We asked members of our Facebook group what Breasfeed Chicago meant to them. Here’s what they said. Wow.
Someone who would like to talk you out of breastfeeding might whine, “Oh, but breastfeeding takes so much time!” And preparing bottles doesn’t? In the first place, our society places too much importance on getting volumes and masses of things done, as if that is how we prove our worth. Yes, breastfeeding takes time. So does paying attention to a child. So does lovingly raising a child, for that matter. When first learning how to breastfeed your baby, you’ll need two hands and maybe even a pillow. As time goes on, you’ll find you can get one hand free. Here is a list (incomplete, to be sure) of things you can do while breastfeeding your baby: Relax and be in the moment.
- Talk on the phone.
- Count your baby’s eyelashes.
- Read to your older child.
- Talk to your baby.
- Read the complete works of Charles Dickens.
- Doze off for a beauty rest
- Drink water (hydrate, hydrate)!
- Visit with friends.
- Eat a nutritious snack.
- Mentally list your daily 10 Things to Be Grateful for
- With baby in a sling, take a walk.
- Relax outdoors.
- Play guessing games with your older child.
- Eat ice-cream while pampering your face with a homemade facial mask
- Sure, you can text and surf and post, but it may not seem very important as those nursing hormones center your mind and open your heart.
Most of all, you will find that “getting a lot of stuff done” is no longer as imperative as it once seemed. Now, simply “being” is “enough.”
It’s a common question for new moms. As of last year the answer is YES! With the passing of the Affordable Care Act (ACA), the law now mandates that breast pumps be covered under the plan at no out-of-pocket expense to the new mother, with some exceptions which are explained below.
Although ACA requires insurance companies to provide pumps, the style and type of pump covered is not specifically set. There are three main styles of breast pumps: manual, electric, and hospital grade. From my experience, the majority of plans are covering a double electric breast pump.
Common Requirements and Limits:
- Most insurance companies require you to purchase your pump through an in-network Durable Medical Equipment (DME) provider.
- Most insurance plans will limit what they pay to a specified amount. Common retail models like a Medela Pump in Style often fall outside the maximum allowable cost. The main reason for this is because most retail models come with extra accessories that many insurance companies consider a convenience item: a bag, extra bottles and ice packs, cleaning supplies, and AC (car) adaptors, etc. For this reason most manufactures of breast pumps have moved to special “insurance model” breast pumps which only include the basic items required for pumping. You can always purchase the “convenience” items separately.
Every plan is a little different so there are a few good questions that you want to call and ask your insurance company to know what your benefit is. It is also helpful to speak their language, so below is a list of questions you can ask.
Is my plan ACA compliant?
- Most insurance plans now are ACA compliant; however, not all. How and why is rather complex, but some insurance plans are “grandfathered” and therefore not subject to ACA. If your plan is “grandfathered” it can be excluded or subject to deductible and out of pocket.
What type of pump is covered?
- As mentioned above there are three main categories of pumps: Manual (E0602), Electric (E0603), and Hospital Grade (E0604). Each is going to have its own set of rules allowable, and billing code called a HCPCS, which are given in parentheses. If you just call your insurance company and ask about a breast pump, they could be giving you rules on a manual (E0602) and you are thinking it’s an electric (E0603). Also please note that an E0603 is called an electric breast pump. The insurance companies do not distinguish between a single and double. When you are talking to your DME provider, you want to make sure they are providing a double electric pump.
How much will they cover?
- For each of the billing codes, the DME supplier and insurance company have a contracted amount which is known as an “allowable.” Allowables vary based on your specific plan, but I’ve found that most private insurance companies have an allowable of about $150.
- One common misunderstanding is that when you call your insurance company, they will likely say something like: “The breast pump is covered under the Women’s Preventive Care Benefit, and payment is considered at 100% no copay, coinsurance, or deductible apply. There is no maximum to this benefit.“ What they are saying is that there is no maximum to what the insurance will pay under the Women’s Preventive Health Benefit, which includes many different benefits – breastfeeding is just one. However the insurance company will still limit payment to the contracted amount for the breast pump. The full list of ACA mandated women’s preventive health benefits can be seen by Clicking Here.
