Key message nine: Provide support to minimise the trauma and hold the possibility of reunification in mind

The separation of a baby from their mother close to birth is a profound experience for all involved. It's been described by leading judges in England and Wales as a draconian measure. And we know from the research the profound impact that it has on the mother, the father, the wider family and the practitioners involved.

Yet despite this, we have no national guidelines, and the born into care research tried to fill this gap through listening closely to the perspectives of all stakeholders and building guidelines to help support practice. What we heard from parents was that often plans were shared far too late, that they didn't know that the local authority planned to separate at birth until very close to when the baby was born.

And in the worst case example, the mother was in labor when she received the call while social workers talked about how difficult it was to share that information or being frightened about preempting court decisions. There is no doubt that from a parent's perspective, having time to prepare and get your head around what must be the most devastating of experiences really mattered.

If we think about this through the lens of trauma, offering time choice and control become absolutely essential. We've heard from some areas of the country where they've started to introduce co-produced birth plans, where they discuss what arrangements parents would like to be in place. These things make a difference. We've also, through the Born into Care research and through the production of the guidelines, started to think about ways in which choice and control can be offered.

And these might seem really trivial things, but they really make a difference to families when you're having the biggest choice taken away from you. Having an opportunity to meet the foster carer ahead of the discharge planning meeting, having an opportunity to discuss with whoever's going to be caring for your baby things such as what milk brand you'd like them to use, whether you've got a favourite lullaby you want them to sing, whether you want them to use a pacifier, what brand of nappy?

These things matter because they give you some sense of still being a parent. And yet, in the rollercoaster ride of the family justice system, the busyness of preparing for court and trying to plan for that separation and placement, these are the very things that get stripped away. What we need is that injection of compassion, that injection of thought and sensitivity as we prepare for separation, because it could be the very thing that helps to minimise that trauma.

Research and the guidelines also point to possible changes within practice in the maternity setting. What midwives told us that on busy wards without specific specialist midwives, it was very difficult to provide the level of trauma informed care that they new mothers in this situation needed. Where there were specialist teams and there was some continuity of care that really helped for mothers on wards surrounded by other women giving birth.

Having the curtains pulled round by their lawyer or social worker visited. Still having conversations in Asia of other mothers or having your door propped open so that people could keep an eye on you was incredibly stigmatising. Trying to ensure that midwives in their training have a level of specialism and understanding of this group of women's needs and are properly resourced also forms part of trying to minimise the trauma experienced by women in this situation.

As we mentioned previously, it could well be that developing that sense of being a mother or a father might be the very thing that brings about change. So trying to follow, trying to find ways to hold on to that maternal and paternal identity are crucial.

In the links below, you can hear more about innovations that are taking place across the country to try to give a more trauma informed response around separation. This includes the co-produced offer called the Hope Boxes and details can be found below.

I'm gonna move on now to think about if the court decision is that there's going to be a separation, how might we prepare for that? Um, and again, we heard from the research that there was really poor information sharing with parents around what that was gonna look like. 

So some parents thinking they've gotta kind of, you know, be at the speed of light up the motorway to get, if they've driven to court or, you know, panicking about getting back if they've been at court because they think the baby's gonna be gone. 

Um, so, you know, real explanation around what that process is likely to look like, how long they're likely to have with their baby. If this is the outcome, it's really, really important to be able to minimise the trauma. I think none of us can imagine how that must feel, the idea that your baby's going and you don't know if the, if you are actually gonna see them when you leave court. Um, so that, that feels really important and trying to build in some time. And lots and lots of social workers do do this routinely, but it's reliant on the individual and in our view, that's not good enough. This needs to be something that is really transparent to everybody involved. And often midwives didn't know either what the plan was and how long, how that, that was going to look like. So there's no routine preparation for separation. And we got this feeling that everybody, um, just wanted it to be over. It was just, um, a horrible experience for professionals, a horrible experience for parents emotionally, just, um, so difficult.

