Assuming care : experiences and outcomes for childbearing women, babies, midwives and other professionals in the child protection practice of Assumption of Care at birth in NSW, Australia

  • Christine Marsh

Student thesis: Doctoral Thesis


In New South Wales Australia, a newborn baby is removed from her or his mother into formal care when the NSW Department of Family and Community Services consider there is immediate risk of serious harm to the newborn baby. Family and Community Services may assume the care of a newborn by a Care Order given to the hospital and the mother. This is defined by the Children and Young Persons (Care and Protection) Act 1998 Section 442 Emergency Removal and is known as an ‘assumption of care’ (AoC).
This is frequently a deeply traumatic event for all concerned, not least the mother. Health professionals and others that may be involved include social workers, family and community case managers and midwives. Midwives are implicated in this event when child protection concerns are raised in pregnancy and or an Assumption of Care occurs just after birth. Little was known about how this is experienced from those involved.
This thesis presents a portfolio of works including two studies and four published papers. Study One draws on data from Family and Community Services, describing the incidence and characteristics of babies (less than 7 days old) entered into out-of-home care from 2006 to 2014. Over this period of time 1,834 newborn babies were entered into care with a prenatal report and babies entered into care steadily increased each year. Aboriginal and Torres Strait Islander babies were over represented. Few babies were restored to parents or adopted over this time.
Study Two uses a narrative approach to explore the experience from the perspective of several groups: the women (the mothers) whose newborn baby was removed from her care by Family and Community Services, the midwives and social workers who are actively involved in the process and Family and Community Services case managers who physically carry out the AoC. The women’s stories took centre stage in the analysis with those of the other players on the periphery. The stories are presented in three parts: a prelude; the focal point (AoC) and the coda (which brings the stories to a close). Significant intergenerational social and economic disadvantage and sometimes previous trauma was evident in the prelude, often accompanied by physical and mental health concerns. The women’s stories of the event (AoC) are harrowing. It is deeply traumatic and experienced as such by all concerned but most significantly by the mothers. In addition, social workers and midwives feel professionally compromised where there is concealment associated with the AoC. The trauma is long-lasting for the women and they describe a disenfranchised grief; grief that is not socially sanctioned. There is little support afforded these women and their trust in health professionals has been lost. They continue as best they can though with the additional trauma brought by the experience of AoC, impacting an already complex life. Many women experiencing Assumption of Care go on to have more babies.
This thesis argues for two important changes to practice. Instead of the statutory process currently in place for maternity care a collaborative therapeutic justice model should be used and each woman who is at risk of her baby’s care being assumed by the state should be provided continuity of midwifery care. Therapeutic justice models are built on values that include the restoration of human dignity, of damaged human relationships, of compassion and caring, empowerment and the restoration of a sense of duty of a parent and the role of the community. Continuity of midwifery care models provide important benefits such as facilitating communication, mutual trust and respect as well as clinically important outcomes improvements with no adverse outcomes. Continuity of midwifery care used in collaboration with other care providers enables health professionals to provide safe woman centred care for women with complex pregnancies and social situations.
This study provides insights into the incidence and processes of AoC in NSW including the accompanying emotional and physical consequences for the women and the conflicting ethical and moral positions imposed upon the professionals involved in this practice. Recognising that we can do better, midwifery continuity of care and a therapeutic justice model is recommended for the future.
Date of Award2018
Original languageEnglish
SupervisorDeborah Davis (Supervisor) & Jenny Browne (Supervisor)

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