Pregnant women in Wales who are at risk of having their baby being taken into care in the first year of the child’s life are far more likely to have experienced mental health problems in comparison to other pregnant women, research has found.

In fact, over half (53 per cent) of women whose children were at risk of being taken into care reported an existing mental health condition at their initial antenatal assessment, and over three-quarters (77 per cent) had a GP or hospital contact or admission related to mental health at some point prior to their child’s birth, the report by the Nuffield Family Justice Observatory found.

Lisa Harker, director of Nuffield FJO, said: “These new findings show that the sharp rise in the number of babies being taken into care is as much a mental health crisis as it is a parenting crisis. It underscores the need – and highlights the opportunity for – timely and enhanced support. If help can be provided to women, especially when they report with health concerns early in pregnancy, it may be possible to reduce the number of infants taken into care.”

In Wales, the number of infants appearing in care proceedings at birth, or in the first year of life, is increasing, and there is growing recognition that parents need to be supported pre-birth if these numbers are to be reduced.

The report, ‘Born into care: One thousand mothers in care proceedings in Wales,’ looked at more than 1,000 birth mothers whose babies appeared in care proceedings before their first birthday. Researchers looked back at maternal health and well-being in and before pregnancy, interaction with maternity services, and birth outcomes, in comparison to other pregnant women in the general population.

The report found:

- Over half (53 per cent) of the pregnant women at risk of care proceedings reported an existing mental health condition at their initial antenatal assessment – compared to 17 per cent in the comparison group.

- More than three-quarters (77 per cent) had a mental health-related GP or hospital contact or admission recorded in their health records prior to their child’s birth – twice the proportion of pregnant women in the general population (38 per cent).

- Furthermore, 38 per cent had a GP or hospital contact or admission relating to substance use before their child’s birth compared with six per cent in the general population group.
63 per cent were smokers at booking and 60 per cent at childbirth compared to 17 and 15 per cent, respectively, of mothers in the comparison group.

- Despite the multiple health and well-being issues, babies of mothers at risk of care proceedings do not appear to be significantly less healthy than their peers at birth 97 per cent were in a good physical condition immediately after birth, compared to 99 per cent of babies born to mothers in the comparison group. However, slightly more were born pre-term and with low birth weights.

The report also provides new statistics on how mothers of children involved in family court proceedings interact with maternity services. Anecdotal evidence suggests this particular group of women delay contact, or may even conceal their pregnancy out of fear that children’s services will remove their baby at birth. However, the findings challenge this assumption, with a significant proportion of mothers interacting with antenatal services at a timely point.

Almost two-thirds had booked an initial assessment by the end of the 12th week compared to 87 per cent of mothers in the comparison group – and sufficiently early in pregnancy to enable timely intervention and support. Only five per cent reported a very late initial assessment at or after 30 weeks.

The report aims to improve pre-birth support and deliver better outcomes for children and families. The key message from this study is that women’s mental health needs must be far more central in pre-birth assessment and support.

The report also makes several recommendations including;

- Social work pre-birth assessment must be attuned to maternal mental health and broader well-being. Consultation with social workers around these findings is an important next step, to ascertain whether they feel able to identify and respond to maternal mental health, and to identify any professional training needs.

- Smoking cessation programmes need to further understand barriers to stopping smoking during pregnancy, which may be particularly difficult for women with mental health issues.

- There is clear opportunity for more intensive, earlier engagement with women at risk of becoming involved in care proceedings, at an earlier point. It is critical that mothers seeking early engagement receive a holistic response from midwifery services at booking, including timely referral to early help services in pregnancy, and where appropriate to children’s social care.

- A smaller group of mothers require additional and targeted support or encouragement to ensure timely engagement with antenatal services.

One of the authors Dr Lucy Griffiths from Swansea University said: “Welsh policy makers and practitioners require an evidence-informed picture of families involved in the family justice system in order to tailor services more closely to their needs, and to make the best decisions. Previously, very little was known about mothers in care proceedings in terms of their overall health and well-being before or during pregnancy, pregnancy outcomes, engagement with antenatal services or age profiles. This report, the third in the ‘Born into care’ series, provides a better understanding of the needs and vulnerabilities of mothers, and will help guide the intervention that might be needed. It also sets the scene for more in-depth analyses; further insights on child and maternal health soon after birth and in the longer term are needed, especially given evidence that a history of mental health during pregnancy, as well as substance use, can increase the risk of poorer child outcomes.”

The study was commissioned by Nuffield FJO and undertaken by the Family Justice Data Partnership which is a collaboration between Lancaster University and Swansea University.

Born into care: One thousand mothers in care proceedings in Wales