Hand Held Ultrasound Machine for Pregnancy Testing

Pregnancy and Intimate Partner Violence

Hand Held Ultrasound Machine for Pregnancy Testing 1

by Professor Jenny Gamble and Dr Kathleen BairdBeing pregnant offers no protection from intimate partner violence (IPV). Up to 30% of women first experience IPV during pregnancy, probably because they are more reliant on their partner for support and are therefore more vulnerable. Over 400,000 Australian women report IPV in pregnancy. Males who are violent toward their pregnant partners have few moral boundaries. They are more likely to use increasing force in the attacks, placing their partners at increased risk of homicide. The unborn baby is at significant risk as perpetrators often target blows to the abdomen — a strategy that increases both fear and control. Children suffering from the incidences and impacts of domestic and family violence are not only known to be socially and academically disadvantaged over the long term, but are also more likely to become distrusting of adults, with 1 in 5 developing antisocial behaviours such as aggression and violence.White Ribbon Day raises community awareness about the need for a range of preventative measures and responses to domestic violence, it can also be observed that health professionals such as midwives have been underutilised and have the potential to play a key role in both preventing and responding to violence.Not being asked about violenceWe know that many women are reluctant to disclose their experience of violence for fear of:not being believed,being judged and stigmatised,the risk of having children removed, orsimply because she may think nothing useful can be done about her situation. Women want to be asked about IPV during pregnancy and can feel let down if they are not given an opportunity to disclose their experience of violence.In our research, one woman commented about the failure to ask about IPV saying,"No, the midwife did not ask me about domestic violence and I found it really hard to talk to her. …. I was thinking I should tell the midwife, but I did not know how to bring it up. … if the midwife had asked me, or I knew the midwife better, I might have told her".Another woman talked about feeling alone and wishing the midwife had asked her about IPV saying,"The midwife never actually asked me and I wish they had and offered me some help. You feel you are the only person living with violence …"It seems unreasonable to expect a woman to willingly disclose abuse to health professionals in our fragmented maternity care system, where they traverse maternity services and experience a different health professional at almost every encounter. Transforming maternity services: Relationship-based careWhile midwives could play a much greater role in asking women about abuse, offering an initial response and facilitating access to other services, this is much more likely to be effective if we remodel the delivery of maternity services.High quality evidence from 15 randomised controlled trials and over 17,000 participants show that women and their babies fare better when they are provided with their own midwife throughout pregnancy, labour and birth and up to at least 6 weeks after birth.In a 2015 update of a Cochrane systematic review demonstrated:a reduction in preterm birth,lower rates of death for babies,higher rates of normal birth, andlower rates of intervention in labour for women provided with continuity of midwifery care. Outcomes were improved, or were no worse, for every outcome measured. This model of service delivery also costs less than the current system for providing maternity services and women prefer it.Other research indicates that midwives offering continuity of care experience lower rates of stress and work related burn out. There increasingly high quality and robust evidence to support the provision of women with a continuity of midwifery care than for just about any other health care intervention. Despite this overwhelming evidence, less that 8% of Australian women have access to this model.We also know that women experiencing violence or at an increased risk of violence are much more likely to disclose to a trusted person. Trust develops through relationships. Our professional experience in providing continuity of care is that women will make contact again at different times in their life, sometimes years later.In continuity of care relationships, women have a person to turn to — a trusted, knowledgeable person to share sensitive information with and not feel judged.Changing the model of maternity service delivery so that each woman has her own assigned midwife (with back-up midwife) would enable her to establish a close relationship with one or both healthcare professionals. Basing midwives in the community, co-located with other community services providing home visits during pregnancy and after birth, accompanying the woman to the hospital or centre for the birth has significant potential to meaningfully address intimate partner violence.Midwives are welcomed into homes and can engage with families in ways that many other professionals can not . This relationship has the potential to provide safe opportunities for disclosure and to offer support, including referral to expert agencies that work in the community. What about primary prevention?Primary prevention strategies seek to remove the causes of violence, to prevent the development of risk factors associated with violence, and/or to enhance the factors protective against violence.Prevention strategies midwives could implement include:providing general information,skills training in respectful couple relationships,community development to grow a network of women to foster adequate general social support.assisting the couple with their transition to parenthood and parenting which we know is protective against violence. Midwives can support women to identify their needs and help them set their expectations of support. The midwife can assist and support a woman in understanding attitudes and social norms that support violence, enable her to identify disrespectful behaviours, as well as communicate the standard of respect required in an intimate relationship. Importantly, the midwife is in a prime position to assess the level of partner support and to witness controlling behaviour and couple conflict. As one woman attending the intimate partner violence summit commented,"It probably seems simplistic but it's really important to raise awareness and increase people's knowledge about the issues, because the bottom line is if a person does not see that there's a problem, they are never going to do anything.".This applies to the whole community.The cultural change needed to prevent violence, as with other complex health and social issues, requires a multidisciplinary approach involving reinforcing strategies implemented with individuals, families, organisations and communities. It is important that midwives are integrated into such a response using relationship-based continuity of midwifery care model of maternity service delivery. Listen to Rachel Kayrooz, a former victim of domestic violence while pregnant, and Dr Kathleen Baird, talk about the need for training for midwives in handling cases of domestic violence.ABOUT THE AUTHORSProfessor Jenny GambleProfessor Gamble is Head of Midwifery at Griffith University. She is internationally recognised professional leader and researcher into models of maternity care and perinatal mental health. She is a strong advocate for women-centred of care, and humanising and de-medicalising care.She has authored over 100 peer-reviewed published papers and several book chapters. As Head of Midwifery she developed an award winning innovative Bachelor of Midwifery program, and developed a high quality academic team with depth and breadth of clinical expertise. She pioneered continuity of midwifery care in Queensland when she established a private midwifery practice. She was the first midwife to gain visiting rights to a Queensland hospital (1992).She was honoured with a Churchill Fellowship in 2007 in recognition of her commitment to quality maternity care and supporting transition to motherhood for socially disadvantaged and vulnerable women. Her life's work has been aimed at reforming maternity services and developing the capacity of midwives to respond to childbearing women's needs.Dr Kathleen BairdDr Baird is a Senior Midwifery Lecturer at the School of Nursing and Midwifery, Griffith University and Director of Midwifery and Nursing Education, Women's and Newborn Service, Gold Coast University Hospital.For the last fifteen years Kathleen has researched intimate partner violence, with a focus on violence during pregnancy. Her PhD explored women's experiences of partner violence during pregnancy, birth and the postnatal period. Kathleen has been involved with domestic violence training of health professionals, undergraduate and postgraduate health students and members of the voluntary services for several years. Kathleen is currently involved with several research projects in relation to intimate partner violence and the role of health care and has recently been invited to join the Queensland Domestic and Family Violence Prevention Council. Return to the Machinery of Government.

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