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1.8.2 Pre-Birth Child Protection Procedure

Bedford Borough, Central Bedfordshire and Luton Safeguarding Children Boards gratefully acknowledge that this chapter is based on Surrey Safeguarding Children Board's Procedure.

RELATED CHAPTERS

This chapter was added to the manual on December 2015.


Contents

  1. Introduction
  2. Recognition and Referral
  3. Response
  4. Pre-birth Multi-Agency Strategy Meeting
  5. Pre-birth Section 47 Enquiry and Assessment
  6. If it is Suspected that a Baby May be Born at Home
  7. Pre-Birth Conferences

    Appendix 1: Pre-Birth Assessment and Intervention Timeline

    Appendix 2: Hospital Birth Plan

    Appendix 3: Guidance in relation to Pre-Birth Planning and Assessments

    Appendix 4: Pre-Birth Assessment Tool


1. Introduction

UK Law does not legislate for the rights of the unborn baby. In some circumstances, agencies or individuals are able to anticipate the likelihood of Significant Harm with regard to an expected baby.

Although it is recognised that in the ante-natal period a number of professionals have responsibility to promote the welfare of the mother and unborn baby, the welfare of the unborn baby should be paramount.

Such concerns should be addressed as early as possible to maximise time for:

  • Full assessment, including establishing the whereabouts of any previous children;
  • Enabling a healthy pregnancy;
  • Supporting the parents so that (where possible) they can provide safe care.


2. Recognition and Referral

Where agencies or individuals anticipate that prospective parents may need support services to care for their baby agencies need to consider whether an Early Help Assessment is needed in the first instance an Early Help Assessment should always be considered for expectant mothers up to the age of 19. This should be completed soon after the expectant mother has booked in with the community midwife. The Early Help Assessment may lead to the Team around the Family meeting being called and the Family Action Plan delivered.

If it is considered that the baby may be at risk of Significant Harm, a Referral to Bedford Borough, Central Bedfordshire or Luton Children’s Services must be made as soon as possible after 14 weeks of pregnancy. (Appendix 1: Pre-Birth Assessment and Intervention Timeline gives details of expected timeline for referral, assessment and intervention). Children Services will create a record for the child at 14 weeks gestation. Children’s teams will develop a tracking system of the unborn children who have been referred prior to 14 weeks, to ensure that they have been followed up after 14 weeks has passed (in case that they have not be re-referred by the community midwife). The GP and midwifery services are critical to making referrals.

The referrer should clarify as far as possible their concerns in terms of how the parents' circumstances and/or behaviours may impact on the baby and what risks are predicted. It is important that the referrer considers the possible risk to the unborn child of both parents, or mother and partner, or father and his partner, even if they are not living together.

Referrals must always be made in the following circumstances:

  • Where there has been a previous unexplained death of a child whilst in care of either parent;
  • Where a parent or other adult in the household is a person identified as posing a risk, or potential risk, to children;
  • Where children in the household/family are currently subject to a Child Protection Plan or where there have been previous child protection concerns;
  • Where a sibling has previously been removed from the household either temporarily or by Court Order;
  • Where there are significant Domestic Abuse issues;
  • Where the degree of parental substance misuse is likely to impact significantly on the baby's safety or development;
  • Where the degree of parental mental illness/impairment is likely to impact significantly on the baby's safety or development;
  • Where there are significant concerns about parental ability to self care and/or to care for the child e.g. unsupported, young or learning disabled mother;
  • Where any other concern exists that the baby may be at risk of Significant Harm, including a parent previously suspected of fabricating or inducing illness in a child;
  • Where either parent of the unborn child is under 16;
  • Where either parent is or was a Looked After child;
  • Where there are maternal risk factors, e.g. denial of pregnancy, avoidance of antenatal care, non-cooperation with necessary services, non-compliance with treatment, with potentially detrimental effects for the unborn baby.
  • Where there are concerns about the Female Genital Mutilation (FGM) in the family, particular attention to be paid to women who may have fear of using Health services.
  • Where there are concerns about Child Sexual Exploitation (CSE);
  • Where there are concerns about forced marriage;
  • Where there is no access to public funds.

Where the concerns centre around a category of parenting behaviour e.g. substance misuse, the referrer must make it clear how this is likely to impact on the baby and what risks are predicted.

Delay must be avoided in making referrals in order to:

  • Provide sufficient time to make adequate plans for the baby's protection;
  • Provide sufficient time for a full and informed assessment;
  • Avoid initial approaches to parents in the last stages of pregnancy, at what is already an emotionally charged time;
  • Enable parents to have more time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
  • Enable the early provision of support services so as to facilitate optimum home circumstances prior to birth.

