Five principles of perinatal peer support

By Laura Wood

Laura Wood has written extensively about her own experiences of perinatal mental health. In 2016, she was part of the external advisory group for our Parents in Mind peer support programme. Here she talks about her involvement developing perinatal mental health peer support principles with Mind and the McPin Foundation.


Peer support that promotes the emotional wellbeing of new parents has long been one of the key values that NCT is known for, and the Parents in Mind project has enhanced this, providing mum-to-mum support for women experiencing low mood, anxiety or poor mental health during pregnancy or postnatally. As a member of the advisory group for Parents in Mind, I witnessed the joys – and the challenges – of delivering this support in a way that was safe, accessible, and helpful for everybody.

NCT was able to share some of the lessons learned from creating Parents in Mind, contributing to the co-design of the new perinatal peer support principles. I’m one of three lived experience facilitators who worked with staff from Mind and McPin Foundation to produce guidance that would support people to create and deliver peer support that truly meets the needs of women affected by mental health difficulties during and after pregnancy. We held three consultation events, in Birmingham, London and Newcastle, and three focus groups in Scotland, Northern Ireland and Wales. Online surveys were available for people who couldn’t attend. We spoke to mums and families, midwives and health visitors, people working in clinical perinatal mental health services, charities and other organisations facilitating peer support for parents… anyone with relevant experience. We invited people from as many under-represented groups as we could. McPin also did some interviews with perinatal peer support providers, including NCT, to discuss the logistics of offering such support in more depth.

The result is five principles accompanied by explanatory notes and reflective prompts to get people to think about how they can be met whether you’re online, half a dozen mums in someone’s living room, or a large organisation like NCT. Using this guidance will help to ensure that your peer support is safe, inclusive, informed, that it benefits everyone involved, and remains distinct from – but connected to – clinical perinatal mental health services. You can access the principles online, along with a more detailed report about the findings, via the website for the Maternal Mental Health Alliance.

I hope that these principles will make safe, welcoming, nurturing peer support accessible to more mums who need it. I believe that they will as lived experience has been at the heart of the project. Because the principles were co-created with women and families who have lived through perinatal mental health difficulties, they are shaped around their needs, not what others imagine those needs to be.

My own experience has informed the work. In 2014, I emerged from a psychiatric mother and baby unit, dazed and scared, and was promptly dropped by the community mental health team. It was other mums who pulled me through, namely my friend Hayley from NCT classes and everyone who participated in Rosey Adams’ #PNDFamily on social media. I know that peer support, done right, can be lifesaving and can set you up, as a parent, to know and trust yourself and your baby.

The principles have now been developed, tested, and launched. We presented them at Peerfest, Mind’s annual celebration of peer support, in Birmingham on 3rd December and held a workshop with some activities and discussion so that we could all get stuck in. I’m so excited that the principles are ready, and I’m now leading the team in ‘disseminating’ the work – which means making sure that all the wonderful knowledge which people so generously and so enthusiastically shared gets out to where it will be useful. We’ll be touring with more workshops and presentations throughout 2020: drop an email to LivedExp@mind.org.uk to subscribe to our mailing list.


Download the perinatal peer support principles here.

Pre-order Laura’s book on maternal mental health here, and follow her on Twitter @cooksferryqueen.

Today, tomorrow, forever

Our colleague, Ann Carrington, blogged last month. I loved working with Ann. She shared reflections on her time with NCT between 1987 (booking an antenatal course) and now (leaving to look after her first grand-daughter, three days a week).

My time doesn’t compare to this and I write this acutely aware of how many years so many people give to NCT, dwarfing the time I’ve spent as chief executive.

I’m also wary of venturing into rhetoric or hyperbole as I realise I really am leaving this wonderful place.

But as I write this looking out into the world around us, it seems to me hard to think of a time when what we do has been more important. Our charity was conceived to support the very start – to bring people together at the critical and most demanding time of life – to help bring a human into the world – and do the most important job on earth.

I think that, right now, in a time of fake news and divided communities, it’s hard to think of a time when this need for togetherness and support – for reliable information  and lasting friendship – has been more important. Which is perhaps just another way of pointing to the enduring, and eternal importance of what we do – then, now, tomorrow, forever.

It is an enormous privilege to be a part of this.

