Pre-Birth Procedure

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).

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.

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.

Pre-Birth Assessment guidance for Childrens Social Care staff.

The Myth of Invisible Men: Safeguarding Children Under 1 Year Old From Non-Accidental Injury

Pre-Birth Timeline

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)

Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance - NICE guidelines [CG192]

NICE Postnatal Care - Quality Standard

Birth Companions - Birth Charter for women with involvement from Children’s Social Care