Domestic violence among the pregnant women is among the leading causes of poor child development and weak maternal health (CEMACH 2007). Cases of domestic violence among pregnant women are on rise (McQuigg 2011). Countries like Ireland experience the highest rate of domestic violence (Women’s Aid 2010). Domestic violence among pregnant women is very common (Women’s Aid 2010). This fact contradicts the common belief that women are protected during pregnancy (Women’s Aid 2010). According to Campbell (2010), domestic violence is defined as abuses which include physical, sexual, emotional as well as financial ones. These abuses are more common in marriage. Domestic violence has been a challenge that is faced by both the developed countries and the developing ones. Cases of assault, harassment and abuse are reported every day by victims of this type of violence. The highest number of domestic violence victims is reported in third world countries (WHO 2005).
There are a number of maternal problems associated with domestic violence during pregnancy. Among these problems are haemorrhage, premature labour, low birth weight, placental obstruction, miscarriage, still birth and maternal death (Campbell 2010). The number of pregnant women reported to have died in the United States as a result of domestic violence between 1990 to 2004 was 1367 (Albert 2011). Those men to whom they unreservedly gave everything that matters and who were supposed to protect became the ones who hurt them most (World Health Organization 2010). Research has shown that several women are still the victims of domestic violence (Women’s Aid 2010). A study done in Ireland showed that 18% of women have in one way or another suffered from domestic violence (Campbell 2010). Another study, done on pregnant women in South Africa’s Rotunda hospital located in Dublin, showed that one of 8 women has experienced domestic violence. These studies however fails to the magnitude of domestic violence as well as what is done to curb this problem.
Most of the literature for this study was drawn from the U.S.A and U.K. Both qualitative and quantitative materials were used for this study. This is because health related issues keep on changing from time to time. The materials used for this study are books, journals, PubMed, Science Direct among others. The key words for this study are intimate partner violence, domestic abuse, and domestic violence. The main themes identified from the literature include Antenatal booking visit screening, Antenatal Screening in Focus, debate on antenatal clinic, Advantages of Antenatal car Working relationship between midwifes and pregnant women, antenatal booking clinic and Bioethics (Women’s Aid 2010). These themes are discussed below.
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Antenatal booking visits for domestic violence
According to World Health Organisation statistics report 2010, 1 of 5 women suffers from domestic abuse. Domestic violence refers to physical, sexual or emotional abuse from an adult perpetrator directed towards an adult victim (Campbell 2010). It is a case of betrayal where a party in a relationship, usually intimate, is assaulted by the person she trusted the most (World Health Organization 2005). It can refer to either party in a couple but in the majority of cases the victim is a woman. As indicated earlier, cases of domestic violence among women who are pregnant are on rise (Women’s Aids 2010). In every five women who are pregnant one experiences domestic violence during pregnancy (Women’s Web 2010). According to CDC (2010), the percentage of pregnant women experiencing domestic violence in the US is 4 to 17. This study is able to provide the existing figure of women suffering from domestic violence. However, there is no mention of various forms of injuries that these women experience. The majority pregnant women suffering from domestic violence are unlikely to report the matter to the health practitioner (Smith 2008). The number of pregnant women reporting incidences of abuse during pregnancy ranges from 4 to 8 per cent (CDC 2010). Screening of these women is, thus, essential to ensure that their maternal health is maintained. This is because domestic violence has implications on both foetal and neonatal well-being.
Approximately 25% of women reported cases of first abuse during pregnancy (World Health Organization 2010). This data is vital as it is meant to assist these women. This study however should have indicated the measure taken after the cases are reported. The violence may start or escalate during pregnancy (Women’s Web 2010). Domestic violence is a major societal public health issue. If a pregnant woman commits suicide or abuses drugs as a way dealing with violence, the innocent unborn suffers too. It may lead to death of pregnant woman, preterm labour, antepartum haemorrhage, birth with disabilities, perinatal death and even indirect harm due to a woman’s inability to get antenatal healthcare (Phelps 2012). Antenatal stress and depression may also cause neonatal disorders and complications in new-borns and this kills the dream of the expectant mother to deliver a healthy baby and robs the world of a great mind, a generation and the like. Recent research shows that the number of trained midwifes is quite low (Women’s Aid 2010). Some of these midwives do not possess the appropriate knowledge to offer counselling for these women (Women’s Aid 2010). This information is important as it will offer a platform for training midwifes.
