6.14 Safeguarding Around the Time of Birth |
SCOPE OF THIS CHAPTER
This guidance is in line with the guidance approved by the Worcestershire Safeguarding Children Board in April 2006.
Please also see Worcestershire Safeguarding Children Board Guidance for drafting Hospital Birth Plans and Coordinated Support Plans for Unborn Babies
AMENDMENTS
This chapter was revised in November 2009 to take account of the recommendations of a Serious Case Review in Worcestershire, and was further revised in September 2010 to take account of Working Together to Safeguard Children 2010.
Contents
- Introduction
- Initial concerns
- Pre-Birth Assessment
- Child in Need
- Child in Need of Protection
- Child Protection – Emergency Protection Order
- Children Born out of Area
- Children who Live in Other Local Authorities
- Bibliography
- Hospital Birth Plan
1. Introduction
| 1.1 | This guidance has been developed to ensure that babies are adequately safeguarded both pre-birth and immediately after their birth. It is intended that where safeguarding issues have been identified before the birth, plans are in place and that all professionals coming into contact with the baby are aware of theses plans and the part that they play in them. |
| 1.2 | This guidance is intended not only for the more extreme and rare cases where it is necessary to remove a child at birth, but also where there are less significant concerns, where a child is in need. |
| 1.3 | This guidance is intended for babies whose home is in Herefordshire, Shropshire, telford & Wrekin or Worcestershire, even when it is planned that their birth should take place in a hospital outside these areas. |
| 1.4 | At the heart of this guidance is the need for timely and clear planning for the needs of the unborn child. It will set out what information is needed, how this will be collated and will determine how it will be stored and accessed by the relevant professionals. It will never be possible to make timely plans for all babies who need safeguarding, as will be the case when agencies are not aware of the pregnancy or only become aware in the very late stages of pregnancy. In these circumstances it will give clear guidance on what action to take when concerns are raised. |
2. Initial Concerns
| 2.1 | Any concerns about the welfare of an unborn baby, or about the future care of the baby when born must be shared with the appropriate agency at the earliest opportunity, as plans for safeguarding may need to be put in place before the baby is born. In situations where there are no child protection issues, but it is felt that the child would benefit from the family receiving some support, this must be discussed with the parents and concerns shared with the appropriate agency. It is however acknowledged that in some cases professionals will not be aware of pregnancies, particularly if a parent has experienced the previous involvement of agencies due to child protection concerns and is anxious to conceal their pregnancy. |
| 2.2 | If any professionals have concerns about the future care of an unborn baby, or that of a new born baby they should discuss these concerns with the parents, unless to do so would put the baby at risk of Significant Harm. It is still good practice to gain consent for a referral to Children and Young People’s Services, if this is possible, but a referral of child protection can be made without gaining parental consent. In a situation where a professional is unclear about the appropriate course of action they should discuss this with Children’s and Young People’s Services. All Agencies should complete a CAF which should be shared with Children and Young People's Services as part of the referral process. |
| 2.3 | Any assessment of need or risk, under the Framework for the Assessment of Children in Need and their Families should be carried out as early as possible in the pregnancy. In some situations, particularly where a parent has impaired learning, problems with substance misuse or mental ill health, a detailed Core Assessment may need to be carried out to establish parenting capacity. |
| 2.4 | If professionals only become aware of a pregnancy after 30 weeks and have concerns about the future care of the child, this referral must be dealt with immediately, particularly if the concerns are due to maternal drug misuse. |
| 2.5 | In the situation where a professional becomes aware of a pregnancy in a family where there have been long-standing child protection concerns it is important that this information is referred promptly to Children and Young People’s Services. This includes the situation where any agency becomes aware that an expectant mother or her partner had a previous child who was or is the subject of a Child Protection Plan .In these circumstances it would be appropriate to treat this as a child protection referral and to share information via a Strategy Meeting. This is particularly important in a situation where it is considered likely that the family may move out of the area, to avoid child protection procedures. In addition, where an agency becomes aware that an expectant mother or her partner had a previous child in relation to whom a Child Protection Conference was convened (whatever the outcome), then this should be discussed with Children and Young People's Services in order to consider the present level of risk and any action required. |
| 2.6 | In a situation where a Children and Young People’s Services social worker has concerns about an unborn child they must speak to the community midwife. These concerns may be about the future care of the child when s/he is born or about the care of the unborn child. This would be particularly important where there is drug or alcohol misuse or domestic violence, both of which could harm the unborn child. |
| 2.7 | It should be borne in mind that the definition of Neglect includes neglect during pregnancy as a result of maternal substance abuse. (Working Together to Safeguard Children, 2010) |
3. Pre-Birth Assessment
| 3.1 | Once a referral on an unborn child has been received by Children and Young People’s Services an Initial Assessment will be carried out in seven working days. This Initial Assessment must include obtaining information from, and consultation with, the midwife, GP and any other relevant health care professional and any other agency that knows the family. |
