The Experiences and Challenges encountered by HSC Professionals around Child Safeguarding Decision Making in Pregnancy

Background: Health and Social Care (HSC) professionals face the daunting task of assessing the risk of harm to an unborn child. Supported by legislation, policies, standards and procedures, professionals must use their clinical judgement when presented with the risk factors impacting upon the safety of an unborn child. There is limited knowledge around professional’s decision making in the area of child safeguarding in pregnancy. This study will provide understanding of the processes and challenges professionals face as they make informed decisions to protect an unborn child.Aim: To study decision making by Health and Social Care professionals where there is a child safeguarding concern in pregnancy.Methodology: This study is an exploratory sequential mixed methods design consisting of three phases. A systematic narrative review of the literature has been completed alongside focus groups with Midwives and children services Social Workers in the SEHSCT in Northern Ireland.Analysis: 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 Burnhard’s (1991) framework for thematic analysis. Summary: 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 and Implications: Decision making by HSC professionals in the area of child safeguarding in pregnancy remains a complex and challenging process. Guidance and frameworks are used to aid decision-making in this area but many other factors influence decisions made to refer. It is a process that relies heavily on communication with professionals and pregnant women using the best available resources whilst dealing with uncertainty as each case presents its own challenges. This study hopes to provide those in management, policy making and the professions of Midwifery and Social Work with an insight into how decisions around child safeguarding in pregnancy are made to inform or improve service provision.