Who do I contact:

• Hannah Gadd, Interim Named Midwife for Safeguarding,Hannah.gadd@nhs.net,01634 974834
• Rebecca Mulvanny, Interim Deputy Named Midwife for Safeguarding, Rebecca.mulvanny@nhs.net,01634 833792
• Medwayft@maternitysafeguarding@nhs.net 
• Team Connect, Community Midwifery Team, 01634 974526, medwayft.teamconnect-midwives@nhs.net

Midwifery Safeguarding response:

• midwifery safeguarding hub
• liaison with maternity safeguarding team
• children's social care
• windwill clinic
• information gathering 
• team connect

Understanding pre-birth assessments:

The pre-birth procedures set out guidance and information for practitioners in Kent and Medway on safeguarding unborn children where risk of harm is anticipated. It includes timeliness of referrals/requests when unborn is at risk of significant harm and the circumstances when referrals/requests for support must be made to local authority children’s services social care.

The UK law does not provide legislative rights to an unborn baby. However, in some circumstances agencies or individuals are able to anticipate a likelihood of significant harm, potential risks and vulnerabilities with regard to the unborn child. These concerns must be addressed as early as possible.

The overall aim of pre-birth assessments is to identify and understand whether the family's care of the child following their birth will be safe enough and what is needed to support the child/ren remaining within the family or whether the situation is so dangerous that consideration should be given to child/ren being removed. 

For an assessment to be reliable it will contain the following three elements:

• what research tell us about risk factors
• what practice experience tells us about how parents may respond in particular circumstances
• the practitioners' professional knowledge of this particular family

The content of an assessment will be formed by looking at:

• relationships between parents
• relationships between the parent/s and the child (whether born or unborn)
• looking at previous history and how this shapes current experiences and the context within which people are living

If you are a professional that is working with an expectant parent who you have concerns about in relation to the welfare of an unborn child must review the Medway Inter-Agency Threshold Criteria.  

An appropriate referral within Medway should be made if there is likelihood that:

• the unborn child has/will have high level intensive needs
• the needs of the unborn child are likely to be so great that statutory specialist intervention is required to keep them safe or ensure their continued development or, the unborn child is at risk of significant harm.

These concerns should be shared with the prospective parents and consent should be obtained to refer to the local authority children’s social care services unless this action may place the welfare of the unborn child at risk. 

Referrals for support should be made as soon as concerns have been identified which indicate that the unborn is at risk of significant harm, and no later than 18 weeks into the pregnancy. It may be that concerns are not known until later on in the pregnancy at which point a referral/request for support should be made.

identified concerns any point during the pregnancy should result in an immediate referral to the children's social care services. 

An appropriate referral should be made:

• the unborn child has/will have high level intensive needs
• the needs of the unborn child are likely to be so great that statutory specialist intervention is required to keep them safe or ensure their continued development or the unborn child is at risk of significant harm

Circumstances when referrals for support must be made to children's social care services:

• there has been a previous unexpected death of a child whilst in the care of either parent, or other adults living in the household, where abuse/neglect is/was suspected
• a parent or other adult in the household, or regular visitor, is a person identified as presenting a risk, or potential risk, to children
• children in the household/family currently subject to a child protection plan
• a sibling (or a child in the household of either parent) has previously been removed by a court order
• there is knowledge that parental risk factors e.g. domestic abuse, mental health illness or substance misuse may impact on the unborn child’s safety or development
• there are concerns about parental ability to self-care and/or to care for the child e.g. unsupported, young, or disabled parent, or parent with a learning disability, where concerns are noted
• consideration needs to be given if there are maternal risk factors e.g. denial of pregnancy, late booking of pregnancy, avoidance of antenatal care (failed appointments), non-co-operation with necessary services, non-compliance with treatment with potentially detrimental effects for the unborn child
• concerns that the child is at risk of significant harm, including a parent previously suspected of fabricating or inducing illness in a child
• the parent is a child in care to the local authority or another local authority
• all pregnant young people under the age of 16 should be referred to the local authority children’s social care services (or the Police) if a risk assessment indicates a risk of sexual exploitation or risk of harm to the child in accordance with the local procedures
• a child under the age of 13 is pregnant
• in the case of a concealed pregnancy a referral/request for support must be made to the local authority children’s social care services

Medway and Swale maternity hub:

In Medway there is a midwifery triage hub to help unborn children and their parent's in Medway help to access the right services at the right time. 

The hub is held once a month at Medway NHS Foundation Trust. 

The hub provides community midwives across Medway with the opportunity to present cases of unborn children who they assess in need of additional support.

Pre-birth child protection conference:

• the pre-birth child protection conference is an initial conference concerning an unborn baby. 
• the pre-birth conference should be convened following section 47 enquiries.
• the conference should take place by 20 weeks of pregnancy - this is to allow sufficient time for an assessment of parenting ability and the preparation of a discharge plan

Developing a child protection plan:

• the conference chair must ensure that a child protection plan is outlined and clearly understood by all concerned
• if agreed that a child protection plan is to be provided for the unborn child, a core group meeting will take place immediately after the initial conference
• the meeting must make a detailed pre-birth plan of any actions to be taken and support to be delivered before and immediately following the birth
• the meeting must have representation of relevant agencies 

Pre-birth and proposed discharge plan:

The aim of a pre-birth and discharge plan is to ensure there is a clear and agreed plan for the mother and baby following the birth, including details of who can or cannot visit and any agency risk assessments or other arrangements in place for any parties. A pre-birth plan should be completed by 34 weeks and in place prior to the baby being born. 

A pre-birth plan should be made for all unborn children who are:

• subject of a child protection plan
• subject of a pre-birth assessment
• subject of a public law outline (PLO) meeting held between the local authority children’s social care services and parent/s

This plan should be made during a multi-agency meeting. 

Concealed pregnancy:

A concealed pregnancy is either:

• someone who knows they are pregnant but does not tell anyone
• not aware they are pregnant 

Why would a pregnancy be concealed:

• situations of domestic abuse which is more likely to begin or escalate during pregnancy
• as a result of previous social care involvement in removal of previous children

Implications of concealment:

• ambivalence towards pregnancy
• immature coping styles
• a tendency to dissociate 
• serious mental health illness
• a lack of monitoring of health and development of the child during pregnancy and labour
• a lack of monitoring of the health and development of the expectant parent during pregnancy and labour 

Following a concealed pregnancy where significant risk has been identified it is important for the local authority children's services should take the lead in developing a multi-agency contingency plan to address the possibility of a future pregnancy. Only when underlying reasons concealed pregnancy are revealed, explored and addressed can the risk associated with future concealment be substantially reduced. 

Free birthing:

Free birthing is going through the pregnancy without assistance or an accredited health professional. 

There are two different types of free birthing.

Born Before Arrival (BBA) this is when the pregnant women or person had every intention of giving birth with the help of a midwife and/or doctor and has engaged with maternity services

Free Birth is when the pregnant women or person decides to give birth at home or somewhere else without the help of a midwife, doctor or other trained health professional in attendance.

It is important to understand that it is a criminal offence for anyone other than a registered midwife or doctor to 'attend' a person during child birth (Article 5 of the Nursing and Midwifery Order 2001)

Understanding the pregnant women or person's reasons for having a free birth is critical to assessing safeguarding risk and level of need.

The impact of Domestic Abuse on the unborn child:

• mother may be prevented from attending antenatal appointments
• high levels of stress experienced by an expectant mother may negatively affect the development of the unborn baby's nervous system and brain
• mother may rely on substance misuse due to poor mental health which can affect foetal growth and result in life long problems