
  • Poor/non-attendance at clinic.
  • Non-compliance with treatment.
  • Overbearing/ever present partner.
  • Injuries inconsistent with explanation.
  • Frequent attendance to health services, admissions with minor symptoms.
  • Mental health problems.
  • Substance misuse.
  • Appearing evasive, frightened, hesitant.
  • Poor obstetric history, miscarriage, terminations, preterm birth, IUGR.
  • Unexplained medical complaints, e.g. gastrointestinal issues, genitourinary symptoms, sexual health issues.

Adults


There will be some situations where a person experiencing domestic abuse may also be an adult at risk of harm as outlined in the Adult Support and Protection Act 2007. An adult at risk is a person over the age of 16, unable to safeguard their own wellbeing, property, rights or interests; and they are at risk of harm as they experience disability, mental disorder, physical or mental illness.

Adult Support and Protection Act (2007)

Please refer to or discuss with adult support and protection team if concerns and follow guidance available on FirstPort:

http://firstport2/staff-support/public-protection/adult-support-protection/default.aspx

 

Children

A child living at home with domestic abuse is said not to be just a ‘witness’ but they also experience it. When there are concerns for children’s wellbeing, these should be dealt appropriately through NHSL Child Protection processes.

Please refer to Getting It Right for Every Child (GIRFEC) and National Child Protection Framework and local guidance for maternity services in relation to child protection.

For any child at risk of FGM under the age of 16, staff must also refer to child protection procedures
Domestic abuse is recognised as an ‘Adverse Childhood Experience’ that can have long-lasting effects on their physical and mental health.

Please discuss with the child protection team if concerns and follow guidance available of Firstport:

http://firstport2/staff-support/public-protection/child-protection/default.aspx

There are many reasons why a woman may feel unable to leave an abusive partner:

Finances – leaving has a huge financial impact, especially if the person is financially dependent on an abusive partner.

Housing – idea of becoming homeless or finding accommodation can prove significant barrier.

Possessions – economic and emotional impact on leaving personal items behind.

Children – taking children from their environment, school, family and changing routine.

Support network – losing family support network by moving out of area.

Court and legal concerns – legal proceedings of divorce, child contact and access.

Immigration status – right to stay in the UK, partner visa for example, threat of deportation.

One of the main concern is around interventions – social work involvement, children being removed or being part of child protection proceedings.

Safe and Together (2011) principles are to keep children safe and together with the non-offending parent. The focus is for professionals trained in the program to intervene with the perpetrator to reduce risk and harm to the child.

Safe and Together (2011)

Representatives from North and South Lanarkshire attend the Multi-Agency Risk Assessment Conference (MARAC) to discuss the highest risk victims and perpetrators of domestic abuse in their area.

The main aim of the MARAC is to reduce the risk of serious harm or homicide for a victim of domestic abuse and increase safety, health and wellbeing of victims and their children.

Confidentiality – As MARAC deals with very high risk cases of domestic abuse, consent is not required to share sensitive, proportionate information.

Advising the victim that their case will be discussed at MARAC can be done if deemed safe to do so. However, do NOT advise the perpetrator that their information will be shared, as to do so many further endanger the victim and any children.

If a victim is pregnant or has recently given birth, maternity services will be invited to attend and the representative should consider the following:

  • Information that provides detail of the perpetrators pattern of abusive behaviour including abuse to partners, ex partners.
  • Whether domestic abuse was disclosed at routine enquiry.
  • Signs of physical injuries.
  • Concerns about the behaviour of the victim’s partner (e.g. speaking for her, always present).
  • Information on any protective factors, e.g. family support, engagement with services.

Please note that trained professionals in GBV services are available to discuss safety planning with the victim in more detail and safety plans are individualised to each case. However, midwives may be able to suggest the following:

  • Keeping a small amount of clothing, essential items at a friend or relative’s house.
  • Keep important telephone numbers to hand.
  • Ensure important documents are easily accessed, e.g. birth certificate, child information, bank account details.
  • Make an extra set of keys for home or car.
  • Have money saved or hidden for emergencies.
  • Share if there are times you know you can talk safely with specialist worker/health professionals.
  • Empowering victims to make decisions about their safety plan.

