WIBU to get in touch with PALS about my booking appointment?

[WorriedAndPregnant]

I'm expecting my first baby and it hasn't been the easiest time. I posted previously about my emotionally abusive, gaslighting ex (and got fantastic support), who is the father of the baby. I did end up leaving him but it took me a while and the first four and a bit months of the pregnancy with him were awful.

What I keep thinking back to is the booking appointment. He said he wanted to come along so that I "wouldn't have the chance to tell a stranger lies about him". When the midwife asked if I had any serious psychiatric disorders he said "I think there are some undiagnosed ones", and he subsequently told me that when I left to do the urine sample he told her more about how unhinged I was, to which she'd replied "don't worry, pregnant women are often crazy" (I don't know whether this exchange actually happened, of course).

The midwife never spoke to me alone and did not mention the topic of domestic abuse at all. At the time I didn't properly realise that non-physical domestic abuse "counted" when reading about statistics in pregnancy. At subsequent appointments with other midwives (I have not seen the booking appointment midwife since) they picked up on the issues, gave me leaflets, kept checking in about it and this was a huge support and boost in terms of my getting out. I wish it had happened sooner.

I have read on here, and heard from friends, that the midwife at the booking appointment talks to the woman alone and brings up domestic abuse because of its increased likelihood in pregnancy. I also see that according to the NICE guidelines, at Booking the midwife "should give you an opportunity to let them know, if you wish, if you are in a vulnerable situation or if you have experienced anything that means you might need extra support, such as domestic violence..."

My AIBU is should I be contacting PALS (my booking appointment was at a hospital rather than with a GP) to raise this? I do not want to get the midwife into any kind of trouble (she was nice, and although I sense that ex managed to charm her, that's not her fault - he does that), but if it is usually standard procedure to do this at the booking appointment, it could potentially save other women a lot of pain to ensure it is carried out.

My DH came to both booking appointments, all scans (we had more due to DD having significant health problems). He also came to some of the routine midwife appointments.

He was self-employed so was able to do this. I was never asked to be seen alone or asked about DV. It may differ in each Trust.

Yes! Because another vulnerable woman in your position may not have the strength to subsequently take help when it was offered later. 2 pregnancies, one on NHS, one private.. both DH and I give off “naice” middle class vibes, I was asked about DV privately in both cases with DH asked to step out during the one appt he came along to.

Yes that would be a good idea. It might help someone else, and might help you feel empowered that you have done something to improve a situation.

In my booking in appt I was taken to another room away from my partner to be weighed and measured 'as that's where the scales are' - this was their set-up to ask about our relationship and DV. I was expecting that they would ask me about DV away from my partner, it is a routine and important part of the assessment. And yes we would have appeared (and are!) a nice supportive middle class couple.

Well done on getting away from your abusive partner.

You should absolutely share your experience with the hospital. It is kind and generous of you to think of other vulnerable women and the help they might need.

In my hospital, when you went to give a urine sample, there were instructions included to place a sticker on your sample pot if you needed to have a private conversation with the midwife about dv.

I thought this was an interesting way of being able to alert hcp to the need for help without them needing to ask directly, but it does rather put the responsibility on the vulnerable woman (who may not even realise she’s in an abusive relationship) so not without its flaws.

YWNBU to go to PALS. Ask them to highlight that your booking in appointment did not follow NICE guidelines and because of this your access to resources to support you and your baby in an abusive relationship was delayed. This will give the hospital a chance to consider if they can improve their policies or training to help other women.

”I sense that ex managed to charm her, that's not her fault - he does that.”

I would say this would very much be her fault. Professionals are supposed to follow guidelines, stay focused on their objective and maintain the ability to assess in a detached manner in order to avoid this sort of thing (amoung other things). If this is what happened, a complaint is important so this midwife could do be spoken to, because her profession demands a bit more of her than that. I’m sure it isn’t easy, but don’t play down the standard of professionalism most nurses and midwives manage to maintain the vast majority of the time.

I think you should definitely share this. It's so important for women to get the opportunity to share any issues like this.

Absolutely reasonable. Every midwife has a specific duty of care to their clients around DV and have annual updates which remind us the importance of asking every woman if she 'feels safe at home' at booking and then at subsequent pregnancy appointments.

It's not happening because it's awkward for both parties but that's no excuse.

Glad you're out of the relationship. Just a thought, what if the midwife did pick up on his controlling behaviour and her risk assessment was that if she tried to speak to you alone he would have made things worse for you? How long between booking and first appointment where you were given the appropriate support? It's possible that she put something on your notes to raise this with other HCPs? I didn't realise this was part of NICE guidelines, interesting to read the research that suggests DV increases in pregnancy.

Her pregnant women are crazy comments sound as if she was trying to acknowledge him, to make him think she believed him. Did she follow up by suggesting you go to your GP? If not she didnt believe him. I know thats not much help, you needed support and she missed a chance.

My midwives clinic states that you have to have at least one appointment alone ie without partner, presumably for this reason. It doesnt necessarily have to be the initial booking appointment though.

Thank you all very much for your advice and for sharing your experiences. It is interesting to see that most (but not all) of you were asked the DV question at your booking appointments. I think the idea of a sticker is potentially clever as a first base.

@S0upertrooper and @redexpat I'm almost certain that this wasn't the case in my situation. The midwife was acting very concerned towards him and his feelings. For e.g., I said near the start of the appointment that the baby was a little earlier than planned but I was over the moon about it; he was looking mournful and saying he wasn't sure and she said something along the lines of "You (pl) have lots of options. There's still plenty of time to decide whether you want to keep it and this appointment does not commit you both to having the baby" which I thought was a bit off as I had stated my feelings and had been looking forward to the appointment as a time to start looking forward to having the baby 'officially'.

