Synopsis
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.
- 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.
Key red flags
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.
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.
Investigation priorities
Create a safe opportunity to identify fear, coercion, violence, sexual abuse and control in the patient's own account.
Management branches
Booking or another antenatal contact provides an opportunity to ask about abuse.
- Arrange for the patient to be alone using a routine service process and use an independent interpreter whose channel is safe.
- Explain confidentiality and its limits, then ask kind, direct questions about fear, control, physical or sexual harm and interference with healthcare.
- If there is no disclosure, leave information safely and create future private opportunities; if abuse is disclosed, validate and move immediately to danger assessment.