4.8 Concealed Pregnancy and Pre-Birth Safeguarding

 1. Concealed Pregnancy

1.1 Introduction

There is no single accepted definition of a concealed pregnancy, but it covers situations where a woman, through fear, ignorance or denial, does not accept, or is unaware of, her pregnancy. It can include no, or late, engagement with maternity services, such as presenting at hospital in labour or delivering the child with no medical intervention.

It can cover a variety of situations such as:

• undetected: where both the woman and her carers are unaware that she is pregnant;
• conscious concealment: where the woman is aware of her pregnancy and is emotionally bonded to the unborn baby but does not tell anyone;
• conscious denial: where the woman has physical awareness of her pregnancy, but lacks emotional attachment;
• unconscious denial: where the woman is not subjectively aware of her pregnancy and genuinely does not believe the signs of pregnancy or even the birth of the baby.

Women may conceal or deny their pregnancy for a variety of reasons including:

• mental illness or learning disability;
• fear of disapproval of pregnancy / religious or cultural disapproval;
• unwanted pregnancy / too late to terminate pregnancy;
• conception following rape / incest / extra-marital paternity;
• fear around social care involvement following removal of previous child/ren;
• concerns about immigration status / modern slavery or trafficking / language barrier;
• concerns around home situation such as domestic abuse or substance misuse;
• desire for a ‘natural’ birth and objection to medical intervention.

Whilst there is a criminal offence of concealment of birth (the secret disposal of the dead body of an infant to conceal knowledge of the child’s birth), there is no criminal offence of concealment of pregnancy. A woman with mental capacity is free to choose not to engage with maternity services. However, where the woman does not have mental capacity or there is uncertainty as to mental capacity, legal advice should be sought. Lack of mental capacity may be due to factors such as learning disability, mental health or age (see also Mental Capacity and Consent chapter). If the mother is a child herself, a referral should be made to children’s social care. Action may be required to safeguard the mother and / or the child once born. If she is less than 16 years of age, a criminal offence may have been committed and police should be informed for further investigation.

1.2 Risks

Lack of antenatal care presents a risk to the unborn child due to lack of assessment of the maternal history, gestational age and health of the pregnancy, and research has shown that women who do not engage, or engage very late, with maternity services are at higher risk of maternal and foetal complications.

Risks for the baby include:

• prematurity / low birth weight and associated health issues;
• stillbirth / neonatal death;
• exposure to harmful substances in the womb / withdrawal;
• infanticide / neonaticide (the deliberate act of a parent murdering their own child during the first 12 months / 24 hours of life);
• abandonment by mother.

1.3 Referral and assessment

Where there is considered to be a risk of significant harm to the child, a referral to children’s social care should be made (see Referrals chapter). Consideration should be given to the reason for the concealment and a risk assessment of the reason undertaken by means of a multi-agency assessment (see also Assessments chapter).

Previous concealed pregnancies are a risk factor for future concealed pregnancies, and multi-agency information sharing is an important consideration.

2. Pre-Birth Safeguarding

2.1 Risk factors

Action to safeguard a child may be necessary before the child is born where there are concerns around the ability of the parents to effectively care for and safeguard the child once born. This may include:

• concerns around concealment of the pregnancy and the reasons for such concealment;
• concerns relating to the parent/s such as mental ill health; learning disability; substance misuse; young age and vulnerability such as currently looked after or care leavers / victim of criminal exploitation; modern slavery; history of violent and / or criminal behaviour; involvement in criminal activity such as county lines;
• concerns around the home situation such as domestic abuse; unsatisfactory / unsuitable home conditions;
• previous concerns of abuse and neglect, such as removal of previous children / criminal convictions.

2.2 Multi-agency practice

Born into Care: Best Practice Guidelines for When the State Intervenes at Birth (Nuffield Family Justice Observatory) sets out guidelines to inform multi-agency practice when action is taken to safeguard children at birth:

• when there are safeguarding concerns, parents and their unborn baby should be referred to children’s social care quickly, and professional engagement should start early in pregnancy to include a timely offer of specialist support (first trimester);
• case allocation should maximise continuity of professional involvement throughout the pre-birth period and beyond;
• parents and practitioners should co-define needs and goals, and work collaboratively to identify and build on strengths throughout the pregnancy;
• practitioners should work proactively with parents and the family and friend network to provide support matched to identified needs and concerns that may place the baby at risk of significant harm during pregnancy and after birth;
• processes should be initiated in a timely manner to facilitate careful and planned decision making;
• practitioners’ concerns and plans should be shared with parents at every step of the way, including any plan to initiate care proceedings at birth; the understanding of parents should be continually checked;
• practitioners should support parents to access robust, comprehensive and expert legal advice;
• the birth arrangements and plan for the baby after birth should be shared at a timely point. The birth arrangements should contain sufficient detail of the management of risk. Choice and control should be offered to parents wherever possible.

Any practitioner who has concerns about the welfare of the unborn child should discuss with their safeguarding lead and consider whether a referral needs to be made to local authority children’s social care. This should be done without delay if there is a concern that the child is likely to suffer significant harm (see Referrals chapter).

The focus of multi-agency work should be on assessing the ability of the parent/s to protect and care for the child once born, what support needs to be put in place to facilitate this, action needed to safeguard the child and plans for the birth.

An early help assessment may be undertaken to assess what help needs to be put in place. Where there are concerns that the child may be at risk of significant harm once born, a child protection conference should be held to enable agencies to share all relevant information and reach a decision as to whether the child will be made subject to a child protection plan at birth and a core group established to implement the child protection plan (see Child Protection Conferences and the Child Protection Plan chapter).

Timescales should allow for the possibility of premature birth, especially where there are risk factors such as substance misuse by the mother or previous premature birth/s.

2.3 Removal of child at birth

Legal advice must be sought where concerns are such that the child needs to be removed from the parents at birth. Court orders cannot be granted in respect of the child until it is born, but arrangements must be made so that an application for an interim care order can be made as soon as the child is born and / or joint risk assessments to keep mum and baby safe.

A pre-birth planning meeting should be held with relevant agencies to set out the birth arrangements and plan for the baby after birth. This should contain sufficient detail of the management of any risks. The plan should cover necessary steps to safeguard the child immediately after birth, such as:

• action needed to ensure the child’s immediate protection, such as use of police powers of protection where there is a risk that the parents may seek to remove the child from the hospital before the interim care order is obtained. See Immediate Protection chapter;
• meeting the child’s health needs such as managing withdrawal symptoms of babies born to substance-misusing mothers;
• discharge arrangements;
• arrangements for contact between the child, parents and other relevant family members;
• practical arrangements such as contact details of practitioners, out of hours cover and contingency plans.