Memorandum submitted by the Association
for Improvements in the Maternity Services (AIMS)
As a UK-wide pressure group covering maternity
care with nearly 50 years experience, we are particularly interested
in the problems of babies and small children in care, and their
families. These are the children least able to speak for themselves,
and the potential for long-lasting damage is great, not only to
the children but to bonding with the parents to whom most of them
will return. We draw attention particularly to loss of breast-feeding,
damage to bonding and attachment, damage to relationships with
siblings and the extended family, inadequacy of arrangements for
contact, relationships with siblings. Social workers and courts
do not seem to understand the special needs of small children,
and unnecessary damage is inflicted. We would also draw attention
to the fact that the lack of respect shown to parents within the
system means they lose trust in professional services and some
avoid accessing care and services in future. Yet high quality
research from the USA shows that a more supportive, less authoritarian
and punitive approach to parents, yields better results.
1. Although the unborn child has no legal
status, it is now common for local authorities to convene a pre-birth
conference when they know a woman is pregnant. Often this is because
she comes into certain risk categories rather than because of
information that she individually poses a risk to her child. Having
been brought up in care, for example, poses a high risk for the
mother of having her child removed, which seems to say "the
state as a corporate parent did such a bad job that you yourself
are unfit to be a mother" rather than "you may need
extra help. Let us talk about what we can provide."
2. Social workers seem unaware of the fact
that there is now a substantial body of research showing that
prolonged and severe stress for the mother can do long term harm
to the child she is carryingto its growth, levels of stress
hormones, and behaviour. Our experienced team is used to dealing
with families in stressthose who have lost babies, had
a birth-damaged child, or even a maternal death. However, we have
been appalled at the prolonged and intense levels of stress in
pregnant women faced with the possibility of having a child taken
into care at birthlet alone those which are taken from
the delivery room. Strong research evidence suggests that the
level of damage inflicted on the child before birth by protective
services may well exceed any future harm the mother might be capable
of. Most of these children will be returned to the mother if taken,
or if taken into care or adopted, will have greater problems in
life than they need have had if only supportive rather than "policing"
care had been offered to the mother.
3. One mother has written movingly to us
of the difference in the quality of feeling she has towards her
two children, though she loves and cares for both. There is a
distance from the older child, whose pregnancy and birth was surrounded
by social work "protection" activity. With the second
there was no such involvement and her feelings are warmer and
much more spontaneous. She thinks of his arrival with nothing
4. Sometimes social workers make very strict
pre-birth plans about the conditions under which the mother will
be allowed to keep her baby. They often show ignorance of how
these may impair development of bonding, breastfeeding, or optimal
emotional and physical care of a newborn, or affect the mental
health of the mother. From time to time we have queries from mothers
affected by such future plans. They are women who are willing
to cooperate, and take every responsible step to show they can
be a good parent, but they realise the conditions are going to
be almost impossible to follow and at the same time build a normal
relationship with their child. Any deviation then provides an
excuse for social services to step in and take the child. In one
well-publicised case, a pregnant woman fled abroad to give birth,
because she felt the position was hopeless.
5. Experienced midwives and community support
workers see mother and newborn as a dyad, and the initial "babymoon"
is a precious and sensitive time, during which the umbilical cord
which physically joined the baby to the mother is replaced by
an emotional umbilical cordwhich will be an important protector
of the child even in hard times and poor social circumstances.
At this time supporting the father is also important, as the pair
adjusts to being a family with their first child: this is a very
sensitive time. Intervention may increase the risk of post natal
depression, or worsen it, and a number of postnatal suicides of
mothers have been connected with social work intervention, and
the Confidential Enquiries have expressed concern.
6. In a decision of the European Court of
Human Rights concerning a case where a baby was removed from the
mother after birth, the UK was criticised for not respecting the
baby's rights to family life or to have the opportunity of breast
feeding. (P.C.& S v. UK).
7. The baby has a right to its mother's
breast milk if she is willing and able to breast feed. There is
now a large body of medical research evidence showing the long-term
benefits of breast feeding for the child. In addition, it has
health benefits for the mother, prolonged lactation reducing risks
of breast and ovarian cancer. We have had a number of cases where
breast-fed babies have been removed. In one case it was written
on official papers for the court (which, as advocates and supporters
we are allowed to see) that the child was bottle fed, although
all the medical records clearly showed it was breast fed.
