Pre-Birth Procedure
Scope of this chapter
Please note that providers of health services, in particular those providing Midwifery Care, will have their own detailed agency specific guidance which should be read in conjunction with this guidance.
Related guidance
Amendment
This chapter was updated in June 2025.
Young babies are particularly vulnerable to abuse, and early assessment, intervention and support work carried out during the antenatal period can help minimise any potential risk of harm. This procedure sets out how to respond to concerns for unborn babies, with an emphasis on clear and regular communication between professionals working with the woman, the father/ partner, and the family.
All professionals have a role in identifying and assessing families in need of additional support or where there are safeguarding concerns. In the vast majority of situations during a pregnancy, there will be no safeguarding concerns.
However, in some situations it will be clear that a co-ordinated response by agencies will be required to ensure that the appropriate support is in place during the pregnancy to best protect the baby and family before and following birth.
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 family'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, the use of the Early Help 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(s);
- Plan on-going interventions and support required for the child and parent(s);
- Ensure family and friends network are involved to support the unborn baby and their family;
- Avoid delay where a legal process is likely to be needed such as Pre-proceedings, Care or Supervision Proceedings in line with the Public Law Outline.
Where professionals become aware that a woman is pregnant, at whatever stage of the pregnancy, and they have concerns for the woman or unborn baby's welfare, or that of siblings, they should not assume that midwifery or other health services are aware of the pregnancy, or the concerns identified.
Professionals should consider whether the new-born baby will be safe in the care of their parents/carers and if there is a realistic prospect of parents/carers being able to meet the child’s needs throughout the pregnancy and childhood. If not, a pre-birth assessment should be considered.
Each professional should follow their agency's child protection procedures and discuss concerns with their safeguarding lead/named/designated professional for safeguarding.
Risk factors which could indicate that an unborn child may be likely to suffer significant harm and therefore be subject to a pre-birth assessment may include:
- Involvement in risk activities such as substance misuse, including drugs and alcohol;
- 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;
- Identified as presenting a risk, or potential risk, to children, such as having committed a crime against children;
- A history of violent behaviours;
- May not be able to meet the unborn babies needs e.g. significant learning difficulties and, in some circumstances, severe physical or mental disability;
- Are known because of historical concerns such as previous neglect, other children subject to a Child Protection Plan, subject to legal proceedings or have been removed from parental care.
- Currently 'Looked After' themselves or were Looked After as a child or young person (Care Leavers);
- A history of abuse in childhood;
- Are teenage/young parents who are vulnerable;
- Recent family break up and social isolation/lack of social support;
- Pregnant woman going into custody;
- Any other circumstances or issues that give rise to concern.
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 from their safeguarding lead and the Children Single Point of Access (C-SPA) consultation line about making a referral.
Where pre-birth involvement is a result of the mother’s or father’s learning difficulties causing uncertainty as to their 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/father understands what is happening and is able to present their case.
See also Parents with Learning Disabilities.
Where agencies or individuals anticipate that prospective parents may need support services to care for their baby, agencies need to consider whether an Early Help Assessment is needed In the first instance (see Continuum of Support). When an expectant mother is age 16-18 years an Early Help Assessment should always be considered, prior to referral. This should be completed soon after the expectant mother has booked in with the community Midwife. The Early Help Assessment may lead to the Team Around the Family meeting being called and the Family Action Plan delivered. Click here for Contact information for the C-SPA.
Where a professional is concerned that an unborn child or other children in the family may be likely to suffer significant harm, they should seek advice from their agency Safeguarding Lead without delay. The Safeguarding Lead will consider with them whether to refer to Children's Social Care - see Referrals Procedure. If it is considered that the baby may be at risk of significant harm, the referral must be made as soon as possible (Pre-Birth Timeline gives details of expected timeline for referral, assessment and intervention).
