Safeguarding Unborn Babies

In some circumstances, agencies or individuals are able to anticipate the likelihood of Significant Harm with regard to an expected baby (e.g. as a result of Domestic Violence and Abuse, parental substance misuse, removal of previous children in the family or mental ill health).

Any such concerns should be addressed as early as possible before the birth so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care. See Section 3, Pre-Birth Referral, Section 4, Pre-Birth Assessment and Section 6, Pre-Birth Initial Child Protection Conference.

This chapter has been developed to support practitioners working with pregnant women when there are safeguarding concerns in relation to the unborn baby and specifically managing risks following birth. The chapter will provide clarity in relation to the professional and legal requirements; the legal framework; and issues relating to consent and separating the baby from its mother.

The majority of assessments undertaken for pregnant women will result in the provision of support and services for the family with the baby going home upon discharge from hospital after birth. However, the chapter also provides specific information in relation to the removal and accommodation of babies where the risks are considered too great for them to be discharged home.

Early Help Assessments.

Where concerns or needs have been identified, that do not meet the threshold for intervention by Children's Social Care, then organisations should consider what single agency or multi agency provision is required to meet those needs. At this point the practitioner identifying the need should consider initiating an Early Help Assessment with consent to ensure this work is coordinated. Further information about Early Help and links to relevant assessment tools can be found in Pathway to Provision (county), Family Support Pathway (city) and Responding to Abuse and Neglect Procedure, Early Help.

A referral to the Family Nurse Partnership (FNP) for first time mothers aged 19yrs or under should be considered in parallel to any Early Help and must have been made and accepted prior to 26 weeks gestation.

Multi-Agency Pregnancy liaison meetings

Cases of concern can be heard at multi-agency pregnancy liaison meeting, from the point of professionals becoming aware of the pregnancy to 16 weeks gestation and prior to a referral being made. The purpose of the pregnancy liaison meeting is broadly the same across the three acute trusts that provide services in the area and is to provide a forum which will offer information and advice to professionals, to ensure that pregnant women are enabled to access support services, risk of harm are identified and managed. Terms of Reference for the MAPLG for each acute trust can be found in Additional Resources.

Where agencies or individuals anticipate that prospective parents may need support to care for their baby or that the baby may be at risk of Significant Harm, a referral must be made as soon as the concerns are identified.

Wherever possible this referral should be made on confirmation of a viable pregnancy but by the 16 week stage to:

• Allow sufficient time for assessments to be undertaken and protection plans to be put in place;
• Avoid a situation where initial approaches to parents are made 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 so as to facilitate optimum home circumstances prior to the birth.

All referrals should be made to children’s social care, even if the referral relates to a family where siblings are an open case. (See Referrals Procedure).

If the parent/s of the unborn child are under 18 years of age then consideration must be given as to whether or not the parent/s of the unborn child must be assessed in their own right.

The Pathway to Provision (county) and Family Support Pathway (city) provide guidance on the thresholds for services which should be applied to the level of need or risk of harm to an unborn baby. A referral should always be made where:

• A parent or other adult in the household has been identified as posing a risk to children;
• A sibling in the household is the subject of a Child Protection Plan;
• Another child has previously been removed from the care of either parent (or parents partner), either temporarily or permanently, by a voluntary arrangement or by Court Order. Where the parent, their partner or any other member of the household has previously had a child removed, this will always lead to a Children and Family Assessment. It is highly likely in such circumstances that an Initial Child protection Conference (ICPC) will be appropriate.

Strategy Meeting/Discussion

Where the referral or assessment identifies that an unborn baby is likely to suffer significant harm, child protection enquiries will be initiated. The following chapter outlines the procedures and timescales for initiating these enquiries (see Child Protection Enquiries Procedure).

Where Strategy Discussions involve an unborn baby the responsible midwifery service should be involved.

