More about the NDC Lactation Fellowship

Dr Pamela Douglas28th of Jan 20245th of Nov 2024

Who will deliver the NDC Lactation Fellowship?

Dr Pamela Douglas is a highly experienced breastfeeding medicine physician, 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. Her 30 or so research publications have a foundational focus on

Clinical breastfeeding and lactation support
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 management
- Treatments for breastfeeding problems which lack efficacy or worsen outcomes
Mechanobiology and human breastfeeding and lactation.

Pam's passion right throughout her professional life has been to make a contribution towards improved well-being for breastfeeding women and their infants.

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). But often clinicians are taught to use clinical approaches built upon methodologically weak research or implicit and assumed theoretical frames as if they are facts. This may occur more commonly in the field of clinical breastfeeding and lactation support than in other health fields, due to historically-constructed relative paucity of evidence. 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 the interplay between Dr Douglas's clinical experience and her and her team's 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.

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.

In addition to covering the topics in the NABBLM-C curriculum, The NDC Lactation Fellowship is for doctors and breastfeeding medicine physicians 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?
Genuinely holistic 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.

Dear colleagues,

If you are interested in participating in the NDC Lactation Fellowship pathway please register your interest with our Education Manager, Cathryn Proberts, at education@ndcinstitute.com.au

Much of the research and clinical guidelines for the NDC Lactation Fellowship have already been prepared, as part of the body of work (as yet unpublished) known as 'Breastfeeding stripped bare - of unnecessary medications, exercises and surgery'.

The NDC Institute will charge incrementally so you know you are getting value for money, step by step, and will keep fees as low as possible for first cohort.

I hope you might be interested in joining me on this adventure!

Kind regards,

Pam

You can purchase The Fussy Breastfed Infant module here. You can purchase Nipple Pain and Wounds in Lactation here. You can purchase Breast Inflammation in Lactation here. These modules are composed of highly advanced health professional facing content. Anyone can purchase 12-month access to the modules. Only NDC Lactation Fellowship participants can use it as part of their course and the Fellowship qualification.

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.