IoS Christmas Appeal: When pregnancy spells lethal danger to a mum-to-be and her baby
Training midwives to detect a father's potential violence, and advocates to help an abused mother, are two key areas of Refuge's work. Emily Dugan reports on the horrors visited upon one young woman and how she was able to cope and withstand them
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Beth was eight weeks pregnant last year when her boyfriend, Jason, killed their unborn child. In a rage, he hurled a cot at her stomach. She miscarried. Eleven weeks into her second pregnancy, the violence started again. She was frequently hit and thrown around. At six months pregnant, after constant abuse, Beth, 21, tried to end the relationship. Jason became frenzied with anger and, as she called her mum to get help, he pummelled her stomach and slammed down the phone.
The hours that followed are now a blur. One minute she was lying on the floor wondering if she and the baby were about to die, and the next she was in a hospital bed and Jason was in a police cell.
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Beth's horror story is all too common. Expecting a child is ordinarily seen as a time of happiness and intimacy for a couple. But 30 per cent of domestic violence cases begin or get worse during pregnancy. There is evidence to suggest it could be the biggest killer of unborn babies in the UK.
Around 3.4 per cent of mothers are physically abused by their partners during pregnancy but many midwives feel ill equipped to help. The domestic violence charity Refuge, which The IoS is supporting for this year's Christmas appeal, has set up a pioneering unit in a London hospital to support expectant mothers who suffer abuse and to train health workers to detect it.
Sandra Horley, chief executive of Refuge, says she has witnessed first hand the need for intervention during pregnancy. "Men who abuse women do so because they can get away with it. When they abuse women during pregnancy it is often because their perceived needs are not being met and they are no longer the focus of attention. In my 30 years working in this area I've seen some appalling cases, including a woman six-and-a-half months pregnant who had been kicked so repeatedly in the abdomen that her baby was stillborn. Another woman had a baby who was born with three fractured limbs."
Beth is one of more than 200 women Refuge has helped to escape abuse since establishing its team of three independent domestic violence advocates in the hospital just over a year ago. The IoS is not revealing its exact location for fear it would deter abusive fathers from letting their partners access its maternity services.
Beth is sitting in the team's office with her contented four-month-old baby, Ben, asleep on her chest. She was in hospital for three days after Jason's final attack and Ben was born two months premature. Remembering the circumstances of their first meeting, Beth holds Ben closer. "At first, they couldn't find the heartbeat and I thought I'd lost him. It's the worst feeling you could ever have – trying to find your baby's heartbeat and not knowing if he's alive or not. I had a fist mark on the side of my belly, marks all up the side of my back and arms but I was only worried about the baby."
A midwife asked her if she would speak to Refuge's advocate, Sophie, and she agreed. "They explained that there was someone who would come and talk to me. I didn't want to tell the midwife about what had happened: how would she understand? But when I spoke to Sophie, it was so easy because I felt I could talk without being judged."
"Thanks to Sophie, I've been strong enough not to go back. Every time I feel even the slightest bit low I've always got Sophie on the other end of the phone and she always knows exactly the right thing to say. It makes such a difference knowing she's by my side. She helped me change my number and now he can't contact me."
While Beth was still in hospital, Sophie contacted the police to find out if Jason had been arrested. "Nobody else had updated me with what had happened," recalls Beth. "The police didn't call me to say he'd been arrested, but Sophie told me he was and I felt safer."
Charges have since been brought against Jason for common assault. Beth is still waiting for the trial.
She believes her pregnancy provoked Jason's further violence. "We were together four years and he started being abusive after about six months. But it got worse when I was pregnant. I think it's the fact that he felt he owned me more. He said 'you can't leave me now – look, you'd be a single mum'."
Dr Heidi Stöckl, lecturer in gender violence at the London School of Hygiene and Tropical Medicine, said: "It's a hidden problem because you think of pregnancy as a wonderful time for family and a relationship, but, actually, a lot is changing at that time and violence is much more likely to occur.
"Antenatal care really is a window of opportunity to intervene and help. Women are more open to receiving help at that time and we can get women at most risk of severe violence."
Teaching health workers to detect the signs of domestic violence can save the lives of mothers and babies. NHS guidelines say midwives and other health workers are supposed to ask expectant mothers about domestic abuse as a matter of routine. But research suggests that, without training, as few as one in 10 will ask, citing factors such as time constraints and a fear of having no way of helping a victim if the answer is yes.
Refuge's advocates at the London hospital have already trained more than 300 midwives, which has helped hospitals in the region go from finding almost no pregnant victims of domestic abuse to referring more than 200 to Refuge in a year. By basing Refuge workers in a hospital, midwives have someone they can immediately send mothers to for help.
When maternity staff are given specialist training such as that offered by Refuge, the proportion of them asking expecting mothers routine questions on domestic abuse rises from 15 per cent to 47 per cent, according to a study at King's College London.
Janet Fyle, a midwife and policy adviser to the Royal College of Midwives, said programmes such as Refuge's could help midwives pick up on the problem. "The research that's been done suggests that pregnant women who are being abused are crying out for midwives to ask them about it. The National Institute for Health and Clinical Excellence guidelines recommend that midwives ask. But often they don't feel able to – they don't want to open up that can of worms as they're not sure what they'd need to do next.
"Pregnancy is a critical time for women in terms of domestic abuse. There's an element of jealousy when a woman is pregnant because partners feel it's going to take their place. Most people cope with that fact, but some just cannot psychologically accept it. And if a violent partner is bent on making sure a woman miscarries he will make sure it happens."
Names have been changed to protect identities
The Independent on Sunday Christmas Appeal is for the national domestic violence charity Refuge. To make a donation visit: refuge.org.uk/independent-on-sunday-appeal/