I was about 32 weeks pregnant with Hope when I thought about hiring a doula. Knowing friends who had used them, I thought it might be something I would benefit from, especially because I wanted to have a med-free birth. I emailed Charlie Rae Young, a doula that Jenny had used during her pregnancy with Noah. We met a few times before my due date and she was always available via phone or text if I had any questions. When I called my insurance company to inquire about coverage, their answer was short and to the point - "Sorry, but your insurance doesn't cover doulas. Even though I was going to pay $800 out of pocket, it was an experience I definitely didn't want to pass up. (for anyone wondering, that money covered two pre-natal home visits, the entire birth, a post partum home visit, lactation support and constant availability via text/email/phone).

I briefly wrote about how amazing it was to have a Charlie present at the birth of Hope. If anyone is on the fence or questioning having a doula for their birth experience, I say do it! You can never have too much support while you're in labor.

In January, I decided to write a letter to my insurance company, requesting reimbursement for my doula, or "labor support services." Even though I had been turned down over the phone, Charlie said it wouldn't hurt to send a letter. I mean, really, the worst they could say was no - and I'd already heard that.

Below is the letter I sent (certain areas blocked out for privacy):

(Name/Address/Phone)
DOB: x/xx/xx
(Insurance ID & Account Number)
Date of Delivery: November 15, 2012

January 8, 2013

With the labor support of Charlie Rae Young, DOULA, CLC, SM, I was able to forgo medical pain management and avoid other interventions that are costly to (Insurance Carrier), including a cesarean birth, during my recent vaginal birth at Florida Hospital.

The following were charged to Cigna during the birth of my first daughter on 11/15/10:

Vacuum Extract/Forceps: $197.00
Vacuum Mityvac: $126.83
Hi Risk Care per hour: $552.00 (8 hours)
Urinary Cath Ins-Foley: $202.00 (2)
OB Epidural Service: $506.00
Urinary Cath Ins-ST CA: $101.00
Daily Bed Service: $1508.00 (quicker recovery, so stayed one less night this time)

This is a savings total to (Insurance Company) of at least $3192.83, plus the cost of pain medication, as I used much less during the recovery period this time around. The cost of my labor support was $800.00, in which I am requesting reimbursement.

Please feel free to call with any questions.

Sincerely,
Sarah

I mailed it off, crossed my fingers, and waited to hear back. Four weeks later, I opened up my mailbox to see this:

I went screaming into the house, I was so excited. Progress! And my total out of pocket expenses? $230. Not bad. 

Feel free to use the above letter to start drafting a letter to YOUR insurance company. If more companies were willing to cover labor support, I'd like to think we'd be on our way to less inductions, c-sections and an all around happier birthing experience for all women. Good luck!

(*Update - I also included an itemized invoice from Charlie along with my letter - something most doulas should provide.)

Today marks 33 years of the WHO code, or the International Code of Marketing of Breastmilk Substitutes. Social media outlets of all kinds are trying to inundate businesses today who choose not to comply with this code -- add your picture to show your support.

 In my post about getting a breastpump, I mentioned the WHO-Code and different companies who are or are not in compliance with the code. But what is the Code? And who cares? Or should I say, WHO cares? Here is a break-down:

Everything that was decided was done so in order to protect breastfeeding and breastmilk. We know not everyone can breastfeed, and not everyone chooses to breastfeed. Formula isn't the subject up for debate -- it is a necessity in our world and it is the safest option we have for babies not receiving breastmilk. But the way formula companies advertise undermines breastfeeding.

For example, have you noticed advertising often depicts breastfeeding moms as lounging in their beds and their pajamas all day? Or surrounded by expensive-looking gourmet or "extra-healthy" food? The message is simple: To choose to breastfeed, you will be tied down to you home, your bed, your pajamas, and you baby -- and you must eat costly food to be healthy enough to nurse.

Moms depicted giving their babies bottles of formula, on the other hand, look put together, dressed professionally, ready to take on the world with their awake, alert babies. Or better yet, just a cute baby alone with her bottle, showing independence!

Celebrate the making of the WHO Code, and the businesses who choose to comply with it. When breastmilk is not the option, we know formula is available. Unethical marketing practices only serve to hurt moms and babies. 

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.