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Why pre-birth assessment?

28 May 2019

Mary Ryan and Claire MasonClaire Mason and Mary Ryan

Intervention in pregnancy, or immediately following birth where there are safeguarding concerns, is one of the most challenging areas of social work practice and is fraught with moral, legal and ethical practice issues.

The lack of legal recognition for the foetus, together with a pregnant woman’s rights over her body, means that although assessment and care planning may take place prior to the infant’s birth, court proceedings to protect an infant can only be initiated after birth. During the pre-birth period, practitioners must skillfully manage the respective rights and needs of mothers and wider family members, whilst maintaining a focus on the welfare of the unborn child.

Despite the complexity of this work, there is no clear national, statutory guidance for health and social care practitioners on pre-birth assessment or safeguarding activity, other than an acknowledgement that planning may need to take place before birth. This lack of national guidance means that local areas have developed their own policies and procedures or protocols and so there is varying practice across England and Wales. There has been some research into practice pre-birth and some assessment models and interventions have been developed, but again knowledge about them is patchy.

Recurrent care

Social workers, lawyers and judges have long been aware that some women return to court as respondents in care proceedings after having already experienced the removal of one or more children in previous proceedings. It is also recognised that a proportion of these women return to court on many occasions and lose multiple children to public care and adoption.

A team at Lancaster University published a final report of a Nuffield-funded research study into Vulnerable Birth Mothers and Recurrent Care Proceedings. The study analysed data held by Cafcass on all care proceedings in England, enabling the researchers to demonstrate the scale of the issue – that one in four birth mothers will reappear in care proceedings, within seven years, following an initial set of proceedings. Qualitative elements of the research included in-depth interviews with mothers and information from a review of case files, improving our understanding about the factors related to women reappearing in care proceedings.

During 2017-18 we were also involved in delivering the Research in Practice Change Project on recurrent care. This has recently released a new publication and web resource, including summary research findings, PowerPoint slide presentations, case studies, exercises, short film clips, tools, materials provided by participants and links to other resources or sources of information.

We have also recently been involved in the production of the Born into Care study, which provided the first published information on the number of newborns involved in care proceedings between 2007 and 2017. The Born into Care study launch event in October 2018 demonstrated the interest in this issue and the concern among practitioners about the variation in practice in perinatal assessment and intervention. 

Pre-birth assessment workshops

A clear need to develop evidence-informed pre-birth assessment practice has been identified. In the upcoming Research in Practice Knowledge Exchange sessions, we will enable a two-way interaction between research and practice experts to build local practice, shape Research in Practice outputs on this topic and inform the work of the Family Justice Observatory.

The one-day workshops will provide an opportunity for participants to hear about recent research pertinent to pre-birth assessment practice and share their own experiences of working in this area within their local authority. The day will include presentations of recent research about infant removal at birth, information about the legal issues that need to be considered and highlight models of pre-birth assessment, their theoretical basis, what they offer and how they differ.

The events will be interactive, participants will have the opportunity to learn about practice in each other’s local authorities and comment on different models of assessment and intervention and suggest alternative approaches. Participants will be signposted to other useful resources and tools to help inform their pre-birth assessment planning. Once all four events have taken place we plan to use the information gathered to develop a Research in Practice resource on the topic of pre-birth assessment and intervention

Who is delivering the sessions?

The sessions will be delivered by Mary Ryan and Claire Mason, senior associates of Research in Practice. We are also both members of the development team for the Nuffield Family Justice Observatory.


About the authors

Claire Mason is a senior research associate at the Centre for Child and Family Justice Research at Lancaster University. She was lead researcher in the team who carried out the national research into women who experienced repeat care proceedings and repeat removal of their children.

Mary Ryan is an independent consultant, whose work involves research, evaluation and policy development. She is a lawyer who, when in practice, specialised in public law relating to children. 


Related Research in Practice resources and events

Pre-birth assessment: Knowledge Exchange Workshops

11 June, Birmingham: view details

12 June, London: view details

1 October, Manchester: view details

15 October, Bristol: view details 

Working with recurrent care-experienced birth mothers: Online resources (open access)

Working with recurrent care-experienced bith mothers: Resource Pack

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