And because it wasn't discussed as one midwife said it was, it was like death. Everybody knew it was coming, but nobody wanted to talk about it, which was really unhelpful to parents. So, as I've already said, if appropriate part of that birth planning could in... could include if the parents feel able to think about it, what that might look like, and how the family and friend network might support that.

Who do they want there? Um, at the moment, the, the way in which discharge planning meetings are, are held from parents' perspective and actually from the professional's. Everybody hates them. Everybody thinks they're really tense, difficult meetings. As a result, everybody seems to kind of go back into ultra professional bureaucratic mode when, you know, the emotionally charged nature of those meetings makes it very difficult for anybody actually to hear anything, particularly the parents. 

So what of that, what of that kind of work could be done outside of the meeting? So I've already talked about informal meetings with the foster carer. That baby's got profound health needs, for example. How much of that does need to be discussed in that meeting in front of parents who found that incredibly shaming? Would there be possibilities for some of that to be done outside of that formal discharge meeting? 

Um, and then a really, sort of a real thought around the psycho, psychological impact of that separation as a birth trauma. And what can we do to minimise that trauma? So think about all those principles around trauma-informed care and the planning and the choice and the control, um, and the discussion and the continuity of support. 

It's somebody they know who's with them, they know who's going to be there. Those details really, really matter. Parents told us that often they were leaving that hospital not knowing when they were next going to see their baby. Um, so not only were they being separated, but family time arrangements were really unclear. Um, so again, in, uh, thinking about it from a trauma-informed perspective, that was really important. 

So in the guidelines, there's a lot of emphasis on pre-planning and discussion and thinking through that separation, introducing choice and control over the detail down to, um, I think the mother and father choosing what outfit the baby wears. They might wanna strap them into the car seat. They might want to walk the baby off the ward like every other parent does, if safe to do so.

And if not that they know that in advance, they know what they are and aren't able to do, so that they can prepare. And that that information is shared about alternative carers. Seen lots of practice change happening around this area. 

So for those, um, organisations that have developed new birth arrangement forms, they've introduced these questions as part of that, that may be done in the pre-birth period, or it may be done once the baby's born and a separation is planned, but really sitting and talking through in advance, how do you want this to look? 

How can we make this the best it can possibly be? It's always gonna be terrible, but how can it be, um, the least worst scenario for you? Um, so they've, they've, they've, they've introduced those choices and wishes as part of the birth arrangements or birth plan forms. They've tried to arrange for foster carers to be able to meet parents outside of discharge planning meetings.

And we heard in the research from foster carers who said where they had had a chance to meet the birth parents in hospital, they felt that got them off onto a much better first footing than where they were meeting them for the first time at contact. 

And one, um, foster carer's words really struck me. And she said that often she would walk into a, a contact centre with a baby and she could see the birth mother's birth parents looking around thinking "Is that my baby?" Because they're in a different car seat if they're not wearing an outfit that they recognise they've never met the foster carer.

And you imagine how that must feel. Of course, babies look fairly similar. You may not immediately recognise your baby if you've been separated from them. And how does that feel? Whereas if you've been with the foster carer, at least seen a picture of them, you will immediately recognise them. Um, how can we improve that? 

I'll come back to the HOPE boxes. Um, improvements around planning for family time. And at least if you can't provide that precise detail, let them know when you will be able to and give lots of reassurance about when it's likely to be. 

So some of this is updating. "I can't tell you right now, but I will be able to tell you later today, tomorrow, oh, I'll ring you and tell you, I'm really sorry. I still don't know." It's that reassurance that somebody is keeping you in mind and hasn't just taken your baby and gone off into the, into the sunlight, which is how it feels for many parents in this sit, situation. And then finally, the post-separation planning. So again, in some of our local authorities, they've included a post-separation planning form. 

Um, I'm now going to talk specifically through the Giving HOPE Project. So the, um, HOPE Project came out of the Born Into Care work. Um, because as part of our research, we heard from, we... we came across a group of innovative midwives in various parts of the country who were already trying to adapt, usually bereavement pathways to offer something to women who were walking out the hospital without their baby. Most of them had taken kind of bereavement memory boxes and, and tried to use them. They were acts of kindness by individual midwives or groups of midwives. 

