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Assessment where there are concerns that an unborn child is likely to suffer significant harm is one of the most difficult tasks that social workers undertake; the legal and ethical context makes the process of assessment and intervention during this period complex. This paper explores pre-birth assessment guidance and practice in England. Local safeguarding guidance in 147 English localities was accessed and analysed, and interviews were conducted with 22 practitioners involved in pre-birth assessments. The findings showed that while most local safeguarding guidance was more detailed and explicit than the national guidance, legal and ethical issues were rarely addressed. Interview data showed that, in general, guidance to support social work assessments during the pre-birth period was insufficient, and that few practitioners used standardised tools to aid assessment. Some practitioners regarded pre-birth assessments as less urgent than cases involving infants/older children, thereby increasing delays in decision-making. It is concluded that existing guidance and practice with regard to pre-birth assessment are inadequate. [ABSTRACT FROM AUTHOR]