World Breastfeeding Week – Breastpumps Covered by Insurance?

Have you heard yet about the Affordable Care Act?

On August 1, 2011, the Department of Health and Human Services (HHS) adopted additional Guidelines for Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening – that will be covered without cost sharing in new health plans starting in August 2012. The guidelines were recommended by the independent Institute of Medicine (IOM) and based on scientific evidence.

Bolding mine.

And from a bit farther down in the article:

Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their children’s and their own health. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.

I am thrilled to hear about this.  There are so many moms (including myself) that have to go back to work full-time shortly after the births of their children.  Right now, in the US, those moms typically have to go back to work at 12 weeks postpartum.  This falls under FMLA, which makes no requirement that these moms get paid during that time.  If you’re lucky enough (like me) to work for a company that does elect to pay during this time… Great!

Many moms aren’t that lucky.  I can’t imagine what it must be like to be a mom from a low-income family, have a baby, and then be faced with the prospect of having to choose to put food on the table for their families or stay home with their babies.

So imagine this scenario: You’ve just had your baby. You’re about to return to work just a few short weeks after the birth. You’ve worked so hard to breastfeed your baby during those critical first few weeks. You know that your work is required by federal law to allow you time and space to express milk.  But you’ve just been out of work and unpaid for a few weeks.  Finances are really tight.  You don’t have an extra $100-$300 laying around to get the double-electric pump you know you’ll need to be able to express enough milk during your short break to be able to send to daycare with your baby.  You think about the cost of formula, and while you know it’s cheaper in the right now, it’s so much more expensive in the long run.  And anyway, you really wanted to breastfeed your baby and you’ve worked so hard at it.

What kind of a choice is this?  It’s not a choice.  Not at all.  And it’s completely unfair.

According to the CDC:

Breastfeeding rates were examined by income status group. Income status was defined using the poverty income ratio (PIR), an index calculated by dividing family income by a poverty threshold that is specific for family size (3). Low income was defined as PIR less than or equal to 1.85, and high income was defined as PIR greater than 1.85. For the total population, the proportion of infants who were ever breastfed was lower among infants whose families had lower income (57%) compared with infants whose families had higher income status (74%).

Considering how many friends I know that have lost jobs in the current economy, making sure women have access to affordable healthcare, including lactation support if they need it, is critical.

I’m glad that the Affordable Care Act will be going into effect.  I don’t think it is a complete solution. I wish that all women, insured or not, had easy access to the same resources that I do.  I wish that all women could make the choice of how to feed their child–whatever that choice might be–without the outside pressures of simple and brutal economics.

I wish, I wish, I wish.



I’m celebrating World Breastfeeding Week with Natural Parents Network!

You can, too — link up your breastfeeding posts from August 1-7 in the linky below, and enjoy reading, commenting on, and sharing the posts collected here and on Natural Parents Network.

(Visit NPN for the code to place on your blog.)

Back at work, midwives, and feeling blessed

It’s Wednesday.  Day 3 of my return to work, and it’s going amazingly well.

I was nervous about coming back.  I didn’t know what it would be like to get up early and be upright in a chair all day.  My job is completely sedentary computer work, but there is no opportunity to just go have a lie down.  After being parked on the couch for two months, I was worried about the physical demands of being back.

My first day back ended up being incredibly positive, even though by the end I was exhausted.  I had so many people stop me in the walk-ways and come by my desk to welcome me back.  It made me feel so good to know how many people had been thinking of me.  Invariably, everyone asked how I was doing, and I was pleased to say, “I’m doing so much better.  It’s great to be back among the living.”  Lots of people asked about my pump, which, oddly, I appreciated.  I thought I would feel self-conscious about it, but I think it would have been worse if they’d stared at it and tried to pretend it wasn’t there.  Somehow it’s less embarassing to be able to explain it and make a joke about it.

