Safeguarding Unborn Babies

1. Potential Risk of Harm to an Unborn Child

In some circumstances, agencies or individuals are able to anticipate the likelihood of Significant Harm with regard to an expected baby (e.g. as a result of Domestic Violence and Abuse, parental substance misuse, removal of previous children in the family or mental ill health).

Any such concerns should be addressed as early as possible before the birth so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care. See Section 2, Pre-birth Referral and Assessment and Section 3, Pre-Birth Conference.

2. Pre-Birth Referral and Assessment

Where agencies or individuals anticipate that prospective parents may need support to care for their baby or that the baby may be at risk of Significant Harm, a referral must be made as soon as the concerns are identified. Wherever possible this referral should be made at around the 16 week stage to allow sufficient time for assessments to be undertaken. All referrals should be made to the Referral and Response Team, even if the referral relates to a case which is open.

Prior to the referral being made, the case can be heard at the Pregnancy Liaison Meeting, from the point of professionals becoming aware of the birth to 16 weeks gestation. The purpose of the Pregnancy Liaison Meeting is to provide a pathway which will offer information and advice to professionals, to ensure that pregnant women are enabled to access support services at the right stage in pregnancy.

In addition the meetings will:

• Promote joint working with partner agencies;
• Support the oversight of cases which are being managed within Universal and Early Help services;
• Monitor the progress of pregnancies during this time; and
• Allow information sharing so that decisions can be made regarding the correct pathway to provision for families.

Multi-agency discussion and information sharing will enable the early detection of any safeguarding concern, meaning agencies can intervene early to improve the emotional and physical outcomes for Pre-Birth Children.

Making a referral

The referrer should clarify as far as possible their concerns in terms of how the parent's history, circumstances and / or behaviours may impact on the baby and what risks are predicted. A referral should be made at the earliest opportunity and, wherever possible at around the 16 week stage, 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 a situation where initial approaches to parents are made 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.

Concerns should be shared with prospective parent/s, and consent obtained to refer to Doncaster Children's Services Referral and Response Team unless obtaining consent in itself may place the welfare of the unborn child at risk e.g. if there are concerns that the parent/s may move to avoid contact with investigative agencies.

If the parent/s of the unborn child under 18 years of age then consideration must be given as to whether or not the parent/s of the unborn child must be assessed in their own right.

Pre-birth Children and Families Assessment

A pre-birth Children and Families Assessment should be undertaken on all pre-birth referrals which meet the threshold for Doncaster Children's Services intervention, prior to the birth of the child. It is important that this assessment is commenced as early as possible for the reasons outlined above and also due to the potential for any child to be born prematurely. A Strategy Meeting/Discussion will be held where:

• A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children;
• A sibling in the household is subject of a Child Protection Plan;
• A sibling has previously been removed from the household either temporarily or by court order;
• The parent is a Looked After Child (consideration must be given to the provision of Family Nurse Partnership resources);
• There are significant Domestic Violence or Abuse issues (see Domestic Abuse Procedure);
• The degree of parental substance misuse is likely to impact significantly on the baby's safety or development (see Parents who Misuse Substances Procedure, and Nofas UK – for information on foetal alcohol syndrome);
• The degree of parental mental illness/impairment is likely to impact significantly on the baby's safety or development (see Parents with Mental Health Problems Procedure);
• 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 pre-birth involvement is a result of the mother's learning difficulties causing uncertainty as to her ability to meet the needs of the child once born, the Court of Appeal in D (A Child) [2021] EWCA Civ 787 stressed the importance of effective planning during the pregnancy for the baby's arrival, and of taking adequate steps to ensure that the mother understands what is happening and is able to present her case. (see Parents with Learning Disabilities Procedure);
• 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 (see Fabricated or Induced Illness / Perplexing Presentations Procedure) or harming a child;
• A child aged under 13 is found to be pregnant (see Child Sexual Exploitation Procedure).

Pre-birth Strategy Meeting/Discussion

The need for a Section 47 Enquiry should be considered and, if appropriate, initiated at a Strategy Meeting/Discussion held as soon as possible following receipt of the referral. The expected date of delivery will determine the urgency for the meeting. (Preferably, the Strategy Discussion/Meeting will be undertaken at 27 week gestation).

The meeting should  include a representative from the hospital where the birth is planned or expected or where the responsible midwifery service is or would be if the parents have not booked for service provision prior to birth.

