Pre-Birth and Post Birth Planning

AMENDMENT

In March 2022, Section 2, Risks was updated to include information in relation to pre-birth assessments and planning where the mother has learning disabilities.

1. Introduction

This procedure applies to all practitioners who have identified any concerns for an unborn baby and provides a framework for responding to safeguarding concerns and safety planning by practitioners working together, with families, 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 are more likely to engage in the pre-birth assessment process at an early stage, therefore where it is anticipated that prospective parents 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.

Young babies are particularly vulnerable to abuse, and early identification/assessment and support work carried out during the antenatal 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.

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. 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 consider their safety and support needs.

Practitioners should consider whether the baby will need support or protection following birth, taking into account 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 antenatal period provides a window of opportunity for practitioners and families to work together to:

  • Form relationships with a focus on the unborn baby;
  • Identify risks and vulnerabilities at the earliest stage;
  • 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 parent and protect the unborn baby and the baby once born;
  • Identify if any assessments or referrals are required before birth; 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.
Each professional should follow their agency's child protection procedures and discuss concerns with their safeguarding lead/named/designated professional for safeguarding.

2. Risks

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;
  • Perinatal/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 who are not able to understand/meet the unborn baby's needs e.g. based on significant learning difficulties 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;
  • Parent currently 'Looked After' themselves or were looked after as a child or young person (care leavers);
  • A history of abuse in childhood;
  • Young parents; children under 14 years should always be referred to Children Social Care;
  • Recent family break up and social isolation/lack of social support;

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 child. If in doubt, professionals should seek advice about making a referral from their safeguarding leads or in consultation with Children's social care.

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 also Children of Parents with Learning Disabilities Procedure.

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, noting that when substance misuse is an identified risk for parent/s, there is an increased risk of potential early labour or complications within labour;
  • Avoids making initial approaches to parents in the final stages of pregnancy, at what is already an emotionally charged time unless there is immediate risk of significant harm;
  • Enables 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 to facilitate optimum home circumstances prior to the birth, reduce risk and build safety.

3. Working with Fathers

Fathers play an important role during pregnancy and after. The National Service Framework for Children, Young People and Maternity Services (2004) states:

'The involvement of prospective and new fathers 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 and post-birth assessment and support, fully consider the significant role of fathers and wider family members in the care of the baby even if the parents are not living together and, where possible, involve them in the assessment. This should include the father's attitude towards the pregnancy, the mother and newborn child and his thoughts, feelings and expectations about becoming a parent.

Information should also be gathered about fathers and partners who are not the biological 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 partner 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 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 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 in a positive way is important in ensuring a full assessment can be carried out and any possible risks fully considered. Fathers and partners should be included by professionals in the ante-natal work throughout the pregnancy.

4. When to Refer

When any professional becomes aware that a woman (or the partner of a man 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 service user, 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 who can support consideration of referring to Children's Social Care.

Where agencies or individuals anticipate that prospective parents 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 referrer must make clear how this is likely to impact on the baby and what risks are predicted based on their professional expertise.

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;
  • A parent or other adult in the household has been convicted for violent conduct;
  • The mother, father or a sibling in the household has a Child Protection Plan;
  • Where a previous child of either parent/ carer has been subject to care proceedings;
  • 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 substance misuse is likely to significantly impact on the baby's safety or development;
  • The degree of parental mental illness/impairment is likely to significantly impact on the baby's safety or development;
  • There are serious concerns about the prospective parents' ability to care for themselves and/or to care for the child, for example where the parent 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.
  • Any other concern exists that the baby may be suffering or likely to suffer Significant Harm, including a parent previously suspected of having Fabricated or Induced Illness in a child (see Fabricated or Induced Illness Procedure, or a prospective parent who has been the subject of fabricated or induced illness as a child themselves;
  • Concerns that parent/s are rejecting medical advice or treatment which may place the unborn baby at risk of significant harm.

Concerns should be shared with prospective parent/s and consent 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/s may move to avoid contact with social workers or other professionals. See Information Sharing Procedure.

5. 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.

In relation to a pre-birth Strategy Discussion (see Strategy Discussions Procedure), this should involve the case-holding midwife and midwife specialist 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).

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 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 timescale).

The assessment process can offer additional opportunities to share key safety information with parents. 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;
  • Parents 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.

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

The pre-birth Assessment should be led by Children's Social Care and if necessary Initial Child Protection Conferences Procedure, Pre-Birth Conferences (Child Protection Conferences Procedures) convened to manage any concerns for the safety of the unborn child.

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.

6. 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 e.g. there needs to be an assessed risk of parental engagement and the impact on the unborn child from parental mental health, learning difficulties, substance misuse and domestic abuse;
  • 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 which already have children who are the subject of a Child Protection Plan;
  • A person known to pose a risk to children resides in the household or is known to be a regular visitor;
  • A mother under sixteen about whom there are concerns regarding her ability to care for herself and/or to care for the child.
If the expectant mother is a Looked After 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.

7. 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 have the opportunity to reduce risk.

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 planed for the time of the baby's  birth.

Clear plans need to be in place for the birth of the baby 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.

8. An Unborn Child with a Child Protection Plan

If a decision is made that the unborn child should be made subject to 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 with the safeguarding unit 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.

If the child is resident outside of the area at birth, the local authority in whose area the child is resident must be advised that the child is in their area and is the subject of a Child Protection Plan.

9. 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.

The Pre-birth Planning meeting may be held as a Core Group meeting, but with the specific  purpose to develop the plan for admission and birth – this should be clearly indicated within the core group, captured in the record and the meeting should always include midwifery staff. 

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

A Birth Plan should be agreed and shared with all professionals in writing. This plan should include arrangements for labour, time at hospital, recording observation of the parents, 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 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. 

10. 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.

The should be convened to allow all relevant agencies and family members to participate and if possible conduced 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, 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 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 use substances (see A review of SUDI where children are  at risk of significant harm);
  • 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.

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

  • Cases where a plan is made for a baby to be subject to a legal application at birth;
  • Cases where specific concerns have emerged since birth based on observations on the ward which are documented in the ward's parenting logs;
  • Cases where a baby is showing signs of withdrawal from substances which may require careful monitoring and support post discharge;
  • Cases where the parent (S) requires 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, 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 disagreement 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.

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.

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;
  • Where the previous Conference was inquorate.