Pre-Birth and Post Birth Planning

AMENDMENT

In April 2024 this chapter was revised throughout and should be re-read.

1. Introduction

This procedure applies to all practitioners who have identified any concerns for an unborn baby and provides a framework for responding to needs for support and/or safeguarding concerns and safety planning by practitioners working together, with families and their support network, to safeguard the baby.

This pre-birth procedure provides a framework and pathway/flowchart guidance for practitioners to consider when safeguarding an unborn child as early as possible. Research shows that parents or significant others are more likely to engage in the pre-birth assessment process at an early stage, therefore where it is anticipated that prospective parents or significant others may need intensive support services to care for their baby, or that the baby maybe at risk of significant harm a referral to social care should be made immediately at the first point where the pregnancy is identified by any professional.

Young babies are particularly vulnerable to abuse, and early identification/assessment and support work carried out during the Pre-birth period can help minimise potential risk of harm to the unborn child. Timely assessments should lead to robust planning for the safety and wellbeing of the baby. Professional/practitioners should have a shared understanding and approach.

All professionals/practitioners have a role in identifying and assessing families in need of additional support or where there are safeguarding concerns. In most situations there will be no safeguarding concerns during the mother's pregnancy, however, in some cases a co- ordinated response from agencies will be required to ensure that appropriate support is in place during pregnancy to safeguard the child before and following birth. Professionals/Practitioners when they become aware of the pregnancy and of any safeguarding concerns in relation to the mother, unborn child, or siblings, should consider the action they need to take to ensure their safety and support needs are met. This would include Mothers who have a known history of risks and vulnerabilities who express a wish to terminate the pregnancy, but the initial appointment is not kept.

Practitioners should consider whether the baby will need support or protection following birth, considering what is known about mother, father, or partners. Consideration should be given to whether they will be able to care for the child throughout the child's childhood.

The Pre-birth period provides a window of opportunity for professionals/practitioners and families to work together to:

Form relationships with a focus on the unborn baby; approaching families and their wider networks and communities with empathy, respect, compassion, and creativity;
Identify risks and vulnerabilities at the earliest stage;
Support the development of a positive relationship between the parents or significant others and their unborn baby to understand parental capacity to change as well as potential parenting capacity, avoiding reinforcing family shame, suffering, and blaming;
Use strength-based approaches, working with parents to identify what is working well and how their strengths could support them to effect positive change;
Identify if any assessments or referrals are required before birth: for example, Early Help involvement or other support organisations.
Recognise and understand the impact of past and current trauma and how these experiences may present during the pre-birth period;
Link to Practice Principles for engaging fathers;
Understand the importance of continuity of professionals/practitioners from all services to build and maintain trust;
Recognising self-protective behaviours and where they originate from and consider how best to overcome these barriers using a trauma informed approaches, adapting their responses to the specific challenges being faced;
Understand the impact of risk to the unborn baby when planning for their future;
Explore and agree safety planning options;
Assess the parent's and the family network's ability to adequately to meet the needs of the child and protect the unborn baby and the baby once born;
Identify if any assessments or referrals are required before birth as soon as possible; for example, Early Help intervention/assessments agreed locally;
Ensure effective communication, liaison and joint working with adult services that are providing on-going care, treatment, and support to a parent/carer(s);
Plan on-going interventions and support required for the child and parent(s);
Avoid delay for the child where a legal process is likely to be needed such as Pre- proceedings, Care or Supervision Proceedings in line with the Public Law Outline;
Assess, discuss, and share information known about parent/s whose circumstances, past experiences or needs make it difficult to access or engage or avoid services that support them and the pregnancy/unborn child;
Understand the families background, ethnicity, religion, financial situation, ability, education, gender, ages, sexual orientation and needs;
Being mindful of negative stereotypes and discrimination which might lead to false assumptions;
Each professional should follow their agency's child protection procedures and discuss concerns with their safeguarding lead/named/designated professional for safeguarding.

2. Risks

Eileen Munro Working with uncertainty and risk in children’s social care.

