20.20 Pre-birth Child Protection Procedure
This chapter was reviewed and revised in October 2020.
- 1. Introduction(Jump to)
- 2. Recognition and Referral(Jump to)
- 3. Response(Jump to)
- 4. Pre-birth Multi-Agency Strategy Meeting(Jump to)
- 5. Pre-birth Section 47 Enquiry and Assessment(Jump to)
- 6. If an Unborn babies’ siblings are already open to Level 4 services(Jump to)
- 7. If a Baby on a CP Plan is Born at Home Unexpectedly(Jump to)
- 8. Pregnant Woman Who Go Missing(Jump to)
- 9. Pre-Birth Conferences(Jump to)
- 10. Timing of Pre-Birth Conferences(Jump to)
- 11. Attendance(Jump to)
- 12. Decision(Jump to)
- 13. Timing of Review Conference(Jump to)
- Appendices(Jump to)
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, prior to referral. 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. Contact information for the Children’s Single Point of Access (C-SPA) can be found here.
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 (Appendix 1: Pre-Birth Assessment and Intervention Timeline gives details of expected timeline for referral, assessment and intervention).
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 (‘the Referral Circumstances’):
- Where there has been a previous unexplained death or serious injury of a child whilst in care of either parent;
- Where a parent or other adult in the household or the close family network 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, including coercive control;
- 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 parent(s);
- 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 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 Harmful traditional practices including Female Genital Mutilation (FGM), honour-based violence and forced marriage 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 either or both parents are a ‘Looked After Child’ (see definition below).
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.
Where either or both parents are a Care Leaver a risk assessment using the level of needs document should be made to decide if the baby is at risk of harm and a referral to children’s services made as appropriate. If risk factors have not been identified, then a referral to children’s services may not be warranted. Referral to support services should be discussed in partnership with the parents.
Looked After child
In England and Wales, the term “Looked After Children” is defined in law under the Children Act 1989.
A child is looked after by a local authority if he or she is in their care or is provided with accommodation for more than 24 hours by the local authority.
The Children (Leaving Care) Act 2000 which amended the Children Act 1989 defines it as a person who has been in the care of the Local Authority for a period of 13 weeks or more spanning their 16th birthday.
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. Where concerns are shared with parents, their response should be considered in the assessment of risk and shared with Children’s Social Care if a referral is being made.
When making a decision to refer for an unborn baby, you must consider both the Surrey Effective Family Resilience (Multi-Agency Levels of Need], as well as the ‘Referral Circumstances’ within this policy in order to make an informed decision.
All pre-birth referrals to Children's Social Care Services, which meet the ‘Referral Circumstances’ (as listed in Section 2 above) at the point of referral must trigger a Pre-birth Child and Family Assessment. All agencies must work together in the interest of the unborn child and it is recognised that at times there are differences of opinion on how to progress a case. There is an Escalation Policy (see Inter-Agency Escalation Policy and Procedure) which seeks to identify how resolution can be sought where there are differences of opinion, and it should be used to ensure that all matters are resolved.
It may also be necessary to hold a multi-agency Strategy Discussion/Meeting depending on the severity of the Referral Circumstances outlined in Section 2, Recognition and Referral. It is important to note that there may be instances when the ‘Referral Circumstances’ are not the cause for concern within the referral and in these situations, the decision to progress to a Child and Family Assessment or Strategy Meeting can be based solely on the Multi-Agency Levels of Need. The expected delivery date will also determine the urgency for the meeting and subsequent timeline for necessary assessments.
The need for a Section 47 Enquiry should be decided at the Strategy Meeting which should be held as soon as possible following receipt of the Referral and within statutory timescales.
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 be chaired by a Children's Social Care Services Team Manager and involve:
- Lead Safeguarding Midwife;
- Social worker;
- Health Professionals (GP, named nurse, Health visitor, named midwife (if allocated), and any other relevant health professional;
- Other professionals as appropriate e.g. Mental Health services, Adult Services, Probation, Substance misuse professionals; South East Coast Ambulance (SECAMB)
The purpose of the meeting is the same as that of other Strategy Discussions/Meetings and should determine:
- Whether threshold for a Section 47 Enquiry is met;
- 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. NB: A Hospital Birth Plan Form is currently being developed. This will only be a part of the strategy meeting discussion when it takes place near the expected delivery date (EDD).
