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Biomedical subjects

Susan Bewley

Publications and source records attributed to Susan Bewley.

At least 19 recordsLinked to original sources
PubMed2006

A qualitative exploration of the nature of domestic violence in pregnancy.

This article presents a small, qualitative study of 16 women who had experienced domestic violence in the previous 12 months. The violence was perpetrated by a current or former partner in all but one case. Ten of the 16 women had experienced domestic violence during their recent pregnancy, of whom four women had also been assaulted in at least one previous pregnancy. Three women had been assaulted by their partners in a previous pregnancy but not during their recent pregnancy, and three had experienced domestic violence outside of pregnancy only. Some women reported increased feelings of insecurity, jealousy, and possessiveness in their partner during their pregnancy. Abuse within the relationship centered around the arrival and care of the new baby: financial worries, the woman's lessening physical and emotional availability during pregnancy, the lack of practical and emotional support from the male partner, and doubts about paternity.

Adult↗
PubMed2005

Domestic violence, lifetime trauma and psychological health of childbearing women.

OBJECTIVE: Although histories of abuse are associated with psychiatric illness in women, health professionals rarely enquire directly about such experiences. This study examined the association between physical and sexual violence and lifetime trauma and depressive and posttraumatic stress symptoms in women receiving maternity care. DESIGN: Cross sectional study. SETTING: South London Hospital maternity services. POPULATION: Two hundred women receiving postnatal or antenatal care. METHODS: Two hundred women receiving postnatal or antenatal care at a South London maternity service were screened for lifetime experiences of trauma and domestic violence. Information was obtained about self-harming behaviour, suicidal thoughts and attempts and psychiatric history. Women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Posttraumatic Diagnostic Scale (PTDS). MAIN OUTCOME MEASURES RESULTS: One hundred and twenty-one (60.5%) women reported at least one traumatic event and two-thirds of these had experienced multiple traumatic events. The most frequent (34%) was witnessing or experiencing physical assault by a family member. Forty-seven (23.5%) women had experienced domestic violence. Physical and sexual abuse commonly co-occurred. Thirteen (10.7%) women with a trauma history had current posttraumatic stress disorder. Severe posttraumatic symptoms were associated with physical and sexual abuse histories and repeat victimisation. Adult and childhood physical and sexual abuse histories were also associated with more severe depressive symptomatology. Significant social factors associated with depression were being single, separated or in a non-cohabiting relationship. CONCLUSION: Traumatic events are under-recognised risk factors in the development of depressive and posttraumatic stress symptoms in childbearing women. Childhood abuse creates a vulnerability to re-traumatisation in adulthood. Awareness of the impact of trauma and abuse on psychological health may enable more appropriate targeting of clinical services and support for women receiving maternity care.

Adult↗
PubMed2005

The management and outcome of 18 pregnancies in women with polycythemia vera.

BACKGROUND AND OBJECTIVES: Polycythemia vera (PV) is rare in women of childbearing age with only 20 previous pregnancies reported. DESIGN AND METHODS: We report a series of 18 pregnancies (19 fetuses) in eight women with PV managed prior to or following implementation of management guidelines tailored to PV in pregnancy, and review the literature. RESULTS: Seven of these pregnancies were managed by standard antenatal care (group A) without specific attention to the women's PV. All remaining 11 pregnancies (group B) were managed following a formal protocol and received tailored management principally comprising tight control of the hematocrit by venesection, and the use of interferon ? in three patients, in addition to aspirin 75 mg, and prophylactic low molecular weight heparin (LMWH). Each pregnancy was monitored with uterine artery Doppler examinations and regular fetal scanning. In group A (n=7) there was one live birth, which required delivery at 34 weeks due to placental insufficiency, three first trimester miscarriages, two stillbirths and one combined stillbirth and neonatal death (twins) associated with placental dysfunction. All 11 patients in group B received aspirin and post-partum LMWH; four also received venesection (during pregnancy), three interferon-a and three antenatal LMWH. There were ten live births, nine at term, one first trimester miscarriage and no intrauterine growth retardation. INTERPRETATION AND CONCLUSIONS: Pregnancy in PV without meticulous attention to hematocrit is associated with poor fetal outcome. Aggressive intervention with control of hematocrit, aspirin and some LMWH appears to be associated with significantly better outcome (p=0.0017).

Adolescent↗
PubMed2004

Domestic violence: prevalence in pregnant women and associations with physical and psychological health.

