Oxford Handbook of Midwifery (40 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

BOOK: Oxford Handbook of Midwifery
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    • It works as a buffer against stress.
    • It assists the development of coping strategies.
    • It can influence behaviours that impact on health.
    • It can facilitate recovery from illness.
      Midwives and social support
      Midwives have a key role in supporting women through pregnancy and childbirth. Key areas of midwifery support identified by women are:
      2
    • Good communication
    • Good listening skills
      •
      Practical support
    • Knowing their carers and being known by them
    • Continuity of care and carer.
      3
      Social support should be integral to maternity service.
      Effects of social support
      In pregnancy
    • Reduces anxiety resulting in greater confidence, lack of nervousness, reduced fear, and positive feelings towards birth.
    • Reduces psychological and physical morbidity.
    • Can increase satisfaction with care and communications.
    • Gives an increased sense of control.
      In labour
      It can reduce:
      4
    • Duration of labour
    • The amount of pain relief required
    • Operative vaginal delivery
    • The 5-min Apgar score of <7
    • Reduce the likelihood of caesarean section where companions were not normally admitted.
      SOCIAL SUPPORT
      143
      There is also evidence of
      3
      :
  • Greater satisfaction with birth
  • Longer duration of breastfeeding
  • Decrease in perineal trauma
  • Less postnatal depression and less difficulty in mothering.
    Considerations
  • Social support may not be adequate to counter the effects of poverty and social disadvantage on health.
  • Little is known as to which elements of social support are useful or effective.
  • Doulas have been found helpful in providing social support especially in labour although they are not commonly present at birth in England.
  • A wide range of interventions have been utilized in research and all are classified as social support.
    1. Schumaker S, Brownell A (1984). Towards a theory of social support: closing conceptual gaps.
      Journal of Social Issues
      .
      40
      , 11–36.
    2. McCourt C, Percival P (2000). Social support in childbirth. In: Page LA (ed.)
      The New Midwifery: Science and Sensitivity
      . Edinburgh: Churchill Livingstone.
    3. Hodnett ED (2005). Continuity of caregivers for care during pregnancy and childbirth.
      Cochrane Library
      , Issue 2. Oxford: Update Software
    4. Oakley A (1996). Giving support in pregnancy: the role of research midwives in a randomized controlled trial. In: Robinson S, Thomson A (eds)
      Midwives, Research and Childbirth
      . London: Chapman and Hall.
      CHAPTER 8
      The need for social support
      144‌‌
      Screening for domestic abuse
      • Domestic abuse refers to a wide range of physical, psychological, sexual, emotional, and financial abuse of people who are, or who have been, intimate partners regardless of gender or sexuality. It also covers issues that mainly concern women from minority ethnic backgrounds,
        i.e. forced marriage, female genital mutilation and ‘honour crimes’.
      • The Confidential Enquiry into Maternal and Child Health
        1
        highlights that 20% of women in England and Wales say they have been physically assaulted by a partner and more than 30% of cases first start during pregnancy.
      • Women may also experience an increase in the extent and nature of physical abuse during pregnancy.
      • Domestic abuse impacts on maternal and perinatal mortality and morbidity.
        1
      • Domestic abuse is generally underreported. It has been found that women are more likely to disclose if asked specific questions by
        a midwife, than if left to disclose themselves.
        2
        This then enables opportunity for women to access help.
        What do women need?
        Women need to be:
      • Asked
      • Believed
      • Treated with respect
      • Given time
      • Given information.
        Use RADAR, a mnemonic for professionals:
        R = Routine enquiry
        A = Ask direct questions
        D = Document findings safely A = Assess woman’s safety
        R = Resources; give women information on resources available and Respect their choices.
        Routine enquiry
      • Offer at a range of points throughout the childbirth experience.
      • Women should be seen alone at least once during the antenatal period to enable disclosure more easily.
      • Because disclosure can be difficult, asking at different times during the childbirth experience is recommended. Suggested times:
        • At booking
        • 15/16 weeks
        • 28 weeks
        • 36 weeks
        • During the postnatal period
        • At discharge
        • Or at any opportune time.
      • To facilitate disclosure, the environment needs to be quiet and private and where confidentiality can be assured.
    SCREENING FOR DOMESTIC ABUSE
    145
  • Women whose first language is not English, or with other communication barriers, should have access to appropriately trained interpreters.
  • It is important that the woman understands the limits of confidentiality with regard to the well-being and safety of any children in the household.
    Ask direct questions
  • Women should always be unaccompanied when being asked about domestic abuse.