Guidance regarding undertaking an assessment is available (see Child Protection Enquiries Procedure, Pre-Birth Assessments) and should be referred to when completing an assessment. The following guidance provides additional advice to consider when undertaking an assessment for an unborn baby. A pre-birth assessment must be carried out by a social worker employed by the Local Authority on all unborn babies where there are child protection concerns relating to the mother and/or father’s ability to parent the baby safely.

This assessment is critical and will form the basis for decision making, ensuring appropriate safeguarding plans are made pre-birth and to ensure the safety of the baby immediately following the birth.

As soon as child protection concerns are identified, the Section 47 enquiries and pre-birth assessment should be initiated; in most circumstances the pre-birth assessment must be completed 6 weeks prior to the due date;

• Late presentation / concealed pregnancy may make this unachievable in which case the assessment should be completed as soon as possible. In the case of twins and other high-risk pregnancies it is likely that they may deliver prematurely and in these situations efforts should be made to complete assessments by 34 weeks of pregnancy;
• 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 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;
• In addition, the pre-birth assessment must examine what support the maternal and paternal families may be able to provide, in addition to any risks these relatives may present.

The pre-birth assessment should consider all the dimensions/domains 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. The assessor should gain an understanding of the parent’s backgrounds, their experiences of being parented and their ability to parent a baby;
• Particular attention should be paid to the following issues which should alert the assessor to investigate further if one or both parents are:
  • Teenage parents;
  • Young parents for whom this is their first experience of parenting;
  • Parents with limited support who are isolated / have had children known to social care (Child In Need or Child protection) / have had previous children removed from their care or have children who do not live with them due to other circumstances;
  • Have a care history, are care-leavers, or have been known to social care as children in need or in need of protection;
  • Have the following; learning disability / poor mental health / drug or alcohol issues;
  • There is current and/or a history or knowledge of domestic violence within the family / significant relationships;
  • Have a history of violence or have committed offences which suggest they may present a risk to children;
  • Children born into families where there is a history of sexual offences.
• The assessor must be alert to the fact that a combination of these factors, the presence of the trilogy of risks (Domestic Violence and Abuse, Substance misuse and Mental Health) raises the level of concern and risk to the unborn baby significantly.

This is not a definitive list of potential triggers, there will be other factors not included here, which the practitioners need to consider and each pre-birth assessment must be conducted on in individual basis and in a child centered manner and should include the circumstances and needs of other children in the family.

The existence of one or more of these triggers does not necessarily mean the parent(s) will not be able to provide good, safe parenting, however it should prompt the social worker to focus on the particular issue(s) and seek out information from parents/previous files and from other agencies in order to understand the significance of the trigger(s) and assess whether it could be a potential risk factor.

The pre-birth assessment should take into account the views of all agencies involved including professionals who have previously worked with the parents. This should include using information gathered during any previous assessments, Child Protection procedures or court proceedings for the family, either locally or in another local authority area and locating these and using the information to inform the current assessment is essential.

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 should then be shared with other agencies to enable partnership discussion and agreement where possible.

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.

At any point, if the pre-birth assessment suggests that a baby may need to be removed from the mother following birth; this should 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. (See Section 10, Consent to Accommodate for further exploration of the issues in relation to consent.)

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 should 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 following birth. This can be a traumatic experience for the family and needs to be carried out sensitively with clear planning in place to assist all professionals involved in undertaking their responsibilities.

The following section describes the role and function of each meeting required in order to undertake appropriate planning and information sharing within the legal framework.

There may be exceptional circumstances where it is not possible to hold these meetings in this order due to the timescales, for example a concealed pregnancy or a pregnant woman moving from another local authority. In these cases, the Legal Planning Meeting, which may be held over the phone in urgent scenarios, can be held before the ICPC to ensure full legal advice is sought prior to the birth.

If time constraints do not allow for a Birth Protection Planning Meeting to be organised, there MUST be a discussion between social care (including the Emergency Duty Team), the Named Midwife (safeguarding) for the appropriate hospital, the community midwife and the police where appropriate and the outcome of this discussion must be recorded.

