By Deann Shaffner
According to the CDC among the infants born in the United States, 83.8% start to breastfeed and by 12 months the amount of breastfed babies is down to 36.2%.
“A more recent study that used costs adjusted to 2007 dollars and evaluated costs associated with additional illnesses and diseases (sudden infant death syndrome, hospitalization for lower respiratory tract infection in infancy, atopic dermatitis, childhood leukemia, childhood obesity, childhood asthma, and type 1 diabetes mellitus) found that if 90 percent of U.S. families followed guidelines to breastfeed exclusively for six months, the United States would save $13 billion annually from reduced direct medical and indirect costs and the cost of premature death. If 80 percent of U.S. families complied, $10.5 billion per year would be saved. (Economic Effects).”
There are a variety of reasons mothers stop breastfeeding by 6 months including, concerns of milk supply, baby’s weight, issues with latching, unsupportive work policies, lack of prenatal leave, cultural norms, and lack of family support. So, what is a mother to do if she desires to breastfeed? In my previous post I gave an overview of the importance of seeking an International Board Certified Lactation Consultant (IBCLC); because they have received thorough lactation education. IBCLCs can be found in many areas, but many of them are employed in Hospitals, WIC offices, and Private Practice.
In Hospitals where an IBCLC or a Certified Lactation Counselor (CLC) are present, a visit to assist mom with a correct latch with baby, as well as address any breastfeeding concerns, is done during the mothers’ hospital stay. As the baby grows each week after his/her birth the breastfeeding experience can continue to change; bringing new questions on how to know if you’re doing this whole breastfeeding thing correctly! Most Hospitals will assist you during the entire course of your breastfeeding journey. However, some mothers forget that they can receive help from the hospitals IBCLC or CLC staff beyond the newborn stage.
WIC participants benefit greatly from having the ability to contact breastfeeding support during pregnancy, after birth and up to the child turning 5. Many WIC offices have IBCLC, CLCs and Breastfeeding Peer Specialists; these specialists are experienced breastfeeding mothers that have undergone some training to assist mothers. At WIC, a parent could work with these available sources with the continued visits required at WIC for nutritional help. Although WIC is income-based and not available to every parent. As well as the fact, that some mothers report it is easier to access baby formula through WIC than breastfeeding help. (Source- Breastfeeding in the Public Arena Pg. 153 MJR).
Private Practice IBCLCs may face more of a challenge with assisting clients due to a conflicting relationship with insurance companies. Insurance providers have a variety of policy plans available to their customers. It may be in your best interest to call your insurance company during your pregnancy to see what is covered with breastfeeding supplies, (like a breast pump) or lactation visits, what documentation will be required, and the time frame you may face while waiting for coverage, if you have any, with your insurance. The information provided by your insurance company based on your plan, which can easily differ from other individuals’ plans, may help give you a better understanding of what you need to prepare for. Many insurance plans require an “in-network” provider, this means the lactation consultant has an agreement with the health plan to provide services. For some private practices, this may be easier said than done. An e-mail survey of U.S. IBCLCs in March of 2011 conclusion recorded that, “IBCLCs provide key care to a vulnerable population. However, we found that these services are not consistently reimbursed. IBCLCs poorly communicate their health care activities to insurance providers, but insurance providers also inconsistently recognize and reimburse IBCLC care.”
I recently interviewed IBCLC Heather Gansky, her practice is The Tree of Life Lactation located in South Carolina. She has also been a La Leche League Leader since August of 2016.
Question: Have you come across mothers experiencing difficulties nursing their baby and insurance companies denying coverage for Private Practice appointments with a Lactation Specialist?
Heather: Yes there are a ton of denials from insurance companies. Most moms do have to resubmit with different codes because each insurance seems to have it own way they like to do things.
Question: If a mother does not qualify for WIC, and is unable to attend La Leche League meetings, where do you suggest she go for assistance?
Heather: If I run into a parent who doesn’t have WIC or can not come to meetings I will either refer her to an IBCLC in our area, myself being one of them on a list about 3 others. Also, there are hospitals that have support groups, and some areas have baby cafés that anyone can drop into for help they need. It really depends on the situation and if she needs one on one help or peer to peer support.
Question: From your experience, how often do you think mothers seek breastfeeding help? Where is the best source for them to turn to address breastfeeding concerns? (Newborn stage, 3 months, 6 months, 12 months, 2 +years.)
