Managing the circumstances of returning to work or a NICU baby
by Jenn M. Foster
May 14, 2018

For moms returning to work, the decision to breastfeed presents a whole new set of special circumstances to manage. Break Time for Nursing Mothers under the FLSA offers support. Provisions of the Affordable Care Act (ACA) include making breast pumps available as a covered item. With the passing of the Affordable Care Act, insurance companies are now required to provide a breast pump to a pregnant mother. There are a few exceptions to this rule, such as the “grandfathered plans,” but the vast majority of insurance plans are required to do so. It is easy to find out if a breast pump is covered by insurance and find plan benefits. Many major breast pump companies have insurance locator tools that can be used to contact the contracted durable medical equipment (DME) company that will mail the breast pump. Breast pump coverage and details are specific to the insurance plan and the consumer’s state of residence. Every coverage is unique, but the breast pump models should be consistent. There are very few insurance plans that only have a specific model of breast pump as the only choice. Consumers should know all the options.

New moms are surrounded by the influences of their social environment. They have questions, and the answers they get may vary based on who they ask, the website that ranks first on Google and the influence of friends and family on Facebook or in person. With all the changes, emotions and demands of a newborn, new parents can feel pressured and overwhelmed.

Types of Breast Pumps and Systems

Moms need to be educated on the differences between breast pumps that are available through insurance plans. For example, single-user breast pumps are intended for the sole usage of one mother. On the other hand, multi-user breast pumps can be used by more than one person. Multi-user breast pumps typically are rented out for increase of milk supply or separation of baby and mother with the need to express her breast milk. There are two types of breast pump motor systems, regardless of the brand or model of a specific breast pump—the open-valve breast pump system and the closed-valve breast pump system. The open-valve breast pump does not have a barrier method in place, and bacteria or particles can pass from the mother while pumping, into the pump motor and back out to the mother/baby via the tubing. The closed-valve breast pump has a barrier method in place where nothing can pass from the mother to the baby, or into the motor via the tubing.

Hospital-Strength Pumps

When a mom returns to work or is separated from baby for more than three hours at a time, it is recommended that she use a hospital-strength pump. These come in mostly closed-valve system pumps, in single-user or multi-user breast pumps. Insurance should cover a hospital-strength single-user pump. In some situations, such as a NICU baby, insurance will cover both the single-user and multi-user pump (for when the baby is in the hospital, by rental option). Researching pump brands is recommended. Seek guidance from a lactation professional (such as an IBCLC, which stands for international board-certified lactation consultant and shows specialty in the clinical management of breastfeeding). A local support group or a trusted breastfeeding/pumping mom (online or in person) may be helpful, too. These resources, along with evidence-based information gathered along the way, can help a new mom determine how much to pump, when, and what to leave for baby, and how to develop a pumping schedule.

Feeding a Newborn

A newborn needs to be breastfed eight to 12 times per day. As the newborn gets more efficient at breastfeeding, the nursing sessions become less in time at breast. The mother’s milk supply begins to regulate around 6 to 8 weeks postpartum. The foundation of a mother’s milk supply for the entirety of the breastfeeding relationship is based upon the removal of milk during this time. Exclusively-pumping mothers should still begin with pumping at least every three hours to ensure a good milk supply. Baby-at-breast follows a natural “suck, suck, swallow” pattern. Breast pumps work to mimic this behavior with stimulating the let-down of the milk and cycles per minute, like a baby would do at breast. However, when breast milk is provided to the baby when not at breast, moms need to follow that natural pattern. Pace feeding allows for this action to occur. With pace bottle feeding, the bottle is positioned horizontal to the baby. This way, the baby is able to self-regulate their own intake of mother’s milk, just as he or she would do at breast. An average, normal pumping yield is 2 to 3 total ounces per session. The average full-term baby (37 weeks gestation or older) will need around 23.67 ounces to 26.37 ounces per day from birth through six months. So, breathe easy when there is less than 5 to 8 total ounces per pumping session.

Medications During Breastfeeding

Many pediatricians, pharmacists or other health care providers may not be educated on how medication, or even common over-the-counter (OTC) medicines will impact the mother and baby prenatally, or postpartum when breastfeeding. Consult a specialist. If guidance is needed for how to know what medications are okay to take while breastfeeding, pregnant or sick, consult the specialists in these specific areas at the InfantRisk Center, infantrisk.com. This service, which is provided by the Texas Tech University Health Science Center, is available at no cost to consumers.

The Unique Needs of Mom and Baby

There is no cookie-cutter answer or path for mom and baby. Seeking support, using evidence-based information, and staying flexible can help relieve some of the stress of new motherhood. It is important for everyone to realize that what may have worked for one mother and baby (family members included) may not work the same for another. Seek expert advice. Follow the facts. Follow the heart.