• The ICPC should be held no later than 6 weeks before the expected date of delivery;
• The Core Group should meet within 10 days of the ICPC (see Child Protection Plans Procedure, The Core Group)
• The Pre-Birth Planning meetings must be convened following the ICPC and the birth protection plan clearly documented and shared with all agencies. It may be expedient to combine this with the Core Group Meeting;
• The Pre-Birth Planning meeting should ideally be held and a plan in place by 36 weeks.

Fathers/partners play an important role during pregnancy and following the birth of a child. 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 even if the parents are not living together and, where possible, involve them in the assessment. This should include the father's reaction to their partners pregnancy, ability or willingness to provide emotional and practical support to their partner and newborn child, but also explore their thoughts, feelings and expectations and any support they may need to prepare them for the upcoming birth and becoming a parent for the first or subsequent time.

Involving fathers/partners in a positive way is important in ensuring a comprehensive assessment can be carried out , to understand where there are strengths which can be supported and built on and to identify and fully consider any possible risk possible risks.

This assessment should extend to any partners who are not the biological 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 woman 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'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:

• Individuals who have had a background of abusive, neglectful or inconsistent parenting themselves;
• People who have histories of impulsive behaviour and low frustration thresholds;
• People 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;
• People who mitigate their difficulties with others through an easy default to violence and controlling and angry behaviour;
• People 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 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.

^{* We use the word ‘partner’ to include:}

1. ^{The partner(s), spouse or civil partner (including same-sex partners) of the mum or birthing parent;}
2. ^{The biological father of the child;}
3. ^{The co-parent(s);}
4. ^{The secondary adoptive parent having a child through surrogacy.}

Purpose

A pre-birth conference is an Initial Child Protection Conference (see Child Protection Conferences) concerning an unborn child. Such a conference has the same status and purpose and must be conducted in a comparable manner to any Initial Child Protection Conference.

Pre-birth conferences should always be convened where there is a need to consider if a multi-agency Child Protection Plan is required. This decision will usually follow from a pre-birth assessment.

A pre-birth conference should be held where:

• A pre-birth assessment gives rise to concerns that an unborn child may be at risk of Significant Harm;
• A previous child has died or been removed from parent/s as a result of Significant Harm;
• A child is to be born into a family or household that already has children who are subject of a Child Protection Plan;
• An adult or child who is 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 (see Parental Mental Ill Health Procedure), learning disabilities (see Parents with Learning Difficulties Procedure), substance misuse (see Parents who Misuse Substances Procedure) and Domestic Abuse;
• A mother under 18 years of age about whom there are concerns regarding her ability to self-care and/or to care for the child.

It is essential the ICPC has a clear focus on a safe outcome for the child, and makes clear recommendations for the Child Protection Plan (if required) and future meetings required i.e. Core Group, Legal Planning Meeting (if not held prior to the ICPC) and Pre-Birth Planning Meeting;

• Provides clarity on the specific safeguarding issues in relation to the baby, including any that present an immediate risk following birth, and recommendations as to how these should be managed;
• Makes clear recommendations in relation to any requirement to remove or separate the baby at birth including the timing of this;
• Agrees how consent will be discussed with the mother and by whom and how this will be confirmed in writing following the birth, if appropriate;
• Contingency arrangements, including any need to prepare for the application of an Emergency Protection Order, removal under police protection powers or an Interim Care Order;
• Clear recommendations linked to all identified risks;
• Support for the mother and father.

The recommendations from the ICPC must be available for the Legal Planning meeting (if not held prior to the ICPC) the Pre-Birth Protection planning meeting and the core group meeting.

Pre-birth Child Protection Plan

If a decision is made that the unborn child should be subject of a child protection plan, this must be set out in terms that will commence prior to the birth of the baby.

The Core Group must be established and meet if at all possible prior to the birth, and definitely prior to the baby's return home after a hospital birth. A template plan is available in the Additional Resources.