One of my office friends asked about it in the break area, and another fellow, who is really more of an aquaintance piped up and said, “I know what that is!  I have one, too!”  And he pulled out his insulin pump.  It was really cool to meet someone who had a pump, too.  I had been explaining to people that it’s like an insulin pump, but I had never met someone in real life who actually had a pump.  I’d never seen one in person before either.  We ended up spending some time talking about it, and he was kind enough to let me ask some questions: How often does he have to change the sites and where does he think it’s easiest to put it.  He only changes his sites every 3 days (lucky!), and he likes to put his in the back of his arms, something that’s not an option for me because the Zofran gets pushed through at a higher volume than the insulin pump.  Like me, he thinks the belly is the worst place.  His pump is sleek and shiny and fits neatly in his pocket compared to my big clonker which I have to wear around my neck in a bag.  It makes me feel lucky, though, to know that I get to kiss my pump goodbye in a few weeks (!!!), whereas he’s got his for the rest of his life.  It’s comforting to know, though, that I’m not the only cyborg in the office.

Monday, I also called one of the local midwifery practices to set up a consultation.  I mentioned that I had been suffering with HG, and instead of suggesting acupucture or ginger (like the previous midwifery practice), she immediately asked about PICC lines and meds.  When I explained that the PICCs failed, she asked if I had a line tunneled into my chest.  Wow!  That’s exactly the order of interventions my doctor had listed!  When I told her I was impressed by her ready knowledge of HG and wanted to be sure to see her specifically for the consult, she laughed and said, “Don’t worry.  Both my partner and I know about HG.  I learned from her.  She got her knowledge through firsthand experience!”

You could have peeled me up off the floor.  I wanted to cry with relief.  One of my major concerns about seeing a midwife is that they would dimish the experiences I have had with the HG.  I simply can’t believe my luck.  How could I have stumbled into a town that has both a doctor and midwives who know so much about HG?

These midwives work in a birth center located less than 5 minutes from the best NICU in the county.  They know about HG.  They can do waterbirths.  They are willing and able to work with my doctor in whatever capacity I need to ensure the HG stays under control.  They are willing to save a space for me in their practice until I’m weaned off the zofran pump to ensure a smooth transition.  And most of all, there’s that feeling in my gut that things are right.  The consultation is scheduled for next Thursday, late afternoon.  It can’t come soon enough for me.  I can’t be certain things are right until Mr. Grasshopper and I meet with them, so please keep your fingers crossed.

With all of the positivity of coming back to work and speaking to these midwives, not to mention the joyful pregnancy affirmations I’ve been listening to as part of my hypnobabies practice, I am feeling incredibly blessed.  Do you ever have moments where you feel like your heart is just so full it’s about to overflow?  I just feel so full of joy and positivity right now.  It is such a good feeling to have.  I am coming out of a very dark place and the sunlight feels so good on my face.

Hyperemesis Gravidarum has Me Feeling the Monday Blues

It’s Monday, and the week is off to an inauspicious start with the hyperemesis gravidarum.  Feeling slightly worse every day.  I imagine after this week my doctor will write me out of work completely.  For the time being, my office has said that my half-days will need to come out of sick time.  Whatever.  It’s only 5 days.  I don’t really care at this point.  I’m just looking forward to being out.  The smells of people heating their lunch were brutal today.  The smell of the microwaved air was pretty horrifying.

I managed to eat a really good lunch today, but I’m paying for it right now.  It was some of my favorite cheese enchiladas from a local Mexican restaurant.  I spent most of the morning getting ready to tie up loose ends at work.  I made new customer sheets to give to whoever is backing me up.  I don’t know what will happen to my customers, but at least I have a few days to figure it out.

The fridge smell is getting worse also.  I’m going to get out my aromatherapy oil and see if that helps.  I’ve got an old bandana of my dads, so I imagine myself walking around the house looking like I want to hold up a bank in the wild west.  Also, the Grasshopper’s smell hit me weird for a few hours yesterday, which I found to be very upsetting.  The HG is probably going to take a lot away from me for a while, but I do not want it to take my relationship with my daughter.  We do quiet things together a lot like reading, cuddling and watching movies, and so far I’m still able to nurse.  I really don’t want to give up any of that.

Tomorrow we’ll be diverging from our normal posting again.  I finally got brave enough to write a submission for the Carnival of Natural Parenting, and it was accepted!  I’m pretty excited about that.  So be sure to stay tuned for that.  There will be links to lots of other posts from other participants as well, so it should be pretty good.  For a better idea of what Natural Parenting is all about, check out the button on the right side of the screen.  It’s fun stuff.  Like anything, take what you need and leave the rest!