Then

Nearly sixty four years ago, we sprang, or toddled bravely, from the compelling vision set out by Prunella Briance. Grounded in the insight and conviction that education and community can radically transform the experience of childbirth and early parenting, for good and forever.

Since then, we have supported millions of women and parents through birth and early parenthood whilst also securing major advances in professional practice and public policy.

Today

So four years ago, we came together in thousands of conversations across NCT, to talk about what we wanted to achieve in the decade ahead. As we celebrated our sixtieth, we talked about what we wanted to do in the next ten years. And together we started to write what came to be called #ourNCTstory.

It’s a tale, at its heart, of supporting all parents across the first 1,000 days. Of becoming truly inclusive.

Building on all we have done.
So that we’re here for all parents.
Across the first 1,000 days.

It means strengthening our core work in antenatal education and infant feeding. Increasing our reach into less affluent communities. Extending the support we provide postnatally. Modernising our image. And building a much stronger organisation to better support volunteers and practitioners – in turn to support new parents.

And because we took real time to talk about this ambition, we find ourselves, today, part way through our third year of this great, ten-year ambition.

We’ve achieved a lot together in this time:

  • Radically improving our free online information, accessed over 6 million times – and 20% more in the past year
  • Creating the #HiddenHalf campaign for early identification and support for new mums’ mental health
  • Building much stronger relationships with our colleagues at The Royal Colleges and amongst other pregnancy and baby charities
  • Strengthening our safeguarding
  • Getting GDPR right
  • Changing how we support our volunteer branches and our regional volunteer leaders, where more than 15,000 new parents access NCT services free each week
  • Undertaking ourNCTservices – a complete, rigorous, evidence-led review of how in a fast-changing world our services remain accessible, relevant and impactful
  • And looking to build a new model of education to ensure we are developing sufficient numbers of high-quality new practitioners from diverse backgrounds in all the areas parents want to access NCT

This is just a selection of what we’ve done together. All of it and more built by volunteers, staff and practitioners working as a team.

Tomorrow

There is a quote I often return to by the US civil rights leader John Lewis. It was shared by tutor Dot Parry on one of the first conference calls I had when I joined NCT. “We have some huge challenges ahead of us. And we have the energy to do this. And if not us then who?”

I think we have done a lot. And I know there’s so much more to do.

Not for one moment am I naive about the scale of the challenge we have set ourselves, of supporting all parents, through pregnancy, birth and early parenthood.

Nor, as I leave, am I ignorant of the scale of the task ahead. Be that transitioning the extraordinary complexity of NCT from a bespoke IT system. Growing our core income in courses, membership and branches at a time of a falling birth rate, national economic uncertainty and when patterns of membership and volunteering are changing profoundly in society. Or building one antenatal course so that every parent experiences the best of what we deliver. These are not easy things to do. Some days it’s going to feel really hard because it will be really hard.

And vigorous debate, honest difference, a joyous plurality of personalities and perspectives, have long been a hallmark of our movement. So I don’t think there’ll be that many quiet days either.

Forever

Yet three things I know.

1 – NCT will always be a part of my life. And being its chief executive for a time has been an immense privilege. And I have felt that every day. Even on the challenging ones. Perhaps in fact, especially on the challenging ones. My successor has an incredible job.

Because – 2 – what we do is amazing. At our best we are sublime. I think to the now hundreds of courses and sales and bumps and babies and drop-ins I’ve revelled being in. And I find, not for want of trying, that I don’t really have the words to adequately crystalise the power, the life-changing power that trusted knowledge and lasting friendship confers. And I know it’s OK that I can’t quite find the words. Because we all know them in our own words and minds and experience.

And the ambition we have set ourselves of telling this story, in places where we aren’t yet, to people who haven’t yet heard, is one of the most important things I can imagine being involved in.

Parents supporting parents. At the critical time of life. In a country crying out for ways of coming together. Whoever you are. Wherever you’re from. No one going it alone.

Imagine your street, village, neighbourhood, country where every new family has trusted knowledge and lasting support. This is a hard thing to do. And it’s our NCT story.

And – 3 – we can do this because NCT is full of wonderful people. This isn’t blind optimism or a glib final line. We all have our flaws and all institutions their foibles. Yet not a day has gone by when I haven’t been struck by the commitment and skill and tenacity and love across this charity. Thank you.

We are, you are, all of us, part of something startling, reaching far behind and way ahead of us.

We are NCT.

