Background
Domestic abuse and disability
Domestic abuse and pregnancy
Domestic abuse, disability and pregnancy
Research questions
Theoretical framework
Methods
Recruitment
Participants
Hanna | Congenital physical impairment & mild learning difficulty |
---|---|
Jessica | Congenital physical impairment |
Rachel | Long term mental health condition |
Kirsty | Long term mental health condition |
Laura | Long term mental health condition & acquired physical impairment |
Data generation
Prompt questions | Andersen’s model | CIT |
---|---|---|
Tell me about a situation where you needed to see a health professional about your pregnancy or post-natal health | Actual Use | Behaviour |
● What happened? | ||
● Who did you see? | ||
Why did you need to see them? | Need Intended Use | Motivators |
Did you get the care you needed? | Actual Use | Consequences |
● In relation to pregnancy? | ||
● disability issues? | ||
● domestic abuse? | ||
What helped/or would have helped you to get the care you needed? | Enabling Factors | Context |
What made it difficult to get the care you needed? | Disabling Factors | Context |
● Did maternity services accommodate your disability needs? | ||
● How did domestic abuse affect your access to care? | ||
How did that affect you? How did it affect your child (baby)? | Consequences | |
In what ways did using maternity services make a difference to you? OR How would better maternity care have made a difference to you? | Consequences |
Data analysis
Ethics
Results
Psychosocial aspects of the Andersen model within selected critical incidents | ||||
---|---|---|---|---|
Attitudes | Knowledge | Social Norms | Perceived control | |
Facilitators | 3 | 1 | 6 | 6 |
Barriers | 2 | 1 | 4 | 6 |
Total | 5 | 2 | 10 | 12 |
Psychosocial aspects of the Andersen model across all critical incidents (n = 45) | ||||
Attitudes | Knowledge | Social Norms | Perceived control | |
Facilitators | ||||
Barriers | ||||
Total | 19 | 17 | 13 | 31 |
Having knowledge
I found the information because I sought it out. With my first two births, I didn’t know better… there’s enough patient education resources available where you can make decisions for yourself… When you’re empowered with the information, just if you’re given the information about the risks and benefits or informed consent about things, it kind of gives you your power back. And being from a disabled situation or an abuse situation, it’s kind of the power that you’ve lost that you never knew that you lost until you get it back (Knowledge; Control) (Laura)
So I’ve not heard from anybody in weeks. And then I found out I was supposed to make my own appointments, I was like, “Oh, great.”…so I was like, “Really?” So I didn’t even know I was to do that, I’d forgotten…until right later on in the pregnancy, I think it was more like 30 weeks or something. (Knowledge) (Kirsty)
Because I’m not so mobile, they gave me an injection to thin my blood out, which was called [pause] Cycli – no. I’m trying to think. Cyclizy or something, something along those lines… listening to all this medical jargon. They say something and you’re like that, “What? What is that?” (Knowledge) (Hannah)
When they were doing the section, there were voices being thrown back and forth saying, “No, give her a spinal,” and then it was like that, “No, give her a general,” and they were like that, “No, hold on, she’s going to go for a spinal,” and they were like that, “No, she’s got to go for a general.” I just didn’t know what was happening (Knowledge; Control) (Hannah)
I phoned the doctor and said… “I think I’ve got an iron deficiency,” because I’d had blood tests done, and my iron one week I’d had it done it was 11.4, and then it was 10.1, and I was just like totally exhausted. And he was like, “No, that’s normal, you’re fine,” and I was like, “Alright.” So I went on a few more days, and it was just getting worse. I phoned the midwife and she was like, “No, that’s completely wrong.” She got the iron tablets issued for me. Once they’d kicked in, I was a lot better… That was a bad experience I had with that, it was just like a nightmare… (Knowledge; Attitudes; Control) (Kirsty)
Women’s attitudes towards health professionals
[When I was in labour with my second baby] I wanted to get down and walk to the loo [toilet], but I found it difficult to get down because the bed was so high… [The midwife] brought this bedpan, but I just couldn’t get on [it] between contractions… She got the bedpan and actually threw it across the room, said that I was wasting her time… I was really scared to then have my third [baby], because I thought, “Oh, is the care going to be the same?” I don’t want somebody treating me like that (Attitudes; Control) (Rachel)
