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8.10 Concealed Pregnancy

AMENDMENT

This sub-section was updated in February 2012.

Contents

Definition

8.10.1

A concealed pregnancy is when

  • A woman knows she is pregnant but does not tell anyone; or
  • A woman appears genuinely not aware she is pregnant.
8.10.2

Concealment may be an active act or a form of denial where support from appropriate carers and health professionals is not sought.

8.10.3

This can become apparent at any stage of the pregnancy. Concealment of pregnancy may be revealed:

  • Late in pregnancy;
  • In labour; or
  • Following delivery. The birth may be unassisted and may carry additional risks to the child and mother's welfare.
8.10.4

A late booking is defined as presenting for maternity services after 24 weeks of pregnancy.

8.10.5

There may also be longer-term outcomes for consideration for example what did the mother intended for the child i.e. did she hope it would survive?

Risks/Protection Issues

Reasons

8.10.6

The reason for the concealment will be a key factor in determining the risk to the child and that reason will not be known until there has been a systematic multi-agency assessment.

8.10.7

Where there is concealment, there can be risks for the child's health and development in utero as well as subsequently, especially if this is a result of alcohol or substance misuse. There may be risks to the unborn baby from prescribed medications.

8.10.8

A pregnancy may be concealed in situations of domestic abuse which is more likely to begin or escalate during pregnancy.

8.10.9

There may be risks to both mother and child if the mother has concealed the pregnancy due to fear of disclosing the paternity of the child, for example where the child has been conceived as the result of sexual abuse, or where the father is not the woman's partner. Young teenage women may conceal the pregnancy due to fear of recrimination from their parents or peers or professionals.

Implications

8.10.10

The implications of concealment are wide-ranging. Concealment of a pregnancy can lead to a fatal outcome, regardless of the mother's intention.

8.10.11

Concealment may indicate ambivalence towards the pregnancy, immature coping styles and a tendency to dissociate, all of which are likely to have a significant impact on bonding and parenting capacity.

8.10.12

Other possible implications for the child arising from mother's behaviour could be:

8.10.13

Lack of antenatal care can mean that:

  • Any potential risks to mother and child may not be detected;
  • Inappropriate advice is given; or
  • Investigations being undertaken, such as potentially harmful medications being prescribed by a medical practitioner unaware of the pregnancy or exposure to harmful substances such as X Rays;
  • The health and development of the baby during pregnancy and labour may not have been monitored and foetal abnormalities not detected;
  • Underlying medical conditions and obstetric problems will not be revealed.
8.10.14

An unassisted delivery can be dangerous for both mother and baby, due to complications that can occur during labour and the delivery.

8.10.15

Post natal risks include

  • A lack of willingness/ability to consider the baby's health needs; or
  • Lack of emotional attachment to the child following birth; or
  • Poor adaptation.
8.10.16

All of the above highlight the need for increased monitoring in the period following the birth of the baby.

Recognition and Referral

Action on Suspecting Concealed Pregnancy

Young People aged under 16

8.10.17

If a young person under 16 is thought to be pregnant and denying or concealing, the professional who has the concern should consider the appropriateness of asking the young person if they are pregnant.

8.10.18

If the professional still has a concern, then they should make a referral to Children's Social Care in the name of the young person and a Child and Family Assessment will be carried out.

8.10.19

It may still be appropriate for a professional from any agency to make initial approaches to the young woman to discuss the possibility of her being pregnant. She should be provided with the opportunity to satisfy an appropriate professional she is not pregnant, by undertaking appropriate medical examination or investigation, or, if she is pregnant, beginning to make realistic plans for the baby, including informing her parents.

8.10.20

If the young woman refuses to engage in constructive discussion, in the face of clear reasons to continue to suspect that she is pregnant, the professionals involved should consider informing the young person's parents.

8.10.21

In these circumstances, the potential risks to the unborn child would outweigh the young woman's right to confidentiality.

8.10.22

If a young person under 16 is thought to be pregnant but denying it, or concealing it, the practitioner should be mindful that there could be many reasons for this.

8.10.23

If the young person continues to refuse to engage in constructive discussion, and the professionals have clear reasons to suspect pregnancy in the face of continuing denial then Children's Social Care should inform her parents and continue to assess the situation with a focus on the needs/welfare of the unborn baby as well as the young person (see section on assessment).

Young People/Women Over 16

8.10.24

Where the 'expectant mother' is over 16, every effort should be made to resolve the issue of whether she is pregnant or not.

8.10.25

Clearly no woman can be forced to undergo a pregnancy test, or any other medical examination, but in the event of refusal, social workers should proceed on the assumption that the woman is pregnant until or unless it is proved otherwise, and endeavour to make plans to safeguard the baby's welfare at birth.

Actions On Concerns That A Young Person/Woman Is Concealing A Pregnancy

8.10.26

Multi-agency  liaison should occur  involving GP, midwife, health visitor and any other relevant agency to assess the information and to construct a plan.

8.10.27

It may be appropriate to invite a representative from Mental Health Services (child or adult as appropriate) so that support, advice and/or consultation is available at an early stage.

