Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Safeguarding and domestic abuse in pregnancy
Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending
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Current violence may require immediate protection
Recent strangulation, weapon threat, escalating assault, sexual violence, stalking, forced confinement, suicidal or homicidal threats, perpetrator presence or a child in immediate danger creates a time-critical safety and safeguarding emergency.
Action: Move to a safe private area, call emergency security or police when danger is immediate, treat maternal injuries and assess the pregnancy, involve the safeguarding lead and specialist domestic-abuse service, and share proportionate information needed to protect the patient and children.
Role and principles
Create safe opportunities for disclosure, recognise domestic abuse and wider safeguarding risk during pregnancy, and coordinate proportionate maternal, unborn-child and family protection without increasing danger through documentation or contact.
Pregnancy may be the first sustained contact with healthcare and can coincide with the onset or escalation of domestic abuse. Abuse is not limited to assault. Ask about intimidation, humiliation, sexual coercion, control of money, food, medicines, immigration papers or appointments, monitoring of phones and location, isolation, stalking, threats to children or pets and interference with contraception or pregnancy decisions. Consider abuse in any relationship between personally connected people and avoid assumptions based on gender, age, ethnicity, disability, wealth, sexuality or relationship status.
NICE recommends asking at booking, or at the earliest opportunity, in a kind and sensitive way when the patient is alone. A private consultation should be routine so the companion is not singled out by suspicion. Use a neutral service explanation, arrange a credible reason to see every patient alone and use an independent interpreter. Do not ask while a relative, friend or child interprets, and do not send a disclosure question through a device or portal that may be monitored. If privacy cannot be achieved safely, document the need and create another opportunity rather than asking publicly.
Assessment and patient selection
Controlling pattern
Monitoring, isolation, restricted money or healthcare, reproductive coercion and threats form a pattern of domination even when no physical assault is disclosed.
High-lethality indicators
Strangulation, weapons, threats to kill, escalating attacks, stalking and recent separation substantially increase concern for severe or fatal violence.
Pregnancy injury signal
Abdominal trauma, genital injury, repeated unexplained presentations, late care or a controlling companion may indicate abuse and requires private enquiry.
Child impact
Seeing, hearing or experiencing the consequences of domestic abuse can harm a child, while pregnancy concerns can require assessment before birth.
Technology-facilitated abuse
Shared devices, location tracking, account access, portal monitoring and impersonation can reveal appointments, referrals or attempts to seek help.
Red flags requiring action
Non-fatal strangulation, suffocation, weapon use, threats to kill, escalating frequency, stalking after separation or forced entry identifies a high risk of severe or lethal harm.
Head injury, neck pain, voice change, swallowing difficulty, neurological symptoms, loss of consciousness, incontinence or breathing symptoms after strangulation requires emergency medical assessment even when external marks are absent.
Baseline assessment
01Private trauma-informed enquiryFirst step
Why
Create a safe opportunity to identify fear, coercion, violence, sexual abuse and control in the patient's own account.
Interpretation and limitations
Disclosure supports immediate risk and support planning; a negative answer in unsafe circumstances or at one encounter does not exclude abuse.
02Immediate danger and structured risk assessment
Why
Identify escalation, strangulation, weapons, stalking, homicide threats, unsafe separation and risks to children.
Interpretation and limitations
Any imminent threat triggers emergency protection; a structured score informs local IDVA or MARAC referral but does not override clinical judgement.
03Maternal injury and mental-health assessment
Why
Detect occult strangulation injury, head trauma, sexual harm, self-harm risk, intoxication or other treatment needs.
Interpretation and limitations
Normal external appearance does not exclude airway, vascular or neurological injury; symptoms and mechanism determine emergency imaging and specialist care.
04Gestation-appropriate fetal assessment
Why
Identify fetal compromise, abruption, membrane rupture or fetomaternal haemorrhage after assault or obstetric symptoms.
Interpretation and limitations
Use fetal-heart assessment, CTG, ultrasound and anti-D or fetomaternal-haemorrhage pathways according to gestation and mechanism; maternal stabilisation remains primary.
Interventions
01Safe enquiryCreate privacy before askingFirst stepBooking or another antenatal contact provides an opportunity to ask about abuse.+
1Arrange for the patient to be alone using a routine service process and use an independent interpreter whose channel is safe.
2Explain confidentiality and its limits, then ask kind, direct questions about fear, control, physical or sexual harm and interference with healthcare.
3If there is no disclosure, leave information safely and create future private opportunities; if abuse is disclosed, validate and move immediately to danger assessment.