Can I pay the difference for the pump I want?
- The quick and easy answer is no. In order to be an in-network provider, we as a DME company sign a contract with the insurance company saying that we agree to accept the allowed amount for each billing code, and write off any remaining balance. However, we are given the discretion to decide which items we are willing to bill to insurance and which we are not. There are many retail pumps that cost $300-$500, and these pumps would have the same billing codes that cost $150. Theoretically, we could bill the $500 pump, but we would still only get paid the $150, which would be far less then our cost on the pump. Clearly no DME company could afford to do this and stay in business.
Does the pump require any documentation?
- Often a prescription is required just for the DME company to establish you are, in fact, pregnant.
- If you want a hospital grade pump, there must also be a medical reason why it’s needed. Common examples are things like inverted nipples, premature birth, or multiples birth. Hospital grade pumps typically are provided as a rental, with a maximum benefit of 12 months per pregnancy.
Do I need to go to an in network supplier?
- To get your maximum benefit, most insurance companies will require you to use an in-network provider. They should be able to give you names and numbers of in-network providers in your area.
When can I order?
- Most policies do not require any specific time frame for advanced orders and will allow you to receive your pump at any point during your pregnancy. However, I have seen some policies that require you to wait until 30 days before your due date, and others will not provide a pump before the actual birth.
Can I get multiple breast pumps?
- Many plans will allow you to have two pumps if you are planning on going back to work.
This article was provided by Stephen Sear with Mark Drug Medical Supply. Mark Drug is a Blue Cross Blue Shield PPO preferred provider and can provide you with your breast pump. They stock a variety of different pumps, including the Medela Pump In Style Starter Kit You can visit their site: http://www.markdrugmedicalsupply.com/breastpump.htm. Phone # 847-537-8500 Fax # 847-537-8500 Email Stephen@markdrugmedicalsupply.com
Do you have an older mother in your life (or perhaps she’s not even older) who is trying to make you see the light and mother “her way”?
She may be your mother-in-law, your grandma, your mom, or even a sister or friend. She’s sure she’s right, and you are, in her mind, making Mistakes with a capital “M.” She hints, she sends you links to articles, she comes out and tells you that she doesn’t know what book you just read, but you must listen to her now, while there’s still time.
It’s exhausting. It’s also undermining and insulting. Yet, your patience and tolerance forbid you from directly telling her to keep her opinions to herself, and she takes that as encouragement to keep on trying to convert you to her ideas.
Or maybe your patience is at an end, and you find yourself in open conflict with her over breastfeeding, attachment parenting, cloth diapers, when to start solid foods, and on and on.
Would you like peace in your life and in your heart?
Let’s take a look at what is going on here: What is the sub-text underneath her criticism? If there were subtitles flashing under her face as she points out (kindly or not) the error of your mothering ways, what would those subtitles say?….
“Do you think I’m a bad mother? Is your style of mothering a veiled criticism of mine? [And if she is your mother-in-law]: Will my son think less of me as a mother because of your way of breastfeeding, feeding solids, or diapering? If you think you are right, does that mean that I am wrong? Are you a better mom than I? Because if you are a better mom than I am, I will be crushed.”
That, dear young mother, is what is going on here.
Your mother-in-law (or fill in the name of your nemesis here) is, whether she knows it or not, reacting to your parenting style from fear. Like you, she has some insecurity in a world where there is conflicting advice everywhere about the “best” way to parent. Like you, she wanted to do the very best job she could as a mom. Just as you will hope, she hopes that the choices she made were above reproach.
Now imagine how she might feel, to see at close range, a mother who is lovingly devoted to her baby–and doing so many things very differently from the way she did them.
Some women can relax in that situation, knowing that they did their best when it was their turn, and wishing all the best to the young mom. However, a mom who harbors a lot of insecurity (no doubt hidden under a cloak of great confidence), feels alarmed. She needs reassurance that she did all right. And what would be most reassuring, would be if you would do things the way she did.
Understanding this, how will you calm her fears? That is the question.
When her fears are calmed, she will stop trying to change you.
Might you give her a compliment on her own mothering? For example, one young mother told her mother-in-law, “I know that Joe always appreciates how you were always there for him when he came home from school each day.”
