1.2.12 Pre Birth Assessment Tool |
SCOPE OF THIS CHAPTER
This is simply a tool. It is designed to help professionals to carefully consider a range of issues and to tease out issues that have potential for having a significant negative impact on the child.
The word "parent" should be loosely interpreted as appropriate to mean the natural mother and father, the mother's partner, anyone with parental responsibility, and anyone else who has or is likely to have day-to-day care of the child. It is crucial to involve everyone who is a potential parent or carer in the assessment.
This tool draws extensively on the work of Martin C Calder - as described in "Unborn Children: A Framework for Assessment and Intervention".
RELATED CHAPTER
Contents
- The Assessment Tool
- Information Required from Midwife / Health Professional as Part of a Pre Birth Risk Assessment
- Assessment of Parents and Potential Risks to Child
- Overall Risk Assessment and Conclusions
- Framework for Practice: Risk Estimation
1. The Assessment Tool
Family Structure
Names, addresses, ages etc. Extended family and potential support should be included.
Ante-Natal Care: Medical And Obstetric History
General Guidance
Antenatal care begins as soon as the pregnancy has been confirmed and midwives continue care in the postnatal period for at least 10 days following birth. A booking interview with the community midwife takes place ideally between 8-12 weeks gestation. This is usually in the woman's home or at the GP's surgery. It is at this interview that the midwife is able to assist women in their choices for childbirth and ensure they are informed of all the options available to them.
Women are given choices in early pregnancy of lead professional and place of birth:
Midwife-led care (MLC) means the midwife is the lead professional. All antenatal care would be conducted in the community and is often shared with the General Practitioner (GP). Women would have the choice of giving birth in the hospital under MLC or at home with midwives in attendance.
GP led care is less frequently offered and again all antenatal care is conducted in the community and is shared between GP and community midwife. The place of birth is rarely at home with the GP in attendance so most GP births occur in a low-risk hospital environment.
Consultant led care is offered to women who have recognised health risk factors or who choose to see the consultant team. These pregnancies require additional surveillance both pre-birth and in labour. Care is shared between the community midwife, GP and a hospital consultant team consisting of midwives and doctors specialising in care of high risk pregnancy. Delivery of the baby will take place in the hospital.
The booking interview is a time of collection of information and an opportunity for the midwife and mother to plan her care in pregnancy. It is an ideal time for the midwife to assess health and social needs of families and to consider packages of care and support suitable for individual needs.
Antenatal appointments are arranged to suit the individual clinical needs of the mothers and the initial choices may change if complications of pregnancy arise. A collaborative approach between all health professionals is encouraged with direct midwife referral to obstetrician being available at all times.
In the case of home births all postnatal care is provided in the home by the community midwife. For births in hospital - with either the midwife, GP or obstetrician as the lead professional - initial postnatal care is provided by midwives and support staff on the maternity wards. Hospital stays are getting shorter with many women going home within a few hours of birth but generally 12-48 hours are the more normal lengths of stay. On transfer home care is undertaken by the community midwife for at least 10 days following the birth. Care can be extended to up to 28 days if a particular clinical or social need is identified. Liaison between the Health Visitor attached to the GP's surgery and community midwife usually takes place during the antenatal period with some Health Visitors making contact with the mother in pregnancy. Following the birth of the baby most Health Visitors arrange a primary visit at 10 days postnatal, which coincides well with the handover of care from the midwives.
Assessment Of Parents And Potential Risks To Child
Pregnancy can create special circumstances/influences for both parents, which need to be accommodated and understood by all professionals who come into contact with these families. Pregnancy will have a major impact on some people's lives and will affect both behaviour and relationships. Pregnant women's health and their responses to external factors often change in pregnancy - and the physiological, emotional and social influences that both cause and are affected by these changes can have a direct impact on their behaviour and health and how they manage in key relationships.
2. Information Required from Midwife / Health Professional as Part of a Pre Birth Risk Assessment
This section should be completed by an appropriate Health Professional. The central question is whether there is anything in the medical and obstetric history that seems likely to have a significant negative impact on the child? And if so, what?
Some basic details:
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Assessment issues
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3. Assessment of Parents and Potential Risks to Child
This section will usually be completed by the Social Worker - but they will need to draw on help from a range of other professionals regarding some aspects of it.