  • How to ask: ‘Because abuse or violence is so common in women’s lives, we now routinely ask about abuse in relationships so that we can give all women information about agencies that can help’.
  • This can then be followed up by more specific questions, for example;
    • ‘Have you ever been afraid of your partner’s behaviour or are they verbally abusive?’
    • ‘Have you ever been hurt by your partner—slapped, kicked or punched?’
    • ‘Have you ever been forced to do something sexual that you didn’t want to?’
      Document findings safely
  • Healthcare professionals have a duty of care to record domestic abuse. The records may form part of future protection for an abused woman.
  • Where to record:
    • In the hospital notes, not in the hand-held notes.
  • What to record:
    • Who accompanies the woman, with information regarding their
      behaviour.
    • Any disclosure.
    • Are there any children in the household?
  • Try to obtain a safe correspondence address from the woman.
    Assess woman’s safety
  • Does she feel safe?
  • Is it safe for her to go home?
  • You may need to help her with direct referral to support services.
  • Discuss safety planning.
    Resources
  • Give women information and contacts for local services that provide support:
    • Wallet cards
    • Leaflets
    • Free phone National Domestic Abuse Helpline—0808 2000 247
    • Display information within the maternity unit
    • Wallet cards available in ‘women only’ areas, e.g. toilets.
  • Routine enquiry about domestic abuse can help reduce the stigma associated with abuse and the hidden/taboo nature of domestic abuse.
    CHAPTER 8
    The need for social support
    146
    • Your role within routine enquiry is to signpost the woman towards appropriate support services, rather than attempting to solve her problems. Find out how women and midwives can be supported in the area where you work; what are the local support services and how can they be accessed?
      Recommended reading
      Department of Health (2010).
      Responding to domestic abuse: A handbook for health professionals,
      . London: DH. Available at: M www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/dh/en/
      documents/digitalasset/dh4126619.pdf (accessed 18.2.11).
      Tacket A (2004).
      Tackling Domestic Violence: The Role of Healthcare Professionals
      . 2nd edn. Home Office Development and Practice Report. London: Home Office Publications. Available at: M
      www.homeoffice.gov.uk/rds (accessed 24.3.10).
      1. Lewis, G (ed.) (2007).
        The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer
        —
        2003–2005
        . The 7th report on Confidential Enquires into Maternal Deaths in the United Kingdom. London: CEMACH.
      2. Bacchus L Mezey G, Bewley S,
        et al.
        (2004). Prevalence of domestic violence when midwives routinely enquire in pregnancy.
        British Journal of Obstetrics and Gynaecology
        ,
        111
        (5), 441.
      This page intentionally left blank
      CHAPTER 8
      The need for social support
      148‌‌
      Recognition of sexual abuse
      It is important that midwives are open to the possibility that any woman they are caring for may have been sexually abused. It is difficult to estimate how many women have suffered sexual abuse, as statistics vary widely and it is often underreported. However, it is suggested that up to a quarter of all women may be subjected to unwanted sexual experiences.
      1
      Consequences of sexual abuse for pregnancy and childbirth
    • Increased risk of pregnancy.
    • Increased risk of late booking.
    • Increased anxiety about birth.
    • Slower, more difficult birth.
    • Increased risk of intervention.
    • Increased difficulties with breastfeeding, bonding, and postnatal depression.
      Recognition of sexual abuse survivors
      Women who have a history of sexual abuse may present with a combina- tion of any of the following:
    • Little or no prenatal care
    • Multiple unplanned pregnancies, many ending in abortion
    • Repeat attendance at antenatal clinics, GP, or emergency departments for minor injuries or trivial or non-existent complaints
    • Drug and alcohol abuse
    • History of multiple sexually transmitted diseases
    • Recoiling when touched
      •
      Obsession with cleanliness
    • Scars from self-mutilation
    • Unusual fear of needles
    • Insistence on female carers, unless cultural
    • Extreme sensitivity about body fluids on under-pads, sheets, and gowns
    • Unable to labour lying down
    • Extreme concerns about exposure and nakedness during labour and with breastfeeding
    • Refuses catheterization
    • Intense gag reflex
    • Refuses the taking of infant’s temperature rectally.
      Simple steps to prevent re-traumatization
    • As part of routine antenatal care, ask all women sensitively if they have been sexually abused. Reassure that this is more common than many women realize, but certain events in childbirth can trigger memories and flashbacks.
    • Consider what you would say and do if a woman discloses a sexual abuse history to you.
    • Never trivialize or minimize the impact of sexual abuse. It is important to adopt non-judgemental and supportive responses to women who disclose.
      RECOGNITION OF SEXUAL ABUSE
      149

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