The referrer should clarify as far as possible their concerns in terms of how the parents' circumstances and/or behaviours may impact on the baby and any siblings and what risks are predicted. It is important that the referrer considers the possible risk to the unborn child of both parents, or mother and her partner, or father and his partner, even if they are not living together.
Referrals must always be made in the following circumstances (‘the Referral Circumstances’):
- Where there has been a previous unexplained death or serious injury of a child whilst in care of either parent;
- Where a parent or other adult in the household or the close family network is a person identified as posing a risk, or potential risk, to children;
- Where children in the household/family are currently subject to a Child Protection Plan or where there have been previous Child Protection concerns, are subject to a Child In Need Plan or is a Child Looked After;
- Where a sibling has previously been removed from the household either temporarily or by court order;
- Where there are significant domestic abuse issues, including coercive control;
- Where the degree of parental substance misuse is likely to impact significantly on the baby's safety or development;
- Where the degree of parental mental illness/impairment is likely to impact significantly on the baby's safety or development;
- Where there are significant concerns about parental ability to self-care and/or to care for the child e.g., unsupported, young, or learning-disabled parent(s);
- Where any other concern exists that the baby may be at risk of significant harm, including a parent previously suspected of fabricating or inducing illness in a child;
- Where either parent of the unborn child was under 16 years old at the point of conception.
- Where there are maternal risk factors, e.g., denial of pregnancy, avoidance of antenatal care, non-cooperation with necessary services, non-compliance with treatment, with potentially detrimental effects for the unborn baby. See Concealed Pregnancies;
- Where there are concerns or suspicions about harmful practices including but not limited to Female Genital Mutilation (FGM), witchcraft, honour-based violence and forced marriage in the family. Particular attention to be paid to women who may be sceptical of using health services;
- Where there are concerns about Child Sexual Exploitation, Criminal Exploitation, Radicalisation, Modern Day Slavery, Human Trafficking or other types of exploitation;
- Where either or both parents are a ‘Looked After Child”;
- When there are significant concerns about the home/ living conditions, living arrangements or lifestyle of the parents/ partner;
- When a pregnant woman is going into custody (if the mother will be going to HMP Bronzefield or HMP contact the prison Social Workers for support as well as referring into C-SPA). (Referral to the Local Authority the woman lives not the Local Authority the Custody/ prison is located)
Where the concerns centre around a category of parenting behaviour e.g., substance misuse, the referrer must make it clear how this is likely to impact on the baby and what risks are predicted.
Where either or both parents are a Care Leaver a risk assessment using the continuum of support document should be made to decide if the baby is at risk of harm and a referral to Children's Social Care made as appropriate. The risk assessment should consider either parent being a first-time parent and/or still open to the Care Leaver service. If risk factors have not been identified, then a referral to Children’s Social Care may not be warranted. Referral to support services should be discussed in partnership with the parents.
When any professional in Adult Services 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 might 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. They should also make a decision as to whether to refer to Children's Social Care using the above guidance.
Concerns should be shared with the prospective parent(s) and consent be obtained to refer to Children's Social Care unless this action in itself may place the welfare of the unborn child at risk e.g., if there are concerns that the parent may move to avoid contact or is a victim of Domestic Abuse. Where concerns are shared with parents, their response should be considered in the assessment of risk and shared with Children’s Social Care if a referral is being made. See Children and Families moving across Local Authority boundaries or abroad.
The link to the Surrey Request for Support Form to make a referral and contact number for advice/ urgent referral is here Multi-Agency Safeguarding Forms - Surrey Safeguarding Children Partnership).
Any professional who becomes aware of a woman's pregnancy and has concerns that the newborn may be at risk of significant harm or that the parents may require significant support to care for the child should make a referral to Children's Social Care as soon as the pregnancy is confirmed, or risks are identified.
Professionals must not wait for the pregnancy to have progressed before referring to Children's Social Care. Delay must be avoided in making referrals to:
- Provide sufficient time to make adequate plans for the baby's protection;
- Provide sufficient time for a full and informed assessment;
- 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 to assessments;
- Enable the early provision of support services to facilitate optimum home circumstances prior to birth.
