An open letter to the medical community regarding breastfeeding, insurance coverage, and our country's public health issues.

To the medical community that supports moms and babies:

As an Internationally Board Certified Lactation Consultant (IBCLC) and owner of Breastfeeding and Babies, Yeah!, www.breastfeedinglv.com ,  I have decided to take this time to write an open letter to all in the medical community to make sure that all physicians are aware that under the new AFFORDABLE CARE ACT (ACA) almost all moms who have private insurance have Lactation Consultation Coverage at 100% coverage with no deductible and no copay. All Medicaid moms qualify for WIC and are able to receive assistance from an IBCLC at many local WIC offices throughout the city. 

Breastfeeding, unlike formula feeding, is a process that is best handled through PREVENTATIVE CARE. 

Lactation challenges are best handled by a trained professional who is board certified. This is part of the reason Lactation Consultation, by an IBCLC, is covered by insurance, and IBCLCs are now contracted providers under the ACA.

Breastfeeding unlike formula feeding is time sensitive based on hormones produced at birth. Best outcomes, with mom’s who desire to breastfeed, are most often seen when small challenges are recognized either prenatally, while still in hospital on postpartum, or within the first few days of a mom noticing supply changes or latching challenges.

I would like to personally encourage any and all physicians to refer all families that desire to breastfeed, are being asked to supplement, or have identified fertility issues or a history of lactation challenges directly to their insurance or to the local breastfeeding coalition’s list for a referral to a local IBCLC for proper preventative lactation care. 

All moms who are being asked to supplement should also be pumping postfeed, most often with a hospital grade pump for adequate stimulation and emptying of the breast. Resources for pump rentals are also noted on this often noted on this resource list as well.  

If you have any questions, please feel free to contact your local breastfeeding coalition or your local La Leche League leader. If we all work together than we can all together assist families reach their personal breastfeeding goals and follow the AAP guidelines of breastfeeding of infants for the first six months of life.

                                                                                                               

What is an ACA (Affordable Care Act) Breast Pump?

All of the dust has settled and now we all, healthcare professionals and families, are asking,

"What is this affordable care act stuff and what is my coverage?"

For Women's preventative services the Affordable Care Act (ACA) covers multiple items. The article found at ACA coverage  sums everything up nicely and summarizes your coverage as a breastfeeding mom with "Breastfeeding support, supplies, and counseling: Pregnant and postpartum women 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 health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies." 

So, how do you take advantage of this? It really is an easy process.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for a personal ELECTRIC pump? "

2. The next questions is: "Where can I get this pump from?" The insurance company should be able to give you list of providers or DME offices they are working with.

3. The pump you receive will be a special ACA pump. It will more than likely come in a brown box with the company name on it- Medela, Ameda, Hygeia - and should contain a personal electric pump with a pump kit for your personal use.

Now I have my pump, but what if I need follow up with breastfeeding challenges?

Again, this is covered under ACA. To find out your coverage follow these steps.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for lactation consultation with an IBCLC?"

2. Find out what your coverage is specifically: Is it prior to deductible, after deductible? Is it different in network vs out of network? What is your copay amount? How many visits do you have at this rate?

3. The next questions is: "Who do you have as listed Lactation Consultants that I may see?" The insurance company should be able to give you list of providers and their direct contact information as well as their websites. These providers have been credentialed by the insurance company and carry an NPI so they may bill insurance.

4. Make sure to do your homework! Just because a provider is listed doesn't mean they are the best available. Like many do for other healthcare professionals be diligent. Check YELP, Yahoo, etc.  for reviews and go to the providers website if provided. References should be available in one or both of these locations. You can also check the providers licensure status at the IBCLE site at IBCLC registry

Other hints to help you navigate this process:

1. DO this work prior to delivery. KNOW your benefits before the pump or consult is needed. It is always easier to deal with this preventatively rather than reactively.

2. CALL your hospital and find out who their IBCLC is and how long they typically spend with a patient in L&D and on Postapartum. If the answer is 15 min or less and that their hours are Mon-Fri 8-5 then make contact with your insurance company's IBCLC ahead of time. When the time comes you will be glad that all you needed to do was let them know you have delivered and could they come and guide you through to your successful path.

3. DON'T be afraid to ask questions. ACA has included coverage for breastfeeding moms for a reason. The AAP as well as the Surgeon General as well as your government are making this a priority and they want you  to do the same.