Concerns should be shared with the prospective parent(s) and consent be obtained to refer to Children's Social Care Services unless this action in itself may place the welfare of the unborn child at risk e.g. if there are concerns that the parent may move to avoid contact


3. Response

All pre-birth Referrals to Children's Social Care Services, which met the threshold for referral must be subject to a Single Assessment and a multi agency Strategy Discussion/Meeting must be held in the circumstances outlined in Section 2, Recognition and Referral.

The need for a Section 47 Enquiry should be considered and if appropriate, initiated at the Strategy Meeting held as soon as possible following receipt of the referral. The expected delivery date will determine the urgency for the meeting.

Consideration of the need for a Section 47 Enquiry should follow the procedures as described in Strategy Discussions and Section 47 Enquiries Procedure.


4. Pre-birth Multi-Agency Strategy Meeting

The Strategy Meeting should be chaired by a Children's Social Care Services Team Manager or Assistant Team Manager and involve:

  • Lead Safeguarding Midwife;
  • Police;
  • Social worker;
  • Named Health Visitor and named midwife;
  • Other professionals as appropriate e.g. mental health services, probation, substance misuse professionals;
  • Where required, a legal adviser;
  • GP.

The purpose of the meeting is the same as that of other Strategy Discussions/Meetings and should determine:

  • Information sharing and analysis of risk;
  • Whether a Section 47 Enquiry is required;
  • Role and responsibilities of agencies within the enquiry;
  • Role and responsibilities of agencies to provide support before and after the birth, particularly the role of adult services working with expectant parent(s);
  • Identity of responsible social worker to ensure planning and communication of information;
  • A contingency plan in case of premature labour;
  • How and when the parent(s) are to be informed of the concerns;
  • Required action by obstetric team as soon as the baby is born. This includes labour/delivery suite, post natal ward staff and the midwifery service. Team to complete the Hospital Birth Plan Form as attached at Appendix 2: Hospital Birth Plan;
  • Any instructions in relation to invoking an Emergency Protection Order at delivery should be communicated to the midwifery manager for the labour/delivery suite;
  • The need for a pre-birth Initial Child Protection Conference.

The assessment plan must be consistent with standards required for possible Court proceedings, including the letter of intent under the Public Law Outline.

The parent(s) should be informed as soon as possible of the concerns and the need for assessment, except on the rare occasions when medical guidance and advice suggests that this may be harmful to the health of the unborn baby and/or mother.


5. Pre-birth Section 47 Enquiry and Assessment

See Appendix 3: Guidance in relation to Pre-Birth Planning and Assessments.

In undertaking a pre-birth Section 47 Enquiry and Assessment the Children's Social Care Services, the Police and relevant other agencies must follow the Strategy Discussions and Section 47 Enquiries Procedure. This must include representation from the maternity service and if relevant the neo natal services.

  • The overall aim is to identify and understand:
  • Parental and family history, lifestyle and support networks and their likely impact on the child's welfare;
  • Risk factors;
  • Parental needs;
  • Strengths in the family environment;
  • Factors likely to change and why, including timescales;
  • Factors that might change, how and why, including timescales;
  • Factors that will not change and why, including timescales.

Section 47 Enquiry must include consideration of both parents, any potential carers for the child and the partners of both parents. Pre-birth Risk Assessment Tool should be used to inform the outcome of the Section 47 Enquiry (see Appendix 2 in the accompanied Guidance for Professionals undertaking Pre Birth Assessments).

The Section 47 Enquiry/Assessment must make recommendations to the reconvened Strategy Meeting regarding:

  • If there is concern that the baby will suffer Significant Harm at birth an urgent legal planning meeting must be convened by Children's Social Care Services. At the same time as convening a legal planning meeting, a pre-birth Initial Child Protection Conference should be held in order to plan for the period prior to initiating any legal proceedings;
  • The need for a pre-birth Initial Child Protection Conference. This decision will be confirmed at the reconvened Strategy Discussion/Meeting. The Conference should be held wherever possible at least 10 weeks prior to the expected delivery date or earlier if a premature birth is likely - see Section 7, Pre-Birth Conferences;
  • The need for services to be offered as a child in need as determined by the intervention plan within the Child and Family Assessment.


6. If it is Suspected that a Baby May be Born at Home

The Local Clinical Commissioning Group (CCG) and Children's Social Care Services have a duty to contact any relevant agencies if they have concern about an unborn child.

If it is suspected that a child may be born at home or delivered prior to arriving at the hospital a referral should be made to the East of England Ambulance Service by the responsible community midwife.

Information should be shared with the Ambulance Service if there are concerns that the child may suffer or be likely to suffer Significant Harm, or is currently subject to a Section 47 Enquiry and/or an Assessment, or is subject to a Child Protection Plan.

