Any NCT teachers here?

[Libra1975]

i would like to start an AIBU thread but before I do I would like to get my facts straight. I was told that NCT teachers are not permitted to give out information about bottle-feeding unless specifically asked about it, and by specifically asked I do not mean "I would like to FF" but "I would like to FF and need some information about ". The reason apparently they are not allowed to give out information about bottle-feeding is that they have signed up to the WHO guidelines over breastfeeding.

Is this really true?

Info on bottlefeeding on the NCT's website here

And here too. Seems to be available to anyone who searches/asks for the info.

Thanks for that but my question was more are the NCT teachers allowed to volunteer information about bottle-feeding (and in this context I mean FF).

I don't know about that. I assume they'll have the NCT's ethos at heart and a huge part of that is promoting breastfeeding. Whether they have to sign any gagging orders with things allowed and things not allowed to talk about, I don't know but I doubt it.

cthea, I was surprised to hear about the gagging order (good way to put it) as well which is why I want to double check it. As much as the NCT should promote breastfeeding it is a charity that apparently
"support thousands of people through the incredible life changing experience of pregnancy, birth and early parenthood."

I think a charity set up to support new parents should be able to cover FF in it's classes.

Libra, I am an NCT breastfeeding counsellor, and the reason we do not teach formula feeding in classes is pretty clear, and is not a 'gagging order'. Vast majority of specialist workers, teachers and bfcs, and the membership, too, are happy about this.

It's been discussed before on mumsnet, so you could check the archives.

As a body, we support UNICEF/WHO guidelines on teaching breastfeeding, and this precludes any 'how to' demonstration or 'how to' discussion of formula feeding in a group. This is because group teaching of bottle feeding is i) not safe, as it needs to be done one to one ii) undermining to the choice to breastfeed, which is fragile in our society.

We do talk about the use of bottles though, and expressing, and what impact using bottles might have on bf and the way to minimise it.

We have formula factsheets which can be given out to people who want to know more.

The fact that breastfeeding will be the main focus of the breastfeeding class, run by a breastfeeding counsellor, should not come as a suprise to anyone signing up for a course

If people are very sure they do not want to breastfeed or find out about breastfeeding, they could skip this session.

Thanks tiktok, I am in a NCT group of 8, 5 of us b/f, 3 of our group didn't (why is irrelevent in this discussion they chose to FF which is their right) and said they felt isolated and difficult to find information. Everyone in the class felt that more information could be provided by a charity that apparently supports parents. Just because the majority are happy with the status quo doesn't actually make it the correct course of action.

I was not talking about the specific breastfeeding class of the NCT courses which of course should deal with breastfeeding.

However I know of at least one b/f NCT counsellor who wished she was known as a feeding counsellor rather than breastfeeding counsellor, she feels this would make her more approachable by everyone and thus may actually help people who were going to change to FF perserve with the b/f.

Libra, I agree with you about the majority not necessarily being right!

But there are sound reasons why NCT classes do not do 'how tos' of formula feeding in a group, and I have explained them below.

Lack of information about formula is a real issue, and one that NCT campaigns against. The charity is involved in actions to make formula manufacturers to comply with legislation on labelling and packaging, and to prevent spurious health claims. We think parents should be fully informed about formula brands, and get this from an independent source - not be reliant on slogans and ads. We think decent legislation on marketing issues protects formula fed babies, too, so their mothers can make an informed choice.

Manufacturers have not standardised or updated their instructions on making up bottles, for instance (or they hadn't, last time I looked). NCT was active in bringing this to govt. attention, pointing out that parents should read the same instructions on the pack as are given by their HCPs and by NHS leaflets on bottles.

Hope this helps.

A breastfeeding counsellor who prefers to be known as a 'feeding counsellor' is in a minority of one, I think....that's a bizarre idea, and misleading to parents.

Tiktok - genuine question but why isn't it safe to explain bottle feeding in a group? How big a group is too big? e.g. I presume you'd show a couple (mother-father) how to mix the powder with the hot water, it would be ridiculous to do it one-to-one, why not do it in a group too? I'm not being awkward, I just don't understand the precaution and is it really stipulated in the WHO directive that you should specifically not present info in a group or is it an interpretation of do not promote bottlefeeding. Or even is it do not undermine breastfeeding. Thanks.