Women suffering from domestic violence exhibit an increase in gynaecological, central nervous system and stress related problems (Phillips 2007). This study shows the various forms of abuse experienced by women. The study should have however indicate the measures taken in case these cases are reported in the health centre. Being a case of betrayal, domestic violence leads to a horde of adverse mental health impacts, including anxiety, post-traumatic stress disorder, and fear. It is one of the key causes of suicides and substance abuse among women (Women’s Web 2010). Overall decline in women’s immunity to diseases is also highly attributed to the stress from abusive relationships (Armstrong et al 2012). Most maternity facilities do not offer training for midwifes (CDC 2010). This study will allow for intervention by the government ministries to offer the training required by the women..
Research has revealed that, though assaulted, pregnant women seek medical assistance for injuries sustained from abuse by trusted intimate partners, they do so in a manner similar to attending to health problems not related to abuse (World Health Organization 2005). Most pregnant women are not willing to seek help whenever they experience domestic violence (Women’s Aid 2010). Screening for domestic violence has been done with success in a number of health institutions (World Health Organization 2010). The screening protects the unborn child as the necessary measures are taken to ensure that the mother is protected against further abuse by the spouse. It also reveals that she will only open up to a healthcare professional who is non-judgemental, benevolent and caring, besides close friends and family. A similar study has shown that an assaulted pregnant lady will appreciate assistance from a trustworthy professional who showcases compassion, and is supportive and understanding (Phillips 2007). This. Though indirectly, she will answer to questions asked in a sensitive manner and this forms one of the bases of designing the antenatal screening tool. Health officers, such as physicians, nurses and midwives, with the aforementioned traits will also listen to hints that depict a broken spirit, get to know the possible risk factors and assist the women (Armstrong et al 2012).
Response to domestic violence has fronted various initiatives within health services. The last two decades have experienced formation of clubs, focus groups and movements that sensitize women on gender based domestic violence. Policies have been fronted with many protocols and training programs in place (World Health Organization 2005). Antenatal screening is one of the methods recommended to help in the analysis of potential risks, identification of women experiencing domestic violence and trying to provide solutions to help end such violence and assist the survivors through the healing process (Armstrong et al 2012). Midwives are being trained on the whole process of conducting ‘seed bearing’ antenatal screening (Phelps 2012). Many pregnant women are not willing to reveal the fact that they are victims of domestic violence. Study done by Leone et al (2010) reveal that the use of various methods such as interview, use of questionnaire, as well as focus group discussion that can help in extorting information from these women.
Antenatal Screening in Focus
Antenatal screening in the context of domestic violence refers to routine procedures provided by midwives, nurses and other healthcare officers to expectant women seeking to find out whether the developing foetus may be affected by physical, physiological and emotional discomfort of the mother (World Health Organization 2005). In other words, it is woman-centred care aimed at identifying possible risks that may affect the unborn baby for the purpose of informed decision making. These procedures have been endorsed by various stakeholders, among them British Medical Association, The Royal College of Midwives, Royal College of Obstetricians and Gynaecologists and the Royal College of Psychiatrists (Phelps 2012).
Antenatal classes in general provide a wide range of services with great differences depending on the risk level facing the expectant mother (Armstrong et al 2012). Labour mechanisms, relaxation techniques, controlled breathing, attention focusing manoeuvres during labour are among the topics discussed (Jones 2012). The pregnant woman and the supporting friends and family, who are also allowed to be there during the process, are able to learn the norms of the hospital and the delivery rooms, the rules and regulations of the hospital in relation to delivery in order to prevent the last minute rush. It is during the screening process that the mother gets to know what she expects: a boy or a girl, whether she expects twins or not. This knowledge is also necessary for preparing the mother’s kit. As scientific as the screening suggests, some tests, such as blood group of the foetus and the Rhesus factor issue among others, are also addressed during the antenatal screening booking (Jones 2012).