The meeting must decide:

• Whether a Section 47 Enquiry is required (unless previously agreed at any earlier ante-natal meeting);
• What areas are to be considered for assessment;
• Who needs to be involved in the process;
• How and when the parent/s are to be informed of the concerns;
• The actions required by adult services working with expectant parent/s (male or female);
• The actions required by the obstetric team as soon as the baby is born. This includes labour/delivery suite and post-natal ward staff and the midwifery service, including community midwives;
• Any instructions in relation to invoking an Emergency Protection Order (EPO) at delivery should be communicated to the midwifery manager for the labour/delivery suite.

The parents should be informed as soon as possible of the concerns and 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.

Pre-birth Section 47 Enquiry

In summary the Section 47 Enquiry should identify:

• Risk factors;
• Strengths in the family environment;
• The factors likely to change, the reasons for this and the timescales.

The 'Doncaster Health and Social Services Pre-Birth Planning Meeting' form must be completed. This should be completed, preferably by 32 weeks gestation and copies should be made available in both Children's Services and midwifery files. At 16 weeks all pregnant women have a health, social and obstetric assessment which can be used to inform the pre-birth assessment.

The Section 47 Enquiry must make recommendations regarding the need, or not, for a pre-birth Child Protection Conference which should wherever possible be held ten weeks prior to the expected delivery date (at approximately 30 weeks gestation) or earlier if a premature birth is anticipated. (See Child Protection Conferences Procedure).

If there is any disagreement about the outcome of the process see Decision Making Dispute Resolution Process.

If it is suspected that a child may be born at home

The local Integrated Care Boards (ICBs) and Doncaster Children's Services have a duty to contact any relevant agencies if they have a concern about an unborn child. If professionals are concerned that a child may be born at home or is likely to be delivered before reaching the hospital a referral should be made to the Ambulance Service.

The Midwifery Service would liaise with the Ambulance Service in order for information to be shared where a pre-birth Child Protection Conference has decided that the baby is likely to suffer Significant Harm and should be taken into Police Protection when s/he is born.

The Midwifery Service will inform the Ambulance Service of all relevant details concerning the unborn baby and mother. Any change of details obtained by agencies should be passed to the Midwifery Service who will forward the information to the Ambulance Service.

3. Pre-Birth Conference

Purpose

A pre-birth conference is an Initial Child Protection Conference concerning an unborn child. Such a conference has the same status and purpose and must be conducted in a comparable manner to any Initial Child Protection Conference. See Child Protection Conferences Procedure.

Pre-birth conferences should always be convened where there is a need to consider if a multi-agency Child Protection Plan is required. This decision will usually follow from a pre-birth assessment.

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;
• A previous child has died or been removed from parent/s as a result of Significant Harm;
• A child is to be born into a family or household that already has children who are subject of a Child Protection Plan;
• An adult or child who is 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 (see Parents with Mental Health Problems Procedure), learning disabilities (see Parents with Learning Disabilities Procedure), substance misuse (see Parents who Misuse Substances Procedure) and Domestic Abuse;
• A mother under 18 years of age about whom there are concerns regarding her ability to self-care and/or to care for the child.

All agencies involved with pregnant women should consider the need for an early referral to the Children's Services so that assessments are undertaken as early as possible in the pregnancy.

Timing of the conference

The pre-birth conference should take place as soon as practical and at least ten weeks before the due date of delivery (at approximately 30 weeks gestation), so as to allow as much time as possible for planning support for the baby and family; see Child Protection Conferences Procedure.

Where there is a known likelihood of a premature birth the conference should be held earlier.

Attendance

Those who normally attend an initial Child Protection Conference must be invited. In addition, representatives of the midwifery and relevant neo-natal services should also be invited.

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.

Pre-birth Child Protection Plan

If a decision is made that the unborn child needs the safeguarding of a protection plan, this must be set out in terms that will 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 definitely prior to the baby's return home after a hospital birth.

Timing of Child Protection Review Conference

The first Child Protection Review Conference should take place within one month of the child's birth or within three months of the date of the pre-birth conference whichever is sooner.

Doncaster Children's Services  undertaking or commissioning a post-natal assessment should ensure that the assessment is structured in such a way as to provide a comprehensive report to the Child Protection Review Conference.

In exceptional circumstances the review conference date may be extended by a month with the written authorisation of a Doncaster Children's Services Manager/Head of Safeguarding if the review falls so soon after the birth that information from a post-natal assessment cannot be collated in time for the review conference. When this review is extended care must be taken to ensure it is held within the three month time period.