Intended for healthcare professionals

Opinion

We need to focus on the health of women subject to pre-birth and infant care proceedings

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1839 (Published 10 August 2023) Cite this as: BMJ 2023;382:p1839
  1. Naomi Delap, director,
  2. Kirsty Kitchen, head of policy and communications
  1. Birth Companions, Dalton House, London SW19 2RR, UK
  1. info@brthcompanions

Women subject to care proceedings during and after birth are being lost in the system; a national commitment is needed to improve support and health care for these women and their babies, write Naomi Delap and Kirsty Kitchen

The number of babies and infants subject to care proceedings in the UK is growing,1 while the health of their mothers worsens.2 Women experiencing mental ill health, using substances, coping with trauma and abuse, or caught up in the criminal justice system are too often overlooked by services and are falling through the gaps between health and social care.

Failure to fully consider the health needs of women in these circumstances carries huge risk. Research shows a high and increasing rate of social care involvement among women who die during pregnancy, childbirth, and the year after birth.3 MBRRACE-UK’s 2022 report on maternal deaths found that 20% of the women who died between six weeks and a year after the birth of their baby were known to social care services.3 This figure has substantially increased over recent years, up from 12% in 2012-14 and 17% in 2017-19. Eleven per cent of the women who died by suicide and 59% who died through substance misuse had had an infant removed into care or were subject to ongoing care proceedings. For several of the women who died, separation from their baby led to an escalating pattern of mental ill-health, substance misuse, and domestic abuse.

The MBRRACE report found that postnatal support, including mental health services, for women separated from their babies was severely lacking. Women receiving specialist perinatal mental health services lost access to this support when their babies were removed from them. The authors noted that fears of having a child removed often influenced women’s willingness to disclose symptoms of mental ill health or substance misuse. These fears were poorly recognised and responded to by health professionals.

Despite the strength of this evidence, and the centrality of mental health and postnatal support in the Women’s Health Strategy,4 there is still no national policy that identifies the specific needs or governs the care of women involved with children’s social care during the 1001 “critical days” from conception to their child’s second birthday—a period shown to lay the foundations for long term development. These women are missing from key health and social care strategies and documents, including the NHS Long Term Plan, perinatal mental health services, NHS equity and equality guidance for local maternity systems, The National Institute for Health and Care Excellence guidance on pregnancy and complex social factors (NICE clinical guideline CG110), and the government’s reform strategy for children’s social care. They are also missing from or underrepresented in relevant research and data.

We must do better for these women and their babies. Birth Companions has published The Birth Charter for women with involvement from children’s social care to help bring greater attention to the needs of women who are almost entirely overlooked in policy and guidance in the health, social care, and family justice systems.5 The charter was developed with the Lived Experience Team and sets out how services and systems in England should support all women who have contact with children’s social care from conception to their child’s second birthday. It outlines principles to inform and shape policy, commissioning, and professional practice, supported by up-to-date evidence and insights from women with direct personal experience.

The Birth Charter principles

Pregnant women and mothers of children under the age of 2 years with involvement from children’s social care should receive support that is specialist and continuous during pregnancy, birth, and early motherhood. This support must focus on the woman and her individual needs, be holistic, and be culturally appropriate to ensure equitable support. This support must be informed by and responsive to experiences of trauma. It must also be tailored to the specific needs of the mother before, during, and after separation from their baby.

Mothers should be helped to give their babies the best possible start in life. To do this, support should be delivered from all services, including health care, as early as possible. This must focus on the health of mothers and babies by providing appropriate mental health support and respecting the mother’s birth choices. There should be an emphasis on mothers retaining or regaining care of their baby where possible.

Mothers must have their rights upheld by helping them to understand and engage with every aspect of their involvement with children’s social care and the family justice system. This means allowing access to independent advocacy support and having channels for expressing concerns, challenging inaccuracies, and making complaints about unfair or poor practice.

The need for a national policy

Building on these principles, we are calling for a national health and social care pathway for pregnant women and mothers of infants who are subject to pre-birth or parenting assessment or child protection proceedings.

The government-backed National Bereavement Care Pathway sets a strong precedent here.6 The pathway was created to equip healthcare professionals with frameworks, tools, and educational resources to provide the best possible care to parents and families after pregnancy loss or the death of a baby.

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have backed our call for a national pathway, along with support from the Chief Social Worker for Children and Families in England, the Association of Child Protection Professionals, and prominent family law professionals. We hope that together we can use the Birth Charter to drive a national commitment to improving care for this group of women with social care involvement. Compassionate, trauma-informed, and fair treatment could mitigate risks for mothers and babies, reduce the number of avoidable separations, and improve health and social care outcomes for women and their children.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned, not externally peer reviewed.

References