CHAPTER 25: Pre-Birth Procedures (LAST REVISED AUGUST 2011)

If concerns are identified, health professionals in contact with pregnant women should routinely assess the needs of the mother and of the unborn baby. The midwife should refer to the health visiting service wherever possible prior to 16 weeks gestation and a Common Assessment should be undertaken between the midwife, health visitor and other professionals involved with the family.

Midwives should notify the named midwife for child protection within their unit if concerns are identified and discuss their concerns with the G.P.

In some cases relevant records identifying one or more risk factors may only be available to the GP e.g. where an adult has moved frequently. The GP must therefore consider the need for an early assessment or referral of the unborn baby when any of the factors listed below (apply to a prospective mother, father or carer - see Duty to Refer to Children's Social Care of Recognition and Response Procedure.

Identifying concerns early , and wherever possible prior to 16 weeks gestation, will 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
• Early identification of significant relative or family member who might be able to support or provide primary care

Parents should be informed as soon as possible of concerns and of the need for assessment, except on the rare occasions when medical advice suggests this may be harmful to the health of the unborn baby and/or mother*. If medical advice does suggest this, then a referral to Children's Social Care should be considered (see section 4, Referral to Children's Social Care below).

If any of the circumstances described in Paragraph 4.2 apply, a referral must be made to Children's Social Care immediately.

PRE-BIRTH ASSESSMENT

All Pre-Birth Assessments must reference the Assessment Framework and the NICE guidance below:

Unborn Baby

• Unwanted/concealed pregnancy
• Perceptions
• Awareness of baby's needs
• Ability to prioritise baby's needs
• Awareness of unborn baby's health
• Antenatal care
• Parental expectations of new born baby
• Planning
• Parenting plans
• Special/extra needs
• Premature birth

Parenting Capacity

• Childhood experiences
• Age - very young parent/immature
  • Positive childhood
• Mental disorders or illness
  • Multiple Carers
• Learning difficulties
• Recognition of effects of own behaviour on others
• Physical disabilities/ill health
• Inability to work with professionals
• Drug/alcohol misuse
• Cultural issues
• Abuse/neglect of previous child(ren)
• Positive mental health

Family/Household/Environmental

• Domestic abuse
• Relationship disharmony/instability
• Violent or deviant network
• Multiple relationships
• Poor impulse control
• Not working together
• Unsupportive of each other
• Lack of community support
• Frequent moves of house/homelessness
• Poor engagement with professional services
• No commitment to parenting

References:
National Institute for Health and Clinical Excellence (2007) Intrapartum care: care of healthy women and their babies during childbirth, NICE clinical guideline 55, September 2007
National Institute for Health and Clinical Excellence (2008) Antenatal care: routine care for the healthy pregnant woman, NICE clinical guideline 62, March 2008.
Both available at National Institute for Health and Clinical Excellence

MULTI-AGENCY MEETING

If an unborn child is not at risk of Significant Harm and a Common Assessment or an assessment by Children's Social Care indicates that additional services are required, a multi-agency meeting should be convened within a timescale appropriate to the needs of the unborn baby and within a maximum of 28 days from the date the assessment began. The prospective parents should be invited to this meeting.

The meeting should consider the concerns for the unborn baby and make a plan to address these.

Referral must always be made in any of the following circumstances:

• There has been a previous child death in the household of either parent which raises concerns about future parenting and risk of Significant Harm to the unborn baby.
• A parent or other adult in the household is a person identified as presenting a risk, or potential risk, to children
• Children in the household / family currently subject to a Child Protection Plan or previous child protection concerns
• A sibling (or other child in the household of either parent) has previously been removed from the household by Children's Social Care either temporarily or by court order
• There is knowledge of parental risk factors including mental illness, domestic abuse, substance misuse and learning difficulties, that may place the unborn baby at risk of Significant Harm.   Where concerns centre around a category of parenting behaviour, the referrer must make clear how this is likely to impact on the baby and what risks are predicted.
• There are concerns about parental ability to self-care and/or to care for the child that may place the unborn baby at risk of Significant Harm e.g. unsupported, young or learning disabled mother
• There are maternal risk factors e.g. denial of pregnancy, avoidance of antenatal care (failed appointments), non-co-operation with necessary services, evidenced non- compliance with treatment with potentially detrimental effects for the unborn baby
• Any other concern exists that the baby may be at risk of Significant Harm

