Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden

Objective: to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden. Design: an inductive qualitative design, using focus groups interviews. Setting: midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals. Findings: five categories emerged: 'Knowledge about the different faces' of violence', perpetrator and survivor behaviour, and violence-related consequences. 'Identified and visible vulnerable groups', at risk' groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 'Barriers towards asking the right questions', the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. 'Handling the delicate situation', e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. The crucial role of the midwife', insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category 'Failing both mother and the unborn baby' which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. Key conclusions and implication for practice: avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden. (C) 2010 Elsevier Ltd. All rights reserved.