8.10.28

Where there are additional concerns, e.g. lack of engagement, possibility of sexual abuse, or substance misuse, the referral should be dealt with under child protection procedures (see Section 47 Enquiries Procedure), which may include convening a pre-birth Child Protection Conference (see Pre-Birth Child Protection Procedure).

Planning and Intervention

8.10.29

An unborn child has no legal standing. Law cannot force an expectant mother, to have any medical intervention at birth unless she is deemed not 'of sound mind'. It is only possible to make appropriate contingency plans and to ensure that the woman/girl is fully aware of the consequences of her actions. In such circumstances, legal advice should be sought.

8.10.30

Only when the underlying reasons for a previous concealed pregnancy are revealed, explored and addressed, can the risk associated with future concealment be substantially reduced.

8.10.31

Assessments should identify clear expectations of parents and ensure that should they fail to comply this would constitute a significant risk factor and point to the need to activate further child protection processes and / or Care Proceedings. Under such circumstances then legal advice should be sought.

8.10.32

The Police must be notified of any child protection inquiries made by Children's Social Care following a concealed pregnancy. Consideration will be given to whether a joint investigation is needed. This will be dependent upon whether an offence may have been committed or if the child is at serious risk of Significant Harm.

Action on Presentation In Labour Or Following An Unassisted Delivery Of A Concealed Pregnancy

Action by Hospital Staff

8.10.33

In all cases where a young girl/woman arrives at the hospital in labour or following an unassisted delivery, which has been the result of a concealed pregnancy, an immediate referral must be made to Children's Social Care - see Making a Referral Procedure.

8.10.34

The baby should not be discharged until a Strategy Meeting has been held and relevant assessments undertaken. This Strategy Meeting must consider the initiation of a psychiatric assessment.

8.10.35

Where the referral is received out of hours in relation to a baby born as the result of a concealed pregnancy, the Emergency Out of Hours Service will take steps to prevent the baby being discharged from hospital until Children's Social Care have been informed and given their approval for discharge, in most instances this would be after a Child and Family Assessment has been undertaken. The baby should not be discharged out of hours.

Action by Children's Social Care Staff

8.10.36

In the situations where a young girl/woman presents during labour then consideration should be given to commencing a Section 47 Enquiry.

8.10.37

If a young girl/woman presents following unassisted delivery at the end of a concealed pregnancy then a Section 47 Enquiry must commence.

Immediate Protective Actions

8.10.38

In normal circumstances this would be through a voluntary agreement, although clearly there could be circumstances in which it might be necessary to consider an application for an Emergency Protection Order, or to seek the assistance of the Police, e.g. Police Protection, in preventing the child from being removed from the hospital.

8.10.39

In both situations Children's Social Care should consider allocating the assessment to a worker with mental health expertise.

8.10.40

The Police must be notified of any child protection inquiries made by Children's Social Care following a concealed pregnancy. Consideration will be given to whether a joint investigation is needed. This will be dependent upon whether an offence may have been committed or if the child is at serious risk of Significant Harm.

8.10.41

If the child has been harmed, has died or been abandoned, child protection procedures will apply and a joint investigation will be conducted with the relevant Children's Social Care team.

Actions on Discharge

8.10.42

Midwives should ensure that:

  • Information regarding the concealed pregnancy is placed on the child's records, as well as the mother's records;
  • The discharge summary from maternity services to primary care must record if a pregnancy was concealed or booked late (after 24 weeks).
8.10.43

Following a concealed pregnancy or unassisted delivery, midwives need to be alert to:

  • The level of professional engagement allowed to the mother (and her extended family); and
  • The receptiveness to future contact with health professionals.

Future Pregnancies

8.10.44

Following a concealed pregnancy where significant risk has been identified, Children's Social Care should take the lead in developing a multi-agency contingency plan, to address the possibility of a future pregnancy. This will include a clearly defined system for alerting Children's Social Care if a future pregnancy is suspected.

8.10.45

Where it is known there is a history of previous concealed pregnancy, referral must be made to Children's Social Care as soon as any subsequent pregnancy is known. Women who have already concealed a pregnancy are at a particular risk of doing so in the future.

8.10.46

Children's Social Care will convene a multi-agency Strategy Meeting and make a plan to address any potential risk within a future pregnancy. Sharing information openly will be a critical factor in safeguarding the unborn child and professionals will need to accept this may be without the consent of the mother concerned.

8.10.47

Only when the underlying reasons for a previous concealed pregnancy are revealed, explored and addressed, can the risk associated with future concealment be substantially reduced.

8.10.48

Where there is a known plan in place, it should be activated as soon as professionals become aware of a subsequent pregnancy. The urgency of the meeting will depend on the stage of pregnancy. It is important that all key professionals working with the family are included. At any stage in the process, consideration must be given to the appropriateness of a full psychiatric assessment.


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This page is correct as printed on Tuesday 27th of June 2017 12:14:05 AM please refer back to this website (https://sussexchildprotection.procedures.org.uk) for updates.
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