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The Authors Assert That The Concept Of Empowerment And Education (howe And ...



The authors assert that the concept of empowerment and education (Howe and Anderson 2003) should be at the forefront of the midwife's agenda and this will act as a bridge to build up trust and a working relationship that can help to detect domestic violence when it occurs and then to help support the victim with appropriate intervention and agency notification. Although as a concept paper, this is eloquently presented and rationally considered, one is left with the thoughts that a more critical analysis of the message of this paper could be that, as altruistic as these particular aims are, in the current structure of the NHS it is difficult to see how a midwife could actually embrace all of the different concepts and activities that this paper suggests. This is not meant to imply that one should not aspire to achieve all that is suggested, but may indicate the fact that in order to achieve a more public health orientated service, then more protected time may be required to allow the midwife to fulfil all of these functions. In fairness, the paper includes a comment that appears to recognise the fact that change is necessary by exhorting midwives in general to seek to respond positively to service changes to achieve the goal of multidisciplinary, non-hierarchical patient-centred services. In facilitating change midwives should seek to use their influence to the benefit of the pregnant woman.

The paper by Taket (A et al. 2003) is another overview concept paper which rehearses many of the arguments that we have presented elsewhere in this review, but it is noteworthy for the fact that it devotes a considerable amount of energy in the examination of the role of domestic violence on the children and points to the fact that the midwife may have her suspicions aroused by the behaviour patterns of affected children even if she has not considered the possibility of domestic violence in relation to the mother's behaviour or presentation.

The authors point to the fact that some studies (viz.Humphreys C et al. 2002) suggest that children who are living in a house where domestic violence is active are 30 - 60% more likely to experience child abuse (the paper does not specify physical abuse, but abuse in the wider sense). They are more likely to present with neurotic types of problems including sleep disturbance, poor school performance, emotional detachment, stammering, suicide attempts, and aggressive and disruptive behaviour. The relevance of any of these factors should be regarded as firstly an indicator for the midwife to actively consider making direct, but sensitive, enquiries in relation to domestic violence, as well as making sure that the affected children are referred to the appropriate agency in order that these traits may be actively investigated and treated.

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