We’ve Moved!

After almost 30 years supporting breastfeeding mothers in Southern Maryland, I have moved to Williamsburg, VA.  It was incredibly hard for me to leave Milky Way, as I have enjoyed helping thousands of mothers and their new babies to achieve their breastfeeding goals.  I am still available for phone or SKYPE consults, but please try to access the other resources in the area which you can find under the SMBA tab.

It has been my privilege to work with you all over the years, and I hope that there will soon be another private practice lactation consultant available to mothers in Southern Maryland.

Happy Breastfeeding!


2020 Update: I am excited to announce that Laurel Cahill, IBCLC, is now serving Southern Maryland as a private practice lactation consultant! Please contact her at 410-703-5365 or somdlactation.com

Milky Way Celebrates 20 Years!

This month, Milky Way Lactation Services celebrates its 20th anniversary supporting breastfeeding mothers in Southern Maryland.  I can’t believe that it has been that long since my dream to start a lactation service came to fruition.  A lot has changed in the world of breastfeeding over the past 20 years!

When I first started Milky Way in 1996, I had already spent years as a La Leche Leader, so I was familiar with the challenges of breastfeeding in an unsupportive society.  It wasn’t until I took things to the next level, however, achieving IBCLC certification and actually opening a business, that I found out just how bad things were!  I had lived a charmed life of supportive family and friends while I breastfed.  I soon learned, however, that my social circle was not exactly representative!  My first shock came when I sent a business announcement to the local newspaper.  I was called by an assistant editor who reamed me out for “bad mouthing” doctors by suggesting that women don’t always get all the support they need to breastfeed successfully.  He felt that by simply opening this business, I was insulting the medical profession, and, as he put it, women wouldn’t even choose to breastfeed in the first place unless they already had the help they needed!

My first act of assertiveness was to go over this editor’s head to insist that my business announcement be posted.  It was, and things went on well for a while.  Sure, this was before the days when women in Maryland had legal protection to breastfeed in public.  This was back when the American Academy of Pediatrics had strong financial ties with the formula companies.  No hospitals in the area had even considered progressing to Baby-Friendly status, and all of them gave out bags of formula, even to breastfeeding mothers.  There were no advertisements on TV or in magazines about the importance of breastfeeding.  Yet, most women I worked with felt breastfeeding was still worth doing, and they struggled to make sure it worked for them and their babies.

Another shock came a few years later when an OB/GYN in the area insisted that breastfeeding mothers can’t breastfeed if they have a fever.  When I provided him with copies of overwhelming evidence that fever is not a contraindication, I got no response.  That was nothing compared to my experience with another OB/GYN who called me to yell at me and insist that I was committing insurance fraud by trying to help mothers get insurance reimbursement.  How ironic that today the Federal Government mandates that insurance MUST cover lactation services!

Despite these negative experiences, working with mother and babies in Southern Maryland was full of positive reinforcement, so I soldiered on!  I have worked with mothers who breastfed after mastectomies, who maintained lactation while deployed, who breastfed babies with serious birth defects.  I have been so inspired by their persistence.

At the same time, the physicians in the area and I have developed a good working rapport.  I feel comfortable talking to them about specific concerns or ideas, and on many occasions they have contacted me to ask my opinion about a breastfeeding issue.  Most of the hospitals in the area developed dedicated lactation programs to help their mothers get off to a good start, and none of them give out free formula bags anymore!

Society at large has changed its attitudes toward breastfeeding.  Breastfeeding in public is now a legal right.  Time and place to pump at work is now legally protected.  Insurance companies are required to provide pumps and coverage for lactation services.  The importance of breastfeeding is regularly part of public health announcements.  Those who argue against breastfeeding are widely seen as out-of-touch or on the defensive due to their own concerns.

In many ways, this is a wonderful time to be a lactation consultant.  Except when it isn’t.  In my next post, what has not changed for the better over the past 20 years.



Insurance Reimbursement Update

It has been almost 3 years since I wrote about insurance coverage for lactation services. A lot has changed in that time.  Most insurances will now provide new mothers with an electric breast pump as soon as the baby is born, if not before, at no cost to her.  The insurance plans now comply with the Affordable Care Act when it comes to breast pumps.  However, coverage for lactation help is still spotty.

Insurances which otherwise must abide by the Affordable Care Act are required to cover lactation services as well.  Some of my clients have found, though, that when they inquire about this coverage, they are given several excuses of why they will not be reimbursed for a lactation consultation.  The most common excuses are

1.  We only cover lactation services while you are in the hospital

2.  We only cover services provided by a licensed provider

3.  We only cover services provided by in-network providers

Luckily, the Federal government has gotten wind of these excuses and is putting a halt to them!  In October of 2015, the US Department of Labor published a document that addressed these excuses and other concerns about preventive services covered by the Affordable Care Act.  You can read the document yourself at http://www.dol.gov/ebsa/faqs/faq-aca29.html

If you don’t want to read the whole thing, however, then here are the most important facts to know when you discuss this with your insurance company.

