Kirsty Kitchen, head of policy at Birth Companions, emphasises the need for a better approach to working with women during pregnancy and early motherhood.

The needs of women who have involvement from children’s social care when they are pregnant or during the first two years of their child’s life are acute, yet all too often overlooked in the midst of siloed and overstretched services. That must change if we are to reverse deeply concerning trends: the increasing rate of infants subject to care proceedings; worsening maternal outcomes; and growing numbers of women who die during pregnancy, birth and the year after birth while subject to ongoing child protection proceedings or having had a child removed.

There is plenty of evidence to show us how vulnerable these women are. And it’s not only women who already have social care involvement; many have noted the fact that women’s fear of having their babies removed is a huge barrier to disclosure of mental health concerns, domestic abuse, and other significant needs.

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.

Despite the best efforts of many professionals across social care, health and the voluntary sector, many services struggle to identify and address women’s needs in pregnancy and early motherhood where there is social care involvement. As a result, pathways of care are fragmented and incomplete. Specialist focus and dedicated services are required in order to improve poor maternal and infant clinical and public health outcomes, reduce trauma, and disrupt intergenerational cycles of disadvantage for these mothers and their babies.

That’s why we at Birth Companions have published The Birth Charter for women with involvement from children’s social care, setting out fourteen principles to inform 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 two with involvement from children’s social care should:

Receive support that is

1. specialist and continuous during pregnancy, birth and early motherhood

2. woman-centred, holistic and culturally appropriate

3. trauma-informed and trauma-responsive

4. equitable

5. responsive to specific needs before, during and after separation from their baby.

Be helped to give their babies the best possible start in life through

6. support from all services as early as possible

7. appropriate mental health support

8. having their birth preferences respected

9. appropriate support in hospital before, during and after birth

10. opportunities to bond and form attachment with their baby

11. retaining or regaining care of their baby where possible.

Have their rights upheld through

12. help to understand and engage with every aspect of their involvement with children’s social care and the family justice system

13. access to independent advocacy support

14. 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 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. This would be trauma-informed and woman-centred, to be embedded and locally adapted by Integrated Care Systems. As social care involvement can act as a proxy indicator for a range of particularly acute social factors, this work would also support learning and inform service delivery to address health inequalities more widely.

With the support of powerful voices, including the Chief Social Worker for Children and Families in England, the Association of Child Protection Professionals, the Royal Colleges of Midwives, and Obstetricians and Gynaecologists, and prominent family law professionals, we hope the Birth Charter will help reshape the care given to women. 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.