Safeguarding and Protecting Children in Maternity Services: Implications for Practice

Judgements of health and social care professionals on a child protection referral of an unborn baby: Factorial survey

BACKGROUND

Midwives and children's services social workers have responsibilities to identify and support pregnant women where there are child protection concerns. Professionals seek to anticipate the risk of harm and initiate interventions to provide support to families. There is little research on how professionals prioritise risk factors and the challenges they face in protecting unborn babies.

OBJECTIVE

To measure the impact of identified risk factors regarding child protection referrals of unborn babies on the professional judgements of midwives and children's services social workers.

METHODS

A factorial survey design using vignettes with randomised factors within a standardised structure, administered digitally using Qualtrics software.

PARTICIPANTS & SETTING

Midwives (n = 250) and children's services social workers (n = 88) from one Health and Social Care Trust in Northern Ireland.

RESULTS

One thousand and ninety-six vignettes were completed by 118 participants. Analysis using multiple regression showed that the risk factors together accounted for 44% of the variance in perceived risk of harm and of the variance on perceived need for a referral. The significant Independent Variables (IVs) in order included: drug use, alcohol use, age, antenatal care attendance, mental wellbeing, domestic violence and the pregnant woman's I the childhood experiences. There were no significant differences between midwives and social workers regarding judgements about important risk factors.

CONCLUSIONS

This survey provided an ordering of major risk factors influencing decision making to protect an unborn baby from the perspective of experienced social workers and midwives. The study helps professionals in judging the seriousness of risk factors. The interaction effects between risks requires further research.

Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study

OBJECTIVE

To investigate the long-term impact of antenatal domestic violence on maternal psychiatric morbidity and child behaviour.

DESIGN

Cohort study.

SETTING

Avon, UK.

POPULATION OR SAMPLE

A birth cohort of 13,617 children and mother dyads were followed to 42 months of age.

METHODS

Experiences of domestic violence and depressive symptoms were gathered at 18 weeks of gestation and up to 33 months after birth, together with maternal, paternal and child characteristics.

MAIN OUTCOME MEASURES

Child behavioural problems were assessed at 42 months using the Revised Rutter Questionnaire.

ANALYSIS

Logistic regression with the use of multiple imputation employing chained equations for missing data.

RESULTS

Antenatal domestic violence was associated with high levels of maternal antenatal (odds ratio [OR], 4.02; 95% confidence interval [CI], 3.4-4.8) and postnatal (OR, 1.29; 95% CI, 1.02-1.63) depressive symptoms after adjustment for potential confounders. Antenatal domestic violence predicted future behavioural problems at 42 months in the child before adjustment for possible confounding and mediating factors (OR, 1.87; 95% CI, 1.45-2.40); this association was not significant after adjustment for high levels of maternal antenatal depressive symptoms, postnatal depressive symptoms or domestic violence since birth.

CONCLUSIONS

Antenatal domestic violence is associated with high levels of both maternal antenatal and postnatal depressive symptoms. It is also associated with postnatal violence, and both are associated with future behavioural problems in the child at 42 months. This is partly mediated by maternal depressive symptoms in the ante- or postnatal period.