All pre-birth referrals to Children's Social Care, which meet the ‘Referral Circumstances’ (as listed in Section 3 above) at the point of referral must trigger a Pre-birth Child & Family Assessment. For other referrals, C-SPA will decide on whether to progress to statutory assessment, Early Help support or information and guidance.
An unborn baby that is unknown to Children's Social Care will be referred to the Assessment Team to undergo a Child & Family Assessment. The timescale for this assessment is within 45 working days depending on the managers assessment of urgency and need. This applies for unknown babies with extreme circumstances. An unborn baby whose parents have previously had a child removed, in care proceedings, or on a Child Protection Plan (all within the last 2 years) will be referred directly into the Family Safeguarding Team for a Child & Family Assessment. If the baby is born during the pre-birth assessment process, a discharge planning meeting must be held before the baby goes home; with the plan shared with parents, involved professionals (including Health, Education, and any other agencies)) and wider family if appropriate.
A decision will be made, if prospective parent(s)/partners who are under 18 years of age require an assessment concerning their needs in their own right. If not, this should be recorded in the Management Oversight with clear rationale. If the parent is subject to a Child In Need Plan, Child Protection Plan or is a Looked After Child, best practice would dictate the unborn baby has a different Social Worker. This is to ensure both the unborn baby, and the parents needs are advocated without conflict or affect the relationship between the parent and their worker.
Part of the assessment process should include referral for a Family Group Conference and exploration of the wider family and friend's network. To support the unborn baby and their family as well as early parallel planning.
All agencies must work together in the interest of the unborn child, and it is recognised that at times there are differences of opinion on how to progress a case. There is an Escalation Policy which seeks to identify how resolution can be sought where there are differences of opinion, and it should be used to ensure that all matters are resolved. Surrey Escalation Policy (FaST – Finding a Solution Together).
Any agency risk assessments should be completed at least 4 weeks before the expected delivery date. All discussions, decisions and actions should be clearly documented in the appropriate agency record, including dates and names of professionals involved.
It may also be necessary to hold a multi-agency Strategy Discussion or Meeting depending on the severity of the Referral Circumstances. It is important to note that there may be instances when the Referral Circumstances are not the cause for concern within the referral and in these situations, the decision to progress to a Child & Family Assessment or Strategy Meeting can be based solely on the Continuum of Support. The expected delivery date will also determine the urgency for the meeting and subsequent timeline for necessary assessments.
The need for a Section 47 Enquiry should be decided at the Strategy Meeting which should be held within statutory timescales. Consideration of the need for a Section 47 Enquiry should follow the procedures as described in Strategy Discussions and Child Protection Enquiries - Section 47 Children Act 1989 Procedure.
A strategy meeting should be chaired by a Children's Social Care Team Manager and involve:
- Lead Safeguarding Midwife;
- Police;
- Social Worker;
- Health Professionals (GP, Named Nurse (if relevant), Health visitor, Named Midwife, and any other relevant health professional);
- Other professionals as appropriate e.g., Mental Health services, Personal Advisor, Parents Social Worker, Adult Services, Probation, Substance misuse professionals; Southeast Coast Ambulance (SECAMB).
The purpose of the meeting is the same as that of other Strategy Discussions and should determine:
- Whether threshold for a Section 47 Enquiry is met;
- Role and responsibilities of agencies within the enquiry;
- Role and responsibilities of agencies to provide support before and after the birth, particularly the role of adult services working with expectant parent(s);
- Identity of responsible Social Worker to ensure planning and communication of information;
- A contingency plan in case of premature labour;
- How and when the parent(s) are to be informed of the concerns;
- Required action by obstetric team as soon as the baby is born. This includes labour/delivery suite, post-Natal ward staff and the Midwifery service. A Hospital Birth Plan form needs to be completed. This will only be a part of the Strategy Discussion when it takes place near the expected delivery date (EDD);
- Any communication about the intention of the Local Authority to seek legal orders post-delivery should be coordinated with the Lead Safeguarding Midwife and communicated at the relevant time to the Midwifery manager for the labour/delivery suite;
- The need for a pre-birth Initial Child Protection Conference.