Information must be shared with East of England Ambulance Service if a decision has been made to apply to remove the baby at birth, and agreement reached between the social worker and the Ambulance Service as to where the baby should be taken.

It is important to update the Ambulance Service of any known changes of personal details that would assist them to further identify the mother they will be dealing with.


7. Pre-Birth Conferences

A pre-birth conference is an Initial Child Protection Conference concerning an unborn child. Such a conference has the same status and proceeds in the same way as other Initial Child Protection Conferences, including decisions about the Child Protection Plan, and must be conducted in a comparable manner to an Initial Child Protection Conference.

Pre-birth conferences should always be convened where there is a need to consider if a Child Protection Plan is required.

  1. This decision will usually follow from a pre-birth Child and Family Assessment and a conference should be held;
  2. Where a pre-birth assessment gives rise to concerns that an unborn child may be at risk of Significant Harm;
  3. Where a previous child has died or been removed from parent(s) as a result of Significant Harm;
  4. Where a child is to be born into a family or household which already have children who are the subject of a Child Protection Plan;
  5. Where a person known to pose a risk to children resides in the household or is known to be a regular visitor
  6. Other risk factors to be considered are:
    1. The impact of parental risk factors such as mental ill-health, learning disabilities, substance misuse and domestic violence;
    2. A mother under sixteen about whom there are concerns regarding her ability to care for herself and/or to care for the child.

All agencies involved with the expectant mother should consider the need for an early referral to Children's Social Care Services so that assessments are undertaken and family support services provided as early as possible in the pregnancy.

Timing of Pre-Birth Conferences

The pre-birth conference should take place by the time expectant mother is 24 - 28 weeks pregnant, so as to allow as much time as possible for planning support for the baby and family (see Appendix 1: Pre-Birth Assessment and Intervention Timeline).

Where there is a known likelihood of a premature birth, the conference should be held earlier.

Attendance

The key agencies involved in the delivery of the child must attend the conference. It is important that this conference makes an informed decision about whether or not the child should remain in the parents' care and draws up protection plans that link to either decision.

In addition to those who normally attend an Initial Child Protection Conference, midwifery, relevant neo-natal and Children’s Centres must be invited. See Bedfordshire and Luton Health listings in the Local Contact Details Appendix.

Parents or carers should be invited as they would be to other Child Protection Conferences and should be fully involved in plans for the child's future.

Decision

If a decision is made that the child requires a Child Protection Plan, the main cause for concern must determine the category of abuse or neglect under which the decision is made and the Child Protection Plan must be outlined to commence prior to the birth of the baby.

The Core Group must be established and meet if at all possible prior to the birth, and certainly prior to the baby's return home after a hospital birth.

If a decision is made that the unborn child requires a Child Protection Plan, this should be recorded, including the child's name (or 'baby', if not known) and expected date of delivery, pending the birth. The senior midwife must notify the Lead Social Worker of the name and correct birth date following the birth. If this takes place out of hours, then the senior midwife must inform the Emergency Duty Team, who will then notify the Lead Social Worker by the beginning of the next working day. The Lead Social Worker must then ensure that the name and correct birth date is notified to the Manager of the Safeguarding Children Unit following the birth.

Timing of Review Conference

The first Child Protection Review Conference will be scheduled to take place within 1 month of the child's birth. This may be extended by up to three months with the written authorisation of a Children's Social Care Services manager and the Conference Chair if information from a post-natal assessment is crucial for a well informed review conference.  If there are other children in the family who are already subject of a Child Protection Plan the 1st Review Child Protection Conference for the unborn baby may have to be held independently of siblings’ conference but each subsequent Review Child Protection Conference should combine the unborn baby with its siblings. 


Appendix 1: Pre-Birth Assessment and Intervention Timeline

Click here to view Appendix 1: Pre-Birth Assessment and Intervention Timeline.


Appendix 2: Hospital Birth Plan

Click here to view Appendix 2: Hospital Birth Plan.


Appendix 3: Guidance in relation to Pre-Birth Planning and Assessments

Guidance in relation to Pre-Birth Planning and Assessments

This guidance is for managers and practitioners involved in work with families prior to the birth of a child where there are indications of identified needs/risk.

The guidance is intended to inform a sustained approach to assessment in which parents are engaged and supported throughout the ante-natal period. Identifying the needs of and potential risks to the unborn child at the earliest possible stage reduces the likelihood of last minute activity around the time of birth and enables help to be provided at the earliest possible stage.

This guidance should be read in conjunction with Pan Bedfordshire Child Protection Procedures, the information sharing guidance and the joint protocols on multi-agency working.

