1. 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
2. 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
3. Core principles
Support Information
for all parents for
Opportunity decision making
for positive
feeding
experiences
potential
potential
tension
tension
Promotion
of breastfeeding
4. 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.
5. 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.
6. Milk Feeding
100
Important
for 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
7. NCT positives
• BFC support – non-judgemental, person centred
• Collaborative working – peer support, children’s centres,
NHS
• Effective campaigning
• Good information (especially information sheets)
8. 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’
9. 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
10. Some mothers who use formula milk feel under-
supported
Parents who use
formula milk feel
Promote ‘choice’
supported in their
feeding decisions
All parents
feel
supported
Breastfeeding is not
further undermined Promote
by presenting as an breastfeeding
equal or inevitable
choice
11. 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.
12. Some mothers feel under-prepared for problems
Mothers ready when Lots of antenatal
pain problems occur information on
and feel supported by problems
NCT
Positive
breastfeeding
experiences
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.
13. 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.
14. 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
manageable
Parents find it
easy to obtain
support when
they need it
Mother gets
breastfeeding support Proactively
when she most needs approach new
it and doesn’t have to mothers
make the approach.
15. 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
16. Our new 2020 direction for feeding
Support parents’ decision making journeys, whilst
ensuring that decisions to breastfeed are enabled
and protected
18. 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?
19. Bring our key concerns front and centre...
3. Pressure (however you feed)
4. Unwanted early breastfeeding cessation
And explain how they interrelate
20. Does NCT promote breastfeeding?
NCT seeks to promote and protect the conditions that
make a mother’s decision to breastfeed more
straightforward.
21. 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.
22. 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.
23. 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.
24. 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
25. 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
26. 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
27. Next steps
– internal and external communication
– implementation work (training, helpline, media work etc)
Your input into shaping this