Antenatal booking visit screening is one of the programmes by healthcare professionals with a focus on pregnant women (Armstrong et al 2012). This is so because expectant mothers are also highly affected by domestic violence, just like any other woman out there. When this happens more than once and the woman’s life is endangered, there becomes evident the necessity of having a programme specifically tailored for pregnant mothers (Jones 2012). Stress, depression and bodily harm to an expectant lady may have adverse implications directly to the mother and indirectly to the unborn baby. Many postnatal disorders on babies of abused mothers have been associated with violence. At times, cases of preterm births and miscarriages are reported and this leaves bitter memories to the survivors of domestic violence (World Health Organization 2010). Midwives, psychiatrists and other healthcare professionals are, therefore, charged with the responsibility of preventing such cases and helping the expectant mothers through the healing process (CDC 2010).
The objective of this review is to delve deeper into the relationship between domestic violence on pregnant women and the antenatal booking visit screening (Jones 2012). It also focuses on the importance of these procedures with materials borrowed heavily from Cochrane library, Elsevier Library, World Health Organization and other literature works with a statistical and medical inclination.
Antenatal Booking Visit Screening for Domestic Violence
One of the key objectives of antenatal screening is to facilitate early identification of abuse (Jones, 2012). This is essential in eliminating violence and subsequent health problems in women’s lives and those of their children (Jones 2012). It was noted earlier that abused women may not be in a position to disclose the situation. This is because they have stigma and may also be protecting their spouses against being taken to jail (Women’s Web 2010). In addition, the signs of abuse are not always obvious (Jones 2012). This means that if healthcare professionals rely on presence of visible suspicious injuries, they may miss out on providing valuable assistance (CDC 2010). Worse still, they may prescribe the wrong treatment to the underlying cause of ailments. This may further jeopardize the well-being of the woman and the unborn baby. As mentioned earlier, the dream, desire and yearning of every expectant woman is to give rise to a healthy baby (World Health Organization 2005). The fear of losing the baby in women who do not understand what the antenatal screening process entails is, thus, understandable. This, therefore, calls for a description of the process and the screening tools. The process in the context of domestic violence is more of a question and answer process and the screening tools herewith referred are a set of questions aimed to help the healthcare officer in determining whether the woman in question has suffered or is suffering from domestic violence. The process does not put the baby to risk (Jones 2012).
Debate on Antenatal Clinic
The inclusion of biomedical term ‘screening’ limits the process to medical professionals as argued by those opposed to antenatal booking visit screening (World Health Organization 2005). This is found to be misleading since the antenatal process is more of a communal duty than a professional duty as the health professionals put it. The process is, however, considered to be more of counselling than medical treatment (Armstrong et al 2012). It deals with the treatment of stress and stress-related ailments which majorly rely on counselling and speaking out on the part of the afflicted than it does on medical procedures. It is argued that a trusted well informed friend, family member, or even a qualified counsellor may help in the healing process of a survivor of domestic violence and her baby even though further treatment may be required (World Health Organization 2005). The word ‘screening’ also makes the whole idea of antenatal screening to appear like the diagnosis of a disease while in essence it is not a disease (NICE 2013).
Phillips (2007) argues that antenatal booking visit screening focuses its attention on the disclosure of abuse but the most crucial end point which concerns assisting the abused woman is sometimes left unattended (World Health Organization 2005). He argues that midwives will call it shots after asking the assaulted the question ‘Would you like to be assisted?’ If the victim answers ‘yes’ to this question, she is provided with the same reading materials provided to another lady who answered ‘no’ to the same or similar question (Phillips 2007). In other words, there is no specialised assistance to the suffering woman. This has made the women to continue suffering (clinical guideline, 2008).
Working Relationship between Midwifes and Pregnant Women
In conducting the antenatal screening, the midwife is required to develop a good rapport and a trusting relationship with the pregnant woman in order to create an easy moment and eliminate the discomfort of asking personal questions (Phillips 2007). The assaulted woman must be expressly assured that the information she gives will remain confidential to make sure that she feels secure. As noted earlier, the woman may be a little bit conservative in answering direct questions (World Health Organization 2005). The screening tool being used by the midwife should, therefore, contain questions that are both direct and indirect (NICE 2013). The midwife must also assure the expectant mother of confidentiality and deal with how to respond to disclosures of abuse (National Assemblies for wales, 2001).
