Midwife Safeguarding Referral Reflection: ERA

Experience

During a routine antenatal appointment, a woman disclosed details of her home situation that raised safeguarding concerns for her and her unborn baby. She asked me not to tell anyone. I explained gently that I could not keep that kind of information confidential, discussed what would happen next, and made a referral to the safeguarding team the same day, following our local procedure and documenting the disclosure carefully in her words. I also discussed the case with my safeguarding lead before submitting the referral.

Reflection

The hardest moment was the conflict between maintaining her trust and my duty to act. Telling her I had to share the information felt like a betrayal of the rapport we had built, and I worried she would disengage from antenatal care as a result. On reflection, I believe being honest with her about the limits of confidentiality - rather than referring behind her back - was the right approach, and it is what our professional standards require. I was glad I had discussed the threshold with the safeguarding lead rather than carrying the decision alone; their confirmation that the referral was proportionate settled my doubt. I also noticed how physically stressful the appointment was, and that I went home still carrying it. I had not used any of the support available to staff after difficult disclosures.

Action

I will continue to be explicit with women about the limits of confidentiality early in our contacts, so a disclosure never turns into a felt betrayal. I have booked onto the next level of safeguarding training to strengthen my confidence around thresholds. I have also agreed with my team leader to use our post-incident debrief arrangements after future difficult disclosures instead of processing them alone, and I checked in with the woman at her next appointment to keep her engaged with her care.