The first core group meeting should be held within 10 working days of the ICPC. The purpose of this first meeting is to add detail to the child protection plan, which was agreed in outline at the ICPC. It is important that the child protection plan informs the Pre-Birth Planning Meeting

It is essential when holding multiple meetings that all plans produced complement one another and are not contradictory. Team Managers MUST scrutinize these plans in order to ensure they run alongside each other. Any amendments/changes or updates to any of the plans must be communicated to all relevant parties including the parents.

Where the social worker has assessed the baby as being at risk of significant harm at birth, they should book a Legal Planning Meeting (LPM) 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 early in the case as possible. Section 31(2) reads:

"A court may only make a care order or supervision order if it is satisfied:

1. That the child concerned is suffering, or is likely to suffer, significant harm; and
2. That the harm, or likelihood of harm, is attributable to:
   1. The care given to the child, or likely to be given to him if the order were not made, not being what it would be reasonable to expect a parent to give to him; or
   2. The child being beyond parental control."

The purpose of a LPM is to ensure Children’s Social Care professionals have full legal advice in order to effectively plan interventions that are appropriate. This will include establishing whether evidence is available that the legal threshold for applying for a court order to safeguard the baby has been met. Nottinghamshire and Nottingham City Children’s Social Work have specific guidance regarding the conduct of LPM and this can be accessed via Nottinghamshire Children’s Social Care Service Manual, Legal Gateway/Planning Meetings Procedure and Nottingham City Children's Services Manual, Legal Gateway / Planning Meeting Procedure.

The recommendations from the ICPC will be scrutinized at the LPM and advice given around its clarity and legality. It will be clearly recorded whether the plan is to accommodate or remove the baby shortly after birth or upon discharge and whether this will be with a parent’s consent or court order.

If the plan is to accommodate or remove the baby either upon discharge or before, advice will be given about the contact and supervision of its arrangements whilst mother and baby remain on the ward.

If it is established or agreed at the LPM, following further evidence coming to light, that the recommendations from the ICPC and therefore the proposed Birth Protection.

Plan differs from that recorded at the ICPC, this should be recorded and reasons given why it deviates from the original agreement. The social worker should also inform the Independent Reviewing Officer (IRO) of this decision, who may then wish to reconvene the ICPC.

The information provided to the LPM and decisions made must be available for the Birth Protection Planning Meeting. Detailed minutes of these meetings should not be produced at the BIRTH PROTECTION PLAN, as the information is subject to legal privilege, the decisions and rationale behind these should however be clear.

The Birth Protection Planning Meeting is organised by the Social Worker and should include all relevant professionals from the hospital, named midwife for safeguarding / community midwife, health visitor, social care (including EDT) and any adult service workers directly working with parents.

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 ICPC and LPM to ensure they are transferred into a practical action plan to be followed once the baby is born. This will include ensuring information is shared with all relevant practitioners; consent and contact issues; any risks associated with the mother, father or other family members/known adults; and the separation of the baby from the mother.

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

• A summary of the identified child protection risks;
• Under what legal status will the baby be removed or accommodated away from the mother;
• Whether the Pre Birth Consent to Accommodation Form has been signed by the mother and father (if he has PR) and if not, the reasons recorded and contingency plans agreed;
• If it is a removal, how will the removal take place?
• What contact arrangements will be in place for the mother, father, extended family members and others?
• How will this plan be executed, if mother gives birth out of office hours?
  • This should include arrangements for making sure that EDT are alert to the fact that a baby about which there are concerns may be born out of hours;
  • Ensuring that EDT have all the appropriate information available to them and understand what action is required – this information should be shared a month prior to the Expected Date of Delivery where possible;
  • Ensuring that EDT are aware of the need for them to visit to ensure that mother is still consenting to the plan and that the s.20 paperwork form giving consent is signed;
  • Arrangements for supervising contact including approaching social care staff/contact workers to establish if they are willing to assist and/or safe family members.
• Actions to be taken if the baby is born at home;
  • At the point it becomes known that labour has commenced the midwife will inform the named social worker/EDT and the police (N.B. the police should attend as a matter of urgency but not be in the same room during labour;
  • The parent may request that the social worker is not present in the home or is in a different room and this should be adhered to;
  • Principles around separating the baby from the mother should be followed with consideration around whether the baby should be removed immediately or whether the mother can hold the baby for a time limited period;
  • During labour and following birth the midwife must remain with mother and baby until the police and social worker arrive – if attempts are made to remove the baby the police should be contacted immediately;
  • Babies born at home where the plan is for separation at birth or discharge should be taken by ambulance to the Emergency Department at hospital for paediatric examination – the baby will not be discharged until the paediatrician has completed their examination and concluded it is medically appropriate.
• 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 Birth Protection 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;
• Support for the mother, and other family members, including who will provide this.

