Safeguarding Unborn and Newborn Babies

The procedure applies to all practitioners who have identified any concerns for an unborn baby and provides a framework for responding to safeguarding concerns and safe planning by practitioners working together, with families, to safeguard the baby at birth.

In cases where the baby is born and there is no prior knowledge of the pregnancy by health or Social Care services but where there is information that the baby may be at risk of significant harm, see Concealment and Denial of Pregnancy Procedure.

Unlike many safeguarding situations when the pregnancy is known about early the antenatal period gives a window of opportunity for practitioners and families to work together to:

• Form relationships with a focus on the unborn baby;
• Identify and understand the impact of risk to the unborn baby;
• Assess the family’s ability to adequately parent and protect the unborn baby;
• Explore safety planning options;
• Identify if any assessments or referrals are required before delivery – e.g. Early Help Assessment – for more information, see Early Help Guidance: Integrated Working with Children, Young People and Families With Vulnerable or Complex Needs) or Psychiatric Report;
• Plan on-going interventions;
• Agree a Discharge Plan well in advance of discharge;
• Avoid delay for the child where a legal process is likely to be needed such as pre-proceedings.

Where the mother has older children and is pregnant again, the needs of the unborn baby must be considered in their own right.

Initial contact with a woman who is deemed pregnant and her midwife is normally between 8-10 weeks. This is then followed by an ultrasound scan usually at 12 weeks which confirms the pregnancy viability. Referral to Children’s Social Care should be at the earliest opportunity after pregnancy is confirmed, even if this is prior to the scan. (For more information, see Referring Safeguarding Concerns about Children Procedure). It could be later in the pregnancy if health practitioners are not notified by the parent in time or there is a concealed pregnancy (for more information, see Concealment and Denial of Pregnancy Procedure.

If a practitioner becomes aware of pregnancy or impending parenthood and has a concern for the unborn baby they must inform maternity services of their involvement and highlight any concerns and risks. They must also make a referral to Children’s Social Care if there are significant concerns for the safety of the unborn baby or any other children in the family. For more information, see Referring Safeguarding Concerns about Children Procedure.

A pre-birth assessment by a local authority social worker must be undertaken on all pre-birth referrals as early as possible, where:

• A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children (see Persons who Pose a Risk to Children Procedure);
• A sibling in the household is subject of a Child Protection Plan, see Implementation of a Child Protection Plan - Lead Social Worker and the Core Group Responsibilities;
• A sibling has previously been removed from the household either temporarily or by court order;
• There has been a previous unexpected or unexplained death of a child whilst in the care of either parent or a previous child has suffered from any type of abuse or neglect from the mother and / or a previous partner;
• The parent is a Looked After Child;
• There are significant domestic violence issues (see Safeguarding Children at Risk because of Domestic Abuse Procedure);
• The degree of parental substance misuse is likely to impact significantly on the baby's safety or development (see Safeguarding Children of Alcohol Misusing Parents Procedure and Safeguarding Children of Drug Misusing Parents Procedure);
• The degree of parental mental illness / impairment is likely to impact significantly on the baby's safety or development (see Safeguarding Children at Risk where a Parent has a Mental Health Problem 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; (see Children of Parents with Learning Disabilities Procedure);
• There are maternal risk factors e.g. denial of pregnancy, concealed pregnancy (see Concealment and Denial of Pregnancy Procedure), avoidance of antenatal care (failed appointments), non-co-operation with necessary services, non-compliance with treatment with potentially detrimental effects for the unborn baby;
• There are concerns that a parent previously was suspected of fabricating or inducing illness in a child (see Management and Safeguarding Children Where there are Perplexing Presentations (including Fabricated and Induced Illness/FII) Procedure);
• A child aged under 16 is found to be pregnant and there are safeguarding risks for the mother or unborn child (see Child Sexual Exploitation Procedure and Children from Abroad, including Victims of Modern Slavery, Trafficking and Exploitation Procedure);
• Any other concern exists that the baby may have suffered, or is likely to suffer, significant harm

A referral must be made at the earliest opportunity in order to:

• Provide sufficient time to make adequate plans for the baby's protection;
• Provide sufficient time for a full and informed assessment of the needs, risks and strengths to support the baby from birth;
• 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 for the baby;
• Enable the early provision of support services so as to facilitate optimum home circumstances prior to the birth.

