Guidelines to be developed on removal of newborn babies amid concerns over inconsistent practice, misunderstandings of legal framework

The Nuffield Family Justice Observatory (Nuffield FJO) is to develop the first national, evidence-informed good practice guidelines for health and social work professionals involved in the process of removing newborn babies from their mother at birth for child protection reasons.

The move follows a rapid evidence review and a case law review that showed “the acute pain and stress experienced by all involved in cases where a baby is removed from their mother at birth – both family and practitioners”, it said. 

Previous Nuffield FJO research has revealed the increasing numbers of newborn babies who are subject to care proceedings in England and Wales.

Its Born into care England report found for example that in 2007/8, care proceedings were issued with respect to a total of 1,039 newborns (32% of all cases involving infant age under 1 year). By 2016/17, this number had more than doubled at 2,447 newborns (42% of all infant cases). There were also significant regional differences.

Nuffield FJO said: “Many cases in the new reviews demonstrate the effectiveness of the current legal framework in protecting children, but the studies also reveal evidence of inconsistent practice, such as delays and insufficient time for robust pre-birth assessment, misunderstandings of the legal framework or a failure to follow due process, which can lead to insensitive practice or injustice.”

The guidelines will be developed over the next 18 months by researchers at Lancaster University and the Rees Centre at the University of Oxford, led by Professor Karen Broadhurst.

The guidelines will then be piloted in eight local authorities and health trusts during a six-month period and used in at least 30 child protection cases involving newborn babies.

Nuffield FJO said the ambition was for the guidelines to be adopted and developed into guidance by local authorities, health authorities, the police and the judiciary throughout England and Wales, and for local authorities and the judiciary to understand why so many infants are being taken into care and to explore measures to prevent this.

The case law review found that all the 28 cases analysed had demonstrated “a need for an improved and more co-ordinated response to ‘removal at birth’ and for more attention to be paid to addressing the impact of complex trauma evident in so many of the parents who experience recurrent care proceedings.”

The rapid evidence review meanwhile identified key messages of immediate relevance for practitioners, policy makers and researchers:

1. Delayed response and insufficient time for robust pre-birth assessment: “A shortened window for assessment – which appears to be due to unborn babies being considered a lower priority than other children – provides insufficient time for parents and professionals to make changes/support change in parenting capacity, promote the health and wellbeing of the unborn child and potentially divert cases from care proceedings.”
2. The importance of effective, collaborative relationships: “Professionals and birth families valued practice predicated on trust, honesty and openness. Birth mothers were sensitive to feelings of being judged by practitioners, and both health professionals and social workers placed significant emphasis on non-judgemental practice in building more positive relationships. Professionals recognised the importance of both collaborative working and effective information sharing.”
3. The psychological impact that state intervention has on birth mothers and babies: “The separation of an infant at birth from his or her mother, father and indeed wider family, is an acutely distressing experience for all concerned. The literature also points to the emotional impact that this challenging work has on professionals (felt most acutely by midwives), with studies noting the importance of support and supervision for all staff involved.”
4. Insufficiency of current levels of professional knowledge and guidance: “Findings suggest gaps in both professionals’ substantive knowledge (relevant to assessment processes) and, in the case of midwives, the mechanisms of child protection processes. Variation in national and local guidance pertaining to pre-birth assessment and intervention following birth contributes to a lack of clarity.”
5. Research gaps: “Although it has been possible to derive some key and important messages from the published research, there is an overall sparsity of literature, and some significant gaps to address….. Further research is needed to respond to the concerns raised in this review, to ascertain the extent to which shortfalls in practice are widespread, and to identify and develop good practice. An inclusive approach to the development of best practice principles would serve to ensure the voice of families helps shape service intervention in the challenging circumstances of both pre-birth assessment and removal of infants at birth.”

Lisa Harker, Director of the Nuffield Family Justice Observatory, said: “Over the past decade there has been a sharp rise in infants in care proceedings, with marked regional variation in the number of cases. In this context, the Nuffield Family Justice Observatory is working in partnership with local authorities to understand the reasons behind these increases and variations, and to support the development of good practice.”

Professor Karen Broadhurst, lead researcher on the Born into care project said: “This new Nuffield FJO project promises to make a real difference to the experience of infants and family members, when local authorities take the very difficult decision to issue care proceedings at birth.”