Midwives Perceiving and Dealing With Violence Against Women: Is It Mostly About Midwives Actively Protecting Women? A Modified Grounded Theory Study.

Heidi Siller,Martina König-Bachmann,Susanne Perkhofer,Margarethe Hochleitner

doi:10.1177/0886260520927497

Abstract

Violence against women (VAW) affects pregnancy, birthing, and puerperium. In this sense, domestic violence (DV) or intimate partner violence (IPV) may increase during pregnancy, sexual child abuse may affect the birthing process, and obstetric violence may occur during birthing. Thus, consideration of violence during pregnancy and puerperium is essential to providing optimal care for women. This implies that midwives should be able to identify women affected by VAW. Therefore, this study explored VAW as perceived by midwives in one region of Austria. Interviews with 15 midwives (mean age 38.7 years) were conducted in Tyrol, Austria, between December 2014 and December 2015. Data were analyzed with a modified version of Grounded Theory. The core category “protecting but walking on eggshells” showed the caution with which midwives approached VAW and in particular DV or IPV. Including VAW in midwifery was connected to midwives being active protectors of women in their care. This meant being an intuitive, sensible, guiding, and empowering midwife to the woman. Staying active was necessary to fulfill the protective role also with regard to DV. However, this was influenced by the visibility of the connection between VAW, pregnancy, childbirth, and puerperium. The key to including VAW and particularly DV was midwives’ professional role of actively protecting women. Neglecting DV during pregnancy, labor, and puerperium meant further silencing DV, and keeping it hidden. Considering these aspects in planning and implementing actions to prevent VAW is expected to support sustainability and motivation to ask women about all forms of violence during and after pregnancy.

Highlights

Any attempt to research violence against women (VAW) over the life course means focusing on periods of potential vulnerability
We focus on VAW to examine VAW in its entirety, but we refer to specific forms of VAW such as domestic violence (DV), intimate partner violence (IPV), or obstetric violence (OV) if required by the context
DV and IPV stood out and had a specific status compared to other forms of VAW

Summary

Introduction

Any attempt to research violence against women (VAW) over the life course means focusing on periods of potential vulnerability. During pregnancy, childbirth, and puerperium, women may be vulnerable to VAW or impacted by having experienced violence in the past Violence in this context refers most often to childhood abuse, domestic violence (DV), intimate partner violence (IPV), and obstetric violence (OV). A qualitative study with six midwives in Jamaica showed that midwives without formal training about VAW perceived their professional role to include intervening when caring for a woman experiencing gender-based violence (Pitter, 2016). In Great Britain, focus group findings of 11 midwives who received training on DV found that they took pride in supporting women who had experienced DV and perceived asking about DV as a critical part of their professional role (Baird et al, 2013) Despite these findings, research on midwives’ perception has been relatively limited, regarding VAW in its entirety. DV or IPV affects the neonate through an increased risk of spontaneous abortion, preterm labor, or low birth weight, as evidenced by a literature review (Alhusen et al, 2015) and a survey of 468 victimized women in Australia (Meuleners et al, 2011)

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