If it is considered that there are insufficient grounds for an Assessment by Children’s Social Care or for a Strategy Meeting to be undertaken, signposting to other appropriate agencies will take place to ensure that early help and support are in place if this is necessary. The consent of the mother / parent/s is necessary if a referral is made to Early Help or other services. For more information, see Early Help Guidance: Integrated Working With Children, Young People and Families With Vulnerable or Complex Needs and Multi-Agency Threshold Descriptors.

The early help or third sector services should be made aware that concerns were raised about the unborn baby and that they should re-refer if there have concerns that the unborn baby or newborn may be at risk of significant harm. For more information, see Referring Safeguarding Concerns about Children Procedure.

If there are concerns that the unborn baby may be at risk of significant harm, a Strategy Meeting should be convened as soon as possible following receipt of the referral. Ensure that older siblings are included in the Strategy discussion to make certain their protection and needs are addressed.

The Strategy Meeting / Discussion should follow the procedures described in Strategy Discussions / Meetings (see Strategy Discussions/Meetings Procedure). It should take place at 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.

In addition to the issues outlined in the Strategy Meeting / Discussion procedure, the meeting must decide:

• Whether a Section 47 Enquiry and pre-birth assessment is required;
• 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 if this has not already happened;
• The actions required by adult services (e.g. adult mental health or adult Social Care services, drug and alcohol or domestic abuse 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, GP and health visitor – see Section 13, Discharge Planning Meeting;
• Any instructions in relation to invoking an Emergency Protection Order (EPO) at delivery or in relation to an immediate care proceedings application by the local authority (see Section 12, Legal Gateway Planning Meeting (LGPM) and Public Law Outline Proceedings Panel (PLOPP) should be communicated to the midwifery manager for the labour / delivery suite and confirmation provided to CSC of receipt by the midwifery manager.

The parents must 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.

A pre-birth assessment must be carried out by a social worker employed by Rotherham Children & Young People’s Service on all unborn babies where there are safeguarding concerns or concerns about the ability to parent the baby safely by either or both parents, according to the threshold descriptors (see Multi-Agency Threshold Descriptors). The social worker will be the lead practitioner and Children’s Social Care (CSC) will provide administrative support, including minute taking for meetings.

The pre-birth assessment will consider the strengths in the relationships, parenting capacity and family network, balanced with needs and risk. It is essential the pre-birth assessment includes the birth father wherever possible. If the father is not part of the household, it is still important to understand and assess what role the father / father’s family will play in the baby’s life. Any other significant adults (including new partners of either parent who are not birth parents) and young people who live with the mother or father or have significant contact with them must also be included in the pre-birth assessment. Practitioners need to be mindful of ‘The Hidden Male’ and be aware that the mother may say her partner does not live or visit the property when there may be indicators in the home that that is not the case – i.e. adult male clothing / shoes are visible along with adult male toiletries etc. The pre-birth assessment should also include older siblings or other children in the household.

In addition, the pre-birth assessment must examine what strength and support the maternal and paternal families may be able to provide, in addition to any risks they may present. This may include canvassing the possibility of short or long placement with members of the extended family.

The pre-birth assessment should be conducted using the assessment protocol (see Children's Assessment Protocol and the Assessment Procedure). Practitioners from partner agencies should contribute to the assessment and any ongoing plans. This includes where either parent has, for example, a current allocated Adult Social Care social worker or drugs worker.

In all cases, the pre-birth assessment should consider all the dimensions contained within the Assessment Framework and pay particular attention to risk factors which may impact on the baby’s overall safety and well-being. This must include a profile of the birth parents and their families and an understanding of the parent’s backgrounds, their experiences of being parented and their ability to parent a baby. It is important that the assessment identifies what is working well in the parent’s capacity to care for the child and how this can be strengthened.

The pre-birth assessment should take into account the views of all agencies involved, including practitioners who have previously worked with the parents. This should include using information gathered during any previous assessments.

