Safeguarding the unborn baby

Where a practitioner anticipates that prospective parents may require support services to care for their baby or that the baby may be at risk of significant harm, a referral is to be made to Childrens Social Care.

Referring an Unborn Baby to Children’s Social Care

Where an unborn baby is likely to be in need of services from Children’s Social Care when born, a referral is to be made to Children’s Social Care.

Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain agreement to refer to Children’s Social Care, unless this action may place the unborn child at risk, for example, the parent(s) possibly making their whereabouts unknown.

These circumstances include (but are not limited to):

  • Where concerns exist regarding the mother’s ability to protect.

  • Where alcohol or substance abuse is thought to be affecting the health of the expected baby

  • Where the expectant parent(s) are very young and a dual assessment of their own needs as well as their ability to meet the baby’s needs is required

  • Where a previous child in the family has been removed because they have suffered harm or been at risk of significant harm

  • Where a previous child/children has experienced neglect

  • Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family

  • Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities

  • Where the child is believed to be at risk of significant harm due to domestic violence.

    In any of the above circumstances, or where there are other factors which meet the threshold for a referral to Children’s Social Care, the referral is to be accepted and a pre-birth assessment is to be undertaken, led by Children’s Social Care.

    The above also applies to surrogacy arrangements (see below).

    Where the criteria for a SAFER referral does not meet the threshold a referral can be made into Early Help. This should be made at 12 weeks gestation but can be made at any stage during pregnancy.

     Timing of Referral

    Referrals about unborn babies should be submitted from 16-18weeks of the pregnancy, unless it has not been possible to meet this timescale, for example, because the pregnancy has been concealed.

    Practitioners will also need to be aware of their own Local Protocols which may advise that unborn referrals are to be made at an earlier stage.

    Referring at this time:

  • Provides sufficient time for a full and informed assessment.

  • Avoids initial approaches to parents in the latter stages of pregnancy, as this is already an emotionally charged time.

  • Enables parents to have more time to contribute their own ideas and solutions to concerns and increases the likelihood of a positive outcome.

  • Enables the provision of support services so as to facilitate optimum home circumstances prior to the birth.

  • Provides sufficient time to make adequate plans for the baby’s protection, where this is necessary.

    Initial Multi-disciplinary Planning Meeting

    An initial multi-disciplinary planning meeting may be held to plan the pre-birth assessment. A pre-birth assessment must be based on a robust assessment model, such as that given in Section Two.

    This meeting, to be convened by Children’s Social Care, is to be held during the 19th or 20th week of pregnancy.

    Agencies/professionals who should be invited include:

  • Children’s Social Care Team Manager and Social Worker

  • Identified Midwife

  • The likely Health Visitor

  • The family GP

  • A representative of the local Children’s Centre or equivalent.

  • Any other professional involved with the family.

    Relevant information held by the Police and by the Named Nurse/Senior Nurse’s for Child Protection from each health agency should be obtained.

    Parents should be fully involved throughout the planning process unless this was to place the unborn baby at further risk.

    A date should be set for a further multi-disciplinary planning meeting (which is to take the form of a child protection strategy meeting if the assessment outcome indicates the baby is likely to be at risk of significant harm).

    Pre-birth Assessment led by Children’s Social Care

    The assessment is to be completed within Single Assessment timescales of 45 working days from being commissioned.

    A pre-birth assessment must be thorough and robust, covering all relevant areas.

    Assessment re Parental Substance Misuse, including Alcohol Misuse

    ‘Substance’ refers to both legal and illicit substances, for example heroin, cocaine, crack, amphetamines, benzodiazepines, LSD, methadone, ecstasy, prescription drugs, solvents and problematic alcohol use.

    Parental substance misuse can particularly impact on the health and development of the child before birth and very seriously affect the life chances and future health and development of the child.

    Practitioners must ensure a thorough assessment of risk to the baby is completed, both before and after the birth

    Professionals must remember that substance misuse may be one significant feature amongst others, such as domestic abuse, previous harm to a child etc. and should therefore not be the only focus for assessment.