The assessment planning that develops throughout the strategy meeting, Section 47 Enquiry, and Child & Family Assessment must be consistent with standards required for possible care proceedings, including the need to start the pre proceedings process in accordance with the Public Law Outline.
The parent(s) should be informed by the child’s Social Worker as soon as possible of the concerns and the need for assessment, except on the rare occasions when medical guidance and advice suggests that this may be harmful to the health of the unborn baby and/or mother.
The undertaking of a pre-birth assessment is a multi-agency task led by Children’s Social Care which “should help us move from a reactive, crisis-led response to a more considered, proactive, and needs led response” (Calder 2003).
The pre-birth assessment process should aid the multi-agency network in planning a timely intervention for an unborn child and their family, with the needs of the unborn child seen as paramount throughout, whilst working collaboratively with parents to fully understand their needs, strengths, and overall parenting capacity. (see Pre-birth Assessment Guidance Template).
In undertaking a pre-birth Section 47 Enquiry and Assessment the Children's Social Care, the Police, Health, and other relevant agencies must follow the Section 47 Enquiries Procedure. This must include representation from the Maternity service and if relevant the Neo Natal services. The overall aim is to identify and understand:
- Parental and family history, lifestyle and support networks and their likely impact on the child's welfare;
- Risk factors;
- Parental needs;
- Strengths in the family environment;
- Factors that will not change and why, including timescales.
Section 47 Enquiry and/or pre-birth Child & Family Assessment must include consideration of both parents, any potential carers for the child and the partners of both parents.
The Section 47 Enquiry and/or pre-birth Child & Family Assessment must make the following recommendations clear within the Section 47 Enquiry.
- The need for a pre-birth Initial Child Protection Conference (ICPC). This decision will be confirmed within the recommendation of the Section 47 Enquiry;
- If a need for continued services is required at a Child In Need level an intervention plan with measurable outcomes and timescales should be outlined within the pre-birth Child & Family Assessment;
- If a need for parallel permanency planning and Legal Advice due to significant concerns for the welfare of the unborn baby;
- If there is no need for statutory involvement, with either a step down to Early Help or Universal services or closure with information and advice.
Discharge planning meetings should be held for all children who have an allocated Social Worker. All unborn children on Child Protection Plans should have both a birth plan meeting and Hospital Birth Plan form completed at approximately 30 weeks (including Midwifery, Peri-natal Midwifery team if involved, family, and allocated Social Worker) as well as a discharge planning meeting before leaving the hospital.
The Child & Family Assessment should also address parallel permanency planning at the earliest possible point. See the SCC Permanence Planning Guidance.
All Pre-Birth Child & Family Assessments should begin as soon as possible and cover additional headings outlined within the guidance document. Assessments are required to drive our intervention with the family and therefore when appropriate notice is given Pre-Birth Child & Family Assessments should be completed by 24 weeks gestation. If the unborn baby has siblings open to Children's Social Care, they must have a Child & Family Assessment completed before they are added to the workbook, this is to ensure their needs and care are fully assessed in their own right. If the prebirth has siblings already open to Children’s Social Care once the assessment is completed do not tick “workbook” as an outcome but rather add the unborn baby to the workbook already open (only once the Child & Family Assessment is completed).
If at any point within the assessment phase, it is determined that pre-birth planning should consider pre-proceedings and/or proceedings see Care and Supervision Proceedings, Legal Gateway Meetings and the Public Law Outline section 3.8 Pre-Proceedings and the PLO process with unborn babies.