The Pre-birth Triangle below should be used as a guide:

A Social Care Team Manager must always sign the pre-birth assessment to demonstrate that the risk analysis and recommendations are agreed. The pre-birth assessment must then be shared with other agencies to enable partnership discussion and agreement where possible. The assessment should form the basis of a plan, depending on the outcome of the assessment and progress of the case: a Child in Need Plan, Child Protection Plan (see Implementation of the Child Protection Plan - Lead Social Worker and Core Group Responsibilities) or a legal plan. Practitioners from partner agencies need to be part of the plan and have key tasks within it to ensure the needs of the unborn baby are being appropriately met. The plan must be SMART (Specific / Measureable / Achievable / Realistic / Timely) with clear timescales and a contingency plan should it not be progressed as planned. Practitioners must contact the midwife or social worker if there are any concerns.

If any practitioner disagrees with the outcome of the pre-birth assessment, they need to discuss their concerns with their manager or Designated Safeguarding Lead and consider using the Practice Resolution Protocol: Resolving Professional Differences of Opinion in Multi-Agency Working with Children and their Families.

The parent(s) should have been involved throughout the pre-birth assessment and must be informed at the earliest opportunity of its outcome and decisions made so they are able to understand what it means for them and to help provide any support they require, including the need for them to be advised to seek legal advice if required.

If at any point, the pre-birth assessment suggests that a baby may need to be removed from the mother following birth - this must be discussed with the mother and the father at the earliest possibility. This discussion must be recorded within the file and must assess their understanding of the assessment, the possible recommendation in relation to separation and their views on this. Legal advice must be taken as soon as possible see Section 11, Action before the Birth of a baby if the baby is to be Separated from the Parent/s.

It may be appropriate to commission specialist assessments to contribute to the overall assessment of the mother’s / parent’s capacity to parent the baby. This may be from specialist adult mental health or CAMHS depending on the age of the mother, psychological or psychiatric or adult Social Care services (e.g. cognitive functioning assessment) or, for example, from drug and alcohol agencies.

If the conclusion of the pre-birth assessment is the baby cannot be adequately safeguarded in the parent(s) care, an Initial Child Protection Conference (see Initial Child Protection Conferences Procedure) must be held to determine if the baby is at risk of Significant Harm when born and plan appropriate support and interventions, which may include the need to separate the baby from its mother. This can be a traumatic experience for the family and needs to be carried out sensitively with clear planning in place to assist all practitioners involved in undertaking their responsibilities.

Where the threshold for a Child Protection Conference is met for the unborn baby, this should be held as early as possible and a Child Protection Review Conference should be held at least 6 weeks before the expected date of delivery of the baby. The timescales should be decided on a case-by-case basis appropriate for the individual circumstances and should be agreed at the Strategy Meeting prior to the Initial Child Protection Conference - for more information, see Initial Child Protection Conference (see Initial Child Protection Conferences Procedure). Advice should be sought from the Midwife or Obstetrician as to the likelihood of an early delivery. This is because the risk indicators associated with premature births are often present in expectant mothers who are assessed as vulnerable, e.g. substance misuse, domestic abuse, poor nutrition etc.

The Child Protection Conference can decide to make the baby subject to a Pre-birth Child Protection Plan under any of the usual categories (physical or emotional abuse or neglect) (for more information, see Implementation of the Child Protection Plan - Lead Social Worker and Core Group Responsibilities). The conference may decide that the baby will live at home with the mother subject to a Child Protection Plan and the plan will be agreed and implemented through the Core.

If the Conference recommends:

• The baby should be separated from the mother;
• The baby and mother should live in a specialist mother and baby placement;
• The baby and possibly mother should live with a relative while further assessment is undertaken;

then these decisions will be subject to further review at a Section 12, Legal Gateway Planning Meeting (LGPM) and Public Law Outline Proceedings Panel (PLOPP).

Please note that the Initial and Child Protection Review Conferences should be used to inform planning for the Discharge Planning Meeting see Section 13, Discharge Planning Meeting.

