Aim: Using a healthy settings framework, this study aims to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse; their perceived role and willingness to identify abuse; record keeping; reporting of suspected or definite cases of child abuse; and training received.
Methods: A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland, which resulted in 488 midwives completing the questionnaire, a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation and the questionnaire was validated using exploratory factor analysis.
Results: Community midwives reported receiving more training on domestic and child abuse. Although a high percentage of both hospital and community midwives acknowledged a link between domestic and child abuse, it was the community midwives who encountered more suspected and definite (p < 0.001) cases of child abuse. More community midwives reported being aware of the mechanisms for reporting child abuse. However, an important finding is that although 12% of community midwives encountered a ‘definite’ case of child abuse, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of child abuse. Findings suggest that lack of education and training was a problem as only a quarter of hospital midwives reported to have received training on domestic violence and 40% on child abuse. This was significantly less than that received by community midwives, where the figures were 57% and 62%, respectively.
Conclusion: Midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about domestic violence.
Lewis G. (ed). The Confidential Enquiry into Maternal and Child Health (CEMACH), Saving Mothers’ Lives, The Seventh Report into Maternal Deaths in the United Kingdom. London: CEMACH , 2007
2.
Department for Education and Employment.Working Together to Safeguard Children. London: HMSO, 2006
3.
Department for Education and Skills.National Service Framework for Children, Young People and Maternity Services: Core Standards. London: HMSO, 2004
4.
Department of Health.The Children’s Act Report. London: HMSO, 2002
5.
Lazenbatt A. , Freeman R.Recognizing and reporting child physical abuse: A cross-sectional survey of primary healthcare professionals . Journal of Advanced Nursing2006; 56(3): 227-237
6.
Department of Health.Green Paper Consultation Document: Every Child Matters. London: HMSO, 2003
7.
Hall D., Williams J.Safeguarding, child protection and mental health. Archives of Disease in Childhood2008; 93: 11-13
8.
British Medical Association.Domestic Violence: A Healthcare Issue?London: British Medical Association, 1998
9.
Bacchus L., Mezey G., Bewley S.Women’s perceptions and experiences of routine enquiry for domestic violence in a maternity service. British Journal of Obstetrics and Gynaecology2002; 109: 9-16
10.
Home Office and Cabinet Office.Domestic Violence: Findings from a New British Crime Survey Self-Completion Questionnaire. Home Office Research Study 191. London: HMSO, 1999
11.
Shadigian EM , Bauer STScreening for partner violence during pregnancy . International Journal of Gynecology & Obstetrics2004; 84(3): 273-280
12.
Silverman MR , Decker E., Reed A., Raj A.Intimate partner violence victimization prior to and during pregnancy among women residing in 26 US states: Associations with maternal and neonatal health. American Journal of Obstetrics & Gynecology2006; 195: 140-148
13.
McFarlane J. , Parker B., Soeken K.Abuse during pregnancy: Associations with maternal health and infant birth. Nursing Research1996; 45: 37-42
14.
McFarlane J. , Campbell JC, Sharps P., Watson, K.Abuse during pregnancy and femicide. Obstetrics & Gynecology2002; 100: 27-36
15.
Coker AL, Sanderson M., Dong B.Partner violence during pregnancy and risk of adverse pregnancy outcomes . Paediatric and Perinatal Epidemiology2004; 18: 260-269
16.
Edleson JLStudying the co-occurrence of child maltreatment and woman battering in families . In: Graham-Bermann SA, Edleson JL, editors. Domestic Violence in the Lives of Children: The Future of Research, Intervention and Social Policy (pp 99-110). Washington, DC: American Psychological Association, 2001
17.
McGuigan WM , Pratt CCThe predictive impact of domestic violence on three types of child maltreatment. Child Abuse Neglect2001; 25(7): 869-883
18.
Jones LP, Gross E., Becker I.The characteristics of domestic violence victims in a child protective service caseload. Families in Society2002 ; 83: 405-415
19.
Ramsay J., Richardson J., Carter YH, Davidson L., Feder G.Should health professionals screen women for domestic violence? Systematic review. British Medical Journal2002; 325: 1-13
20.