1. Purpose

Where it has been identified that a women and her family are in need of support and or where there are safeguarding concerns the main purpose of a Pre-Birth assessment is to identify:

  • What the needs of and risks to the newborn child may be;
  • Whether the parent/s are capable of recognising these and working with professionals so that the needs can be met and the risks reduced;
  • What support the parents may need;
  • What plans need to be put in place to ensure the needs of the expected child are met and risks addressed.

Hart (2000)[1] states that there are two fundamental questions when deciding whether a pre-birth assessment is required:

  • Will the newborn baby be safe in the care of these parents/carers?
  • Is there a realistic prospect of these parents/carers being able to provide adequate care throughout childhood?
  • Where there is reason for doubt about the above a pre-birth assessment is required.

[1] Hart, Di (2000) ‘Assessment Prior to Birth; in Howarth, Jan (Ed)(2000) The Child’s World: assessing children in need – Reader, Department of Health, NSPCC, University of Sheffield.

2. Principles

Pre-birth assessments should be multi-agency.

Early referrals (within the second trimester) are essential in order to ensure the following:

  • Sufficient time is allowed in order to undertake a detailed assessment;
  • including the preparation of a detailed chronology;
  • There is sufficient time for effective planning;
  • Parents have time to contribute to any assessment and to increase the likelihood of a positive outcome to the assessment;
  • Support services can be provided in a timely fashion;
  • To facilitate an immediate Multi-Agency response at the earliest and most appropriate opportunity.

3. Pre-Birth Assessment and Interventions

The majority of women access their GP within 6-8 weeks of pregnancy leading to a booking appointment with Midwifery Services between 6 and 12 weeks of pregnancy, where routine antenatal assessment and screening processes are commenced.

The Community Midwives, GPs and Obstetricians are in a key position to identify women and their families who are in need of early support or when there are child protection concerns.

Other practitioners working in Children’s or Adults’ Services may also be in contact with pregnant women or their partners. They should actively consider any support needs; whether any additional services are identified and could be provided through an Early Help Assessment, or if there is any child protection issues that warrant a referral to Children’s Social Care.

All practitioners should refer to their agency records to establish whether information held in relation to a previous pregnancy or family history may have an impact on the current pregnancy.

It is vital that there is good communication with the pregnant women, the birth father and, if different, her current partner. Consideration must be given to the communication needs of the pregnant woman and her family, and communication aids, interpreters, sign language should be used as appropriate.

4. Early Help and Support

Where it has been identified that the parent/s may need additional support to meet the needs of their unborn child, a referral should be made for an Early Help Assessment as the means to clearly identify needs/strengths and the support required.

Families who may need early support and help include:

  • Parent/s who are asking for help;
  • Young parents under 18 or with limited support from family/friends, including care leavers;
  • Families who dynamics result in a level of instability;
  • Parent/s struggling to maintain standards of hygiene /repair with the family home;
  • Families in poverty or where food, warmth and other basics may not always be available;
  • Families where the advent of a new baby may exacerbate existing difficulties;
  • Families with housing issues which places them at risk of homelessness or are currently homeless;
  • Parent/s with mental health issues or drug and/or alcohol issues or with learning disabilities, where it is considered that this may impact on parenting;
  • A parent has self-harmed during pregnancy;
  • Female genital mutilation victims;
  • Parents who may not be able to care for their baby adequately because of a physical disability;
  • Parent has a mild learning difficulty;
  • Where there is domestic abuse within the household;
  • Late presentation/booking.

In all cases where there has been late presentation of pregnancy urgent consideration should be given to timely follow up and appropriate information sharing.

A review meeting should take place at 24 weeks pregnancy to review the progress of the action plan. There should be an explicit discussion about whether the Early Help Assessment remains the most appropriate way to meet the unborn baby’s needs. Given the relatively short timescales of a pregnancy, any decisions regarding the effectiveness and impact of the Early Help needs to be tightly managed. If the services involved with the family believe that they cannot meet the needs of the pregnant women and her family or additional services are required but unknown, a referral to the Multi-Agency Safeguarding Hub (MASH) should be considered.

5. Initial Contact Stage

MASH will be responsible for screening all pre-birth referrals. This will be undertaken within 24 hours of receipt of the referral. If there is insufficient information to establish whether the grounds are met for undertaking the Pre-Birth assessment, MASH, may with parental consent, liaise with the referring agency/ midwifery/GP and other relevant agencies, including Adults’ Services and the Mental Health Team if they are involved with the mother if they are involved, or her partner.

If it is considered that there are insufficient grounds for a Pre-Birth Assessment to be undertaken, signposting to other appropriate agencies will take place to ensure that early help and support are in place.