Best wishes and if you are in the Las Vegas area and need guidance please feel free to look us up at http://Breastfeeding and Babies, Yeah!  .

-Lisa Weinshenker, RN, IBCLC

The Cost of NOT Breastfeeding?

Yes, there is a cost of not breastfeeding. It comes in many forms from the cost of formula, to the cost of sickness to the baby and to the mom, to the cost to your company or the medicaid system for the illnesses caused by not providing what your baby needs through breastmilk,  to the cost of emotionally feeling like you did not achieve your desired path.

First, the cost of formula.
1. The cost of a consult without insurance can be anywhere from $80-400 depending on where you live and the standard cost of a consult with an IBCLC in the area where you live. The cost of formula at 3 months of age for one week with a standard formula (not a high cost organic formula or one with special antifussiness pricetags) can be calculated by using a site like babycenter.Formula Calculator or on theKellymom calculator 

Or you can do the math yourself. At about $25-27 for one formula container which should yield about 150 ounces of formula (8.7 grams powder yields one 2 ounce bottle, 657 grams in a container) your 3 month old who is consuming probably 30-40 ounces a day will eat their way through at least 2 of these a week. So in a matter of 1.5 weeks you have paid for at least one consultation by an IBCLC to solve your breastfeeding challenge.

At $50 a week for formula (or probably more) you could have rented at least 3 hospital grade pumps for that month to maintain your supply for a baby who is not latching well. (general cost of hospital grade pump rentals for supply maintenance for the exclusive pumper or full time working mom is between 45-80 a month) .

At $50 a week for formula you could buy multiple packages of lactation cookies by Milkin' Cookies  orMilkmakers .

At $50 a week for formula you could have multiple pill form galactagogues from companies like golacta   or Motherlove .

Second, the cost of healthcare for a formula fed infant with no formula intolerance reaches far beyond the cost of a consult. First one must consider health risk to the infant. Infant's who are not breastfed are at risk for multiple childhood illnesses that include obesity, diabetes, autism, and ear infections to just name a few. Third one must consider the health risk to mom by not breastfeeding. By breastfeeding mom reduces her risk of breast cancer, ovarian cancer, and postpartum depression.  A more indepth list can be found in these articles. Reviews in Obstetrics and Gynecology    and From Canada,   WIC easy to read article and  A great review of the res .

I could also review the risks to mom separately but I think they are laid out pretty well in the articles mentioned above. Overall, I think anyone can clearly see the value in a lactation consultation either prenatally, within a few days postpartum, or when trouble arises. I also think it is pretty clear what the cost of not asking for help or searching out your local breastfeeding resources is both short term and long term to both your wallet, your health, and more importantly your infant's health. Yes, there are some who can not breastfeed whether for physical, anatomica, or psycho-social reasons, but in general almost everyone can make the attempt and have some level of success even if it is only for the first few weeks or months.

Get out, get help, and don't hide behind your front door!! 

Your local IBCLC or La Leche League is waiting for your call and is more than willing to help you overcome your challenges!

For more info in the Las Vegas area please contact Lisa at Breastfeeding and Babies, Yeah! or your local Breastfeeding Coalition or your local La Leche League at llli.org

CLC, CLE, CLEC, IBCLC....OMG!! What does it all mean?

Let's face it, when you are sitting in your hospital room with a crying, screaming baby and nipple soreness you really don't care who it is who helps, you just want help! It could be from a mom, a dad (who really just wants to fix things), an auntie, a grandma, a friend, a nurse, a doctor, or someone in the lactation field.

If that kind person who helps you in the hospital or in your home is someone in the lactation field it is important that you stare strong and hard at their badge and their bio and find out what their initials are after their name. These initials are not random and like RN, MD, and APN they mean something quite significant in terms of their scope of practice, education background, and standard of practice.

Lactation Field Defined:

CLC: Certified Lactation Counselor
CLE: Certificated Lactation Educator
CLEC: Cerificated Lactation Educator Counselor

IBCLC: Internationally Board Certified Lactation Consultant

What is behind the letters?

CLC, CLE, CLEC:
These courses are NOT Board Certified nor are the Advanced Practice Certifications.

