Support for Breastfeeding from the Medical Community

Breastfeeding has been heavily promoted in the medical community for years now, yet we haven't figured out how to eliminate the barriers nursing moms or prospective nursing moms face.  My friend's recent experience with insufficient support from her baby's pediatrician and a runaround from her insurance company makes me want to bang my head against this keyboard. 

She had brought her second child in for a routine weigh-in at two weeks old and was surprised to learn that he hadn't regained his birth weight.  She was told to supplement with formula because her baby wasn't getting enough to eat.  When she relayed the story of the visit to the pediatrician, the diagnosis didn't make sense to me, because she had not had any problems with supply during the 18 months she breastfed her first child. 

Many moms, especially first-time moms, would have stopped with this one pediatrician's diagnosis.  They would have believed they can't make enough milk and either would have endured the cumbersome process of nursing and then supplementing with a bottle, or they may have given up all together.  If you're already preparing a two-ounce bottle, why not make a full bottle and let your partner get up in the middle of the night?  I know that's the path I would have taken. 

Even if a doctor's recommendation doesn't sit right with a mom, she may not have available or know about additional resources.  Luckily my friend has a whole network of mom friends whose varied experiences with breastfeeding she could draw upon and she knew about a lactation consultant group at one of the local hospitals.  She made an appointment with a lactation consultant and before she took her son back for another weigh-in, she requested an appointment with a pediatrician who supported breastfeeding.  The second doctor still recommended supplementing with formula, but only until the reason for the lack of milk could be identified and addressed.   

Since my friend had never been to a lactation consultant before, she called her insurance company to see who was "in-network" and was told that lactation consulting wasn't covered because it was a "convenience."  She called the lactation consultant back and was instructed that if she told the insurance company it's a "facility fee" the appointment would be covered.  First of all, what the heck does that mean?  And second, has health insurance coverage gotten to the point that we need to know the super secret code word in order to be covered?

If the medical community agrees that breastmilk is healthiest for baby, (and breastfeeding is healthiest for mom) why won't insurance companies willingly cover this type of health issue? And why aren't pediatricians referring more moms to lactation consultants?  When I went to my family doctor because my knee was continuing to bother me when I ran or played soccer, he referred me to a sports medicine specialist, who was better able to diagnose the problem, and who referred me to a physical therapist.  All this was covered under my health insurance plan.  The second pediatrician my friend saw didn't know any more than the first why her baby wasn't getting enough milk.  Pediatricians are generalists when it comes down to it, so they shouldn't be expected to know how to solve every breastfeeding challenge. But she listened to my friend's concerns and what she wanted, and she referred her to a lactation consultant. 

At least my friend's breastfeeding story ended on a positive note.  The lactation consultant noticed her baby wasn't latching properly, which means he wasn't able to get enough milk, and because lactating womens' bodies produce milk based on supply and demand, her body wasn't getting the signal that it needed to make more.  My friend was shown how to help the baby get a better latch and was advised to pump after each feeding to stimulate supply.  And while having to pump adds one more cumbersome step to each feeding, she now has breastmilk she can offer him for the next bottle, and she feels better that she's actively doing something to return to exclusive (and bottle-less) breastfeeding.