Her mother-in-law replied quickly, “He says that?”
“Oh yes,” replied the peace maker. “That’s something I hope to be able to do, too. He’s mentioned those after-school memories more than once.”
Believe it or not, criticisms slowed down and eventually ceased, as this smart mom nurtured the frightened inner child of her mother-in-law.
And that is how you can make your mother-in-law chill. Try it, and let me know how it goes.
Most parents assume that finding a doctor who is supportive of breastfeeding will be an easy task; after all, the medical field applauds the health benefits of breastfeeding for both mothers and babies. Unfortunately, other than very basic knowledge about the benefits of breastfeeding, this topic is sadly overlooked in medical education. Unless physicians receive extra education on breastfeeding, as well as make a commitment to spend time with breastfeeding dyads, they may not be as supportive as breastfeeding as one would hope.
So how do you know if your doctor is truly supportive of your breastfeeding goals? Let’s look at the big five–GROWTH, SLEEP, SOLIDS, MEDICATIONS, and VIBES.
Did you know it’s normal for newborns to lose some weight in the first few days after birth? Your doctor should! Your doctor should also know that exclusively breastfed babies grow differently than their formula fed counterparts. In the first 2-3 months of life, breastfed babies grow faster than formula fed babies. This growth slows down, and by 3-12 months of age they begin to grow slower. If your doctor chooses to plot your baby’s growth on a chart, it’s really important for him or her to use growth charts provided by the World Health Organization (WHO) because they are formulated by averaging growth of breastfed babies all over the world. The Center for Disease Control (CDC) growth charts that are targeted to formula fed babies, which tend to weigh more, may make exclusively breastfed babies seem underweight. Of course, the most important thing your doctor can do when monitoring your baby’s growth look at your baby as a whole, not just a number on the chart. How is your baby’s mood? Is he or she meeting developmental milestones? Weight gain is just one small part of your baby’s overall health.
Our culture has a lot of expectations about when babies should sleep through the night–but your doctor shouldn’t! And mamas, I hate to be the one to tell you, but it might not happen for a while.
For all babies, but especially breastfed babies, it’s normal, healthy, and necessary for them to wake during the night. If your doctor is telling you that your baby “should be sleeping through the night by now,” consider that remark carefully. There are many reasons why babies wake at night–hunger, teethingpain, desire to be close to mom. For many mother-baby pairs, it’s necessary for babies to wake at night in order to get all of the milk they need in a 24 hour period. And despite the myths running rampant, formula or rice cereal in a bottle before bed won’t help your baby sleep longer. And on the topic of rice cereal…
Is your doctor recommending your baby start solids before 6 months of age? If so, they’re not following the recommendation from the American Academy of Pediatrics (AAP) and WHO that babies be exclusively breastfed for at least 6 months before solid food is introduced. Some doctors are suggesting that solid food be offered at 4 months of age–or even earlier! In addition to taking your baby’s age into account, a quality doctor will look for other signs of food readiness–like being able to sit up without support and use the thumb and finger to pick things up. Some babies may not be ready to start solid food until later than 6 months of age–remember, your baby is an individual! Babies that receive solid food before 6 months of age are at greater risk for digestive problems and have higher rates of iron deficiency anemia (even when given that iron-fortified rice cereal your doctor is telling you about!) One final point to make about rice cereal is that the AAP no longer recommends it as a universal first food, and acknowledges that fruits, vegetables, and meat are naturally nutrient rich, viable first foods.
Is your doctor telling you to pump and dump your milk, or even worse, wean your baby while you take a medication? Unfortunately, some doctors automatically assume that medications given to breastfeeding mothers are not safe for babies, and recommend temporary or complete weaning. In reality, many medications do not pass into mother’s milk in large quantities, or if they do, they are safe for baby. If you’re feeling skeptical about advice you receive from your doctor about breastfeeding while taking a medication, consult the Infant Risk Center’s website or call them M-F 8am-5pm at 806-352-2519. Perhaps you will find that the medication has been deemed safe for breastfeeding women, or if not, consult your doctor about alternate medications that may have the same effects and be more breastfeeding-friendly. A top-notch doctor will understand the importance of prescribing breastfeeding-friendly medications and be willing to have an open discussion with you about the benefits and risks involved.
