Tuesday, June 23, 2015

The best take on breastfeeding in public I've heard so far

In response to a PopSugar article called "Dear Breastfeeding Moms, Is It Really That Hard to Cover Up?" one facebook user shared this poignant response and social commentary (reposted with permission). A longer version can be found here.

First lesson: Lactation is an innate part of reproduction. Barring medical complication, lactation is the next step after delivery. At times induced (which is so awesome I can't even... But I digress) the point is, lactating may be innate, but nursing is not. Nursing is learned activity. Learned. Contrary to myth, women aren't born with the instinct to know exactly what to do. Mom and child are getting the hang of this together. Primates (that's us) require observation and exposure for continued success and sustained efforts. Normalizing is vital. Seeing nursing moms and children matter. It's empowering and necessary. The choice to cover should only be preference of mother/child. Never infringe on their comfort.

Second: Modesty deals with arbitrary sexist standards birthed from coverture. There is nothing indecent about feeding a child. If you see a child nursing and modesty comes to mind, the issue is yours. And sure, we sometimes view breasts sexually. Welcome to the amazing world of a human body. Where we use our mouths and hands sexually too. I certainly hope you aren't thinking of those as sexual when kissing and holding a child. Think about it.

Third: Those of you asking for your discomfort to be respected, pay attention: My rights to nurse my child without cover DO outweigh your nonexistent right to not be offended. This is fact of law. You hold no such right. The public square is for the public. There are more than enough offenses we all must tolerate, including bigoted, uneducated, ignorant ones. Alas. Learn the difference between what is a right under law and what isn't.

I'm a little confused why you think I ought to hold in high esteem the ignorant aversions of a stranger in regards to nursing? Of course I won't respect that kind of ignorance. That person's offense is not my business or issue. And I'm certainly not going to cater to it over the right of my child to eat without a cover over his face or the breast he is feeding from. Why would I? Why would you even expect me to?

Should we have respected the aversions people had to others drinking from the same fountain? Should we have said "oh, respect their bigotry, their opinion matters too". Of course not. Again: Of course not.

I am not going to respect the view that women and children be treated as second class citizens that are shamed under cover into hiding because an idiot has an aversion to seeing a human mammal feed from a human mammary gland. Never.

And quite frankly, you shouldn't either.

Fourth: Images are empowering. They matter.

We live in an age where rants of TMI is the norm. We post pictures of our pets, our food, our shoes and yes, we share images of our families too. But when women share photographs of the moments they share nursing their children, scorn rips defiant calling women exhibitionist. It shouldn't matter what motive a woman has, but if we needed a reason, there are plenty of them. The images are empowering to many who are looking. They normalize breastfeeding as just another memorable moment a parent is having. And they encourage those who don't understand why critics didn't just keep scrolling.

Fifth: Human mammals require milk beyond infancy. Milk is a developmental requirement custom to species. Jaws alter, cheek fat diminishes, milk teeth drop, mammals wean. Until then, it's nonsense to suggest there would be anything weird about a human mammal expressing human milk from human mammary glands. What's weird is that we'd drink milk from another species after the wean. But alas, cheese. The age of weaning is a spectrum, not an arbitrary line. And telling my child he is weird because your child didn't nurse through those years is absurd.

If you're concerned about children being exposed, perhaps your answer is to teach them anatomy.

Monday, June 22, 2015

Bed-sharing: What your pediatrician won't tell you

Here's how the typical American story goes: Mom and dad take baby home. When nighttime rolls around, they put baby in his crib and head to their own bed. Baby gets hungry some time later and starts stirring. He starts smacking his lips, moving his head around looking for mommy's breast. He doesn't find it and starts to wail. This pulls mom (and dad) out of sleep, and mom drags herself to go pick baby up and try not to fall asleep as she feeds him. She will repeat this several times a night for months.

