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Pre-birth

SCOPE OF THIS CHAPTER

Please note that providers of health services, in particular those providing midwifery services, may have their own detailed agency specific guidance which should be read in conjunction with this guidance.

This chapter was added to the manual in March 2017.


Contents

  1. Introduction
  2. Risks
  3. Working with Fathers
  4. Protection and Action to be Taken
  5. Pre-birth Planning Meeting (Where the Outcome is the Decision to Remove the Baby)
  6. Issues

    Further Information


1. Introduction

Young babies are particularly vulnerable to abuse, and early assessment, intervention and support work carried out during the antenatal period can help minimise any potential risk of harm. This procedure sets out how to respond to concerns for unborn babies, with an emphasis on clear and regular communication between professionals working with the mother, the father and the family.

All professionals have a role in identifying and assessing families in need of additional support or where there are safeguarding concerns. In the vast majority of situations during a pregnancy, there will be no safeguarding concerns.

However, in some cases it will be clear that a co-ordinated response by agencies will be required to ensure that the appropriate support is in place during the pregnancy to best protect the baby before and following birth. Referred to as the perinatal period.

The antenatal period provides a window of opportunity for practitioners and families to work together to:

  • Form relationships with a focus on the unborn baby;
  • Identify risks and vulnerabilities at the earliest stage;
  • Understand the impact of risk to the unborn baby when planning for their future;
  • Explore and agree safety planning options;
  • Assess the family's ability to adequately parent and protect the unborn baby and the baby once born;
  • Identify if any assessments or referrals are required before birth; for example the use of the Early Help assessments agreed locally;
  • Ensure effective communication, liaison and joint working with adult services that are providing on-going care, treatment and support to a parent(s);
  • Plan on-going interventions and support required for the child and parent(s);
  • Avoid delay for the child where a legal process is likely to be needed such as Pre-proceedings, Care or Supervision Proceedings in line with the Public Law Outline.

Where professionals become aware a woman is pregnant, at whatever stage of the pregnancy, and they have concerns for the mother or unborn baby’s welfare, or that of siblings, they should not assume that Midwifery or other Health services are aware of the pregnancy or the concerns held.

Professionals should consider whether the new-born baby will be safe in the care of these parents/carers and if there is a realistic prospect of these parents/carers being able to provide adequate care and the likelihood of harm to the unborn baby. Consideration should be given to making a Multi-Agency Safeguarding Hub (MASH) enquiry. See MASH Enquiries Procedure.

Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain agreement to refer to Children’s Social Care, unless this action may place the unborn child at risk.

Each professional should follow their agency’s safeguarding procedures and discuss concerns with their safeguarding lead/named/designated professional for safeguarding to decide upon the appropriate action to be taken.


2. Risks

Parental risk factors that may indicate an increased risk to an unborn baby and which may mean that an assessment by Children’s Social Services is required at the earliest opportunity include:

  • Involvement in risk activities such as substance misuse, including drugs and alcohol;
  • Perinatal/mental illness or support needs that may present a risk to the unborn baby or indicate that their needs may not be met;
  • Victims or perpetrators of domestic abuse;
  • Identified as presenting a risk, or potential risk, to children, such as having committed a crime against children;
  • A history of violent behaviours;
  • May not be able to meet the unborn baby’s needs e.g. significant learning difficulties and in some circumstances severe physical or mental disability;
  • Are known because of historical concerns such as previous neglect, other children subject to a child protection plan, subject to legal proceedings or have been removed from parental care;
  • Known because of parental involvement as a child or adult with Children’s Social Care;
  • Currently ‘Looked After’ themselves or were looked after as a child or young person (care leavers);
  • A history of abuse in childhood;
  • Are teenage/young parents;
  • Recent family break up and social isolation/lack of social support;
  • Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family;
  • Where the pregnancy is concealed or denied. The reason for the concealment or denial of pregnancy will be a key factor in determining the risk to the unborn child or new-born baby;
  • Any other circumstances or issues that give rise to concern.

The list is not exhaustive and, if there are a number of risk factors present, then the cumulative impact may well mean an increased risk of significant harm to the unborn baby. If in doubt, professionals should seek advice about making a MASH enquiry. Following which either a pre-birth assessment or Child Protection Procedures will be considered.


3. Working with Fathers

Fathers play an important role during pregnancy and after. The National Service Framework for Children, Young People and Maternity Services (2004) states:

‘The involvement of prospective and new fathers in a child's life is extremely important for maximising the life-long wellbeing and outcomes of the child regardless of whether the father is resident or not. Pregnancy and birth are the first major opportunities to engage fathers in appropriate care and upbringing of children’ (NSF, 2004).

The NSPCC (2008) ‘Learning from serious case reviews’ emphasises how critical the fathers’ role is to the child’s wellbeing. Findings propose that fathers should:

  • Be encouraged to attend antenatal appointments and classes;
  • Be involved in assessments;
  • Be asked directly about risky behaviours such as drug and alcohol use and offer them services based on their needs;
  • Be informed of any concerns relating to their child;
  • Be consulted on plans, invited to child protection conferences and included in core groups.
This should include where the parents are not living together and take into account the father's attitude towards the pregnancy, the mother and newborn child and his thoughts, feelings and expectations about becoming a parent.

Information should also be gathered about fathers and partners who are not the biological father at the earliest opportunity to ensure that any risk factors can be identified.