If the mother and father are not present at the Birth Protection Planning Meeting, the social worker, or another agreed professional, should make all attempts to meet with them and discuss the Birth Protection Plan, ensuring that both their views are recorded.

The Birth Protection Plan and Pre Birth Consent to Accommodation must be explained fully to the mother and signed by her if she is in agreement.

A copy of the agreed Birth Protection Plan must be sent without delay to the parents and all relevant agencies involved including the Emergency Duty Team (EDT) in case the birth takes place out of office hours, with a request that EDT visit following the birth and prior to any removal.

If it is decided that the risks are too great for a baby to remain with their mother the mother may give consent to the accommodation of her baby away from her care either following birth or upon discharge from hospital under Section 20 of the Children Act 1989.

Usually, this is on the basis that the mother accepts that they are unable at that time, but not necessarily permanently, to provide the baby with suitable accommodation or care.

Issues related to obtaining consent to accommodate a child are dealt with in detail within the Decision to Look After and Care Planning chapters of the procedures manuals for children’s social care in Nottinghamshire and Nottingham City:

• Nottinghamshire Children's Social Care Service Procedures Manual;
• Nottingham City Children's Services Procedures Manual.

Consent to accommodate should be sought 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 Birth Protection Plan and her decision.

If a mother disagrees with the Birth Protection Plan and does not agree that her baby should be accommodated, the alternative plans agreed within the Legal Planning Meeting and also recorded within the Birth Protection Plan should be followed, including applying for the most appropriate order to remove the baby.

Either parent with parental responsibility for a baby may at any time withdraw their consent to the baby being accommodated by the local authority under section 20 Children Act 1989 and remove the child from the hospital or other setting. It is important to understand that consent given under Section 20 is a voluntary agreement.

Contingency plans recorded in the Birth Protection Plan will need to be considered should parental consent be withdrawn or any professional is no longer satisfied that there is informed consent at birth. For example, the mother’s mental health deteriorates following birth, and she is assessed as having reduced capacity due to medication or complications.

The timing of the accommodation and revisiting the issue of consent under section 20 of the Children Act 1989 with the mother following birth are sensitive issues. The closer to the birth that consent is confirmed, the greater the risk of this action being challenged in relation to the nature of consent and whether it is informed. It is therefore critical that informed pre-birth written consent is given by the mother as early as possible either at the Birth Protection Plan Meeting or, if the mother was not present, as soon as is practically possible afterwards and this document is available following the birth. This will assist the process of revisiting and obtaining further written consent after the birth by asking the mother to sign Section 20 paperwork. The timing of this revisit to the matter of consent after birth is sensitive and critical and should be decided on a case by case basis. It should be discussed at the LPM and advice sought around what is a reasonable period to leave after the birth before asking the mother to sign the Section 20 paperwork. In addition, the situation following the birth should be assessed in relation to the health and emotional impact of the birth on the mother.

There will be situations when the decision is taken to remove or accommodate the baby but it is deemed appropriate and safe for mother and baby to remain together in hospital for an agreed number of days. In these cases, consent should be re visited shortly prior to discharge, confirmed by the social worker and the Section 20 paper work signed.

No local authority or social worker has any power to remove a child from its parents or to take a child into care without the parent(s) informed consent, unless they have obtained a court order authorising them to take that step.

