People are talking this week about the news that supposedly changes things for new mothers, especially (but not only) new mothers who work.
And while many people think it’s fantastic that insurance companies must now cover the cost of a breast pump under the Affordable Care Act (many women just became eligible this month), things aren’t suddenly all pie and ice cream for milking women.
Word on the street is that some insurance companies are covering only low-performing pumps, such as hand pumps (and that many of the approved medical-supply companies don’t actually deal in breast pumps, or the suppliers listed don't have any of the major brands in stock).
And if it isn’t the lack of a clue from these insurance companies, it’s the pervasive attitude (reminiscent of the birth-control debate that plagued us pre-election) still infecting the discussion: “Why should insurance cover pumps? Why should we all pay for it? Why should the government pay for a $300 piece of luxury equipment”? Never mind that we’re talking about private insurers here, in a system that employees pay into, and not Medicaid (which does cover pumps for low-income women in some states).
Are we back in the Victorian era? Should we forget seeking out the basic, modern inventions that can help our babes get breast milk? Maybe we should just hire a wet nurse.
I get it. On paper, tucked into what must be a mile-long list of the drugs, procedures and equipment insurance companies deal in, “automatic pump” vs. “hand pump” might not mean much.
So I’d like to take this opportunity to explain to the corporate executives who make these decisions what a hand pump is, and why coverage of one is basically like offering someone who just accidentally chopped off their finger with a kitchen knife a Band-Aid.
Since Biblical times, we have had the cultural impression that breastfeeding is beautiful and natural.
But if you think that honeyed milk just magically flows when it needs to and halts when doesn’t, you must also believe that babies come from the Stork.
Breastfeeding is a complex physiological process, and it works differently for every woman. Feeding another human sometimes requires a stash of supportive gear.
When I gave birth to my first daughter, my milk didn’t come in, meaning that after my body began manufacturing milk, it didn’t flow down to my ducts, where the baby drinks, for five days. By the time the milk arrived, my daughter was furiously pissed off and screaming-hungry, I was confused and frantic, and my breasts — having suddenly received this massive, flowing deliverance — were burning hot, the skin stretched and pulling, and too full and painful for my baby to latch onto and drink from.
Because breastfeeding fell out of fashion during my mother’s Boomer generation, there was not one of us around that had any freaking idea what the hell was going on.
The pain was so bad I thought I would die.
Desperate, I grabbed one of the items I had added, somewhat mystified at the time, to my maternity shopping list. It was a hand pump for expressing milk, a tool about the size of a large sport water bottle that had cost around $50, with a cone-shaped flange at the top that fit over one breast. It looked like one of those commercial whipped-cream canisters with a funnel attached to the top.
I shoved my swollen breast into that little plastic flange and began squeezing the manual handle.
I pumped again. A tiny spurt of clearish-white milk dribbled into the cup. I pumped again, faster, my right hand starting to cramp up, pain shooting up through my nipple. After 15 minutes I had as much milk in the little bottle as you would add to your morning coffee.
How would some women whose babies couldn’t feed from the source, or who had to go back to work during the daytime, do this six–eight times a day, by hand, for 20–30 minutes each time?
It would be like hand-pumping air into a pile of deflated basketballs, every day, six times a day.
Near hysterical, feeling feverish, I retired to the bathroom to soak in the tub and sob.
Insurance executives: This is the part of the story where many mothers would utter the totally understandable words, “I quit.” Or, more accurately for the onslaught of pain and hormones that follow childbirth, “F– this.”
What follows of course is a babyhood of formula, which I’m not condemning here, not at all. But which, many studies show, is not as perfect a food as human milk.
What also follows is the loss of all the health benefits breastfeeding has to offer, for mom and for baby, and for society as a whole. Less illness, stronger immunity and a lower cost on the health-care system, too.
But I was a lucky one.
While I lost my mind in the bathtub, my intrepid husband pulled out another item I had purchased pre-baby: An electric pump. This was bigger, more intimidating and much more expensive ($250) than the hand pump.
If you think, for even a second, that an electric breast pump is a “luxury” item, like a Louis Vuitton diaper bag or one of those $1,200 ergonomic strollers that do everything short of changing a baby’s diaper, then you are not only ignorant but you are also insulting and patronizing women by way of an exhausted trope.
Insurance executives and other naysayers, let me help you:
If you’ve never seen or used a breast pump, I will be the first explain, it’s a scary contraption — very medical-looking indeed, with none of the smooth hides of a fancy handbag.
There’s a rectangular box that contains the motor, on the outside of which are two dials. One controls the speed at which the machine sucks, and the other adjusts the force of said suckage. Running from the motor box are two clear flexible tubes that attach, on the other end, to the flanges: hard plastic funnels that fit over the breasts, yanking, with repeated pump-powered motion, the woman’s ever-purpling nipple into a quarter-sized tunnel with considerable discomfort, thereby extracting milk into an attached bottle.
I'm not telling you this to gross you out. I'm saying it because it's what we don't say boldly enough as women. We appreciate the health campaigns urging us, from billboards and radio ads, to give our babies the best. Yeah, thanks for those.
This is what we need to do that.
If your pump is a pretty good one, as I discovered that day my milk came in and got blocked up, then after 15 or 20 minutes, you can extract a bottle-sized amount of liquid, enough to feed your baby (and get things flowing).
Because I could afford it at the time, I was lucky enough to have that pump on hand. It wasn’t the world’s most powerful or effective electric pump (hospital-grade pumps are most effective at extracting milk for a baby who can’t breastfeed or for a mother who needs to store milk for later and keep up her supply while she’ working).
But it was enough to help us, and to ensure we kept breastfeeding. If I had not had the money to buy the pump, I likely would have given up.
The law is the law, and insurance companies should follow both the letter and the spirit — not out of the goodness of their hearts, but because it makes sense to support the health of mothers and babies in our society and in our health system. And we should strive for effective tools so that our system can serve all our needs.
The faster we have the basic equipment we need to support nursing mothers, the easier it will be for the majority of mothers to breastfeed successfully, the way the American Academy of Pediatrics now recommends doing for at least 12 months of age.
And with electric pumps and lactation clinics and community and employer support, mothers can also successfully navigate the gantlet that is working and breastfeeding, which requires a whole additional bag of tricks.
In between school drop-offs and coffee binges, Natalie Singer-Velush is ParentMap’s Web Editor. In her former life she wrote for newspapers and once pumped milk in the bathroom of the King County Superior Courthouse while covering a murder trial. Natalie lives in Seattle with her husband and two school-aged daughters. Her breasts have mostly recovered.