02Immediate responseProtect without increasing dangerThe patient discloses current abuse or clinical findings raise an urgent concern.+
1Determine whether the perpetrator is present, whether the patient can leave safely and whether emergency police, security or medical treatment is required.
Targets, monitoring and follow-up
Recheck whether the chosen phone, voicemail, text, postal address and patient portal remain safe before every contact or appointment reminder.
Review escalation indicators, separation, stalking, strangulation symptoms, weapons and threats at follow-up because domestic-abuse risk can change abruptly.
Confirm that IDVA, safeguarding, housing, mental-health, sexual-health and substance referrals were received and that the patient can access them safely.
Monitor maternal injury, sleep, mood, self-harm, medication access and antenatal attendance while avoiding blame for missed visits that may reflect coercive control.
Track fetal growth and wellbeing only according to the clinical injury and obstetric risk, ensuring that normal fetal testing does not erase the adult-safety plan.
Update the birth and postnatal safety plan, including visitor controls, infant records, discharge destination, contraception, newborn registration and safe primary-care handover.
Special situations
Privacy is a clinical intervention
A routine one-to-one antenatal period protects the patient from being singled out and creates the conditions in which a truthful answer may be possible.
Leaving can escalate danger
Separation may provoke stalking or severe violence, so advice to leave immediately without expert safety planning can increase rather than reduce risk.
Strangulation can look normal
Serious airway, vascular or neurological injury may follow neck compression without bruising, making mechanism and symptoms more important than visible marks.
Children experience the abuse
A child need not be directly struck to be harmed; hearing, seeing or living with the consequences can require support and safeguarding action.
The record has an audience
Automatic portal release, shared phones and handheld notes can expose disclosure, so information governance and safe contact are part of the safety plan.
Common pitfalls
01
Asking about domestic abuse in front of a partner, relative, child or family interpreter and recording the resulting denial as reliable.
02
Focusing only on visible assault while missing sexual, economic, coercive, reproductive or technology-facilitated abuse.
03
Confronting the suspected perpetrator, arranging couples counselling or disclosing the report to family members without a safety assessment.
04
Promising absolute confidentiality before explaining child protection, serious-harm and legal information-sharing limits.
05
Treating a risk-tool score as more important than strangulation, escalating threats, professional judgement or the patient's own fear.
06
Placing referral details in handheld notes, routine text messages or a shared portal without checking whether the perpetrator monitors them.
07
Assuming a normal CTG after assault resolves the adult's immediate danger or the unborn child's continuing safeguarding context.
Practice
Two practice questions
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Question 1 of 2
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Obstetrics and gynaecologyOriginal SBA
Creating a private enquiry
At booking, a patient's partner answers every question, insists on interpreting and refuses to leave the room. There is no immediate visible emergency. What is the best next step?
Sources and review status8 sources · checked 27 Aug 2026 · clinical review pending+
Sources
Sources and review status
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem ·
Start with normalising and specific questions: whether anyone makes the person afraid, controls daily life, hurts or forces sex, restricts healthcare or monitors communication. Observe repeated unexplained injuries, delayed care, missed appointments, a controlling companion, inconsistent history, anxiety around contact and limited access to money or documents, but absence of signs does not exclude abuse. Thank a person who discloses, state that the abuse is not their fault and ask what they need now. Avoid disbelief, interrogation, promises of absolute secrecy or instructions that assume leaving is immediately safe.
Risk assessment is dynamic. Establish whether the perpetrator is nearby, whether it is safe to go home and whether violence is escalating. Ask about strangulation or suffocation, weapons, threats to kill, stalking, sexual assault, forced confinement, pregnancy-focused assault, separation, suicidal or homicidal threats and risks to children. Use the locally adopted structured domestic-abuse risk tool and specialist advice; a score supports but never replaces professional judgement. High-risk cases may require an independent domestic violence adviser and multi-agency risk assessment conference, while immediate danger may require emergency police or security response.
Clinical assessment runs in parallel. Treat injury and pain, examine according to consent and forensic considerations and assess mental health, self-harm, substance use and sexual health. After abdominal trauma, bleeding, contractions, fluid loss, pain or reduced movement, use urgent gestation-appropriate obstetric assessment, including fetal monitoring and rhesus prophylaxis review when indicated. Strangulation can injure airway, vasculature and brain without visible bruising, so voice change, swallowing difficulty, dyspnoea, neurological symptoms, loss of consciousness or neck pain requires acute assessment.