Parental risk factors that may indicate an increased risk to an unborn child and which may mean that a pre-birth assessment is required;

Involvement in risky activities such as substance misuse, including drugs and alcohol impacting on parenting;
Pre-Birth /mental illness or support needs that may present a risk to the unborn baby or indicate that their needs may not be met.
Victims or perpetrators of domestic abuse;
A history of violent behaviours; including adults identified as presenting a risk, or potential risk to children, such as having committed a crime against a child;
Parents or significant others who are not able to understand/meet the unborn babies’ needs e.g., based on diagnosed or suspected learning disabilities [1] or significant learning difficulties [2] and in some circumstances severe physical or mental disability;
Adults are known because of historical concerns such as previous neglect, other children subject to a child protection plan, subject to legal proceedings or where older child may have been removed from parental care;
Parent known because of significant involvement as a child or young adult with Children's Social Care;
Either Parent or their partner is currently 'Looked After' themselves or are Care experienced;
A history of abuse in childhood;
Young parents or significant others, children under 14 years should always be referred to Children Social Care;
Recent family break up and social isolation/lack of social support;
Parent/s who are being prevented from or actively avoiding accessing services in relation to the pregnancy;
Where there is limited detail related to confirmation of the pregnancy including establishing the gestation of pregnancy;
Sex workers who are pregnant, of no fixed abode, or homeless;
Deprivation increases risks to infants – key is poverty, health, unemployment, teen pregnancy, substance misuse, poor educational attainment.

The list is not exhaustive and, if there are a number of risk factors present, then the cumulative impact may well mean an increased risk of significant harm to the unborn baby. If in doubt, professionals should seek advice about making a referral from their safeguarding leads or in consultation with Children's Social Care. At this stage further information could be requested from Children’s Social Care and the Police. If there are any issues with information not being provided, then the Escalation Procedure should be considered.

Delay must be avoided when making referrals to:

Provide sufficient time to make adequate plans for the baby's protection;
Provide sufficient time for a full and informed assessment, noting that when substance misuse is an identified risk for parent/s, there is an increased risk of potential early labour or complications within the pregnancy and/or the labour;
Avoid making initial approaches to parents or significant others in the final stages of pregnancy, at what is already an emotionally charged time unless there is immediate risk of significant harm;
Identify the family and support network for both parents or significant others and what they can contribute;
Enables parents or significant others to have more time to develop coproduction where parents or significant others contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
Provide adequate opportunities for parents or significant others to connect with their baby and demonstrate their capacity for change.
Enable the early provision of support services to facilitate optimum home circumstances prior to the birth, reduce risk and build safety.

[1] Adults with a learning disability have an overall cognitive impairment, which may be mild, moderate or severe, but will in most cases need some additional support to function well in daily life. This may be provided informally by family members, or when there are higher levels of need, by agencies including health and adult social care. People with a learning disability tend to take longer to learn and may need support to understand complicated information, interact with other people, and develop new skills (such as parenting). Many people are diagnosed with learning disabilities as children. Although, it is possible for an individual to reach adulthood having never received a diagnosis (Leicestershire Partnership NHS Trust).
[2] Adults with learning difficulties do not usually need a high level of support and day to day life but may need professionals to make adjustments to take into account issues such as literacy or communication needs (Leicestershire Partnership NHS Trust).

3. Working with Fathers and Partners

Fathers or partners of parents or significant others play an important role during pregnancy and after.

'The involvement of prospective and new fathers or partners of parents or significant others in a child's life is extremely important for maximizing the life-long wellbeing and outcomes of the child regardless of whether the father is resident or not. Pregnancy and birth are the first major opportunities to engage fathers in appropriate care and upbringing of children' (NSF, 2004).

It is important that all agencies involved in pre-birth and post-birth assessment and support, fully consider the significant role of fathers or partners of parents or significant others and wider family members in the care of the baby even if the parents or significant others are not living together and, where possible, involve them in the assessment. This should include the father's and partners of parents or significant others’ attitude towards the pregnancy, the mother and newborn child and their thoughts, feelings, and expectations about becoming a parent.