The whole thing was picked up ten weeks later at a 20 week appointment (I'd also had a 16 week one) when I mentioned him myself to the midwife - no hint of anything being flagged.

I would say this would very much be her fault. Professionals are supposed to follow guidelines, stay focused on their objective and maintain the ability to assess in a detached manner in order to avoid this sort of thing I can see that you are right. In fact, I think that while the midwife picked up that things were difficult between us, she was slightly blinded by her own history as she said the father of her first baby, whom she had had very young, had also found it very hard to come to terms with but they had ended up together and she hoped it would all work out for us too.

Just wanted to add the sticker might not actually have helped me, as it happens . I thought "domestic violence" only meant being beaten up.

At my booking in appointments the midwives never mentioned DV at all, except they always ask for a urine sample, and there is one poster on the back of the door that asks about DV and if you need to talk to someone alone then you put a sticky dot onto your sample holder, you then out the sample in a cupboard that has a door in the toilet and a door in the room next door.

Sorry to hear about your tough time, and YANBU.

I was asked about dv in all 4 pregnancies but my dp didnt come to all appointments so cannot comment there

I know they always recorded who i attended with so my partner or a dc

My husband came to every single midwife appointment and more than once she asked him to fetch me a cup of water or something else from reception so she could talk to me about DV. There aren't any issues but I think it's right that they do this so YANBU

Oh and i dont think you would be unreasonable to mention it

I recently accompanied a daughter on her booking in appointment (at her request, as her DH was away). She wanted me to come in with her but the midwife wanted to see her on her own first. She told me afterwards that she’d been asked about DV and her unfortunate medical history. Then, before asking me to join them, the midwife had even asked if there was anything not to be mentioned in front of me.

That midwife was doing the right thing.

I remember when I went to hospital for my scans (had other MW appointments locally), when I went to do my sample there was a packet of sticky dots on the back of the loo door and it said if you need to alert your midwife to DV or need help, pop a sticky dot on your sample bottle lid and she will get you help confidentially. Would have been fantastic in your situation OP.

Sorry OP, just read your previous comment about a sticker not necessarily helping you. In my hospital this was accompanied by a poster explaining all types of domestic abuse and generally saying if you had any concerns, not just if you were being physically abused. I wonder if this might have prompted you to realise that what you were experiencing was abuse.

YWNBU.

If a client's partner had made a comment about their partner's MH like the one you mention, it would have raised enough of a flag with me for me to explore it further with the client alone. Even if the client then assured me that things were fine, I'd make sure she knew that if ever it wasn't fine, she didn't have to put up with it, that she had options and that I could help her through them.

Our police force is brilliantly pro-active when it come to DV/DA, and they have done lots of work with other agencies who may be working with people at risk in identifying possible indicators and helping victims.

At the very least, what happened to you identifies a significant training need, and reporting this will help get that need met.

Your midwife should have asked you about DV, however, if you weren't alone and she was unable to get you alone then it's not unreasonable that she didn't ask - yes there are guidelines suggesting when the question should be asked, but there are also specific situations in which it isn't appropriate to ask.

Your partner being present is one of them.

And it's not only the booking appt where this should be asked - you should have been asked any time you were alone with the midwife.

So it may be that it wasn't an appropriate time for her to ask. That said, it could well be that she isn't habitually asking anyone, which should be addressed. Therefore it wouldn't be unreasonable to comment on this and in which case I'd take it further. If you want to make a formal complaint, then go through PALS, but for a less formal complaint, you can take it to the midwife's community Midwifery team leader - phone the antenatal clinic that you had your booking and ask for the community team leader's name and to be put through.

I'm sorry that you were in such a desperate position, and congratulate you for getting out of it.

If a sticky dot wouldn't have helped you then why would the midwife asking about domestic violence have helped? Its the same principle.

Biology - the sticky dot would have meant the OP would have had to make a black or white decision (is it/isn't it abuse) and then have the strength to put the sticker on without quite knowing what the next step would be.
OTOH if a midwife asks the OP face to face she (the OP) can find out a lot more eg. tentatively mention what has gone on, discuss how abuse comes in a lot of forms, be reassured about the way forward and how it will be dealt with. She will be supported and lead from the initial disclosure. A midwife would (should?) also be able to pick up from hesitant reples, body language etc if a woman is holding back something and unsure about a situation that maybe troubling her and can encourage her to open up.

@BiologyMatters The midwife who helped me see the abuse asked me questions like “how are things at home?” and “what sort of things has he been saying?” before gently explaining that what I’d described was domestic abuse.

I am sure the yellow stickers are a huge improvement on nothing, however. I might have realised I was entitled to use one if there had been a poster spelling out that domestic abuse wasn’t always physical.

We're asked when we make our booking appointments to come alone here now. We weren't when I had my first baby and I took DH (not abusive) with me and the midwife asked him to wait outside until she'd done her 'initial assessment' which involved her asking me about DA. He'd only come because it was first baby excitement anyway. I went alone to this booking in appointment. We discussed DA again and the midwife gave me a load of leaflets and said they gave them to everyone and if they we're of no use to me to leave them somewhere public for women, like a ladies toilets as they might help someone.

I can't really see a need for men to come taking the sensible non emotional view - it's a medical appointment for you, you don't hear or see anything exciting. Scans are different of course, that's the only thing my DH is coming to this time.

OP I would flag it with PALS, there should be a way of communicating about this or ensuring that the conversation is had regardless of a partner being there. Hi should have at least asked him to leave for a bit.