A study exploring UK midwives' knowledge and attitudes towards caring for women who have been sexually abused.

OBJECTIVE: to investigate midwives' knowledge and attitudes in relation to caring for women who have been sexually abused.

DESIGN: survey using a postal questionnaire. The questionnaire looked at midwives' knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using chi2-test, logistic regression, Mann-Whitney U-test, Kruskal Wallis test and Mantel-Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London].

SETTING: four National Health Service trusts within the East and West Midlands.

PARTICIPANTS: 489 community and hospital-based midwives.

FINDINGS: 372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse (n=207, 56%), with a further 109 (29%) midwives being 'unsure' if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives (chi2=4.044, df=1, p=0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.