Special Report: The 'acute pain and stress' of removing newborn babies at birth revealed

When a baby is removed from their families at birth for care proceedings, it causes "acute pain and stress" to everyone involved from families to professionals, an evidence and case law review published by the Nuffield Family Justice Observatory has found.
The number of newborn babies who are subject to care proceedings in England and Wales has more than doubled in the last decade, previous research by the Nuffield FJO found.
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.”
When there are safeguarding concerns regarding an unborn child, local authorities and related agencies can intervene during pregnancy. This is meant to assess the risk to the baby following their birth and mitigate any potential issues by providing tailored support to the parent/s. If the local authority determines that the concerns are so great that following birth an infant cannot remain safely in his or her parents’ care, action may be taken to remove the baby from his/her parents.
The number of newborn babies taken into care has doubled
The Nuffield FJO Born into care England report found that care proceedings were issued to 1,039 newborn babies - 32% of all cases involving infant age under one year - in 2007/8. By 2016/17, this number had more than doubled at 2,447 newborns representing 42% of all infant cases. The report also found that there were also significant regional differences.
Based on an overall rate (2008-2016), Yorkshire and Humber and the North West recorded the highest incidence rates, with overall rates above 30 cases of care proceedings concerning newborns, per 10,000 live births in the general population. In contrast, in London and the South East there was the lowest overall rates at 18 newborns per 10,000 live births and 20 per 10,000, respectively.
The likelihood of a child coming before the family courts in care proceedings is highest for infants, when the size of the respective child age populations is taken into account. For example, between 2007/08 and 2016/17, the incidence rate was 70 cases of care proceedings per 10,000 infants aged less than one year in the general population, compared to 19 per 10,000 children aged between one and four years old.
However, the latest evidence and case law review warned that given the vulnerability of infants and their mothers in the immediate post-natal period, issuing care proceedings at or close to birth is fraught with moral, ethical and legal challenges.
Without effective, timely assessment and support during pregnancy, intervention at birth is likely to be poorly planned and can result in instability for the new baby and huge distress for family members.
Yet despite the complexity surrounding the practice of removing newborns from their parents at birth, the report found that there is scant reference to either pre-birth assessment or removals at birth in national statutory guidance.
More than half of newborns taken into care did not have a sibling already subject to care proceedings
As a result, the Nuffield FJO carried out a rapid evidence review to identify key messages from research concerning birth parents’ and professionals’ experiences and perspectives of pre-birth assessment and infant removal at, or shortly following birth. The review wanted to identify key messages and provide an insight into system-level challenges. The studies were primarily conducted in England and Australia, but also in Canada, USA, Northern Ireland and Scotland. The review largely focused on birth mothers in the community, although two studies involved removals at birth from mothers in prison. A substantial proportion of literature is based on the perspectives of birth mothers with drug and alcohol problems.
The review said it was important to ascertain how many newborns were “subsequent infants”, meaning that an older sibling had already appeared before the courts in s.31 proceedings. While 47%of newborns between 2012/13 and 2016/17 were “subsequent infants”, 53% of newborns did not have siblings who had already been subject to care proceedings.
"If the court has not already dealt with an older sibling, this raises the question of the basis of a claim of likely significant harm. For infants whose family is new to the court, pregnancy provides only a short window for the assessment of parenting capacity and support for change," said the report.
More cases of care proceedings concerning infants completed within 26 weeks over time. In 2012/13, only 28% of cases concerning newborns completed within the statutory time frame of 26 weeks, whereas in 2016/17, this increased to 61%. The duration of care proceedings reduced over time for all infants and children given a new statutory timescale for the completion of care proceedings introduced under the Children and Families Act 2014. However, a greater proportion of cases concerning newborns completed within 26 weeks, than cases for older infants in the dataset.
Almost half of newborns taken into care were placed for adoption
The review revealed that 39% of newborn cases in 2016/17 exceeded the 26 weeks statutory timescales and recommended that further qualitative research is needed to understand why newborn cases do or do not complete within 26 weeks and the grounds for seeking more time in the longer running cases.
Almost half of all newborns recorded the final legal outcome: “placed for adoption” meaning the percentage of placement/adoption orders was also highest for newborns than for all other age bands of infants.
Fewer newborn babies were placed “with extended family” than for older infants. The total percentage of all orders for newborns falling into this category was 21%.
The report said that it is important to note that whether care proceedings were issued for newborns or later in infancy, a similar (albeit small) percentage of cases recorded the final legal order: “with parents”. For example, a total of 13% of all orders made for newborns fell into this category and a similar percentage was recorded for infants aged 39 to 52 weeks at 14%.
The literature provided some consistent and important key messages for practitioners, policy makers and researchers.
Firstly, there is delayed response and insufficient time for robust pre-birth assessments. There is a shortened window for assessment which, the report says, appears to be due to unborn babies being considered a lower priority than other children. This provides insufficient time for parents and professionals to make changes and support change in parenting capacity, promote the health and well-being of the unborn child and potentially divert cases from care proceedings.
The review suggests that front line agencies should ensure a consistent and earlier response to pregnancy to ensure that mothers and fathers and wider family members are given support at a timely point, which may catalyse change. However, it notes that workers may not always possess enough knowledge or access to guidance and tools to support effective early assessment and intervention in pregnancy.
Distressing experience
The review emphasises the importance of effective, collaborative relationships. Professionals and birth families valued practice predicated on trust, honesty and openness. Birth mothers feared 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.
The review highlighted the psychological impact that state intervention has on birth mothers and babies, saying; "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 review also points to the emotional impact that this challenging work has on professionals - and which was felt most acutely by midwives - with studies noting the importance of support and supervision for all staff involved.
There was also insufficiency of current levels of professional knowledge and guidance. The review suggests gaps in both professionals’ substantive knowledge in relation to the assessment processes and, in the case of midwives, the mechanisms of child protection processes. There is also variation in national and local guidance pertaining to pre-birth assessment and intervention following birth contributes to a lack of clarity.
Lack of research about social workers' experiences
The review revealed gaps in research and said while 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.
There is limited research on birth parents’ perspectives and the literature which is available is largely focused on the experiences of birth mothers and in particular, pregnant women with problems of substance misuse. There is a paucity of literature on the experience of fathers and extended family members.
There is very little evidence of birth parents’ and professionals’ experiences specifically where an infant is separated from his or her parents at, or near, birth. With regards to professional perspectives, the literature is weighted towards midwives and other health professionals, with a smaller number of studies concerning social workers. The review said this is "surprising, given the central role played by this group in state intervention during pregnancy and at birth".
"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," the report concluded.
Pre-birth assessment and infant removal at birth: experiences and challenges

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