safeguarding; child protection; midwives; pregnancy; healthy settings theory
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 cooccurrence 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 noncoercive, 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.
The safety and welfare of children has been of increasing public concern over the past 50 years, and although safeguarding has improved significantly, there are still improvements to be made.1 Safeguarding is a relatively new term which is broader than 'child protection' as it also includes prevention and the role of public services in promoting the welfare of children and young people. It emphasizes not only the diagnosis and management of child abuse as it is conventionally understood, but also includes the importance of ensuring the wellbeing of children by recognizing vulnerable children in distress and intervening where possible to prevent a range of adverse outcomes. The government has defined the term 'safeguarding children' as:
'The process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully.'2
The health service, including maternity services, plays an important role in the development of the National Service Framework for Children, Young People and Maternity Services3 which sets out a 10-year strategy for improving children's health and wellbeing, including a national standard for safeguarding and promoting children's welfare. Health professionals should ensure that children and families receive the care, support and treatment they need in order to promote children's health and development. The universal nature of health provision means that they are often the first to be aware that families are experiencing difficulties. All healthcare organizations have a duty under the Children Act 20044 to make arrangements to safeguard and promote the welfare of children and young people. …