And when we so choose, to look up and look out, we have it in us to change the world for good.

And, that, is an extraordinary thing to be a part of.

It has been an enormous privilege being part of this incredible organisation. I will miss it, and all of you, very much.

Thank you.

Nick

What questions should we ask about anxiety in pregnancy and after birth?

Rose Coates, Louise Williams, Andrea Sinesi & Susan Ayers, The MAP Research Team at City University of London and the University of Stirling

NCT practitioners, volunteers and peer supporters will be aware that mental health in pregnancy and after birth is very important for the mother, her partner, and their baby. Unfortunately, however, an estimated 10-20% of women will experience a mental health issue such as anxiety or depression, in pregnancy or within the first year of having their baby. This not only negatively impacts on the mother and those close to her, but has also been linked with poorer future outcomes for the children, such as behavioural, social and emotional difficulties. It is therefore important that mental health issues are identified as early as possible to ensure that further treatment can be provided if necessary.

Whilst some women may tell their GP, midwife or health visitor that they are experiencing mental health difficulties, how should we go about identifying those women who don’t disclose how they are feeling?

How are mental health problems currently identified?

The National Institute for Clinical Excellence (NICE) has long recommended that GPs, midwives, health visitors and other healthcare professionals who meet with pregnant women or women who have just had a baby, consider asking two questions to identify those experiencing symptoms of depression. The questions are ‘During the past month, have you often been bothered by feeling down, depressed or hopeless?’ and ‘During the past month, have you often been bothered by having little interest or pleasure in doing things?’ If a woman responds with a ‘yes’ to either question, the next step is to ask further more detailed questions or refer on to the GP or a mental health professional if a severe problem is suspected (NICE, 2018).

NICE base their recommendations on reviews of the research evidence base worldwide, and support for these questions identifying depression in pregnancy and after birth is provided (NHS, 2018). However, it is currently unknown whether these questions might also work to identify other mental health issues such as anxiety. It is unlikely that one set of questions will identify everyone with depression, and it is also important that questions do not falsely identify women who actually are not depressed. Additionally, the questions are only likely to work when healthcare professionals have been properly trained on how to ask the questions sensitively. Healthcare professionals also need enough time to ask questions as part of a conversation, and clear referral and care pathways. The NCT’s Hidden Half campaign is relevant to this. The campaign is demanding an improvement to the 6-week postnatal check up to enable GPs (or other healthcare professionals) to spend more time with each woman and therefore enable identification of mental health issues at their last routine maternity appointment.

What about anxiety?

In addition to depression, anxiety is commonly experienced in pregnancy and after having a baby. Some worries and anxieties, especially during pregnancy, are relatively common and are experienced by a considerable number of women. However, a substantial minority of women experience anxiety symptoms that are more intense or persistent, and that might thus require clinical attention. Anxiety can be experienced in many ways and specific disorders include generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias, post-traumatic stress disorder and social anxiety disorder. Women may not have a disorder, but may still be troubled by symptoms of anxiety, which affect both the body and the mind. These include excessive worrying, having a sense of dread, feeling restless or unable to relax, faster breathing and problems sleeping amongst others (MIND, 2017).

Do healthcare professionals ask about anxiety?

In 2014 NICE added a recommendation to their antenatal and postnatal mental health guideline that healthcare professionals consider asking two questions about anxiety (NICE, 2018). The questions are: ‘Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?’ and ‘Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?’ An answer of ‘Not at all’ scores 0; ‘Several days’ scores 1; ‘More than half the days’ scores 2; ‘Nearly every day’ scores 3. If a woman has a total score of 3 or more, the next step is to ask further questions or refer the woman to her GP or to a mental health professional for suspected severe anxiety.

The difficulty with this recommendation is that there was very little research available to allow NICE to make any definite conclusions about the most effective questions to ask. In fact there was so little research with pregnant women and those who had recently had a baby, that the guidelines were based on research with other (not pregnant) populations. Essentially, we don’t know whether these 2 questions work well to identify pregnant or postnatal women experiencing problematic anxiety symptoms. Neither do we know what women think about these questions, or about healthcare professionals’ experiences of using these questions.