Information should also be gathered about fathers and partners who are not the birth father but may be involved with providing care, this should be done at the earliest opportunity to ensure that any risk factors can be identified, understood, and managed.

Where birth mother refuses to give information about birth father or current partner or partner of parent (where these are different) any professional who has knowledge about the details of birth father or partner should share this with the social worker.

A failure to include fathers or partners of parent and partners may mean that practitioners are not able to accurately assess what mothers and other family members might be saying about the father's/partner of parent role, the contribution which they may make to the care of the baby and support of the mother, or the risks which they might present to them. Background Police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Involving fathers/or partner of parent in a positive way is important in ensuring a full assessment can be carried out and any possible risks fully considered. Fathers or partner of parent should be included by professionals in the pre-birth work throughout the pregnancy.

Please view this report "The Myth of Invisible Men 2021".

There are increased risks to babies from fathers and male carers where the following issues are present:

Substance misuse;
Neurodevelopmental diagnosis e.g., ADHD or awaiting diagnosis;
Mental health history e.g., anxiety and depression;
Violence in the past e.g., previous injuries to self;
Poor emotional control in the past or in childhood/adolescence;
Care Leavers;
Other children of this father/male where their cases have been through court processes.

4. Responses to Trauma in the Pre-birth Period

It is important that all staff working with women in the pre-birth period recognise the prevalence of trauma and understand how this may impact on parents or significant others to be.

During pregnancy and the pre-birth period, women may revisit past experiences of trauma. These experiences can generate a range of responses and women would benefit from staff understanding and being attuned to these. Some women disclose previous abuse or trauma for the first time;
Parents or significant others-to-be may reflect on their own childhood experiences and consider how they themselves were parented. This may be particularly challenging for those who have experienced attachment trauma (trauma caused by poor or disrupted parent-infant bonding, resulting from abuse, neglect, separation or loss) as they consider good models of parenting and what their relationship with their own baby might be like;
For some, the physicality of pregnancy and birth itself may be a cause of worry or anxiety. History of previous birth trauma, sexual violence or abuse has been associated with a severe fear of childbirth and lead to a request for a caesarean section. Some women may feel a loss of control as their body changes. Some aspects of childbirth can cause triggers or flashbacks to past trauma, particularly sexual abuse or Interpersonal Violence. These may include close proximity of a relative stranger and feeling exposed during procedures or examinations by healthcare staff, being told not to move, the sight of blood or the smell of medical settings. Past trauma may impact on the parents or significant others ability to trust professionals, their understanding of risk and their ability to access support that is available;
Some women with a history of trauma may experience escalating levels of anxiety and flashbacks as pregnancy progresses. This can result in ‘fight or flight’ responses, such as – fighting, surrendering or retreating, in an effort to take control of their experience. They may also experience dissociation (which may include depersonalisation, ‘out of body’ experiences and loss of memory or awareness of time) during labour. Pregnancy and childbirth can trigger a relapse of pre-existing mental health difficulties or symptoms related to past trauma. Fathers and partners may also have experienced trauma, which may impact on their mental health and wellbeing during the perinatal period. This can include anxiety and fear around parenting and their needs should also be considered;

For parents or significant others who have had their previous children removed from their care engagement with pre-birth services is crucial and is likely to inform decision making. However, parents or significant others may feel overwhelmed by the number of agencies involved in their care and are struggling to deal with their grief and loss related to the separation of their child. They may feel shame and be fearful of a referral being made;

Research in Practice – Working with parents who are disengaging – reconceptualising non-engagement;

Engaging in positive relationships with parents or significant others is a fundamental component of building trust with effective, open communication at the very heart of developing attuned relationships. Positive relationships are built on trust, respect and collaboration and will support the parent to engage with services;
Research in Practice – lived experience of parents.

5. When to Refer

When any professional becomes aware of someone with whom they are working is pregnant and they are of the view that there will be a need for additional support for the unborn child who will be vulnerable due to the circumstances of their parent/prospective parent with whom they are working, they should inform maternity services of their service involvement and highlight any vulnerabilities they have identified.