Heather: I find mothers sometimes wait too long to seek help for breastfeeding issues. It’s only until they are able to throw in the towel due to pain or poor weight gain in their baby that they actually seek help, and sometimes that’s much too late. Generally, we see babies in the newborn stage-1 month; then again around 3 months when babies really need to be good and suckling and using their tongues and mouths correctly to actively get milk out. If we didn’t see a baby in the early days but see them in the 3-month range it is typically due to mouth abnormalities which went undiagnosed either due to moms oversupply/ overactive letdown and the baby was riding the huge letdown portion of the feeding session.
Question: Do you think insurance companies are helpful to mothers seeking breastfeeding help? Or does the process of waiting for approval leave moms in a position of crisis where they turn to formula feeding, even though breastfeeding was their first choice in how they wanted their baby fed?
Heather: Some insurance companies have staff on hand to help with common issues/questions over the phone. There are some IBCLCs that are in-network for some insurance companies, but most work in offices and don’t do home visits. Most parents need help right away and aren’t waiting for insurance approval. In the case where parents don’t have money to pay for a consultation out of pocket they sometimes can go back to the hospital they delivered at however they are put back in the same situation with the same providers who are time-constrained and didn’t help them, to begin with. Many parents just don’t want to go back to those providers.
Question: Do you think that if health insurance companies were more supportive on coverage for visits with a lactation specialist that there could be a possible increase in breastfeeding rates?
Heather: Oh I’m sure of it. Most families are living paycheck to paycheck. They can’t afford a lactation visit… especially when one or both parents are out of work for the birth of the baby.
Question: Do you think families would benefit from visiting with an IBCLC before baby is born?
Heather: Yes. Education before birth is one of the key factors in initiation as well as the duration of breastfeeding.
The cost of breastmilk itself can be free. However, breastfeeding may have some additional costs. A mother could get around not having a breast pump and could choose to hand express, but meeting with an IBCLC or other lactation specialists may be more beneficial in helping you reach your breastfeeding goals. A visit with a consultant may range in price from $100.00-$300.00 depending on your location, but this is still a very low cost compared to a months’ worth of formula which can cost up to $243.00 per month, or you can use this Formula cost calculator to determine costs. If you plan to breastfeed, and during pregnancy you read the books, attend the breastfeeding classes, you may still want to be prepared to visit with a lactation specialist after the birth of your baby. Requesting funds as a baby shower gift, holiday or birthday, to visit with a lactation consultant would be an amazing gift to receive if you feel you may need help with affording the cost to visit with a consultant. You may be lucky enough to even be reimbursed by your insurance company after these visits, but it is best to save up on your own for a visit to avoid a feeding crisis, then waiting for the insurance to get everything in order. Either way, if you want to breastfeed, that is your choice. Income and Insurance coverage should not be left to chance.
More on education:
Please see the Free Webinars offered through the United States Breastfeeding Committee. The next 11/20 Session: Building Relationships: a Key to the Rise of our Indigenous Breastfeeding Communities
will be presented by Amber Kapuamakamaeokalani Wong Granite, Breastfeeding Hawai’i Coalition.
O ke kahua ma mua ma hope ke kūkulu: First the foundation, then the structure can be built.
This Hawaiian proverb teaches us the importance of building relationships in order to ensure the rise of our people.
Whether we seek to influence fellow learners, patients, or customers, we must get to know them before we can ask them to make a change. Once we seek and understand where they come from, what is truly important to them, and then help them unpack their stories, the real work can truly begin. During this session, we will hear an oli, Nā ʻAumakua. This oli acknowledges our ancestors, our land, and our nation. It invites strength, knowledge, and power into our space. MOM founder and director, Martha Joy Rose has participated in these and found them educational and helpful. (See the certificate at the bottom of the page)
Sources:
https://www.cdc.gov/breastfeeding/index.htm
https://mommuseum.org/2019/10/31/breastfeeding-education-might-not-be-what-you-think-it-is/
https://www.treelifelactation.com/
https://www.ncbi.nlm.nih.gov/books/NBK52687/
https://www.ncbi.nlm.nih.gov/pubmed/23962773
https://kellymom.com/pregnancy/bf-prep/bfcostbenefits/
https://www.fns.usda.gov/wic/wic-eligibility-requirements
New Maternalisms, “Breastfeeding in the Public Arena”, Martha Joy Rose (Demeter Press 2016)
Deann’s Other Blogs at MOM:
Breastfeeding Education Might Not Be What You Think It Is
