Case study: 'cancelling' whilst extracting from an evidence-based primary care innovation which offers alternatives to low value care for management of breastfeeding problems and unsettled infant behaviour

The NDC or Possums programs have been developed as a response to the high levels of overmedicalisation and paramedicalisation in early life care

"All flourishing is mutual." Robin Wall Kimmerer

Over the past two decades, in direct response to the growing problem of low value care of common breastfeeding and infant care problems, and with the help of various teams, I have developed Neuroprotective Developmental Care (NDC or the Possums programs) as a primary health care (or community-based) clinical innovation developed by applying the principles of implementation science. My approach to program development has aligned with the principles articulated by Armstrong 2018:

“There is growing recognition within healthcare improvement research of the gains to be had from ensuring that the design and execution of improvement efforts are appropriately theoretically informed, and [articulate] a clear theory of change, an account of how and why the planned activities are credible as a means through which the desired outcomes can be achieved. It’s also important to ensure robust evaluation of efforts to tackle the problem.”

The NDC or Possums programs are a multi-component suite of clinical interventions which address the domains of breastfeeding, feeds, sleep, cry-fuss problems, infant sensory motor needs and development, and perinatal and infant mental health, based on acknowledgement of the interrelated complexity of each of these domains. The NDC interventions are clinical translations of theoretical frameworks established in about 20 systematic or narrative theoretical framing reviews, and have been refined in response to 10 peer-reviewed published evaluations which demonstrated the programs’ efficacy, as well as ongoing feedback from clinical practice. Education pathways for health professionals include NDC Accreditation and a high level Lactation Fellowship.

You can find here the scientific publications contributing to the development of NDC which have raised the alarm about overtreatment and unintended outcomes in management of breastfeeding problems and unsettled infant behaviour.

Breastfeeding and lactation non-profits use commercial levers to ‘cancel’ the Possums or NDC innovations in clinical breastfeeding and lactation support

The International Board of Lactation Consultant Examiners (IBLCE) currently operates a global monopoly on breastfeeding education for International Board Certified Lactation Consultants (IBCLCs), of whom there are about 39,000 worldwide. It is not necessary to be a registered health professional in one's own country to qualify as an IBCLC. The non-profit Lactation Education Accreditation and Approval Review Committee (LEAARC) establishes criteria for evauating and approving the courses which prepare individuals to qualify as International Board Certified Lactation Consultants, and is described as the third pillar of the lactation consultancy profession. LEAARC also requires full compliance with the International Code of Marketing of Breast-milk Substitutes as a pre-requisite for having a course evaluated and approved.

IBCLE has withdrawn the right to attribute Continuing Professional Development points to the NDC or Possums education programs and my related presentations world-wide (although IBCLCs can still self-log any time they spend upskilling using my work), in response to my publication of two research articles which challenge bodywork- and frenotomy-dominated approaches to breastfeeding problems, and which offer alternative evidence-based clinical strategies.

Withdrawal of public CPD point attribution to conference presentations or education ‘cancels’ this innovative suite of evidence-based interventions from visibility amongst IBCLCs and breastfeeding medicine doctors internationally. You can find out more about this here.

Unfortunately, this has become a widespread problem, affecting dozens or more of the world's leading researchers in the field of breastfeeding and lactation, and has the affect of seriously skewing the kind of education received by breastfeeding medicine doctors and other health professionals, including IBCLCs.

I discuss how exclusion goes hand-in-hand with unethical extraction here.

Recommended resources

Possums Breastfeeding & Lactation articles which address lactation non-profits, ideology, and harm

Selected references

Armstrong N. Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research. BMJ Quality and Safety. 2018;27:571-574.

Azad MB, C NN, Bode L. Breastfeeding and the origins of health: interdisciplinary perspectives and priorities. Maternal and Child Nutrition. 2020;17:e13109.

Chetwynd E. From censorship to conversation: agnotology, market infuence, and the ethics of breastfeeding research. Journal of Human Lactation. 2025;4(3):303-305.

Kendall-Tackett K. Have we returned to the Dark Ages: Excommunication and its chilling effect on science. Clinical Lactation. 2020;November:DOI: 10.1891/CLINLACT-D-1820-00024.

Kimmerer, Robin Wall. The serviceberry: abundance and reciprocity in the natural world. New York: Scribner 2024.