Where a professional is concerned that an unborn child or other children in the family may be at risk of, or suffering, harm, they should seek advice from their agency Safeguarding Lead without delay. Their agency Safeguarding lead can then support consideration of referring to Children's Social Care.

Where agencies or individuals anticipate that prospective parents or significant others may need support services to care for their baby or that the baby may be suffering or likely to suffer Significant Harm, a referral to Children's Social Care Services (see Referrals Procedure) must be made as soon as the concerns are recognised. Referrals must be made to avoid delay and to ensure that the family receive appropriate services.

Where the concerns focus on an aspect of parental behaviour, for example substance misuse, the referral must make clear how this is likely to impact on the baby and what risks are predicted based on their professional expertise. Please LLR Local Resources Safeguarding Practice Guidanc for Jane Barlow research on supporting vulnerable mother’s and their babies.

A pre-birth referral should always be considered where:

There has been a previous unexplained death of a child whilst in the care of either parent/partner/significant other;
A parent or other individual in the household has been convicted for violent conduct;
Any individual in the household is the subject of a Child Protection Plan or Child in Need Plan;
Where a previous child of either parent/ carer/partner has been subject to care proceedings or have had previous children removed from their care;
When the degree of domestic violence (see Domestic Abuse Procedure) known to have occurred is likely to significantly impact on the baby's safety or development. Unborn babies and those under 12 months old are particularly vulnerable to violence. Practitioners who become aware of any incident of domestic violence in a family with a child under 12 months old (even if the child was not present) or in families where a woman is pregnant, should make a Referral to Children's Social Care Services. For more information see Referrals Procedure;
The degree of parental/partner substance misuse is likely to significantly impact on the baby's safety or development.
The degree of parental/partner mental illness/impairment is likely to significantly impact on the baby's safety or development.
There are serious concerns about the prospective parents or significant others' or partners ability to care for themselves and/or to care for the child, for example where the parent/partner has no support and/or has learning disabilities; or when their own traumatic childhood experiences may impact on their parenting;
Where a current pregnancy has been concealed or denied by the birth mother or where there has been a previously denied or concealed pregnancy. Concealed pregnancy;
Where any other concern exists that the baby may be suffering or likely to suffer Significant Harm, including a parent/partner previously suspected of having Fabricated or Induced Illness in a child (see Medically Unexplained Symptoms, Perplexing Presentations and Fabricated or Induced Illness (Fii) Procedure), or a prospective parent /partner has been the subject of fabricated or induced illness as a child themselves. The referrer should be able to identify the risk to the unborn child, due to the impact of FII on the parent/partner;
Concerns that parent/s or partners are rejecting medical advice or treatment which may place the unborn baby at risk of significant harm;
A pregnant person who is prevented from accessing, fails to engage or actively avoids services that support them and the pregnancy/unborn child.

Concerns should be shared with prospective parent/s and parents or significant others should be kept fully informed of processes and actions by staff and consent obtained to refer to Children's Social Care Services unless this action may place the welfare of the unborn child at risk in which case consent is not required e.g., if there are concerns that the parent/s may move to avoid contact with social workers or other professionals, parent/s may show signs of complex trauma by lacking trust and disengaging from services. See Information Sharing Procedure.

If the expectant mother is a Care Experienced Child and is placed out of authority, the pre-birth assessment and Child Protection Conference procedures for the unborn child should be conducted as per Children and Families Moving Across Local Authority Boundaries Procedure. Both local authorities should be informed.

6. Action to be Taken

Where a referral for an unborn baby indicates that there is reasonable cause to suspect that the baby is suffering or likely to suffer significant harm a pre-birth strategy discussion should be convened.

When considering a late presentation of pregnancy -at the time the pregnancy is revealed the key question is "why has this pregnancy been denied or concealed"? The circumstances in each case need to be explored fully with the expectant mother and appropriate support and guidance given to her.

For further information on concealed and denial of pregnancy see the Concealment and Denial of Pregnancy Procedure. For information on children and families who go missing see the Children and Families Who Go Missing Procedure.