Delay must be avoided when 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 the birth
• Identify significant family members who might be able to provide support and consider the use of a Family Group Conference to facilitate this

Where a referral concerns a pregnancy in a young person under the age of 18, a separate initial assessment should be completed for the young person. Wherever possible this assessment should be completed by a different social worker to that undertaking the initial assessment of the unborn child.

There may be circumstances where it has been specifically determined that it would be beneficial for both mother and baby for the initial assessments to be carried out by the same social worker.  If this is the case, the reasoning should be noted on the case file.

MULTI-AGENCY MEETING

If an unborn child is not at risk of Significant Harm and a Common Assessment or an assessment by Children's Social Care indicates that additional services are required, a multi-agency meeting should be convened within a timescale appropriate to the needs of the unborn baby and within a maximum of 28 days from the date the assessment began. The prospective parents should be invited to the meeting.

If it is suspected that the baby may be at risk of Significant Harm, Section 47 Enquiries must be initiated and a Strategy Discussion chaired by a Children Services line manager must be held, involving the:

• Community midwife
• Named midwife for child protection
• G.P.
• Health visitor
• Police officer
• Social worker
• Other professions as appropriate e.g. obstetricians, mental health services, drug and alcohol services, probation
• Where required, a legal adviser

The Strategy Discussion / Section 47 Enquiries should determine:

• Cause for concern and the potential impact on the care provided to the baby
• Particular requirements of the pre-birth Core Assessment
• Role and responsibilities of agencies and specialists in the assessment e.g. involvement of expert in substance misuse if applicable
• Role and responsibilities of agencies to provide support before and after the birth
• Identity of responsible social worker to ensure planning and communication of information
• Timescales for the assessments and enquiries, bearing in mind the expected date of delivery
• How and when parent/s are to be informed of the concerns
• Required action by all professionals when the baby is born
• The need for a pre-birth conference, or (where this will depend on the outcome of assessments) establish the date by which this decision must be made, given timescales in - see Section 8, 'Timing of Conference'.

Children's Social Care's responsible manager should determine any need for a pre-birth child protection conference. 

Core Assessments should be undertaken with reference to section 3, Pre-birth Assessment

Where a referral concerns a pregnancy in a young person under the age of 18, a separate Core Assessment should be completed for the young person. Wherever possible this assessment should be completed by a different social worker to that undertaking the Core Assessment of the unborn child.

If an unborn child is not at risk of Significant Harm, a multi-agency meeting should be convened within a timescale appropriate to the needs of the unborn baby and within a maximum of 28 days from the date the assessment began. This meeting should discuss the conclusions and recommendations of the ongoing assessment with the prospective parents and consider the concerns for the unborn baby and make a plan to address needs.

PURPOSE

THRESHOLD FOR PRE-BIRTH CONFERENCE

A pre-birth conference should be held where a:

• Pre- birth assessment gives rise to concerns that an unborn child may be at risk of Significant Harm
• Decision to initiate Care Proceedings has been made as a result of a pre-birth assessment
• Previous child has died or been removed from parent/s as a result of Significant Harm
• Child is to be born into a family or household which already have child/ren subject to Child Protection Plan/s
• Person identified as presenting a risk, or potential 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 abuse
• A mother under 16 about whom there are concerns regarding her ability to self-care and/or to care for the child

TIMING OF CONFERENCE

TIMING OF REVIEW CONFERENCE

The first review conference should take place within three months of the last pre-birth conference.

There should always be a Review Child Protection Conference within eight weeks of a baby's birth.