Protecting the Innocent: Child Safeguarding Decision Making by HSC Professionals in Pregnancy

Background: In 2014, 954 children in need referrals were made in Northern Ireland (DHSSPS 2014). The highest number of referrals was made in the South Eastern Health and Social Care Trust (n=294) (DHSSPS 2014). Health and Social Care (HSC) professionals face the daunting task of assessing the risk of harm to an unborn child. Therefore, understanding HSC professional’s decision making in relation to child safeguarding in pregnancy will enhance professional practice.Aim: To study decision making by Health and Social Care professionals where there is a child safeguarding concern in pregnancy.Methods: This is a mixed-method study with three phases and this paper will focus on Phase 2, focus groups with HSC professionals. The aim was to determine the relevance of the identified risk factors from the structured literature review within a Northern Ireland context and to explore the experiences of Midwives and Social Workers in making decisions about cases of child safeguarding in pregnancy. Results: Data were collected from four focus groups consisting of Midwives (n=14) and children’s services Social Workers (n=16) and analysed using Newell and Burnard’s framework (2006) for thematic analysis. Twelve themes were identified which impacted upon decision-making: Assessing risk, timing, engagement with women, communication, professional experience, mental health knowledge/training, impact on staff, evidence, case planning, pregnant women behaviour, recording of information and frustration.Conclusion: Decision making by HSC professionals in the area of child safeguarding in pregnancy remains a complex and challenging process. Professionals are living in a state of ‘uncertainty’ as each case presents unique challenges. The uncertainty regarding the uniqueness of cases requires application of a diverse knowledge base, which further adds to the complexity around decision making.