2020 TourSupporting 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 Support Information for all parents for Opportunity decision making for positive feeding experiences potential potential tension tension Promotion of breastfeeding
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.
Milk Feeding 100Importantfor NCT? 9/10 before 75 76 they want Percentage 60 mix feeding 50 48 In context of WHO Advice 38 34 25 25 21 18 2 wks 6 wks 4 mths 6 mnths 9 mnths 7 0 3 Any BF Exclusive 2000
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 Promote ‘choice’ supported in their feeding decisionsAll parentsfeelsupported Breastfeeding is not further undermined Promote by presenting as an breastfeeding equal or inevitable choice
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.
Some mothers feel under-prepared for problems Mothers ready when Lots of antenatal pain problems occur information on and feel supported by problems NCTPositivebreastfeedingexperiences Mothers are not put-off Do not re-enforce breastfeeding and do negative not see breastfeeding perceptions. Focus as inherently ‘difficult’. on a good start.
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 in control of Wait for mothers to relationship and BFC contact a BFC capacity issues manageableParents find iteasy to obtainsupport whenthey need it Mother gets breastfeeding support Proactively when she most needs approach new it and doesn’t have to mothers make the approach.
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 feedingSupport parents’ decision making journeys, whilst ensuring that decisions to breastfeed are enabled and protected
New Message FrameworkNCT Values and approaches to infant feeding support
Development process• X-disciplinary team• Based on impact research• Consultation• ConfirmationWhat 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...3. Pressure (however you feed)4. 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 differencesBUT:• 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