A pre-birth Initial Child Protection Conference (see Child Protection Conferences Procedure) may be required if Children's Social Care assess:
- That the unborn child is suffering or likely to suffer Significant Harm;
- Where a previous child has died, been injured, or been removed from parent(s) because of Significant Harm;
- Where a child is to be born into a family or household which already have children who are the subject of a Child Protection Plan;
- Where a person known to pose a risk to children resides in the household or is known to be a regular visitor;
- Other risk factors to be considered are:
- The impact of parental risk factors such as mental ill-health, learning disabilities, substance misuse and domestic violence (including coercive control) including harmful practices. Glossary;
- A parent under sixteen about whom there are concerns regarding their ability to care for themselves and/or to care for the child.
A pre-birth conference should share all the relevant information and develop a Child Protection Plan if required. The timing of the conference should take into account the expected date of delivery and ideally take place by 28-30 weeks of the pregnancy (see Pre-Birth Timeline and explanation of the Pre-Birth Policy for Looked After Children and Care Leavers). Or earlier if there is a history of premature birth, the unborn baby needs to be linked to the older sibling’s Child Protection Plan or if legal framework to apply (20-24 weeks).
The Pre-birth Child & Family Assessment should be used as the Initial Child Protection Report.
It is important that this conference makes an informed decision about the level of safeguarding intervention required, makes recommendations that will address the unborn child’s safety, and draw up protection plans that link to these decisions.
In addition to those who normally attend an Initial Child Protection Conference, Midwifery, Health Visitor, relevant Neo-Natal professionals, and Family Centres must be invited. See Surrey Health Contacts.
Parents or carers should be invited as they would be to other Child Protection Conferences and should be fully involved in plans for the child's future.
Decision
If a decision is made that the child requires a Child Protection Plan, the main cause for concern must determine the category of abuse or neglect under which the decision is made, and the Child Protection Plan must be outlined to commence prior to the birth of the baby. The senior Midwife must notify the Lead Social Worker of the name and correct birth date following the baby’s birth. If this takes place out of hours, then the senior Midwife must inform the Emergency Duty Team, who will then notify the Lead Social Worker by the beginning of the next working day. The Lead Social Worker must then ensure that the name and correct birth date is notified to the Independent Chair and the Safeguarding Children Unit following the birth.
The Core Group must be established, and the initial meeting must be held 10 days following the conference and if possible, prior to the birth, and certainly prior to the baby's return home.
A discharge planning meeting is required for all babies on a Child Protection Plan and even in some instances of Child in Need when concerns for baby and parenting capacity is complex and requires a coordinated response from the multi-agency network. All unborn children on Child Protection Plans should also have both a birth plan meeting at approximately 30 weeks (including Midwifery, Peri-natal Midwifery team if involved, family, and allocated Social Worker) with a Hospital Birth Plan form completed.
The first Child Protection Review Conference will be scheduled to take place within 1 month of the child's birth. This may be extended by up to three months with the written authorisation of a Children's Social Care Assistant Director and the Conference Chair if information from a post-natal assessment is crucial for a well-informed review conference. If there are other children in the family who are already subject of a Child Protection Plan, the first review conference for the unborn baby may have to be held independently of siblings’ conference, but each subsequent review conference should combine the unborn baby with its siblings.
If there are significant concerns about the welfare of an unborn child, the decision may be made to initiate the pre-birth pre-proceedings Public Law Outline (PLO) process., If, at time of the Child & Family Assessment or the Child Protection Conference, the recommendation is for the unborn baby and their family to be supported through the PLO process, the lead Social Worker is to discuss with their Team Manager and follow the Legal Gateway Meeting Procedure (Surrey Children's Services Procedures Manual) and guidance and Pre-birth Timeline.
Throughout the pre-birth PLO process, the emphasis is on partnership working and relationship-based practice. The Local Authority aims to work collaboratively with the family, respecting their views and providing support to address concerns, with the child's welfare as the paramount consideration. Timings of assessments and interventions will need to be carefully planned as, for example, cognitive assessments, should not be undertaken close to expected due date or soon after.
