Midwives' identification of and response to domestic violence during pregnancy in the UK: An analysis of midwives' accounts including barriers encountered

This study explores midwives' accounts of identification and response to domestic violence, including discussing barriers and methods of overcoming obstacles in working with women who are experiencing domestic violence. A qualitative design was used to conduct interviews and focus groups with 19 midwives. Thematic analysis was then utilized. Midwives reported challenges in negotiating policy and practice around domestic violence. They discussed working through identification by calling upon duty to screen routinely, employing midwife intuition, and engaging in communication as part of the midwife-patient relationship. Routine screening, seen as a solution to value judgements because of the understood universal nature of abuse, was undermined by a variety of factors without a routine or consistent solution. In responding to domestic abuse, they described navigating the tension between policy and practice by utilizing strategies such as collaboration with others and acknowledging limitations on their roles as midwives. In understanding issues in cross-cultural interaction, midwives' accounts included talk around communication complexity, emphasizing the additional challenges when patients have no recourse to public funds. Midwives expressed challenges in negotiating the complexities of encounters with women and working within a policy framework. These were described as being met with a variety of solutions, including engineering private time with the patient, utilizing resources and knowledge, navigating the midwife-patient relationship, and emphasizing their role as midwives. Additional solutions were recommended, including implementation of policy for routine private consultation, strengthening resource availability, revisiting the named midwife structure, engaging in a best practices session, and further research in solution evaluation.