With the other two [pregnancies]… I went to the doctor straight away. It wasn’t like that [this time]… I didn’t want to go through, you know, it’s almost traumatic just to go to the doctor, because you have these strangers, they’re very invasive with pelvic exams, and doing a bunch of procedures without even asking your permission… (Attitudes; Control) (Laura)
I thought the midwives were going to be stuck up and right up themselves. But they weren’t. I even said that to my consultant, I was like that, “Are the midwives up themselves? Are they stuck up?” and she was like that, “No, they’re really, really nice”… So I was like, “Right, okay then.” And I got admitted, and they were. They were exactly how [she said they would be], if not more (Attitudes) (Hannah)
Social norms
Some of the forms [in my previous pregnancies], I didn’t really fill much out. And I don’t know whether I did put that much in detail, I don’t know, it’s a bit embarrassing to put things down… just because I’ve got that diagnosis, I’m not mental or anything. I am normal… but I think just because of everything that’s happened this time, like my husband [being more] abusive towards me [there is] more in my record this time. Because this is the first pregnancy that … a midwife that deals with that kind of thing was asked to come on board and offer me a bit more support (Social Norms) (Rachel)
I was a little bit reluctant to share my history and everything that I knew was relevant, but at the same time I didn’t want to open myself up… They ask you questions in their questionnaire, “Have you been involved in domestic abuse? Have you done this and this and this?” and it’s kind of like a piece of paper, and you check off all the problems that you have with yourself… why do they even want to know all this stuff? And I really feel – and I might be just jaded or cynical about it, but I really do feel it’s because they want to judge you about what kind of decisions you can make for yourself. (Attitudes; Social Norms) (Laura).
[I was in labour] and I felt like the contractions were coming and it was getting quite sore. Then I asked for gas and air, but they were like, “No, you can’t have that,”… [but] I felt I did need that gas and air, because that’s what I do to help me cope (Control; Social Norms) (Rachel)
I was sent to the high-risk clinic… and I printed out a whole sheet of all the memories I could have from my previous birth, so my health history and everything like that. I spent a lot of time working on this, and they were just like, “Oh, okay,” and tossed it to the assistant. And every time I would go they would ask me the same questions and I’m like, “Okay, I’ve already answered all this for you guys, I took the time to print it out,” but then it was like they didn’t even read my medical history (Control; Knowledge; Social Norms) (Laura).
It’s really easy to put a stereotype on someone, like “Oh, well, this person cannot make good decisions for themselves because a) they’re disabled or b) they made such horrible decisions to put themselves in an abusive situation,” which the two don’t have anything to do with each other a lot of times. I think it’s understood in society that if a woman is in an abusive situation, she can’t make good decisions for herself (Laura)
Perceived control
Jessica: I was scared of social services taking my baby so I waited until I was five months pregnant before I had a scanInterviewer: So what made you go for the scan at five months?Jessica: To check the baby’s health and due date (Control) (Jessica)
I was quite open with the midwife, and I just said… that the way I was treated with my daughter was totally unfair. I was treated like a criminal. I’d had a breakdown. They were supposed to be there to help, but all they did was take my daughter away from me, and treated me like…it was as though I had committed a murder. That’s the way I was being treated… So, I did say to the midwife, “I’m not going to get care if I know that you’re going to disclose information [without my permission].” I said, “I need your support.” (Attitude; Control) (Rachel)
I did tell them [maternity staff], “I cannot lie flat on my back. I sit up in a chair.” Because the first [midwife] came in when they were hooking me up and they put the bed in the lithotomy position or however you call it, and I said, “I cannot lie like that,” and they said, “Oh, well, you have to for this exam,” or, “You have to.” And when I went to the [other] midwife, she said, “Okay, well let me get a couple of pillows and put it behind you,” which made all the difference in the world (Control) (Laura)