Hall DMB , Elliman D.Health for all Children. Fourth edition. Oxford: Oxford University Press , 2003
21.
Lundy M., Grossman SFThe mental health and service needs of young children exposed to domestic violence. Families and Sociology2005; 86(1): 17-29
22.
Butchart A. , Villaveces A.Violence Against Women and the Risk of Infant and Child Mortality. Geneva: World Health Organization, 2003
23.
Goodall E., Lumley T. ‘Not Seen and Not Heard’. Child Abuse: A Guide for Donors and Funders. London: New Philanthropies Capital, 2007
24.
Hester M., Pearson S.Making an Impact: Children and Domestic Violence. A Reader. Bristol: School for Policy Studies, University of Bristol; NSPCC/Barnardos, 1998
25.
Mullender A. , Hague G., Imam U., Kelly L., Malos E., Regan L.Children’s Perspectives on Domestic Violence. London : Sage, 2003
26.
Mullender A.‘What children tell us: "He said he was going to kill our mum"’ . In: Humphreys C, Stanley N, editors. Domestic Violence and Child Protection - Directions for Good Practice. London: Jessica Kingsley, 2005
27.
Bacchus L., Mezey G., Bewley S.Prevalence of domestic violence when midwives routinely enquire in pregnancy . Obstetrical & Gynaecological Survey2005; 60(1): 11-13
28.
Gazmararian JA , Lazorick S., Spitz AMPrevalence of violence against pregnant women
29.
A review of the literature. Journal of the American Medical Association1996; 275: 1915-1920
30.
Jasinski JLPregnancy and domestic violence: A review of the literature. Trauma Violence Abuse2004 ; 5(1): 47-64
31.
Hunt S., Martin A.Pregnant Women, Violent Men: What Midwives Need to Know. Hale: Books for Midwives Press, 2001
32.
Mirrlees-Black C.Domestic Violence: Findings from the British Crime Survey Self-Completion Questionnaire. London: Home Office, 1999
33.
Mezey GC, Bacchus L., Haworth A.Midwives’ perceptions and experiences of routine enquiry for domestic violence. British Journal of Obstetrics & Gynaecology2003; 110(8): 744-752
34.
Mezey GC, Bewley S.Domestic violence and pregnancy. British Medical Journal1997; 314: 1295
35.
Craig C.Domestic Violence and Health Professionals. Belfast : Northern Ireland Women’s Aid Federation, 2003
36.
Casanueva CE , Martin SLIntimate partner violence during pregnancy and mother’s child abuse potential. Journal of Interpersonal Violence2007; 22(5): 603-622
37.
Osofsky JDPrevalence of children’s exposure to domestic violence and child maltreatment: Implications for practice and intervention. Clinical Child & Family Psychology Review2003; 6(3): 161-170
38.
Protheroe L. , Green J., Spiby H.An interview study of the impact of domestic violence training on midwives. Midwifery2001 ; 20(1): 94-103
39.
Smith F.Safeguarding the young. Paediatric Nursing & Midwifery2003; 15(10): 24-25
40.
King MC, Ryan J.Woman abuse: The role of nurse-midwives in assessment. Journal of Nurse-Midwifery1996; 41(6): 436-441
41.
Thompson RS , Rivara FP, Thompson D., Barlow WE, Sugg NK, Maiuro RD, Rubanowice DMIdentification and management of domestic violence: A randomized trial. American Journal of Preventive Medicine2000; 19(4): 253-263
42.
Espinosa L. , Osborne K.Domestic violence during pregnancy: Implications for practice. Journal of Midwifery & Women’s Health2002; 47: 305-317
43.
Nasir K., Hyder A.Violence against pregnant women in developing countries. European Journal of Public Health, 2003; 13(2): 105-107
44.
Lazenbatt A. , Cree L., Mc Murray F.The use of exploratory factor analysis in evaluating midwives’ attitudes and stereotypical myths related to the identification and management of DV in practice. Midwifery: An International Journal2005; 21: 322-334
45.
