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Screening for Domestic Violence

15 November 2017

Recently announced changes to MBS Obstetrics services item numbers – aimed at improving care and mental health screening for women during pregnancy and the postnatal period - include screening for drug and alcohol use and domestic violence. Screening for mental health conditions, alcohol and substance misuse and domestic violence is a now a Medicare requirement in pregnancy and the postnatal period.

Violence against women - intimate partner violence, domestic violence, or family violence - describes harm perpetrated by a current or previous partner. It is the most common form of violence against women (WHO 2010). Behaviours that are coercive and controlling and include physical abuse, emotional/psychological abuse, sexual abuse, financial deprivation, and social and cultural isolation are all possible examples domestic violence (COAG, 2009).

 Domestic and family violence may begin during pregnancy or, if violence already existed, increases in severity during pregnancy and into the first month of motherhood.

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Women who are subjected to violence during pregnancy are more likely to suffer complications during the perinatal period and are more likely to experience poor birth outcomes, depression, trauma, and anxiety.
 
Pregnancy and early parenthood are opportune times for early intervention: women are more likely to have contact with health and other professionals. Discussion of domestic violence requires rapport between the health professional and the woman. Such rapport may assist women to disclose experiences of violence and enables access to additional support and care. Women experiencing abuse may not speak up when the subject is first raised but may choose to confide later, possibly at subsequent visits, when they feel sufficient trust and have developed confidence in the health professional.
 
 For women who are subject to violence, referral pathways will depend on the setting and the access to services available in the area. All obstetricians should become familiar with locally-available support services and adopt a collaborative approach. Public hospital maternity services should have established multidisciplinary referral pathways that typically include social workers and allied mental health clinicians.
Women may be referred back to their GP if there is shared care. For obstetricians in private practice, referral is likely to be to the woman’s GP or directly to a psychologist or a psychiatrist, depending on the individual situation and availability. Whichever pathway is chosen, there is a need for documentation, coordinated care and inter-professional communication as well as clear communication with the woman.
 


Useful Resources

 


References

  •  Council of Australian Governments (COAG). (2009). National plan to reduce violence against women and their children. Canberra: COAG.
  •  World Health Organization. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva: WHO.
  •  Austin M-P, Highet N and the Expert Working Group (2017) Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence.
 



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