stephenrollnick

I am doing some work in planning workshops with a regional public health nurse who is developing ways of implementing policy and practice in the area of infant feeding that is directed at increasing the rate of breast feeding. A recent piece of research evaluating mothers experiences of how midwives and other health professionals have approached the issue of infant feeding choices has shown disappointing results regarding the approaches to date (a check-list approach that has been adopted to cover the 'must do' standards of information giving related to breast feeding).

A lot of the experiences expressed by women in this qualitative study (prenatal and in the first year after birth) have described feelings of being judged, not listened to, not believed etc when in conversations about this delicate subject. There are many factors that are believed to influence how effective individual nurses or midwives are in conducting these conversations  - how they have fed their own babies or been fed themselves, how confident they feel in raising the issue in the first place, pre-conceptions about the mother's previous choices and so on.

We are setting out to invite these practitioners to reflect on how they may try to engage in a way that is more constructive and I have some ideas that I think will be useful - adopting a guiding style, key communication skills of asking, listening, informing and some strategies such as agenda setting, exploring importance & confidence, EPE information exchange.

I wondered if anyone on this forum had any experiences of working in this area as a practitioner,researcher or trainer that they have found helpful in helping mothers make important choices about infant feeding.

Warmly

Kathy

Dear Kathy,

Everything you describe as being useful here makes good sense to me. The scenario is also familiar.

I can see a trap that many a well-intentioned MI practitioner and project have fallen into however. A single change focus. One sees this in countless evaluations of MI, and the rationale goes along these lines: "Let's try to improve ---- (smoking cessation; breastfeeding; exercise.... etc etc).  Let's use MI."

So the practitioners, with a firm change agenda and good MI skills raise the subject. Resistance, and poor outcomes.

The problem could be that the focus is too narrow, and the subject is not raised in a broad context.

The best example of genuinely generic intervention with mothers I have come across is the Family Nurse Partnership (there is a team in Northern Ireland, by the way - I met them; a great bunch of people from Derry). These nurses are trained in MI, and lots more. Their focus is on the heart's desires of the mothers. Breastfeeding will be discussed in that context.

You can learn about this lovely programme via google ( see for example, http://www.dcsf.gov.uk/everychildmatters/strategy/parents/healthledsupport/healthledsupport/).

The founder of this programme, David Olds once described to me the place of MI thus: "Its a powerful ingredient in the fuel that drives good practice". No more, no less!  Its good practice that were all after.

if you get hold of that team in Derry, maybe they can help?

Kind regards, Steve

Thanks Steve, I was aware of some of the work of the FNP programme I will check out with the nurses you speak of from Derry what their experiences are. I have had a few nurses from the Surestart schemes in Northern Ireland attend trainings I have provided and I recall they worked specifically with targeted groups of young mothers who were struggling to grow into the demands of becoming a mother. They had a few ideas about becoming more curious with the young mothers about how they could achieve the aspirations they had fro their babies.

I have been thinking a lot about the trap you describe and about how not being broad in developing a conversation about caring for the child could undermine any good work/aspirations of the practitioner/mother. It is top of my agenda to find a helpful way of exploring with these midwives how they can raise the subject in a way that doesn't elicit resistance or scream of the righting reflex by assuming their aspirations of parenting are narrowly determined by how the mothers choose to feed their babies. Their practice experiences have been guided by an approach that are typical of many contexts - ensure you assess/address a,b&c so moving to an approach that requires the practitioner to be more flexible and demands good skilful listening will be central to all other work.

I too will have to be mindful of my aspirations as the trainer - doing a few simple things well in the one day workshop I have with 5 different groups - about 100- 120 midwives/health visitors working in maternity units/community settings!  I am hoping to encourage them to use this discussion forum to share their experiences and expand on their thinking around these practice challenges, it would be really something if the FNP colleagues you speak of could add their voices!

Thanks again

Kathy