OBJECTIVES: To examine the prevalence of domestic violence (DV) and its associations with obstetric complications and psychological health in women on antenatal and postnatal wards. STUDY DESIGN: A cross-sectional survey conducted in an inner-London teaching hospital. Two hundred English-speaking women aged 16 and over, were interviewed between July 2001 and April 2002. The Abuse Assessment Screen was used to assess for experiences of DV. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The analysis of predictors of obstetric complications grouped together those known to be associated with DV. RESULTS: 23.5% of women had lifetime experience of DV, 3% during the current pregnancy. Women with a history of DV were significantly more likely to be single, separated or in non-cohabiting relationship and to have smoked in the year prior to and/or during pregnancy. Higher EPDS scores were significantly associated with DV, single, separated or non-cohabiting status, and obstetric complications. Both a history of DV and increased EPDS scores were significantly associated with obstetric complications after controlling for other known risk factors. CONCLUSIONS: Domestic violence is regarded as an important risk marker for the development of obstetric complications and depressive symptomatology. This finding of itself justifies training and education of maternity health professionals to raise awareness.

Adolescent↗
PubMed2004

Prevalence of domestic violence when midwives routinely enquire in pregnancy.

OBJECTIVE: To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. DESIGN: A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period. SETTING: The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London. SAMPLE: Women aged 16 and over booking for maternity care between 14th September 1998 and 21st January 1999. METHODS: Midwives were required to routinely enquire about domestic violence at booking, 34 weeks of gestation and postpartum (within 10 days) using a series of structured questions. MAIN OUTCOME MEASURES: The lifetime and annual rates of domestic violence. The prevalence of domestic violence in pregnancy. RESULTS: The prevalence of domestic violence in pregnancy was 1.8% at booking, 5.8% at 34 weeks of gestation and 5.0% at 10 days postpartum. Eight hundred and ninety-two women were asked about domestic violence on at least one occasion, of whom 22 (2.5%) reported domestic violence in pregnancy. Two hundred and sixty-five maternity notes were reviewed for the retrospective case note survey and one (0.37%) case of domestic violence in pregnancy was identified. Routine questioning increased the rate of detection of domestic violence by 2.1% (95% CI = 0.1-3.4%; P= 0.03). The lifetime prevalence of domestic violence was 13%, and 6.4% in the previous 12 months. CONCLUSIONS: Routine enquiry for domestic violence can increase the rate of detection in maternity settings, thereby providing an opportunity for women to access help early.

Adolescent↗
PubMed2003

Experiences of seeking help from health professionals in a sample of women who experienced domestic violence.

The present paper describes a qualitative study of women who suffered domestic violence. The aim was to explore their experiences of seeking help from health professionals and assess their psychological health. Purposive sampling was used to select a subsample from a larger sample of women who were screened for domestic violence as part of a study undertaken at Guy's and St Thomas' Hospitals in London, UK. In-depth, semi-structured interviews were conducted with the subsample of women during the postpartum period (up to 14 months). Interviews were conducted in women's homes and general practitioners' (GPs) surgeries. The sample consisted of 10 women who had experienced domestic violence in the past 12 months (including the current pregnancy), and six women who had experienced domestic violence in the past 12 months but not the current pregnancy. The main outcome measures included: women's experiences of seeking help from health professionals; and assessment for postnatal depression, post-traumatic stress disorder (PTSD) and psychological distress. Women scored highly on measures of postnatal depression and PTSD. With regard to seeking help, there was a tendency for women to regard GPs, and accident and emergency staff as less helpful compared with health visitors in responding to domestic violence. Lack of privacy, continuity of care and time constraints were dominant themes which emerged from women's contacts with health professionals. Very few women voluntarily disclosed domestic violence to a health professional and even fewer were asked directly about domestic violence by one. It is important for health professionals to enquire about domestic violence in a sensitive manner and provide a response that takes into accounts the complexity of women's needs. Domestic violence training is necessary to equip health professionals with the knowledge and skills they need to respond to domestic violence more effectively.

Adult↗
PubMed2003

Postnatal morbidity after childbirth and severe obstetric morbidity.

OBJECTIVE: To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum. DESIGN: Questionnaire assessment of postnatal outcome in a cohort study. SETTING: South East Thames, UK. POPULATION: All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998. METHODS: Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls). MAIN OUTCOME MEASURES: Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF-36)], sexual activity and use of health services between 6 and 12 months postpartum. RESULTS: There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (P = 0.25; 95% CI for difference -2.2% to 7.9%), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (P < 0.001; 95% CI for difference 8.9% to 21.9%). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (P < 0.001; 95% CI for difference 9.1% to 19.9%) and 3.7% (P < 0.001; 95% CI for difference 2.4% to 9.0%), respectively, in controls. CONCLUSION: Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.

Case-Control Studies↗
PubMed2003

Midwives' perceptions and experiences of routine enquiry for domestic violence.