You know what I mean–you can feel it! Maybe it’s that every time you go to the doctor he remarks that your baby is on the small side. Or there was that time you got mastitis…she told you to pump and dump while taking antibiotics. But you talked to your friend who said she took the same medication and continued to breastfeed. What about when he told you a bit of rice cereal in a bottle would help your four month old baby sleep through the night? Red flags aside, a breastfeeding friendly doctor would use the latest evidence to support your breastfeeding goals. If the relationship isn’t feeling right, it isn’t right. Use your intuition, mama!
In summary, a doctor that is truly supportive of breastfeeding will…
…monitor your baby’s growth with the WHO growth charts AND as just one factor in the overall health of your baby.
…have realistic expectations about infant sleep, and understand the importance and normalcy of night time feedings.
…recommend starting solid food after 6 months of age, accompanied by signs of readiness.
…make an effort to prescribe medications that are safe for breastfeeding and provide accurate information about the safety of a medication.
…make you feel good about the choices you are making for your family.
If your doctor isn’t meeting your expectations, visit the files section of the Breastfeed Chicago Facebook page to find a breastfeeding supportive doctor near you!
Maura Frauenhofer is a birth doula and Breastfeeding USA counselor. After spending a year and a half in medical school, she decided the midwifery model of care was more her style and is currently pursuing nurse midwifery at UIC. She has a passion for women’s rights, especially those related to birth and breastfeeding, and enjoys helping women and families advocate for their healthcare wishes. She is mama to a 17 month old girl, still breastfeeding!
My daughter just unexpectedly weaned at 16 months. I wasn’t ready, I’m still not ready. And, I definitely wasn’t prepared for what hit a few days later – the baby blues, or as some call it, the booby blues (Elizabeth Weiss McGolerick, She Knows Parenting).
At first, I attributed these feelings of defeat, failure, sadness, and anxiety to the fact that I hadn’t met my goal of at least breastfeeding until she was 2 years old. After a few days, when the feelings intensified, I wanted, NEEDED, to find out why I was feeling so down. So, I came up with a plethora of reasons as to why she stopped nursing – thinking if I could come up with the cause, I could change it and get her back to the breast. I told myself she quit because I yelled out in pain when she bit me. Then, I blamed myself for being so stressed out due to the holidays, a family medical emergency, her teething, and tons of travel. My mind started wandering and I told myself she stopped because I used a different body wash for a couple of days and then because I overindulged in some wine a couple of nights. Suddenly, it clicked – this blame game, all of this self-deprecating I was engaging in, was really the baby blues.
Could all of the above be the reasons she might have weaned? Absolutely. Was there anything I could do about it now? No. I had already tried all of the tricks I knew to encourage her to nurse again, from taking baths together, babywearing, skin to skin, napping, offering the breast but not forcing it…I just now had to accept the fact that she had weaned and I had to focus on the present instead of focusing on the woulda, coulda, shouldas.
So, that’s what I am currently doing. Focusing on being here for all of my kids, and focusing on getting back to being me – breastfeeding or not. I have goals to take better care of myself. Exercising and eating healthier. I want to focus more on my relationship with my husband. I want to be more patient, kind, playful and affectionate to my kids, something that I lose when I experience bouts of depression and anxiety (I also experienced PPD). I also am in contact with my physician and we are coming up with a treatment plan that will help me overcome this – whether through medication, therapy, or both.
Why is changing my focus and creating these goals so important to me? Well, to answer that, first you need to know how milk is produced. There are many hormones involved in the lactation process, but two of the biggies that are released when breastfeeding are prolactin and oxytocin. Prolactin makes the milk and oxytocin stimulates milk let-down (Lauwers, J & Swisher, A Counseling the Nursing Mother). When prolactin is released, it has a calming effect on the breastfeeding mom. And, when oxytocin is stimulated, it promotes bonding between mom and baby, which is also why it’s known as the love or mothering hormone. When you wean, whether through baby-led weaning or for other reasons, these hormones are not being released by your body at the same rate as when you are breastfeeding. Thus, this may be one of the reasons for these baby blues (booby blues). So, for me, these goals are important because exercise, forms of affection and intimacy with a loved one, laughing and eating healthier – these are all things that release oxytocin. And, my hope is by meeting these goals, I can help conquer these blues.