Safeguarding encompasses the pregnant adult, unborn child and other children. In England, Working Together to Safeguard Children 2026 explicitly includes unborn children and strengthens recognition of domestic and sexual abuse and coercive control. The Domestic Abuse Act framework recognises a child who sees, hears or experiences the effects of domestic abuse as a victim in their own right. Follow local child and adult safeguarding thresholds, consult the named professional and consider early help as well as statutory protection; do not assume that referral automatically means child removal.
Consent remains central, but confidentiality has limits. Explain who may need information and why. Seek informed consent for IDVA, advocacy, housing, sexual-assault and other support where safe. Information can be shared without consent when necessary and proportionate to protect a child or adult from serious harm, meet a legal duty or respond to an immediate threat. Consult the safeguarding lead and record the decision and legal or safety basis. Tell the patient about sharing unless doing so would increase risk or impede an urgent protective action.
Documentation can protect or expose. Record the history factually, identify who was present, use the patient's own words for threats and document observed injuries rather than conclusions. Use body maps or photographs only with consent and local forensic policy. Record risk, children, advice, referrals, information shared, with whom and why. Confirm a safe telephone number, time, voicemail wording, postal address and portal use every time; suppress unsafe automatic messages where the system permits. Do not place a domestic-abuse plan in handheld maternity notes or discharge paperwork that the perpetrator may read.
The legal and service route differs across the UK. Working Together 2026 and the Children Act framework cited here apply to England; Wales uses the Social Services and Well-being (Wales) Act and Wales Safeguarding Procedures, Scotland uses its national child-protection and adult-support framework, and Northern Ireland uses regional safeguarding procedures and HSC Trust Gateway routes. Use the patient's location and current local policy rather than copying English terminology. Specialist services should address immigration, disability access, language, housing and financial barriers so that a referral is usable, not merely offered.
Key points
Ask about domestic abuse kindly at booking or the earliest opportunity when the patient is alone, and create a private one-to-one discussion even when no indicator is visible.
Never ask in front of a partner, relative or child and never use a companion as interpreter; use an independent professional interpreter and check whether telephone or video interpretation is safe.
Domestic abuse includes physical and sexual violence, emotional or psychological abuse, economic abuse and controlling or coercive behaviour; stalking, technology monitoring and reproductive coercion may be central.
Respond by listening, believing, validating, assessing immediate danger and offering choices; do not confront the suspected perpetrator or pressure the patient to leave without a safety plan.
Assess maternal injuries, gestation and fetal wellbeing, including urgent maternity review after abdominal trauma, bleeding, pain, fluid loss or reduced movement.
Ask about every child and the unborn baby, consult the named safeguarding professional and follow the local threshold and referral route for the nation in which care is delivered.
Explain confidentiality and its limits before detailed disclosure where possible; seek consent for referral, but share necessary proportionate information without consent when law or serious safety risk requires it.
Record facts, the patient's words, observed injuries, risk assessment, advice, referrals and safe contact method; avoid unsafe patient-held notes, messages or portal entries that a perpetrator can access.
Abdominal assault, bleeding, pain, contractions, fluid loss, reduced fetal movement or maternal instability requires urgent obstetric assessment alongside forensic and safeguarding care.
A child or unborn baby exposed to domestic abuse, neglect, substance-related danger or credible threat requires local child-safeguarding consideration; an adult's request for confidentiality cannot cancel protection from significant harm.
Forced marriage, female genital mutilation, so-called honour-based abuse, trafficking, sexual exploitation or immigration-related coercion may involve multiple perpetrators and needs specialist safeguarding advice without family mediation.
An unsafe phone, shared patient portal, controlling companion or perpetrator who monitors appointments can turn routine messages, printed plans or visible records into an immediate safety risk.
05Safeguarding and safe-contact review
Why
Map every child or adult at risk, current agencies, communication hazards and practical barriers to protection.
Interpretation and limitations
The output is a proportionate local referral and contact plan; risk changes when the perpetrator learns of disclosure, separation or service involvement.
2
Assess injuries, strangulation, mental health and pregnancy symptoms, and involve maternity urgently after trauma, bleeding, pain, fluid loss or altered movement.
3Contact the safeguarding lead and specialist domestic-abuse advocate, use the local high-risk pathway and avoid confronting or alerting the perpetrator.
03Continuing safetyCoordinate referral, records and contactImmediate needs are stabilised and an ongoing support plan is required.+
1Agree safe ways, times and words for contact and decide which printed, electronic or patient-held records could expose the disclosure.
2Seek consent for specialist advocacy and practical services, while making necessary proportionate safeguarding disclosures when serious harm or legal duty requires them.
3Document facts, decisions and ownership, schedule a safe follow-up and reassess danger, children, housing, mental health and obstetric wellbeing at later contacts.