- Any communication about the intention of the Local Authority to seek legal orders post-delivery should be coordinated by the Lead Safeguarding Midwife and communicated at the relevant time to the midwifery manager for the labour/delivery suite;
- The need for a pre-birth Initial Child Protection Conference.
The assessment planning that develops throughout the strategy meeting, Section 47 Enquiry, and Child and Family Assessment must be consistent with standards required for possible Care proceedings, including the need to start the pre proceedings process in accordance with the Public Law Outline.
The parent(s) should be informed by the child’s Social Worker 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
The undertaking of a pre-birth assessment is a multi-agency task led by Children’s Social Care which “should help us move from a reactive, crisis-led response to a more considered, proactive, and needs led response” (Calder 2003).
The pre-birth assessment process should aid the multi-agency network in planning a timely intervention for an unborn child and their family, with the needs of the unborn child seen as paramount throughout, whilst working collaboratively with parents to fully understand their needs, strengths, and overall parenting capacity. (see Appendix 2: Guidance for Professionals undertaking Pre-birth Assessments).
In undertaking a pre-birth Section 47 Enquiry and Assessment the Children's Social Care Services, the Police, Health and other relevant 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.
- The need for a pre-birth Initial Child Protection Conference (ICPC.) This decision will be confirmed within the recommendation of the Section 47 Enquiry. The Conference should be held wherever possible at least 12 weeks prior to the expected delivery date or earlier if a premature birth is likely - see Section 9, Pre-Birth Conferences;
- If, in addition to the Initial Child Protection Conference, it is assessed that concerns may require legal advice or intervention consideration needs to be given to the timing of the ICPC and legal advice sought before the ICPC where possible- see Legal Gateway Meetings and Accessing Legal Advice
- If a need for continued services is required at a Child in Need level an intervention plan with measurable outcomes and timescales should be outlined within the Child and Family Assessment.
- The Child and Family Assessment should also address parallel permanency planning at the earliest possible point. See the SCC Permanence Planning Guidance.
If at any point within the assessment phase, it is determined that pre-birth planning should consider pre-proceedings and/or proceedings, (see ‘Care and Supervision Proceedings and the Public Law Outline’ - Section 3.1 Pre-Birth Planning and Proceedings. See also ‘Assessments’ - Pre-birth ‘Good Practice Steps’)
6. If an Unborn babies’ siblings are already open to Level 4 services
Please note that where the unborn baby has siblings who are already open to Level 4 services, the timescales for conducting a Pre-Birth Assessment are the same as for any other unborn child.
For multi-agency partners, a referral may or may not be required given the following circumstances:
- If you represent an agency that is already fully engaged in the older children’s network and have confirmation from the case holding team that the unborn is open and the appropriate assessment is underway, you are not required to make a referral.
- If you represent an agency that is already fully engaged in the older children’s network but do not have confirmation from the case holding team that the unborn is open and the appropriate assessment is underway, you are required to make a referral.
- If you represent an agency that has no involvement with the older siblings or have confirmation the older siblings are involved with Surrey Children Services and feel a referral is required for the unborn, you are required to make a referral.
Where a family have children currently open to Children’s Services as Child in Need and notify a professional of a pregnancy, the responsibility to assess the unborn sibling falls under the allocated worker for the siblings. The case holding team will be responsible for setting up the Unborn and the referral should not come via the C-SPA.
Where a family have children currently open to Surrey Children’s Services with a Child Protection Plan or currently involved in care proceedings and notify professionals of a pregnancy, the responsibility to assess the unborn falls under the allocated worker for the siblings. A strategy meeting should be held in these circumstances in order to initiate the Child Protection Process for Unborn or begin the comprehensive Pre-birth Child and Family Assessment.
The timing in joining the unborn sibling to the sibling’s CP process should be carefully considered.
- It is recommended that the Pre-birth Child and Family Assessment should take place in line with the Pre-Birth Assessment and Intervention Timeline (Appendix 1), to ensure all assessments are complete and allow for the Initial Child Protection Conference to take place by 28 weeks of gestation, where possible. The Pre-Birth Policy sets out that an assessment can take place as early as possible, but due care and consideration should be given to wait until the pregnancy is confirmed by a health professional where time and level of need allows for this.