We also heard from foster carers who were doing similar. So they recognised the importance of really developing that parental identity and tried to give parents extra things of the baby to remind them that they were a parent and they should keep fighting. They should keep trying to engage and bringing about the change in their own lives. 

So they were sending them cards from the baby, or they were, you know, given a locket of hair in a necklace for the mother to wear, or they were, um, making sure they took lots of extra photographs. Um, so again, acts of kindness under the radar.

But what we, most importantly, we heard from parents what a difference those things made. We had a group of 12 women with lived experience working with us across the whole of the project, and those women told us, um, well, they were bowled over really by, by this work. And they wanted to do something bespoke, something specific that kind of built on this learning, but made it an offer for everybody.

So that's how the HOPE boxes were born. So we have co-designed learning from those, those wonderful midwives, learning from perinatal loss charities, and we've had real amazing help, um, from a perinatal, um, loss charity from recurrent care services and from foster carers, but most importantly through the lived experience group and what they have done.

Uh, we designed two boxes, one for mother, one for baby, but have items in it, um, to really follow the mother and baby through their journey. So, to start with, um, the boxes are really about trying to reduce trauma at the point of separation. So there's things in the box that are around trying to, um, help the, the, the parents to focus on the baby to a a, a baby book where they're encouraged to write about their experiences of pregnancy, the, the babies, you know, the baby kind of coming into the world, um, the first things they've noticed about their baby. 

 Um, there are memory making activities around hand and footprints, for example, which, you know, are common things for every parent to want to do. They're encouraged to take photographs and there's a photo frame which the women who've designed the box saw as a gift from them to other women because they say often you don't get presents. People dunno what to say to you. They don't bring you presents in the way that other mothers get presents. So this is our present to them. So it allows for a conversation between the midwife usually, although in some areas it's the family support worker that's doing this work.

It's a vehicle to have a conversation, to really notice the woman at this point, um, and to say "We see you and we think you're important." And then it's about reducing stigma because the boxes have been designed by other women. And in that box, there's a letter that goes before that explains why the boxes have been put together.

And there's a poem that's been written by the Lived Experience Group, which says you're not alone. We've been through this. Hold on. Pain eases. Um, and if we've got time, we can listen to the poem in in a minute.

Once the mother and baby are separated, there are items to try to keep connections. So there are matching blankets, a matching soft toy to be swapped at contact, to keep the cent of the baby, the mother, and vice versa. Foster carers told us that was really important for settling the baby in placement.

Mothers told us how important it was to have the scent If their baby, particularly if they were breastfeeding. And that's about trying to minimise the trauma. And there are things in that box for the mother - a diary to be able to write her thoughts, a, a scented candle to think about sensory awareness and bringing her back into the moment when she feels overwhelmed. 

Um, there are things then also about, um, really trying to keep that, that maternal identity alive. So for example, um, an acknowledgement of life certificate. The mother often doesn't get the birth certificate. So something that that tells us she's this baby's mother, the baby's wristbands, um, which often go with the foster care and, and aunt given to the mother so there's duplicates so that she can have them too. Those things we were told by the women really mattered. And then if there is a permanent separation, then it would be that box would be used for grief and loss work with the mother.

So a recurrent care service like, um, Pauses for example, or Breaking the Cycle or Strengthening Families... there's many of them now across the country. Comma in Stockport. Um, or potentially the Maternal Mental Health Service if they've got a pathway, would do that. Loss and grief work. Um, and then it's also about identity work for the baby. So their box becomes part of their lifestory work, and adopted adults have told us that often these bits of their life are completely missing. They know nothing about their very early, their very early days or their mother's pregnancy, and they're absolutely crucial in terms of your own identity.

And then if the mother goes on to have more children or is thinking about more children, that box might be play a part in terms of thinking about sibling identity or helping her to look back and think about how things can be different this time around. So it has a different purpose at different stages of the system. 

