2020 Tour

Supporting mothers’ decisions and protecting breastfeeding

New strategic directions

Heather Trickey, Helen Allmark, Rosemary Dodds, Jessica Figures, Heather Neil, Mary Newburn,

Gail Werkmeister, Patricia Wise

NCT Baby Feeding Impact Review

• Evidence about experience of feeding in UK, feedback from parents, NCT practitioners, professionals, policy makers

• Our strengths

• Identification and analysis of long-running problems

New strategic directions

Core principles

Supportfor all parents

Informationfor

decision making

Promotionof breastfeeding

Opportunity for positive

feeding experiences

potentialtension

potentialtension

NCT are different

• PARENTS (not babies) – beliefs‘parents are motivated to do the best for their children’‘right for themselves and their families’‘mother-focused, family-focused’

• EXPERIENCES, well-being, self-fulfilment, confidence, self-efficacy, parent decides. Breastfeeding support in this context. Expanding the decision making context.

• WHOLE TRANSITION, not just feeding.

Two key concerns

• Feelings of pressure and guilt regardless of feeding method

• High levels of early problems, drop-off and disappointment with breastfeeding. Mothers stopping before they want.

NCT strategy must have a positive impact on both concerns.

60

48

34

2518

38

21

73

76

0

25

50

75

100

Percentage

Any BF Exclusive 2000

2 wks 6 wks 4 mths 6 mnths 9 mnths

9/10 before they want

Important for NCT?

In context of WHO Advice

mix feeding

Milk Feeding

NCT positives

• BFC support – non-judgemental, person centred

• Collaborative working – peer support, children’s centres, NHS

• Effective campaigning

• Good information (especially information sheets)

Person-centred approach

‘Others will have tended to ‘tell’ them what to do ... This makes their whole experience with us significantly different’

‘As part of our training we are thoroughly de-briefed .. This means that we do not take our baggage with us and burden the client’

‘breastfeeding counsellors support women who decide to stop breastfeeding... being with the woman’

Long-running problems

• Mothers who use formula milk feel under-supported

• Mothers can feel under-prepared for problems with breastfeeding

• Many mothers who might benefit from feeding support don’t access help

• Our geographical and social reach

Some mothers who use formula milk feel under-supported

Parents who use formula milk feel supported in their feeding decisions

Parents who use formula milk feel supported in their feeding decisions

Breastfeeding is not further undermined by presenting as an equal or inevitable choice

Breastfeeding is not further undermined by presenting as an equal or inevitable choice

Promote ‘choice’Promote ‘choice’

Promote breastfeedingPromote breastfeeding

All parents feel supported

All parents feel supported

Supporting mothers’ decision-making processes and protecting breastfeeding

• Review the language and tone of information – stop talking about ‘choices’.

• Stop categorising mothers and focus on need for mother-centred regardless of feeding trajectories.

• Ensure rationale for investing in protecting breastfeeding decisions is widely understood.

• Improve individualised support for formula use, minimising the need to rely on commercial sources.

Mothers ready when pain problems occur and feel supported by NCT

Mothers ready when pain problems occur and feel supported by NCT

Mothers are not put-off breastfeeding and do not see breastfeeding as inherently ‘difficult’.

Mothers are not put-off breastfeeding and do not see breastfeeding as inherently ‘difficult’.

Lots of antenatal information on problems

Lots of antenatal information on problems

Do not re-enforce negative perceptions. Focus on a good start.

Do not re-enforce negative perceptions. Focus on a good start.

Positive breastfeeding experiences

Positive breastfeeding experiences

Some mothers feel under-prepared for problems

Develop the concept of an

investment or adjustment period

• Better evidence to understand the impact of the content of antenatal breastfeeding education on maternal confidence and peventing problems.

• Improve signposting to support.

• Promote broad cultural awareness that during the early weeks new mothers who decide to breastfeed often benefit from informal support from family and friends.

Some mothers who might benefit don’t access help

Mother gets breastfeeding support when she most needs it and doesn’t have to make the approach.

Mother gets breastfeeding support when she most needs it and doesn’t have to make the approach.

Mother in control of relationship and BFC capacity issues manageable

Mother in control of relationship and BFC capacity issues manageable

Wait for mothers to contact a BFCWait for mothers to contact a BFC

Proactively approach new mothers

Proactively approach new mothers

Parents find it easy to obtain support when they need it

Parents find it easy to obtain support when they need it

Develop mother-centred,

proactive models of support

• Use of different types of support to manage capacity

• Incorporate evidence for mother-centered approach into intevention design.

• Re-affirm maternal experience of support as an outcome of interest

• Develop evidence base on effectiveness and acceptablity of a range of proactive support models

Our new 2020 direction for feeding

Support parents’ decision making journeys, whilst ensuring that decisions to breastfeed are enabled and protected

New Message Framework

NCT Values and approaches to infant feeding support

Development process

• X-disciplinary team• Based on impact research• Consultation• Confirmation

What are we for?• Promoting health? choice? positive experiences?• Why do we focus on breastfeeding?• How do we support mothers using formula milk?

Bring our key concerns front and centre...

1. Pressure (however you feed)2. Unwanted early breastfeeding cessation

And explain how they interrelate

Does NCT promote breastfeeding? NCT seeks to promote and protect the conditions that

make a mother’s decision to breastfeed more straightforward.

Does NCT promote feeding choice?

NCT tends to talk about feeding ‘decisions’ rather than feeding ‘choices’, because having a ‘choice’ implies a range of equal and equally accessible options and this is not the experience of many UK mothers. The idea that mothers have a free ‘choice’ contributes to many feeling pressured or judged.

Does NCT promote the public health benefits of breastfeeding?

NCT provides evidence based information on health differences

BUT:• Information about health benefits without good postnatal support can

lead to mothers feeling exhorted but not sufficiently enabled or supported to breastfeed.

• Information without understanding that mothers are best placed to make feeding decisions can lead to those who decide not to breastfeed feeling judged.

Why does NCT provide an antenatal ‘breastfeeding session’ rather than a ‘feeding session’?

NCT antenatal breastfeeding classes do focus on breastfeeding, because this is a service that is desperately needed. The decision to breastfeed can be fragile and the breastfeeding class is about making this decision a realistic possibility for families - socially, culturally, and physiologically.

What kind of support can a mother using formula milk expect from NCT?

NCT believes that mothers using formula milk should have support to do so safely and access to factual, supportive information that is free from commercial influence.

- NCT practitioners- Information & website- Helpline

NCT avoids categorising women into ‘breastfeeding mothers’ and ‘formula feeding mothers’

– Most mothers do both– Categorisation emphasises differences, we focus

on mutual support and common experiences

Re-emphasise core NCT values

– non-judgmental, empathetic– mutual support– parents best placed to decide– lobbying for supportive services to enable decisions– protecting physiological normality from external pressure

Next steps– internal and external communication– implementation work (training, helpline, media

work etc)

Your input into shaping this