8. In order to maintain her supply of breast
milk and to feed the baby, the mother has to have frequent access,
and the best way to establish breast feeding and to nourish the
child is to feed on demand. In no case has adequate access been
allowed when a child has been removed into care. We have had contact
with a number of distressed mothers who have wanted to express
milk to continue supplying what they know is best for their baby.
There has been no question raised that these mothers were street
drug users or addicts. Yet social workers have often refused to
take the milk, or if it has been delivered to their office, the
mothers discovered it had been thrown away. Who is doing their
best to protect the child herethe state or the parent?
9. In one case a mother's first child was
taken into care. The baby was being breast fed. It was placed
in a foster home where there were older school children. The baby,
too young to be immunised, got whooping coughpresumably
caught from the other children. Had it remained at home, as the
sole child in the household, the risk of exposure would have been
less. The risk of contracting the illness even if exposed would
have been less because the mother would have passed on her immunity
to this, and other infectious diseases, in her breast milk. Fortunately
the baby survived what could have been a fatal illness at that
age. The baby was returned to the mother; it seemed that there
were inadequate grounds for its precipitate removal in the first
place. She was unable to re-establish lactation.
10. We have had two cases where a mother
had to bring her breast-fed child to contact with an older child
who was in care. On both occasions a male social worker was supervising
the visit and insisted on remaining, although a female social
worker was also present. One of the mothers was Asian, and the
other was West Indian. Both were deeply upset and asked the male
worker to withdraw, but in each case he refused, making remarks
which they found offensive.
11. In many of the cases we have seen, the
State could have provided a Norland Nanny for a family with a
baby or young child at far less cost than that for social workers,
lawyers, medical experts, foster carers, etc, involved in the
current process, with better results and with far less damage.
A number of new mothers, some of whom knew they might need help,
said their ideal situation would be to live for a time with an
experienced granny, who would support and advise them, while they
gained confidence and experience and enjoyed their new baby. These
mothers did not have aunties or mothers of their own nearby who
could do the job. Why could such a service not be provided, at
least for some mothers?
12. Removal of these children happens at
a crucial time for attachment, and interruption or loss of the
usual continuous carer can, as we know, have long term effects
on the child's personality and mental health for the rest of life.
From his own extensive work in Child Guidance Clinics, Dr John
Bowlby showed in his classic study of 41 Thieves, that the crucial
factor which distinguished young offenders from boys brought up
in similar unfavourable circumstances, was that they had been
separated from their main carer at a crucial period for attachment.
We find it surprising that his classic volume of work, which is
a cornerstone of modern psychiatry, and much more work which followed
it, does not seem to have been read, understood, or taken on board
by social workers. It suggests that unless there are very good
grounds babies and toddlers should not be separated from the mother
or main carer, and other measures proven to be supportive to the
mother and family unit should be used in preference wherever possible.
13. We find ourselves sharing the concerns
of mothers whose young children are removed; they are too young
to understand what is happening, or to take in explanations, and
their experience of time is very different. Twice weekly contact,
to a two or three year old, is a huge time gap, and weekly or
fortnightly incomprehensible. Explanations cannot convey to them
when Mummy and Daddy will be seeing them again.
14. It is well known that continuity of
placement with as few foster homes as possible is important, but
what has been little remarked on or investigated is how much disruption
there is within the foster home, even in longer placements, and
how important this may be for very young children. One mother
had been telling us for a few weeks that her two very young children
seemed to have deteriorated, become disturbed, and lost weight
in a foster home where they were previously doing welland
much better than in an earlier placement. Then she discovered
that there had been an emergency placement of a family of four
children in that home, so her bewildered children were getting
little attention. Social workers would not listen to her concerns.
15. Another cause of disruption within the
foster home is when foster carers go away for holidays with their
own children, so fostered children are moved to other families.
A mother adopted a two year old who had been
with the same foster family, who specialised in fostered babies,
since birth. She had not expected the degree of persisting attachment
difficulties she found: this child would go to anyone. She learned
that the foster carers had had frequent holidays abroad, leaving
the foster children with a series of different familiesand
what is more, families who were not monitored.