1.  Insurers must provide coverage for lactation services for THE DURATION OF BREASTFEEDING.  That means they must cover it if you need help at any point while you are breastfeeding, not just in the hospital.

2.  There is only one state in the United States which currently offers licensing for lactation consultants.  Insurers may not refuse to cover for an unlicensed provider, so you should be covered to see an IBCLC (International Board Certified Lactation Consultant).

3.  Insurers must provide coverage for out-of-network providers if they have no in-network providers in your area.  This is usually the case as there are very few in-network lactation consultants around the country, and, currently,  none in Southern Maryland.

This is all good news, but it doesn’t mean that dealing with the insurance company is always easy.  You still need to pay up front and then submit for reimbursement from your insurance company.  I’m sure you will agree, though, that that is a small price to pay for expert help in your home when you most need it!

The Affordable Care Act has definitely changed insurance company involvement in breastfeeding, but one thing remains the same.  Expert lactation help is worth the investment.  Even if you have to pay for it, it will more than pay for itself as you save on formula and doctor’s visits.  And who can put a price on peace of mind?




Breastfeeding: Making Us Better Mothers

There has been a lot of discussion in the media recently about the mother who left her baby in the carseat all day while she was at work. Sadly, the baby died. The mother reported that she simply forgot about him. Stories like this are always shocking, and, as mothers, we like to think we could never do any such thing. Deep down, though, we know that we often get overwhelmed, overtired, and distracted. At that point, we have to admit that anything is possible.

As a lactation consultant I can’t help thinking that a breastfeeding mother simply cannot forget her baby for 8+ hours. Her full breasts will remind her long before that. Even a mother away at work is reminded of her baby every time she pumps.

This is just one of the many ways that breastfeeding helps us to be the best mothers we can be. We all wish we could be perfect mothers, but, face it: That is never going to happen. We are going to make mistakes, some minor, some big. We are going to sometimes ignore what we know to be the better choice. We will lose our tempers and our composure. We will all disappoint ourselves from time to time.

As breastfeeding mothers, though, we won’t forget about our babies for very long. We won’t fail to give them a lot of physical contact. We won’t forget to take a little time to sit and hold our little ones—biology simply won’t allow it.

Nature has ways of making sure to protect our offspring. Human babies need to be kept close to their mothers and they need to eat frequently. Mothers need to be reminded to take a break and focus on their babies when their lives become harried. This was not only true for “cave” mothers and babies. It is equally true today, as the reports of numerous babies left in carseats reminds us. Breastfeeding is nature’s way of protecting our children from some of our inevitable failures as mothers.

Insurance Coverage for Lactation Consultations

I get asked everyday whether or not Milky Way participates with any insurance companies.  The short answer is “No.”  Although many of my clients get reimbursed for their consultation fees, I am not a preferred provider with any insurance company.

By the end of this year, every new mother’s insurance should cover at least one lactation-related visit.  The Affordable Care Act dictates that all insurance companies must offer this, at no charge to the mother.  This sounds great, but the reality is not so perfect.

Currently, to the best of my knowledge, there are no IBCLC’s (international board certified lactation consultants) in Southern Maryland who participate with any insurance companies.  In fact, there are only a few throughout the country.  The insurance companies have been slow to figure out how to begin credentialing lactation consultants.  In addition, many LC’s, like myself, are hesitant to begin working with the insurance companies.  So far, the rates offered to LCs have been far below what we normally charge.  In addition, the billing is so complicated that even our professional organization has recommended that we will need to hire a billing service.  Finally, no rates have been developed for home visits.

I do not want to cut the level of service I offer clients.  If I begin participating with your insurance,  I will not be able to see you as quickly since I will have to confirm your insurance participation ahead of time.  In addition, I won’t be able to spend as much time with you because I will have to cram more clients into my day to make up for the financial losses and the new fees I must pay a billing service.  Finally, if I participate with your insurance, I will have to limit or discontinue home visits since they are not currently paid at a higher rate even though they take much more time.

I hope that all of these issues can be remedied in a way that helps everyone.  However, that process is likely to take months, if not years.  So what do you do if you need a lactation consultation now?  Many of my clients receive reimbursement after the visit, simply by submitting the superbill I give to their insurance companies.  However, you won’t know for sure if this is going to work unless you speak to the insurance company ahead of time. I recommend these steps:

1. Call your insurance company and ask about your coverage.

2. If you are told that you must see a participating provider, ask for a list of providers and make sure you are actually getting IBCLCs.