One of the best ways to decrease the likelihood of being depressed postweaning is to slowly wean. Wait until the baby is ready, let her lead, and take your time. If you already have weaned and noticed you are having mood swings, feelings of sadness, being overwhelmed, a sense of dread, or just a sense of something being off – know you aren’t alone. If you need to, please contact your physician or refer to our facebook group’s resource document on PPD https://www.facebook.com/notes/breastfeed-chicago/breastfeeding-friendly-ppd-resources/385738358179990. If you are not a member of our facebook group, if in Illinois, please refer to this website to find help: http://www.ppdil.org/ppdhelp.html. Not in Illinois? Check out this link and hotline for help: Postpartum Support International, http://www.postpartum.net, PSI Depression hotline: 1.800.944.4PPD
More info on Weaning and Depression:
Pearson, Catherine, Weaning and Depression Linked in Many Women http://www.huffingtonpost.com/2012/02/26/weaning-depression-link-breastfeeding-postpartum-depression_n_1301233.html
Comfort Measures for Mom during Weaning: http://kellymom.com/ages/weaning/wean-how/weaning_mom/#sadness
McGolerick Elizabeth Weiss, Coping with The Booby Blues: http://www.sheknows.com/parenting/articles/958781/depression-from-weaning
Other stories on feeling depressed after weaning:
Goddard, Joanna, Motherhood Mondays: The hardest two months of my life: http://joannagoddard.blogspot.com/2012/02/motherhood-depression-and-weaning.html
Jennifer Adams is a mom of 3 who pumped for her first and breastfed her second and third. She is a CAPPA Certified Postpartum Doula, Certified Lactation Specialist, and serves on the Board of Breastfeed, Chicago! Jennifer wants to normalize breastfeeding in Chicago and beyond.
So you’re back at work, figured out your pumping schedule and found a system that works for you and your baby. Then you find out you need to travel for work. Now what?
First, if possible, schedule your travel around your feeding schedule. It’s so much nicer if you can catch your ride to the airport after fitting in that last morning feed. And there’s nothing like returning home just in time for a bedtime nursing session.
Bringing the Right Supplies
Pump: If you’ll be away for more than a few days, consider bringing the pump you use regularly (I take my hospital grade pump along if I’m away for more than 3 days). If you use an electric pump that also runs on batteries be sure to bring extra batteries. A hand-pump can be absolutely key as a backup or as a more discrete way to pump (for example when sitting on the airplane or in a taxi). Be sure to bring extra pump parts (shields, valves, membranes) in case they get lost.
Storage: For a short trip, bottles can be convenient. For a longer trip, pump directly into bags, which pack much more compactly. Bring more bags / bottles than you think you’ll need in case your trip is longer than expected.
Other supplies: Zip loc bags to double bag your milk in case of leaks and use as extra ice packs (ask any fast food place in the airport to fill it with ice once you pass security). Sharpies for labeling bags/bottles. Scotch tape for labeling bottles or for securing the bag on to the pump while pumping. Shawl in case you need to pump in your plane seat or a taxi/car ride. Reusable bag or extra small cooler bag for carrying supplies or splitting up your milk. Small container of dishwashing soap for cleaning (that’s the one I keep forgetting). Paper towel or baby wipes for cleaning up small spills (or just use your shawl). Obviously plan for pumping-friendly clothes (though maybe at this point your entire work wardrobe is pumping-friendly).
When and Where to Pump
Try to follow your pumping/feeding schedule if possible – but recognize that may not be possible.
Some places to pump could include:
- In your hotel room
- In your rental car
- In a pre-arranged space at your office/ hotel/conference center (call ahead and confirm with both the conference organizer and the hotel/conference center manager). Check if the office you’re visiting has a lactation room you can use.
- In your plane seat or in a car ride (longer than 30 minutes) with a hand-held pump and covered by a shawl
- Private spaces at the airport (my favourite is the interfaith chapel/prayer room, I also heard of a new yoga room at O’Hare).