If the decision of the Child Protection Conference (see Initial Child Protection Conferences Procedure) is that the unborn child will be made subject to a Child Protection Plan, the Core Group meeting must be held within 10 working days of the Child Protection Conference. The purpose of the first meeting is to add detail to the Child Protection Plan, which was agreed in outline at the Conference. It is important that the Child Protection Plan informs the Discharge Planning Meeting. Where the birth of the child is imminent, it may also be expedient in these situations to consider holding a Combined Core Group/Discharge Planning Meeting. This would avoid the need for the parents to attend three separate meetings dealing with the proposed separation from their child. For more information, see Implementation of the Child Protection Plan - Lead Social Worker and Core Group Responsibilities).

If the recommendation of the Child Protection Conference is that the baby will be separated from the mother, action must be taken in preparation. Care proceedings can only be started after a child’s birth (for more information, see Court orders and pre-proceedings for local authorities, April 2014, p17).

Care proceedings should be issued as soon as possible after the baby is born, unless there are exceptional circumstances not to do so. Section 20 is not usually appropriate in these circumstances unless the protection needed is only short-term and there is no welfare or parenting capacity issue in relation to the parent with parental responsibility, who can be supported to achieve the degree of protection for the child needed on the basis of a clear safety plan. Very exceptionally, Section 20 may be used in relation to babies and very young children where the circumstances for a shared care arrangement are identified in a robust social work assessment. The rationale for this must be clearly recorded, along with a record of management oversight.

Where the local authority is considering bringing proceedings after birth, the pre-proceedings process provides an effective framework for social work with the parents before the birth of the child, ensuring fairness by enabling parents to get free, non-means-tested legal advice relating to:

• Pre-birth assessments;
• Agreeing arrangements for support of the parents before and after the birth;
• Agreeing arrangements after the baby’s discharge from hospital, and the timescales anticipated;
• Assessment of parental care following the birth and any follow up assessments required;
• Contact arrangements.

If the mother is in agreement to the baby being accommodated and this is considered the appropriate course of action, the social worker will need to obtain the mother’s signature for the voluntary accommodation of the baby under Section 20 of the Children Act 1989. 

The mother will also be required to sign the Discharge Plan to record that she understands the plan, and also whether or not she is in agreement with it. This should be done as far in advance of the birth as is possible, once the pre-birth assessment is complete, to enable the mother sufficient time to understand and come to terms with the Discharge Plan and her decision. The issue of consent should be discussed and reviewed with the mother and father throughout the process on a regular basis. This will also enable the social worker to be confident that they have informed consent, if given.

If the mother does not consent to the baby being accommodated under Section 20, her decision should form part of the discussion at the Pre-Birth Child Protection Conference (see Section 9, Pre-Birth Child Protection Conference) and Discharge Planning Meeting (see Section 13, Discharge Planning Meeting).

In the event that the parent intends to move across local authority boundaries, the team manager must ensure that the pre-birth case is referred quickly and not held open without active assessment or support being provided.

If the mother goes missing before the birth, and the unborn baby is subject to a Child Protection Plan, the Child Protection Conference must be reconvened to make any necessary amendments to the Child Protection Plan, including a plan to locate the mother (see Child Protection Review Conferences Procedure). If the unborn child is not subject to a Child Protection Plan, a Section 47 Enquiry (see Child Protection Enquiries - Section 47 Children Act 1989 Procedure) should be initiated.

Where the social worker has assessed the baby as being at risk of significant harm at birth, and the plan is to separate the baby from the mother, they should seek legal advice by convening a Legal Gateway Planning Meeting (LGPM) to seek legal advice on whether or not the threshold criteria under Section 31(2) of the Children Act 1989 is met and to plan for the birth as soon as possible and also to consider any additional services which may be needed to add strength to the plans for the baby.

The purpose of a MASP is to ensure Children’s Social Care practitioners have full and accurate legal advice in order to effectively plan interventions that are appropriate. This will include establishing whether evidence is available that the legal threshold for PLO (Public Law Outline) pre-proceedings to be initiated, or where the birth of the child is imminent and concerns are significant, applying for a court order to safeguard the baby has been met.

The LGPM may have one of three outcomes:

1. The Section 31(2) threshold has not been met and services will continue under Child in Need or Child Protection Planning;
2. The threshold has been met and a PLO Pre-Proceedings process will be initiated in a planned way;
3. The threshold has been met and because of the assessed seriousness of the risk of significant harm, a recommendation that care proceedings should be issued urgently.

