Through the ACA, insurance companies are required to cover a breastpump for women who have nursing babies.  I am not going to get all law-tech-bureaucratic on you, but since I recently went through the process and have had a lot of inquiries on how it worked for me, I thought I would share my experience.

It is my understanding that even though this is something insurance companies are "required" to offer, the follow-through is what varies from company to company.  Some only allow a manual breastpump; some allow a higher-quality, hospital-grade pump if your baby was premature.  Still others set the fee of what they will cover, and if you go over that with upgrades or a higher-level pump, the difference is yours to pay.

After Ezra was born in April and we were dealing with his tongue and lip ties (which I wasn't aware of yet), I called my insurance company (Anthem Blue Cross) to see about getting a pump.  They gave me the information for two DMEs (durable medical equipment suppliers).  I was in a lot of pain and experiencing a lot of engorgement.  I was desperate!  I called one company, and even their hold message stated they were backed-up for pump orders.  I hung up and called the other DME.  After some waiting, I got through.  They only offered two pumps: Playtex and Medela.  Coming from a breastfeeding advocacy background, this wasn't good to hear.  My issue with Playtex:  We often counsel women not to buy pumps from companies that make bottles -- the research and science isn't there when it comes to putting together a breastpump that works well.  My issue with Medela:  They are no longer WHO-code compliant (easy to understand info here), and while that isn't the biggest deal to some, it is something very important to me. After a lengthy conversation, exchange of a lot of information, and a hot cell phone to my head (hot baby to my chest, hot engorged breasts), I chose the Medela pump.

I waited a week, and after not hearing from anybody, I called the DME to see what the status was.  I was told I needed to pay around $80.  Now I had been told by my insurance company I would pay 20%, so $80 for a $250ish pump seemed wrong to me.  I talked to someone else in some other department, and she said they would look into it and get back to me.  What really must have happened was, the order got cancelled, because I never got a breastpump, and they never got back to me.  But by then, I was feeling much better and we had worked some of our issues out.

Fast forward to about a month ago.  I was at a LLL meeting and a mother said she had just ordered a Hygeia pump through her insurance and they covered the whole thing at 100%.  I then learned, we had the same insurance!  This was her advice:  Contact Hygeia directly and tell them you want their pump.  I did, and a week later, I got my pump, nothing paid out of pocket, and I already have some milk in the freezer!

Not everyone's process will be that easy.  It is worth a try, though. My understanding is, you have from your third trimester until your baby's first birthday to get a pump.  I didn't think about getting one before birth because I have been trained and ingrained to counsel women NOT to buy pumps while pregnant.  It is often on that baby registry -- a Medela Pump in Style (PIS).  With my childbirth ed classes I have suggested, if a woman isn't going back to work or school immediately, to hold off on buying a pump. With more time and a meeting with an IBCLC, often a women can better determine what type of pump will fit her needs best, versus the PIS simply because that is the one she has heard of, and her sister/best friend/next door neighbor used it, and maybe even someone is giving her their old pump, so she's set.

The thing about the PIS is, it is not the best pump out there -- like we say about carseats, the best carseat for your child is the one that best fits your child AND your car.  Same with pumps.  The best pump is the one that best fits you, not only physically (nipple size) but also functionally (are you going back to work or will you just need some milk for date night?).  Pumps are pricey...they aren't always something needed before a baby is born. In the beginning, mom and baby are supposed to be determining how the relationship goes, how to latch, how often to feed, how much milk, etc.  The pump, under normal circumstances, doesn't need to be a part of that early relationship.  If a woman finds herself pumping, it is often because there are some adjustments needed due to soreness or pain, and that is where a LLL Leader or IBCLC can come in handy.  If you have a premature baby, or a baby who is unable to latch, of course a pump is what you need to protect the milk supply until baby can return to the breast, so don't think I am saying it always goes smoothly -- I know it doesn't.  In situations like that, though, a hospital-grade pump, which needs to be rented, is almost always going to be a better choice, so you still wouldn't miss out if you hadn't purchased a pump before birth.