In relation to a pre-birth Strategy Discussion (see Strategy Discussions Procedure), this should involve either the caseload holding midwife or the specialist midwife for safeguarding, and other relevant practitioners including GP, Police, health visitors (it is important that health visitors are involved in the planning for safeguarding the unborn child and mother at the outset). Health visitors should be present and would be able to add background details with other children and the family context.

All agencies should be involved in considering the threshold for Section 47 enquires and contributing to the development of a safeguarding risk assessment where undertaken. Any risk assessments should be completed as early as possible and before the expected delivery date (see Appendix 1: LLR SCP Pre-Birth Pathway Flowchart).

Assessment, support and decision making should be undertaken as early as possible and ensure that the assessment informs planning for the safety of the unborn child, and also gives the parents or significant others the opportunity to understand what needs to change and gain support to increase the safety of the baby, (see Appendix 1: LLR SCP Pre-Birth Pathway Flowchart for timescales).

The assessment process can offer additional opportunities to share key safety information with parents or significant others. This may be in addition to routine information sharing by health professionals within their specific roles. This would include:

Research in respect of Safe sleeping arrangements; to help reduce the risks of Sudden Infant Death in Infancy (SUDI) (A review of SUDI where children are at risk of significant harm). Further consideration should be given to this where there are concerns of domestic abuse, substance or alcohol misuse and parental responses explored. This would be in addition to routine information sharing by health practitioners; Safer Sleeping Resources;
Parents or significant others and carers should also have ICON discussed with them to stress the importance of how to plan their response to normal crying of babies in order to reduce the risk of abusive head trauma triggered by crying. Supportive materials are available via the ICON website;
Substance misuse advice – Turning Point “Reducing the risk of harm to children in your household” leaflet.

All pre-birth assessment should follow local assessment procedures: Leicester; Leicestershire; Rutland.

The pre-birth Assessment should be led by Children's Social Care the outcome of which will determine if and what further action is required.

7. Pre-Birth Conference

A Pre-Birth Conference is an Initial Child Protection Conference (see Child Protection Conferences Procedure) concerning an unborn child. The conference has the same status and purpose and must be conducted in a comparable manner to an Initial Child Protection Conference.

Pre-Birth Conferences should be convened following Section 47 Enquiries, where there is evidence that the child is suffering or is likely to suffer significant harm and where there is a need to consider if a Child Protection Plan is required.

This decision will usually follow from a pre-birth Assessment and a conference should be held where:

A pre-birth assessment gives rise to concerns that an unborn child is suffering or likely to suffer Significant Harm.

8. Timing of Pre-Birth Conferences

Also see: Appendix 1: LLR SCP Pre-Birth Pathway Flowchart.

The initial Pre-Birth Conference should take place as early as possible, by 26 weeks of gestation, to allow as much time as possible for planning support for the baby and family. If there is any late identification of risk in relation to the unborn, then the pathway to conference should be expedited and be compliant as much as possible with the pathway/flowchart.

If legal advice is required, this should be initiated as early as possible in the planning process to ensure that the parents or significant others can reduce risks. Specialist legal advice for parents or significant others with learning disabilities may require additional time and tools to enable parents or significant others to understand the information.

The Public Law Outline sets out streamlined case management procedures for the Local Authority for dealing with cases where an application to court may be required. The aim is to identify and focus on the key issues for the child, with the aim of making the best decisions for the child within the timetable set by the Court and avoiding the need for unnecessary evidence or hearings. This should be considered as part of the Child Protection Conference. The Local authority can start the Pre-proceeding process in the pre-birth period although a court application cannot be made until the baby is born. It is important that all agencies are kept up to date when the Public Law Outline is started and when a legal application is planned for the time of the baby's birth. It is important to check parent/s / significant others understanding of the information shared and where agreed the parent/s support network are kept informed.

For the court hearing process, the mother would be allowed a safe private space to access the hearing whilst she is an inpatient.

