Let’s get the obligatory disclaimers out of the way: I fully support a family’s right to feed their baby in whatever way works best for them. Formula is not an enemy. And for women who desire to breastfeed we need to do everything in our power to help them succeed. We should be bulldozing the hurdles and sewing up the loopholes.
We have made great strides in the last few years; the Affordable Care Act (ACA) has brought lactation services and plan-covered breast pumps to most insured mothers, yet the remaining gaps are large and tricky to navigate.
When I got pregnant with my son I went to my insurer’s benefit booklet to see what pumps I could choose from and was greeted with the phrase, “grandfathered health plan.” This means my plan did not have to comply with many ACA changes. I work for a major medical system that has received accolades for its breastfeeding friendly status, yet their employee plan would not cover the most basic of supplies needed by a working mother. The dichotomy felt unfortunate, but a friend offered me her unused pump and I moved on.
Then my son, Rowan, was born two months early, weighing in at three pounds. Breastmilk suddenly became potentially life-saving medicine fed to him a few millilitres at a time through a nasogastric tube. The pump I had was not going to cut it when it came to establishing and keeping a milk supply for a baby who was too weak and uncoordinated to latch. I was provided a hospital-grade pump during the time I spent in the hospital after delivery and while visiting him in the NICU, but I was on my own when it came to maintaining supply at home. We ended up renting a hospital-grade pump, which cost more than $60 per month.
After Rowan had been home for a month I was still struggling to meet his nutritional needs through breastfeeding alone. I was pumping, breastfeeding, and bottle feeding every three hours around the clock, and inside I was crumbling. Some people will say that I should have given up, and I completely understand the sentiment. But I nursed my daughter until she was two and a half, so I could see the end game; I knew what a great nursing relationship could look like, if only I could get us there. I needed to call in the help of an International Board Certified Lactation Consultant (IBCLC).
Guess who has two breasts and a plan that doesn’t cover lactation services? Yep, this girl.
I’m going to check my privilege right here. I sought help anyhow, because I was able to afford it. I will probably end up paying the out-of-pocket expense, because I’m tired of dealing with it. I had a large network supporting me and helping me through, and at one year old he is a breastfeeding machine. In short, I am amazingly lucky.
Our issues were complicated and beyond the scope of most pediatricians. During his six weeks in the hospital our main goal was for him to eat – the delivery system was secondary – and as a result he had developed a preference for the Thanksgiving-full feeling and instant gratification of the bottle. He also had a lip and tongue tie. Oh yeah, and he wasn’t supposed to be born yet. With the help of an amazing IBCLC we slowly got back on the right track. If I was the type of person who sent holiday cards, she would definitely be on my list.
Because of Rowan’s prematurity and subsequent feeding difficulties we were able to get services covered for him. This left me wondering exactly who they thought was providing the milk, and what sort of logic suggested that covering him, but not me, was sufficient? He needed to learn how to eat in a new way, and I needed to learn how to help him.
In the meantime, even women who have plans that fall under ACA are still facing obstacles to lactation services and supplies. According to the National Women’s Law Center (NWLC) many insurance plans are taking advantage of every possible loophole, which undermines the intent of the law. Some plans only cover manual pumps, which are woefully insufficient for most women’s needs. There are plans with no in-network IBCLCs and inadequate out-of-network options. In fact, the requirement is only for “lactation support,” which can leave women turning to providers with limited education in breastfeeding issues. Coverage is inconsistent between states and companies.
Another common complaint is that women are denied access to breast pumps until after the baby is born, at which point they have to jump through administrative hoops to get a pump. I don’t know about you, but after my kids were born I was in no state of mind to jump through anything. I was busy bleeding out of my wherever and crying about everything. I didn’t need a pump at some undetermined future point, I needed a pump immediately.
We can do better.
Insurance companies — you can do better.
You need to treat breastfeeding as the preventative care that it is, supplying moms with what they need for success, not just the bare minimum required by law. Grandfathered plans need to step up and be proactive in adding lactation coverage.
I know that there will be comments telling me what I should have done, and what else I could have tried — and by all means share those ideas to help other moms — but the fact remains that though I am well-versed in leaping over lactation hurdles and navigating insurance companies, I found myself surprised at the height of the jump. Access to IBCLCs and breast pumps should not be just theoretically easy, it should be easy in practice. If we are going to encourage women to breastfeed we need to put the money where the nipple is and make sure the system is created to give them the tools they need. We should not have to fight through red tape, loopholes and surprise barriers to reach our breastfeeding goals.
I am lucky to have what will certainly be a long breastfeeding relationship with my son, and for that I am grateful. But without equity in resources we are leaving women behind — women who want desperately to breastfeed their babies, but cannot navigate the murky insurance waters to find the tools they need for success. We need to make sure the toolbox is open for everyone.