Lazenbatt A. , Taylor J., Cree L.A Healthy Settings Framework: An evaluation and comparison of midwives’ responses to addressing domestic violence in pregnancy. Midwifery (in press)
46.
Bewley S.The role of the midwife. In: Bewley S, Friend JR, Mezey G, editors. Violence Against Women . London: RCOG, 1997
Leventhal JMThe challenges of recognizing child abuse: Seeing is believing. Journal of the American Medical Association1999; 281: 657-659
49.
Department of Health.Domestic Violence: A Resource Manual for Healthcare Professionals. London: HMSO, 2000
50.
Grossman R., Scala K.Health Promotion and Organizational Development: Developing Settings for Health. Copenhagen: WHO Regional Office for Europe , 1993
51.
Baric L.The settings approach - Implications for policy and strategy. Journal of the Institute of Health Education1993 ; 31(1): 17-24
52.
Baric L.Health Promotion and Health Education in Practice: Module 2 - The Organizational Model. Altrincham: Barns, 1994
53.
Dooris M., Dowding G., Thompson J.The settings-based approach to health promotion. In: Tsouros A, Dowding G, Thompson J, Dooris M, editors. Health-Promoting Universities: Concept, Experience and Framework for Action. Copenhagen: WHO Regional Office for Europe; 1998. Available at: http://www.who.dk/document/E60163.pdf
54.
Dooris M.Joining-up settings for health: A valuable investment for strategic partnerships ? Critical Public Health2004 ; 14(1): 37-49
55.
Antonovsky A.The structure and properties of the sense of coherence scale. Social Science and Medicine1993; 36: 725-733
56.
Poland B., Green L., Rootman I.Settings for Health Promotion: Linking Theory and Practice. London: Sage, 2000
57.
Hunter B.Conflicting ideologies as a source of emotion work in midwifery. Midwifery2004; 20: 261-272
58.
Henderson C.The public health role of the midwife. British Journal of Midwifery2002; 10: 268-270
59.
House of Commons Select Committee. Fourth Report - Provision of Maternity Services. London : HMSO, 2003
60.
Friend C.Aligning with the battered woman to protect both mother and child: Direct practice and policy implication. In: Geffner R, Jaffe P, Suderman M, editors. Children Exposed to Domestic Violence: Current Issues in Research, Intervention, Prevention and Policy Development (pp 345-358). New York: The Haworth Abuse and Trauma Press, 2000
61.
Badger LWReporting of child abuse: Influence of characteristics of physician, practice and community. Southern Medical Journal1989 ; 82: 281-286
62.
Altman DGPractical Statistics for Medical Research. London : Chapman & Hall, 1991
63.
Bradley F., Smith M., Long J., O’Dowd T.Reported frequency of domestic violence: Cross-sectional survey of women attending general practice. British Medical Journal2002; 324: 271
64.
Carter J., Schechter S.Child Abuse and Domestic Violence: Creating Community Partnerships for Safe Families. Suggested Components of an Effective Child Welfare Response to Domestic Violence. San Francisco, CA: Family Violence Prevention Fund, 1997
65.
Mills LGWoman abuse and child protection: A tumultuous marriage. Children and Youth Services Review2002; 22: 199-205
66.
Saunders DG , Anderson D.Evaluation of domestic violence training for child protection workers and supervisors: Initial results. Children and Youth Services Review2004; 22: 373-395
67.
Salmon D., Murphy S., Baird K., Price S.Evaluation of the effectiveness of an educational programme promoting the introduction of routine antenatal enquiry for domestic violence. Midwifery2006; 22: 6-14
68.
Whitelaw S. , Baxendale A., Bryce C., MacHardy L., Young I., Witney E.Settings-based health promotion: A review . Health Promotion International2001; 16(4): 339-353
69.
Corbally MAFactors affecting nurses’ attitudes towards the screening and care of battered women in Dublin accident and emergency departments: A literature review. Accident and Emergency Nursing2001; 9(1): 27-37
70.
Fleck-Henderson AFDomestic violence in the child protection system: Seeing double. Children and Youth Services Review2000; 22: 333-354