It is not legally possible to apply for an order to remove a baby before the baby’s birth because they have no legal identity in utero. It is also not possible to have the Section 20 paperwork signed to accommodate a baby with consent prior to the birth.

The removal or accommodation of a baby at birth can only be lawfully carried out in the following circumstances:

• The mother and father with parental responsibility can give consent to her/their child being looked after by any other person or can agree under Section 20 of the Children Act 1989 to the baby being accommodated by the local authority;
• If the situation is urgent the Local Authority can seek an Emergency Protection Order (EPO) with notice under Section 44 of the Children Act 1989. The EPO will last for 8 days with one further extension of up to 7 days with permission of the court;
• The Local Authority can also apply for an ex parte EPO. An ex parte EPO should only be made in exceptional circumstances justified by there being compelling reasons for believing the baby’s welfare would be further put at risk by giving the mother/parents notice;
• For non-emergency cases, the Local Authority can apply for an Interim Care Order, under Section 38 of the Children Act 1989;
• If there is an immediate risk (and the mother does not consent or there are doubts over her capacity to give informed consent) the Police are empowered to remove a baby for up to 72 hours under Section 46 of the Children Act 1989 where the police officer has reasonable cause to believe that the child would otherwise be likely to suffer significant harm. This is known as Police Protection;
• Any person, for example a health professional on a maternity ward, may intervene, if necessary, to protect a child from immediate violence at the hands of a parent. However, this only covers an immediate response to safeguard the child in the event it is felt the child would otherwise be at risk, if not removed. That person would then need to consider police assistance under their police protection powers to authorise the continued removal of the child from its mother and or father, if it is considered still unsafe to return the child;
• Other action by hospital staff coming within Section 3(5) of the Children Act 1989 under which a person who has care of a child but does not have parental responsibility, can do what is reasonable in all the circumstances for the purposes of safeguarding or promoting the child’s welfare, for the purposes of medical treatment requiring intervention where there is no opportunity to obtain a legal order.

It is a fundamental legal principle, underpinned by Human Rights principles that intervention which impacts on the rights of a parent should only be made with due legal process and should be limited to such intervention as is necessary to safeguard the child, and must be proportionate to the risk. In this regard, the use of Police Protection and ex parte applications are heavily scrutinised by the courts and these powers are in practice only used as a last resort.

No order can be made until the child is born and the mother and baby will normally only be on a hospital ward for a short period of time before they are medically fit for discharge. In other circumstances the mother may not have admitted herself to hospital to have the baby. A decision to remove a child therefore requires meticulous contingency planning and potentially supervising the mother with her baby whilst other processes are engaged, as all may be possible or necessary, depending on the circumstances.

Such planning requires fine judgments about the nature and extent of the likely risk to the child and the proportionality of the planned response in advance of the baby's birth, taking into account the extreme vulnerability of a new born baby. These judgments may be further complicated by the mother having had no previous direct parenting experience on which to judge future parenting behaviour.

There may be those exceptional cases where an application may be required under the High Court’s inherent jurisdiction for a declaration that a proposed plan of removal immediately following birth without alerting or involving the mother/parents is lawful following the 2009 case of Baby D v Bury Metropolitan Borough Council. Legal advice is crucial when considering such action.

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 knowledge of the parents and will be undertaken at the point of discharge rather than immediately following the birth.

In a small minority of cases however, exceptional circumstances mean that that 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 should be sought. Such discussions will be held where necessary in LPMs, but outside of LPMs consultation with the Children and Adult Legal team/Legal Services is imperative in such cases in order to consider what steps are necessary to safeguard the baby immediately after birth.

Where this level of risk exists the council’s legal advisers may give consideration to approaching the court prior to the birth, at least by the end of the 8th month to gain approval from the Court allowing the Local Authority to plan for the baby’s removal without informing the parents or including them in the planning process, as in Bury 2009 case. The Local Authority social workers would need to provide strong evidence to the court that sharing information/seeking consent would escalate risk to both the unborn baby and to the baby in the hours following birth. These steps would only be appropriate where there is evidence to indicate that the mother's emotional or psychological state is such that it is likely to suggest mother could harm the baby or her behaviour is very unpredictable and as a consequence her baby would be at risk of significant harm almost immediately following the birth. The legal authority for removing the baby however can only be obtained once the baby is born.

