Working with mothers and their unborn babies where there are concerns for the welfare of the unborn child
Introduction
Research indicates that young babies are particularly vulnerable to abuse but that work carried out in the antenatal period can help minimise harm if there is early assessment, intervention and support. Working Together (2010) specifically identifies the need of the Unborn Child.
Purpose
The purpose of this protocol is to ensure that a clear system is in place to respond to concerns for the welfare of an unborn child and to maintain clear and regular communication.
Scope
This joint protocol particularly applies to Social Care staff, police and health.
Definitions
Concerns for the welfare of an unborn child include:
- Concerns that the parent/carer’s current behaviour, e.g. known mental health concern or substance misuse poses a threat to the unborn baby.
- Concerns that the parent/carer may not be able to care for the baby to an acceptable standard, e.g., significant learning difficulty, previous neglect or other children subject to child protection plans or have been removed from parental care.
- Concerns that the behaviour of the father (or any other person) poses a threat to the unborn baby, e.g. domestic abuse or known allegation or conviction for offences against children under 18years of age.
- Concerns that the behaviour of the father (or any other person) will impact on the ability of the mother to care for the baby to an acceptable standard.
The presence of one of these factors does not automatically require referral but they highlight the need to consider the known pre-disposing factors to child abuse.
Early Identification & Assessment
All professionals working with families need to be alert to the factors that may indicate a potential risk to the child either before or after birth.
It is vital that assessments are started early and that information is shared so that the child and family have the necessary support and best start to family life thereby minimising the need for child protection intervention.
If necessary a child protection conference will be held or a children in need plan must be in place as soon as possible but no later than by week 28 of the pregnancy, unless there is a late referral when plans must be agreed as soon as possible following identification of concerns.
Any assessment must include details of the mother’s partner, wider social and family history and environmental factors (as can be found in the Common Assessment Framework) as well as the obstetric history.
Routine Antenatal Enquiry
The National Service Framework for Children, Young People and Maternity Services (D.O.H, 2004) states that ‘all pregnant women must be offered a supportive environment and the opportunity to disclose Domestic Violence and that local services are trained to respond appropriately’.
This means that on initial booking, or at another appropriate time (see The Royal College of Midwives RCM position paper 19a), the midwife will raise the issue of domestic abuse. Research informs us that 30% of domestic violence starts in pregnancy and that domestic violence is a prime cause of miscarriage or still birth (Why Mothers Die, Department of Health, 2001). A significant number of expectant mothers will need referral to other services
Low Level of Concern
1. Initial Contact (Approx 8-12 weeks gestation)
- If in the initial assessment the health professional (e.g. midwife or GP) has some level of concern (considering the risk factors) the family should be informed that there is a need to liaise and possibly refer to other professionals.
- The health professional should discuss any concerns with their supervisor or with their child protection lead professional. They should refer to ContactPoint and consider the appropriateness of completing a common assessment.
- The health professional should make an enquiry to the appropriate safeguarding children unit to ascertain whether there are any children from the family who are subject to a child protection plan.
- The health professional may refer the pregnant mother to the social care (children’s services) team following their ‘booking-in’ appointment and Obstetric Booking Assessment form that takes place at approximately 10-12 weeks of pregnancy.
- If the family already have an identified social worker, then the referral needs to be made to them. The referring health professional must confirm the referral in writing, either by letter or confidential fax, within 48 hours.
- The social care (children’s services) team will acknowledge receipt of referral and communicate their decision on the next course of action within one working day to the health professional.
- When concerns have been raised by someone other than the midwife the social care worker involved must bring them to the attention of the named community midwife, if known, or the child protection lead midwife or named nurse for acute or primary health. This enables the midwife to continue to monitor and support the family.
- If the midwife makes a referral, they must inform the Senior Community Midwife/ child protection lead, G.P & Consultant Obstetrician if appropriate.
N/B It is the responsibility of the professional making the referral to follow up a referral if there is no response within the given timeframe.
Initial assessment social care
- If the threshold for an initial assessment is not met then a decision must be taken as to whether there should be future support through a common assessment.
- If initial assessment is deemed necessary from the social care (children’s services) team, this must be completed within 7 working days. A decision will be made about the need for a core assessment.
- If child protection concerns are identified, a ‘strategy discussion’ will be held (see below)
- Throughout pregnancy the midwife will continue to monitor and support the family. If at any time concerns resurface then the Social Care (Children’s Services) team must be contacted with the new information.
- Post-natally the midwife will again monitor and offer support until handover to the Health Visitor. The Health Visitor will maintain contact with the family and as for all families will take a lead role in assessment and intervention.
Click here for Appendix A – Unborn baby procedure flowchart
2. Medium/High Level of Concern
The assessment indicates that this may be a child in need or at risk of significant harm who is unlikely to achieve and maintain a reasonable standard of health and development without the provision of services. There is an indication that there is a likelihood of impairment of health and development.
This level of concern relates to when there are concerns that an unborn baby may be ‘in need’ (section 17) or ‘in need of protection’ (section 47) which means that their basic physical and/or psychological needs will not be met and is likely to impair the child’s health or development.
Where initial contact is made by professionals primarily working with the adult family members, e.g. Police, probation, housing or voluntary agency, mental health and learning difficulties professionals and there is this level of concern then the social care (children’s services) team must be notified regarding the unborn baby.
Any professional who has concerns for the welfare of the unborn child must ensure that the midwifery service is aware of the concerns and that any relevant information is passed on in writing.
Once the referral has been made the processes are exactly the same as for any child in need/child protection referral. If child protection concerns are identified, a ‘strategy discussion‘ will be held and a child protection conference, if necessary.
If necessary a child protection conference will be held or a children in need plan must be in place as soon as possible but no later than by week 28 of the pregnancy, unless there is a late referral when plans must be agreed as soon as possible following identification of concerns. Any assessment must include details of the mother’s partner, wider social and family history and environmental factors (as can be found in the core assessment) as well as the obstetric history.
Click here for Appendix A – Unborn baby procedure flowchart
Escalation / resolution policy
If after following all protocols flowcharts the professional still has concerns, then they would need to contact their named professional for child protection who if necessary will implement the relevant resolution policy.
Practice Guidance
Although this protocol does not explicitly mention fathers and extended family members it is implicit that they must be included as appropriate in the assessment and support to the mother and unborn child.