CLC: This is a 5 day class. 45 contact hours for CE provided, from flyer looks like 40-45 hours of classroom instruction, no clinical hours, no attendance at breastfeeding class. From the organization that presents CLC it is important to know that they state, "The CLC certification carries no regulatory authority for licensure. All participants should seek information about how this competency verification certification relates to employment in their community." Taken from webiste: http://www.healthychildren.cc/PDFs/4PageFlyer_2013.pdf

It is also important to note that it also states " The Certified Lactation Counselor® Exam is administered by the Academy of Lactation Policy and Practice (ALPP)" which is a division of Healthy Children Project, Inc. which is the presenter of the CLC and defines the CLC. Here is their pamphlet from 2010: http://www.talpp.org/CLC_Candidate_Handbook_2010S.pdf

CLE: 20 hours instruction time; 4 hours clinicals; Info can be found at: CAPPA; There are also course offerred as 45 CEUs (45 hours) through organizations such as this with no clinical component much like the CLC above. BASTYR Education

CLEC: 45 CEUS offered as: 45-60 hours instruction time; 4 hours clinicals; Info can be found at UCSD Lactation Program


IBCLC, RLC:
These are all Board Certified and Advanced Practice Certifications

IBCLC (often represented as RLC on hospital badge): This is an Internationally Board Certified Lactation Consultant.  Your IBCLC can be an RN, MD, OT, Speech Therapist, Dietician, RT, LPN, La Leche League Leader, or just an interested breastfeeding supporter. Their practice as an IBCLC will be greatly influenced by their other experiences, knowledge, and certifications. Which ever path leads one to be an IBCLC, remember they are an Advanced Practice Clinician and are Board Certified in lactation.

Just like your RN, LPN, RT, or MD passed an exam and stringent qualifications that included schooling and clinical experience, so too did your IBCLC! This person's scope of practice, practice, and licensure is maintained by IBLCE (International Board of Lactation Consultant Examiners) . This person has a license number that you can verify here: http://americas.iblce.org/ibclc-registry.  IBCLC is defined in this document: http://americas.iblce.org/what-is-an-ibclc. Pathways that your IBCLC followed to qualify to take the examination can be found here: Pathways to Becoming an IBCLC and a great video to watch to learn more can be found here: How to Become a Lactation Consultant  .

IBCLCs, like MDs and other healthcare professionals can apply for an NPI (national patient identifier) so that they may join a panel of health professionals and receive payment for services through health insurance.

To complicate matters further:
Now to complicate things further some programs have added more letters to the IBCLC and have intertwined CLC and IBCLC. For instance the use of ANL and ANLC. Over the past few years there has been a fair amount of controversy surrounding CLCs calling themselves consultants and making their practice equivalent to that of an IBCLC. In these courses this melding of the two is done so that an IBCLC and a CLC  can come out with ANL or ANLC at the end of their name.Healthy Children defends their argument in this document: IBCLC and CLC equal? For commentary on this debate you can turn to some fabulous blogs: Public Health Doula ; Anthro Doula ; Lactation Laura

UGH!! Like you weren't already confused, right?

Personally, I just find the creation of this mess of letters by Healthy Children is just one more way to confuse the issue and complicate the pathway for a mom in pain and desperation to find the correct assistance for her breastfeeding challenges.  As you can see from the basic qualifications required for each certification no matter what you put after your name if it is not IBCLC or RLC then you may be interacting with a professional who has had far less exposure and education on the abnormal and incredibly complex issues that can arise when breastfeeding takes a wrong turn. The definitions are also well stated and laid out in this article: http://www.bellaonline.com/articles/art63829.asp.

In the end it comes down to two things. 1. Those of us in the lactation field CORRECTLY representing ourselves and making sure a mom (and we) understands out scope of practice. 2. Moms, dads, partners, aunties, friends, sisters, and those who want to help taking the extra few seconds to ask what a persons qualifications are and quickly checking for an IBCLC certification verification online just as you would for any MD visit. (It's just that important!)

Preventing the Pump.....HUH??

Yes, the title of this note is Preventing the Pump.

First, why would you want to prevent the pump? Well, let's start with it is not the baby. It is not warm and cuddly and instead is cold and plastic and hard. It is not free and can not be popped on in a park. Instead it is constantly attached to a wall socket and usually used in a closed room separated from family, colleagues, work partners, home partners, and in general a very isolating process. It does not hide the results and it does not feed on demand. Instead it shows how much or how little or how in between your body is on that day at that moment in that time. In doing this it often increases anxiety, the push to make more which causes stress and then in turn decreases your milk production, and makes a mom 'chase the milk trail' as I often put it. And finally it is not free. In order to provide adequate stimulation and emptying of the breast one will need a high powered specifically designed hospital grade pump and there is nothing cute or easily portable about this.

