RCGP Safeguarding toolkit

Becoming pregnant and having a baby can be an exciting time for parents and their wider families. However, this time can also be fraught with difficulties and challenges, particularly for parents with complex factors such as:

• parents who misuse substances (alcohol and/or drugs)
• parents/families who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English
• young parents including those in care or care leavers
• pregnant women who are experiencing any form of abuse including domestic abuse
• parents/families who are homeless or vulnerably housed
• parents who have had previous children removed from their care
• parents with pre-existing mental health issues
• parents who have experienced abuse and neglect as a child themselves
• parents who are socially isolated with little support.

Risks in this period can include:

• direct harm to the baby (before and after birth) due to alcohol/drugs or abuse
• direct harm to the mother due to alcohol/drugs or abuse
• worsening of pre-existing mental health illness which can impact the health and wellbeing of both baby and parents: this can impact the bond between parents and their baby as well as other children as well as impact the ability to care for the baby
• parents who have experienced abuse and neglect as a child themselves may feel ill-equipped to deal with parenthood and may not know what safe parenting looks like
• parents who have had previous children removed from their care may feel reluctant to engage with all services, including health, due to fears of having this baby removed as well. This can mean they don’t have the help and support they need as well as the risk of unidentified health problems during the pregnancy
• high levels of stress
• a baby that cries a lot can lead to exhaustion which can lead to anger and frustration which can then lead to a baby being shaken which can have catastrophic consequences
• a child with complex medical conditions and/or disabilities can result in difficulty bonding with the child and impact on the ability to care for the child
• pregnancy is a particularly high-risk time for domestic abuse. 30% of domestic abuse begins during pregnancy. 40 – 60% of women experiencing domestic abuse are abused during pregnancy.

There are also a number of communication and structural challenges in this area that complicate responsiveness, such as a lack of routine information sharing between GPs, midwives, and health visitors – there are many causes for this and there are different mechanisms in different areas to try and overcome this. Holistic care for these parents and families is vital, not just to identify risk and vulnerability, but to identify strengths and support available.

References

• NICE. Clinical Guideline. CG110. Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors. 2010.
• For Baby’s Sake. Domestic abuse and baby’s first 1001 days.