OBJECTIVE: To examine midwives' perceptions and experiences of routine enquiry for domestic violence. DESIGN: Focus groups and semi-structured interviews. SETTING: The study was conducted in the maternity services of Guy's and St Thomas' NHS Hospital Trust, an inner London teaching hospital. SAMPLE: Twenty-eight midwives were interviewed. METHODS: One hundred and sixteen out of 145 (80%) midwives were trained to screen routinely pregnant women for domestic violence at booking, at 34 weeks of gestation and postpartum. Twenty midwives attended one of four focus groups and eight semi-structured interviews were conducted. Interviews were transcribed and analysed using content analysis. MAIN OUTCOME MEASURES: Midwives' views of routine enquiry for domestic violence. RESULTS: Midwives felt that domestic violence was an important issue to be addressed. However, practical and personal difficulties were encountered during the study. These included: time constraints, lack of confidential time, safety issues, staff shortages, low staff morale and midwives' personal experiences of domestic violence. The study produced a raised awareness about domestic violence within the maternity unit. There was considerable support for the idea of a specialist domestic violence midwife. CONCLUSIONS: Routine enquiry for domestic violence cannot be implemented effectively without ensuring that in-depth training, resources, staff support and policies to ensure that screening can be conducted safely and confidentially are in place.

Attitude of Health Personnel↗
PubMed2002

Quantitative foetal fibronectin as a predictor of successful induction of labour in post-date pregnancies.

OBJECTIVE: To study the relationship between induced labour, quantitative levels of fibronectin and the Bishop score. STUDY DESIGN: Vaginal fibronectin/Bishop score were estimated in 33 nulliparous women undergoing induction of labour for post-dates at the Department of Obstetrics and Gynaecology, Guy's and St. Thomas' Hospital London. RESULTS: There was no significant relationship between either the fibronectin level or Bishop score and the duration of the latent phase (R(2)=0.001; P=0.86 and R(2)=0.12; P=0.08, respectively). There was no relationship between the total prostaglandin dose and fibronectin level (R(2)=0.03; P=0.39) nor any significant correlation between either the Bishop score or fibronectin level and the induction to delivery time (R(2)=0.13; P=0.11 and R(2)=0.0006; P=0.97, respectively). Significant relationships were observed inversely between the total prostin dose and Bishop score (R(2)=0.33; P=0.002), between the total prostin dose and latent phase (R(2)=0.54; P=0.000009) and between Bishop score and the fibronectin levels (R(2)=0.19; P<0.01). CONCLUSIONS: Quantitative foetal fibronectin is not a useful test for inducibility at term.

Adolescent↗
PubMed2002

The comprehensiveness care of sickle cell disease.

Millions of people across the world have sickle cell disease (SCD). Although the true prevalence of SCD in Europe is not certain, London (UK) alone had an estimated 9000 people with the disorder in 1997. People affected by SCD are best managed by a multidisciplinary team of professionals who deliver comprehensive care: a model of healthcare based on interaction of medical and non-medical services with the affected persons. The components of comprehensive care include patient/parent information, genetic counselling, social services, prevention of infections, dietary advice and supplementation, psychotherapy, renal and other specialist medical care, maternal and child health, orthopaedic and general surgery, pain control, physiotherapy, dental and eye care, drug dependency services and specialist sickle cell nursing. The traditional role of haematologists remains to co-ordinate overall management and liase with other specialities as necessary. Co-operation from the affected persons is indispensable to the delivery of comprehensive care. Working in partnership with the hospital or community health service administration and voluntary agencies enhances the success of the multidisciplinary team. Holistic care improves the quality of life of people affected by SCD, and reduces the number as well as length of hospital admissions. Disease-related morbidity is reduced by early detection and treatment of chronic complications. Comprehensive care promotes awareness of SCD among affected persons who are encouraged to take greater control of their own lives, and achieves better patient management than the solo efforts of any single group of professionals. This cost-effective model of care is an option for taking haemoglobinopathy services forward in the new millennium.

Anemia, Sickle Cell↗
PubMed2002

Women's perceptions and experiences of routine enquiry for domestic violence in a maternity service.

OBJECTIVE: A qualitative study examining women's perceptions and experiences of routine enquiry for domestic violence in a maternity service. DESIGN: Purposive sampling was used to select a sub-sample from a larger group of women who participated in a domestic violence in pregnancy screening study undertaken at Guy's and St Thomas' Hospitals in London. SETTING: Interviews were conducted in women's homes and general practitioner's surgeries. SAMPLE: Ten women who experienced domestic violence in the last 12 months (including pregnancy), six women who experienced domestic violence in the last 12 months, but not in pregnancy, and 16 women with no history of domestic violence. METHODS: Semi-structured interviews conducted during the postpartum period (up to 14 months). MAIN OUTCOME MEASURES: Women's views on the acceptability and relevance of routine enquiry for domestic violence. RESULTS: Routine enquiry for domestic violence in maternity settings is acceptable to women if conducted in a safe, confidential environment by a trained health professional who is empathic and non-judgemental. The effectiveness of routine enquiry to elicit a history of domestic violence is influenced by factors such as lack of time, confidential consulting time, continuity of care, training and availability of resources. CONCLUSIONS: Further research is needed to determine whether the use of on-site specialist domestic violence workers will increase midwives' ability to routinely enquire about domestic violence.

Attitude of Health Personnel↗