Recurrent Care Resource Pack: Section 4

Section 4: Workforce development. Understanding complex grief and the impact on mothers of removal at birth

This section covers:

• Data on removal at birth, process and legal issues.
• The impact on vulnerable women of removal of their babies at birth.
• The nature of complex grief and the longer-term impact on mothers of their children’s removal.
• Different ways of planning for and dealing with removal at birth, so that the level of trauma experienced by mothers might be reduced.
• Barriers to improving practice.
• How an improved understanding of these issues can influence the development of your service.

This section includes three suggested learning modules comprising a series of film presentations and exercises. You can use these locally to build and enhance learning and understanding across your workforce on the issues of complex grief and the impact on mothers of removal at birth.

Each learning module is designed to be flexible for you to adapt into a programme of shared learning for your team or workforce.

Learning Module 4: An overview of research, policy and law in relation to removal at birth

This module covers:

• The national context of removal at birth.
• Relevant legislation and some case decisions.
• Research findings on removal at birth and its impact from the 'Vulnerable Birth Mothers and Recurrent Care Proceedings' study.

Allow 35 minutes to watch Films 8, 9 and 10, then move straight on to Exercise 11.

• Film 8: ‘Removal at birth: Women’s perspectives from the Vulnerable Birth Mothers and Recurrent Care Proceedings study’ Speaker: Claire Mason, Senior Research Associate, Centre for Child and Family Justice Research, Lancaster University. Claire shares messages from the study and, in particular, from her interviews with 72 birth mothers, nearly half of whom had experienced the removal of a newborn infant within hours or days of their child’s birth (7 minutes and 12 seconds).
• Film 9: ‘Removal of infants at birth’ Speaker: Mary Ryan, lawyer and Senior Associate at Research in Practice. Mary introduces the legal context and significant case law in relation to the removal of an infant at birth (8 minutes and 10 seconds).
• Film 10: ‘Understanding loss and grief in the context of recurrent care proceedings’ Speaker: Claire Mason, Senior Research Associate, Centre for Child and Family Justice Research, Lancaster University. Claire talks about how to apply messages from the wider research literature on loss and grief when working with women who have experienced court-ordered removal of children (19 minutes and 41 seconds).

Exercise 11: Removal at birth – reviewing local practice

Time: Allow 45 minutes for this exercise

What you’ll need: Flipchart paper and pens, or Post-its

What to do: Having listened to the evidence (in the slides and film), work in pairs or small groups for about 30 minutes to discuss:

• What happens in your area currently?
• Would you like to see a different approach?
• What would that look like?

As part of your discussions, consider the following questions:

• Are there protocols for pre-birth assessments in your area?
• How early on do you begin pre-birth assessment and planning? Are you starting too late?
• What are the links between Children’s Services social care and midwives? Are they working well? How do you know this? Do you need to find out more?
• If removal at birth is being planned, what placements are available that would enable mothers and babies to stay together?
• How are removals managed?

After half an hour, come back together for 15 minutes of feedback and whole-group discussion. Keep a note of suggestions for improving practice.

Learning module 5: The experiences of birth mothers whose babies are removed at birth

Film 11 relays the experiences of mothers through their own words and photographs. These are the words and images the women chose to describe their experience of having a baby removed at birth. The presentation is based on the PhD research conducted by midwife Dr Wendy Marsh.

Allow 27 minutes to watch Film 11. After the presentation, move directly on to Exercise 12.

• Film 11: ‘What can midwives learn from “women like me”? Stories from mothers whose babies have been removed at birth’ Speaker: Dr Wendy Marsh. Wendy shares findings from her doctoral research and experience as a specialist midwife for safeguarding. Her narrative inquiry gathered the stories from five women over three years in order to develop tools and resources to build improved midwifery practice with women (26 minutes and 16 seconds).

Exercise 12: Understanding the impact of removal at birth

Time: Allow 20 minutes for the first part of this exercise, plus a further 10 minutes.

What to do: After listening to this presentation, work in pairs or small groups take some time to reflect on:

• The impact of removal on mothers. Share relevant experiences you may have had.
• Now take some time to reflect on the impact on professionals of removal at birth.

Come back together as a whole group for a further 10 minutes of reflection.

Learning module 6: Supporting isolated women in the perinatal period

In Film 12, Denise Marshall describes the work of Birth Companions, a voluntary organisation that provides support to women who are having a baby in prison or who live in the community and are experiencing severe disadvantage. The presentation provides information about the different sorts of support mothers may need, the ways in which they cope with separation, and the importance of listening to what women want.

Allow 22 minutes for the presentation. Then move straight on to Exercise 13.

• Film 12: ‘Supporting mothers having babies removed at birth’ Speaker: Denise Marshall of Birth Companions
• Denise’s presentation focuses on working with women experiencing severe disadvantage during pregnancy, birth and early parenting. This includes women both in prison and in the community (21 minutes and 50 seconds).

Exercise 13: Consolidating your learning to optimise your service

Time: Allow 45 minutes for this exercise (this doesn’t include time for viewing all the films on removal at birth; for this exercise, it’s assumed participants will already have seen films 8, 9, 10, 11, either immediately before film 12 or at an earlier stage)

What you’ll need: Flipchart paper and pens or Post-its

What to do: Working in pairs or small groups, reflect on all the films about removal at birth (Film 12, and also Films 8, 9, 10, 11 and 12) and discuss the following questions:

• What have you learnt from these presentations?
• How will you take account of the messages from these presentations in the development of your recurrent care service?
• Are there any quick wins in relation to improving the experience for birth families?
• What can you do in relation to the impact of removal at birth on professionals – social workers, midwives, nurses, other support services?

Then come back into one large group to share feedback.

Tips from practice: Key messages for developing your service

Here are a series of tips drawn from the work of the various presenters in this section and from participants in the Change Project. The tips can be used to prompt discussion after watching the presentations above and completing the exercises. The tips are also intended to help with the planning and development of a recurrent care service.

Training issues

Think about developing local training:

• That includes these messages about the impact of removal at birth. One senior practitioner participant in the Change Project has begun to run sessions on removal at birth for social work teams, Cafcass, and multi-agency groups locally.
• For foster carers on the impact of removal at birth and on the impact of complex trauma on parents’ behaviour.
• On the impact of removal on parents and on professionals to be delivered to social workers and midwives together.

When running training on these issues, bring in the perspectives of mothers and fathers. Make sure social workers in their assessed and supported year in employment (ASYE) receive this training.

Practice issues

• In one area involved in the Change Project, the recurrent care service facilitates joint sessions between midwives and social workers to provide an opportunity to discuss the impact of this work and ways in which the process can be improved for the mothers and the professionals involved.
• Bear in mind that parents are ‘parents for life’. A parent may not be caring for their child and may no longer have parental responsibility, but they will always be the child’s parent. For some women, their desire to have a family becomes all-consuming.
• Contact with children who have been removed is a major issue for birth parents, so it will be important to think about how your service is going to help them with this.
• Think about how to support your staff, because removal at birth is often a trauma for them too. Think about ways to help practitioners develop resilience – through training, supervision and support.
• Think about ways you might contribute to better planning in early pregnancy and to an improved pre-birth assessment and support process.
• If there is no pre-birth and removal at birth protocol in your area, raise this as an issue that needs attention.

Part of the 'Working with recurrent care-experienced birth mothers resource pack'.