Social Worker and Midwife Decision Making Regarding Child Protection Risk and the Unborn Baby: A Qualitative Study

Abstract

A newborn baby is vulnerable to abuse and neglect, and the professional role may involve assessment before the baby is born. The aim of this paper is to explore the perspectives and experiences of midwives and child protection social workers regarding the protection of unborn babies within Northern Ireland. Data were gathered using four focus groups (14 midwives and 16 child protection social workers) within one Health and Social Care Trust. The data were analysed in terms of understanding risk factors and forming a professional judgement. The mental wellbeing of the pregnant woman, drug use, alcohol use, domestic violence, the pregnant woman's childhood experiences, gestation period and antenatal care attendance were the main risks identified. Observations, engaging with the pregnant woman and using ‘soft intelligence’ were key aspects in forming a professional judgement. The appraisal of the ability of the pregnant woman to recognise danger was an important moderating factor, and perhaps formed part of a professional judgement heuristic to assist in making sense of wide‐ranging information about diverse risks. Key Practitioner Messages Identified risk factors included mental wellbeing, age, feelings about the pregnancy, drug and alcohol use, domestic violence, the pregnant woman's childhood experiences, gestation period and antenatal care attendance. Pregnant women were unable to recognise the dangers in misusing illegal or prescription drugs, excessive alcohol consumption and initiating/maintaining relationships with sex offenders. Key skills in forming a professional judgement involved engagement with the pregnant woman, professionals' experience and observations, and the use of ‘soft intelligence’.

Judgements of health and social care professionals on a child protection referral of an unborn baby: Factorial survey

“…In Northern Ireland, it is estimated that between 10-20% of women may develop a mental illness during the perinatal period (PHA, 2017). Mental illness in pregnant women was regarded as important, adding weight to the need for more effective detection and treatment of mental illness in pregnant women to ensure that their babies are not placed at risk and they are supported with their illness (Mc Elhinney et al, 2020). Particular emphasis was placed on the risk to unborn babies from women who were receiving treatment for depression.…”

“…The vignettes were constructed to be representative of the types of child protection cases involving unborn babies that are encountered by professionals in practice. To ensure construct validity and reliability of the survey tool, the independent variables were selected by (1) undertaking a systematic narrative review of the literature; (2) focus groups with HSC professionals (Mc Elhinney et al, 2020); and (3) discussion with management in maternity and children's social work services. A USA professor with extensive experience of factorial surveys in health and social care was consulted on the structure of the independent variables and appropriate levels of independent variables displayed within the vignettes (Figure 1).…”

“…Where there are concerns, they assess the possibility of significant harm from the point where the baby in utero is viable so as to initiate, from birth if necessary, appropriate protective interventions and support to families…." (Lazenbatt & Greer, 2009, Mc Elhinney et al, 2020. Despite approaches to better understanding the epidemiology of child abuse (Jud et al, 2016), professionals seem to rely on their personal experience and multi-professional collaboration as primary methods to inform their judgements, whilst also managing the fear of judicial review if there are challenges to decisions (Duffy et al, 2006;Trocme et al, 2016), Taylor & Campbell, 2011).…”

Vulnerable Children and Early Intervention – What about Health Visiting?

“…'Pre-birth risk assessment involves understanding the impact of risks to the unborn infant when concerns arise during pregnancy' reported that some pregnant women were not able to 'see the risks in their behaviour' (Mc Elhinney et al, 2021, p. 104) and that they were unable to 'recognise the dangers in misusing illegal or prescription drugs, excessive alcohol consumption and initiating/maintaining relationships with sex offenders' (Mc Elhinney et al, 2021, p. 98). Midwives also described finding it difficult to discuss both current and historical mental health issues with pregnant women and reported that they were not trained or equipped to deal with the deteriorating mental health of a pregnant woman (Mc Elhinney et al, 2021).…”

“…In this study, Mc Elhinney et al (2021) gathered data through four focus groups involving 14 midwives and 16 child protection social workers in one of the five health and social care trusts in Northern Ireland. Focus group discussion centred on identifying risk factors around referrals of unborn babies, risk assessment approaches and decisions to refer.…”