An agreement/declaration from the courts that such action is lawful will be a requirement in such cases.

The hospital / midwife should notify the named social worker, team manager or EDT worker if out of hours, as soon as mother is admitted into hospital in labour and implement the Birth Protection Plan with delegated responsibilities and initial actions clearly identified.

If any safeguarding concerns are identified for a woman admitted to the hospital in labour where there is no Birth Protection Plan, the hospital must contact the appropriate Social Care Duty Team (or EDT out of hours) to establish what safeguarding measures are required. Where required, Children’s Social Care will contact their Legal department for advice.

The hospital should nominate a named midwife or nurse to coordinate the Birth Protection 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 the hospital to nominate 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 accommodate baby following 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 ICPC, LPM and Birth Planning Protection 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 Birth Protection Plan.

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 it is accommodated on another ward. This should be clearly defined within the Birth Protection Plan. In these cases, during this period, the mother and baby will be able to remain on the labour suite.

Separation at birth

In a small minority of cases babies will need to be removed or separated from their mother shortly after birth to ensure their safety and protection. In these cases, the following actions are required:

• Clarity of the legal framework appropriate to the removal / accommodation of the baby as defined in the Birth Protection Plan;
• Immediate notification to Social Care of the presentation of the woman in labour followed by regular updates and notification of imminent delivery;
• Sharing of information, including the above, with EDT if the woman presents in labour out of office hours;
• If the above notification is to Social Care within office hours but it is expected the delivery will take place out of office hours, Social Care will inform EDT of the situation by telephone and follow this up with written information as appropriate;
• If any additional safeguarding concerns are identified during this time, the midwife must contact the social worker, team manager or EDT immediately to agree action required to safeguard the baby;
• Immediate visit to the mother and baby from the social worker (or EDT social worker) following delivery to revisit consent, ensure the Section 20 paperwork is signed and accommodate the baby. This should take place as soon as possible and at least within the first 4 hours, depending on the baby and mother’s health and the risks identified within the pre birth assessment, the ICPC and the Birth Protection Plan;
• If a baby requires immediate medical attention following birth, the hospital staff can separate on medical grounds (normally with the parent’s agreement) to allow the baby to be treated in another area (e.g. neo natal ward, specialist unit, etc.) and the Section 20 paperwork and revisiting of consent should be delayed until an appropriate time. During this time it is essential that ongoing communication between the hospital and social care is maintained to ensure the baby is appropriately safeguarded. In these cases, an immediate visit from the social worker is required to agree supervised contact arrangements;
• In cases where consent to accommodate the baby under Section 20 of the Children Act 1989 has not been given, or there is doubt about the mothers capacity to consent, a legal order will be required to remove the baby and the contingency plan detailed in the Birth Protection Plan should be actioned and the following steps taken:
  • The baby must not be removed from the mother prior to an order being obtained, other than if there is an immediate risk of significant harm (see Section 10, Legal Framework for Removing a Child);
  • The social worker, with legal advice, will make a decision as to which legal process is appropriate (i.e. Police Protection (PP), Emergency Protection Order (EPO) or Interim Care Order (ICO);
  • Where the decision is to apply for an EPO or an ICO, the mother, father and other family members may require supervised contact with the baby, until an order is sought. This will be provided by an assessed family member, significant other or social care member of staff. The Social Work Team will need to be clear which staff can be contacted to supervise the contact.
  • The social worker or EDT worker must ensure that a copy of the signed or draft order EPO/ICO is given to the mother, father and hospital.

Immediate contact issues when removing shortly following birth

In certain situations the mother may present an immediate risk to the newborn baby.