In (iii) above, a place must be booked at the Public Law Outline Proceedings Panel (PLOPP) to consider the recommendation and to either confirm the recommendation that care proceedings should be issued or to decide what action needs to be taken.

In situations where the birth of the baby is imminent, with the endorsement of the Locality Service Manager, emergency legal advice should be requested by convening an urgent Legal Gateway Planning Meeting. If the outcome of this meeting is to recommend that care proceedings should be issued, this must be endorsed by the Head of Service or above. 

 If you need more information about Legal Gateway Planning Meetings and Public Law Outline Proceedings Panel (PLOPP), speak to the social worker who is the Lead Practitioner for the child you are working with.

For more information about Discharge Planning, see Discharge Planning from Hospital when there are Safeguarding Concerns about a Child Procedure.

The Discharge Planning Meeting (DPM) is organised and led by the Social Worker in liaison with the Midwifery Team and must include all relevant practitioners from the hospital based on the individual needs of the case - e.g. Midwife, Community Midwife, Health Visitor and Social Care. The mother and father, and any other appropriate family members, should also be invited and supported to attend. The purpose of this meeting is to carry forward the decisions of the Child Protection Conference/s (see Initial Child Protection Conferences Procedure, Decision Making at a Child Protection Conference) and the MASP to ensure they are transferred into a practical action plan to be followed once the baby is born.

The Discharge Planning Meeting must occur whether or not the intention is for the baby to be separated from the mother or if it is intended that the baby will go home with the mother with or without a Child in Need Plan or to a mother-baby placement subject to a Child Protection Plan or elsewhere. There should be a Pre-Birth Discharge Planning Meeting which should take place well in advance of the expected date of delivery which documents the operational plan from the Child Protection Conferences. It should be held in the community near to the locality where the expectant mother is living unless she is in hospital due to medical concerns. This could be the Core Group if the unborn child is already subject to a Child Protection Plan.

The Pre-Birth Discharge Planning Meeting should be held before the 32nd week of the pregnancy to allow time to ensure plans are in place in case of a premature birth. This is because the risk indicators associated with premature births are often present in expectant mothers who are assessed as vulnerable, e.g. substance misuse, domestic abuse, poor nutrition etc. Advice should be sought from the Midwife or Obstetrician as to the likelihood of an early delivery.

There should also be a Post-Birth Discharge Planning Meeting which occurs after the baby is born but before the mother and baby are medically fit for discharge, ideally within 24 - 48 hours of the expected discharge.

Children’s Social Care will be responsible for allocation of administrative support for minuting the meetings and disseminating the minutes to all relevant practitioners and family within 48 hours of the meeting.

The Discharge Planning Meeting will include:

• Consideration of any additional help and support needed by the parents/carers of the baby at birth;
• Clear expectations around duration of stay in hospital and plans for discharge when mother and baby are medically fit and it is safe to do so. Unnecessary delays should be avoided. If legal proceedings are being taken, a plan must be in place to ensure that arrangements are in place for the baby to be discharged to a safe and legal environment as soon as possible;
• Ensuring information is shared with all relevant practitioners;
• Consent issues;
• Contact issues – particular consideration needs to be given to the need for any supervised contact to place in the hospital to safeguard the baby and how this will be done and who will supervise - for more information, see Contact between Parents and their Children in Hospital where there are Safeguarding Concerns Procedure;
• Any strengths / risk associated with the mother, father or other family members/known adults;
• The separation of the baby from the mother / father if this is the plan and immediate post separation contact for both parents if applicable;
• Agreement of appropriate place of care for baby if separated from mother;
• Alerts to other hospitals and ambulance service if appropriate.