Well we can disagree with each other on the bizarre idea as I personally think it would make counsellors more approachable, like it or not b/f counsellors can get reputations as 'militants' and I don't think it is misleading.

'undermining to the choice to breastfeed, which is fragile in our society.'
well new mums who ff are fragile too and not being able to find reliable information about FF makes them feel even more out of the loop.

thank you for that information and I am glad to see that the NCT behind the scenes is doing it's bit with regards to FF however I still don't really understand why the information can't be more readily available upfront.

The 'not in a group' thing is from UNICEF, and is based on research that shows demonstrating a practical skill to a group is not a safe or effective teaching method - you'd have to ask UNICEF Baby Friendly if their research is based on an actual study of bottle using parents, but I don't think it is in doubt in educational circles that practical skills have to be performed by the learners in order to assess competence. That goes for brain surgery, manicuring, speaking French, knitting, and just about everything, I suspect! Bear in mind that merely watching these skills, or listening to a description of them, perhaps some weeks before you need to to them for real, is not likely to be v. effective, either.

Now it would be hard to breastfeed in an unsafe way, so group demo'ing and explanation of breastfeeding is not gonna be harmful but the same thing is simply not true of making up a bottle of formula and other skills - especially with the new safety guidance.

To bottle feed safely demands quite a lot of separate tasks. I want to see parents do this safely, and I think the right opportunity is with a midwife or HV, with a real bottle and powder, and ideally in the parents' own kitchen.That should not be beyond the scope of the postnatal services.

I think demo'ing to a group of parents in a breastfeeding class is very undermining to breastfeeding - which needs protecting. It is assuming they will need the info, and they will not continue with breastfeeding.

I agree ff parents may be fragile and may need support. They will not get it with a dim memory of someone making up a bottle weeks or even months before. I support many mothers who call or email about formula, often after they have introduced it and feel mixed and sad about it. I don't judge, and if they wish, I will explain about what might have made their breastfeeding less than wonderful.

Why is the word 'feeding' non-militant and the word 'breastfeeding' militant? I don't get it. It is misleading to talk of 'feeding' counsellors - we can talk about the feelings to do with using formula, but we are not trained to talk about bottles and teats or diffrent brands or types of formula, so it would be very misleading to parents if we changed our 'title'.

Ask anything else if you like - I will try to answer!

Libra - I agree with you about new mums using formula who cannot find good information. NCT's factsheets are unique - there is nothing else I am aware of that actually gives the same information, but even with these, full information (independent comparison of brands and types) is not available to mothers or anyone because no one has really done the research into which brand is best - mothers have to try and guess and experiment with different types until they find something that suits. Not good enough. But not the fault of NCT!

Thanks for all that information Tiktok, my initial problem with the NCT was that they were apparently not allowed to give out information unless specifically asked and yet as you have said they do have these factsheets about it which could be useful to FF mothers. So my original question still stands - does an NCT teacher have to be asked a specific question about FF before these factsheets are produced or is an NCT teacher allowed to volunteer these factsheets as part of one of her sessions with no prompting?

Thanks for answering this, Tiktok. Leaving bottle preparation aside, you say "but I don't think it is in doubt in educational circles that practical skills have to be performed by the learners in order to assess competence." That's when you assess and test competence, perhaps for examination purposes. But you're not going to test course participants at the end. You would show a group how to change a nappy or how to do baby massage, or yoga moves, whatever, maybe going to each one in turn to see that they do it correctly. Much like a teacher showing some 12 year olds how to mix some chemical substances over a flame.

I think it's best to give a leaflet or be told where to get one if needed. But that's because you won't remember the details rather than because it's such a complicated skill (heat water, pour over formula, check the tin for details) that it can't be done safely in a group.

cthea - but you need to assess competence, to check on safety. No one can hurt a baby by changing a nappy wrongly, or doing massage in the wrong way. But you can harm a baby by making up a bottle incorrectly. You are seriously underestimating the skills - and the things to remember. Have you see the newer guidance?

Libra - no they cannot hand out the leaflets routinely, but they certainly can in response to a question.