Scotland's Domestic Abuse Helpline 0800 027 1234 (24 hour service)
Public Protection team (Child, Adult, GBV service) 01698 894124
Scottish Women’s Aid 0131 226 6606
Rape Crisis Scotland 08088 01 03 02 6pm to midnight, 7 days a week)
NSPCC Female Genital Mutilation Helpline 0800 028 3550
Forced Marriage Unit 020 7008 0151
Police Scotland 999, non-urgent crime 101
Scottish Women’s Rights Centre 0141 331 4183
South Lanarkshire Women’s Aid Hamilton 01698 891498 East Kilbride 01355 249897
North Lanarkshire Women’s Aid 01236 730992
Medics Against Violence www.mav.scot/navigator/  University Hospital Wishaw 07463930890

  1. Domestic abuse awareness raising tool Accessed: https://www.daart.scot/#/lessons/twEiePvJCKS41lihVBCVpHmKIXZFDH2v
  2. Department of Health: Responding to domestic abuse A resource for health professionals (2017)
  3. Duluth Model Power and Control Wheel Domestic abuse intervention programs www.theduluthmodel.org. Accessed online: January 2021
  4. Getting it Right for Every Child (GIRFEC) (2008) Accessed: https://www.gov.scot/policies/girfec/
  5. MMBRRACE-UK: Saving Lives, Improving Mothers’ Care 2024: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020-22 (2024)
  6. NHS Education for Scotland Dr Sue Brechin Advice for Health and Care Professionals https://vimeo.com/408344058 Royal College of Obstetricians and Gynaecologists (RCOG) Coronavirus (COVID-19) Infection
  7. SafeLives Domestic Abuse (2020) Accessed: https://safelives.org.uk/news/lockdown-eases-surge
  8. Safe and Together (2011) David Mandell and Associates
  9. Scottish Government: Adult Support and Protection Act (2007) Accessed: https://www.legislation.gov.uk/asp/2007/10/part/1/enacted
  10. Scottish Government. Equally safe: Scotland’s strategy for preventing and eradicating violence against women and girls. Edinburgh; 2016. Accessed: www.gov.scot/publications/equally-safe-scotlands-strategy-prevent-eradicate-violence-against-women-girls 
  11. Scottish Government: Healthcare Policy and Strategy (2008) Gender Based Violence Action Plan Guidance for Health Boards Accessed: https://www.sehd.scot.nhs.uk/mels/CEL2008_41.pdf
  12. Scottish Government. National guidance for child protection in Scotland. Edinburgh; 2014 Accessed: www.gov.scot/publications/national-guidance-child-protection-scotland/NES
  13. Scottish Government. Domestic Abuse Recorded by The Police in Scotland, 2018-19. Edinburgh; 2018 Accessed: www.gov.scot/publications/domestic-abuse-recorded-police-scotland-2018-19/
  14. Scottish Government. The Domestic Abuse (Scotland) Act 2018 Accessed: www.legislation.gov.uk/asp/2018/5/section/13/enacted 

CONSULTATION AND DISTRIBUTION RECORD

Contributing Author / Authors Liz Walsh/Ann Hayne
Consultation Process / Stakeholders Maternity CEG process
Distribution All in Maternity

CHANGE RECORD

Date Lead Author Change Version No.
October 2015 M McCredie
M Moffat
Original version via Maternity Domestic Abuse Sub Group 1
December 2024 F Burns Update 2

Editorial Information

Last reviewed: 01/12/2024

Next review date: 31/12/2027

Author(s): Fiona Burns.

Version: 2

Approved By: CGGEG; Maternity Clinical Effectiveness Group

Reviewer name(s): Heather Weir.

Document Id: February 2025