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1. Pre-birth Multi-Agency Procedures

UK law does not legislate for the rights of the unborn baby. In some circumstances, agencies or individuals will be able to anticipate the likelihood of significant harm with regard to an expected baby.

Such concerns should be addressed as early as possible to maximise time for:

  • Full assessment, including establishing the whereabouts of any previous children;
  • Enabling a healthy pregnancy;
  • Supporting the parents so that (where possible) they can provide safe care.

2. Recognition

Where agencies or individuals anticipate that prospective parents may need support services to care for their baby or that the baby may be likely to suffer Significant Harm, a referral to Children’s Social Care must be made at the earliest opportunity – see the Making Referrals to MASH Procedure, Referral Process for Children in Need of Protection.

A referral must always be made in the following circumstances where:

  • There has been a previous unexplained death of a child whilst in the care of either parent;
  • A parent or other adult in the household 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 or previous child protection concerns;
  • A sibling has previously been removed from the household either temporarily or by court order;
  • There are maternal risk factors, e.g. denial of pregnancy, avoidance of antenatal care (failed appointments), non-cooperation with necessary services, non-compliance with treatment with potentially detrimental effects for the unborn baby;
  • Other children in the household are open to Children’s Social Care.

Referrals must be considered in the following circumstances where:

  • There is knowledge of parental risk factors including substance misuse, mental illness, domestic violence;
  • There are concerns about parental ability to self care and/or to care for the child e.g. under 16 year old parents or learning disabled parents;
  • Any other concern exists that the baby may be likely to suffer Significant Harm, e.g. home circumstances, neglect of pets.

Where the concerns centre around a category of parenting behaviour e.g. substance misuse, the referrer must make clear how this is likely to impact on the baby and what risks are predicted.

Delay must be avoided when making referrals in order to:

  • Provide sufficient time to make adequate plans for the baby’s protection;
  • Provide sufficient time for a full and informed assessment;
  • Avoid initial approaches to parents in the last stages of pregnancy, at what is already an emotionally charged time;
  • Enable parents to have more time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
  • Enable the early provision of support services so as to facilitate optimum home circumstances prior to the birth.

3. Response

All pre-birth referrals to Children’s Social Care should be subject to an Early Help Assessment (EHA).

A multi-agency Strategy Meeting must be held in the circumstances described at paragraph 1.3 where child protection concerns are identified.

When the referral is made for a parent(s) under 18, consideration must be given to the need to provide services for them in their own right.

4. Pre-birth Multi-Agency Strategy Discussion

This discussion should be in the form of a meeting chaired by a Manager from Children’s Social Care and include:

  • Community midwife or Maternity Services representative;
  • Health visitor;
  • Police;
  • Social worker;
  • Other professions as appropriate, e.g. obstetricians, mental health services, probation.

The purpose of the meeting is the same as that of other Strategy Discussions and should determine:

  • Particular requirements of the pre-birth Single Assessment;
  • Whether a Section 47 Enquiry is to be initiated;
  • Role and responsibilities of agencies in the assessment;
  • Identity of responsible social worker to ensure planning and communication of information;
  • Timescales for the assessments and enquiries, bearing in mind the expected date of delivery;
  • How and when parent/s are to be informed of the concerns.

Subsequently Children’s Social Care will lead in undertaking the Core Inter Agency Procedures as contained in Action to be taken where a Child is Suffering or Likely to Suffer Significant Harm – Section 47 and, as appropriate, the subsequent chapters of Part 1 of this manual.

5. Practice Guidance – Pre-Birth Assessment and Risk Factors

Model for Assessment

The assessment should, as well as having components from the individual disciplines,be based upon the Assessment Framework and should include all the dimensions of the three domains, including strengths and risk factors. Antenatal assessment should include both parents and the wider family and environmental factors.

Risk Factors to be Considered when Undertaking a Pre-Birth Assessment of Risk

Unborn Baby

  • Special / extra needs;
  • Premature birth.

Parenting Capacity

  • Negative childhood experiences;
    • Abuse in childhood;
    • Denial of past abuse.
  • Drug / alcohol misuse;
  • Violence / abuse of others;
  • Abuse / neglect of previous child(ren);
  • Previous children removed;
  • Age – very young parent / immature;
  • Unwanted/concealed pregnancy;
  • Unwanted/unconcealed pregnancy;
  • Lack of awareness of baby’s needs;
  • Unattached to unborn baby;
  • Unrealistic expectations;
  • Exhibit inappropriate parenting plans.
  • Mental ill health;
  • Learning disabilities;
  • Physical disabilities / ill health;
  • Postnatal depression;
  • Abuse or neglect of animals;
  • History of poor self care;
  • Poor literacy skills;
  • Inability to prioritise baby’s needs;
  • Poor antenatal care;
  • No plans.

Family / Household / Environmental

  • Domestic violence;
  • Violent or deviant network;
  • Poor impulse control;
  • Unsupportive of each other;
  • No commitment to parenting.
  • Relationship disharmony / instability;
  • Multiple relationships;
  • Poor engagement with professional services;
  • Frequent moves of house;
  • History of offending.

Strengths/Protective Factors to be Considered when Undertaking a Pre-Birth Assessment of Risk

Unborn Baby

  • No special or expected needs.

Parenting Capacity

  • Positive childhood;
  • Evidence of change in previous violent behaviours/relationships;
  • Acknowledges seriousness and responsibility without deflection of blame onto others;
  • Full understanding and clear explanation of the circumstances in which any previous abuse occurred;
  • Realistic expectations.
  • Maturity;
  • Presence of another safe parent;
  • Cooperation with professionals;
  • Insight into the possible effects of abuse on children;
  • Recognition and understanding of any potential risk to their child;
  • Appropriate preparation;
  • Understanding or awareness of baby’s needs;
  • Unborn baby’s needs prioritised.


  • Mutually supportive relationship;
  • Stable, non-violent relationship;
  • Protective and supportive extended family;
  • Supportive community.
  • Family/extended network supportive of successful efforts to address issues and secure changes (e.g. drugs/violence);
  • Appropriate balance of power in relationship;
  • Commitment to equality in parenting.


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