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INTRODUCTION: Keeping children in the centre of practice is an established mantra for the children’s workforce internationally and is also enshrined in the Aotearoa New Zealand Children, Young Persons and Their Families Act 1989. The principle that the welfare and interests of the child are awarded paramount consideration (s6) when these are in conflict with others’ needs is incontestable. However, we suggest that how this translates into day-to-day social work practice is open to multiple interpretations. This interpretation emerged from a women’s health social work team, providing services to pregnant women experiencing complex social factors.METHOD: An audit collected and analysed data from cases that were identified as having achieved successful outcomes in this context. A metaphor emerged from the reflective analysis of these findings. This metaphor, ‘walking the tight rope, maintaining the balance’ was put to the practitioners via a reflective process. FINDINGS: Research findings indicate that by taking up a child welfare orientation to practice positive outcomes are possible. This practice was found to rely on a number of personal, professional and organisational factors, most dominant were those associated with relationship based practice. Findings suggest that women’s health social workers need to maintain a fine balance with several critical elements, such as the provision of reflective supervision acting as a practice safety net. CONCLUSION: It is argued that the binary either/or positions of adopting a child centred or a woman’s centred approach to practice should be avoided and an and / both orientation to practice be adopted. This reflects a child welfare orientation to practice – one in which prevention is a primary focus.