So then, How do you prevent the pump?

Preventing the pump is not something you will see publicized by Gerber or Playtex or Medela or Ameda or EvenFlo or anyone making nipples, bottles, advertisements for your television, or the swing your baby loves. Preventing the pump, like all preventative medicine, is often low profile preventative action that produces high reward for those who search it out. Preventing the pump involves indepth, family specific breastfeeding education. Basically, it involves a plan for feeding your baby.

WHAT? A plan to feed my baby?

Yes, just as you planned your pregnancy and carefully chose those physicians who will take care of you while you grow that beautiful baby inside you there are many who guide you through making plans in conjunction with your wishes, wants, and dreams on how to feed your baby.

This is best done with an IBCLC well versed in the normal pregnancy and the many pregnancy complications like gestational diabetes, high blood pressure, IUGR, preterm birth, and proper management of c-sections for breastfeeding.

With an IBCLC a plan can be made for the perfect birth and then a plan for 'Oh My God What Happened Now? ' situations. A plan should include education on what an appropriate blood sugar is for a breastfeeding baby, appropriate supplementation and when and what should be used if needed, management of jaundice, and skin to skin 'when and where' it should be done. This plan should also include a discussion of pumps and which ones are most appropriate for situations like oversupply at 7-10 days or babies in the NICU or babies who have difficulty with the first latches in the first 7 days or traumatic births.

This plan should also include follow up within 48 hours of birth as well as follow up at 5-7 days postpartum and 2 weeks postpartum as mom and baby build their breastfeeding relationship and grow through the first two milestones of oversupply at 7-10 days postpartum and baby regaining birth weight by 2 weeks of age.

If you plan to prevent the pump then when you need the pump the correct pump will be used.

In preventing the pump you ensure your best chance at a positive breastfeeding experience!
In preventing the pump you ensure the best possible bonding experience with baby!
In preventing the pump you also prevent loss of money on pumps that are not appropriate or damaging to the breast when used inappropriately!

In preventing the pump you will achieve your dreams!

For more information on prenatal lactation consultations and preventing the pump please visit Prevent the Pump!


Best Wishes!
Lisa Weinshenker, RN, IBCLC
A practice of consultation and
sisterhood support for breastfeeding
families.

Pumping Tips for Moms!

Just a few ideas that I use in my practice as general guidelines for successful pumping. 

For Mom/Baby Separation 24 hours a day during the first few weeks postpartum:

1. It is advised to pump for 20-25 minutes with heat and massage 8 times in 24 hours which is every 2-3 hours with one 4 hour rest at night.
2. It is advised to use small colostrum containers from the hospital of from the Boobie Boutique when pumping in the first 3-5 days.
3. For the first 3-5 days postpartum depending on the amount of fluid you received you may or may not get any colostrum in the bottles. The purpose of pumping at this time is to provide effective and efficient stimulation to the breast to help bring your milk down to meet the baby as quickly as possible AND to signal the fluid you received in your IV prior, during, or after delivery to not enter your breasts and ‘hold your milk hostage’ and delay its flow. You NEED this 20-25 minute stimulation 8 times in 24 hours to trigger your hormonal cascade into high gear to make the appropriate amount of milk for your baby.
4. Following your 20-25 minute pump sessions it is advised to do 5 minutes of hand expression on each side. This will provide the compression needed to express the colostrum from the breast. A good 7 minute video to watch for this is the Stanford Hand Expression Video which can be found by googling or at: http://newborns.stanford.edu/Breastfeeding/HandExpression.html

For Going Back to Work:

1. It is advised that while at work you pump every 3 hours for 20-25 minutes with heat and massage.
2. Prior to returning to work, it is advised that you begin pumping and bottlefeeding 2 weeks before returning to work. It is advised that you pump 2 times a day for 10 minutes to get your body used to your pump and to create a storage of about 1-2 ounces a day. It is usually advised that baby is bottlefed once a day for two weeks prior to your returning to work. This will give both the baby and your body time to get used to the pump.
3. It is advised that while pumping you DO NOT look at the pump. Forcing your milk to flow doesn’t work, but looking at pictures of your baby, talking to your baby by phone, or use of other distractions will relieve your mind of stress and assist you to let down for your pump.