- The Pre-birth Child and Family Assessment should be used as the Initial Child Protection Report.
- The Initial Child Protection Conference should not take place any later than 28 weeks of the pregnancy.
- Where possible, hold the strategy meeting, 15 days before the siblings next Review Child Protection Conference in order to link the Unborn sibling to the older sibling’s conference. If it is not possible to join the siblings conference considering the above timescales, then the Unborn sibling can be considered at an Initial Child Protection Conference of their own and then later joined to siblings.
Where a family are currently open with on-going care proceedings, the responsibility to assess the unborn falls under the allocated worker for the siblings. A strategy meeting should be held in the first instance in order to establish the potential risk of significant harm, timing of the Pre-Birth Child and Family Assessment, and to obtain legal advice.
7. If a Baby on a CP Plan is Born at Home Unexpectedly
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 South East Coast Ambulance Service (SECAMB) by the Safeguarding Lead and/or the allocated Social Worker.
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 South East Coast Ambulance Service if a decision has been made to make an application to court to remove the baby at birth to ensure all relevant professionals are aware of the risks/concerns and appropriate actions to take. Children Social Care should be alerted via the Children’s Single Point of Access or Emergency Duty Team. At all times practitioners should be mindful of the fact that the baby cannot be removed at birth without parental consent unless there is a court order permitting this or the baby can legitimately be removed for reasons of police protection or the babies clinical condition is such that immediate removal to hospital is required to prevent death or serious harm.
If there is no clinical indication for the mother or infant to be conveyed to hospital, the ambulance service may in normal circumstances and in collaboration with midwives, leave a family in the care of a home birth team. If this would not be appropriate, clear instructions should be provided to the Ambulance Service as to what actions should be taken postpartum.
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.
8. Pregnant Woman Who Go Missing
When there is a loss of contact with an expectant mother where safeguarding concerns have already been established, all agencies must take this seriously. It is important that proactive and reasonable efforts are made to establish whereabouts of the pregnant woman and once it is clear that there is a loss of contact the agency aware of the missing woman should inform their line manager and Police. The following actions should then take place:
- More extensive measures taken to understand the pregnant woman’s whereabouts through informal routes such as family, friends, neighbours, etc as is considered reasonable and appropriate.
- Check any and all available information systems with countrywide and national alerts placed through Health and Children’s Services.
- Make enquiries through other local agencies involved with the woman/unborn child.
- Consideration should be given to a Cause for Concern’ to be completed and circulated to appropriate Assistant Director and Directors.
- Consideration should be given to use media to support the search, where this is appropriate.
- Children’s Social Care should initiate a strategy meeting, involving Police, midwife, and any other agency which will support a plan to locate the woman and address measures to safeguard the unborn. A maternity alert to be created by Children’s Services and disseminated to appropriate local/regional/national localities. Information that should be included in the alert to other local authorities:
- Woman’s name
- Date of birth
- Estimated delivery date
- Name and DOB of anyone the woman may be with
- Reason for concern
- Enough information to enable an Emergency Duty worker to act appropriately
Scope of circulation, i.e. places likely to go, planned place of delivery and contact details of Named Midwife for Safeguarding Children.
9. 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 (or pre-birth parenting assessment undertaken as a part of the Parenting Intervention Programme) and a conference should be held;
- Where a pre-birth Child and Family assessment gives rise to concerns that an unborn child may be at risk of Significant Harm;
- Where a previous child has died, been injured 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 (including coercive control) including harmful traditional practices.
- A parent under sixteen about whom there are concerns regarding their ability to care for themselves and/or to care for the child.
All agencies involved with the expectant parents should consider the need for an early referral to Children's Social Care Services so that assessments are undertaken, and family support services as early as possible in the pregnancy.
10. 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 the level of safeguarding intervention required, makes recommendations that will address the unborn child’s safety, and draw up protection plans that link to these decisions.
In addition to those who normally attend an Initial Child Protection Conference, midwifery, health visitor relevant neo-natal and Family 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 the initial meeting must be held 10 days following the conference and if at all possible, prior to the birth, and certainly prior to the baby's return home.
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 Independent Chair and the Safeguarding Children Unit following the birth.
13. 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 Assistant Director 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.