A Discharge Plan will be agreed at this meeting which must document the following:

• Summary of the identified strengths and any child protection risks;
• Summary of help required to assist the family and how this will be provided;
• Likely expected duration of stay in hospital for baby and safe plans for discharge – see Section 14, Action following the Birth of the Baby;
• Likely expected duration of stay in hospital for mother and safe plans for discharge – see Section 17, Separating the Baby for the Mother;
• Under what legal status will the baby be removed or accommodated away from the mother and agreement of appropriate place of care;
• Whether the mother and father consent to the plan and if not, the reasons recorded;
• If there is a removal, how and when the removal will take place;
• What contact arrangements will be in place for the mother, father, extended family members and others visitors;
• How this plan will be executed, if mother gives birth out of office hours;
• Actions to be taken if the baby is born at home;
• An agreement for a Social Worker to meet the mother after the birth but prior to the removal of the baby, to revisit the details of the Discharge Plan and sign the Section 20 paperwork giving informed consent to the accommodation of the baby where appropriate;
• Contingency plans, particularly in relation to written consent being withdrawn or concerns escalating if the baby is to be placed with the mother;
• Support for the mother, and other family members, including who will provide this;
• Arrangements for transport and admission to the mother and baby placement if that is the plan;
• Arrangements for if the mother gives birth in a different hospital or the baby is transferred or placed in a different hospital, a copy of the Child Protection Plan is to be sent immediately to the new venue and a Discharge Planning Meeting is to be held.

If the mother and father (where he has Parental Responsibility) are not present at the Discharge Planning Meeting, the Social Worker, or another agreed practitioner, should make all attempts to meet with them and discuss the Discharge Plan ensuring that both their views are recorded. The Discharge Plan and LAC Consent to Accommodation must be explained fully to the mother and signed by her if she is in agreement. A copy of the agreed Discharge Plan must be sent without delay to all relevant parties including parents and the Out of Hours Team in case the birth takes place out of office hours, with a request that Out of Hours Team visit following the birth and prior to any removal. Out of Hours Team, the hospital and any other agencies should also be fully briefed verbally and in writing on the Discharge Plan and all relevant issues.

If a mother disagrees with the Discharge Plan and does not agree that her baby should be accommodated, the alternative plans agreed within the Multi-Agency Support Panel and also recorded within the discharge plan should be followed, including applying for the most appropriate order to remove the baby.

Removing a baby from its mother at birth is rare. It should be used as a last resort and only in exceptional cases will the threshold be met.

The amount of time a mother and baby are able to remain in hospital following birth is variable depending on the individual circumstances, e.g. the health of the mother and the baby, the level of assessment completed prior to the birth, previous knowledge of the family and the assessment of risk presented. It is not acceptable to keep mothers and or/babies in hospital without a medical rationale – discharge should not be delayed due to ineffective planning or processes; but even with effective planning, depending on the circumstances, delayed discharge may be in the child’s best interests.

In the majority of cases, the pre-birth assessment will conclude that it is most beneficial for the baby, once born, to remain in its mother’s care on the hospital ward for an agreed time. The multi-agency group must agree that any risks in the case are manageable and if supervised contact is required between mother and baby or any other party then appropriate arrangements for this must be made.

There will be occasions however, when the pre-birth assessment concludes that the risks are too great to allow the baby to remain in its mother’s care following birth even whilst at the hospital. In these situations, the baby will need to be separated from the mother shortly after birth. The Social Worker and other practitioners must acknowledge that a mother may be consenting to the Discharge Plan prior to birth, have signed the Discharge Plan but can change her mind at any point and in particular she may change it after the baby is born. Legal advice must be sought in these circumstances.

Babies can only be removed or accommodated away from their mothers under the following circumstances (see Statutory Framework):

• With the written, informed consent of the mother following the birth under Section 20 of the Children Act 1989;
• By the police using Police Protection (Section 46);
• With a court order under Section 44 (Emergency Protection Order, with or without notice) of the Children Act 1989;
• With a court order under Section 38 (Interim Care Order) of the Children Act 1989;
• In exceptional circumstances, a Wardship granted by a judge of the Family Division of the High Court;
• Relinquished babies.

Any person, for example a social worker or a health practitioner, may intervene, if necessary, to protect a child from immediate violence or harm at the hands of a parent and immediate action should be taken. This may include calling the police or security staff. It is essential that the appropriate management and legal advice is sought by all parties in undertaking any of these duties and in rare circumstances Police assistance may be warranted.