- In an emergency – in the bathroom. Not ideal but sometimes necessary. Try to find a large bathroom with a lounge or a family bathroom that gives you more space.
Cleaning pump parts
Store your pump parts in your cooler bag during the day and wash with dish soap you brought when you arrive at your hotel room. Some people like the Medela wipes – which can be helpful for wiping down the shield. But in my experience they don’t reach all the milk – so refrigerating the horns in your cooler bag and doing a full wash when you can is better.
Call ahead to your hotel and find out if they can provide a fridge in your room (most will do this for medical reasons) or if they have a mini bar fridge you can use. If that’s not possible, ask them to store your milk in their main fridges (bring an extra reusable bag or small cooler so you can split up your supplies). Many offices/conference centers will also have fridges where you can store your milk. If it’s a day trip, your milk should be ok in a cooler bag with ice packs the entire time. You can also ask the hotel to store your ice packs in their freezer and pick it up when you check out. Double check your milk bags and bottles are sealed and double bag your milk bags and bottles in Ziploc bags to avoid accidental messes.
If you’re traveling for more than a few days you may want to look into shipping your milk back with dry ice or freezing your milk and keeping it frozen on your trip back. I don’t have much experience with this – but if anyone does, please include your tips in the comments.
I was always adamant about bringing all my milk back – but depending on the age of your little one, you may want to consider whether you prefer to bring it back or dump it.
Travel and Security
If you’re traveling in the US you’re in luck! In my experience, the TSA has been very supportive about traveling with milk. Allow a little extra time and declare your milk before going through security. They will likely test your milk for explosives (sometimes wiping the bottle, sometimes opening and wafting above it – never touching the milk itself). If you didn’t have a chance to freeze your reusable freezer packs, you can fill a Ziploc bag with ice on the other side of security (ask any fast food place to fill it).
Here is the official TSA policy:
When carrying breast milk through security checkpoints it is treated in the same manner as liquid medication. Parents flying with, and without, their child(ren) are permitted to bring breast milk in quantities greater than three ounces as long as it is presented for inspection at the security checkpoint. Additionally, empty bottles and ice packs are permitted under these conditions.
Frozen items are permitted as long as they are solid and in a “frozen state” when presented for screening. Cooling liquids or gels used to keep medical or infant/child exemptions cold are not bound by 3-1-1 requirements. These items may be presented at the screening checkpoint in a frozen or partially-frozen state. It is important to remember that any item must be properly screened before being allowed into the secure area of the airport.
Although formula, breast milk, and juice is inspected at the checkpoint, you, your infant or toddler will not be asked to test or taste the breast milk, formula, or juice. Our Security Officers may test liquid exemptions (exempt items more than 3 ounces) items for explosives. Officers may also ask you to open the container during the screening process (Source: http://www.tsa.gov/traveling-formula-breast-milk-and-juice)
Traveling internationally is another story. I had a terrible experience at Heathrow where I was told I could not travel with my milk 20 minutes before my international flight. I finally ended up checking my cooler bag at the last possible minute and 5 minutes later realizing I also checked my manual pump horn with it and had no way to pump on my 9 hour flight back to the states. Find out the specific regulations for the country to which you’ll be traveling. Consider that you may need to check your milk and bring a cooler that can be checked. The upside is that the checked baggage stays nice and cold the entire way. The downside is obviously the risk that your milk won’t make it.
More than likely something will go wrong on your trip. Maybe you’ll be forced to check your milk. Or they’ll lose your bag. Or your milk will leak. Or your flight will be delayed and you’ll miss bedtime.
And even if things go perfectly it will be tough. And your supply is likely to take a bit of a dip when you return and will take a few days to build back up
But there’s nothing like that first nursing session back to make you feel like you’re really home and connect back with your little nursling.
Safe travels mamas!
What are your travel and pumping tips and experiences? Feel free to comment below.
Danit Schleman lives in Wicker Park with her husband, dog and 2 daughters (3 and 1) She works in Diversity and Inclusion for a Management Consulting firm and enjoys cooking and yoga in her (limited) spare time.