If the Pre-birth Child Protection Conference concludes that the child should be removed at birth, Children's Social Care should seek legal advice at this point about an application for an Interim Care Order. The application to the Court can only be made once the child is born but there should be no delay in seeking the order and having the relevant assessments and Court documents prepared (as much as is possible) in advance of the birth. A Pre-Birth Planning Meeting should be arranged.
The Assessment should be shared, when completed, with the parents and, if instructed, to their solicitor to give them opportunity to challenge the proposed Care Plan and assessment.
The circumstances of the mother and other relevant adults should be reviewed regularly to allow for ongoing assessment of need and risk and consider any action required to safeguard the child. The Assessment should be updated to take into account relevant events pre-and post-delivery where these events could affect an initial conclusion in respect of risk and care planning of the child.
A Pre-Birth Planning Meeting should be arranged following the outcome of the decision to remove the child. The meeting should agree a detailed plan to safeguard the baby around the time of birth which should include:
- How long the baby will stay in hospital (for babies born to substance using mothers there needs to be a period of time to monitor for withdrawal symptoms and compliance with medical advice);
- How long the mother will remain on the ward;
- Any risks to the baby in relation to breastfeeding e.g. HIV status of the mother;
- The arrangements for the immediate protection of the baby if the risk assessment has highlighted serious risks to the child e.g. from parental substance misuse, mental health concerns, domestic abuse. This should also include contacting the Police or the use of hospital security;
- The risk that the parents might seek to remove the baby from the hospital especially if the plan is to remove the baby at birth;
- The plan for managing contact with the baby by the mother, father, or an extended family and who will supervise the contact;
- The plan for the baby upon discharge, and what visits will be made upon discharge and by whom;
- Contingency plans should be in place in the event of a sudden change in circumstances. These should include instructions for Health professionals if the mother delivered over the weekend or a Bank Holiday. It should be clear who to contact if the birth takes place after hours. The Children's Social Care Emergency Duty Team should also be notified of the pre-birth plans for the baby.
All agencies attending the meeting should receive a copy of the plan as well as other relevant agencies for example the parents' GPs. The Lead Midwife should inform Midwifery staff of the details of the plan.
Where the unborn baby has siblings, who are already open to statutory services, the timescales for conducting a Pre-Birth Child & Family Assessment are the same as for any other unborn child (24 weeks where possible and psychological assessments being completed by the ICPC where possible), With full understanding that all assessments (e.g. parenting assessment, cognitive assessment and so on should be concluded by 36 weeks to eliminate increased pressure or stress too close to baby’s due date and allow for necessary planning).
For multi-agency partners, a referral may or may not be required given the following circumstances:
- If you represent an agency that is already fully engaged in the older children’s network and have confirmation from the case holding team that the unborn is open and the appropriate assessment is underway, you are not required to make a referral;
- If you represent an agency that is already fully engaged in the older children’s network but do not have confirmation from the case holding team that the unborn is open and the appropriate assessment is underway, you are required to make a referral;
- If you represent an agency that is not involved with the older siblings or have confirmation the older siblings are involved with Children’s Social Care and feel a referral is required for the unborn, you are required to make a referral.
Where a family have children currently open to Children's Social Care as Child in Need and notify a professional of a pregnancy, the responsibility to assess the unborn sibling falls under the allocated worker for the siblings. The case holding team will be responsible for setting up the Unborn and the referral should not come via the C-SPA.
Where a family have children currently open to Surrey Children’s Social Care with a Child Protection Plan, Child In Need Plan or currently involved in care proceedings and notify professionals of a pregnancy, the responsibility to assess the unborn falls under the allocated worker for the siblings. A Strategy Discussion should be held in these circumstances to initiate the Child Protection Process for Unborn or begin the comprehensive Pre-birth Child & Family Assessment.
