Domestic abuse disclosure and a request for secrecy at 22 weeks

First minutes

• Do not react with alarm or pity; keep your voice level and thank her for telling you. Disclosure is the hardest part and her assessment of your reaction decides whether she tells anyone else.
• Ask open, then direct questions: 'What happened to your arm?' 'Is there anything else that's been happening at home?' 'What are you afraid of right now?' Avoid 'why' questions, which sound like blame.
• Do not press for a detailed account of every incident. You are not an investigator; you need enough to understand risk.
• Check immediate safety: is he coming back soon, does she have somewhere to go tonight, does she have her own money, keys, documents?
• Ask about the 4-year-old - what she has seen or heard, whether he is ever violent towards her.

The promise You cannot give it, and saying so badly does real damage; saying so well can build trust. Something like: 'I can't promise to keep this completely between us - I'd be lying to you, and you'd find out later. What I can promise is that I won't do anything without telling you first, except where a child is at risk. The notes are read by the midwives and doctors caring for you; he doesn't have access to them unless you give him access. Can we talk about the app and how he gets into it?' That is honest about the limits and gives her something concrete in return - control over timing and knowledge of who sees what.

Reasoning: confidentiality in maternity care is not absolute. The ethical obligation is to be transparent about how information will be used, not to extract a false promise in exchange for disclosure.

Documentation

• Record in the maternity record, not a separate private note (a hidden record is itself a risk and may not be seen by the team who need it).
• Use her own words in quotation marks, record the bruising objectively (size, site, colour, and offer a body map per local policy), the missed appointments, his control of finances and phone, and the consent and advice conversation you had.
• Record that you explained the limits of confidentiality and what you would do next.
• Flag the record according to local safeguarding procedure so it is visible to the right staff.

Digital safety

• Ask how he accesses the app and consider turning off notifications, changing the password with her, or using an agreed safe contact method and code word.
• Do not leave a voicemail or text that could be seen. Agree the safest number and time to call, and confirm 'is this a good time?' each contact.
• Offer details of a specialist domestic abuse service and note the 24-hour helpline; do not put literature in her bag where it might be found.

The children

• The unborn baby and the 4-year-old are both exposed to risk from a violent adult in the household; there are reasonable grounds for a referral to children's social care and, where used, the MARAC/IDVA pathway.
• Tell her you are doing it before you do it, explain that this is a legal duty rather than a choice, and involve her in how it is framed so she is not ambushed.
• She can decline a police report for herself; she cannot veto a safeguarding referral for the children.

Reasoning: adults retain the right to make their own decisions, including risky ones; children do not have that option, and the midwife's duty to the child is independent of the mother's consent.

Staying is a common and rational decision - leaving is the most dangerous period, and she has a child, no visible money and nowhere to go. My job is not to talk her into leaving but to make sure she survives the decision she has made.

What I would do

• Safety plan with her, not for her: where she would go in an emergency, a bag left with a friend, a code word with a neighbour, her own phone credit, copies of documents, knowledge of the 24-hour helpline and of her right to a solicitor.
• Ask directly, every contact: 'Is there anything you need to tell me about your safety since we last met?' - and record the answer, including 'no'.
• Agree a follow-up interval and be reliable; consistency is the intervention.
• Offer referral to the specialist IDVA and to a GP or perinatal mental health service if she is low in mood or frightened.
• Do not over-promise what services can deliver, and do not take over decisions about the pregnancy that are hers.

What changes the tempo

• Escalation of violence, strangulation, threats to kill, weapon use, stalking, or threats about the pregnancy.
• Any injury to the 4-year-old, or disclosure that the child is witnessing assaults.
• Pregnancy progressing towards birth with no plan for who is present at the birth, or a partner who intends to control that.
• Features of coercive control that meet the threshold for a crime irrespective of any single assault - this is a police matter in its own right and she should be told so, without pressure.
• Signs of trafficking, or of her being prevented from accessing care.

Reasoning: the professional value being tested is neither rescue nor collusion. It is sustained, non-judgemental engagement that keeps the door open and keeps the child's safety visible in the background.