youtube video 6.3

Midwife/nurse conducting an INITIAL ANTENATAL ASSESSMENT.
Routine practice: all women are screened for family & domestic violence (FDV) during pregnancy because:
- Violence can begin or escalate in pregnancy.
- Protects both mother & fetus.
Emphasis on confidentiality:
- Information recorded in Katie’s personal medical record.
- Duty to breach confidentiality only if safety of Katie or baby is at risk.
- External services may be contacted in that circumstance.

Permission sought: “Are you okay if I ask you some of these questions?” (patient-centred, trauma-informed approach).
Core questions asked:
- Has anyone ever put you down, humiliated, embarrassed, or tried to control what you say/do?
- Has partner ever hurt or threatened to hurt you?
Follow-up probing for specific examples when red flags appear: “What do you mean by ‘gets a bit rough’?”

Controlling behaviours disclosed:
- Mark “likes to know where I am all the time.”
- Must ask permission to go to shops/appointments; described as “normal” & “protective.”
- He checks phone & email; accuses her of affairs (PARANOIA ⇒ red flag for coercive control).
Emotional abuse:
- Calls her “useless,” “selfish bitch.”
- Repeated insults while she is fatigued from pregnancy.
Physical intimidation / violence:
- Throws objects “around” and at her when angry.
- Recently pushed her (physical contact ⇒ assault even if ‘not that bad’ in her words).
Gaslighting / Minimisation:
- Katie repeatedly excuses behaviour: “He doesn’t do it to be mean… he just cares.”
- Rationalises with Mark’s stress: police job, unplanned baby, financial pressure, has $2$ children with ex-partner.
Isolation & financial control:
- She stopped working because “Mark thought it would be best.”
- Creates dependence and limits her social exposure.

Normalises stress of pregnancy but names behaviour as abusive (“These behaviours don’t sound normal to me”).
Explains that abuse can be non-physical (psychological, social, financial).
Warns that abuse can escalate during pregnancy & postpartum.
Provides MULTIPLE SUPPORT OPTIONS:
- Info booklet: “Finding Help.”
- Social Worker referral (next visit if time constrained).
- Domestic Violence phone line – available $24$ hours a day, $7$ days a week (confidential).
Safety check: “Do you think you’re SAFE to go home today?”
Encourages follow-up: “Feel free to make an antenatal appointment to see someone.”

Coercive Control: Pattern of domination (monitoring movements, phone surveillance, financial dependence).
Cycle of Violence: Tension-building → Incident (throwing/pushing) → Reconciliation/minimisation → Calm.
Pregnancy as High-Risk Period: Hormonal changes, increased dependency, added stress can trigger or worsen abuse.
Duty of Care & Mandatory Reporting: Health professionals must balance confidentiality with obligation to act if imminent harm.
Trauma-Informed Care Principles demonstrated:
- Consent before questioning.
- Validation of feelings.
- Offering choices & autonomy.
- Ensuring privacy and safety planning.

Autonomy vs. Protection: Respecting Katie’s choices while safeguarding mother & fetus.
Potential impact on fetal development: Stress hormones, injury risk.
Intergenerational trauma: Children exposed to FDV may face long-term psychological effects.
Role conflict for Mark as a policeman: May deter Katie from seeking help (fear he “knows the system”).
Importance of non-judgmental language to counter self-blame.

Always obtain informed consent prior to FDV screening.
Red flags include: constant monitoring, name-calling, isolation from work/social roles, physical aggression (pushing/throwing objects).
Abuse ≠ only physical; emotional, psychological, financial, and social forms equally harmful.
Safety assessment must be conducted before discharge if abuse suspected.
Provide multiple discreet resources (booklet, helpline, social worker) & respect patient’s pace.
Documentation: Record disclosures factually in medical notes; may become legal evidence.
Know local referral pathways (social work, shelters, legal aid, crisis lines).

“List and explain at least FOUR non-physical signs of domestic abuse.”
“Describe the steps you would take after a patient discloses partner violence during antenatal care.”
“Explain why pregnancy is considered a high-risk period for escalation of domestic violence.”
“Outline the ethical principles involved when balancing patient confidentiality with duty to protect.”