Midwives trained to recognise domestic abuse and support women sometimes do not realise or acknowledge they are victims themselves, reveals new research by the Royal College of Midwives.
A survey of RCM members found 82% said they had experienced domestic abuse during their working lives.
“It’s seen as a professional failing to admit that things at home are anything but perfect”
However, it also revealed a mixed picture of the support on offer at work, with many reporting poor experiences or that they were too ashamed to seek help from colleagues.
Previous research suggests nurses, midwives and healthcare assistants are up to three times more likely to have experienced domestic abuse in the past year than the average UK citizen.
The RCM’s Safe Places? report sets out to gain a better understanding of the prevalence of domestic abuse among midwives, and explore the availability and nature of support provided by trusts and health boards.
It brings together findings from a survey of nearly 250 midwives and maternity support workers, with responses to questions on domestic abuse from the college’s annual survey of heads and directors of midwifery services across the UK.
The RCM also obtained information from trusts and health boards via a Freedom of Information request, which found about half in England do not have a specific policy to support staff who may suffer domestic abuse.
“They point fingers and ‘haul you in’ for one-way discussions. It is absolutely disgusting”
While many midwives said they had experienced abuse, more than two thirds – 67% – reported they did not seek help at work to deal with the issues they faced. Just over half – 52% – said they received help but 48% said they did not.
An analysis of midwives’ comments suggested one of the main reasons they felt workplace support was not available was due to a lack of knowledge and understanding.
“I think that although people cared, they lacked the ability or understanding to see how difficult it was to even get to work,” said one victim of abuse.
Around a fifth cited the fact that rules and practicalities got in the way. “My manager tried to be supportive but explained she was tied by protocol. How is this right?” said one respondent. The survey also suggested that student midwives were less likely to get the help they needed.
“Worryingly, those RCM members in training felt that their ‘lesser’ position as a non-permanent or non-registered member of staff was a contributing factor in not receiving workplace support,” said the report.
“This suggests that specific workplace policies may be lacking, unenforceable or underutilised”
Despite the fact midwives were trained to spot the signs of domestic abuse and have a key role in safeguarding vulnerable women and children, some who experienced abuse said they did not recognise what was happening to them and it was only with hindsight they realised they were victims.
Around 10% said they did not seek help because they were “in denial”, according to the report. Others, who expressed their anger at the lack of support and the way were treated at work, described how workmates were actually unkind and unsupportive.
One respondent, who had a restraining order on her ex-partner, said she found out colleagues had been talking to him about her and even sent him photos.
When it came to why people did not seek help at work, the analysis of comments found nearly a third – 31% – cited embarrassment and shame.
“When you work in this profession, it’s seen as a professional failing to admit that things at home are anything but perfect,” said one.
Meanwhile, around a quarter – 24% – cited a lack of faith in the system.
“The challenge will be to implement effective strategies and policies”
When asked about the type of support on offer, 33% said they had benefitted from peer support and gestures of kindness, while others said they had been helped with changes in working arrangements, received counselling or support from their organisation’s occupational health team.
However, 29% said they had received no support or had a poor experience.
“They point fingers and ‘haul you in’ for one-way discussions. It is absolutely disgusting. I had no strength to stick up for myself at such a vulnerable time,” said one.
The fact many recounted bad experiences at work “even when the question did not invite these types of responses”, was an indication of the strength of feeling involved, said the report.
“This perhaps demonstrates the frustration and ruminating emotional distress that such poor experiences have caused,” it said.
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One of the key recommendations to come out of the research was the need for specific policy to support staff who may be experiencing domestic abuse.
The Freedom of Information request to 160 NHS trusts and health boards found differences between UK nations when it came to such policies.
In England, 56 trusts said they currently had a specific policy in place, while two said they were in the process of agreeing a policy.
But 57 trusts said they did not have a specific policy. Of those, 40 said this kind of support was covered by other documents such as policies around safeguarding, managing violence, absence and flexible working.
Others said staff were directed to local charities or support groups, occupational health departments or employee support programmes.
In contrast, all 14 health boards in Scotland and all five in Northern Ireland had a specific policy for domestic abuse support.
In Wales, six of the seven health boards had a specific policy while the seventh did not respond to the FOI request.
“Many felt fearful and ashamed about what was happening to them”
When heads and directors of midwifery were asked if their organisation had a specific policy around domestic abuse, 66% said they did. However, only 25% said they had referred to it.
“This suggests that specific workplace policies may be lacking, unenforceable or underutilised,” said the report.
An analysis of comments found most heads or directors of midwifery felt they were active and able in supporting staff.
However, one in five said they had no experience and a handful said they felt unable to support staff mainly because they felt “ill equipped”.
The RCM said it was important to have a specific support policy in place – as opposed to relying on wider workplace policies – in order to ensure both safeguarding and practical considerations, like flexible working and special leave were taken into account.
Other recommendations included the need to provide and publicise support services such as access to independent domestic violence advisors, external counselling and legal services.
The report emphasises the need for more training for managers and frontline staff, including ensuring managers were able to spot the signs and staff knew about the support available.
However, it also stressed that some victims of abuse may not welcome workplace support because of a strong desire to keep their professional and home lives separate.
“The challenge will be to implement effective strategies and policies whilst recognising that the workplace support needs of individual midwives vary greatly because of how they view ‘professionalism’,” said the report.
“The stigma that affects so many survivors of abuse affects our RCM members too”
RCM chief executive and general secretary Gill Walton said that, despite the fact midwifery was a predominantly female profession and that most abuse victims were women, “it is so easy to forget that a great many midwives and maternity support workers may themselves be victims of domestic abuse”.
“The irony is that some midwives and maternity support workers as frontline health professionals, who are trained to recognise domestic abuse and support women, were sometimes not recognising that they themselves were victims of domestic abuse,” she said.
“If they did, many felt fearful and ashamed about what was happening to them,” she said. “The stigma that affects so many survivors of abuse affects our RCM members too.”
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It was, therefore, important that the right structures and training were in place to provide support when needed, she added.
“Our members told us in this survey that a supportive and confidential environment in the workplace, where they feel able to disclose information about domestic abuse without fear or shame, could well be the light at the end of the tunnel,” she said.
Ms Walton stated: “They need leaders and colleagues to be supportive, have robust policies to give that support some structure, and know that disclosing makes them stronger.
“This is why the RCM is bringing forward recommendations for the NHS and managers of maternity services on the back of this survey, so that midwives and maternity support workers can get the same help and support they are being asked to provide to the women they give care to,” she said.
The report was launched last week at the RCM annual conference in Manchester.