Tuesday, March 22, 2011

Breast pump outrage!

Breastfeeding is one of those issues that can be extremely controversial among mothers (dads don't seem to care so much). For the record, I think breastfeeding is a woman's choice. If a mother feels for whatever reason she can't do it, I don't think we should chastise her. It's horrible that some women will approach a mother feeding her baby a bottle in public, and feel a need to comment to this stranger that the baby should be getting breastmilk. If you've ever approached a stranger and said something like that or given any sort of unsolicited parenting advice, you're nuts and should mind your own business. Just so you know.

That said, I think breastfeeding is wonderful. Both for the health benefits and the bonding. I think that we should provide every possible resource (finances, time, moral support) to make it easier for women to give their babies breastmilk.

Recently a woman at work told me that her insurance company had paid for her breast pump. Then she gave away that pump to a friend and they paid for a SECOND breast pump for her next child. I was impressed. I thought it was incredibly forward-thinking of insurance companies to pay for breast pumps.

Because I might hypothetically need one someday in the future, I decided to call my insurance company to ask if they would cover a breast pump. The answer was no, which wasn't a big shock. But what really surprised me was when the woman on the phone added, "Unless it's medically indicated."

Of course, I had to ask, "What do you mean by 'medically indicated'?"

"Well, if the baby is premature or has an abnormal sucking reflex," the woman told me.

After thinking about this a bit, I found it kind of disturbing. Basically, they're admitting that breastmilk is important and beneficial for babies, because they're providing the pump for women who can't nurse the natural way. They're saying that if a baby can't nurse directly from the breast because they're premature or have an abnormal sucking reflex, they want the baby to still have that breastmilk because it's SO important.

But if the woman can't nurse directly from the breast because she has to go back to work... well, those ladies are on their own.

There are some states in the U.S. where you get 12 weeks of family leave time that's unpaid, but at least your job is guaranteed. After that, you can lose your job. In other states, you can get short term disability to pay for those 12 weeks of leave. But that just means you have a three month baby when you get back to work. So are insurance companies saying that it's not "medically indicated" for three month old babies to get breastmilk? And I think many people reading this blog who live in the U.S. probably took far less than 12 weeks. (I did.)

I think that kind of stinks. Insurance companies pay for preventive care, vaccines, etc. But for some reason, they won't pay for a relatively modestly priced breast pump to facilitate a newborn getting breastmilk from their working mother. Seriously, could this country be any less supportive of breastfeeding? I think all women who manage to do it, especially when they have to go back to work, deserve a round of applause.


  1. A few thoughts on this:
    1) I don't think the insurance companies see a financial gain in having moms pump. Yes, babies may be a little less likely to be sick, but I don't think on average it is a big difference.
    2) I think too many women will be like your friend - get one for the first baby, sell it, and then request another one. This again cuts down on the financial benefit for the company.
    3) I wonder if they would pay for one if your doctor requested it? Maybe if the doctor gave a reason (citing the health benefits, etc) they would accept it? Maybe it is just because they don't want people asking for them, getting them, and then not using them???

  2. AJU5:
    1) But what is the gain then in providing a pump to moms who have a premmie, etc? That's the part that stumped me.
    2) She actually gave it away, didn't sell it. She says she told them that and they insisted on paying for a new one. I want that insurance!
    3) It's possible if I made a fuss, I made get one. Although I can't honestly say I have ever won a fight with an insurance company, even when I thought I was clearly in the right.

  3. Babies need food, but it's not something insurance covers, and with good reason.

    I'm guessing the preemie thing has to do with babies being in the hospital for a long time and mothers not being there 24/7?

  4. In case you're wondering why premiums have gone up....What, she didn't know she was having another kid? I wouldn't have authorized a second pump if I was that insurer. That being said, buying one's own breast pump would seem a small investment compared with having to buy formula for say, 9 months. Seems like there was something on the news that said you can pay for pumps with HSA money.

  5. Anon: Both term babies and premies need food... why do just the premies get the pump?

    mamadoc: I doubt premiums have gone up because the insurance companies might buy breast pumps for a few women twice. I went to a doctor a year ago for a minor issue and the doctor ordered a huge rainbow panel of unnecessary blood tests... I'm barely 30 and I've somehow had my cholesterol checked 4 times (always excellent)... maybe this is a better explanation of why premiums are high, because defensive medicine is out of control. Interestingly, my friend who got two pumps told the company she'd get her pump back from the friend she gave it to, but they insisted she should have a new one.

  6. fizzy- I have completely agreed with your last few posts!

    I borrowed a friend's medala when I started school
    when my son was six months. I'm still using it at 13 months. but my hospital allows employees and students to use the pump room.

    wouldn't this (http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1616v1) make insurance companies have enough interest in bfing/ pumping? I'm still rather ignorant about most things insurance company related...

  7. Can't you just buy the pump online or something?

    Also how long did you guys breastfeed? Doesn't it hurt if you use a pump?

    Sorry, I'm a newbie. And haven't had babies.

  8. I breastfed all 3 of mine for 13 months or so. I used the HSA to buy my pump and yes it is a lot cheaper than formula. That said, I had a clean private place to pump not all women have that.I think getting a pump paid for is less of an issue than having a place and the time to pump.

  9. Barefoot: I think there's plenty of medical evidence to support paying for a breast pump. I suspect in the future, they will probably wise up and decide it's financially worth it.

    Anon: I bought my first pump at the hospital where I gave birth. It was about $200 plus a little extra for the bottles and stuff. It doesn't hurt to pump and it's what most working women do when they want to breastfeed.