| 3.2 | It is the purpose of the Initial Assessment to identify what, if any, further services are required. A number of recommendations are possible as a result of the Initial Assessment. It may be concluded that there are no concerns about the present or future care of the child and there will be no further intervention. In the situation where there are concerns or further support has been identified as being needed, the baby will be a Child in Need. In more serious cases the child may have been identified as at risk of Significant Harm, either before birth or after birth, and as such will be a child in need of protection. |
| 3.3 | In carrying out the pre-birth assessment it is important to consider if the family may need some support as a result of disability or cultural background. For example will written information need to be translated, will an interpreter be needed or extra support as a result of a disability |
| 3.4 | Where there is to be no further action and the baby is not considered to be a Child in Need, it is important that the social worker who completed the assessment informs the referrer in writing of this outcome. It is particularly important that the relevant health workers are informed, as in the event that concerns arise once the baby is born, they would need to make a further referral to the Children and Young People’s Services. |
| 3.5 | Where a referral is made to Children's and Young People's Services late in the pregnancy and there is insufficient time for the pre-birth assessments to occur before the baby's birth, there should be a multi agency Strategy Discussion prior to the baby's discharge home from the maternity hospital. |
4. Child in Need
| 4.1 | Where it has been identified that the baby will be a Child in Need, it is important that a Child in Need Plan is drawn up by the commissioning social worker, before the birth of the baby and distributed to all relevant professionals. The Children and Young People’s Services’ worker drawing up the plan must ensure that copies are: placed on the child’s file; sent to the Emergency Duty Team; the future health visitor; and any relevant professional working with the parents. A copy must be sent to the community midwife, if it is planned that there will be any additional support around the time of birth. |
| 4.2 | If it is identified that some support and observation will be needed immediately after the birth, then a Hospital Birth Plan must be completed. It will be the responsibility of the Children and Young People’s Team Manager to ensure that this is completed, in consultation with the midwife, ensuring that the appropriate ward or unit is identified. The Team Manager must then ensure that it is circulated as appropriate. Any specific issues resulting from the parents’ cultural background or disability must be included. |
| 4.3 | Due to the difficulty of accurately assessing parenting skills before the birth of a child, it will often be necessary to carry out further assessment on a Child in Need, once s/he is born. This assessment will in all probability include Children and Young People’s Services in carrying out training and assessment in parenting skills. Some of this work can take place prior to the birth of the baby, but it is important that assessment continues once the baby is born. Any assessment of parenting skills needs to start as early as possible in the pregnancy. |
5. Child in Need of Protection
| 5.1 | If the Initial Assessment identifies that the unborn baby is, or will in the future, be a child in need of protection, a Core Assessment will be carried out by Children and Young People’s Services. Once this assessment is started the social worker must contact the Nurse Consultant/Named Nurse for Child Protection to share information and to ensure that health services are aware of concerns. The Nurse Consultant/Named Nurse will inform the relevant health professionals. |
| 5.2 | The Core Assessment will inform the decision on the need for an Initial Child Protection Conference. It is important that any Conference is held as early as it is possible, to ensure that plans can be put in place for the assessment of services. Any Child in Need Plan must be drawn up prior to the birth. It is particularly important with substance misusing mothers, as these babies are often born prematurely. It is good practice to hold any conference by 32 weeks and if possible the pre-birth conference should be convened earlier than 32 weeks if the mother has a known substance misuse pattern or a history of prematurity. Only in situations where the pregnancy has been concealed from professionals, until a late stage, should the Child Protection Conference take place later than 32 weeks. |
| 5.3 | If the conference decision is that the child will need a Child Protection Plan, this will be drawn up at the Core Group meeting, which must take place within 10 days of the conference. The Child Protection Plan will be based on the recommendations of the Child Protection Conference. This Core Group must include the future Health Visitor. |
| 5.4 | Any unborn child who is in need of a Child Protection Plan will also require a Hospital Birth Plan. This is to ensure that all health professionals who come into contact with the new born child are aware of any child protection concerns and know what protective measures are required. This is particularly important where there are shift changes and medical and nursing staff who will not be aware of concerns. The hospital birth plan will be drawn up at the Child Protection Conference and the midwife will ensure that the plan is placed in the mother’s medical notes and on the delivery suite. |
| 5.5 | The Child Protection Conference must have a representative from midwifery, who will be responsible for ensuring that the Hospital Birth Plan is completed, with the relevant information and decisions from the conference. The following issues must be addressed in the plan:
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| 5.6 | In the situation where the family of an unborn child, with a Child Protection Plan, leaves the area, it is necessary to inform all other Local Authorities in the country. It is the responsibility of the Children and Young People's Services team manager to notify the Service Manager with responsibility for Safeguarding, who will ensure that all other Children and Young People's Services are informed of the family and alerted to the child protection issues. The nurse consultant/named nurse for child protection is responsible for ensuring that all maternity units in the country are given details of the mother. |
6. Child Protection – Emergency Protection Order
| 6.1 | On very rare occasions a Child Protection Conference may decide that the risk to an unborn child is so great that the child would not be safe in the care of the parents. In these circumstances the conference would decide that the baby should be made the subject of a Child Protection Plan and could recommend that an Emergency Protection Order be sought as soon as the baby is born. In these circumstances the Hospital Birth Plan is critical in safeguarding the child whilst in hospital. It is important to remember that the baby may only be separated from his or her mother with her consent or a Court Order. It is not possible to obtain a legal order until the child is born. A police incident number must be obtained at the conference and placed on the plan, in case Police assistance at the hospital is required. Police Protection is unlikely to be appropriate as part of a planned action, but may be necessary where the Hospital Birth Plan cannot be implemented and the child is at immediate risk of Significant Harm. |
| 6.2 | If an Emergency Protection Order is to be sought on any child the allocated social worker must be informed when the mother goes in to labour. If it is out of normal office hours the Emergency Duty Team must be informed. The social worker will alert the Magistrates Court officer that they will be applying for an order. Once the baby is born the midwife, or other medical staff must inform the social worker or Emergency Duty Team immediately. Any necessary information will be obtained by the social worker and the application will be made. |
| 6.3 | The Emergency Protection Order will be sought as quickly as possible by the social worker and once obtained brought to the hospital and served on the mother. If there is an attempt to remove the child before the order is obtained the hospital staff must contact the Police, via “999”, quoting the incident number. The Police will exercise their powers of Police Protection if the circumstances require such action. The baby can then be placed elsewhere in the hospital, away from the mother, in a place of safety. |
| 6.4 | When a baby is removed from parents on an Emergency Protection Order, he/she will be placed on the Neo-natal Unit, for up to 48 hours, until placed in suitable accommodation by the social worker. In exceptional circumstances, such as the medical needs of the child, this stay on the Neo-natal Unit may be extended. |
| 6.5 | In the situation where an Emergency Protection Order is to be sought, but the mother chooses to have her child at home, it will be necessary to take special precautions not only to protect the child, but also the professionals involved. In these situations, once a woman has expressed her intention to have her baby at home, it will be necessary to convene a Management of Risk Conference. This conference will draw up a plan to ensure the safety of the baby and the professionals involved. The conference must include: police; social worker; midwife and ambulance trust. Any actions decided on in the management of risk conference must be added to the Hospital Birth Plan, which will then be re-circulated. |
| 6.6 | In these circumstances it will be necessary for two midwives to be present at the delivery. Once the woman goes into labour and the midwives go to the home, the Police will be informed, as well as the social worker. The Police will accompany the midwives to the home, but will remain outside if appropriate. When the baby is born, the social worker will be informed immediately and make the application for an Emergency Protection Order. If the Order is granted, the Police will accompany the social worker to serve the Order and remove the baby. It is important that the midwives remain with the family until the Emergency Protection Order is obtained, if at all possible. The Police must ensure that the baby is not removed from the premises, before the Emergency Protection Order is obtained. When the baby is removed s/he will be taken directly to hospital. |
7. Children Born out of Area
Some women may choose to have their babies in hospitals situated in neighbouring local authorities. They will still however receive antenatal care from community midwives in their home area. It is important, in these situations, for any unborn Child in Need, or in need of protection, that the midwife alerts the social worker, so that information can be shared with the appropriate hospital. If there is a Hospital Birth Plan, this must be sent by the midwife to the appropriate hospital. The social worker must also inform the relevant Emergency Duty Team. Any child protection concerns arising in the hospital will have to be dealt with locally in an emergency. It is important that the local child protection services have all necessary information and liaise with child protection services in the home area.
8. Children who Live in Other Local Authorities
If there are concerns about the care of a child born in an in-area Hospital, who will live in another local authority area, it is important that the appropriate Children and Young People’s Services are made aware of the concerns. Any urgent child protection issue should be referred to the Children and Young People’s Services where the child is born or local Police as appropriate. If urgent protective measures need to be taken these would be done locally.
9. Bibliography
Children’s Needs – Parenting Capacity H. Cleaver, I Unell, J Adlgate (The Stationery Office)
The Children’s World, Assessing Children in Need Ed. J Horwath (Jessica Kingsley publishers)
Parent Assessment Manual - Trecare NHS Trust, Truruo - Sue McGaw
10. Hospital Birth Plan
Click here to view an example of a Hospital Birth Plan
Please also see Worcestershire Safeguarding Children Board Guidance for drafting Hospital Birth Plans and Coordinated Support Plans for Unborn Babies
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