    Professionals undertaking the parental substance misuse assessment are expected to use the Standing Conference on Drug Abuse Guidelines (SCODA) questionnaire/assessment tool.

    Further Multi-disciplinary Planning Meeting or Strategy Meeting

    The completed pre-birth assessment report should be considered at a further multi-disciplinary planning meeting.

    If it is clear from the Pre-birth Assessment Report that there is reasonable cause to believe the baby will be at risk of significant harm when born, this meeting should be replaced by a Strategy Meeting / Discussion held under child protection procedures.

    Either meeting is to be held by the end of the 28th week of the pregnancy.

    The purpose of either meeting is to consider the findings and recommendations from the report and make plans about next steps in relation to support and any necessary intervention to protect the baby.

    Where a Strategy Meeting is being held, it should include those already involved and the relevant Safeguarding Nurse for Child Protection from the relevant NHS Foundation Trust. The Police Protecting Vulnerable People Department should also be invited and relevant information sought.

    If the Strategy Meeting/Discussion concludes that it is likely the baby will be at risk of significant harm when born, arrangements are to be made for a Pre-birth Child Protection Conference. This applies whether or not there is an intention to take legal proceedings in respect of the child when born.

    Initial Child Protection Conference

    The procedures regarding an Initial Child Protection Conference are included at Section 1.8 in the Safeguarding section of the Tees Procedures.

    Pre-birth Planning 

    A specific plan for care of the UBB/new-born at delivery should be sent to the maternity unit prior to the expected date of delivery. This plan should be drawn up at multiagency pre-birth meeting or be written and circulated by Children’s Social Care following discussion with other involved agencies. Where there are concerns around maternal mental health a Mental Health birth plan may also be put in place by the Perinatal Mental Health Team.

    Pre discharge meeting (PDM)

    Following birth a pre discharge meeting should be held to review the protection plan prior to the baby’s discharge. The focus of this meeting will be to identify a clear plan of expectations of parents and agencies following discharge from hospital. If this is not possible the core group should meet within 7 days of the baby’s birth. The PDM/Core Group are to determine when the Review Child Protection Conference is to be held (this date may have been arranged at ICPC).


    When any member of staff is made aware of a pregnancy as a result of a surrogacy arrangement they must seek advice from their Designated Officer for Child Protection or the Designated / Named Doctor or Nurse with responsibility for child protection, to enable them to make the necessary enquiries to satisfy themselves of the legitimacy of the arrangement. i.e that the treatment was undertaken by a licensed clinic.

    If the treatment has been undertaken by a licensed clinic, local authorities can be assured that the treatment will have been in accordance with the Code of Practice. It is advised that written evidence is obtained. The prospective parents may have written confirmation from the licensed centre of their genetic relationship to the child and the fact that their treatment involved the surrogate. It is preferable that as far as possible any information is obtained by the people involved.

    If Health professionals, following consultation with the named doctor or named nurse for child protection, are satisfied that the Code of Practice has been followed the local authority need not be informed unless there are other concerns being expressed that might indicate that the child may be a risk.

    Where the circumstances of the conception and subsequent arrangements for the baby are not clear the parents should be informed of the need to inform Children’s Social Care to allow for further enquiries to be made.

    A referral will be made to Children’s Social Care in accordance with the Tees Safeguarding Procedures.

    On receipt of the referral Children’s Social Care will make such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child’s welfare.

    All enquires will be undertaken in accordance with the Tees Safeguarding Procedures and Working Together.

    In the event of a surrogate mother and prospective parents arriving at hospital, without prior maternity services involvement and where the surrogate mother is in labour, enquiries should be made to the surrogacy arrangements. Where there is reason to believe that the unborn baby may be at risk of harm Children’s Social Care should be informed immediately. Should staff have concerns about the immediate safety of the unborn or baby once born and threats are made to remove the baby from the ward the police should be contacted by dialling 999. This will allow for emergency action to be taken to promote the welfare of the child and ensure its immediate safety.

      Safeguarding The Unborn Baby Flowchart 2018

Forms and Guidance