The Canadian Association of Midwives (CAM) and the National Council of Indigenous Midwives (NCIM) are partners with McMaster University on a project to build the capacity of midwives to recognize and respond safely to family violence. To achieve this goal, an undergraduate curriculum, professional development workshops and discussion circles as well as practical resources have been developed over three years. This project to address gender-based violence from a health perspective is funded by the Public Health Agency of Canada.
Browse this page to learn more about addressing family violence, and to read, view and download resources to support clients experiencing violence.
Resource Toolkit
The Midwives Recognize & Respond to Family Violence Resource Toolkit includes tip sheets, tools, backgrounders and scenarios to support learning and practice of trauma-informed care. These quick guides can be used as stand-alone resources or with other related resources in the toolkit.
Graphic Novel
Something is Off – A graphic novel about pregnancy & intimate partner violence
My name is Shayla. I am a midwife. When someone becomes pregnant and chooses to bring a life into this world, they need to be strong enough for themselves and their child. My job is to support pregnant people and help them build that strength. Pregnancy amplifies life. All our feelings swell in reaction to it. Where love exists, it flourishes. So can abuse. But abuse can stay hidden from family, friends, social media…
Workshops and Discussions
Addressing Family Violence in Perinatal Care
This undergraduate curriculum, developed by project partner McMaster University Midwifery Education Program, aims to guide and educate students to address the needs of people impacted by family violence. The discussion-based content is designed for undergraduate midwifery students and those studying other health professions. Scenarios and learning activities encourage reflection and are a starting point for learning. The richness of the undergraduate workshops is in the small group discussions. Peer conversations help build student understanding of their roles and the roles of others caring for people experiencing trauma and family violence in the perinatal period.
Topics include:
- Health inequities
- Trauma-informed care
- Responding to trauma
- Child protection services
- Self-care for healthcare providers
- Professional advocacy
The course content and learning activities helped students develop skills in working with vulnerable populations and people who experience violence. Participants appreciated the practical scenarios and how they highlight multiple factors impacting any situation. Students also appreciated varied perspectives and contributions from faculty.
Offered four times over the last three years, the course was facilitated by practicing midwives and faculty and included several guest speakers. In this video, Indigenous Registered Midwife Lisa Bishop talks about advocating for clients experiencing intimate partner violence. The video is a sample of the addressing family violence content offered by the McMaster Midwifery Education Program.
Professional Development Workshops
CAM and NCIM have each developed a series of four professional development workshops to recognize and respond safely to family violence. Each training series aims to guide and educate midwives to address the needs of people impacted by family violence. Through a social justice lens, the workshops and discussion circles recognize the root causes of violence in power dynamics, oppression and structural violence.
The CAM workshops have been held on-line twice and in-person in Toronto and Vancouver. As a result of these workshops, participants said they will integrate a health equity lens into their clinical practice and will aim to connect with more local organizations. Others said they will strive to help people without involving potentially harmful healthcare or social service systems. Still, others said they will now assume all clients have had some experience involving violence. With this perspective shift, their goal will be to provide care in a safe environment where trust can be built over time and where clients can feel safe to talk when they feel ready. Others appreciated the resources and practical tips provided.
CAM workshop topics include:
- Trauma-informed care and health equity
- Recognizing and responding to IPV
- Advocacy and safety in practice
- Recognizing child maltreatment, racism among health care providers
The NCIM-led discussion circles have run on-line three times over the last two years. As a result of the discussion circles, participants learned that connection with people experiencing violence is an avenue for healing and that relationship-building is the key to transformation and change. Others noted they learned the importance of modeling clear boundaries for clients and not creating pressure for expected outcomes. Participants appreciated the opportunity for collective learning in a culturally safe space.
NCIM discussion circle topics include:
- Resilience , strengths and protective factors of Indigenous Nations and communities
- Defining and expanding culturally safe, trauma-informed and aware care
- Responding to intimate partner violence using practice-based strategies that consider the realities and locations of Indigenous communities
- Strengthening ancestral and intergenerational circles of love and care
The professional development workshops and discussion circles are facilitated by practicing midwives and guest speakers. In this video, Rebecca Plett discusses health equity, power and privilege. She is a professor in the Anthropology department at McMaster University and is one of the co-designers of the CAM professional development workshops. The video is part of the CAM workshop series.
Avoiding Harm: Pregnancy, Family Violence and Trauma-Informed Care
Watch this replay from the Knovember 2022 conference. This panel discussion aimed to break the taboo of pregnancy and family violence. Midwives and intimate partner violence experts discussed best practices in trauma-informed care, including Indigenous-led approaches, culturally aware care, and community engagement. The presenters were Esther Enyolu, Jacqueline Benn John, Stephanie George and Bounmy Inthavong. The panel was moderated by Elvira Truglia.
Knowledge Assessment Survey Report
This report from the Canadian Association of Midwives and National Council of Indigenous Midwives highlights that most midwives and midwifery students who responded to the Knowledge Assessment Survey on Family Violence work with people who are vulnerable to family violence. However, they are more likely to work with people vulnerable to intimate partner violence compared to child maltreatment.