It is important that the expected date of delivery (EDD) is ascertained from the referrer at the point of referral and recorded on Azeus. If this is not established at the point of referral this will be a priority task for the allocated social worker.

The details of the father of the child and the current partner of the mother if this is different must also be obtained and recorded on Azeus.

If there are any difficulties in establishing relevant health information, locating health visitors etc. there must be consultation with the lead safeguarding nurse at this stage.

6. Assessment Stage

Pre-birth Assessments should be considered on all pre-birth referrals where any of the following factors are present:

  • There has been a previous unexplained death of a child whilst in the care of either parent;
  • A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children;
  • A sibling is the subject of or has been a Child Protection Plan;
  • The parent is or was, a Looked After child and where concerns have been identified;
  • A sibling has previously been Looked After voluntarily or via a Court Order;
  • Domestic abuse is known to have occurred or domestic abuse has occurred/been discussed during pregnancy;
  • The degree of parental substance misuse is likely to have a significant impact on the baby’s safety or development;
  • The degree of parental mental illness/impairment is likely to have a significant impact on the baby’s safety or development;
  • There are concerns about parental maturity and ability to self-care and look after a child e.g. an unsupported young mother;
  • The degree of parental learning disability is likely to have a significant impact on the baby’s safety;
  • Both parents have mild or moderate learning difficulties;
  • There are concerns about a parent’s capacity to adequately care for their baby because of the parent’s physical disability;
  • A child aged under 14 and found to be pregnant;
  • A child aged under 16 and found to be pregnant where there are concerns identified that cannot be met through Early Help;
  • Any other concern exists that the baby may be likely to suffer Significant Harm including a parent previously suspected of fabricated or inducing illness in a child;
  • Where there is an indication of Child Sexual Exploitation (CSE).

This list is not definitive and further discussion should take place with the appropriate Manager if required.

There should be at least one joint visit made with the health visitor and midwife during the course of the assessment and other joint visits with the health specialist and relevant agencies as appropriate during the assessment which is likely to occur between 20-30 weeks of pregnancy.

Once the decision has been made for the Pre-Birth assessment to be undertaken a Pre-Birth Multi Agency Meeting should be held within 15 working days, in which both the allocated social worker and their Manager should attend. Items for discussion at this meeting should include:

  • Introduction of the presenting concerns by the chair of the meeting;
  • Clarification of both parent’s details and any siblings, including dates of birth, ethnicity and religion;
  • EDD of the baby;
  • Ante-natal care and obstetric history;
  • Social care history, including parent’s own childhoods;
  • Current family structure, extended family and proposed support;
  • The parental relationship, including any DV history considering nature, frequency and severity of violent incidents, and triggers to violence;
  • Family functioning: lifestyle, roles and responsibilities and how they envisage adapting to the arrival of a new born baby;
  • Previous abuse and convictions, and any comments about parent’s ability to accept responsibility for the abuse and any treatment/ counselling they received;
  • Family attitude towards previous professional involvement and likely ability to engage with the current intervention process;
  • Risks and needs in relation to either parent’s ability to understand a baby’s needs and ability to meet them within a timescale commensurate with their developmental level, including consideration of the impact of any parental learning difficulties;
  • Risks and need in relation to any identified mental health issues for either/both parents, including compliance with treatment;
  • Issues of equality and diversity and how they may impact on the ability of the parents to meet their child’s needs or the child’s prospective life, including risk of discrimination;
  • Protective factors and strengths in relation to parent, their extended family and supportive network;
  • How the parents individually and together are feeling and responding to the expected baby –planned or unplanned/ wanted or unwanted pregnancy?
  • Issues which may affect the individual characteristics of the baby such as risk of premature birth, likely to stay in hospital following delivery, risk of disability, indicators that parent-child relationship may not produce a secure attachment;
  • Future plans of the parents including the roles they plan to play in caring for the baby and whether these are realistic. Have they considered the impact of the child on their lifestyle and relationship?
  • What assessments and by whom are required to ensure risk and need are identified comprehensively;
  • Are there any factors that may trigger a premature birth; such as a mother under 19, drug use, domestic abuse or previous premature birth.

If the meeting is following a late referral and birth is likely within the next month the meeting should be convened as soon as possible, where the following questions should also be considered:

  • Practical arrangements for mother and baby;
  • Who will inform the social worker of the birth;
  • Plans for out of hours/emergency birth;
  • Discharge plans and a support package;
  • Contact arrangements with parents and other family members;
  • Parental attitudes to the plan;
  • Management of parental non co-operation;
  • Arrangements for legal planning/proceedings/removal;
  • Health and safety issues.

The Pre-Birth Assessment should be completed within 45 days of the referral and a review multi agency meeting to be held prior to the completion of the assessment. This is to ensure that an agreed plan in place.

