Tees Safeguarding Children Partnerships' Procedures Download Referral Form Consult 'Providing the Right Support'

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 Children's Social Care.

1. Referring an Unborn Baby to Children’s Social Care

1.1 Where an unborn baby is likely to be in need of support from Children’s Services when born, It is the responsibility of all professionals to make such a referral to either Early Help or Children’s Services dependant on the gestation of the unborn the level of concerns and parental consent. 

1.2 Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain agreement to refer to either Early Help prior to 18 weeks gestation or Children’s Social Care post 18 weeks gestation, unless this action may place the unborn child at risk, for example, the parent(s) possibly making their whereabouts unknown.

1.3 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 unborn baby
  • Where expectant parents are themselves deemed as children/ young people (under age 18yrs) and there are a number of concerns/complicating factors evident that would need to be considered to ensure the safety of parent/s and unborn.
  • Where expectant parents are under the age of thirteen a referral regarding expectant parent/s and unborn baby must be submitted.
  • Where a previous child in the family has been removed because they have suffered harm or been at risk of significant harm.  However, referrals for second or subsequent unborn babies (with siblings who are already living at home) only need to be made where concerns exist that another child in the home may increase risk of harm.
  • Where the expectant parents are currently active to Social Care and/or they have children who are currently active to Social Care.
  • Where a previous child/children have experienced neglect, emotional, physical or sexual abuse and these concerns continue to be evident and would impact on the unborn baby in pregnancy and once born by virtue of the child being dependant on their caregiver.
  • 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.

1.4 In any of the above circumstances, or where there are other factors which professionals believe threshold has been met for a referral to Children’s Social Care, the referral will be explored and reviewed by the Children’s Hub (CHUB) (Stockton and Hartlepool) / South Tees Multi-agency Children’s Hub (MACH) (Middlesbrough and Redcar) to determine the most appropriate response, and dependant on the gestation of the unborn.

1.5 Where there are any of the above concerns parents of unborn babies should be offered intervention and support at the earliest opportunity. This will assist parents by offering them support services at a much earlier stage and will support in future care planning and assessments.  

  • Early help involvement can be offered as soon as the pregnancy is known with a lead professional being identified to co-ordinate the support and intervention to ensure their needs are met and positive outcomes are achieved.  

1.6 An early response to expectant parents

  • 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.
  • There is an expectation that professionals will discuss with parents the value of early help intervention and support and will ensure consent is obtained. 

1.7 If consent is refused practitioners throughout their involvement should continue to advocate the benefits of this. However if a refusal to give consent continues and practitioners believe that the threshold for statutory services is met a referral should be made to Children’s Services between 16 and no later than 20 weeks of gestation.

1.8 If parents’ consent and a referral is made to Early Help and parents then do not engage it is the responsibility of Early Help to inform the referrer so that the referrer can continue to promote early help support and then if necessary follow the pathway above.

1.9 If parents engage with Early Help and then later disengage it is the responsibility of the Early Help professionals to make the referral to Children’s Services as detailed above if it is felt statutory services are required.


2. Referral to Children’s Services

2.1 Referrals about unborn babies where it s believed statutory services are required should be submitted between 16 and no later than 20 weeks of the pregnancy, unless it has not been possible to meet this timescale, for example, because the pregnancy has been concealed. Referrals at this stage allows for:

  • Sufficient time for a full and informed assessment.
  • The provision of support services so as to facilitate optimum home circumstances prior to the birth.
  • Sufficient time to make adequate plans for the baby’s protection, where this is necessary.


3. Initial Multi-disciplinary Planning Meeting

3.1 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.

3.2 This meeting, should be convened by Children’s Social Care within 4 weeks of the referral being received.

3.3 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 including the Early Help Lead.

3.4 Relevant information held by the Police Midwife, 0-19 service and any other person involved with the family should be obtained.

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

3.6 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).


4. Pre-birth Assessment led by Children’s Social Care

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

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


5. Assessment re Parental Substance Misuse, including Alcohol Misuse

5.1 ‘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.

5.2 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.

5.3 Practitioners must ensure a thorough assessment of risk to the baby is completed, both before and after the birth. This should include the practitioner discussing the risks of parents/carers deliberately giving babies/children methadone or other drugs or alcohol in order to soothe them. 

5.4 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.

5.5 Professionals undertaking the parental substance misuse assessment are expected to use the Drug Abuse Guidelines (SCODA) Questionnaire/Assessment Tool.


6. Further Multi-disciplinary Planning Meeting or Strategy Meeting

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

6.2 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.

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

6.4 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.

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

6.6 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.


7. Initial Child Protection Conference (ICPC)

7.1 At the ICPC the chair of the conference should stipulate as part of the plan that the birth response plan will be formulated at the first Core Group and sent to the Safeguarding Midwife within 10 working days. Particular attention should be given to any requirements around the supervision of parents whilst on the maternity unit.  Child Protection Medical Assessments 

7.2 Once this has been approved by the Safeguarding Midwife they will have responsibility to forward the final copy to the hospital and the Emergency Duty Team. The Social Worker will be responsible for ensuring any other person as deemed necessary will receive a copy. The procedures regarding an Initial Child Protection Conference are included at Initial Child Protection Conference 

7.3 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.


8. Pre discharge meeting (PDM)

8.1 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 to update the plan. The Review Child Protection Conference must be held within 10 working days of the birth or within three months of the ICPC whichever is the soonest.


9. Surrogacy

9.1 When any member of staff is made aware of a pregnancy as a result of a surrogacy arrangement they must make the necessary enquiries to satisfy themselves of the legitimacy of the arrangement. i.e that the treatment was undertaken by a licensed clinic.

9.2 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 Surrogacy Arrangements Act (1985). 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.

9.3 If Health professionals 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.

9.4 Where the circumstances of the conception and subsequent arrangements for the baby are not clear the parents should be informed of the need to discuss with the Safeguarding Team and a referral to Children’s Social Care may be made to allow for further enquiries to be made.

9.5 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.

9.6 All enquires will be undertaken in accordance with the Tees Child Protecction Procedures and Working Together to Safeguard Children.

9.7 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 a referral should be made to Children’s Social Care 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.


10. Forms and Guidance