A failure to do so may mean that practitioners are not able to accurately assess what mothers and other family members might be saying about the father's role, the contribution which they may make to the care of the baby and support of the mother, or the risks which they might present to them. Background police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Involving fathers in a positive way is important in ensuring a comprehensive assessment can be carried out and any possible risks fully considered.


4. Protection and Action to be Taken

When any professional becomes aware that a woman (or the partner of a woman with whom they are working) is pregnant and they are of the view that there will be a need for additional support for the unborn child who will be vulnerable due to the circumstances of their service user, they should inform maternity/health services of their involvement and highlight any vulnerabilities they have identified.

An Early Help assessment can be undertaken in relation to the unborn child. If the mother is under 18, they should also be offered an Early Help Assessment. Where a professional is concerned that an unborn child or other children in the family may be at risk of, or suffering, harm, they should seek advice from their agency Safeguarding Lead without delay who will consider whether to refer to Children's Social Care (MASH enquiry) - see MASH Enquiries Procedure.

All agencies should be involved in the development of a safeguarding risk assessment where undertaken. This should be at the earliest opportunity in the pregnancy All discussions, decisions and actions should be clearly documented in the appropriate agency record, including dates and names of professionals involved.

Where concerns are raised and Children’s Social Work are involved then the process is:

  • An Assessment is undertaken ideally by 14 weeks of pregnancy;
  • Outcome of may be to undertake a pre-birth assessment, ideally by 17 weeks of pregnancy, or follow Child Protection procedures within standard timeframes;
  • Pre-birth assessment outcomes include progressing Child Protection, Child In Need or legal processes (see below).

A pre-birth conference (see Child Protection Conferences Procedure) may be required if Children’s Social care assess that the child is at risk of significant harm. A pre-birth conference should share relevant information and develop a Child Protection Plan. The timing of the conference should take into account the expected date of delivery and ideally take place by 28 to 30 weeks of pregnancy of the pregnancy, or earlier if there is a history of premature birth.

If a decision is made that the unborn child will be made the subject of a Child Protection Plan from birth, a Core Group should be established at the Initial child protection conference and ideally meet prior to the birth and certainly prior to the baby's return home.

If the Assessment concludes that the child should be removed at birth, Children’s Social Care should seek legal advice at this point about an application for an Interim Care Order. The application to the court can only be made once the child is born but there should be no delay in seeking the order.

The Assessment should be shared, when completed, with the parents and, if instructed, to their solicitor to give them opportunity to challenge the Care Plan and risk assessment.

The circumstances of the mother and other relevant adults should be reviewed regularly to allow for ongoing assessment of need and risk and consider any further action required. This is especially so where these events could affect an initial conclusion in respect of risk and care planning of the child.


5. Pre-birth Planning Meeting (Where the Outcome is the Decision to Remove the Baby)

A Pre-Birth Planning Meeting should be arranged following the outcome of the decision at the legal planning meeting to remove the child. The meeting should agree a detailed plan to safeguard the baby around the time of birth which should include:

  • How long the baby will stay in hospital (for babies born to substance using mothers there needs to be a period of time to monitor for withdrawal symptoms);
  • How long the mother will remain on the ward;
  • Any risks to the baby in relation to breast feeding e.g. HIV status of the mother;
  • The arrangements for the immediate protection of the baby if the risk assessment has highlighted serious risks to the child e.g. from parental substance misuse, mental health concerns, domestic abuse. This should also include contacting the police or the use of hospital security;
  • The risk that the parents might seek to remove the baby from the hospital especially if the plan is to remove the baby at birth;
  • The plan for managing contact with the baby by the mother, father or an extended family and who will supervise the contact;
  • The plan for the baby upon discharge, and what visits will be made upon discharge and by whom;
  • Contingency plans should be in place in the event of a sudden change in circumstances. These should include instructions for hospital staff if the birth happens over the weekend or a Bank Holiday and who to contact if the birth takes place after hours. The Emergency Duty Team should also be notified of the pre-birth plans for the baby.

All agencies attending the meeting should receive a copy of the plan as well as other relevant agencies for example the parents’ GPs. The Lead Midwife should inform midwifery staff of the details of the plan.


6. Issues

A detailed pre-birth assessment can provide an early opportunity to develop a good working relationship with parents during the pregnancy, especially where there are concerns. It can mean that vulnerable parents can be offered support early on, allowing them the best opportunity to parent their child safely and effectively. Importantly, it helps identify babies who may be at risk of significant harm, and can be used to develop plans to safeguard them.

There are some potential issues that can arise. The involvement of social care (especially if there is a decision to remove the baby at birth) can result in the parents going missing or the mother not attending hospital at the time of birth.

It may have an adverse effect on the parents’ mental or physical health or heighten the risks that had raised the concerns in the first place. The fear of losing the baby may undermine the attachment and bonding process between the parent and child. There is a danger that the mother may end up harming herself or her unborn baby or seeking to terminate her pregnancy.

It is vital that there is good communication with the pregnant woman, the birth father and, if different, her current partner in order to reduce the chance of such issues arising.


Further Information

The National Service Framework for Children, Young People and Maternity Services (DoH, 2004)

NICE guidelines [CG192] Antenatal and postnatal mental health: clinical management and service guidance - Updated 2015

NICE guidelines. Postnatal care up to 8 weeks after birth. CG37. Updated 2015

End.