Clear plans need to be in place for the birth of the baby as early as possible and immediate safeguarding prior to 32 weeks of pregnancy wherever possible and no later than 36 weeks. Where there are concerns such as drug use, which may mean that the mother is likely to go into early labour, plans should be in place as early as possible. Specialist advice can be sought from Turning Point for substance misuse and the Specialist midwives in the Pheonix Team.

9. An Unborn Child with a Child Protection Plan

If a decision is made that the unborn child should be made subject of a Child Protection Plan, the main cause for concern must determine the Category of Significant Harm and the Child Protection Plan must be outlined to commence prior to the birth of the baby.

The multi-agency Core Group must take place within 10 working days of the ICPC and within 28 days of the review conference.

If a decision is made for an unborn child to have a Child Protection Plan, the child's name (or 'baby', if not known) and expected date of delivery should be shared by the midwife. If/when the baby is born the midwife at the delivery would share this information with the named social worker. The social worker would share the relevant information with everyone in the core group to let them know that the baby has been born. The safeguarding unit within the local authority and the record will indicate that the Child Protection plan has started. The Lead Social Worker must then ensure that the name and correct birth date is notified to the safeguarding unit following the birth. Once the unborn or born child is on a CPP the safeguarding unit should add the CPIS alert onto the mothers or newborn baby record. The relevant NHS number is obtained by the midwife. The CPIS initiates the safeguarding alerts through the NHSE initiative. (see “Child Protection – Information Sharing CP-IS”).

Once the baby is born there is a universal system whereby the NHS number is generated, and a new birth notification is sent to the GP and the health visiting service. If the GP and health visitor have been invited to the previous safeguarding meetings, they should link the birth notification to the safeguarding concerns.

If the child is born outside LLR, the allocated social worker from the originating area of the child, has a responsibility to let the receiving area know of the safeguarding issues related to the child, including whether or not they are subject to a child protection plan.

There is an expectation of maternity and health visiting services that where there are existing safeguarding concerns that there is a comprehensive handover where a baby is born over the border and their address is in LLR and for babies and children transferring into LLR.

10. Planning for Birth

For Unborn babies subject to a Child Protection plan a Pre-Birth Professionals (Safety) Planning Meeting for the hospital admission should take place no later than 36 weeks and if possible take place by 32 weeks (or as soon as possible if it is a late referral and labour is imminent prior to the Estimated Date of Delivery (EDD)).

For women who are misusing substances the timing of this meeting must take account of any possible impact of substances misuse on the pregnancy including early delivery. Consider seeking the specialist knowledge and advice from Turning Point and the specialist midwives in the Pheonix Team.

The Pre-birth Planning meeting is NOT a core group meeting. A member of the safeguarding midwifery team and the social worker attend this meeting, with the specific purpose to develop the plan for admission and birth. All invitees of this meeting should receive a copy of the plan.

The meeting will be held in a way to ensure best participation for both agencies and family members. It may be coordinated virtually, face to face or a hybrid meeting. The aim will be to allow the best participation for professionals and the family network. Virtual participation should not reduce the effectiveness of information sharing and planning.

Where the plan is for separation at birth the plan should consider who will be present at the birth and the role of the family in support and supervision on the ward. Helping the parents or significant others think about bonding, timing of the separation and how the parents or significant others would like this to happen, it is important that parents or significant others know how long they will have with their baby. If carers have been identified if it is possible for the parent/s to meet the carers prior to separation this could be helpful. Consider privacy needs, can they be in a side room with their baby. How would they like to create memories. Consider physical and emotional aftercare of the mother how will she get home, who will be there to offer support, linking them in with postnatal care, inform the GP that separation is the plan.

A Birth Plan should be agreed and shared with all professionals and the family in writing, or communicated in a means that would ensure understanding and meet the needs of the parents. Currently plans are not shared by maternity in writing with parents to mitigate certain risks that could be posed to other parents and staff for example police intelligence and potentially breaching GDPR. This plan should include arrangements for labour, time at hospital, recording observation of the parents or significant others, safe discharge plan and other risk factors to be managed.