What ends up happening is that moms will fall asleep with the baby in her arms on the couch, in the glider, or in her bed. This can be dangerous if the baby slips out of her arms into soft couch cushions. But there is an alternative. Safe bedsharing, or as this article calls it, "smart bedsharing." I'm convinced that if you took out all of the unintentional bedsharing (any instance of falling asleep with baby in an unplanned, unprepared way), the data would show that intentional bedsharing is as safe as "safe sleep" (ie: putting the baby on his back in an obstacle-free separate space).  

I had already made the decision to bedshare with my newborn daughter by the third day she was home. Like most new parents, I was under the impression that the baby has to be in her own space. I tried to put her down, but she wouldn't cooperate. She simply slept best on me. For the first two nights, I slept on the couch the whole night with her on my chest. (Read: very dangerous!)

Then I hired a post-partum doula. She, of course, would not advise me to bedshare. I'm pretty sure it's a liability issue. Nobody will advise you to do it. Yet, every parent I talk to says that they bedshare(d) with their infants, whether or not they intended to. Many sheepishly admit they did it, adding that it's inevitable.

If bedsharing is inevitable, then can we please talk openly about how to do it safely and its benefits? And while we are being real, let's admit to ourselves, collectively, that far more infants die in car crashes from sleep-deprived parents on the road than die in bedsharing accidents? Yet, we aren't really telling parents to stay off the road.

I'll start by saying what I love about bedsharing:

1. It helps establish milk supply. With the baby next to me or sleeping on me, I get plenty of skin-to-skin contact with her. This helped to establish my milk supply in those early days.

2. Significantly improved sleep. I wake up when she starts to get hungry, rather than waiting for her to be all-out crying. This means that everyone gets better sleep -- mom, dad, and baby (and any others within earshot).

3. Baby gets comfort from sleeping next to mom. She also gets cues from mom, such as regular breathing.

4. Varied sleeping positions. After she nurses, I'll position her on my chest or on my stomach so that she can be on an incline after feeding -- helping her get burps out. This allows her and me to get right back to sleep without the discomfort of bubbles in her belly. 

5. Both mom and baby love snuggling. This is a scientific fact.

In contrast, putting baby on her back in her own space results in poor sleep for everyone involved (at least in my family), more gas and discomfort, less skin-to-skin, no breathing benefits, and it's less fun for both mommy and baby. But it is reportedly the safest position to reduce SIDS and suffocation deaths.

Here's the truth: people will end up bedsharing. But if it is not recommended or talked about, then parents will not do it intentionally and thus not safely. I mentioned to our pediatrician that I was bedsharing with our daughter, and told her that I was fully aware that the recommendation was to put baby on her back in her own space, but that I had already looked into the matter and had come to a decision. This would have been a great opportunity for the doctor to educate me on making bedsharing as safe as possible. Instead, she went on and on about the guidelines for safe sleep, trying to talk me out of it.

Back to our doula: After recognizing that safe sleep guidelines all recommend back sleeping, she worked with with me to make the bedsharing environment safe. We inspected the mattresses in my home and determined the best one for baby (on the firmer side -- not the pillowtop one). We made the bed with a tight fit with jersey sheets. We pulled down the blanket to mid-bed. We chose a small pillow for me that would be placed under my head, but with my head at one end with the other end away from baby. We tried out several positions -- baby facing me, facing away, on chest, on stomach.

Guidelines for safe bedsharing:
  1. Mattress is firm. Pillowtop or memory foam mattresses should be avoided. Feel a crib mattress for comparison. 
  2. Fitted sheet is tightly tucked so that there are no folds. 
  3. Minimize blankets. I use the top sheet plus one blanket. 
  4. Keep blankets at waist level. You can wear a long-sleeved shirt for warmth up top (though you may want to wear a nursing top). 
  5. Place baby on her back. I also place the baby on her side facing me, but you will have to determine your level of comfort. 

