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Makeup, excuses, lies - a woman can hide the signs of domestic violence in fairly convincing ways. But health-care workers, says Gail Hilton, are in a position to see through the cover-up.

The clues are available not only in emergency rooms but in birthing suites and other hospital units - where health-care workers can get an up-close look at injuries and relationships, says Hilton, a clinical social worker at Cottonwood Hospital.The role of health care in preventing, identifying, intervening in and treating domestic violence will be the topic of a conference on Thursday, Nov. 7, at LDS Hospital. The conference is sponsored by IHC's Salt Lake Valley hospitals.

Birthing suites are an incongruous but all-too-common backdrop for domestic violence, says Hilton.

Pregnancy is a not only a time of stress, she notes, but a time when women are especially vulnerable. And during a woman's pregnancy, the man in her life often reacts abusively both to fears of responsibility and to a decrease in the amount of attention focused on him.

Pregnant women sometimes come in with black eyes, says Hilton. Or with placenta abruption. While the black eye could have been the result of an encounter with a door, and the placenta abruption could have occurred spontaneously, health-care workers need to be alert to the possibility that violence was the cause.

Sometimes, notes Barbara Wilson, nursing administrator for women's services at Cottonwood, Alta View and LDS hospitals, nurses won't suspect a problem until, for example, a family member confides that the woman's husband kicked her in the stomach.

"We tend to think this kind of thing doesn't happen here," says Wilson, "so we don't question it as much as we should," referring to the bruises and broken bones that aren't consistent with the explanations women give.

Health-care workers, she says, need to be alert not only to physical signs of abuse but to the subtle cues they can pick up any time a woman comes to the hospital for care.

In maternity cases, nurses can pick up on clues about the way the father reacts to the mother during labor. In other situations, there may be even more-subtle hints.

"What we tend to see with (abusive) families like this is an overprotective caregiver," says Wilson. "A man may bring his wife in and not want the nurses to be alone with the patient." When nurses or doctors ask questions of the patient, it will be the man who will answer.

"Typically, abusive men are controlling," says Wilson. "They don't want their woman to have autonomy."

By law, health-care workers are required to report cases where there is strong evidence that there has been abuse. In fact, it is a Class B misdemeanor not to report such cases.

Conference attendees will discuss the ways in which the law impacts the men and women involved and the doctor-patient relationship. What happens if a perpetrator is falsely accused? What happens if the perpetrator is justly accused but then takes the accusation out on his victim? What about women who will not admit that they are being abused?

`These are the gray areas of the reporting law," says Hilton.

In Utah, says Wilson, one out of 10 women have been assaulted by their intimate partners, and 47 of the abusers beat their partners three or more times a year.

Domestic violence is the leading cause of admission to emergency rooms for women ages 15 to 44.

For more information, call 321-1976.