There are well-established links between maternal deprivation and care proceedings, and high levels of pre-existing trauma, mental ill-health, domestic abuse and substance use among women involved with social care. So it’s sadly not surprising that recent analysis has shown a high and increasing rate of social care involvement among women who die during pregnancy, childbirth and the year after birth. We should all be deeply concerned by these trends, and commit to reversing them with urgency.
We can’t do that without making sure health and social care can work together to address women’s complex needs. The latest MBRRACE report on maternal deaths noted that postnatal support, including mental health services, for women separated from their babies, was severely lacking. For example, women receiving specialist perinatal mental health services lost access to this support when their babies were removed. That report also reiterated something we see every day in our services; that fears of child removal often influence women’s willingness to disclose symptoms of mental ill-health or substance misuse.
While there are pockets of excellent practice, all too often health professionals are not able to appropriately identify or respond to these fears and social workers aren’t able to consider the consequences of their actions on the health of mothers and babies. That’s because the systems they are working in don’t actively support and promote that consideration.
There is no national policy that identifies these specific needs or governs the care of women involved with children’s social care during the 1,001 critical days from conception to a child’s second birthday. They are missing from key health and social care strategies and documents, including the NHS Long Term Plan; the government’s reform strategy for children’s social care; perinatal mental health services; NHS Equity and Equality Guidance for local maternity systems; and NICE CG110 guidance. They are also missing from much relevant research and data.
That’s why we have published The Birth Charter for women with involvement from children’s social care, outlining 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.
Building on these principles, we are 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.
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.
One woman involved in developing the Birth Charter said: “There’s grief therapy. My children aren’t dead, but they’re dead in my life. They are dead in my world. They’re biologically mine, but they’re not mine. There isn’t anything available to deal with feelings like that.”
With the support of powerful voices, including the chief social worker for children in England Isabelle Trowler, the Association of Child Protection Professionals, the Royal Colleges of Midwives, and Obstetricians and Gynaecologists, and prominent family law professionals, there is a real opportunity for the Birth Charter to help reshape the care afforded to women. Compassionate, trauma-informed and fair treatment can mitigate risks for mothers and babies, reduce the number of avoidable separations, and improve health and social care outcomes for women and their children.
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Naomi Delap is director of Birth Companions
