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Analysis

Doing what's best for baby

6 June, 2011

Doing what's best for baby

As more families are being referred to children's services, many midwives are seeing newborns being taken from their mothers in the interest of the child's safety. Whittington Hospital's clinical practice facilitator Gaynor Wood presented her research into this issue at last year’s RCM annual conference. As more families are being referred to children’s services, many midwives are seeing newborns being taken from their mothers in the interest of the child’s safety. Whittington Hospital’s clinical practice facilitator Gaynor Wood presented her research into this issue at last year’s RCM annual conference.


Midwives magazine: Issue 4 :: 2011

Illustration: Darren Hopes



Little has been written about child protection (CP) in midwifery literature, especially around the subject of removing babies at birth for safeguarding. I had completed qualitative research into CP issues as part of my MSc in midwifery and wanted to present my findings nationally – I achieved this at the RCM’s annual conference. 

My aims were to:
✼ Acknowledge the difficulty and multi-faceted approach of the midwife role
✼ Raise the profile of midwives working in CP cases
✼ Provide recommendations for future research.
Following Lord Laming’s progress report (2009) on CP, there has been a 2% rise in initial referrals to children’s services and a 9% rise in initial assessments for CP plans. In 2008, there were 29,000 children subjected to these plans, which rose to 34,100 in 2009.

Although Lord Laming’s report recognised the complex environments in which professionals work, it made no provisions for the challenging financial times ahead in the NHS and children’s services.

Presenting the findings
To gain insight into how CP issues affect midwives, I conducted face-to-face, semi-structured interviews with nine midwives in a variety of clinical roles, who had worked with vulnerable families. The setting was an acute London hospital with 4000 births a year.

My research was informed by Husserlian phenomenology and, as I examined the data, themes began to emerge, which I clustered using the Colaizzi method of data analysis (Colaizzi, 1978). The themes were:
✼ Identification of vulnerable family
✼ Gut feelings and instincts
✼ Understanding the midwife’s role
✼ Collaborative working/support.
The midwives shared their experiences of removing babies at birth – a ‘voice’ within CP that is often overlooked.

From my research, it was clear that midwives often understood that their agreed role in this situation could be positive. ‘I’m comfortable with that child being removed and play whichever part I have to. It seems hard at the time, but I don’t think there’s any easy way to remove a child,’ said one (B).

Frost and Robinson (2007) said that the multidisciplinary aspect of working together with families is demanding, but can be successfully managed. Another (F) reported: ‘I have a very important role with regards to the women, but I am also in tune with the fact that I have a professional duty to protect the baby and, nine times out of ten, babies are not removed unless
there is a good reason to do it.’

She (F) pointed out how important it was that the team understood each other: ‘The social workers need to have more of an insight into the effects that it may have on a midwife, because it is the most unnatural thing to do in the world, to deliver a baby and then take it off the mother.’

There were no recorded acts of physical violence towards midwives, but the fear of it was present: ‘A midwife on a labour ward may just see her role as delivering the baby. But sometimes it’s quite hard when you fear for your own safety’ (C).

Another (B) said: ‘The baby was born, passed to another midwife who was behind a curtain... the police were standing outside.’

The importance of working collaboratively, respecting diversity, promoting equality, providing a child-centred approach that promotes participation of families in the process (as outlined in the government’s guidelines (DCSF, 2010)) cannot be forgotten. As one midwife (C) attests: ‘I feel that it is not my role to tell the client about her baby not being with her... I don’t have any qualms taking the baby, as long as she knows beforehand that this is what’s happening.’ 

Discussion points:
✼ There was no clear consensus of who should remove a baby at birth – midwife, police, social worker, paediatric team
✼ Each trust differs in where the baby is looked after in those first crucial hours of life – neonatal intensive care unit, postnatal ward, nursery, midwives’ office
✼ No clear guidance is given on how much time a mother should spend with her baby before it is removed from the birthing room. CP plans should individualise this
✼ Midwives have equated the effects of the removal of a baby to that of bereavement.


Key Recommendations
✼Care plans with the multidisciplinary team and family should be agreed where appropriate
✼Clear documentation and plans should be available to midwives prior to the event
✼A place of safety should be defined for the baby
✼Ongoing support for those who are present at the time of removal is required
✼There is a need for inter-disciplinary/multi-agency training specialising in unborn/newborn issues
✼Ongoing research into this phenomenon from a midwifery perspective is needed
✼Supervisor of midwives can offer 24-hour support for out-of-hours child protection cases.


References


Colaizzi P. (1978) Psychological research as the phenomenologist views it: In: Valle R, King M.
(Eds.). Existential phenomenological alternatives for psychology. Oxford University Press: New York: 48-71.

Department for Children, Schools and Families. (2010) Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. HMSO: London.

Frost N, Robinson M. (2007) Joining up children’s services: safeguarding children in multi-disciplinary teams. Child Abuse Review 16: 184-99.

Lord Laming. (2009) The protection of children in England: a progress report. See: http://www.education.gov.uk/publications/eOrderingDownload/HC-330.pdf (accessed 23 May 2011).


Further reading

Bowlby J. (1981) Attachment and loss. Volume 3: Loss. Penguin: Harmondsworth.

Craft A. (2007) Working together to protect children: who should be working with whom? Archive of Diseases in Children 92(7): 571-3.

Fraser J, Nolan M. (2003) Child protection: guide for midwives. Books for Midwives, Oxford.

Klaus HM, Kennel JH. (1982) Parent-infant bonding (second edition). CV Mosby: St Louis.

Masson J, Oakley M, Pick K. (2004) Emergency protection orders: court order for child protection crises (executive summary). See: www.nspcc.org.uk/inform/publications/downloads/eposummary_wdf48088.pdf (accessed 27 May 2011).

Wood G. (2007) Child protection issues: the role of the midwife in safeguarding children. MIDIRS 17(2): 169-74.

Wood G. (2008) Taking the baby away. Removing babies at birth for safeguarding and child protection. MIDIRS Midwifery Digest 18(3): 311-9.





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