Domestic Violence during Pregnancy: The role of Midwifery and Screening in the North of Italy
Corresponding author: L.Driul, Department of Gynecology, University of Udine, Udine, Italy, Email:email@example.com
Domestic violence is defined by the World Health Organization (WHO) as “any behavior within a relationship that causes physical, psychological or sexual abuse to those who are in that relationship” .
Domestic violence is present in the lives of many women; it damages their health and their children and is a major cost to society. This phenomenon is largely hidden, therefore difficult to study .
Between 2000 and 2013 in Italy there are 2,399 women victims of murder: 1,692 of them were killed within the family context (70.5%) .
Midwives have indicated in 61.5% of cases at least two suspicious presence of domestic violence in the lives of their patients: association with this most frequently found to be the behavior of the patient herself and the behavior of her partner / husband.
In 18.6% midwives have suspected violence by a single signal, in most cases (63.7%) had at least two signals associated.
as risk factors for domestic violence during pregnancy in 69.6% of cases: low socioeconomic status, substance abuse and a state of economic dependence. (Table 2)
Violence against women is a transversal phenomenon, present in all levels of society and in all societies, it transcends geographical and cultural boundaries. The types of measures that States must implement concern several fronts: prevention, protection, prosecution and monitoring. Domestic violence is a phenomenon which is largely hidden and therefore very difficult to study, for this reason is identified as “unknown number”. There are still few European studies on costs of violence, because to maintain them you need to have data on prevalence and incidence, data that begin to be available since only a few years. The lack of this information affects the estimated costs of violence in the Italian context. The international literature  do not recommend use of universal screening, but considers screening to be effective only in specific subjects, such as pregnant women. Screening has the great advantage of increasing to seven times the possibility to identify victims of violence, with the consequent possibility of providing information and practical help to these women . The studies in literature [6,7] show that screening is well accepted by the patients: do not feel wounded by the questions, partly because they understand their importance. Screening should be offered at least once in each trimester of pregnancy and once in puerperium. The patient rarely reveal the abuse suffered at the first meeting, it is important to have confidence to be able to talk about this important issue. Screening for violence in pregnancy is often performed in Northern Europe and now new projects are starting in other countries of Europe. The period of pregnancy is considered in literature [8,9]”a window of opportunity”. Many women approach the world of health care only during pregnancy. And regular attendance of the same surgery creates a relationship of trust and confidence, especially with the midwife, who is the key figure. In Italy, the severity of problem of violence against women is becoming important and care protocols are urgent. In this study evaluated the majority of midwives tend to underestimate the phenomenon of violence in pregnancy. In our study, the risk factors for domestic violence in pregnancy which are more often reported in the questionnaire were “low socioeconomic level”, “substance abuse”, “economic dependence of women.” In literature, several studies [10,11] (indicate that the risk factors are very different: previous abuse, unwanted pregnancy or pregnancy at a young age, while substance abuse is strongly related to violence, but not as a cause, rather as a result. In our study midwives indicate “depression in postpartum and “abortion / premature birth”, as the more frequent complications. In literature many studies [11 ] show low birth weight as the most frequent complication.
A very high percentage of midwives (88.8%) feel they are not properly prepared to identify violence during pregnancy and the most of the population in question expresses interest in receiving specific training.
Basic university education should be implemented and specific continuos professional training should be provided. The training should be “tailored to their clinical practice and working environment.”  “Midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question.” It is important also to develop guidelines and specific local protocols.
12.Torres-Vitolas C, Bacchus LJ, Aston G. A comparison of the training needs of maternity and sexual health professionals in a London teaching hospital with regards to routine enquiry for domestic abuse. Public Health. 2010, 124(8): 472-478.