Expecting abuse

Starting next year, all women attending their first visit at the Rotunda maternity hospital will be asked if they are experiencing domestic abuse.  FIONA GARTLANDfinds out the reason behind the question

WHEN A woman is pregnant she is at her most vulnerable and for the majority it is this vulnerability that brings out their husband or partner’s caring and protective side.

But for some women, their pregnancy brings out altogether darker instincts in the men they love.

From next year, all women who present at the Rotunda Hospital in Dublin for maternity care will be asked whether they are experiencing domestic abuse.

The question will not be added lightly to the list of queries typically made of a woman at a first visit; it will be added because staff at the hospital know a percentage of women attending will be victims of abuse.

A survey of 478 women carried out in both public and private clinics at the hospital in 2004 found one in eight were being abused physically, emotionally, verbally or sexually. If that figure is extrapolated, it means of the 200 women who give birth in Ireland every day, up to 25 will have been abused.

International research has found 25 per cent of women who experience domestic violence are physically assaulted for the first time during pregnancy.

And UK research, looking at 295 maternal deaths from 2003 to 2005, found 70 had a history of domestic violence.

Since its 2004 survey, the Rotunda has been developing its approach to how it can best help abused women, culminating in the decision to actively inquire of every woman whether she is being abused.

Eilish McDonnell, head medical social worker at the hospital, says staff will be given training on how to respond to a woman who says she is being abused, although it’s expected many women will simply respond they are fine even if they are not.

“The question will not necessarily bring forth a flood of information, but it will create awareness and maybe the woman will contact the hospital again further down the line,” McDonnell says.

Domestic abuse is about control, she says. “It does not matter what class or income bracket a woman is in, how intelligent she is or how high her self-esteem is, once her partner manages to control her, she becomes susceptible to the continuation of that abuse.”

And it is not all about the physical; the women who present with bruises, cuts, broken bones or bleeding in pregnancy are not the only ones being abused. Some 12 per cent of women who said they were abused in the Rotunda survey had experienced verbal abuse.

“We are not talking about the normal harsh words that might be used when a couple argue – this is verbally threatening behaviour that causes fear in the woman,” McDonnell said.

There are also the comments about weight, appearance and stupidity that undermine the woman’s confidence and help to perpetuate the abuse. And there are the attempts to isolate her from friends, family and any contact that might give her support.

Pregnant women who are being abused may book late for care, may miss many of their appointments and may never attend alone.

Some women, who have become accustomed to being treated badly and to being constantly under surveillance, may not even register they are being abused.

“There is a very grey area in domestic violence; it is under- reported because it may not even be recognised by the woman,” McDonnell says.

If a woman does disclose information to a midwife or doctor at the Rotunda or if medical staff suspect abuse when there are physical signs, the first step is often to admit her to a ward or to extend her stay if she is already in hospital.

This gives her the breathing space to talk to a social worker and to see a support worker from the domestic abuse charity, Women’s Aid. A safety plan is then produced to support the woman.

McDonnell says that as a society we need to change our attitude to abusive behaviour. She maintains there is still a social stigma around challenging the abuser’s behaviour.

“Men need to be told by someone, maybe a family member, that their behaviour is not acceptable. When they realise that people know how they have behaved in private, they sometimes stop that behaviour,” she says.

As part of the Breaking the Silence Around Domestic Violence campaign, which began last week, Women’s Aid is highlighting its concern about domestic abuse in pregnancy.

Workers at the charity hear from women who are beaten and raped while pregnant or who have been forbidden to breastfeed, have been denied contraception or have had their stitches removed.

Margaret Martin, director of the charity, says maternity care during pregnancy offers an opportunity to screen all women who attend. She is fully behind the Rotunda’s decision.

“People have prejudices about who might be experiencing domestic abuse,” she says.

“They think it won’t be the competent business woman or the successful older woman, but it may be anyone. The screening will mean no one is missed.”

‘He insisted she did not go back on the pill’

Martine* was happily married for two years before her first baby, Aoife, arrived. Afterwards she discussed returning to work with her husband John, but he said they could manage on his wages. He also insisted she did not go back on the pill.

Martine was soon pregnant again and very tired, but John refused to help out. He would get angry and shout when the house wasn’t perfect. “I didn’t like him shouting as it frightened Aoife and it frightened me too, as he used to get right up in my face and then, when he stopped, he wouldn’t talk to me for days.”

She went into premature labour and had a Caesarean section. When she came home with Michael she found it hard to lift Aoife out of her cot because of her wound. When she told John she needed help, he said she was bone lazy.

She arranged for her sister Collette to stay and John was rude to her. At night in bed he would say aloud his wife was a really bad mother who wouldn’t even lift her own daughter for a cuddle.

“It was so upsetting to hear all these things and not to be talked to. When I tried to talk to him, he would just turn away from me,” she says.

He accompanied her to her GP visit and refused to leave when the doctor asked him to.

“That day when we got home John started shouting at me, he pulled me into the kitchen by the arm and slammed the door shut, I had Michael in my arms and I was very scared. I turned my back to him to shield myself and the baby. He came flying around in front of me so fast I nearly dropped Michael. I could hear Aoife outside the door crying and calling me, it was so horrible.”

She talked to her sister who contacted Women’s Aid and arranged for a phone call at her home between a support worker and Martine.

“It felt so good to talk to someone who understood and who didn’t expect me to do anything.”

* All names have been changed

'He kicked me in the back, I tried to hide my stomach

Jane* and Mike were two years married and her family thought he was wonderful. They both wanted children, but Jane wanted to wait a while.

“Mike said I mustn’t love him or I would want to have children with him straight away. He flushed all my pills down the toilet and told me not to get anymore from the doctor.”

He checked her handbag every day, and every month when Jane’s period came Mike would become angry and accuse her of taking the pill or getting an injection.

“He would throw things all over the house, breaking stuff, once he kicked a hole in the wall of our bedroom.” He threatened to hurt her if she said no to sex.

After eight months Jane was pregnant, but although Mike said he was happy, he became more aggressive and violent.

“I felt so confused. Mike wanted this baby so badly and everyone was telling me about how happy he was that we were pregnant . . . how could I tell them this person you think is great does these things to me? I had no words for it.”

One morning when Jane was five months pregnant, Mike woke up and started kissing her, he climbed on top of her and when she asked him to stop he became angry.

“He picked up the phone and started hitting me with it, I tried to get away from him and fell on the floor. He started kicking me in the back, I was so frightened I was trying to hide my stomach, I was so worried about the baby.”

When she started to bleed, Mike took her to hospital and told staff she’d been in a car crash. When he had gone home, Jane told a midwife the truth and a social worker spoke to her. She arranged a meeting with Women’s Aid and ultimately got legal protection.

“It was so good to talk to people confidentially, people who didn’t tell me what to do, but who confirmed what I knew – that what Mike was doing was wrong and that I shouldn’t have to experience these things.”

* All names have been changed