Midwives’ practices to support women experiencing intimate partner violence who do not seek help

Abstract

Purpose

Research on perinatal practices of midwives is limited, particularly in cases where female victims of intimate partner violence (IPV) cohabiting with their partners do not voluntarily seek help. Through interviews with midwives experienced in handling IPV cases in medical settings, this study explored strategies that midwives use to support these women.

Methods

The study included midwives working in medical facilities involved in perinatal IPV victim support or those with structured IPV-focused practices. A qualitative descriptive research design was used, conducting semi-structured online interviews. Verbatim transcripts were coded and abstracted to focus on the characteristics of women experiencing IPV without seeking help and their families, and the corresponding midwifery practices. Codes were analyzed for similarities and differences to generate subcategories and categories. The study received approval from the research ethics committees of Kobe Women’s University and Kobe Tokiwa University.

Results

Seven midwives from three medical facilities participated in the study. Three categories were identified describing the characteristics of women experiencing IPV without seeking help and their families: “inability to recognize IPV as an issue”, “resistance to interventions disrupting family balance”, and “children at risk in closed domestic environments”. Six categories describing practices to support such women emerged. Midwives need: “to be certain to accumulate evidence based on signs of concern”, even if the woman does not ask for help voluntarily; to be able to understand a couple's relationship by “engaging in repeated in-depth questioning again and again throughout the course of maternity care”; “to help women recognize IPV and how to signal for help”, and “to assess a couple's ability to care safely for children”. Furthermore, midwives should not only “ensure that support relationships and care are handed down to the community” but also try to “Creating an in-hospital system to maintain connections with families even after they are discharged”.

Conclusion

Although continued cohabitation with the husband poses a high risk of child abuse, women often do not recognize IPV as a problem and resist home interventions. In this situation, midwives applied the following practices. They used IPV screening as a communication tool to discuss marital relationships, and identified IPV by focusing on the marital relationship in various maternity care settings. They fostered trusting relationships with women and created a safe environment in which to talk, using a trauma-informed approach to encourage women to confide their experiences of IPV while also taking into consideration the effects of trauma and creating a sensitive and tactful context. They instructed women in how to signal for help and informed them about how hospitals and public health nurses can serve as a source of support and how hospitals will provide different forms of care. They provided information to public health nurses to assist their assessment of parents' readiness and specific challenges as part of their provision of targeted care. Midwives also assisted public health nurses in nurturing the couple's motivation to receive community support, and promoted the development of a relationship between the couple and public health nurses. In other words, it is important for midwives to assess the couple's relationship, encourage women to acknowledge IPV and seek help, and ensure collaboration with to connect support systems, enabling couples to safely raise their children.