The following action must be taken if the baby is born before the pre-birth conference:

• The midwife must immediately notify the social worker who will arrange an urgent Strategy Discussion. Other professionals should also be notified of the birth in line with internal agency procedures, e.g. health visitor, specialist services involved with the mother;
• The Strategy Discussion should specifically agree the arrangements for care of the child, and for any intervention pending the Initial Child Protection Conference (see Initial Child Protection Conferences Procedure); and
• The child should not be discharged from hospital until after the Strategy Discussion.

For more information, see Concealment and Denial of Pregnancy Procedure.

In the vast majority of cases, mothers and fathers work with agencies in relation to the pre-birth assessment and the plans for their baby once it is born. In most cases, accommodation of the baby is done with the consent of the parents and will be undertaken at the point of discharge.

In a small minority of cases however, exceptional circumstances mean that the baby must be separated from the mother at the point of birth; even in these circumstances it will usually be possible to keep the mother and or father fully informed of the plan to obtain immediate legal authority to remove the baby at birth.

In extreme circumstances it may not be possible to work proactively with the mother, or both parents, in relation to these plans. If, in these exceptional circumstances, the assessment concludes that to inform the parents about the plan to remove / separate the baby from their care will place the baby at even greater risk of significant harm, legal advice must be sought. Consultation with the Legal Team is imperative in such cases in order to consider what steps are necessary to safeguard the baby immediately after birth.

For information about cases where the pregnancy has been denied or concealed right up to birth, see Concealment and Denial of Pregnancy Procedure.

The Hospital / Midwife must notify the named Social Worker, Team Manager or Out of Hours Team if out of hours, as soon as the mother is admitted into hospital in labour and implement the Discharge Plan.

The hospital must nominate a Midwife to co-ordinate the Discharge Plan from within the hospital setting. They will liaise with other practitioners to ensure all appropriate information, contact details, etc., are shared and joint working arrangements are in place. It will also be important for a Midwife or member of ward staff to provide support to the mother during the separation process.

Where there is a plan already agreed with the mother to separate mother and baby at birth (under Section 20 of the Children Act 1989), a social worker must visit to check there is still informed, explicit consent for the separation and ensure appropriate support for the mother is available after the baby is born.

The timing of the separation will have been decided at the Child Protection Conference (see Initial Child Protection Conferences Procedure), Multi-Agency Support and Legal Gateway Panel (MASP) and Discharge Planning meeting. This is a sensitive issue, especially if the decision is one to accommodate shortly after birth and one which is easily open to challenge under a Human Rights argument and therefore needs to be meticulously thought through, advised on and recorded at every meeting and particularly in the discharge.

If a baby is to be accommodated shortly after birth, a decision will have been made whether this is to be immediately or whether it is safe for the mother to have a short period of time, for example two hours with the baby before he or she is accommodated in appropriate alternative care provision. This must be clearly defined within the discharge plan. In these cases, during this period, the mother and baby will be able to remain on the labour suite. The Discharge Plan must explicitly state the timing of the separation of the baby from the mother and whether this is to be at birth or at the point of discharge.

If the plan is for the baby to be placed with foster carers, they should be encouraged to visit and care for the baby prior to discharge if the baby needs to stay in the hospital for medical reasons. These arrangements should also be part of the Discharge Plan.

The Discharge Planning Meeting must consider and agree any requirements for supervised contact between the baby and its mother, father any other family members, particularly in the following circumstances:

• When the mother and her baby can remain together on the ward but only if this contact is supervised;
• When the baby is separated from mother and placed in an appropriate care provision area and contact between mother and baby needs to take place prior to the baby being discharged from hospital.

Whilst mother may go into labour during working hours, it is more likely that the baby will be born outside of these, during the evening, in the early hours of the morning, at the weekend or on a bank holiday.