Thanks as always for your support.  I had a pretty blue weekend and I’m feeling pretty down again today, but it’s amazing the boost I get from you guys and from my family.  Reading your comments really helps me.  This is such an isolating illness, and maintaining the connected feeling is going to make a world of difference I think.  My sister-in-law called Sunday just to check in and chat.  She said she hadn’t seen me posting much on Facebook recently, so she was worried.  She lives overseas, but just knowing she was thinking of me made me feel so good.  I love you Carmen!  You made my day!

Hyperemesis Gravidarum, Employment, and Disability Leave

Talking with employers about pregnancy and hyperemesis gravidarum can be hard. So many people just don’t understand that what we have isn’t morning sickness. Knowing that I will likely have to go out on disability, I decided to start working with HR early.

cubicles office disability leave

Let me start by saying that I work for a pretty big company.  This means that all the employment laws, such as FMLA and and CA labor laws (which are extensive) apply to me.  My company also takes health and safety very, very seriously, so it’s primed to be willing to work with me on this.  Once again, I find myself on the lucky side of the coin.

I started by speaking to my mentor, who happens to be the HR lead for the Americas for the division of the company in which I work.  If that sounds important, it is.  She is very well-suited to making sure I receive the correct information in this regard.

When I spoke to her, I printed out some info from the about what HG is, and what the impact can be.  I will get to why that may have not been a great idea later.  She was pretty decent about it when I spoke to her.  She made it really clear, though, that I didn’t have to tell the what was going on.  All I had to do was say, “I may need to go out on disability.”  No need to give reasons.  She explained the CA disability is really complicated and that she would do some digging for me to make sure I have a clear picture of how it works and how my pay would look.

That was on a Friday.

Monday, we met and she gave me a whole packet here.  It was full of complicated HR stuff that I really am just too lazy to deal with here, but the bottom line is, my company gives 26 weeks short term disability, then you switch over to long-term disability.  During the duration of the short term disability, I would take FMLA for 12 weeks, supplemented by California disability insurance + the difference in pay for full pay for 12 weeks.  The full pay would continue, as I understand it, up to 17 weeks.  Then the other California disability program kicks in for 55% of the pay for an additional 12 weeks, which would carry me into my company’s long term disability program.

Realistically, I hope to not need any of that.  But if I need it, it’s there.  It’s complicated but it’s there.  She also assured me that I would still have a job when I returned.  I was ready to push on this.  A co-worker was out for bone marrow transplants for almost a year, so in my mind the precedent has been set.  Thankfully, no pushing was necessary.

The reason I’m concerned about giving her those printouts, is she referenced them a couple of times when talking.  She mentioned the 5% weight loss a few times.  What I should have said was that we don’t plan to wait for the HG checklist to happen before putting me out of work.  The idea is to keep that from happening and keep the HG from getting too severe.  If I’ve already been sick enough to lose that much weight, I’ve been too sick to be at work, you know?  I don’t think this will be an issue, it’s just something that is sticking in my mind.

At any rate, she told me that if I wanted to tell my boss now, it would be very helpful to the company, but I didn’t have to if I didn’t want to.  I would be well within my rights to tell her the day I go out, “I have to go out on disability.  Bye.”  All the other stuff, like ensuring coverage is not my problem to worry about.

I’m a nice person, though.  I went ahead and talked to my boss.  I kept it simple.  I let her know that I am pregnant, and I do have a history of this disease, so I might have to go out on disability in the next few weeks.  Regardless, I let her know, she would see me having more doctor’s appointments, and I would keep her updated on days I expect to miss time as early as possible.

She was very understanding.  She said, if I feel bad, don’t come in.  They’ll cover for me.  Don’t stress about doctor’s appointments.  As long as she gets some kind of heads up, it’s just fine.  She also said that if I needed to lay down there are some empty offices upstairs with couches in them, and it would be fine to go rest for a bit up there.

Overall the conversation went very well.  I’m so lucky to have a company who takes health and safety so seriously.


Illness update:  So far, so good.  I start feeling a little questionable right around unisom/b6 time, but other than that, I’m just continuing to coast along and hope for the best.  I’m going to feel a whole lot happier when I see that little heartbeat on Friday morning!