7. Child Protection Concerns

7.1 Strategy Meetings

It is important that the potential risks to the unborn child are flagged up as early as possible to inform effective planning and in order to gather information at an early stage including relevant Police checks.

If it is evident at the point of referral or during/at the completion of an Assessment that there are reasonable grounds to believe that the unborn child may be likely to suffer Significant Harm, a multi-agency Strategy Meeting must be held within 72 hours. This is particularly urgent where the referral has been received after 24 weeks’ gestation, or where there has been an attempt by the mother to conceal the pregnancy. (See 7.2 below).

Social workers and managers should refer to the Bedford Borough Child Protection Procedures in relation to the purpose and agenda for Strategy Meetings. These Strategy Meetings can be held in a variety of settings including the hospital/GP practices and should facilitate the attendance of all relevant professionals.

In cases where previous children have been removed by a Local Authority and continue to be Looked After, the allocated social worker from the Service must be invited to the Strategy Meeting in order to provide relevant background information and history.

In cases where previous children have been removed a legal representative must also be invited to and be part of any strategy meeting held.

In cases where Care Proceedings had been conducted, the Assessment worker should ensure that details of the proceedings including any assessments that have informed the court are known.

The Strategy Meeting should consider the circulation of country-wide alerts including hospitals if it is thought if the baby may be born outside of the area.

Social workers need to request that Conference and Review Service send out these alerts on their behalf.

Where there are concerns that the mother may present at a local hospital other than the one she is booked into, social worker to ensure that copies of the strategy meeting should also be sent to the named Midwife at those identified hospitals i.e. Bedford, Luton and Dunstable, Lister, Stoke Mandeville and Milton Keynes Hospitals.

Any plan arising from a strategy should consider the following:

  • Timescales for completion of an assessment;
  • Securing the engagement of the Multi Agency network;
  • Contingency planning;
  • The need for an Initial Child Protection Conference;
  • Whether the Public Law Outline process should be commenced – see Initiating Care Proceedings Procedure.

7.2 Late Bookings and Concealed Pregnancy

For the purposes of this guidance, late booking is defined as relating to women who present to maternity services after 13 weeks of pregnancy.

There are many reasons why women may not engage with ante-natal services or conceal their pregnancy, some of, or a combination of which will result in heightened risk to the child.

Some of the indicators of risk and vulnerability are as follows:

  • Previous concealed pregnancy;
  • Previous children removed from the mother’s care;
  • Fear that the baby will be taken away;
  • History of substance misuse;
  • Mental health difficulties;
  • Learning disability;
  • Domestic abuse;
  • Previous childhood experiences/poor parenting/sexual abuse;
  • Poor relationships with health professionals/ not registering with a GP.

NB This list is not exhaustive.

In cases where there are issues of late booking and concealed pregnancy, it is extremely important that careful consideration is given to the reason for concealment, assessing the potential risks to the child and convening a Strategy Meeting (refer to 7.1 above) as a matter of urgency with further consideration given to the attendance of a legal representative at this Strategy Meeting.

7.3 Parental Non-Engagement

There are many reasons why expectant mothers may fail to engage with the assessment, some of which relate to the factors outlined above. It is extremely important that parental non-engagement does not become the reason for delaying the assessment and the making of multi-agency contingency plans for the birth of the baby.

A Review Strategy will be triggered in the event of:

  • Two failed social work visits;
  • Disengagement from ante-natal process to include Midwifery and maternity care;
  • Disengagement with other involved agencies to include CAN / Mental Health support.

7.4 Pre-birth Child Protection Conferences

If it is decided that a pre-birth Child Protection Conference should be held it should take place as early as is practical and never later than 8 weeks before the due date of delivery, so as to allow as much time as possible for planning support to the baby and family. Where there is a known likelihood of a premature birth, the Conference should be held earlier. E.g. factors which may indicate possible prematurely include young mothers (19 and under); substance misuse; domestic violence; maternal use of some prescribed medication.

7.5 Child Protection Plan

If a decision is made that the baby needs to be the subject of a Child Protection Plan, the plan must be outlined to commence prior to the birth of the baby.

The Core Group must be identified and should meet prior to the birth and prior to the baby’s discharge home after a hospital birth to make detailed plans at both stages.

7.6 Pre-birth Review Child Protection Conferences

The first review Conference should take place within one month of the child’s birth or within three months of the due date of the Pre-birth Conference whichever is sooner.