Therefore it will be necessary for the responsible social worker to ensure the following:

• All relevant information and paperwork, including the Discharge Plan has been sent to the Out of Hours Team. If accommodation is by consent, Out of Hours Team will need to visit (if the birth does take place outside of normal office hours) to ensure that the mother is still consenting to this plan and that the Section 20 paperwork and form giving consent are signed by the parent(s) prior to the accommodation of the baby;
• Out of Hours Team must be notified of the contact arrangements following separation for example if baby is separated following birth to another appropriate area, Out of Hours Team must be informed as to who will supervise the contact. This may be a family member if assessed as appropriate. Where there is an agreed plan to separate the mother and baby at birth, a Social Worker must visit to check this consent;
• The responsible social worker must notify the Legal Team at the point information is received informing Social Care that mother has gone into labour. The responsible worker will need to ensure that the legal team are updated and an application for Interim Care Order is made at the earliest opportunity. Where the baby is born out of hours, this must be actioned on the next working day.

In some situations the mother may have a planned or unplanned home delivery. This presents a number of challenges and additional risks, so planning for this eventuality is therefore of critical importance and must be incorporated into the Discharge Plan. At the point it becomes known that labour has commenced the Midwife will inform the named Social Worker or Out of Hours Team worker and Police immediately.

In most cases, it will be unnecessary for the social worker or police to be present at the birth. However, in exceptional cases where there are concerns that mother is considered to be a “flight risk” or other people are likely to remove the child against the recommendations of a Child Protection Conference (see Initial Child Protection Conferences Procedure) or decision of a MASP, the Police will need to attend the address as a matter of urgency, along with the Midwife (if he/she is not already present).

The Police will not be in the same room during labour, but will be available in another room. The parent may request that the Social Worker is not present in the home, or is a different room at the time of the birth and this should be adhered to. In cases where the baby is born at home, specific consideration should be given as to whether the baby should be removed immediately or whether the mother can hold the baby for a time

During labour and following the birth, the Midwife must remain with mother and baby until the Police and Social Worker arrive. If the mother or father tries to leave the house with the baby, the Midwife must dial 999 immediately and request Police assistance if they are not already present. All babies born at home, where the plan is separation, should be taken by ambulance to the labour ward at the hospital for a paediatric examination. The Midwife will be responsible for calling for the ambulance. The baby must not be accommodated until the Paediatrician has completed their examination and concluded it is medically appropriate to discharge the baby. It will be necessary for a Midwife to notify / alert emergency services / ambulance control / paediatric A & E, mother’s GP / community midwives of a potential home delivery and this should be subject to agreement at the Discharge Planning Meeting.

If any safeguarding concerns are identified for a women admitted to the hospital in labour where there is no discharge plan, the midwife must contact the Multi-Agency Safeguarding Hub (MASH) (or Out of Hours Team out of hours) to establish what safeguarding measures are required. Where required, Social Care will contact Children’s Services Legal Department for advice. For more information, see Concealment and Denial of Pregnancy Procedure.

Where a parent and his/her unborn child are service users, and in particular where corporate parenting responsibilities, or a youth justice order, exist in relation to the parent as a Looked After Young Person, care-leaver or young offender, the Children’s Social Care and youth offending teams will actively promote the welfare of the unborn child and the parent.

There should be separate but linked assessments and plans for the parent and the unborn child. A separate Social Care record should be opened for the unborn child at the earliest possibility. Assessments and planning for the unborn child should be undertaken by a separate Children’s Social Care social worker from the parent’s social worker, involving the relevant practitioners for the child, including the parent’s key worker. The unborn child’s assessment should be informed by the assessment and planning in the parent’s case.

Where the unborn child is the subject of a Child Protection Plan (see Initial Child Protection Conferences Procedure) and one of the parents are already Looked After, the Conference Chair for the baby must be different from the parent’s Independent Reviewing Officer (IRO). However, the IRO for the parent should attend the conferences or reviews held on the unborn child, in order to ensure the plans for the parent(s) and the child are coherent, realistic and take into account the vulnerabilities of both parties.

The key worker for the parent from any other agencies should attend all core group meetings held in respect of the child. The child’s lead social worker should ensure that the parent’s key worker is kept appraised in a timely way of the authority’s actions and the parent’s responses.

In cases where the baby has removed at birth and the plan is for adoption, it is essential that the mother / father and family are signposted for therapeutic support, including bereavement work to support their emotional wellbeing and to prevent further removals.

Appendix 1:Safeguarding Unborn and Newborn Babies Flowchart

Appendix 2: Pathway for Discharge Planning for a Child in Hospital where there are Safeguarding Concerns