Back to the giving-away-of-the-old pump:  I admit, I used my sister-in-law's pump 14 years ago, when my baby was in the NICU for two weeks, and I was grateful to have it.  I knew nothing about pumps, barely anything about breastfeeding.  At that point it had been used for three of her babies, and I am sure it had logged many, many hours.  I don't worry that I could have cross-contaminated my milk in there (the PIS is an open-system, which means milk could potentially get into the motor and come in contact with the next mom's milk), but I probably should have worried about the potential for mold growth and my sick NICU baby's health, or even bugs that can get into the motor(yes, cockroaches can visit and maybe even stay).  Pumps are so expensive, though, it isn't unusual for us to want to share them when we are done, or to even sell them to strangers.  Please, don't.  Not if your pump is designed as a single-user item -- treat it like nose-hair trimmers -- you wouldn't share those with anyone, would you?

Hygeia knows when you spend so much on something and it still has life left, you are likely to share it -- and their closed-system allows this simply by having the next woman purchase her own pump parts -- the tubing, the flanges, the storage containers.  Ameda also makes a closed-system pump.  Bailey is another great quality, lesser-known company that makes pumps.  Like I said before, just because Medela is the best-known, doesn't mean they are the best for you.

Once you decide you want a pump, check out who your insurance company's DMEs are; if they have a pump you like, then go for it.  If you want more choices, try contacting the pump company directly to see what DME they suggest.  I just have to say:  The amount you can pump does not determine how much milk you have -- some women don't respond well to pumps, that is a fact.  If you need help pumping or breastfeeding, contact someone -- you don't have to figure this all out on your own.  LLL Leaders can answer questions and provide information about how to pump more successfully, and a personal consultation with an IBCLC can be invaluable when you are tying to figure out the hows and whys and whens of pumping when you are getting ready to go back to work -- they are a wealth of information.

I do not have any relationship with Hygeia, I am just super-impressed with the measures they take to make their pumps relevant in a market where $200 pumps could essentially be tossed in landfills if they were truly being used properly. 

I would love to hear about your experiences with obtaining a breastpump through the ACA. 

You know how they say, “Wear sunscreen? Well, let me be your cautionary person-writing-this-blog-post and say, up front, WEAR YOUR SUNSCREEN. On that note of “The more you know” (did you just hear the music?), let me also share that we need to watch our skin for more than just those changing moles we always hear about. Yesterday I had a Mohs procedure on a superficial basal cell carcinoma on my face (yes, skin cancer). My only clue this was something that needed attention was the fact that, all summer, I had this spot on my nose that would scab up for a week or so, and then heal.  Scab, then heal. Scab, then heal. It was a shiny piece of flesh-colored skin that maybe looked a bit callused – no pigmentation, no mole appearance, just a regular area of skin that looked and behaved a little differently. A visit to my dermatologist revealed it was problematic, and that leads us to the Mohs procedure.

In order to fully get the root of the tumor, a Mohs surgery can be lengthy.  The skin is numbed, the surgeon draws, and then they cut. They take that piece of tissue and essentially put a cross-hair on it,
mapped to match the area from where it was removed. This is examined to see if all the bad cells are gone (I never said I was an expert). If they see anything remaining on the sample, they know exactly where the offending tissue lies; my surgeon had to come back one more time in true, if-at-first-you-don’t-succeed fashion. There is a wait time of 30 minutes between each sample, which is why this isn’t generally an in-and-out procedure.  

After this was all taken care of, I expected my doctor would just swab some antibiotic ointment and slap a cutesy Band-Aid on and that would be it.  But I was wrong.  I actually had to go to a different part of the building. “I’ll meet you over there, “ my handsome, thirty-something, Mediterranean (Middle-Eastern? Spanish? Who knows) hunky doctor said. Then a nurse walked me through some doors, shoved some things into my arms, and said, “Go ahead and put your clothes in the bag.” Um, what? I am just getting my nose bandaged!? What’s going on?

In the shock of suddenly realizing I needed to strip down, I couldn’t remember if the gown was to open in the front or the back. I tried it one way, spun it around, then twisted it back the first way.  Finally with it half on, fabric clenched in my hands to cover my behind, I stuck my head out to call, “Hey, what’s the story on the gown?  Open in the front or the back?”  The back, definitely the back.   

I continued with my booties and the ever-lovely surgical hair-net thing.  I was placed in a bed and my nurse brought me a warm blanket -- other accoutrements included an automatic blood pressure cuff, and a pulse ox on my right index finger.   My nurse sat and chatted with me for a bit, over such everyday topics as allergies to any drugs (none), was I supposed to take my bra off, because I did (there are so few places outside of one’s own home where I can do this, so why not?  But no, it was not required), and the fact that we both were breastfeeding mothers (can’t remember how that came up). 