16. In addition, separations would occur
when respite care was arranged for foster carersoften it
was respite care which families themselves had been begging for
when they had children with serious problems, but which had never
been provided. As soon as a child went into foster care, many
basic needs which had been denied parents, who had merely become
an irritation because they fought so hard for them, were automatically
provided by a case worker.
17. As with other contacts of older children,
planned frequency as decided by the court, is often not borne
out in practice. It is disrupted by Bank Holidays, foster carer's
arrangements, non-availability of social workers, etc. We have
seen a number of cases where contact is suddenly reduced at a
whim by social workers, quite contrary to court decisions, and
sometimes it seems to be used as a means of disciplining parents
or bringing them into lineas it is a most powerful and
effective tool. Parents dependent on good will dare not complain
about anything in these circumstances, so dissatisfactions are
quashed. But contact is for the child not just for the parent,
and often it has low priority when there are other demands on
18. The levels of cultural competence in
social workers and Cafcass officers can be surprising. They also
often assume that needs of a child from one ethnic group can be
met by placement with a similaror vaguely similar group,
ignoring the fact that differences can be as great as differences
within any other group. They are unaware, for example, that attitudes
and ideas can be very different among families from different
parts of the West Indies, or that a well-educated, UK born parent
from an Asian family might prefer placement with a white family
with similar standards to placement with a family of immigrants.
19. In one home, the teenage daughter of
the foster carer was allowed to use chemical products to straighten
the Afro hair of the young foster child. The mother, who supposedly
had joint parental responsibility and not been consulted, was
appalled. In the first place the products are potentially dangerous
and could have injured the child; they are used with great care
by professional hairdressers. Secondly, her strongly held belief
was that her daughter should be brought up with the confidence
that her heritage appearance was beautiful, and did not have to
be altered to cope white ideas of acceptability. There seemed
to be no concern on either point from the social worker or the
department; they did not even seem to understand the problemsboth
families were of West Indian origin so they saw no problem with
culture clash. This, alas, is a not untypical example.
20. A West Indian foster carer was criticised
by the agency which employed her for the over strict discipline
which was her cultural norm, but not acceptable in the UK. Social
services were also informed of this, and the agency's concern.
The foster carer simply switched agencies, and nothing more was
heard about the problem. The child's birth family felt helplessbut
like so many others, dare not offend social services by making
a complaint to try to protect their child.
21. The English speaking children of a well-educated
English-born mother from a Pakistani family were placed with a
Pakistani immigrant family who spoke their own language at homeand
a different language from that of their Pakistani grandparents.
The children's own language development regressed, and their mother
had to watch this with great anxiety, but her comments and concerns
were not acknowledged. Although the family provided their customary
food, it was not what the English-reared children were used to,
and the mother felt that their nutritional standards had greatly
deteriorated at a crucial period for growth and development. However,
social workers felt that ethnic needs had been met, so they could
not be criticised, and other standard concerns about child rearing
were less important. The mother felt otherwise, but dare not press
22. A young black child, born in the UK
and only English-speaking, was placed with a white foster family
from Europe, who spoke only their own language at home among themselves.
She was bewildered, and her own language development regressed.
23. Most children who are looked after by
the local authority will be returned to their original home. Unfortunately
this will be to a family which may have been damaged by the process
and it is a family which will never be the same. Parents have
been disempowered, had self esteem lowered, and have lost confidence,
as many tell us. Yet there is now excellent research showing that
it is empowerment of parents and raising self esteem which is
one of the most effective tools in improving parenting; this has
been shown in long-term follow up of the randomised trial of home
visiting, with long term follow up, by David Olds and in the final
evaluation of SureStart, which showed that the centres which empowered
and trusted parents were the most successful And alternative approaches
to social work, involving support and care rather than policing
and removal, have been shown in randomised trials in the United
States, to improve outcomes without increasing risks for children
(eg in Minnesota, Missouri and a number of other States).
