Domestic abuse in pregnancy
Good antenatal care depends on midwives understanding the nuances of domestic abuse, especially given that 30% of women who experience it do so in pregnancy (Edin et al, 2009). This study heard accounts of women who had been victims of domestic abuse while expecting a baby, and also sought their partners’ points of view. In addition, 18 professionals caring for such women gave their perspective. The 20-month study, conducted in Northern Ireland, then explored the current care available.
Nine women who experienced domestic abuse in pregnancy were questioned in semi-structured interviews. Excerpts describe physical attacks, with one woman saying:
‘…boiling water threw over me… two bottles and smash me over the head and then stab me in the eye’.
Psychological abuse was also noted. One perpetrator was quoted as saying:
‘F—sake, can you not hang yourself?’
There was also controlling behaviour:
‘He told me he doesn't want me to go out and he doesn't want me to like have me own life. Basically, he doesn't want me to see my own friends.’
Sexual abuse was not reported.
Three male abusive partners acknowledged their actions and the need to engage in perpetrator programmes. Couples, interviewed apart, identified pregnancy as an opportune time for relationship education for parents-to-be. An existing system of antenatal classes was found as a potential context for such intervention, with the majority of health professional participants welcoming the idea. One midwife and one GP who participated in the study voiced concerns that some colleagues were poorly informed about domestic abuse.
Planned caesarean section for a twin pregnancy
Twin pregnancies are becoming more common in midwifery practice, due to an increase in older mothers and assisted conception. This Cochrane review noted that up to 40% of planned vaginal births for twins in hospital end in emergency caesarean section for one or both babies. It analysed previous studies to see whether certain adverse outcomes might be avoided by well-timed, planned caesarean.
The review considered the results of two randomised trials comparing planned caesarean and planned vaginal birth, which included 2864 women. There was no clear evidence of differences between either group for death or serious illness in either mothers or babies. Neither study reported childhood disability. While 90.9% of women in the intervention arm had their caesarean as expected, 42.9% of those in the planned vaginal birth group ended up having a section for at least one twin. There were no significant differences between groups for failure to breastfeed or for postnatal depression.
The researchers concluded that there was insufficient evidence to support the routine use of planned caesarean section for term twin pregnancy with leading cephalic presentation, except in the context of further randomised trials.
Predicting pre-eclampsia
Suspected pre-eclampsia is a common cause of antenatal hospital admission. This observational study investigated whether it might be possible to predict whether pre-eclampsia was likely to occur. Researchers recruited 1050 women with suspected pre-eclampsia, singleton pregnancies and a gestation of 24+0 to 36+6 weeks. A blood test was performed to calculate the ratio between two proteins (serum sFlt-1 and placental growth factor), and the women were observed for onset of pre-eclampsia.
The researchers found that 99.3% of women whose result was 38 or lower had no pre-eclampsia for the subsequent week. This is an exciting development in handling a condition that remains not wholly understood.