The following is a guide for areas that practitioners should consider when creating a birth safety plan:

Proposed discharge arrangements;
Contact while in hospital including any specific risk from adults in the network;
Supervision required in hospital and who will carry this out;
Envisaged timescales for hospital stay;
Observations required and recording;
Risk factors and actions to take to limit these;
Timescale for any updates to the birth safety plan required including any requirement for a specific safe discharge meeting, timing of Core Group meetings post birth or specific requirements prior to discharge;
Any plan to issue court applications and the implication of this for the period of the admission and discharge.

A written copy of the birth Safety Plan must be provided to all agencies and the family by the social worker to ensure both the professionals and family are clear on the expectations in order keep the child safe at the time of birth.

Where an unborn child has been identified as requiring a Child Protection Plan at a Pre-Birth Conference, the first Review Conference should be scheduled to take place within 6 weeks of the child's birth or within 3 months of the Pre-Birth Conference whichever is the sooner.

11. Post Birth Planning

Where a baby has been subject to a Child Protection plan during the pregnancy and a Pre-Birth Professionals (Safety) Planning Meeting identified the need for a safe discharge meeting following birth a Safe Discharge Planning meeting should take place before the baby is discharged from hospital.

They should be convened to allow all relevant agencies and family members to participate and if possible conducted face to face. If it necessary to convene this as a virtual meeting it is essential that attendance allows good information sharing and a plan to be agreed for parents or significant others, family and professional network.

The meeting should always include the core group including family network and professionals involved to discuss any information emerging since the birth, including observations by the hospital staff (by sharing the parenting logs held on the ward), updates of circumstances of the family including current and new emerging risks and identified safety in preparation for planning the discharge from hospital. The meeting should include agreeing the plan for baby post discharge, this will include:

Where the baby will be discharged to live and date of discharge;
The identified main carer and significant other carers for baby;
Any specific restrictions on adult behaviours or how risk will be managed;
Roles and responsibilities of any members of the family network including support to be provided;
Roles and responsibilities of agencies including details of when professionals are visiting in the initial period after birth;
Any restrictions on contact with any member of the network or arrangements for supervision that is put in place;
Reminders around safe sleeping particularly if parents or significant others use substances (see A review of SUDI where children are at risk of significant harm);
See also Promoting Safe Sleeping and Preventing Sudden Unexpected Death in Infancy: Strategic Briefing 2020);
Safer Sleeping Resources;
LLR ICON;
National ICON;
Details of any legal action that is being taken and likely impact on discharge plan;
Who to contact should concerns arise;
The date a time of the next core group after baby is discharged from hospital;
The date and time when the parent will be able to see the baby again, where separation is the plan;
Where possible when the parents or significant others will see their baby post discharge. What information would the parents or significant others like to share with their babies carers. i.e how they like to be held, songs etc.

Some families will always benefit from a safe discharge planning meeting, this will include:

Where a plan is made for a baby to be subject to a legal application at birth;
Where specific concerns have emerged since birth based on observations on the ward which are documented in the ward's parenting logs;
Where a baby is showing signs of withdrawal from substances which may require careful monitoring and support post discharge;
Where the parent/s require specific support to their parenting from either the family or safety network which requires detailed multi-agency planning to build safety.

The specific details of the discharge plan agreed must be captured in a written safety plan and shared for action with parents or significant others, carers, professionals including all core group members and those involved in supporting discharge, for example family members in the support network. The plan must be shared before the date that discharge is to take place.

Where there are professional disagreements about the discharge plan a clear escalation process should be identified to ensure this is resolved prior to the discharge –if this cannot be resolved by discussion between appropriate line managers use of the formal LLR escalation policy must be used and the baby remain in hospital pending resolution if this is possible. See Resolving Practitioner Disagreements and Escalation of Concerns Procedure.

An early Review Conference should be considered in the following circumstances:

Where there is a further incident or allegation of Significant Harm to a child with a Child Protection Plan;
If the Child Protection Plan is failing to protect the child or if there are significant difficulties in carrying out the Plan;
Where there is a significant change in the circumstances of the child or family not anticipated at the previous conference and with implications for the safety of the child.