24. We were delighted to see that in the
Care Matters: Time for Change White Paper the Government
has acknowledged that more attention will be paid to partnership
with parents. This is long overdue. We would like to give some
examples of the protective role many parents try to play when
they are separated from their children, and the fact these are
sadly often discounted and blocked. Parents usually know their
children well, and are keen observers of changes in weight, appearance
and behaviour. Unfortunately many tell us their concerns are dismissed,
and they are seen as a nuisance and a potential source of damaging
criticism to them rather than co-protectors, even when they supposedly
have joint responsibility with the local authority.
25. One mother regularly kept an eye on
her children in care at contact visits. She measured a toddler's
feet, and found it was wearing shoes which were too small which
no-one had noticed. Although she was poor, and no longer received
an allowance for the children, she immediately went out and bought
new shoes for the child. She also bought and provided sun hats
and sun cream when she noticed her very fair skinned children
were getting red in the sun. This was typical of her care, but
never appeared in reports.
26. A mother noticed frequent unusual bruises,
bumps and cuts on one of her children. She pointed them out each
time to the supervising worker at the SureStart contact centre,
and for a few weeks they were recorded in a special book kept
for the purpose. Then the book disappeared, and was never heard
of again, so the record vanished and future episodes were not
27. A mother who had been separated from
her children by severe post-natal depression was alerted by the
relative with whom they had been placed that one was ill. She
went to the home and found a very feverish sick child. Immediately
she stripped the child and began sponging the child with lukewarm
water and told the junior social worker who was present the child
must go to hospital. The social worker phoned the office for instructions
and was told by her senior that the child must go to the GP. So
time was wasted while they went to the surgery, waited for the
GP to return, and he then told them to take the child to hospital
where it was admitted admission had been delayed by over
two hours. A social worker who could not even see the child had
given instructions over the telephone which over-rode this experienced
mother and put the child at risk.
28. A mother, accompanied by a social worker,
watched her children play outside at a family centre used by social
services for many families to have contact. Her little daughter
ran into a large garage which had open doors. When she did not
come out again, the mother looked for her, and found her putting
blue pellets from the floor into her mouth. They were rat poison.
The mother extracted them and pointed it out to the social worker.
If she had been so careless at home, it would have been a source
of criticism which appeared in court reports, but here the matter
29. Some parents have told us how concerned
they are that young children are ferried back and forth to contact
visits by a series of strangers, so that they have no fears of
getting into cars with strangersit has become the norm
30. We hear widely varying reports of centres
used for contact, and the behaviour and standards of staff. We
feel that an inspection, in which views of parents and children
are widely collected, should be done.
31. Some of these staff carry out assessments
of parenting for social services and the courts. We are greatly
concerned at the level of training of staff concerned and the
poor quality of the reports we see. Some parents also strongly
dispute the accuracy of what is written.
32. Although mostly we deal with parents
and young children, their older siblings are often involved, and
we have contact with them. When he knew we were making this submission
one child whose sibling is in foster care telephoned us to make
sure we emphasised how important contact is, and that social workers
who arrive late, thereby reducing the short, precious time allowed,
seem to regard it as a minor matter, when it is not. A mother
also spoke to us pointing out that sometimes a very long journey
is made when a child is a long distance away, so a couple of hours
contact can involve a whole day trip. Whereas fares are paid by
social services, it is a battle to get a quite modest amount to
provide food and drink for a family of children on a long trip.
33. Many of the children whose families
we deal with are too young to speak, or to express their wishes
clearly. But their body language and vocal sounds are often eloquent,
but are unreported, and we see it often The intense engrossment
and mutual prolonged gaze of a mother and baby on a contact visit.
The toddler who studiously ignores his father when he arrives
to take him for a court-ordered overnight visit which will separate
him from his mother, and his piercing screams when he is picked
up and taken out to the car.
34. However we see a worrying number of cases
where children's voices which conflict with social workers' decisions
are downplayed or ignored. It is assumedand perhaps wrongly
assumedthat these must be brainwashed into them by the
parent but some children who have spoken to us are very indignant.
Social workers and Cafcass officers are not invariably accurate,
or unbiased, reporters of the child's views.
35. Often during contact, communication
between parent and child is blocked, and it seems that close supervision
is there not because the parent might do anything dangerous to
the child, but because of fear that the parent might tell the
child a different version of what has happened and why. Children
are left bewildered and confused because parents are not allowed
to tell them what is going on, and once when a sibling blurted
it out, the parent was blamed.