3. If they can’t give you anyone close to you, then tell them you need “in for out” coverage or coverage for a non-participating provider.

4. If you submit and your claim is rejected, resubmit and challenge the decision.  Insurance companies are notorious for rejecting a few times before finally paying.

5. If all this seems like too much trouble, consider just paying for the lactation consultation and worrying about it later.  After all, if you don’t breastfeed, you are going to be throwing away a lot more than $125 on formula in just the next few weeks—and nobody is going to reimburse you for that!

6.  Finally, I never turn anyone away for inability to pay.  If you truly cannot afford the consultation, let me know, and we will work something out.



Origins of the Milky Way

People frequently ask me how I came up with the name Milky Way for my business.  More than 18 years ago my husband and I were sitting on our sofa discussing my new business plan as a lactation consultant.  My husband thought I should have a newsletter and immediately came up with the name Milky Way News.  I never did start a newsletter, but Milky Way stuck because it was appropriate in so many ways.

Our children had called breastfeeding “having milkies” as toddlers.  Many families invent code words for breastfeeding as babies become verbal.   I was always turned off when I heard mothers asking if their children wanted “the boob.”  So when my daughter asked for “milkies” when she was about 15 months, we all latched on to it!  In our household, breastfeeding was called milkies ever after.

In addition, the Milky Way galaxy, according to ancient Greek mythology, was started by breastmilk spraying from the breast of the goddess Hera.  In Roman mythology it was the breastmilk of the goddess Ops.              .

Finally, at that time, few people had even heard of a lactation consultant, and many were not even familiar with the word lactation.  Using the word breast in my business name might have given me problems with print media, and some people would have found it to be too “in your face.”  Milky Way sounded to me like a non-offensive and yet beautiful suggestion of a lifestyle with breastfeeding as an integral part.  I liked that, and hoped that my business would be able to promote breastfeeding as part of a normal life with babies.

If you search the internet today, you will find all kinds of breastfeeding businesses which use Milky Way as part of their name.  Sometimes that bothers me, and I feel like saying “hey, I had it first” but, of course, the candy bar was around long before me!  I try to take it as a compliment that others realize how appropriate the name Milky Way is.

So, I guess my kids and my husband get much of the credit for the invention of the Milky Way name, but I have done my best to make sure that the name means quality breastfeeding help in Southern Maryland to all who hear it.  I’m glad I didn’t go with my husband’s second choice:  Little Suckers!  What do you think?

Water, Water Everywhere, but not a Drop of Milk!

If you are struggling with milk production, how many times have you been told to drink more water? Chances are everyone from your mother, to your friend, to even your doctor, has perpetuated this myth and added to your stress. You are working so hard already, the last thing you need is someone telling you to do something as basic as drinking more water!

But, wait, rather than being irritated by this patronizing suggestion, have you worried that maybe your water intake really is the reason you don’t have enough milk? Stop beating yourself up, and tell all your well-meaning advisors to read this post!

Drinking more water isn’t the solution!

Assuming that you are not seriously dehydrated, your fluid intake has little impact on milk production. Research has shown that mothers who drank as much as 25% to 50% more than what they were thirsty for, had no increase in milk production. (Dusdieker, et al, 1985. Morse, et al, 1992).  Drinking whenever you are thirsty is all that is needed.

You may have heard of someone who drank more water and had a subsequent milk increase.  Maybe this mother was truly dehydrated.  Maybe it was the placebo effect.  Maybe she also changed other factors which could impact milk production.  We will never know, and it won’t hurt you to drink more–if you want to!

However, forcing yourself to drink more than you want can actually work against your ability to make milk!

The body’s reaction to excessive water intake (well beyond thirst) is to dump excess fluid through the urine in order to maintain proper electrolyte balance. Water is diverted away from the breast, and lower milk volume can result. (West & Marasco Making More Milk p 86).

So why do people keep telling you to drink more? It may be because they want to help but don’t know how. Drinking more sounds like an easy and reasonable fix for a problem they don’t understand. Sometimes, even health care providers rely on breastfeeding myths because they want to solve the problem, but don’t know how!

Another reason people suggest drinking fluid is a lack of knowledge about how the breast makes milk. Milk production is a complex procedure that I won’t bore you with here. However, there are a few important points to keep in mind. First, if you have recently had a baby, your body puts milk production high on its priority list.  “The mammary gland may need to produce milk at the metabolic expense of other organs (Lawrence, Breastfeeding: A Guide for the Medical Profession, p 90),   In other words, your breasts are going to take whatever they need from anywhere you have it available.  If there isn’t enough of something available, the rest of your body will suffer before your milk supply does.  This means you would have to be truly dehydrated before your milk supply would suffer.

