The NDC Lactation Fellowship: what makes it different

You can purchase The Fussy Breastfed Infant, Nipple Pain and Wounds in Lactation, and Breast Inflammation in Lactation modules here. These modules are composed of advanced health professional facing content. Anyone can purchase access to the modules. Only NDC Lactation Fellowship participants can use it as part of their course and the Fellowship qualification.

Who will deliver the NDC Lactation Fellowship?

Dr Pamela Douglas is a highly experienced breastfeeding medicine doctor, general practitioner, and researcher, who began her general practice career in an Australian First Nations' community controlled health service in 1987. She first qualified as an International Board Certified Lactation Consultant in 1994, and began publishing in the international medical research literature from 2005. Pam's passion right throughout her professional life has been to make a contribution towards improved well-being for breastfeeding women and their infants. Her 30 or so research publications have a foundational focus on

1. Clinical breastfeeding and lactation support;

2. How the societal disruption of the evolutionary norm of breastfeeding has resulted in widespread health system confusion concerning a range of infant behaviours or signs, which in turn has resulted in

   • High levels of maternal and infant distress

   • Overpathologising of both mother and infant in clinical breastfeeding andlactation management

   • Treatments for breastfeeding problems which lack efficacy or worsen outcomes;

3. Mechanobiology and human breastfeeding and lactation.

The NDC Institute has also invited in guest presenters who will help build the content of the NDC Lactation Fellowship, by drawing on the work of expert researchers and clinicians in the fields of human lactation and infant care.

• You can find the guest speaker program here.

• You can find the NDC Lactation Fellowship Guide here.

• You can find the NDC Lactation Fellowship module content and calendar here.

Why is this course different to other opportunities, and why might it be worthwhile?

The NDC Lactation Fellowship offers clinical guidelines for both common and complex breastfeeding and lactation challenges.

Breastfeeding and lactation medicine, or clinical breastfeeding and lactation support, remain a research frontier.(1) We know from implementation science that explicit naming (and debating) of a theoretical frame through which research is instigated and interpreted is essential for best practice translation of existing research into clinical guidelines.

Unfortunately up to 85% of research in health is wasted in methodologically poor studies, in part because the theoretical frames which underpin the question and the interpretation of results have not been robustly and explicitly named and examined (2). Often clinicians are upskilled in clinical approaches to breastfeeding and lactation support which are not genuinely evidence-based, or are not built from robust theoretical frames. This occurs more commonly in the field of clinical breastfeeding and lactation support than in other health field, due to a historical failure of our health systems to invest in research into breastfeeding and lactation support. A montage style of clinical management guideline development in breastfeeding and lactation medicine education results in unstable clinical management approaches, which alter regularly in response to changing consensus opinions.

The NDC theoretical models are developed from an interplay between Dr Douglas's clinical experience and reviews of extensive interdisciplinary research literature, with clinical translations iteratively refined in response to feedback (that is, from best practice implementation science). These strong theoretical models and the use of implementation science have resulted in the NDC clinical approaches tending to be stable and corroborated by new studies as they emerge, rather than requiring change.

An example of a novel, evolutionarily robust theoretical frame in NDC is the programs' integration of the emerging field of mechanobiology, which investigates the effects of mechanical forces on living tissues and cells. In the NDC lactation domain, mechanobiology foundationally informs the NDC approach to fit and hold (the gestalt method), management of nipple pain and damage, and management of the spectrum of breast inflammation.

The NDC Lactation Fellowship is for NDC Accredited health professionals who are interested in

• Leadership in education within their own communities and countries concerning clinical breastfeeding and lactation support and infant care

• Leadership in mitigation of overdiagnosis and overtreatment in the field of clinical breastfeeding support and infant care, in the face of worsening trends to overdiagnose and overtreat internationally, including with complementary and alternative medicine and bodywork interventions

• Rigorous intellectual engagement with existing research, including the capacity to think critically about and analyse

  • Research study methodologies
  • Current trends in breastfeeding medicine and lactation consultancy practices and education, including pedagogy and leadership

• Genuinely holistic clinical practice: working from the evolutionary premise that effective clinical breastfeeding support requires research-based expertise in the domains of unsettled infant behaviour and perinatal and infant mental health, so that breastfeeding cannot be considered separately from those other domains (the premise that has given rise to NDC)

  • What does it mean to 'lean into the symptom' and why does this approach empower families?

• Evolutionary bodywork: sophisticated clinical skills for empowering mother and baby as single entity comprised of many complex physiological systems, including mechanobiological systems, which dynamically interact in real time (gestalt fit & hold intervention for mother-baby pairs), for the repair of

  • Nipple pain and damage

  • Fussy infant behaviour at the breast

• Thinking about how to interrogate and negotiate

  • The interface between market-driven business forces or pressures and desire to provide genuinely evidence-based clinical breastfeeding support in primary care or hospital settings

  • The role of ideology in clinical breastfeeding support and breastfeeding medicine: what is it, and how does it impact upon clinicians and the families they work with?

  • Orthodoxy and heterodoxy (power, status and rhetoric as determinants of the kind of knowledge that garners institutional and policy support) in the fields of breastfeeding medicine and clinical lactation support, drawing on the work of Professor Trisha Greenhalgh and others (3,4)

• Thorough understanding of how implementation science applies to the field of clinical breastfeeding support and lactation.

For more information

• The NDC Lactation Fellowship Workbook (without learning activities) is available here. The pdf version which contains the learning activities is embedded in the NDC Accreditation pathway and also in Maintenance of NDC Accreditation.

• The NDC Lactaton Fellowship is accompanied by a guest speaker program, also open to all health professionals and providers, found here.

• You can find out what makes the NDC Lactation Fellowship different here.

• The NDC Lactation Fellowship module content and projected dates are available inside the NDC Accreditation pathway and also inside Maintenance of NDC Accreditation.

Selected references

(1) Stuebe AM. We need patient-centred research in breastfeeding medicine. Breastfeeding Medicine. 2021;16(4):349-350.

(2) Rutherford C, Boehnke JR. Introduction to the special section "Reducing research waste in (health-related) quality of life research". Quality of Life Research. 2022;31:2881-2887.

(3) Greenhalgh T, Ozbilgin M, Contandriopoulos D. Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic. Wellcome Open Research. 2021;6(126): https://doi.org/10.12688/wellcomeopenres.16855.12683.

(4) Greenhalgh T, Russell J. Reframing evidence synthesis as rhetorical action in the policy making drama. Healthcare Policy. 2005;1:31-39.