Where a family are currently open with on-going care proceedings, the responsibility to assess the unborn falls under the allocated worker for the siblings. Depending on the timing and associated risks within the pregnancy, a Strategy Discussion and/or Child & Family Assessment should be completed in the first instance to establish the potential risk of significant harm, timing of the Pre-Birth Child & Family Assessment, and to obtain legal advice.
If it is suspected that a child may be born at home or delivered prior to arriving at the hospital a referral should be made to the Southeast Coast Ambulance Service (SECAMB) by the Safeguarding Lead and/or the allocated Social Worker.
Information should be shared with the Ambulance Service if there are concerns that the child may suffer or be likely to suffer Significant Harm or is currently subject to a Section 47 Enquiry and/or an Assessment or is subject to a Child Protection Plan.
Information must be shared with Southeast Coast Ambulance Service if a decision has been made to make an application to court to remove the baby at birth to ensure all relevant professionals are aware of the risks/concerns and appropriate actions to take. Children Social Care should be alerted via the C-SPA or Emergency Duty Team. At all times practitioners should be mindful of the fact that the baby cannot be removed at birth without parental consent, a court order permitting this, for legitimate reasons of Police protection or the baby’s clinical condition is such that immediate removal to hospital is required to prevent death or serious harm.
If there is no clinical indication for the mother or infant to be conveyed to hospital, the Ambulance Service may in normal circumstances and in collaboration with Midwives, leave a family in the care of a home birth team. If this would not be appropriate, clear instructions should be provided to the Ambulance Service as to what actions should be taken postpartum.
It is important to update the Ambulance Service of any known changes of personal details that would assist them to further identify the mother they will be supporting.
If a discharge planning meeting had been planned to take place before the family were to leave hospital, but was subsequently born at home, a multi-agency meeting should take place as soon as possible to address the level of need required to safeguard baby and ensure the right level of support is in place.
When there is a loss of contact with an expectant mother where safeguarding concerns have already been established, all agencies must take this seriously. It is important that proactive and reasonable efforts are made to establish whereabouts of the pregnant woman and once there is a loss of contact the agency aware of the missing woman should inform their line manager and Police. The following actions should then take place:
- More extensive measures taken to understand the pregnant woman’s whereabouts through informal routes such as family, friends, neighbours, etc as is considered reasonable and appropriate;
- Check all available information systems with countrywide and national alerts placed through Health and Children's Social Care;
- Make enquiries through other local agencies involved with the woman/unborn child;
- Consideration should be given to a Cause for Concern’ to be completed and circulated to appropriate Assistant Director and Directors;
- Consideration should be given to use media to support the search, where this is appropriate;
- Children’s Social Care should initiate a Strategy Discussion, involving Police, Midwife, and any other agency which will support a plan to locate the woman and address measures to safeguard the unborn. A maternity alert to be created by Children's Social Care and disseminated to appropriate local/regional/national localities. Information that should be included in the alert to other Local Authorities:
- Woman’s name;
- Date of birth;
- Estimated delivery date;
- Description;
- Name and DOB of anyone the woman may be with;
- Reason for concern;
- Enough information to enable an Emergency Duty worker to act appropriately.
Scope of circulation, i.e., places likely to go, planned place of delivery and contact details of Named Midwife for Safeguarding Children.
Sudden Unexpected Death in Infancy (SUDI), which was formerly called 'SIDS’ or ‘cot death', is the sudden and unexplained death of an infant where no cause is found. Although SUDI s rare, it still accounts for a small but significant percentage of deaths among infants across the UK every year. Every one of these deaths is a tragic and unexpected loss for a family. Research has shown that co-sleeping is a significant factor in SUDI.
Although there is no clear cause or explanation for why SUDI happens, research has identified a simple set of key messages for parents and carers that may help reduce the risk of it happening to their baby. Please see: Safer Sleep for Babies: A Guide for Professionals (lullabytrust).