Pretty in Pink: The real challenge for gender stereotypes

My daughter was born on the same day as the princess in England. We chuckled at the coincidence and promised our daughter that she would never be a princess. Instead, she would be free to make her own choices and pursue her own passions, whatever they may be. And she will certainly be able to dress however she pleases. When I was a little girl, I used to wear shirts with bugs or dinosaurs on them. While I recognize that my influence may not be stronger than the influence of her peers, I secretly hope that she will not be one of those pink-clad, princess-obsessed little girls who is endlessly fascinated with sparkles.

Lucky for me and parents like me, the feminist movement has brought us this: Princess Awesome. It is a clothing company that had wild success getting funded through Kickstarter. The HuffPo article headline read: Moms Launch Stereotype-Bashing Clothing Line That Challenges What It Means To Be 'Girly'. Full disclaimer: this project was started by a former colleague and I wish her great success. I do, however, challenge that it is "stereotype bashing." I think the prints are cute (flowers and ninjas, adorable!), but they are still, alas, dresses. And it is still, alas, called "Princess Awesome."

Our society is fully ready to accept little girls wearing dresses with ninjas and math symbols. What we aren't ready for is little boys wearing dresses and flowers.

My husband and I noticed this trend when opted to wait until our child's birth to discover her sex. We thought it was medically irrelevant during the pregnancy, and my siblings had all done the same with their first child. When we received presents, we noticed a curious thing: folks were willing to give outfits that were clearly meant for boys, but nobody would commit to giving a more traditionally "girly" outfit.

Why are we culturally okay with little girls wearing footballs and trucks, but we would never see a little boy in a frilly dress?

I found an online discussion in an online forum on BabyCenter, where all walks of life come together to discuss everything, and I mean everything, about babies. A user poses this question:

"Can anyone come up with a good reason why dressing your boy child (infant toddler or older) in pink, frilly, flowery cloths is not common practice?" She goes on to say that, while she considers herself to be free of gender biases, especially for infants, she doesn't think she could bring herself to dress a little boy in girly clothes.

Someone responds: "Pink is fine on boys if the clothes have the boy style to them. Flowers...not so much. It just doesn't jibe well for them. It's not biased just can't see a boy with a flowered shirt. And frilly on a boy? Nope can't do that either."

But this response doesn't really hold up.  For one, our perception that flowers and pink are girly is entirely cultural. There is nothing masculine about blue and feminine about pink, and not all cultures even share this view (read more here). For another, it's not even really possible to tell whether babies are male or female once they have a diaper on.

So here's my challenge to anyone who considers him or herself a feminist: Instead of lauding ideas such as dressing up girls in math-print dresses as progressive and "sterotype-bashing", let's really challenge what we are willing to accept. Ask yourself: would you put a dress on a little boy? If you saw a little boy in a pink tutu, what would you think?

I'll end with a story. A little boy wanted a princess-themed birthday party when he turned five. His parents didn't see any reason why they shouldn't oblige his wishes, so they did it. By the time he was seven (when I met him), he was so embarrassed about the party that he was unwilling to talk about it. That's what needs to change.

Wednesday, May 27, 2015

I can't beleive my insurance company is paying for all of this!

This is kind of the anti-post. I have to say that I haven't had much to complain write about since I've been on the University's staff health care plan. It's really quite good coverage, which I guess highlights the huge difference in quality of life that an insurance plan can impact.

I will complain about the state of maternity leave in this country in the next post (promise). 

Here's the latest: I'm now 3 weeks post-partum. My gorgeous sleeping baby is sleeping in the baby carrier strapped to me as I type this. Throughout the pregnancy, I was part of a few groups online for fellow type 1s who are pregnant or moms. There were some crazy stories about the absurd amount of money they had to pay up front to the OB department in order to receive care.

Several women report having to pay $2,000 to $4,000 for their OB care, which doesn't necessarily include all charges, such as lab work, specialists, etc. 

One woman reports, "We pay out of pocket up to $4k I think, then 20% of the next $1k then 0% (in-network). I believe that I'll be paying whatever the standard "high risk" CS delivery is but it's pretty confusing what's included."