The MAP Project

At City, University of London and the University of Stirling, we are working in collaboration with the NCT and Maternal Mental Health Change Agents to assess which questions work best to identify anxiety in pregnancy and soon after having a baby. The study, Methods of Assessing Perinatal Anxiety (MAP) is comparing four different questionnaires, including the two sets of questions mentioned above. The questionnaires were selected based on a review of the evidence. The research incorporates three projects:

1. The first project started in June and aims to find out which questionnaire is most acceptable to women. We are interviewing some women who have experienced anxiety in pregnancy, and some women who have not. We are asking them about their views on the four questionnaires along with their experiences of being asked about anxiety during pregnancy and after having a baby.

2. The second project will find out which of the questionnaires best identifies women who need treatment by comparing questionnaire responses with a longer interview asking about mental health. We will ask women to complete questionnaires at three time points during pregnancy (12 weeks, 22 weeks and 31 weeks) and once after birth (6 weeks postpartum). These discrete time points should also enable us to find out when is the most effective time to ask women about anxiety.

3. The results of the first two projects will inform the use of the questionnaire to be used in this third project. At selected health services in England and Scotland we will ask healthcare professionals what their experiences are of this questionnaire, and how acceptable and practical it is for them to use it.

Who decided to do this research?

We developed this research programme with help and guidance from a group of experts. These are women who have experience of perinatal mental illness, midwives, mental health professionals, the NCT and Maternal Mental Health Change Agents. This group identified the assessment of perinatal anxiety as a priority problem and will continue to work with us through the project to ensure its relevance to women and the NHS. The research team includes psychologists, midwives, obstetricians, health visitors, GPs, nurses and mental health professionals.

What can I do?

If you would like to help with the MAP project, please let pregnant women (and women who have had a baby up to 6 weeks ago) know about our project. This will give them the opportunity to participate. We are recruiting women who do have symptoms of mental health issues, and women who do not. Please feel free to show them this article, our website or a briefer explanation can be found in our advert [below] If you would like hard copies of the advert to hand out at your classes or drop-ins, or have any other questions relating to this research please contact map@city.ac.uk.

If you think that a pregnant woman or someone who has recently had a baby is experiencing anxiety, we encourage you to support them to talk to their GP, midwife, health visitor, or other healthcare professional.

This project is funded by the National Institute for Health Research (NIHR), HS&DR Programme (17/105/16). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

References and Resources

Methods of Assessing Perinatal Anxiety (MAP) Study website: https://blogs.city.ac.uk/map/about-us/

MIND (2017) Anxiety and panic attacks: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/anxiety-symptoms/#.XS8LAJNKg2w

PANDAS Foundation, Pre- and Post-natal depression advice and support. www.pandasfoundation.org.uk

Anxiety UK, provides information and support for those living with anxiety and anxiety-depression: www.anxietyuk.org.uk

NICE (2018) Antenatal and postnatal mental health: clinical management and service guidance, Clinical guideline [CG192]: https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#recognising-mental-health-problems-in-pregnancy-and-the-postnatal-period-and-referral-2

NCT How you might be feeling in pregnancy: https://www.nct.org.uk/pregnancy/how-you-might-be-feeling

NHS (2018). Researchers call for routine mental health screening during pregnancy: https://www.nhs.uk/news/pregnancy-and-child/researchers-call-routine-mental-health-screening-during-pregnancy/

Five things you might not know about NCT’s Trustees

Chair of NCT trustee board, Jessica Figueras
Jessica Figueras, Chair of NCT Trustee Board

Most people know that the Board of Trustees has ultimate legal responsibility for NCT. But not everyone knows that we are unpaid, part-time volunteers. Our overall time commitment is around 1 day a month, and we plan to meet as a whole board five times a year. So how do we trustees discharge our duties?

We focus on strategy, governance and compliance.

Like most boards of large charities, we formally delegate the management of NCT to skilled professionals: our Chief Executive and wider team. This happens within an overall framework of trust and accountability. All must be clear about who is responsible for what, and respect the boundaries.

Exercising accountability isn’t necessarily about disagreeing with particular decisions that have been made. Trustees don’t exist simply to second-guess the experienced professionals, specialist workers and volunteers who run our charity.

But trustees do have a unique responsibility to ask the higher-order questions, such as:

  • Is NCT’s long-term strategy right? Do we have a credible plan and the resources to execute that strategy? Are we making progress against that plan? If not, why not?
  • Do we have the right policies in place to govern day-to-day working? Are we complying with those policies? Are they having the desired effect? If not, why not?
  • What risks do we face? Which are the most significant? Are they being realised? What are we doing to mitigate them?

