ourNCTservices moves towards the next phase

Caroline Star, Portfolio Review Manager

We said at the start of the ourNCTservices project we were going to do this properly. And my goodness we’ve stayed true to that. After hearing from 130 parents during interviews and focus groups and holding 70 workshops with volunteers, practitioners and staff there have been times over the last few weeks where I’ve suffered serious evidence overload. So I am incredibly excited to finally be on the road sharing findings and discussing the next steps at the #ourNCTstory events.

ourNCTservices is a systematic review to understand how, over the decade ahead, we ensure our NCT services are as relevant, accessible and impactful for parents as possible. We are going to focus first on strengthening our existing core services across breastfeeding, postnatal support and antenatal education. And, we are going to start to lay the foundations for increasing our reach and expanding postnatal support. It will consider what we need to stop, start, continue and adapt to ensure that more parents benefit from our existing core services and enable the space and resources to invest in increasing reach and expanding scope in future.

Since the beginning of the year we’ve been gathering evidence from parents, from practitioners, volunteers and staff and from NCT data. My challenge over the last few weeks has been to distil months of work and hundreds of pages of fascinating research into no more than ten key pieces of evidence for antenatal, breastfeeding and postnatal.

One of the things we’ve heard loud and clear from all of you is that we can make things very complicated at NCT. This is a problem because it gets in the way of meeting parents’ needs and costs us a lot of time and money. You’ve told us that we just need to make it simpler to use our skills and expertise to do better for parents.

On antenatal we heard that parents don’t understand the difference between our antenatal courses and people who don’t do NCT simply don’t understand the value of the knowledge and networks above NHS classes and family/friends. Those who do our antenatal courses like it at the time and see the peer groups as a complete lifesaver. But in hindsight they feel unprepared for the realities and are in need of continued support after birth.

We heard that breastfeeding support is a big area of need for all parents but many aren’t getting the right support at the right time – for a whole complicated web of reasons and emotions. Many parents feel judged, pressured and totally unprepared for the challenges. Some report that we’re contributing to these issues.

Postnatal support is vitally important to all parents, in the early weeks but also as they are finding their feet and establishing their new life as a parent. Peer networks aren’t enough and they still need our support. Yet the uncertainties of postnatal life make it harder to get people through the door.  We’re not giving up but we’ll need to do things differently to thrive and make the most of our unique skills and expertise in this space.

We were worried it might all sound a bit obvious. But in the first nine events you’ve told us that it’s incredibly useful to see challenges acknowledged and also to see all the different pieces of the jigsaw brought together for the first time. We’ve learnt a lot that is new about why parents do and don’t engage with services. We’ve revealed new insights on the impact, reach and cost of our services.  We’ve learnt from you about what’s getting in the way. And we’ve also knocked some long-held assumptions off the list of things to worry about. For example:

  • people do still bond and form networks on intensive courses
  • parents thinking about antenatal classes don’t hold a perception that we’re all a bunch of natural birth and breastfeeding zealots
  • the slightly lower income group we spoke to didn’t see any need for antenatal classes whatever the price

Now what do we do with our services as a result of what we’ve heard? That’s the hard bit. It is clear from the #ourNCTstory events so far that there are some areas which many people feel are pretty obvious next steps. Such as moving to one antenatal course and testing out paid-for breastfeeding support alongside the free services we already offer. However, many weeks and months of work lie ahead to figure out how we would actually do this in reality and make a success of it. There are other areas causing more debate – like exactly how to describe and shape our postnatal services and whether they should be pay-as-you-go or booked in a block.

We’ll be collating every single post-it note and feedback comment made at these events during June. We will use these alongside the evidence to identify the service changes with the highest potential to serve parents better and make things easier. In the second half of the year we’ll be exploring what it would take to make a success of these service developments. Proposals will then be discussed with our Board in December. This will ensure that when decisions are made they are based on a good understanding of the time, the people and the resources it would take to put them into action.

I’m about halfway through and I can’t wait to jump on the next train and get on with the second half of the #ourNCTstory events. The conversations I’m having make me really excited about how we can do better for parents and make better use of the amazing skills, expertise and empathy in the NCT movement.

If you’d like to discuss ourNCTservices further please do contact Caroline any time at caroline.star@nct.org.uk or on 020 8752 9190.

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 to women, working for change.

Is it just building sandcastles too close to the waves?

I don’t think so.

Roz Webb, NCT Practitioner
Birth & Beyond practitioner and Breastfeeding Counsellor

I love being an NCT facilitator. For much of the time it feels hugely rewarding, watching a group of people expand their skills, knowledge and friendship group over a 5-week period, and then beyond once their babies are born. As an ex-secondary teacher I would describe it as like teaching your best, keenest A-level class all the time! Or as a Breastfeeding Counsellor, sitting with a new mother and watching her relax and begin to smile is truly lovely.

