Saving Mothers' Lives: - Public Health Agency for Northern Ireland

The mothers affected: 2003-05
During the three years 2003-05, 70 of the women who died from all causes had features of domestic
abuse, including four women with genital mutilation/cutting (FGM/FGC). For the nineteen women who were
murdered the abuse was fatal. The death of a woman who died of a placental abruption almost certainly
caused by a blow to her stomach is counted in Chapter 4 – Haemorrhage, although she and her baby most
likely died directly as a consequence of physical abuse.
Most of the other women, who died from a range of other causes, had proactively self-reported domestic
abuse to a health care professional either before or during their pregnancy. None of these, or any of the
other women whose deaths are considered in this Chapter, appeared to have been routinely asked about
abuse, a previous recommendation in this Report. However, these deaths occurred prior to the introduction
of routine enquiry during pregnancy.
Cases of murder are not routinely reported to this Enquiry although the association between pregnancy
and increasing domestic abuse is well known. The cases described here should therefore be regarded as
being representative of other cases of murder and domestic abuse that remain unknown to the Enquiry.
However, from those that were reported, the warning signs were all too obvious in most cases. Several
features of these reports illustrate the already described features of domestic abuse shown in Box 13.2.
Box 13.2
Indicators of domestic abuse, relevant to maternity care
• Late booking and/or poor or non attendance at antenatal clinics.
• Repeat attendance at antenatal clinics, the General Practitioners’s (GP) surgery or Emergency
Departments (ED) for minor injuries or trivial or non existent complaints.
• Unexplained admissions.
• Non compliance with treatment regimens/early self discharge from hospital.
• Repeat presentation with depression, anxiety, self-harm and psychosomatic symptoms.
• Injuries that are untended and of several different ages, especially to the neck, head, breasts,
abdomen and genitals.
• Minimalisation of signs of abuse on the body.
• Sexually transmitted diseases and frequent vaginal or urinary tract infections and pelvic pain.
• Poor obstetric history:
– Repeated miscarriage or terminations of pregnancy
– stillbirth, or preterm labour
– preterm birth, intrauterine growth retardation/ low birth weight
– unwanted or unplanned pregnancy.
• The constant presence of the partner at examinations, who may be domineering, answer all the
questions for her and be unwilling to leave the room.
• The woman appears evasive or reluctant to speak or disagree in front of her partner.
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