Share your experiences of how risk is communicated during pregnancy

NCT volunteers, practitioners and peer supporters will be familiar with some of the public health messages that try to help women make decisions about what they do and don’t do during pregnancy. Amongst other topics, expectant mums receive advice about what to eat and drink, how much they should weigh, how to exercise, what medications they should or shouldn’t take and how to bond with their baby.

These messages are intended to improve outcomes for mothers and babies. However, navigating this ever-more-complicated risk landscape can often feel confusing and overwhelming – and sometimes judgemental.

Our research with parents has shown just how tricky this can be. During 2018, we worked with Good Innovation to conduct in depth research with expectant and new parents on their experiences of becoming a parent and the support they received. We found that excitement quickly turned to anxiety, in part due to the huge volume of conflicting advice. We found a universal need for support with navigating information and knowing who to trust.

“It was really difficult to find simple guidance…. there’s so many forums with often unhelpful advice that it all felt a bit overwhelming.”

“I googled a lot and found so many conflicting sources of information, it would have been helpful to know who to trust.”

Two expectant mums, reflecting on their experiences of early pregnancy.

We’re therefore really excited to be working with the British Pregnancy Advisory Service (BPAS) and Cardiff University on the WRISK project. This project aims to develop recommendations to improve women’s experiences of how risk is communicated in pregnancy and to contribute to public health. 

At this early stage of the project, we’d love it if as many women as possible could complete this survey to help to shape the recommendations.

The survey is open to all women who have been pregnant in the last five years regardless of experiences of pregnancy or how that pregnancy ended. The survey asks about risk-related topics, how women feel about the advice received, and any areas that could do with greater attention or better communication.

We’d appreciate your support in sharing this survey so that we can reach a wide range of parents across the UK.

As well as this survey, the team will be conducting interviews and focus groups to better understand the experiences of women from a range of backgrounds. Based on these experiences, a panel made up of public health specialists, voluntary support organisations, scientists, social scientists, health professionals and women’s rights advocates will co-produce recommendations to improve the way that risks are communicated.

Further information on the project:

The WRISK project is a collaboration between Clare Murphy and Rebecca Blaylock at the British Pregnancy Advisory Service (bpas) and Heather Trickey at Cardiff University. The co-investigator team includes NCT, Birthrights, Pregnancy Sickness Support, Antenatal Results and Choices (ARC), Public Health Wales and researchers at Southampton University and at UCL. WRISK is funded by the Wellcome Trust. You can read more about the project here: www.wrisk.org

Celebrating peer support in Newham

There are two things that I always do when I visit one of our peer support programmes. Eat too many biscuits and… shed a tear! And last week was no different.

Together with Dorothee Archambault (NCT Head of Partnerships) and Carey Oppenheim (NCT Trustee), I spent a wonderful morning with NCT’s Newham branch last Tuesday at their celebration event for volunteer peer supporters. The celebration brought together Parents in Mind and breastfeeding peer supporters, who have trained with NCT to provide support for new parents with feeding and perinatal mental health.

 

Newham (East London) was one of three pilot sites selected for the development of the Parents in Mind peer support service, alongside Coventry and Warwickshire (Midlands) and Halton (North West). We secured funding from the Department of Health in 2016 to develop this new service, to provide safe and effective peer support for women with mild to moderate perinatal mental health difficulties.

Alongside the centrally funded Parents in Mind programme, NCT Newham have fundraised locally to train several cohorts of breastfeeding peer supporters, who provide support to mums with feeding on postnatal wards and in drop-ins across the borough.

It is always so inspiring to hear women talk about what motivated them to train to support others. And how transformative the experience has been for them. The stigma around perinatal mental health in particular means that it is sometimes only during the training course itself that women finally feel safe to talk openly about their experiences. This takes such careful facilitation by our peer support trainers, creating a safe space for honesty and reflection, whilst building the knowledge and skills required to support others.

The friendship, solidarity and community spirit amongst volunteers is just wonderful, and provides such a strong foundation for the support they provide. And it’s on hearing the stories of how they have supported women when I inevitably shed a tear. On postnatal wards, in community groups or one-to-one, our volunteers support women through incredibly difficult circumstances, experiences and challenges.

One new Parents in Mind volunteer had said after providing one-to-one support: ‘but I hardly said anything, I’m not sure if I helped’. Feedback from the mum was that this was the first time she felt that anyone had actually listened to her and she valued it so much.

Such a lot of work went into securing the funding and building the key elements of the service during the first year of the project. So it is simply wonderful to sit quietly and observe a room full of amazing women who have brought it all to life. When training and workbooks and safeguarding policies and risk assessment and budgets and evaluation tools simply become scaffolding for the things that really matter.

Human kindness.
Trusted relationships.
Listening and understanding.
A way in. A first honest conversation.
Help to access to services.
Not being alone.

The stories bring to life the data that we see as an evaluation team. Women supported by Parents in Mind so far show a statistically significant reduction in depression and anxiety scores. And said that it helped them:

  • feel less lonely/isolated (89%);
  • feel like they have someone to talk to who understands them (86%);
  • access services (87%);
  • know where to get help (85%).

As we enter the final year of the pilot period, I feel grateful to have worked with such a brilliant team to develop a robust model of perinatal mental health peer support – with the flexibility to adapt to local context and individual women’s needs. We’re now working hard to secure funding to ensure many more women can access this support in the future.

Belinda & Andrea

Huge thanks to Belinda Ngugi (Service Delivery Manager for Parents in Mind in Newham, as well as NCT Newham acting branch coordinator) and Andrea Weyand (NCT peer support trainer) for putting on such a great celebratory event. And to all the NCT peer supporters across the UK, who are doing wonderful things every day that make the world a better place.

Expanding NCT’s breastfeeding support services

Head of Knowledge, Sarah McMullenEarlier this year, as part of the evidence-gathering stage of ourNCTservices, we worked with Good Innovation to gather robust insight from parents through 130 in-depth discussions during pregnancy and after birth. We travelled across the UK, speaking to those who had done NCT antenatal courses as well as those that hadn’t.

Unsurprisingly, breastfeeding was one of the most emotive subjects discussed. Women and their partners expressed a desperate need for more accessible breastfeeding support, alongside greater realism of how challenging breastfeeding can be. The vast majority of women that we spoke to found establishing breastfeeding a very challenging experience, much harder than they ever expected. Poor experiences of postnatal care and not being able to access quality support once at home were associated with negative feeding experiences and feelings of failure for many of the women we spoke to. In contrast, mums who accessed good support valued it enormously.

Strengthening and growing our models of breastfeeding support is a key area of focus for us as we move into the implementation stage of the ourNCTservices project, alongside work to ensure all parents feel prepared and supported by our services whatever their feeding decisions.

In the meantime, we already have good news and progress to share from the continual improvement work happening with our central support teams.

The Volunteer Support team have been working closely with Juliet Smithson (Service Operations) and Michelle Longman (Partnerships) to improve the support we provide for NCT branches who are looking to make local grant applications for breastfeeding drop-ins, Baby Cafés or peer support. The team are already working with a number of branches and we hope to be able to share success stories soon. Volunteers and practitioners who would like support with grant applications and setting up services can get in touch via the Enquiries Team.

The Commissioned Services team have also worked with the peer support management group to redesign branch peer support training and reflective support packages to make them better value for branches. We hope this will help make it easier to set up and sustain breastfeeding peer support locally.

We’ve had some great success with securing funding for breastfeeding services recently. In Bradford, our contract to deliver breastfeeding peer support has been extended for another year, including piloting social media support. We have also worked closely with the commissioners to help shape the design of the service and the outcomes that they measure. We have two new grants for breastfeeding peer support training in Nuneaton and Wolverhampton, with lots of other branches submitting applications.

In Scotland, we will be rolling out two new areas for NCT to deliver Baby Café and breastfeeding peer support, including neonatal units across several Level 3 units. We will also be trialling the delivery of peer support training and reflective support by Skype for volunteers on the Scottish Islands. If this works well it could lead to wider roll out of the service across rural areas and other island communities.

We appreciate that not everyone is sharing in this good news – other areas have experienced funding cuts and loss of services locally. This challenging context is why the ourNCTservices project is so important – helping us all to think creatively and carefully about how we reduce the barriers to setting up and funding our services, so that more parents can access much needed support.

Thank you to all of our volunteers and practitioners who are working so hard to make sure families get the support they want and need – it really does make an enormous difference.

Supporting positive feeding experiences for all

Head of Knowledge, Sarah McMullen

How we feed our babies is a very personal decision, dependent on our circumstances, the information and support we receive, the challenges we face, and the social and cultural context in which we live.

To support these decisions, the NCT services we provide for expectant and new parents, including our infant feeding support, are built around a parent-centred approach. This means understanding and respecting each parent’s unique circumstances, and supporting them to make the decisions that are right for them.

Yet very often, right across society, mothers don’t feel prepared or supported to feed their babies the way they want to. They face judgement or feel guilty about their feeding experiences and the decisions they make. This can affect any mother, however she feeds her baby, and has a very real impact on emotional wellbeing at a challenging and vulnerable time.

We want this to change.

Our mission is to help parents have the best possible experience of pregnancy, birth and early parenthood. This means we are committed to informing and supporting mothers’ decisions, whatever that decision is.

  • We want all parents to feel prepared and confident as they welcome their baby into the world.
  • We want parents to know where to go for trusted support, and to be able to access that support, whoever they are and wherever they live.
  • We want them to feel respected in the decisions that they make, and supported to feed their babies the way they want to.

By providing trusted and personalised support, alongside evidence-based information on a range of feeding topics, we have a unique opportunity to help make these ambitions a reality.

What challenges do parents face?

We are particularly concerned about three ongoing challenges to positive feeding experiences:

  1. A high proportion of women find that they have to stop breastfeeding before they want to, often in the first few weeks. These mothers report feeling pressurised but not supported to breastfeed, and this can have a significant impact on their emotional wellbeing. This level of unwanted drop-off and related emotional impact has persisted in the UK for decades, but is not inevitable.
  2. Parents who introduce formula milk often report feeling unprepared or not able to access information on formula feeding. It is important that parents can prepare to formula feed their baby safely and responsively. They need to be able to ask questions about formula feeding without fear of judgement. They also need reliable and non-judgemental information, free from commercial interests, on the use of formula, and to know that they can get that information, plus help and support, from us. Many topics, such as feeding cues, responsive feeding, and an assortment of feeding difficulties, are relevant to all parents – regardless of how they intend to feed their baby.
  3. Women experience unacceptable levels of pressure however they feed their babies… from family and friends, as well as from people they hardly know. Mothers who breastfeed their babies often feel pressurised and constrained about whether, where, how often, and how long, they breastfeed. Similarly, mothers who use formula milk often feel judged or guilty too, particularly – but not only – if they planned to breastfeed.

What are we doing at NCT to address these challenges?

As part of the ourNCTservices project, we are conducting a major piece of new research with parents across the UK, helping to strengthen and shape our future services so that they are as accessible and impactful for parents as possible. One thing we’ve heard very strongly from parents is just how much need there is to be prepared for the reality of feeding their babies, to be able to access good quality breastfeeding support soon after birth, and to be able to access information and support with formula feeding too.

Our breastfeeding counsellors and peer supporters already provide highly valued practical and emotional support to thousands of women and families every year – on our infant feeding helpline, in people’s homes, in community drop-ins and Baby Cafés, and on postnatal wards. With cuts to services being felt across the UK, it is more important than ever that we work to protect and promote good quality support for all.

In addition to this major piece of strategic work, we have a number of other activities already underway.

  • We have updated our infant feeding message framework for our staff, volunteers and practitioners. This framework sets out how the services and support we provide, and the language that we use, can best support all parents with infant feeding and demonstrate inclusivity.
  • We have worked with a team of breastfeeding counsellors, building on parent feedback, to develop a new framework for the antenatal breastfeeding session and to outline how parents who are planning to feed formula milk (whether exclusively or in combination with breastmilk) can be supported antenatally.
  • Our quality team have produced a guide to best practice for antenatal practitioners and breastfeeding counsellors to work together effectively to deliver antenatal education in a way that best meets parents’ needs.
  • We have updated our study day programme for practitioners to build on new evidence and parent feedback, to support our practitioners with their knowledge, skills and confidence as part of their continuing professional development.
  • The quality team have been working one-to-one with a small group of practitioners who find it harder to get positive feedback from parents after their antenatal courses. This has led to significant improvement in parent satisfaction, and we’re continuing to focus on improving experiences for parents through our feedback and quality assurance processes.
  • We are reviewing and updating all of our web content to strengthen our evidence-based information across a range of feeding topics including breastfeeding, formula feeding and combination feeding.

Throughout all of our work, parents are at the very heart of our organisation. Our mission is to help parents have the best possible experience of pregnancy, birth and early parenthood. We are deeply committed to this and to continual improvement. So we always welcome feedback or suggestions for how we can improve what we do.

Listening hard for ourNCTservices

People involved = >220

Number of small group and one-to-ones discussions = 70

Regions of the UK = 12

Sheer volume of learning = awesome

Wow, February and March proved to be a very busy time for the ourNCTservices team. Caroline, Annie and I have been travelling the length and breadth of the UK to meet with more than 200 practitioners, alongside discussions with volunteer coordinators and PSAs. What have we been doing? Listening; listening hard.

Building on #ourNCTstory so far, the ourNCTservices project asks how, over the decade ahead, do we ensure our services are as accessible and impactful for parents as possible. What should we just keep doing the way we currently do? What should we adapt? Is there anything we should stop doing? And what should we consider starting to do?

Learning from your practical expertise and experience of delivering services for parents is absolutely key, alongside listening to parents directly. And so we’ve hosted a series of structured small group and one-to-one discussions, in person or by phone, speaking in depth with over 220 individuals – many of whom you can spot in this montage of photos from our travels!

It has been a truly brilliant experience and we have gained so much from the discussions – what you think are the most important times and ways in which we can support parents, what the barriers are to this locally for you, when and how we should be providing and promoting services, where you think we need to make improvements, and your ideas for better ways of working. Whilst not a quantitative exercise, speaking to so many of you means that we have been able to capture the strength and consistency of feeling to a certain extent, as well as the views expressed.

This beautifully complements the in-depth research we have been doing with parents across the UK, including those who have accessed NCT support and those who haven’t. I’d like to thank everyone involved for your commitment, honesty, enthusiasm and healthy dose of challenge. It’s really going to help us make much better decisions if we continue to work together on this.

It hasn’t all felt easy of course; it was never going to. There are understandably deep-seated frustrations about some of our current ways of working or the pace of change. There is some suspicion that we might already have the answers up our sleeve (we haven’t by the way – this whole exercise is nothing, if not open to listening, learning and analysis, ahead of any decision making). There is both desperation for change and weariness of change – sometimes expressed by the same person in the same conversation. But there remains remarkable consistency in what we’re all here to do (all parents, first one thousand days), and enthusiasm for working together more effectively as an organisation and across specialisms.

What are the next steps? We’re heading into a very busy period of analysis through late April and May, pulling together the evidence from across the workstreams – what we’ve heard from parents, what you’ve told us, what we’ve found from NCT data (e.g. impact, feedback, cost) and what we know from external evidence. We’ll then be sharing initial findings with you all at the #ourNCTstory workshops in June – dates will be shared very soon.

Thank you again to everybody who has contributed and everyone who continues to welcome us along to observe your services. Mother and Baby Yoga (with a willing doll) on a Friday morning was the perfect antidote to a week on the rail network – I may be back very soon!

If you haven’t registered already to be kept up to date with the project via email updates from the ourNCTservices team, please do so here. And we look forward to seeing you lots of you at the next stage!

You can read more about the background to the project in our first blog hereAnd you can catch up on Annie, Nick and Juliet’s reflections from partway through our discussions with parents and practitioners.

Parents in Mind – all systems go!

NCT’s Parents in Mind team have been doing a little happy dance this week, as we’ve reached a significant milestone for the project. All three pilot sites are now up and running, with the first referrals received for women in Newham to access perinatal mental health peer support. This really is a fantastic feeling for the whole team, who have worked so hard to get to this point.

As a pilot project, the Department of Health tasked us with developing a safe, effective and sustainable model of perinatal mental health peer support. We worked with the Institute of Health Visiting to train perinatal mental health champions within NCT, developed a training programme for volunteer peer supporters, recruited three wonderful local service delivery managers, and worked with our academic partners at City University and Kings College London to develop the evaluation framework and tools.

All of this work had to happen before we could begin actual volunteer recruitment and service delivery, and took considerable time and effort. This part of service development and piloting often remains hidden from view, but it’s critical to the success of the project – making sure we build upon what’s already known, develop the ‘service packaging’ which will keep volunteers and service users safe and supported, and can capture the learning and outcomes of the project.

We staggered implementation across the three pilot sites, starting in Coventry and Warwick, then Halton and finally Newham. This meant that we could take the learning from one site into the next, and also made it more feasible to deliver as a whole. And so we are now up to our full set of three pilot sites!

Before Christmas, I spent the most wonderful morning visiting Parents in Mind in Newham, where the newly trained peer supporters got together to celebrate completing their volunteer training. They reflected on their experiences, and shared their plans and hopes for supporting women in 2018. They were joined by recently trained breastfeeding peer supporters, who talked through their early experiences of supporting women in the community and on postnatal wards. They shared such powerful stories of supporting women, often in very challenging circumstances, with time, patience and kindness.

I sensed the close friendships formed amongst the volunteers, the support they are providing each other, and the diversity of experience in the room. I heard how their own confidence and sense of belonging had grown during the training, and of their commitment to supporting women locally. I watched how the peer support trainer (Andrea Weyand), service delivery manager (Belinda Ngugi) and local NCT branch coordinator (Kelly Drake) so expertly facilitated and supported the group. It was truly remarkable. I left wanting to bottle it up, and share it up and down the country. And hopefully one day we will!

During this final year of the Department of Health funded pilot period, we have a lot of work to do. We’re focusing on making the service as accessible as possible to women across the three sites, whether by self-referral or via a health professional. We’ll be continuing to monitor progress and outcomes for women, and to capture the learning about what’s working well and what could be improved. And we’ll be focusing hard on sustainability – how to bottle the magic, and demonstrate the quality and value of the support on offer.

At NCT, we have a shared vision of no parent left isolated and all parents supported. Working on this project –  hearing the very real experiences of women affected by perinatal mental illness, the fear and stigma that surrounds it, and the difference that peer support can make – I feel renewed conviction of the crucial role that we can play in improving experiences of pregnancy, birth and parenthood.

If you’d like to learn more about the project or are interested in working with us as an early adopter of the service in your region, we’d love to hear from you. Please get in touch with Melissa Briscoe, NCT’s PNMH National Project Manager: Melissa.briscoe@nct.org.uk

ourNCTservices – a time for insight and review

The ourNCTservices team – Annie Raff, Sarah McMullen and Caroline Star

Autumn has been a busy time for the newly formed ourNCTservices team,  as we get underway with our review of NCT’s portfolio of services. This is a project close to my heart, as it aims to drive the very changes which brought me to NCT in the first place.  I feel so lucky to have a job which offers such opportunity to improve experiences and outcomes for new parents and their babies. Being part of such a critical project for strengthening and increasing the reach of our support is really exciting.

At NCT, we’re no stranger to a big vision and real ambition in what we aim to achieve – that all parents should be supported to have the best possible experience of pregnancy, birth and early parenthood. And what a difference this would make for the emotional and physical wellbeing of babies and families too.

But a big vision and real ambition is no more than a pipe dream, without the right people, plans and a good dose of passion behind them. We know we have the people and passion – in droves! – and we’ve been focusing hard on the plans. 

ourNCTservices aims to explore what our services for parents should look like in the future and identify how we’re going to get there. What should we continue doing, adapt or stop doing? And what new things should we consider doing?

We are focusing first on strengthening our core services, across antenatal, infant feeding and postnatal. Alongside this we need to lay the foundations to increase our reach to support more parents from less affluent communities and at greater risk of isolation, and to expand our support postnatally.

Why is it so important that we review our services?

We know that the way in which parents access information and forge new networks has changed hugely in the past ten years. And that the world in which we deliver services continues to change rapidly – in terms of parents’ expectations, the context in which they are having babies and the other support on offer.

We also know that many more people could benefit from NCT than do so at present, and that we can do more to support parents postnatally.

So we are taking an honest, complete and creative look at what we deliver, how and to whom. This is to ensure that in ten years’ time NCT’s services are readily accessible and relevant to new and expectant parents. And that these services help them have the best possible experience of pregnancy, birth and early parenthood.

