title: Violence against pregnant women will remain hidden as long as no direct questions are asked.
abstract: OBJECTIVE
  to assess the experience, knowledge, attitudes and routines regarding violence against pregnant women among midwives working at antenatal clinics in the county of Västerbotten, northern Sweden.
  
  
  METHODS
  five qualitative research interviews with midwives were conducted. In addition, questionnaires were sent to all midwives working at the antenatal clinics in the county.
  
  
  RESULTS
  the midwives, although very knowledgeable about and sensitive to pregnant women and their needs, still rarely revealed the occurrence of violence. Symptoms and signals of abuse may vary and are not easily recognised by an outsider. Among pregnant women registered at the antenatal clinic, the midwives roughly estimated that the frequency of known cases of physical and sexual abuse before and during the current pregnancy was 2.3 and 0.6%, respectively for the preceding calendar year. The local programme for antenatal care provided no guidelines regarding response to violence, no instruments for disclosure and no directions about support when confronted with an abused pregnant woman. The midwife did not usually ask any questions if she was merely suspicious but had no strong supporting evidence. In answering the questionnaire however, the midwives were positive towards asking every pregnant woman about abuse in approximately the same way as they asked about other issues already incorporated in the records.
  
  
  CONCLUSIONS
  most likely the midwives in this study were disclosing only a fraction of the cases of abuse against women. Violence of this kind will probably remain hidden as long as the whole issue of violence is not included in the national recommendations or in the local programme for antenatal care.
  
  
  CONCLUSIONS
  there should be specific written recommendations in the national antenatal care programme to guide and support the midwives in questioning all pregnant women about violence. To achieve adequate and optimal assessment and intervention at the antenatal clinic, the midwives need to be given education and training and provided with a supportive professional network both for themselves and for the abused women.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, SE 901 85 Umeå, Sweden. kerstin.edin@epiph.unu.se
authors.forename: Kerstin E
authors.initials: KE
authors.lastname: Edin
authors.forename: Ulf
authors.initials: U
authors.lastname: Högberg
mesh_terms: D001291:Attitude of Health Personnel; D018585:Battered Women / Q000523:psychology*; D017579:Domestic Violence / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000451:nursing*; D008880:Midwifery / Q000379:methods*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods*