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.
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 woman, the father / partner 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.
The antenatal period provides a window of opportunity for practitioners and families to work together to:
Where professionals become aware that a woman is pregnant, at whatever stage of the pregnancy, and they have concerns for the woman 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 safe and effective parenting care throughout childhood. If not, a pre-birth assessment may be required.
Each professional should follow their agency's child protection procedures and discuss concerns with their safeguarding lead/named/designated professional for safeguarding.
In Sunderland, practitioners should refer to the Guide to Our Thresholds of Need and then decide to either refer to the Integrated Contact and Referral Team or Early Help Services, if required when identifying the potential risk factors to an unborn baby.
Risk factors which could indicate that an unborn child may be likely to suffer significant harm and therefore be subject to a pre-birth assessment may include:
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 child. If in doubt, professionals should seek advice about making a referral.
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).
It is important that all agencies involved in pre and post-birth assessment and support, fully consider the significant role of fathers and wider family members in the care of the baby even if the parents are not living together and, where possible, involve them in the assessment. This should include 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 careful assessment of the role that the person has in relation to the woman and any other children in the household as well as their views about the future care of the baby should be undertaken.
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.
When any professional in Adult Services becomes aware that a woman (or the partner of a man 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 might be vulnerable due to the circumstances of their service user, they should inform maternity services of their service involvement and highlight any vulnerabilities they have identified.
An Early Help (or similar) 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.
An assessment can be undertaken in relation to the unborn child. If the mother is under 18, they should also be offered an 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 - see Referrals Procedure.
All agencies should be involved in the development of a safeguarding assessment with a clear focus on the child's needs. Any risk assessments should be completed at least 4 weeks before the expected delivery date. All discussions, decisions and actions should be clearly documented in the appropriate agency record, including dates and names of professionals involved.
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 if required. The timing of the conference should take into account the expected date of delivery and ideally take place by 24 weeks of the pregnancy, or earlier if there is a history of premature birth.
Note: in Gateshead this will take place as per normal timescales as referrals will be accepted as soon as pregnancy is confirmed.
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. The Core group should meet prior to the birth within the locally stipulated days from the Conference date and certainly prior to the baby's discharge home from hospital.
If the Child Protection pre-birth Conference 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. A Pre-Birth Planning Meeting should be arranged.
The Assessment should be shared, when completed, with the parents and, if instructed, to their solicitor to give them opportunity to challenge the proposed Care Plan and assessment.
In Sunderland, if the plan is one of an Interim Care Order, PLO procedures are to be initiated.
The circumstances of the woman and other relevant adults should be reviewed regularly to allow for ongoing assessment of need and risk and consider any action required to safeguard the child. The Assessment should be updated to take into account relevant events pre-and post delivery where these events could affect an initial conclusion in respect of risk and care planning of the child.
A Pre-Birth Planning Meeting should be arranged following the outcome of the decision to remove the child. The meeting should agree a detailed plan to safeguard the baby around the time of birth which should include:
In Sunderland, the SSCP Child Protection/Child In Need Birth Arrangements would be used for this. In Sunderland consideration should be given to sharing the Pre-Birth Plan with neighbouring hospitals and the ambulance service.In Sunderland, the Emergency Duty Team should also be notified of the pre-birth plans for the baby and a copy of the plan should be sent to the Children EDT inbox. These Plans will then be saved by the Emergency Duty Team in the Birth Plans file for out of hours use.
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.
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 likely to suffer significant harm, and can be used to develop plans to safeguard them.
There are some potential issues that can arise. The involvement of Children's Social Care (especially if there is a decision to remove the baby at birth) can result in the parents going missing or the woman 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 woman 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.
Child Protection / Child in Need Birth Arrangements Form - MANDATORY for all unborn babies who are the subject of a Child Protection Plan. It MUST be signed and agreed by the Team Manager. This form must be completed as far as possible by the Social Worker and brought to the Initial Child Protection Conference and must be completed as part of the meeting.
Only valid for 48hrs