WORKING WITH MOTHERS AND
THEIR UNBORN BABIES WHERE
THERE ARE CONCERNS FOR THE
WELFARE OF THE UNBORN CHILD
Working with Mothers and their Unborn Babies where there
are Concerns for the Welfare of the Unborn Child
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Working with Mothers and their Unborn Babies where there
are Concerns for the Welfare of the Unborn Child
Introduction:
Research indicates that young babies are particularly vulnerable to abuse but that
work carried out in the antenatal period can help minimise harm if there is early
assessment, intervention and support.
Working Together (2006) specifically identifies the need of the Unborn Child.
Purpose:
The purpose of this protocol is to ensure that a clear system is in place to respond to
concerns for the welfare of an unborn child and to maintain clear and regular
communication.
Scope:
This joint protocol particularly applies to Social Services staff, police and health.
Definitions:
Concerns for the welfare of an unborn child include:
 Concerns that the mother’s current behaviour, e.g. known mental health
concern or substance misuse poses a threat to the unborn baby.
 Concerns that the mother may not be able to care for the baby to an
acceptable standard, e.g., significant learning difficulty, previous neglect or
other children on the child protection register or have been removed from
parental care.
 Concerns that the behaviour of the father (or any other person) poses a threat
to the unborn baby, e.g. domestic abuse or known allegation or conviction for
offences against children < 18yrs.
 Concerns that the behaviour of the father (or any other person) will impact on
the ability of the mother to care for the baby to an acceptable standard.
The presence of one of these factors does not automatically require referral but they
highlight the need to consider the known pre-disposing factors to child abuse.
Early Identification & Assessment:
All professionals working with families need to be alert to the factors that may
indicate a potential risk to the child either before or after birth.
It is vital that assessments are started early and that information is shared so that the
child and family have the necessary support and best start to family life thereby
minimising the need for child protection intervention.
Any assessment must include details of the mother’s partner, wider social and family
history and environmental factors (as can be found in the Common Assessment
Framework) as well as the obstetric history.
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Routine Antenatal Enquiry
The National Service Framework for Children, Young People and Maternity Services
(D.O.H, 2004) states that all pregnant women must be offered a supportive
environment and the opportunity to disclose Domestic Violence and that local
services are trained to respond appropriately.
This means that on initial booking, or at another appropriate time (see RCM position
paper 19a), the midwife will raise the issue of domestic abuse. Research informs us
that 30% of domestic violence starts in pregnancy and that domestic violence is a
prime cause of miscarriage or still birth (Why Mothers Die, Department of Health,
2001). A significant number of expectant mothers will need referral to other services
See appendix B & C for flowcharts
Low Level of Concern:
1. Initial Contact (Approx 8-12 weeks gestation)

If in the initial assessment the health professional has some level of concern
(considering the risk factors) the family should be informed and that there is a
need to liaise and possibly refer to other professionals/agencies.

The midwives may refer the pregnant mother to the Social Care (Children’s
Services) team following their ‘booking-in’ appointment and Obstetric Booking
Assessment form that takes place at approximately 10-12 weeks of
pregnancy.

If the family already have an identified social worker, then the referral needs to
be made to them. The referring midwife must confirm the referral in writing,
either by letter or confidential fax, within 48 hours.

The Social Care (Children’s Services) team will acknowledge receipt of referral
to the midwife and decide on next course of action within one working day.

When concerns are raised, at any time to Social Care (Children’s Services)
team, by someone other than the midwife, then the Social Services worker
involved must bring them to the attention of the named community midwife, if
known, or the child protection lead midwife or named nurse for acute or
primary health. This enables the midwife to continue to monitor and support
the family.