Advantages of Antenatal Care
Suppose you are wondering why antenatal booking visit screening is so essential. Some of the advantages of this process have been implied in the paragraphs above, among them: the expectant mother gets familiar with the health facility and how it functions early enough (Women’s Aid 2010). Midwives get to know their clients and subsequent visits become easier and friendlier. This reduces anxiety and saves time which would be wasted in looking for specialised attendance during late pregnancy and delivery. During antenatal screening booking the mother will be able to know whether to expect twins, triplet, etcetera, and plan accordingly for what is called the mother’s kit. The scanning also provides pictures of the baby’s position and, thus, detects and prevents any complications that may emerge (Phillips 2007).
Apart from counselling blood screening for anaemia, lack of antibodies, blood group, Rhesus factor, urinary tract infections and sexually transmitted infections analysis are done (Women’s Aid 2010). This allows early diagnosing and prevention of further complications to the mother during late pregnancy and during labour (Ayers 2007). Healthcare professionals put in place measures necessary to prevent transmission of any infections found to the foetus. They prepare themselves for any complications that may occur to the baby during labour and they are able to monitor the mother more closely with facts at hand (Armstrong et al 2012).
Effectiveness of Antenatal Care
The only reason why antenatal care has been highly recommended by governments, highly credible institutions, as mentioned earlier, professionals in healthcare sector and healthcare facilities in general is because the results reported are awesome (World Health Organization 2005). Mothers have reported less pain during labour, the delivery of healthier babies and the reduction of anxiety during late pregnancy and labour periods (Ayers 2007). Neonatal ailments in babies have also reduced as complications are known and controlled beforehand. Mothers and their families reported cost reduction at labour point which is associated with preparedness and the lack of last minute hassles (Women’s Aid 2012).
Midwives are key players in responding to domestic violence. They report to have an easy time knowing their patients during the antenatal booking visits. They were, therefore, familiar with their needs and ready for the endpoint procedures (Ayers 2007). They know when and where to expect which patient and what their needs are. This makes delivery of service faster, more efficient and effective (National Assemblies for wales, 2001).
Antenatal booking visit screening is not a one day thing or rather it is a routine and so the expectant mother should be able to get antenatal care after making several visits to the health facility (Women’s Aid 2010). The ethical issue then comes into the picture: the question is, whether the health facility in question is accessible. If accessibility is an issue, then it is fair to ask whether it is ethical not to provide antenatal care routinely as required. On the other hand, the issue of risk level facing the expectant mother arises. For example, a mother in a third world country, where no rules to protect women from violent partners are in place, is said to be in a more risky situation compared to woman in the developed country. It is unethical to provide care to a low-risk expectant woman as this is considered wastage of scarce resources that could be used elsewhere (Ayers 2007). This study offers the solution to issues relating to domestic violence. it is also able to distinguish between women who are prone to experienced domestic violence.
The significance of antenatal booking visit screening cannot be assumed, especially by women who suffer from domestic violence during pregnancy. This woman-centred care is an empowerment programme that enables informed decision making. Governments all over the world should make the services affordable and ensure that the services are also accessible. Midwives and healthcare professionals must provide high standard services to the expectant mothers and ensure that the prevailing environmental conditions are conducive and secure for the abused woman to pour her heart out and provide sufficient time for consultation (World Health Organization 2010). Family, friends and psychiatrists are there to extend their moral support and in unison the world will enjoy healthier off springs and great minds in future (Armstrong et al 2012). More literature, especially on the role of midwife in screening, is needed as there are quite a few books on the topic. Together we will have a healthy world.
- there is need for studies in the future to include midwives who fail to undergo training. Such groups should be compared. This can include outcomes comparative analysis for women on the basis of differing question models.
- There is need to establish enquiry programs which include appropriate referral, support as well as follow-up for women.
- Midwives ought to undergo both pre as well as post-registration education as well as training.in addition, they should also be supported professionally.
- More staffs who supports women overcome trauma as a result of domestic violence ought to be increased.
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