8. Public Law Outline

In some cases the concerns relating to the unborn child will result in a Legal Planning Meeting. In all cases this meeting should consider all of the risk factors and strengths. Where it has been agreed at the Legal Planning Meeting that work should be undertaken under the Public Law Outline (PLO) framework, there should be as little delay as possible in sending out letters before Proceedings and holding Pre Proceedings meetings. This is in order to avoid such approaches to the pregnant woman in the late stages of pregnancy and to work with the family to explore all options in order to preferably avoid initiating Care Proceedings. In all cases a referral should be made for Family Group Meetings. The PLO process is also an opportunity to commission specialist assessments.

9. Initiating Care Proceedings

The professional network should be kept fully appraised of the Local Authority plan via Pre-Birth Planning Meeting. Where an Initial Child Protection Conference has been held the meeting should be in keeping with the Child Protection Plan and include the Core Group.

This meeting must take place at the most 7 working days after the legal planning decision. The decisions of this meeting should be recorded on Azeus and the by the lead midwife who will ensure that the midwives are fully appraised of the plan for the child.

The purpose of the meeting is to make a detailed plan for the baby’s protection and welfare around the time of birth so that all members of the hospital team are aware of the plans.

The agenda for this meeting should address the following:

  • How long the baby will stay in hospital (a minimum of 7 days is usually recommended to monitor for withdrawal symptoms for babies born to substance using mothers);
  • How long the hospital will keep the mother on the ward once medically fit;
  • The arrangements for the immediate protection of the baby if it is considered that there are serious risks posed to the e.g. parental substance misuse and /or mental health; domestic abuse. Consideration should be given to the use of hospital security, informing the Police and other safety planning measures;
  • The risk of potential abduction of the baby from the hospital particularly where it is planned to remove the baby at birth;
  • The plan for contact between mother, father, extended family and the baby whilst in hospital. Consideration to be given to the supervision of contact – for example whether contact supervisors need to be employed. Hospital staff cannot be responsible for supervising contact;
  • Consideration of any risks to the baby in relation to breastfeeding e.g. HIV status of the mother; medication being taken by the mother which is contraindicated in relation to breastfeeding;
  • The plan for the baby upon discharge that will be under the auspices of care proceedings, e.g. discharge to parent/extended family members; mother and baby foster placement; foster care, supported accommodation;
  • A visiting matrix on discharge;
  • Where there are concerns about an unborn of a pregnant woman who intends to have a home birth, the Ambulance Service Lead should be invited to the Pre-Birth Planning Meeting. The safeguarding team in the hospital should place a marker on the address;
  • How to manage a request for a home birth when there are concerns or the unborn child is subject to a child protection plan;
  • Contingency plans should also be in place in the event of a sudden change in circumstances;
  • Hospital staff should be given clear instructions regarding any birth that is likely to occur over a weekend or Bank Holiday;
  • The Emergency Duty Team should also be notified of the birth and plans for the baby and the plans entered onto Azeus;
  • A copy of the plan should be given to all participants and the parents GP.

10. Birth and Discharge of a Newborn Baby

The hospital midwives need to inform the allocated social worker, or the Emergency Duty Team at weekends and Bank Holidays of the birth of the baby and there should be close communication between all agencies around the time of labour and birth. Maternity staff must keep contemporaneous notes to include visitors / basic care / maternal interaction / parenting style / any unusual activity such as leaving the ward for extended periods.

In cases where legal action is proposed or where the unborn child has been the subject of a Child Protection Plan, the allocated Social Worker should visit the hospital on the next working day following the birth. The Social Worker should meet with the maternity staff prior to meeting with the mother and baby to gather information and consider whether there are any changes needed to the discharge and protection plan The social worker should record a brief note of their visit on the child’s medical notes, which should include the time, key points of the discussion, agreements and social work contact details. The Social Worker should keep in daily contact with the ward staff and visit the baby and the parents on the ward on alternate days to meet with the parents.

If the baby is the subject of a Child Protection Plan, a Core Group Discharge Meeting should be held to draw up a detailed plan prior to the baby’s discharge home. If this is not possible, the Core Group should meet within 7 days of the baby’s birth.

If a decision has been made to initiate care proceedings in respect of the baby, the Allocated Social Worker or Hospital Social Worker must keep the hospital up-dated about the timing of any application to the courts. The lead midwife should be informed immediately of the outcome of any application and placement for the baby. A copy of any orders obtained should be forwarded immediately to the hospital.

11. Pregnancy of Young People in Care

When it is established that a young person in care or a supported care leaver is pregnant, the referrer must ring for a consultation with the MASH. A decision can then be reached about the assessment process between both the referring team and the Assessment Team.

It should not be an automatic decision to complete a pre-birth assessment in relation to the pregnancies of all care leavers unless the thresholds are met as outlined above. Alternatively a referral for an Early Help Assessment should be considered.

