Pre-Birth Protocol

SCOPE OF THIS CHAPTER

This guidance is based on the Pan Lancashire Multi-Agency Pre-Birth Protocol.

1. Introduction

Research and experience indicate that very young babies are extremely vulnerable and that work carried out in the antenatal period to assess risk and to plan intervention will help to minimise harm. A number of local Serious Case Reviews have been critical of agencies' work in the pre-birth stages, with one commenting about the lack of recognition on the part of some key workers and decision makers whose failure to recognise that Significant Harm was already being caused to the unborn child resulted in poor decisions being made.

Antenatal assessment is a valuable opportunity to develop a proactive multi-agency approach to families where there is an identified risk of harm.

2. Purpose

The purpose of this guidance is to ensure that we have a clear system is in place to develop robust plans which address the need for early support and services and identify any risks to unborn children.

3. Identification of Issues or Concerns in Pregnancy

If there is a need for co-ordinated multi-agency support in order to promote the welfare and meet the additional needs of an unborn child, then CAF and TAC should be considered – see Child and Family Assessment/CAF Procedure.

A referral to Children's Social Care for a Pre-Birth Assessment must always be completed if there is reasonable cause to suspect that the unborn baby is likely to suffer Significant Harm before, during or after birth.

Below are some examples of when a multi-agency pre-birth assessment should be considered (please note, this list is not exhaustive).

  • There are concerns that parent/their partner/potential carer may pose a risk to children (examples may include previous Neglect or Physical Abuse of children, or sexual offences);
  • There are concerns regarding parent/their partner/potential carer in terms of their parenting capacity. Such concerns may include mental health problems;
  • Learning disability or inability to parent or protect children from harm;
  • Parent/their partner/potential carer has children that have been made subject to a Child Protection Plan, or Care or Supervision Order at any time in the past (or if proceedings are ongoing);
  • There are concerns re domestic abuse - these could relate to any person who may be involved with the unborn baby;
  • There are concerns regarding problematic drug/alcohol misuse of parent/their partner/potential carer;
  • There are significant concerns about the lifestyle of parent/their partner/potential carer which would impact on their ability to parent or protect children (examples may include a concealed pregnancy, failure to access appropriate ante-natal care).

(This list is not exhaustive and there will be other circumstances when assessments will be necessary)

When undertaking a pre-birth assessment the needs of other children in the household should also be considered.

See Appendix 1: List of Pre-Birth Risk Factors for a full list of pre-birth risk factors. See also Appendix 2: Pre Birth Risk Estimation Tool.

Please note that the department are reviewing the pre-birth policy which includes pre-birth assessment models. Once this has been fully completed this protocol will be updated.

4. Timescales

Referrals to Children's Social Care for a multi-agency pre-birth assessment should be made as soon as it is determined there is reasonable cause to suspect the unborn baby is at risk of significant harm. It is vital that the right support is put in place at the earliest opportunity. Referrals should be made to CADS, please read the Blackburn with Darwen Children's Advice and Duty Service (CADS) Practice Guidance regarding how referrals are made.

During the process of completing a pre-birth assessment, a meeting of all professionals involved must be convened.

Where the outcome of a pre-birth risk assessment is poor and proceedings are to be instigated, a pre-birth planning meeting should be held to both make appropriate plans to manage the birth of the baby and to communicate those plans to the relevant agencies. Legal representation will be necessary and arrangements prior and post-delivery need be noted in the hospital records.     

Where a pre-birth Initial Child Protection Conference (ICPC) is required, it should be convened before 30 weeks' gestation. If the unborn baby is made subject to a Child Protection Plan at that conference, the first Core Group meeting should be held within 10 days to agree the plan for the baby and the baby's discharge from hospital.

If the unborn baby is not made subject to a Child Protection Plan, a Child in Need Plan will be considered. If statutory intervention is not felt to be appropriate, a Team Around the Child (TAC) meeting should be considered where a CAF will be agreed and implemented being held by the agreed lead professional.

The midwife (or representative for midwifery services) should ensure that the pre-birth plan is filed in the maternity records within 2 working days of its completion. A copy should also be sent by the social worker to the Emergency Duty Team.

Maternity unit staff will inform Children's Social Care of the baby's birth immediately. (If out of hours, then the Emergency Duty Team).

The named Social Worker will organise the pre-discharge planning meeting prior to the baby's discharge from hospital. This meeting will confirm the baby's placement after discharge, the nature of multi-agency professional interventions will be agreed and from this meeting a plan will be developed, agreed and  distributed across the agencies involved.

The Child Protection Review Conference must be held within 4 weeks of the birth of the child, or sooner if legal action is being considered.

Appendix 1: List of Pre-Birth Risk Factors

Examples of Pre-Birth Risk Factors Unborn Baby

  • Unwanted pregnancy;
  • Concealed pregnancy;
  • Premature birth;
  • Lack of or inconsistent ante-natal care;
  • Additional/complex health needs (e.g. disability or substance withdrawal).

Parenting Capacity

  • Lack of positive parenting role model;
  • One or both parents were Looked After Children;
  • Lack of recognition of impact of own behaviour on others;
  • Lack of awareness of unborn baby's health needs;
  • Lack of preparation for new born baby;
  • Unrealistic expectations of new born baby;
  • Drug/alcohol misuse;
  • Abuse/neglect of previous child(ren);
  • Age – very young (teenage) parents/immature;
  • Mental ill health that could impact on ability to parent;
  • Learning difficulties that could impact on ability to parent;
  • Physical disabilities/ill health that could impact on ability to parent;
  • Lack of engagement with professionals;
  • Lack of self-care skills;
  • Domestic abuse.

Family/Household/Environmental

  • Domestic abuse;
  • Inappropriate social networks;
  • Poor home conditions;
  • Significant debt;
  • Frequent moves of house/homelessness;
  • Relationship difficulties;
  • Multiple relationships;
  • Lack of community or family support;
  • Poor engagement with professional services;
  • Isolation (physical and social);
  • Anti-social behaviour issues/criminal activity;
  • Dangerous pets.

Appendix 2: Pre Birth Risk Estimation Tool

Click here to view the Pre Birth Risk Estimation Tool