    Sunnimom: I totally agree that in all the challenges of breastfeeding, getting a pump paid for is the least of them. That's why it's frustrating that there's just one more barrier in the way.

  10. Fizzy- it certainly would help to have the pump paid for but the insurance companies look to their bottom line. I wonder if Medicaid or Wic could provide it.

  11. The issue is not the pump. It is somewhat demoralizing that women are made pumping machines and made to go back to work, or loose their job. And many families need two incomes, and woman's income may be the main one. In many developed societies and even developing countries women are alowed to stay at home with their newborn for a year (small pay and job garantee) or three years (no pay, still job garantee) like in my former country. I will be greatly surprized if we will see such changes in this society in my life time. Thus, Fizzy all of us ARE on our own. (P.S like you I had far less than 12 weeks after each pregnancy and even had to fight for my 3 weeks the second go round in my premier nationally recognized institution).

  12. The reason it is "medically necessary" for premies and babies with abnl suck reflex is because these babies would not be able to latch on to stimulate breast milk flow, and only a breast pump would be able to get the milk going. There are other conditions that can cause problems with latching and breast feeding, of course, such as inverted nipples, maternal surgery/illness, etc. These are not accounted for by the insurance company's rules, but perhaps they make exceptions based on a physician's documentation.

    I think it's great that we are now able to use HSA money for breast pumps. It's a start in the right direction. Unfortunately, everyone is constantly looking for ways to cut costs, so the problem is unlikely to improve. Medicaid is being cut in virtually every state, for example.

    On the whole, the US lags behind every industrialized country except South Africa in terms of maternity/parental leave. Really pathetic.

  13. Kelly: It's just irksome because they're admitting that breastmilk is medically advantageous. So babies who can't get it due to latching issues get reimbursed, but babies who can't get it because their moms need to work are just screwed. And you're right... it's pathetic how behind the U.S. is in terms of... well, a lot of things.

  14. Thank you! My son was born at term at is now seven months old. I went back to work when he was seven weeks old and have managed to pump at work (I work in research) since. It has been incredibly stressful and I have received a lot of discouragement from coworkers but I am determined to make it to a year of pumping if I can.

    I have my SIL's old PIS and it is on its last leg. I am hoping it lasts a few more months.

  15. This is a random question. If you breast pump, will your baby still get that oxytocin from that milk? Or does the kid only get oxytocin from suckling? I worry that if I don't breast feed, then my baby won't get the oxytocin from me and there won't be that bond.

  16. Anon: I pumped last time for about a yea and it wasn't easy.

    Med Student: I don't see why the content of the milk would be different from pumping. But in any case, there are very few women who ONLY pump and don't nurse at all.

  17. Hi Fizzy,

    I'd think that there's just a bigger incentive for insurance companies to have preemies have breast milk because it is more likely to result in fniancially measurable benefits (fewer complications, fewer hospital days)than in term/older babies. So it's probably cost efficient for them.

    Not justifying here, just explaining... big supporter of breastfeeding/pumping myself.

  18. FYI the content of pumped milk after a few hours is very different then fresh breast milk. If you check pubmed, there are papers outlining the fast decline in antioxident levels within a few hours after expression. Another reason we need to encourage breastfeeding!

  19. @Med Student:
    I don't know about the oxytocin content in the milk, but I think, if it passes into the milk in significant amounts, then it won't depend on whether the baby causes the ejection reflex or the pump does.
    It's just that the mother won't have the baby around during the oxytocin "surge", so there's nothing for her to bond with. The baby will get the oxytocin upon feeding, so it will bond with the person feeding it.
    My opinion is that the whole bonding stuff is a bit overdone - it's really not like you can't love your baby and bond with it just because it's not suckling at your nipple.
    @Anonymous: oxytocin is not an antioxidant, so the oxytocin content will not necessarily decline that fast. Oxytocin as a drug is stable when kept cool (I as a pharmacist always nag on the OB/Gyns to keep it well cooled - unfortunately they won't hear...), and you usually cool pumped milk as well, so that won't be the problem.

    I'm pumping myself (and not nursing at all because baby strikes at the breast after all the time), but that's because whe had some problems after birth (baby too tired to latch on enough, me being engorged and all), so I chose to go this way because it was easiest for us both.
    It's not because I need to go to work - I hardly dare to tell, but I live in Germany, being blessed with a whole year of paid parental leave. I can hardly imagine how hard it must be for you all to go to work after such a short time with your baby.
    Three weeks postpartum? Wow, that's tougher than tough. In Germany, you're prohibited to work for 8 weeks postpartum - the employer would incur a penalty if he let you work at all...

  20. I went back to work part time three weeks after my c-section. Why? Because if I did not work we made no money. And shortly after I found out I was pregnant, I lost my job, so had a hard time putting together an emergency fund. My husband's job at the time (5 years) paid about $12K a year which would not even pay for food and rent. I both pumped and breast fed until my daughter was 13 months old. I had some problems because I worked often emergency and I couldn't just stop a procedure because I was in horrible pain and my breasts started leaking. I was lucky enough to rate an office/bedroom at work, so I had a clean place to pump.
    As far as the health benefits, I can say that my daughter had one fever in her first year of life... And that did not result in me dragging her into the ped's office= n1 for me. But I feel like it was good for me as well as her, thus important that I do it as long as possible. I only stopped when she started refusing the breast and my supple dropped off virtually overnight after a few nights of having to put off pumping.


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