Particular care should be taken when assessing risks to babies whose parents are themselves children. Attention should be given to a) evaluating the quality and quantity of support that will be available within the family (and extended family), b) the needs of the parent(s) and how these will be met) the context and circumstances in which the baby was conceived, and d) the wishes and feelings of the child who is to be a parent.
1. Relationships
Is there anything regarding "relationships" that seems likely to have a significant negative impact on the child? If so, what? |
2. Abilities
Is there anything regarding "abilities" that seems likely to have a significant negative impact on the child? If so, what? |
3. Social history
Is there anything regarding "social history" that seems likely to have a significant negative impact on the child? If so, what? |
4. Behaviour
Is there anything regarding "behaviour" that seems likely to have a significant negative impact on the child? If so, what? If drugs or alcohol are a significant issue, more detailed assessment should be sought from professionals with relevant expertise. |
5. Circumstances
Is there anything regarding "circumstances" that seems likely to have a significant negative impact on the child? If so, what? |
6. Home conditions
Is there anything regarding "home conditions" that seems likely to have a significant negative impact on the child? If so, what? |
7. Mental Health
Is there anything regarding "mental health" that seems likely to have a significant negative impact on the child? If so, what? If mental health is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise. |
8. Learning DisabilityIs there anything regarding "learning disability" that seems likely to have a significant negative impact on the child? If so, what? If learning disability is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise. |
9. Communication
Is there anything regarding "communication" that seems likely to have a significant negative impact on the child? If so, what? If communication is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise. |
10. Support
Is there anything regarding "support" that seems likely to have a significant negative impact on the child? If so, what? Is support likely to be available over a meaningful time-scale? Is it likely to enable change? Will it effectively address any immediate concerns? |
11. History of being responsible for children
Is there anything regarding "history of being responsible for children" that seems likely to have a significant negative impact on the child? If so, what? If so also consider the following:
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12. History of abuse as a child
Is there anything regarding "history of abuse" that seems likely to have a significant negative impact on the child? If so, what? |
13. Attitude to professional involvement.
Is there anything re "attitudes to professional involvement" that seems likely to have a significant negative impact on the child? If so, what? |
14. Attitudes and beliefs re convictions or findings (or suspicions or allegations)
Is there anything regarding "attitudes and beliefs" that seems likely to have a significant negative impact on the child? If so, what? It may be appropriate to consult with the Police or other professionals with appropriate expertise. |
15. Attitudes to child
Is there anything regarding "attitudes to child" that seems likely to have a significant negative impact on the child? If so, what? |
16. Dependency on partner
Is there anything regarding "dependency on partner" that seems likely to have a significant negative impact on the child? If so, what? |
17. Ability to identify and appropriately respond to risks?Is there anything regarding this that seems likely to have a significant negative impact on the child? If so, what? |
18. Ability to understand and meet needs of babyIs there anything regarding this that seems likely to have a significant negative impact on the child? If so, what? It may be appropriate to consult with Health professionals re this section. |
19. Ability to understand and meet needs throughout childhoodIs there anything regarding this that seems likely to have a significant negative impact on the child? If so, what? It will usually be appropriate to consult with relevant Health professionals re this section. |
20. Ability and willingness to address issues identified in this assessment
Is there anything regarding "ability and willingness to address issues" that seems likely to have a significant negative impact on the child? If so, what? It will usually be appropriate to consult with other professionals re this section. |
21. Any other issues that have potential to adversely affect or benefit the child.E.g. one or more parent aged under 16? Context and circumstances of conception? |
22. Planning for the future
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4. Overall Risk Assessment and Conclusions
Use should be made of the "Framework for Assessment" described below.
The assessment report should address the following issues:
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5. Framework for Practice: Risk Estimation
Framework taken from an adaptation by Martin Calder in 'Unborn Children: A Framework for Assessment and Intervention' of R. Corner's 'Pre-birth Risk Assessment: Developing a Model of Practice'.
Factor | Elevated Risk | Lowered Risk |
The abusing parent |
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Non-abusing parent |
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Family issues (marital partnership and the wider family) |
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Expected child |
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Parent-baby relationships |
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Social |
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Future plans |
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End