A third of women who died during or in the year after pregnancy were known to Children's Social Care - higher than previously reported, new research reveals. The authors say urgent changes are needed to prioritise and improve mothers' care.
The study is published today in BMJ Medicine and led by researchers in the Faculty of Life Sciences & Medicine, Oxford University and the charity Birth Companions, and funded by the National Institute for Health and Care Research. It is the first to detail the situations of the 1695 women who died within a year of pregnancy; of whom 420 were in contact with children's social care. Researchers analysed national surveillance data from 2014 to 2022 to understand how the women died and the quality of the care they received.
The number of newborn babies in care proceedings in England is a growing problem. 2914 were in care in 2019/20; up 20% in seven years. Children under one make-up over a quarter of all children in care proceedings.
Women who died
The study finds three quarters of the mothers known to social services died between six weeks and the year after pregnancy and most deaths were due to suicide (20%), other psychiatric causes including drug related deaths (30%), and homicide (5%). Women with social care involvement more frequently died from homicide and mental health related causes than women without involvement.
Many of the women who died had significant experiences of abuse and mental ill-health. Two thirds (65%) of women with Children's Social Care involvement reported domestic abuse before or during pregnancy, compared to 3% of women without social care involvement. One in three disclosed abuse during childhood compared to 2% of women without social care involvement.
A higher proportion of women known to social care had pre-existing medical problems (75%, versus 59%), mental health issues (75% versus 27%), smoking during pregnancy (73% versus 21%) and known substance use (55% versus 5%) than women with no social care involvement.
The researchers also conducted a confidential care review, which looked at anonymised care records for 47 of these women. The study found uncoordinated involvement of services and agencies, such as maternity and mental health services, children's social care, and other medical specialists. This resulted in overwhelming appointment schedules, and compounded the adversity the women were facing rather than helping them. In several case reviews, women had more than thirty different appointments during pregnancy. In many instances, risk management solely focused on safeguarding the infant, disregarding the mother's own safeguarding needs.
This report details for the first time the high proportion of women with children's social care involvement who die in the UK and the care they receive during pregnancy and the postnatal period.
First author Kaat De Backer from the School of Life Course & Population Sciences
Kaat de Backer added: "What the analysis tells us is that these women come from backgrounds of trauma and abuse, and yet despite their efforts to keep up with demanding appointment schedules, they often face scrutiny and judgment rather than receiving support for the issues they are facing. Too often, the professionals the women are in touch with don't work together to provide holistic care, which increases the pressure on a mother. When women have access to designated multi-disciplinary teams, with specialist knowledge and capacity to provide integrated and holistic care, these barriers can be overcome. It makes it easier to understand who is doing what and when, for women and professionals."
Changes to social care
The researchers highlighted the complex care women have to navigate during pregnancy and the postnatal period. They say urgent changes to practice, clinical guidance and policy are required to prioritise mothers with social care involvement in pregnancy and early motherhood.
Naomi Delap, Director at the charity Birth Companions, said: "This study highlights the acute need for better care for women with Children's Social Care involvement, and the significant barriers that get in the way of providing that care.
"To help improve things, we need coordinated national policy and clear expectations across the health and social care systems. In response to this study, Birth Companions is launching work to co-design a national care pathway, in order to deliver consistent, compassionate support for all women who have Children's Social Care involvement in pregnancy and early motherhood. This work holds the potential to transform care, break cycles of harm, and help ensure fewer mothers lose their lives in such tragic circumstances."
Senior author Dr Nicola Vousden, from Oxford Population Health's National Perinatal Epidemiology Unit, said "This study adds to findings from MBRRACE-UK that women with multiple disadvantages prior to, and during pregnancy, are at increased risk of worse outcomes. We've identified practical changes that are required within maternity care. We also need joined up pathways of care across maternity, social care and community health partners to support the needs of women with children's social involvement, including domestic abuse, substance misuse and mental health. This will require local and national action."
Tia's story
Tia, 33, lost her first two children (then aged 2 and 5) to care when she was involved in an abusive relationship with someone she describes as a 'predator'. She eventually managed to leave that relationship. She then became pregnant with a new partner and fought to keep her third child during her pregnancy. Initially told she would lose the baby based on her history, but she was later signed off entirely by social services after assessments. Despite this, she has never regained care of her two older children who remain in foster care. She has monthly contact with the children who are now around 10 and 13 years-old. Her third child is aged five.
She said: "Losing my children broke me. I did everything they asked when I was pregnant again, and I kept my third child - but the trauma hasn't gone away. I still struggle every day, and there's been no real support for that. I want to use what I've been through to help other mums feel less alone, and to show that things can be done differently, with compassion and care."