Another says, "I had to pay my OB before week 28. 3,200 dollars [sic]... Not including [sic] pediatrician, hospital and anesthesiologist."

So you can imagine my anticipation when I received the hospital bill for my pregnancy. Wait for it... $14. That's it. The rest was covered. And if we are being accurate, the $14 was for two guest meals for my husband while we were in the hospital. I kept asking, during my 40 appointments over the 40 weeks of pregnancy, if I was going to see a bill. I thought that each OB visit qualified as a specialist visit and cost $30 copay. This would add up to $1200, which I was prepared for. 

So you can see how this surprised me, especially after getting unexpected bills quite frequently over the years. 

Good job, PremiereCare/University of Michigan. Now, if you could please work on maternity leave. 

Wednesday, March 18, 2015

MedEQUIP partially reedems itself; Dexcom comes down a peg

I blame my insurance for not being cool and amazing and doing all it can to make life easy for someone with a chronic illness. Let me explain. My insurance doesn't allow for automatic refills (ie: they just autosend you your supplies every three months). I was getting auto refills when on the AMAZING MASSHEALTH PLAN that will live on in my heart and mind as the single best plan I have ever been on. They checked the insurance every month and shipped me supplies if all checked out. The other time I had auto refills was on Kaiser. They did NOT check my coverage for changes before shipping the supplies, and I ended up with a $780 bill (of course I disputed it and WON, because I am the dispute mistress!).

So this insurance plan, which is amazing in almost every way--trust me, I read through the Benefits document front to back, doesn't allow for automatic refills. They require that you call the company (or the company calls you, before shipping out the supplies. This would be fine if the company did it (they are, after all, making money off of this service). I'm less likely to remember to refill my supplies on a regular basis and end up running out and going without a sensor, or worse, without pump supplies, until the new supplies arrive. I'm sure this is why the insurance company does it: to save money when people like me forget to refill regularly.

I was SO FRUSTRATED with MedEQUIP for not calling me when my supplies were up for refill. It happened many times, and they always CLAIMED that they did call me. Uh, in that case, there would be a missed call on my phone, and anyways don't just call once!

Pro tip: Type 1 diabetes DOES NOT GO AWAY. I will always need insulin and supplies. Why the eff do I have to continually deal with refills? There should be an exception when it comes to chronic illnesses.

Anywho, I went through this whole thing where I switched my CGM supplies ordering to Dexcom. They assured me that they would call me every 3 months to get my refill authorization. They have a vested interest in getting more products out the door, right?

I trusted them, but ONCE AGAIN found myself out of sensors, right before heading to Boston for a long weekend. This was not going to be good. I called Dexcom to ask "What the hell?" and the ordering department told me, "Oh, no, we don't call customers to refill orders. We have a lot of customers! We do have an auto-refill program."

SO, who did I have to turn to for last-minute sensors? That's right, MedEQUIP. I called and begged them to refill my sensors right away, as I was heading to the airport and had literally 15 minutes to spare. They totally came through! I swung by the office and grabbed the sensors, and made it in time for my flight. Still, I will stick with Dexcom, just knowing that I will have to call my sensor order in every three months (MedEQUIP would make me do it every month). Dexcom also sent me two free sensors to make up for the loss in my overflow. But, I will no longer shake my fist angrily every time I drive by the MedEQUIP office.

Friday, January 23, 2015

Lumped into a category: Pregnant and diabetic

It's been 26 weeks of this new category: pregnant and diabetic. I've heard others who are a bit further along say they don't know how much more they can take... that they are getting treatment from their insurance companies and medical team that are hindering their ease of diabetes management.

I've been a bit frustrated by the medical industry's lack of interest in accuracy. I know that there have to be broad designations, but there MUST be room for accuracy! Type 1 diabetes + pregnancy = high risk. Period. No way around it.