Each year, more than 3000 mothers in England are separated from their newborn babies due to safeguarding concerns. They are often given very little notice with the initial court hearing that will determine their baby's future being held within days or even hours of giving birth. Their worlds are turned completely upside down. If the judge orders an initial separation, the baby is temporarily placed into someone else's care.

The court will later make a final decision where the baby should live. Long term, this process will likely take six months. The mother is left overwhelmed with feelings of emptiness, anger, and shame.

A mother usually sees her baby for an hour at a time, organised by the local authority while trying to find their feet. Mothers are left managing grief, loss, and stigma. It is lonely. The HOPE Boxes help them to feel connected to their baby and still feel like a mother.

Each hotbox contains carefully chosen items to support a mother with grief, emptiness, anger, and shame. A baby book shared with the baby's carer helps the mother feel part of her baby's day-to-day life. She's comforted by a glance at memories and firsts she may otherwise have missed. Both mother and baby have a blanket that is swapped at family time. The mother's smell comforts her baby and helps them to settle in their new surroundings.

The smell of her baby allows the mother to feel connected. The HOPE boxes have been created by a group of mothers who understand the pain of separation. They send a message of hope. Hold on. Pain eases. The HOPE Boxes help mothers through this dark time with items that provide comfort and connect them to their babies. 

This connection will be crucial if they're separated long term. The Child's HOPE Box will, as they grow, help the child understand their identity and to know they have always been loved.

Separation between mothers and babies happens for varied reasons and with different outcomes. Mothers often feel labelled rather than supported. There is a lack of understanding of the trauma and challenges that mothers face. The HOPE Boxes can help build a bridge of understanding and transform stigma and isolation into solidarity and support. There are thousands of mothers and babies who could benefit from the HOPE boxes.

For more information, please visit the Giving HOPE website and find out how you can help. 

• Read an article that outlines the research underpinning the HOPE boxes.
• The Birth Charter for women with involvement from children’s social care from Birth Companions highlights the need for women to receive responsive support to prepare for, during and following separation from their baby (see pages 10-11).  

Explore sample birth plans from Swansea Council and Together for Children Sunderland.

Geddes, E. (2022). “Some days it’s like she has died.” A qualitative exploration of first mothers’ utilisation of artefacts associated with now-adopted children in coping with grief and loss. Qualitative Social Work, 21(5), 811-832. https://doi.org/10.1177%2F14733250211039008  

Marsh, W. (2016). Babies removed at birth: Narratives of mothers’ and midwives’. [Doctoral thesis, University of Surrey] https://openresearch.surrey.ac.uk/esploro/outputs/99511924802346 

Ott, E., & McGrath-Lone, L. (2022). Perinatal loss: Key messages for infant removal at birth. An evidence review. University of Lancaster. https://www.education.ox.ac.uk/wp-content/uploads/2019/10/Perinatal_loss_key_messages_2022.pdf 

• Broadhurst, K., Mason, C., Bedston, S., Alrouh, B., Morriss, L., McQuarrie, T., Palmer, M., Shaw, M., Harwin, J., & Kershaw, S. (2017). Vulnerable birth mothers and recurrent care proceedings. Lancaster University. 
• Marsh, C. A., Browne, J., Taylor, J. and Davis, D. (2018) ‘Making the hidden seen: A narrative analysis of the experiences of Assumption of Care at birth’, Women and Birth. DOI: 10.1016/j.wombi.2018.04.009.  
• Marsh, W. (2016) Babies removed at birth: narratives of mothers’ and midwives’. Doctoral thesis. University of Surrey.  
• Mason, C., Broadhurst, K., Ward, H., & Barnett, A. (2023a). Born into Care: Best practice guidelines for when the state intervenes at birth. Nuffield Family Justice Observatory.  
• Mason, C., Ward, H., & Broadhurst, K. (2023). Giving HOPE and minimising trauma: an intervention to support women who are separated from their babies at birth due to safeguarding concerns. Child Abuse Review, 32(1).