We’ve got to be evidence-based.

Informed decision-making means getting to grips with a lot of detailed information and data. Our job requires a lot of reading – preparing for a board meeting can take half a day or more.

Evidence-based is a mindset. It means being clear about the question that needs answering and not getting side-tracked. It means weighing different types of evidence, carefully considering all sides of an issue, not leaping to conclusions or letting personal biases get in the way.

Like all charities, we have a strong policy on conflicts of interest to ensure individual trustees aren’t involved in decisions where they have a personal stake in the outcome.

We’ve got to be OK with complexity.

Charities and boards are being held to higher standards of professionalism than ever before by stakeholders, regulators and of course the parents we serve. NCT is a big charity, with complex operations, exposed to material risks including financial ones.

NCT needs its board to pay attention to a really wide range of issues – just five recent examples include supplier management, capital reduction, staff remuneration, grievance policies and service quality.

That doesn’t mean trustees need specialist expertise in all those areas. But we do need to be comfortable handling complex topics. Very often that means knowing what we don’t know, and knowing what to do when that happens.

We act collectively. 

The board is collectively responsible for the charity, so we make decisions collectively.

Sound decision-making requires high-quality challenge and debate around the board table. Diversity of thought and experience helps guard against groupthink by ensuring more angles get considered. And a respectful tone of discussion encourages open debate and open minds.

Once a decision has been made, we – trustees and staff team – respect the principle of collective responsibility by uniting behind that decision. We treat it as binding and support its implementation. This is a founding principle of how charity boards operate, as described in the Charity Governance Code.

Want to know more?

Find out more about NCT’s Trustees – who they are and how they work https://www.nct.org.uk/about-us/our-trustees

Read the Charity Governance Code https://www.charitygovernancecode.org/en/front-page

Read the Charity Commission’s guidance on the formal duties of charity trustees https://www.gov.uk/government/publications/the-essential-trustee-what-you-need-to-know-cc3

Can safe ever be fun?

by Anne Kent-Taylor, Head of Operations and outgoing Safeguarding Lead…

I’m not alone as a Head of Operations in being concerned about the way in which my role is perceived by an organisation. I have heard other operational managers, at other organisations, cry:

“I’m sick of being told I’m too negative.”
“It’s my job to notice potential problems and fix them.”

So when you’re in a role that requires you to be risk-aware, and to keep the organisation safe, how can you make it fun? Adding the responsibility of safeguarding lead to my remit did not seem like the obvious way of making my working day more cutting edge.

My safeguarding role started three years ago with a review of policy and procedure, and the drafting of an action plan. So far, so typical.

I worked together with other staff members, particularly in commissioned services, to ensure that the right procedures were in place to check, train and support staff, volunteers and practitioners that may come in to contact with babies, children, young people or vulnerable adults.

In the first three months as safeguarding lead, I was contacted just three times.

Could this be right? We know that we see nearly 100,000 parents through courses each year; over 10,000 women through commissioned services each year, and around 15,000 parents through branch events each week.

It’s really hard to find out the “right” level of safeguarding concerns for a charity. I have seen one charity present a graph showing an increase in concerns but omitting the numbers from the axis! There are currently a couple of larger children’s charities working together to benchmark safeguarding – but their beneficiaries are different to ours.

How would we know when we were at the right level?

We decided that what we wanted to see was an increase in concerns reported. That we wouldn’t aim for a number, and we would never be worried that it was “too high”, but we wanted more people to get in touch with us.

I carried on implementing the action plan but it wasn’t making safeguarding tangible for people. We had to make it more relevant, more real, more relatable.

The breakthrough was to take a more creative approach – away from policy and action plans – and to make safeguarding come alive. We wanted to be able to talk about safeguarding every month, which meant we needed to find stories to tell.

From the contacts we’d had with practitioners and volunteers, we knew the sorts of things that they encountered and were worried about. So we began a series of “Safeguarding scenarios” in Update, our monthly internal newsletter. I’m pretty sure you will have read one, as they were the most clicked through article in Staff, Practitioner and Volunteer Update for three months in a row and people have been in touch with us to say how useful they find them.

Sometimes we use real life examples – an anonymised version of something that we have been contacted about. Sometimes we invent situations which we know people have concerns about. Sometimes we base it on examples given by other charities. We always provide links to additional resources and make sure that everyone knows to contact the Safeguarding Lead if something doesn’t feel right.