Second, if you don’t have enough milk despite very, very frequent and efficient milk removal, there is likely an underlying health issue involved, and drinking more water will not solve that.

But could you actually be severely dehydrated? Well, first off, if you feel well enough to sit here and read this calmly, you probably are not severely dehydrated. Usually, you have to be in the throes of a terrible stomach virus, or have some other extreme health issues going on for this happen. However, you may be mildly dehydrated, as many of us are, because we aren’t used to having a glass of water always available.  The color of your urine is a good indicator of fluid status. If your urine is pale yellow throughout the day (accounting for any colored vitamins you may be taking) then you are probably decently hydrated.

This doesn’t mean that you shouldn’t keep water available wherever you sit down to breastfeed or pump. Quite often mothers get thirsty at this time but don’t want to get up to get a drink. Keeping water easily available to you throughout the day, in the car, even when you are away from home, means that you are able to drink to thirst. You will be more comfortable and feel better if you can get a drink whenever you want to, but unless you really get seriously behind on your fluid intake, it isn’t likely to affect milk production.

So increasing your water intake isn’t going to help you make more milk. Does this mean that there isn’t anything you can do? There are plenty of ways to increase your milk production, and a good Lactation Consultant can help you figure out the best ones for your situation. In the meantime, drink to thirst, and don’t let anyone get away with telling you to just drink more–they won’t be helping you, or the next 20 mothers they give the same poor advice. Instead, send them to milkwaybreastfeeding.com!

Why Wait? Breastfeeding and Early Inductions

An article in the January 22, 2013 Washington Post Health Section,  “Health insurers crack down on preterm deliveries that are not medically necessary,” discusses the many reasons why inducing or planning a C-section before 39 weeks is a bad idea.

While most babies delivered at 38 weeks do not end up in intensive care, research shows they are more likely to have feeding, breathing, and developmental problems than those born at 39-40 weeks (Galewitz, Phil. “Insurers attempt to curb early deliveries” January 22, 2013, E1).

The article goes on to discuss financial implications for patients and doctors of early deliveries, but little more is mentioned about feeding issues.  Difficulty establishing breastfeeding, however, is a significant health issue with life-altering consequences for both mothers and babies.  A baby who gets off to a bad start with breastfeeding is less likely to be breastfed exclusively or for a biologically-appropriate length of time.

Does a week really make a difference, though?  As a lactation consultant who has worked with thousands of mothers and babies, I can absolutely answer, “Yes!”  While we may label 37 weeks+ “full-term,” as this article points out, anything before 39 weeks gestation is, in fact, early.

The earlier a baby is born, the more likely he or she is to be “sleepy” and difficult to arouse for feedings or inefficient at feeding.  He or she then ends up at greater risk of developing jaundice and/or gaining weight insufficiently.  This baby may not be able to adequately stimulate milk production, thereby down-regulating the supply which leads to further weight gain issues.

The article mentions an increase in all sorts of health issues for babies born before 39 weeks including respiratory issues.  These health issues invariably affect a baby’s ability to feed.  Mothers are then forced to try to pump to establish and maintain milk production until their babies are able to do this on their own.  Pumping, even with a hospital-grade pump, is a challenging way to establish the milk supply.  Unfortunately, many mothers will give up either out of exhaustion or a lack of confidence in their body to produce enough milk.

So if we know that inducing before 39 weeks is not a good idea, why does it happen so often?  Sometimes there is a strong medical indication, and the risk is higher if the pregnancy is allowed to proceed.  However, when hospitals in South Carolina were offered a financial incentive to decrease early deliveries, they were able to decrease early deliveries by 50% while they also decreased NICU stays! (E4).  That is because many early deliveries are for convenience–the mother’s or the doctor’s.  The mother may be uncomfortable, and the doctor says the baby is “ready” anyway.  The doctor may have scheduled “induction” days and likes to keep to his or her schedule.  Sometimes mothers are afraid that their babies are getting too big and the delivery will be more difficult if they wait.

There are many reasons why mothers and doctors may agree to induce or schedule an early C-section.  From a breastfeeding perspective, however, these are a bad idea and anything but “convenient.”  If you want to breastfeed, then don’t ask for or accept an induction or C-section before 39 weeks, unless there is, medically, no other choice.  Better yet, let baby come in his or her own time, and don’t induce at all.  According to the article, infant mortality is greater at 37-38 weeks than at 42+ weeks (Center for Disease Control and Prevention 2008) .  In other words, it is usually safer to be overdue than to deliver early.

Don’t let convenience for the moment get in the way of your baby’s best start for life.