OK, not going to argue over this, although I wonder if the UNICEF's recommendations aren't more appropriate to countries where there's concern over the water used in making up bottles. I'd think that women attending AN classes in the UK can be relied on to use clean water, boil it, let it cool to 70o (half an hour or however long it says in the leaflets) and follow recommendations on using the right amount of powder etc.

Errr....not sure I agree. Take a look at the Bounty forums and check the number of people who still advocate making up a day's worth of bottles in advance. Or ask a paediatrician how many times they have seen a ff baby admitted to hospital due to bottles being made up with too much powder. Or see how many people think that it's ok to make up bottles with bottled water that has not been boiled. Or how many people don't follow the guidelines. Or how the instructions on formula packaging isn't conistent with the guidelines, so no wonder people get confused.

Link here

And, its not cool to 70', it's DO NOT let it cool to more than 70'

Oh dear. not the 'it's only for the third world' thing again....The guideines on boiled water cooled for no longer than 30 mins are Eropean guidelines, because the powder is not sterile - the European Food Safety Commission (I may have the exact name of this body wrong, sorry) issued them to all EU countries as a recommendation after babies died in Belgium and France from enterobacter sakerzaki, and several notified cases of salmonella, all traced to formula powder. Member states then decided whether to adopt these as their own, and the UK dept of health did so about two years ago.

It's really nothing to do with the cleanliness of the water - though this should be boiled anyway,and there has been no suggestion from anywhere that I have read that it shouldn't be.

Lizzytee - I don't read Bounty and I don't know how representative that is of the general public anyway. If the problem is as widespread as you say, then surely that's a good reason to DO something about it, such as educating people.

cmotdibbler - yes, I don't know the nuance between cool to 70 and do not let it go below 70 (so are you saying 100 degrees is good? it is above 70, as per your "correction", perhaps you too should double check before pointing the finger), but that's because I don't need to.

tiktok - I don't get the "oh dear". I haven't had this conversation with you before, maybe it's a boring one for you but you invited questions in a previous post. I know the powder is not sterile, so that's a spurious argument you're bringing. I just didn't think that the average paying antenatal client isn't able to take in such information. Considering the kind of other information they're expected to be able to balanace benefits and risks, boiling water and pouring it over formula while following instructions on a sheet seems like small fry.

Cthea - have a look at the bounty forums and draw your own conclusions. The percentages of people not following guidelines are based on the last national infant feeding survey and are not something that I or the NCT press release I linked to randomly made up. If there is one thing I have learned about MN it's that random baseless statements get hopped on . The other things I've referred to are things I have personally seen, not urban myths.

Do you think that this MN forum is representative of the general public?

Lizzytee - I take your point about the national infant feeding survey and the confusion regarding how to make up bottles. But if the NCT gives factsheets about it then why can't its teachers also be taught about it and how to teach others about it in a safe manner? It doesn't have to be one-to-one, it's not rocket science for the "typical" woman attending paid antenatal classes. I'm curious because I just don't buy the argument that you can spread the info in a factsheet - to be read freely, free of charge by anyone with an interest and an internet connection - but not in a class. I can't see how it's something you can't teach in a class and that UNICEF forbids it for safety reasons. You can say "making up bottles - here's the factsheet, lots of details, read up if you need to". Is this being too simplistic?

There is no purely 'making up bottles' factsheet from NCT, but the DH and UNICEF both produce free ones, widely available. The bottles factsheets (see the links) are doing something different and unique. One of the sheets does have instructions, but alongside info that talks about the impact of bottles on bf and infant health.

We have 2 apparently opposing arguments here:

• that making up a bottle is easy and safe, and should be easily understandable by an anenatal class, so why not show it?

• making up a bottle is actually not very easy and potentially dangerous if you do it wrong, so group instruction is a poor way to teach it

If it is easy and safe, then there is no point in showing it in an NCT breastfeeding class - all people have to do is read the instructions when they need to do it 'for real'.

If it is not so easy and safe, watching a demo in a group weeks (months?) before you need to do it 'for real' yourself, runs the risk of people forgetting or only half remembering - with potentially unsafe effects on the baby.

Either way, the NCT class is not the place! Pick your argument.

Sorry for the 'oh dear' - bit of impatience there I often post on mumsnet correcting the idea that guidance on bottle prep is not applicable in the UK.

I'm so glad we live in a country with good clean sterile water running through our taps