In the last three months, I was contacted 21 times.

The contacts range from safeguarding concerns, to advice about mental health, assessing criminal record checks, and supporting people with sharing information.

The role has allowed a bit of creativity, a lot of variety, and the chance to see something new at NCT.

Now that I’ve spent nearly three years in this role, it’s time to hand over to another staff member. The responsibility of Safeguarding Lead will move to Helen Simkin, our Head of People. This marks the next stage of NCT’s journey in embedding a culture of safeguarding. Placing this responsibility with Helen allows for learning and development – in safeguarding and safer recruitment – along with the chance to upskill the organisation in mental health awareness.

Safeguarding is everyone’s responsibility and I’m proud of the way NCT has developed over the last three years, and the opportunity that focusing on an area where we need policy and process has still allowed creativity and humanity.


Sample safeguarding scenario:

Scenario 3 | December 2018

A couple in a same sex relationship have been attending an antenatal class that you are teaching, they have been engaging and you have no previous concerns. Tonight as you were loading your equipment into the car after the course, you notice that they are arguing loudly in another part of the carpark, you also notice one partner appear to strike their pregnant partner.

  1. What would you do immediately?
  2. Would you record any of this, and if so where?
  3. What actions would you take in the longer term?
  4. If you felt that you needed to take further advice who would you speak to?

  • What would you do immediately?
    • Be aware of your own safety; do not attempt to intervene alone.
    • The same sex relationship is irrelevant; you are witnessing an assault of a pregnant woman and must act as she is in immediate danger.
    • Where is the carpark? Can you call out to security?
    • Is there anyone else in the area who can help?
    • Call the police 999

There is no set order to the actions above, they can be done concurrently. This is a situation where you must act quickly.

  • Would you record any of this, and if so where?
    • Do you have the details of the attendees to hand? The police will need this when they arrive. If possible, make a note of the car registration.
    • Afterwards when you get home, try to make some notes whilst it is fresh in your memory.
    • After you have spoken to the safeguarding lead, you will be required to complete an NCT safeguarding form.
    • As the police have been involved, you may also be required to be available to give further information.

  • What actions would you take in the longer term?
    • Make contact with the NCT Safeguarding Lead (safeguarding@nct.org.uk)
    • You need to speak to the safeguarding lead and agree a plan, BEFORE you attempt to contact the mum who was assaulted. Due to the nature of domestic violence, this mum may not be ready to leave this relationship and may not welcome contact from you. The police will make a referral to the duty safeguarding team as standard and they will use specialist workers along with the police liaison officer to support the family.
    • Keep updating the NCT safeguarding lead.
    • Often after a serious situation such as this, you won’t be given any further updates as it’s considered that your role has ended. Whilst this may feel frustrating, you have to remember that you have done the right thing at the right time and have faith in the statutory services.

  • If you felt that you needed to take further advice who would you speak to?
    • Contact NCT’s safeguarding lead at safeguarding@nct.org.uk, as soon as possible
    • Complete an NCT safeguarding recording form.

Whilst domestic violence may not feel very festive, it has been chosen for the December Update as year on year statistics show a huge spike in incidents over the festive period. You may not ever come into contact with an assault like the scenario, but be mindful, know where to signpost – there are good organisations listed in the further resources section below. The more that you are informed, the more you can help someone – even if it is just showing them a phone number.


Resources

Women’s aid – further information on forms and types of domestic abuse
National domestic vioence helpline – free helpline and information on the website. Anyone can ring for advice.
Save lives – information on policy and statistics
NHS – information for victims

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

Ripples of kindness

by Anne Kent-Taylor,
NCT Head of Service Operations (plus NCT Volunteer)

My NCT story got off to a couple of false starts. There was the Nearly New Sale that I attended when I was six months pregnant that I left in tears after 10 minutes; there was the antenatal course that we nearly couldn’t book on to as there were no spaces; and then there were the coffee groups with the rampaging toddlers who appeared a world apart from my six week old baby.

But from those scary coffee groups came the gem of an idea which allowed my NCT story to really get started. I wasn’t the only one that was nervous about sharing space with gigantic two year olds and it felt as though there was a need for a group for parents of new babies, to share stories and build confidence.