In the circumstances of the mother being assessed as presenting an immediate risk to the newborn it will be up to the Social Worker to ensure all contact between the mother and baby is supervised until the order to remove has been granted (E.P.O / I.C.O). In these situations the midwife will supervise contact up to two hours until the social care staff (including EDT) have arrived.

It is imperative that the planning of contact in these circumstances has taken place and named workers have been identified and legal advice taken at the LPM re this issue.

There might be individual circumstances that might not be covered in the guidance so ensure such circumstances are discussed in detail at the Birth Protection Planning Meeting and any arrangements re supervision of contact pre order have been discussed with legal services and actions recorded in the Birth Protection plan.

Separation at discharge

In the majority of cases the separation of a baby will take place following the issuing of a Court order and around the point of discharge from the hospital. In these cases, the following steps should be taken:

• Notification of the presentation of the woman in labour, regular updates and imminent delivery by the midwife to social care (including EDT) as described above;
• The midwife will clarify with the social worker the expected length of stay in hospital shortly after the birth;
• If the need for supervision of contact with the baby by mother, father or any other family members has been highlighted within the Birth Protection Plan this must be put into place immediately as agreed;
• If any additional safeguarding concerns are identified during the hospital stay, the midwife must contact the social worker, team manager or EDT immediately to agree action required to safeguard the baby. Legal advice will need to be sought by the social worker if it is felt that an Emergency Protection Order (EPO) is required;
• If there is any attempt to remove the baby from the ward by any family member or other, the hospital should contact the police to gain Police Protection and the social worker;
• The social worker must make every attempt to visit the mother and baby during the first day (some babies are discharged after 24 hours) following the birth to ensure appropriate discharge plans are in place for the baby and fully understood by all involved;
• Prior to discharge and accommodating the baby, the social worker should revisit consent, ensure it is informed and explicit and the Section 20 paperwork is signed, (or a court order in place) As described earlier, the timing of this should be planned appropriately;
• If s.20 consent is withdrawn at this point, or there are doubts about the woman’s capacity to consent, again the contingency plans detailed within the Birth Protection Plan should be actioned and the steps outlined above followed;
• If the action agreed within the Birth Protection Plan was to apply for Interim care Order on notice, the social worker should contact legal services as soon as the baby is born so that an application can be issued to the court in order to obtain the earliest hearing date possible.

Post Order Contact Arrangements including Section 20 Consent

The Birth Protection Plan must detail what the contact arrangements will be following accommodation or removal of the baby. The arrangements will be based on recommendations from the ICPC and legal advice from the LPM and must take the mother’s wishes and feelings into account. In some cases, the mother may have given her consent to the accommodation of her baby on the basis she will have contact whilst the baby is in hospital but on a separate ward.

The Birth Protection Plan should document who will be responsible for supervising the contact between baby and the parent(s), the frequency of contact and any additional arrangements in specific circumstances, for example, clarification around handling and feeding of the baby, if necessary. If there are high concerns around these issues, care proceedings should be considered at the earliest opportunity to enable a court to make the final decisions and to prevent possible infringement of the parent(s) human rights. These issues need to be considered at the LPM, if it is felt they should be included in the Birth Protection Plan

Consideration should be given as to whether relatives are able to supervise contact following discussions and initial assessment of their suitability, undertaken by the social worker, ideally as part of the pre-birth assessment. It is not always possible that hospital staff will be able to undertake the supervision on behalf of the Local Authority.

If the decision is made that the baby can be discharged home with the parent(s) there must be an agreed plan between the responsible midwife or neonatologist Consultant and Children's Social Care as to how any identified safeguarding concerns will be addressed and the child adequately safeguarded on discharge. A Discharge Planning template is available to assist practitioners (see Additional Resources).

For a lot of women, being pregnant is the factor which enables them to reduce or stop drinking alcohol. However, when the baby is born these women are more at risk of a relapse. It is a vulnerable period of time.

Safer Sleeping - A risk assessment tool for practitioners.

Safer Sleeping - A guide for practitioners using the risk assessment tool.

Safer Sleep for Babies - A guide for professionals