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Trust and relationships

It is necessary to build a trusting and personalised relationship before screening.
© Coventry University. CC BY-NC 4.0

Building a trusting and personalised relationship facilitates the screening process (Burnett & Bacchus, 2016; Mauri et al., 2015).

Another minimum condition for healthcare providers to ask women about DVA is that it must be followed by an appropriate response (WHO, 2016).

Providers must be trained to ask questions in the correct way (see ‘Asking about domestic violence and abuse’ beginning with Guidance on questioning ) and to respond appropriately to women who disclose violence (see ‘Enhancing safety’ beginning with Validate the person’s experiences, and ‘Facilitating support’ beginning with The need for connections with community-based organisations).

Drawing on the LIVES (Listen, Inquire, Validate, Enhance safety, and Support) approach (WHO, 2014), below are the dos and don’ts in providing frontline support to pregnant women and people who may be at risk of DVA (WHO, 2019).

Do Don’t
Identify needs and concerns. Try to solve their problems.
Respond to emotional, physical, safety, and support needs. Try to convince them to leave a violent relationship.
Listen to and validate experiences and concerns. Try to convince them to go to the police or court.
Help them feel connected to others, calm, and hopeful. Ask questions that force them to relive painful events.
Empower them to feel able to help themselves and to seek help. Ask them to analyse what happened or why.
Explore options and respect their wishes. Pressure them to tell you their feelings and reactions.

Though women and birthing people may not themselves initiate the conversation, evidence suggests that individuals are open to being asked by healthcare professionals about DVA (Taylor et al., 2013).

Active listening is integral to the LIVES approach; in the context of managing domestic abuse it helps create the right conditions for disclosure. This includes giving the person your undivided attention, allowing for silence, and acknowledging what they want and respecting the person’s wishes.

It is important to ask open-ended questions, rather than those that elicit a simple ‘yes’ or ‘no’ response. Check your understanding of what has been said and reflect any feelings shared.

LIVES also recommends inquiry – ask and explore issues as appropriate (‘Could you tell me more about that?’) to help the person identify and explain their needs and concerns, and sum up at the end.

Understandably, healthcare providers can be reluctant to start the conversation about abuse. In Starting the Conversation which we first saw in Week 1 Barriers to disclosure, professionals and survivors reflect on the ways conversations can be started.

References

Burnett, C., & Bacchus, L. (2016). Women find safety planning more useful than referrals in a maternal and child health IPV intervention. Evidence-Based Nursing, 19(2), 43. DOI link

Mauri, E. M., Nespoli, A., Persico, G., & Zobbi, V. F. (2015). Domestic violence during pregnancy: Midwives׳ experiences. Midwifery, 31(5), 498-504. DOI link

Taylor, J., Bradbury‐Jones, C., Kroll, T., & Duncan, F. (2013). Health professionals’ beliefs about domestic abuse and the issue of disclosure: A critical incident technique study’. Health & Social Care in the Community, 21(5), 489-499. DOI link

World Health Organization. (2014). Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook. Web link

World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Web link

World Health Organization. (2019). Caring for women subjected to violence: A WHO curriculum for training health-care providers. Web link

© Coventry University. CC BY-NC 4.0
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Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy

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