In the report, read about:
- How practicing midwives describe their roles in mitigating family violence
- Best practices and challenges in recognizing and responding to family violence
- Systemic barriers to addressing family violence
- Gaps in knowledge, skills and resources
The educational curriculum, professional development workshops, and clinical resources in this project have been created to address the gaps and needs emerging from the Knowledge Assessment Survey on Family Violence.
External Resources
VEGA Family Violence Education Resources
The Violence, Evidence, Guidance, Action (VEGA) Project at McMaster University has created evidence-based guidance and education resources to assist healthcare and social service providers (including students) in recognizing and responding safely to family violence (child maltreatment and intimate partner violence). VEGA developed these resources with funding from the Public Health Agency of Canada (2015-2020) in collaboration with 22 national organizations, including the Canadian Association of Midwives and National Council of Indigenous Midwives. The resources are comprised of learning modules (e.g., care pathways, scripts, how-to videos), interactive educational scenarios and a Handbook.
Registration is freely available at vegaproject.mcmaster.ca/.
If you have any questions and/or comments about VEGA’s resources, please contact the VEGA Project Lead, Dr. Harriet MacMillan, McMaster University at vega@mcmaster.ca.
FAQ
What is family violence?
Intimate partner violence cuts across all racial, social, cultural, economic, political and religious backgrounds. Behind the abuse is the desire to exercise power and control over a person. There are many types of abuse. They include physical, emotional, verbal, psychological, sexual, and financial abuse. Some of the telltale signs for concern are threats, intimidation, manipulation, stalking, economic control, using children and isolation. Children often witness abuse, which negatively impacts their mental health and physical well-being directly and indirectly. Children’s exposure to intimate partner violence (IPV) is a form of child maltreatment. All of this is family violence.
How can I practice trauma-informed care with my clients?
According to Canadian doctor and author Gabor Maté, “trauma is not what happens to you, it is what happens inside you.” In fact, trauma can change the way a person perceives and experiences the world.
Trauma-informed practices recognize that trauma is pervasive in society. Practitioners adapt their approaches to better account for trauma and avoid practices that can re-traumatize people.
For midwives, trauma-informed care should be practiced at all stages of the client-midwife relationship: intake, pre-natal, parturition and post-partum. Throughout each stage, always strive to meet clients where they are, let them take the lead, and don’t push them to do anything out of their comfort zone.
Regardless of what stage in the pregnancy, trauma-informed care means:
- Learning about your client and their community/family
- Understanding the impact of cultural, historical and gender issues
- Checking your own implicit biases
- Collaborating with your client
- Being transparent and keeping things confidential
- Providing informed choices
- Being non-judgemental
- Creating a safe(r) space
I know it’s important to centre Indigenous knowledge, how can I do this in a meaningful way?
Truth and reconciliation are about recognizing the harms of Canada’s colonial history and building respectful relationships with Indigenous Peoples. The painful legacy of residential schools, forced sterilizations, disappeared and murdered Indigenous women and girls, and the destruction of Indigenous lands continue to leave their marks. It’s important to understand how the mass removal of children from families into the child welfare system has caused unspeakable harm. One of the consequences is ongoing intergenerational trauma. As midwives support clients who may be experiencing abuse, they should take special care to avoid re-traumatizing pregnant people. Actively listen, offer support and meet people where they are. Supporting the restoration of Indigenous midwifery and birth to First Nations, Metis and Inuit communities is another way we can work together to redress the harms of colonialism.
How do I make sure what I am doing doesn’t create more harm to communities who face barriers to health equity?
Do your homework. Find out about the communities you are working with. Find out about the resources in your community. And if you don’t feel like you have enough knowledge – speak to a colleague or another health or social service professional.
I am not an expert on violence, how can I support my client best? what I am doing doesn’t create more harm to communities who face barriers to health equity?
You are not expected to be an expert on family violence. You are expected to know the signs, symptoms, and risk factors as well as follow-up protocols to keep you and your client safe.
- Have you done your homework about signs and symptoms, asking about family violence, and assessing immediate risk?
- Are you following documentation guidelines?
- Do you have safety protocols – for home visits and visits in-clinic?
- Do you have client safety planning tools and resources on hand?
Should I report?
It’s complicated. Clients may disclose a situation of ongoing violence that doesn’t require you to report but does require you to support your client to receive the care they need. But when you suspect child maltreatment, you have a duty to report. Get informed about the difference between disclosure and reporting, and where there may be grey areas. This is part of practicing trauma-informed care and can avoid creating more harm.
This is so hard; how do I help my clients and practice self-care?
This is hard work. Midwives often go the extra mile and get burned out in the process. Midwives can also experience moral injury when they do something in a clinical context that may inadvertently harm a client. Self-care is about a lot more than taking downtime, it’s about taking care of your physical, mental and spiritual health. Take the time to map out what that means to you.
Contact
For more information about Midwives Recognize and Respond to Family Violence, please contact Elvira Truglia, Project Lead, Knowledge Translation for Gender-Based Violence Prevention: etruglia@canadianmidwives.org