I was actually wheeled, wheeled, I say! into the surgery (that sounds so Doc Martin, but unlike the European definition, this was the place in the surgery center where they do surgeries, not the office where docs do visits). When my doctor came in, I was kind enough to remind him that it had been a couple hours since last my nose was bee-stinged beyond feeling, so I would love some more drugs to numb that region. Here is the comment that started it all: “I think I have a pretty high pain tolerance, but I don’t want to feel this if I don’t have to.” His response was, “Oh, why do you think that?”  I shared I had 4 babies with no pain meds. He and the two nurses all gasped. Oh, I had one more coming, “And the last one was born at home.”  My nurse fainted to the floor.

Okay, not really. But I they were still abuzz with a lot of questions, that all sounded like “Why?” (Let me come down off my high-horse now.) “I wasn’t planning to have my first without pain meds.  In fact, I said, ‘I have seen women give birth naturally, I think it’s pretty crazy; I am totally getting an epidural.’  Well fast-forward to an unneeded induction, and I wasn’t able to get an epidural. My fear of throwing up won out over my fear of having a baby, so I somehow was able to give birth to my first baby without an epidural or narcotics. It took some time to work through mentally, but eventually, I was happy about it.”

By this time in the surgery, my bed has been lifted up, the doctor has cleaned the left, upper quadrant of my face with iodine, my eyes stinging from the closeness of the fumes, and my face has been covered with a piece of paper with a circle cut out of it so only my nose is exposed.

I continued on…“With my second baby, I wondered what could birth be like if I actually planned to not use any medications?  I got a midwife who delivered in the hospital, and I waited to go into labor on my own. Third baby, the same.  Fourth baby, we moved here, there were no hospital-based midwives, so I found a licensed midwife who came to our home to help us have our baby there.”

“Why would someone choose to not have pain medications?  It is painful to have a baby!” he stated, with much authority (at this point, I did question how he knew this, had he ever experienced it?  To which he conceded, no, but he had seen it a lot).  So I asked him this:  “Why would someone choose to climb Mt Everest?”

“That’s different,” came his reply, “I can understand that.  You want to see what you are able to
accomplish physically.  You are challenging your body, working toward a goal...”  My pulse-ox’d finger interrupted him, pressing, pressing on its imaginary quiz-show buzzer – or maybe it was my voice -- “DING DING DING! You got it!”

I couldn't see him because my face was covered, but his hands paused in their stitching.  “I…could see that,” he came around, slowly. The hands resumed their stitching.  “I am not sure what the big deal is about drug-free birth though.  There is so much pressure to have a natural birth, but we don’t have the longitudal studies that show epidurals, or even c-sections, have life-long health risks.” On the spot, under the cover of plastic-y-paper, I couldn’t think of anything incredible to counter with.  I did cite that babies born via cesarean birth have higher levels of allergies, and that was about all I could think of.

I joined him, then, because I do feel it’s the truth, “There is a lot of pressure for women to go all natural, I see that. It is very similar to the pressure we put on women to breastfeed  -- ”  Okay, this is when he cut me off!  

“ – But those stats are there, we know breastfeeding is beneficial, we have that information.” Interesting!  Super, hard-cord breastfeeding advocate, not so much on the normal birth platform! I decided, since I couldn’t present any compelling evidence-based studies or data from Cochrane, I would just keep it simple and stick with his line of thinking. “We are humans, though, and we know as mammals, breastmilk is the optimal, species-specific diet for our newborns.” He agreed.  "Doesn’t it stand to reason, then, that vaginal birth, as unhindered as possible, is the norm for us as well?  And even though we have the option for epidurals and cesarean births, that vaginal birth would provide the most optimal way for our babies to be born?” Honestly, I can’t remember what he said after that, only I know he wasn’t trying to refute anything.

The cover was lifted off my face and it was time for the nurses to step in and dress my wound.  As he stepped back to let them take over, he asked, “Are you a medical professional?”  I paused before my
answer, and then said, “No, I am a birth doula, a childbirth educator, and a La Leche League Leader.” He shook my hand, nodded his head to me, and then departed to fill out my discharge papers.

What fun!  It made all those 5 bee stings to the nose worth it. I can actually say, due to that conversation, I rather enjoyed my day at the dermatologist. The staff was incredible and attentive (and I am assured my scar will be minimal).  You never know where great birth conversations will happen! But the opportunity to have 20 minutes, one-on-one with a surgeon (albeit a derm surgeon), was pretty darn fun.