If the midwife makes a referral, they must inform the Senior Community
Midwife, G.P & Consultant Obstetrician if appropriate.
N/B It is the responsibility of the professional making the referral to follow
up a referral if there is no response within the given timeframe.
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Initial assessment

If initial assessment is deemed necessary from the Social Care (Children’s
Services) team, this must be completed within 7 working days. If child
protection concerns are identified, a ‘Strategy Discussion’ will be held with the
police, the child protection lead midwife or the named Community Midwife. An
agreement will be made and recorded about the next step.

Throughout pregnancy the midwife will continue to monitor and support the
family. If at any time concerns resurface then the Social Care (Children’s
Services) team must be contacted with the new information.

Post-natally the midwife will again monitor and offer support until handover to
the Health Visitor. The Health Visitor will maintain contact with the family and
as for all families will take a lead role in assessment and intervention.
See appendix B & D for flowcharts
2. Medium/High Level of Concern:

This level of concern relates to when there are concerns that an unborn baby
may be “in need” (section 17) or “in need of protection” (section 47) which
means that their basic physical and/or psychological needs will not be met and
is likely to impair the child’s health or development.
See www.swcpp.org.uk for further guidance

Where initial contact is made by professionals primarily working with the adult
family members, e.g. Police, probation, housing or voluntary agency, and
there is this level of concern then the Social Care (Children’s Services) team
must be notified regarding the unborn baby.

Any professional who has concerns for the welfare of the unborn child must
ensure that the midwifery service is aware of the concerns and that any
relevant information is passed on.

Once the referral has been made the processes are exactly the same as for
any child in need/child protection referral
N/B Remember that at any stage you can consult with Social Care (Children’s
Services) team before making a referral.
See appendix B & E for flowcharts
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Escalation policy

If after following all protocols flowcharts the professional still has concerns,
then they would need to contact the named professional for child protection
who if necessary will implement the relevant escalation policy.
Practice Guidance:

Although this protocol does not explicitly mention fathers and extended family
members it is implicit that they must be included as appropriate in the
casework with the mother and unborn child.
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Appendix B
Multi-Agency Pre-Birth Protocol
NO CONCERN
IDENTIFIED
Midwifery
Assessment
(booking-in) to
include Routine
Enquiry into
Domestic
Violence
MEDIUM/HIGH
LEVEL
CONCERN
OF
3rd trimester
28- birth
2nd trimester
14-28 weeks
1st trimester
0-14 weeks
LOW LEVEL OF
CONCERN
Ongoing
midwifery
assessment
throughout
pregnancy
Ongoing midwifery
assessment throughout
pregnancy
Ongoing midwifery
assessment throughout
pregnancy
Inform GP, health visitor
& other relevant
professionals
Discussion with other professionals
involved including GP. Early referral
from midwife to health visitor.
Consult with Social Care for Children’s
Services & referral if necessary
Ongoing
midwifery
assessment.
Relevant
information
passed to health
visitor or other
professionals as
required
Communication and
consultation with all
professionals involved
with the family. Joint
assessment between
health visitor &
midwife plus
appropriate others
including escalation
if concerns outside of
health
Antenatal contact
by health visitor
with all first time
mums. To start
the health visit or
assessment
process
Antenatal contact
by health visitor
with all first time
mums. To start
the health visit or
assessment
process
Plan agreed with
parents and
midwife
Ongoing routine
midwifery
assessment
Review by health
visitor if requested
Liaison with all
professionals
involved with
family.
Intervention as
planned
Communication and
consultation with all
professionals involved with
the family. Joint midwife
and health visitor visit if
necessary.
Families of med/high level of
concern will be discussed at
multi-agency maternity liaison
meetings.
If required multiprofessional/multi-agency
meeting to plan assessment
and intervention. Initiation
of section 47 inquiries
Antenatal contact
by health visitor
with all first time
mums. To start
the health visit or
assessment
process
Joint assessment including all
professionals involved with
family. Intervention as planned
 Strategy discussions
 CP conference
 Monitoring of action plans
Newborn birth visit by health
visitor & handover from
midwife to health visitor.
Follow up as planned.
Services will be determined
according to need
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Appendix C
ROUTINE ANTENATAL ENQUIRY
No concerns identified at initial assessment
3rd trimester
28- birth
Initial assessment by midwifery
services indicate no concerns
Assessment continues throughout pregnancy
2nd trimester
14-28 weeks
1st trimester
0-14 weeks
Midwifery
Assessment
(booking-in)
Health visitor informed regarding
pregnancy and outcome of early
assessment by midwife
Health visitor contact with family
as soon as possible after 24 weeks
gestation. Health visitor
assessment to be based on the
common assessment framework.
Plan and ongoing contact agreed
with family and midwife
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Appendix D
LOW LEVEL OF CONCERN
The assessment identified that the family will require core child care/health visiting/midwifery
services with limited extra intervention
3rd trimester
28- birth
2nd trimester
14-28 weeks
1st trimester
0-14 weeks
Midwifery
Assessment
(booking-in)
Midwifery/health visiting
assessment identifies that the
family will require core child
care/health visiting/midwifery
services with limited extra
intervention from other agencies,
i.e. Social Care (Children’s
Services)
Midwife to discuss with health
visitor, GP and other professionals
involved with family, or as
appropriate
All professionals involved with the
family who have an input into the
assessment should be kept
informed of the current
information and stage of
assessment. Health visitor to
make contact with family as soon
as possible. Joint assessment with
midwife plus other professionals
as appropriate. It may be
necessary at this point to consult
with Social Care (Children’s
Services).
Concerns must be monitored and
evaluated and additional advice
taken if necessary. Assessment
should identify concerns and plan
intervention to reduce risk
Midwife should maintain contact
with family and professionals, and
take lead role in continuing
assessment , monitoring and
intervention. Services will be
determined according to need
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Updated Feb07
Appendix E
MEDIUM/HIGH LEVEL OF CONCERN
The assessment indicates that this may be a child in need or at risk of significant harm who is
unlikely to achieve and maintain a reasonable standard of health and development without high
level intervention from a number of different services. There is an indication that there is a
likelihood of impairment of health and development.
Midwifery
Assessment
(booking-in)
2nd trimester
14-28 weeks
Ongoing midwifery
assessment. Inform
GP, health visitor &
other relevant
professionals
Communication and
consultation with all
professionals
involved with the
family. Joint
assessment between
health visitor &
midwife plus
appropriate others
including escalation
of concerns outside
of health
During the early antenatal period,
the midwife must inform health
visitor, GP and other relevant
professionals, i.e. Social Care
(Children’s Services) about the
outcome of her initial assessment
and the analysis of risk. An early
consultation with the children’s
social care may be appropriate to
take advice regarding
referral/intervention, particularly if
other children in the family or
concerns regarding mother’s well
being
All professionals involved with the
family who have an input into the
assessment should be kept informed of
current information and stage of
assessment. Health visitor must make
contact with family as soon as possible.
Ongoing assessments should be reviewed
or made jointly between midwife and
health visitor and include consideration
of further consultation with or referral
to children’s social care. If a referral to
Social Care (Children’s Services) is
necessary, the contact must be made at
the earliest opportunity to enable an
early planning meeting to look at the
common framework assessment. A
strategy meeting should be convened
and a child protection/planning meeting
arranged if necessary
3rd trimester
28- birth
N/B If concerns of substance misuse
(drug/alcohol), then substance misuse
assessment must be completed and
specialist midwife informed
Liaison with all
professionals
involved with family.
Intervention as
planned
T:Paeds SNM/Protocols/concerns for welfare of unborn babies
Ongoing assessment and intervention as
planned. Midwife and health visitor to
ensure there is close liaison regarding
assessed risk, plan for delivery and
perinatal period. If child protection
conference is necessary, it should be
held at a time that will optimise the
planning for assessment and ongoing
intervention with the parents/family.
This may be before 24 weeks if specific
risk to the mother or unborn baby is
identified
Updated Feb07