If an assessment is required, the Looked After Children service should provide a full written history and chronology of the young person either at the point of referral or at the Strategy Meeting. The assessment should consider the Care Plan for the young person and any additional resources needed to support the young person throughout the pregnancy. The Independent Reviewing Officer should be kept up to date with the assessment process and should the needs of the (unborn) baby require changes to the care plan for the young person, a Looked After Child review should be convened at the earliest possible time.

If a young person is looked after by another Local Authority and living in either Bedford Borough, Central Befordshire or Luton then the allocated social worker from that Local Authority should be invited to the Strategy Meeting.

If the young person’s placement is out of county the Conference and Review Service must refer of the unborn baby to the relevant Assessment Team within that area. Where a child is a mother/expectant mother and is accommodated or subject to leaving care arrangements (potentially up to 25 years), and is placed by the originating authority in another borough, the authority in which the mother is living is responsible for the baby. However, in practice this is an area where there can sometimes be disputes regarding case responsibility. It is therefore important that case responsibility is negotiated at an early stage by managers.

12. Allocation and Case Transfer

The MASH Team Manager will be responsible for the initial screening of all pre-birth cases referred to MASH. A decision about allocation will be made within 24 hours of receipt of the referral. The case will be passed to the Assessment Team for allocation.

Cases where siblings of unborn children are already open to other Services or in Care Proceedings will continue to be allocated within those Services. In cases where the court proceedings have concluded in the last 6 months, consultation should take place with the Head of Service (Social Work), as to whether the assessment should be completed by the Assessment Team or the previous case holding Team.

Where long term social work planning support is required the transfer will be made to the relevant team as per the transfer protocol.

For families where the unborn child is not the subject of a Child Protection Plan then the Pre-Birth Assessment, with parental agreement, should be shared with the Lead Midwife who will disseminate the relevant professionals.

13. General Guidelines for Conducting Pre-Birth Assessments

The importance of conducting pre-birth assessments has been highlighted by numerous research studies and Serious Case Reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carers.

Pre-Birth Assessment is a sensitive and complex area of work. Parents may feel anxious about their child being removed from them at birth. Referring professionals may be reluctant to refer vulnerable adults and be anxious about the prospective parents losing trust in them.

It is important to undertake the assessment during early pregnancy (following the 13 week scan) so that the parents are given the opportunity to show that they can change. If the outcome of the assessment suggests that the baby would not be safe with the parents then there is an opportunity to make clear and structured plans for the baby’s future together with support for the parents.

Where the concerns have not met the threshold for a Pre-Birth Assessment a referral for an Early Help Assessment should be considered by the relevant Health professional in order to ensure appropriate early help is in place.

It is important that social workers do not conduct assessments in isolation. Working closely with relevant professionals such as midwives and health visitors is essential. Liaising with relevant substance misuse, mental health and learning disability professionals is also crucial. The mental health safeguarding lead will also offer advice on cases with a mental health component and become involved in liaison with mental health professionals.

The importance of compiling a full chronology and family history is particularly important in assessing the risks and likely outcome for the child. Where there have been previous children in the family removed, the previous Court documents such as copies of Final Court Judgements and assessment reports should be accessed at an early stage. If there have been Social Workers involved from the Looked After Children Service, they should be consulted and invited to relevant meetings.

Workers should try to compile a clear history from the parents about their own previous experiences in order to find out whether they have any unresolved conflicts, for example that may impact on their parenting of the child. It is important to find out their feelings towards the newborn baby and the meaning that the child may have for them. For example, the pregnancy may have coincided with a major crisis in the parent’s life, which will affect their feelings towards the child.

It is also important to find out the parents’ views about any previous children who have been removed from their care and whether they have demonstrated sufficient insight and capacity to change in this respect.

It is crucial to seek information about fathers/partners whilst conducting assessments and involve them in the process. Background Police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Working with extended families is also crucial to the assessment process and achieving positive outcomes for unborn children. Consideration should always be given to convening Family Group Meeting in any cases where there is a possibility that the mother may be unable to meet the needs of the unborn child.

Family Group Meetings can enable the families to be brought together to make alternative plans for the care of the child thus avoiding the need for Care Proceedings in some cases. Parallel assessment of alternative family carers can prevent delays in Care Planning for the child.

A pre-birth assessment tool is attached to this guidance to help social workers consider the key questions to address when undertaking assessments. It is important to provide an analysis of the likely impact of parental issues on the unborn child rather than just providing a description. For example, the likely impact of parental substance misuse on both the unborn and the newborn child needs to be spelled out explicitly.

See also: Appendix 4: Pre-Birth Assessment Tool.


Appendix 4: Pre-Birth Assessment Tool

Click here to view Appendix 4: Pre-Birth Assessment Tool.

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