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Midwives are not immune

Dr O’Doherty explains the types of interventions that have been evaluated in research studies.
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I would like to tell you about some of the international research evidence to support practice on domestic violence and abuse during pregnancy. I’ll start with identification practices. Although the exact prevalence of domestic violence and abuse around the time of pregnancy remains unclear, it is evident that it affects a substantial group of women and birthing people. In fact, it is more common than several maternal health conditions, for example pre-eclampsia, but receives far less attention. There is consensus that the perinatal period offers an ideal window of opportunity to address domestic violence and abuse, often being the only moment in the lives of many couples when there is regular contact with healthcare providers.
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Existing interventions for domestic abuse delivered during the perinatal period can be broadly classified into screening, support and counselling, and then visitation programmes. Now in terms of identification practices, what works and for whom? In 2015, I led a Cochran Review to examine the international literature on screening, or interventions that involve asking all service users in a given healthcare setting about their exposure to domestic abuse. Overall, we located insufficient evidence to recommend screening interventions on the basis that there was a mismatch between the numbers identified through screening and the best estimates of prevalence in the population. However, there was one exception.
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Asking all pregnant women about domestic abuse saw a fourfold in the increase of the identification of abuse compared to controlled conditions. These findings were taken up by the World Health Organization in their guidance on managing domestic abuse during the antinatal period. What’s equally important is what happens once women and birthing people disclose. If screening is taking place, health providers need to be able to offer evidence-based options. This takes into account both immediate response and referral as well as consideration of support, advocacy and therapeutic options for victims.
Domestic violence and abuse affects professionals including midwives and others working in maternity services.
Aside from co-creating this course, Dr Sally Pezaro has also worked in partnership with the Royal College of Midwives (RCM) to explore midwives’ experiences of domestic violence and abuse (DVA) in their own lives and the workplace support available to them in this area. This work resulted in the following (PDF) RCM report being published with recommendations: Safe places? Workplace support for those experiencing domestic abuse.
In the video above, Dr Sally Pezaro shares insights on what it might mean for maternity staff, healthcare services and those experiencing DVA.

Report recommendations

Health boards should:
  • Develop specific policies to support staff who are victims of domestic abuse, aligned to existing guidance from the NHS Staff Council developed in 2017. Local policies should be developed in partnership with staff-side representatives, with detailed commitments to provide special paid leave, adjustments to working arrangements and safety considerations if appropriate.
  • Provide and publicise confidential domestic abuse support services for affected staff, including access to Independent Domestic Violence Advisors (IDVAs), external counselling and legal services as appropriate.
  • Ensure that all managers and supervisors are trained on domestic abuse issues so that they can recognise signs of domestic abuse in their staff and confidently undertake their safeguarding obligations.
  • Ensure that staff at all levels are trained on domestic abuse issues and made aware of relevant workplace policies as part of their induction programme and continuous updating and are made aware of support services.

Activity

Reflect on how you might use the findings of this report to support maternity staff experiencing DVA. How might you support colleagues more effectively in practice?
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Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy

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