The purpose of a pre-birth conference is to decide whether serious professional concerns exist about the likelihood of harm through abuse or neglect of an unborn child when they are born. The participants need to prepare an inter-agency plan in advance of the child’s birth.
They will also need to consider actions that may be required at birth, including:
- whether it is safe for the child to go home at birth;
- whether there is a need to apply for a child protection order at birth;
- whether the child’s name should remain on the child protection register.
- It should be noted that as the register is not regulated by statute, an unborn child can be placed on the register. Where an unborn child is felt to require a child protection plan, their name should be placed on the register.
- whether there should be a discharge meeting and a handover to community- based supports.
The pre-birth CPCC should take place no later than at 28 weeks pregnancy or, in the case of late notification of pregnancy, as soon as possible from the concern being raised but always within 21 calendar days of the concern being raised. There may be exceptions to this where the pregnancy is in the very early stages. However, concerns may still be sufficient to warrant an inter-agency assessment.
Where a decision is taken to register an unborn child the registration will be reviewed no later than three months from the date of registration, then after reviews will take place six monthly.
How are unborn children identified and assessed?
Any agency or individual who is providing services to a pregnant woman where concerns may exist about the mother’s ability to provide safe care should ensure that their concerns are shared with the relevant midwife. This ensures, not only, the identification of an unborn child who may require additional support and/or protection, but also ensures that the pregnant woman is appropriately linked to anti-natal care. The named midwife for the unborn baby will undertake a pre-birth assessment to assess any risks and consider any unmet needs to ensure appropriate service involvement.
If child protection concerns are identified a referral will be made to social work services prior to 25 weeks of pregnancy. Screening of referrals will be undertaken by health and social work services to determine whether the assessed risks require child protection proceedings to be evoked. Where child protection proceedings are necessary the team leader will place an alert to the child protection register within 24 hours and a CP1 will be completed by a named social worker within five working days. A pre-birth case conference will then be convened within 28 weeks of pregnancy.
Where child protection proceedings are not deemed necessary the named midwife will continue to assess and support the pregnant mother throughout her anti-natal care. The named person for the unborn child will be the midwife up until 10 days post birth where named responsibility for the child will be transferred to the health visitor. In some instances the assessment undertaken by the health visitor will identify unmet needs or risks which may require the intensive involvement of universal services or a multi agency plan.
What does the assessment look like?
Neonatal abstinence syndrome
When mothers have used opiates, benzodiazepines, alcohol or barbiturates on a regular basis during pregnancy there is a likelihood that the baby will be born with neonatal abstinence syndrome – a reaction to the withdrawal of substance/s after birth. Babies with neonatal abstinence syndrome can exhibit a range of symptoms. These include irritability, problems with feeding and sleeping and other difficulties which may lead to the baby being more difficult to care for than the average baby. The symptoms can become apparent shortly after birth, at five-ten days old, or sometimes at up to three weeks old.
If a baby has neonatal abstinence syndrome the key health professional should contact the child protection advisor, health, to discuss and agree action by the health professional.
This will include:
- a referral to the social work services
- discussion with the parents to advise of action to be taken
- sharing of relevant information with other professionals, who are involved with the care of the mother and baby e.g community midwife, health visitor, GP, social worker
If the case is already allocated to a social worker, an assessment undertaken and child’s plan agreed, then discussion should take place between the social worker and team leader, who will determine if the current measures in place require to be reviewed or not.
If there is a need for the plan to be reviewed then the team leader should discuss the case with the co-ordinator, children’s services to decide what action should be taken, if any.
If a post-birth case conference has already been agreed, then the presence of neonatal abstinence syndrome would bring additional concern to the assessment, matters for discussion at the conference. It should be taken into account when formulating the child’s plan or child protection plan, if the child is made subject to registration
If a referral is made to the social work services of a baby with neonatal abstinence syndrome when the mother was not previously known or no assessment was undertaken, the team leader must allocate the case to a social worker with a minimum of delay.
The social worker should undertake an assessment of risk and need with a minimum of delay.