There was no way that I could do this alone and luckily I didn’t have to. With a fabulous postnatal leader to guide me, and the support of dedicated branch volunteers, we set up a group for parents with babies under six months. It took time to get there and, by the time we were ready to run the first session, I discovered that I was pregnant with our second child.

Every week, I put my own rampaging toddler on the bus with a packed lunch, opened the church hall, set out the toys, and made the tea and coffee. I welcomed mums, hosted guest speakers, and made space for our fabulous postnatal leader to do her stuff.

The purpose of this group was to have a shared space, where parents could grow in confidence, and then move on to the branch Bumps & Babies group. But mainly, I wanted a place where we could be kind to each other – show concern and consideration for each other.

Kindness is a nice feeling to bring in in to the world and has a multiplying effect. Even a tiny act of kindness can improve someone’s day. It tells another human being that they are not alone, that someone out there is thinking of them.

Experiments using games with babies have concluded that kindness is inherent to human beings. Similar studies show the root of empathy in infancy, with mirroring in early months of life leading to the easy concern that children show to their peers in distress. Children develop compassion through acts of caring and kindness towards others, and as they grow, it can guide their actions and behaviours in positive ways.

But being kind goes way beyond the person for whom we made a coffee, or lifted their pushchair off the train, or gave them a supportive word about their parenting. Kindness is a contagion and as we emanate it we spread it.

Imagine standing at the edge of a pond with a small, smooth pebble in your hand. As you throw the pebble in to the water, the tiny burst of energy it creates sends circles gently rippling outwards. Whenever we volunteer our time, share a smile, make a coffee or hear someone’s story, we make that little splash that will ripple out further.

Others will be uplifted by our gesture and be inspired to be kinder themselves. This is where the multiplying effect comes in. When we observe an act of kindness, we are impacted by it in the same way as the recipient. Kindness impacts everyone who sees it, or even hears about it. How many people are impacted by one small act of kindness?

Our group continued all through my pregnancy. The mothers that attended became branch chair, branch treasurer, newsletter editor, nearly new sale coordinator and regional volunteer. The kindness they showed each other rippled out through their community.

Once my baby was born, I handed the group over to other volunteers to hold and share their kindness with other new parents.

My rampaging toddler is now a teenager, and the person that grew alongside that group took her Year 6 SATs this week. Last night I had the pleasure of attending parent’s evening, and looked around the room to see women who had attended that group 12 years ago. Still together, still supporting their community, still being kind.

Why charities sometimes need to do less

Saying goodbye to long-standing and valued colleagues is always hard and there was sadness last month when NCT said goodbye to the small MIDIRS (Midwives Information and Resource Service) team who transferred over to the Royal College of Midwives (RCM).

Along with the card, cake and speeches, there was the inevitable sense of loss – but I was also optimistic about the new arrangement.

MIDIRS was born 34 years ago when a group of midwives recognised the need to provide information, research and guidance in order to support others in their profession.

It began life as an independent charity and within a short time grew to be a stalwart of the midwifery community. Having worked well together for a number of years, MIDIRS approached NCT with a proposition and in 2011 the two charities officially merged.

Today, MIDIRS has a world-class reputation for excellence, high quality, accessible information and is well loved. It also has strong leadership, generates income and lives within its means. So if it ain’t broke, why fix it?

During the first few months of working at NCT, when learning more about our services for parents, I was struck by the significant difference of the MIDIRS portfolio. Its core audience is healthcare professions, who in turn serve parents, whereas the vast majority of NCT’s work is directly with new mums and dads.

While supporting healthcare professionals is well within our charitable mission, MIDIRS within NCT had to work really hard to reach midwives and midwifery students. MIDIRS was an important adjunct to the work of NCT but rarely featured in our discussions around future strategy or areas where we recognized the need to develop.

In short, it didn’t take long to see that MIDIRS appeared to be sitting in the wrong chair. It was taking NCT cost and effort to reach MIDIRS’ core audience of midwives, maternity assistants and midwifery students which the RCM already has.

It’s easy for charities to focus on growth and continually do more in order to deliver on their charitable objectives, but this situation showed that there can be benefits to questioning this approach. In certain situations, a charity stopping parts of its work can be the best way forward.

Negotiations between RCM and NCT’s Board have taken time and effort, but the result is an arrangement that works better for all three organisations. MIDIRS has a new home with the RCM and is much closer it is audience. RCM it has the chance to ensure all its members benefit from MIDIRS.