I've been doing OK with my blood sugars. My A1c hovers around a 6% (the low end of where you start seeing complications). I haven't had too many readings over 200, and only once over 250. I've been exercising 2-4 times a week, and have been taking my vitamins and eating my veggies. My eyes are fine, my kidney function is excellent, my lipids are amazing, my blood pressure and pulse on the healthy end of the spectrum... My doctor agrees that my blood glucose readings give him no cause for concern.

And yet, I still get designated a high-risk pregnancy. Not that I particularly mind; I get far more ultrasounds than the average woman, I've had growth scans every month, an echocardiogram to examine the baby's heart, and I've been sending my numbers to the doctor every week and working with him to adjust my rates. I kind of like the attention. But I don't like the inaccuracy.

This could come to a head when it comes to deciding when and how baby comes into the world. The doctor already told me that he would like to induce labor at 38 weeks. This article explains why it's best to wait until at least 39 weeks. Of course, I would like baby to be as healthy as possible, and come into the world when he or she is ready.

If there is sound medical reasoning for inducing the baby at 38 weeks (based on actual information--like how the baby is measuring, how my blood sugars have been, etc), then I will of course consider it. But if they are saying this because on average, diabetic women (lumping type 1, type 2, and gestational in one category) deliver large for gestational age babies, then I would hope that they would seek to me more accurate when dolling out medical commandments!

Thursday, October 30, 2014

Corporations are people too: MedEQUIP tries to save face through repeatedly lying

As I complain to my husband about the much-hated, much-talked-about-in-our-household Med EQUIP--the medical supplies company that my insurance company forces me to use--he reminds re, "Remember, corporations are people, too."

Apparently they are, because this company would apparently rather save face by lying repeated (verifiable lies, mind you), and hanging up on their customers, rather than actually solving a problem or having good customer service.

Here's the latest: I get a call roughly every month from MedEQUIP asking if I need my Dexcom sensors. "Yes," I tell them every time, "Still a diabetic." Some months they are a few days late in calling, some months they are a week or two late. (Why not just automate the process? We'll get to that later.)

This month, after coming back from a trip, I went to grab a new sensor, but I didn't have any left! Odd, I thought, I didn't get a refill call yet. So I called The Dreaded MedEQUIP (they get an angry fist shake every time I drive by their office), and they told me this very verifiable factoid:

"According to our notes, we called you on October 13 to refill the order."

Here's the thing--my number is a GoogleVoice number and every call, missed call, voicemail, and text message can be looked up in my GoogleVoice inbox. So I looked. Oct. 11, missed call from my mom. Oct. 16, voicemail from my dad. October 13: NOTHING.

They simply lied to me.

I was pretty stern with the woman, letting her know that this was not acceptable and telling her that it is seriously not OK for me to be off my sensors (bordering on rude, but still within the bounds), and next thing I know, I'm HEARING THE DIAL TONE. Lady hung up on me! I called back, but the office had since closed. I called again this morning, and the woman I am used to dealing with, Vicky, was not in the office yet. Not to mention that I need my #$@!ing sensors.

This is not the first time MedEQUIP lied to me.

Last June, when my Dexcom receiver died (the USB port gave out), I ordered a new one through MedEQUIP. Several days went by; nothing. Three weeks passed and still no receiver. So finally I went and camped in the MedEQUIP office (thinking about doing that again today), and talked with Vicky, who told me that it was held up because they were waiting on insurance approval.

I later verified that this was absolutely false, and that the insurance had approved it within a few days.

If you are looking for a medical supplier for sensors that it reliable rather than ego-driven and substandard, my advice is to order through Dexcom and complain to the insurance company, your endo, anyone, so that MedEQUIP is held accountable for its distinctly mediocre service. At least Dexcom will be motivated to get sensors to you on time (they want to move more units, after all). They are also available when you need them, and will overnight sensors in a pinch.

*As a note, I found out that Blue Care Network (University of Michigan's largest insurance provider) does not allow companies to autoship sensors, nor does it allow 90-day fills of sensors. WTF?