So what’s the hard bit? It is hearing the tougher birth stories, the stories of dashed hopes, of disappointment and pain. Many parents say they did at least understand what happened, even if it was way off their plans, which is a relief to me as we would have talked a lot about decision-making, asking questions, being actively involved whatever happens. Like all NCT facilitators, I try to walk the line between presenting straightforward birth in a positive way and valuing and being glad of any necessary medical intervention. It is a hard discipline not to take the horror stories personally, but I work hard at this. I couldn’t carry on otherwise.

What I can do, though, is work closely with the maternity units locally, sharing the parents’ stories and looking at the bigger picture. I attend North Central London (NCL) Maternity Voices Partnership (MVP) which brings together all the local units. NCL is a Better Birth Early Adopter and it is heartening to see so many people devoted to making positive shifts in maternity care. Every time I hear a story of a less-than-kind health professional I just have to think of all the utterly amazing ones I meet with regularly and it puts everything into perspective. I also love having a close link to HOMs and Senior Midwives so I know the local units well and can ask questions when I need to. I think it is also hugely important for NCT facilitators to have a strong empathy for midwives, to really grasp the circumstances in which they work and the challenges they face. There has to be compassion on all sides.

I could sit around being angry. Angry that too many mothers don’t get the birth they hoped for. Angry that the NHS is so chronically underfunded. Angry that midwives at all levels are expected to give and give and give, without being held up financially or emotionally, trapped by the system. Instead, I try to do something constructive…

Scene at the beach

A few years ago, inspired by an NCT Voices event at Acton, I set up Whittington Maternity Voices Partnership (as they are now called) and I haven’t looked back. National and London based MVP events are always extraordinary – full of super-powered women, many of whom are involved with NCT as well. We recently had one at the Oval which was on a whole other level as NHS England was involved too – real coffee, a fancy lunch and a free pen and pad of paper! The national MVP Facebook page is my favourite – incredibly empowering and supportive.

MVPs can really make a difference to local services and people. One mother who came recently had experienced a challenging birth, but had towed the line of ‘well at least I had a healthy baby’ that women so often hold onto to get through. Sometimes it is the ‘right’ response for them, but other times it masks a lot of pain. In this case, coming to the MVP opened the floodgates for her. She was held by a room full of caring women and the next week attended the birth reflections clinic. She hadn’t realised how much sadness she was holding in.

Whilst every MVP is run differently, not least in terms of funding (or lack of it), there is a strong national movement to get them properly valued and recognised. MVPs are a real example of co-production and every NCT facilitator, volunteer and parent can make an incredibly important contribution to Better Births by engaging with their local MVP. So if you’re not already, please do get involved!

There are times when running an MVP and actually seeing any change feels like a Sisyphean task, of building sandcastles too close to the waves. But I am always buoyed up by the responses of the parents who come to our workshops. They feel empowered. They feel heard. They feel healed.

Gearing up for Annual Returns

Carolyn Neal, BFC Co-ordinator
Carolyn Neal, BFC    Co-ordinator

It’s that time of year again when NCT practitioners – myself included – are all asked to complete their Annual Return. It’s a simple questionnaire each practitioner completes every spring that helps provide information to NCT about their practice. This, coupled with specific feedback shared by parents attending courses, helps NCT ensure they offer the right support to practitioners as well as continue to offer high quality services to parents in the first 1,000 days.

I am NCT’s Breastfeeding Counsellor Co-ordinator. The first one in fact since NCT created the role in 2013. I qualified as a Breastfeeding Counsellor (BFC) back in 2005 after having three children. I then went on to develop my NCT career as a Supervisor and a BFC Assessor.

I love to visit mums and new babies and help them with breastfeeding and I also facilitate a couple of breastfeeding sessions a month in my local areas of Selby, York and Leeds. I have five BFCs that I support directly through supervision and I do about 10 assessments a year, travelling round the country to observe and support other BFCs.

Each of my NCT roles are very rewarding – it is a privilege to support so many wonderful women who give up so much of their time and energy voluntarily to support mothers and babies.

I completed my return recently as a practitioner. I found the online questionnaire quick and easy to do – the process has been simplified for practitioners a lot over the past couple of years as NCT now makes use of data already collected so practitioners don’t have to provide this themselves. As a Co-ordinator, Annual Returns time is always a challenge – we have many hundreds of practitioners and we need to make decisions about their Licences to Practice in time for renewal in August. And of course, as an individual practitioner this time can feel a bit daunting. But there’s lots of support available to get you through.

Here are some tips to help you make the process of Annual Returns go more smoothly:

  • Now is a good time for you to check you have met all the requirements
  • Get in touch with your specialist Co-ordinator early if you think there will be a problem
  • You may have time to get in an observation of another practitioner, or a last supervision session or a holistic CPD application
  • Don’t forget the 3-yearly requirements – an observation, a national event and an assessment
  • Plan ahead for your CPD – our Regional Practitioner Forums have proved very popular and some study days get booked up early so check the Study Days System early in the year
  • Make sure you complete your Annual Return by midnight on 30 April

And finally, good luck to all practitioners with your Annual Returns. Remember, we’re here to help so do get in touch!