5.20 Pre-birth Child Protection Procedure
This chapter was reviewed and revised for the March 2015 edition of the manual.
- 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
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 see Surrey Effective Family Resilience (Multi-Agency Levels of Need). When an expectant mother is age 16-18 an Early Help Assessment should always be considered. 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 Children's Social Care 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’s Services will create the ICS (Integrated Children’s System) record for the child at 12 weeks gestation. If concerns about the unborn child come to light prior to 12 weeks gestation, the referrer will be asked to re-refer at the appropriate time (at 14 weeks). Children's Services teams have also developed their own tracking system of the unborn children who have been referred prior to 12 weeks, to ensure that they have been followed up after 12 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 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
All pre-birth Referrals to Children's Social Care Services, which met the threshold for referral must be subject to Child and Family Assessment (see Pre-birth Assessment Procedure) 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 meeting should take place on agreed strategy meeting days within each of Surrey quadrants. The meeting should be chaired by a Children's Social Care Services Team Manager or Assistant Team Manager and involve:
- Lead Safeguarding Midwife;
- Social worker;
- Named nurse and named midwife;
- Other professionals as appropriate e.g. mental health services, probation, substance misuse professionals;
- Where required, a legal adviser.
The purpose of the meeting is the same as that of other Strategy Discussions/Meetings and should determine:
- 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 Guidance in relation to completing pre-birth Assessments (accessible via the ‘guidance and protocols’ button in the menu on the left hand side of the screen.)
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 Surrey 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 Surrey 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.
- This decision will usually follow from a pre-birth Child and Family Assessment and a conference should be held;
- Where a pre-birth assessment gives rise to concerns that an unborn child may be at risk of Significant Harm;
- Where a previous child has died or been removed from parent(s) as a result of Significant Harm;
- 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;
- Where a person known to pose a risk to children resides in the household or is known to be a regular visitor
- Other risk factors to be considered are:
- The impact of parental risk factors such as mental ill-health, learning disabilities, substance misuse and domestic violence;
- 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 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.
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 Surrey 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.
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.