NCT is proud of how we’ve helped MIDIRS on its way, secure in the knowledge that better informed midwives serve parents better. We also have the added benefit of more headspace to focus on our core business: improving support for parents through the first thousand days.

Sometimes in order to do more to support their beneficiaries, charities need to think about doing less.

Branch revival buddies

Kat Whitmore and Sarah Justice

Kat Whitmore (left) is the awesome branch coordinator for West Norfolk. She shouted out to us about the efforts of Sarah Justice (right) bringing her neighbouring branch, Norfolk and Norwich, out of dormancy. Read their stories of volunteers supporting each other, all with the aim to help other parents.

Kat Whitmore, Branch coordinator for West Norfolk

I’ve been Branch Coordinator (BC) for West Norfolk for four years now. In my first year I unfortunately had the sad task volunteering to clear out the storage for our neighbouring Norfolk and Norwich branch as they had gone dormant. Although it seemed like Christmas – because I was a new Coordinator excited about getting the use from lots of their unused toys, banners, balloons etc – at that time I didn’t realise the significance of their dormancy.

As my time as BC went on I met women who’d travelled to our various events. Pregnant or with new tiny babies, I found they lived just outside of West Norfolk branch. Yes you guessed it, they lived in Norfolk and Norwich branch’s area. I have lost count as to the amount of messages, conversations, and emails I’ve had that have started ‘oh yes you would fall under Norfolk and Norwich branch, but unfortunately… they’re dormant’. It was horrible to have to tell them. Expectant parents and new parents at one of their most joyful times of their lives were so disappointed that the groups and support West Norfolk offered weren’t available in their area. Until now!

In the summer of 2018 I was so excited to hear rumblings that the Norfolk and Norwich branch were trying to relaunch. However in October I received the dreaded message on our branch facebook, ‘Please could the Branch Coordinator contact me’. I automatically assumed it was some sort of complaint. I was so pleased I was wrong. Sarah was reaching out, she introduced herself as the new BC for Norfolk and Norwich branch.

And so began the start of a new NCT friendship. Messages have been flying backwards and forwards between us and I have bombarded her with countless emails; copies of agendas, minutes, order forms, event posters, risk assessments, you name it! And guess what? She hasn’t been scared off!

We even met for a pow wow at a soft play, half way between both our branches, so our little ones could play while we chatted. I took her some items back from the storage I’d cleared out years before and we talked about all sorts. From nearly new sales, committee meetings, advertising, babble, toddler groups, goody bags and everything in between!

Sarah was already planning a weekly toddler group and her first event, a Christmas fayre, which she excitedly told me about. She had bundles of enthusiasm and passion. And I since know both have been great successes.

What a brilliant start! I feel a big void has been filled. Norfolk and Norwich branch will now, I hope, go on to support many expectant and new parents. I wish Sarah all the very best for the future and I hope we can continue to remain in great contact as neighbouring branches.

Sarah Justice, Branch Coordinator, Norfolk and Norwich

I first became aware of NCT when researching breastfeeding support roles. NCT’s position statement really resonated with me and it was definitely something I wanted to be involved with. Following an initial interview – with my four month old son in toe – I was accepted onto the Birth and Beyond Foundation Degree.

After completing my first year of university, I moved to Norfolk and was surprised to learn that the Norfolk and Norwich branch was dormant and very few people had heard of the charity. Together with some other women, in October, we attended a branch set up meeting, arranged by one of my fellow student Lorraine Harrison. Just like that, the branch was formed, with me taking the branch coordinator position.

Without Kat’s (West Norfolk Branch Coordinator) support and advice I very much doubt I would have been able to begin our new Tums to Tots group or hold our first event. Kat’s knowledge about NCT and the way the branch works has helped me find my feet in a role that I initially knew nothing about. Kat’s advice has also given me the confidence to seek out volunteers and engage with other branches/professionals.

It was so helpful having a buddy show me the ropes. I’m now aware of the Volunteer Support Team too. The Enquiries team, especially Ash and Helen, have been really helpful.

The Christmas craft gift evening was a learning curve for me. We didn’t have a huge attendance but everyone who did come, donated and had a good time. We made £88 for the night!


To get involved with volunteering for NCT, and search for events near you, find your local branch here.

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.