Open in-depth conversations between professionals and the mother and father/partner of the unborn baby should be held around safe sleeping with the baby after birth; this will involve planning around reducing any risks, as well as avoiding risks to the baby. During these conversations, information should be provided around safe sleeping practices to protect babies. Discussions should also include exploration around peer and support networks for parents to reinforce the information and provide practical advice.
Fathers/partners 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 maximising 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. This includes male and female partners of parents. Even if the parents are not living together and, where possible, involve them in the assessment. This should include the father's/ partner’s attitude towards the pregnancy, the mother and newborn child and their thoughts, feelings, and expectations about becoming a parent.
Involving fathers/ partners in a positive way is important in ensuring a comprehensive assessment can be carried out and any possible risks fully considered.
Information should also be gathered about fathers and partners who are not the biological mother or father at the earliest opportunity to ensure that any risk factors can be identified. A careful assessment of the role that the person has in relation to the mother and any other children in the household as well as their views about the future care of the baby should be undertaken.
A failure to do so may mean that practitioners are not able to accurately assess what mothers and other family members might be saying about the father/ partner'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, not just present but also historic which may include:
- Parents/ partners who have had a background of abusive, neglectful, or inconsistent parenting themselves;
- Parents/ partners who have histories of impulsive behaviour and low frustration thresholds;
- Parents/ partners who abuse substances, especially drugs, to a degree that encourages increased levels of stress and anxiety, sleeplessness, lowered levels of frustration tolerance, heightened impulsivity, poor emotional and behavioural regulation, and poor decision-making;
- Parents/ partners who mitigate their difficulties with others through an easy default to violence and controlling and angry behaviour;
- Parents/ partners experiencing external pressures such as those brought about by poverty, mounting debts, deprivation, worklessness, racism and often very poor relationships with the mothers of the children.
See The Myth of Invisible Men: Safeguarding Children Under 1 Year Old From Non-accidental Injury.
The opportunity for the early identification of fathers/partners who might need extra support and those who might present a potential risk is often not adequately or consistently recognised. In those circumstances, men can sometimes be viewed in a binary way, good or bad, supportive or a risk. Men can often be both and this requires an approach that is characterised by support and challenge, by both listening to them and holding them to account.
A detailed pre-birth assessment can provide an early opportunity to develop a good working relationship with parents during the pregnancy, especially where there are concerns. It can mean that vulnerable parents can be offered support early on, allowing them the best opportunity to parent their child safely and effectively. Importantly, it helps identify babies who may be likely to suffer significant harm and can be used to develop plans to safeguard them.
There are some potential issues that can arise. The involvement of Children's Social Care (especially if there is a decision to remove the baby at birth) can result in the parents going missing or the woman not attending hospital at the time of birth.
It may have an adverse effect on the parents' mental or physical health or heighten the risks that had raised the concerns in the first place. The fear of losing the baby may undermine the attachment and bonding process between the parent and child. There is a danger that the woman may end up harming herself or her unborn baby or seeking to terminate her pregnancy.
It is vital that there is good communication with the pregnant woman, the birth father and, if different, her current partner in order to reduce the chance of such issues arising.
Pre-Birth Assessment guidance for Childrens Social Care staff.
The Myth of Invisible Men: Safeguarding Children Under 1 Year Old From Non-Accidental Injury
Explanation of the Pre-Birth Policy for Looked After Children and Care Leavers
Born into Care: Best Practice Guidelines
NSPCC Learning Infants: Learning from Case Reviews
Promoting Safer Sleeping for Babies in England (University of Oxford, Department of Social Policy, and Intervention - recommends that open conversations between parents and professionals could be used to support safer sleep for babies who have a Social Worker.
Co-sleeping and SIDS - a Guide for Health Professionals (UNICEF)
NICE Postnatal Care - Quality Standard
Birth Companions - Birth Charter for women with involvement from Children’s Social Care
Last Updated: June 9, 2025
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