The number of babies and infants subject to care proceedings is growing (Broadhurst and Mason, 2017). At the same time, outcomes for mothers with social care involvement are getting worse, as they fall between gaps in fragmented and overstretched services (Alrouh et al, 2021). As a result, and often in spite of the best efforts of midwives, vulnerable women and their babies are being let down by the systems that are meant to be supporting them.
Mothers separated from their babies are often left to cope with their grief alone, with no support to address the trauma of separation and the issues that may have contributed. This can lead to the rapid escalation of mental health issues, substance use, domestic abuse and criminalisation, and women in these situations are at risk of death by suicide or substance misuse (Knight et al, 2022). In the latest maternal mortality report, 20% of women who died in pregnancy, birth or the year after birth were known to social services, up from 12% in 2012-2014 and 17% in 2017-2019 (Knight et al, 2022). More than one in 10 (11%) of those who died by suicide and 59% of those who died through substance misuse had had an infant removed into care and/or ongoing care proceedings. We urgently need to do better for them and their children.
Despite this, most general and specialist services are not designed with these women in mind. Professionals across the health, social care and voluntary sectors are doing admirable work to support women in these circumstances, and their dedication can change lives. But this good practice is not consistent or widespread, and most services are under-resourced and overstretched (Mason and Broadhurst, 2020). For example, many social workers lack specialised knowledge of the particular needs and risks associated with pregnancy and early motherhood (Broadhurst and Mason, 2017). And specialist midwifery roles are under huge pressure.
That is why Birth Companions (2023a) have published ‘the Birth Charter’ for women with involvement from children's social care. This is intended 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.
The charter 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 14 principles to inform and shape policy, commissioning and professional practice, supported by up-to-date evidence and powerful insights from women who have 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. Care should be woman-centred, holistic and culturally appropriate, as well as trauma-informed and trauma-responsive. The support provided should be equitable and respond to specific needs before, during and after separation from a baby.
It is important that women in this position are helped to give their babies the best possible start in life through support from all services as early as possible. This includes appropriate support for mental health, having their birth preferences respected in hospital before, during and after birth, opportunities to bond and form attachment with their baby and retaining or regaining care of their baby where possible.
Women must have their rights upheld and should be helped to understand and engage with every aspect of their involvement with children's social care and the family justice system. They should have access to independent advocacy support, and ways to express concerns, challenge inaccuracies and make complaints about unfair or poor practice.
The need for a national policy
Building on these principles, Birth Companions (2023b) is 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.
Mental health conditions, domestic abuse and substance use are highly prevalent among women who have involvement from children's social care, and there are well-established links between deprivation and care proceedings (Bywaters et al, 2014). The charity sees, day in and day out in their services, the impact that children's social care processes have on women's health and wellbeing. And it is not only women who already have social care involvement, many, including the authors of the maternal mortality report (Knight et al, 2022), have noted that women's fear of social care referral is a huge barrier to disclosure of mental health concerns, domestic abuse and other significant needs.
Women in these circumstances are missing from key health and social care strategies and documents, including the NHS (2019) long term plan, the maternity transformation programme (NHS England, 2023), perinatal mental health services, NHS equity and equality guidance for local maternity systems (NHS England, 2021), National Institute for Health and Care Excellence (2010) CG110 guidance and the government's reform strategy for children's social care (Department for Education, 2023). They are also missing from much relevant research and data.
The government-backed National Bereavement Care Pathway (2023a) sets a powerful precedent. It 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. As of 1 January 2023, 108 NHS England trusts (84%) have committed to adopting the nine National Bereavement Care Pathway (2023b) standards.
Birth Companions (2023b) are delighted to have the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists in calling for a national pathway for social care involvement, 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. The hope is that together, we can use the Birth Charter to drive a national commitment to improving care for 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.