Where will we start?

We will start with parents – our beneficiaries – firmly grounded in their experiences and behaviours, and their wants and needs. If we are to achieve the greatest possible impact for parents, then we need to be truly parent-centred in the way we develop and deliver our services.

We will be mining the brilliant data we already have from our extensive evaluation of our services, including the wealth of qualitative feedback. We will be looking at wider research to understand trends, challenges and opportunities. We will also be working with the brilliant Good Innovation to conduct new research with parents, using creative techniques to understand experiences, behaviours and attitudes.

At the same time, we’ll be mapping our existing service portfolio. Taking an aerial view of the range of services we deliver. This will include reviewing the service and funding models, the benefits and value to parents, and what their potential for expansion or adaptation might be. We’ll also be considering their fit with each other and with NCT’s mission, and our capability and capacity to deliver at scale.

Working with you

We can of course only get this right by working with the practitioners, tutors, volunteers and staff who support families every day.  A huge amount of knowledge, expertise and experience exists across our amazing network. We want to hear your views and test emerging findings with you.

There’ll be lots of ways to get involved as the project progresses. The project team – myself, Caroline Star and Annie Raff will be spending lots of our time on listening and learning. As a first step, we’d love to hear how you’d like to get involved and you can also contribute to our evidence gathering stage. Perhaps you have a particular way of working locally that you think we could learn from? Or have data or ideas to share with us?

This is a really exciting project looking at the future of the charity we love so much and how we achieve the greatest impact for parents. Get involved by signing up here!

A glimpse of the future…

Head of KnowledgeLast week, I had a glimpse of the future. Several in fact. And it felt good!

As part of NCT’s Leadership Team, much of my time over the past 18 months has been spent listening and learning, planning and iterating, developing and delivering… on our strategic plans and projects. And sometimes – whether head down at a desk, battling with budget templates, or having difficult conversations about pace and progress – sometimes, it can be easy to lose sight of what we’re working towards. The real reason we’re all here – to help more and more expectant and new parents get the support they need, and to have the best possible experience of pregnancy, birth and new parenthood.

Back in the Spring of 2016, I was thrilled to be one of the NCT Leadership Team facilitating the Common Purpose events for our volunteers, practitioners and staff across the UK. We developed a shared focus on our five core goals – to strengthen our core services, increase our reach to parents at greater risk of isolation, expand our support postnatally, modernise our image and build a stronger organisation to help make all of this happen. Together, as wonderfully engaged groups of volunteers, practitioners and staff, we discussed ideas for how we could achieve these goals. We listened hard and learnt so much, and all of these discussions fed into the development of our more detailed strategic plans for how we would make our goals a reality.

And then in the Spring of 2017, the rail network was well travelled again as we delivered #ourNCTstory workshops across the country. This time we talked through the more detailed work streams and plans that we’d worked hard to develop over the winter, and shared the early progress made. We discussed what it all meant for each other in our different roles and for parents, what the challenges and opportunities would be, and how we could all work together to make it happen.

All of this time was so energising, as is any of the time I spend with those directly supporting parents. From our shared focus on making a real difference for parents at their times of greatest need, to the very practical and creative ideas of how to do this, and the willingness to challenge ourselves and be open to change. All of this is what keeps me motivated and excited about being part of building a bright future for our charity.

We were clear from the outset that we had to focus first on building and strengthening, focusing on the bits people often don’t see but that are absolutely critical to running our charity safely, efficiently and effectively. Governance and planning, safeguarding, data and IT systems, monitoring and reporting… it’s a long list! And it’s not what gets most of us out of bed in the morning, is it? But without these strong foundations, we have little hope of doing and growing all the brilliant stuff for parents that we’re actually here to do.

And that brings me round to my glimpse of the future.

At the first Steering Group meeting for our IT transformation project (Project Lego!), I got to see the new system we’ll be putting in place. This is about meeting new data protection regulations, mitigating risks around our current systems, more efficient data collection and reporting…. But what I also saw was a vastly improved volunteer experience, better ways of connecting and engaging across our communities, and opportunities to demonstrate the value of our support to parents.

We might be focusing hard on strengthen and build, but it certainly is the route to reach and expand….. and to achieve so much more for so many more parents.