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.

I think it's definitely worth raising. I mentioned the fact that the midwife discharging me from hospital with ds asked me about domestic violence in front of dh and my mil when I filled in the feedback form. Yes, in our case she had correctly surmised that he wasn't violent towards me in the slightest but basing that on his attentiveness, concern and desire to get me out of hospital asap is dangerous if done on a regular basis.

Things have changed with our trust between having ds in 2015 and being pregnant now though. With my first dh came to booking and stayed the whole way through. This time I was told when I got the appointment not to bring him for the first half and that he could come in after that if he wanted so it's obviously a concern.

I don't believe the mw made that comment. That was probably a lie. Anyway I was never asked about DV and I certainly didn't see any stickers on any doors.

I wasn't spoken to alone at any point during my booking in appointment either and I get the impression that midwives and other medical professionals have other ways to spot certain things without always having to ask outright.

I think they build an idea of what's going on over the various appointments you have with them and if you went to each appointment with a partner they may ask you to go alone for one of them of need be.

Having said that, if you really do feel they should have seen you alone then give them a call as a conversation won't hurt.

OP, was that appointment (20weeks) the only one where your partner was not present? Is that why it was picked up?

If there’s no opportunity for you to be asked, what exactly do you want her to do? I’m a student midwife, the ideal is that at some point we manage to get you alone during booking and ask, but if we don’t, we revisit the domestic abuse questions the first time you attend yourself. It HAS to be discrete. YABU.

Thanks everyone for your continuing comments, anecdotes and advice.

There were appointments before 20 weeks when partner was not present, in my case.

@katronfon thank you. I do just feel happy to have escaped, though I think if the midwife had brought the matter up at booking things would have been faster. The main thing is just that since I’ve now seen it is NICE guidelines to ask at booking, I have been wondering about trying to help ensure this does happen to help people at my trust in the future.

@BuntyCollocks the thing is, it wasn’t mentioned when I was alone at my 16 week appt either and I was the one who initiated the conversation at 20 weeks. I gather it is common to ask to speak to the women alone at some point during booking; or if this isn’t possible, should a record be made somewhere that the question has not been raised? Otherwise mightn’t the midwife at subsequent appointments assume it has been and not bring it up?

At our booking appointments around here, when the midwife comes out to take you in to your appointment they ask that you come in alone first and then they'll fetch your partner when they're needed. They say this is for the medical history questions as medical history is confidential even from partners. They use that opportunity to ask about DV or any other issues. I think that's how it should be done everywhere tbh, they should have the same rules for each trust.

I think you're well within your right to contact PALS about it. A conversation about it won't hurt and I'm sure they can inform you what the guidelines are for your trust and they'll know whether the MW followed it correctly or perhaps it slipped her mind to ask you.

I'm glad you got away regardless and are happier now OP

@worriedandpregnant I can only speak for our booking system, but we have a box to check if the inquiry has been made. If you are seeing the same midwife each appt then it should be obvious that it still needs to be asked. If it’s someone different each time, I can see how it would slip through the cracks.

Have you had continuity of care, or several different midwives? It’s not an excuse as it should have been asked if you were alone and it hadn’t been already, but working within the system and knowing the pressures there are to get people in and out as quickly as possible, and seeing how my colleagues struggle as they’re unable to give the care they wish to due to these constraints, I can see how it happens far too easily.

I think perhaps people also don’t realise that they’re welcome to phone and advise of this and other issues. Please call us. We can make the note.

Midwives, though, like the rest of our nhs colleagues, are struggling with underfunding and overworking. To provide the care we want to, we need more bodies. I’m sorry this happened to you.

At my booking appointment, they kept the weighing scales in a different room. So you were asked to accompany the midwife out of the room alone to be weighed and the opportunity was used to speak about DV.
They also had the stickers in the bathroom along with a poster explaining different kinds of DV so you could indicate you need help.

If you felt you wanted to speak to PALS about this, it would be an appropriate complaint.
You could also ask to speak to the head midwife of your team if you wanted a less formal approach. Explain the situation and that you don’t want anyone to get in to trouble but it’s a very important issue and clearly additional training is needed with some of the midwives you encounted.

Another reason for the midwife to speak to you alone is in case there is anything in your medical history that you haven't told your partner about.

For example a friend of mine had a termination years before meeting her husband - she never told him about it in the beginning of the relationship as it was too soon but then reached a point where she felt it was too late to tell him IYSWIM so he was never aware.

Obviously you need to tell the midwife details about previous pregnancies/terminations/miscarriages so there has to be an opportunity for women to talk to a midwife without their partner there.

IIRC my friend had the opportunity to tell her midwife and something was put on her file (coloured sticker?code?) to alert other HCPs to the fact that it was not known to her partner

I am very glad that you are out of the abusive relationship. That must have been incredibly difficult. I would raise it as there should be measures in place to speak to women alone about this. My partner doesn't come to MW appts but I quite often see the midwife taking women into the weighing room, or showing them where the bathroom is. We also have stickers in the sample bathroom and posters explaining that there are different types of abuse.