Feeding

Someone asked in April whether the logistics get easier. They do. Not because it changes, but because you stop apologizing for it. I put 'blocked' in the calendar with no explanation, like everyone said, and nobody has ever asked once.

It's 3am. I'm pumping. This is my MOTN session and I've done it every night since February, and I'm typing this one-handed with the Baby Buddha going, because if I don't say it now I'll lose my nerve by morning.

LO is 5 months. EP since week 3. I have never once fed her from my body and I've made my peace with that, mostly, at around 2pm on a good day!

Here's what my life is. Five pumps: 3am, 7am, 12, 4, 9pm. Twenty minutes each, plus setup, plus washing, call it 35 real minutes a session, so about three hours a day. I make 31 oz. She eats 28. I have 340 oz in a deep freezer in the garage that we bought FOR the milk. I have three sets of flanges, two pumps, a wearable for the car, a cooler bag, and a drying rack that lives on my counter permanently and that I hate with my whole chest!

I'm the person who tells everyone else which pump to buy! I have a note on my phone with duckbill valve replacement intervals. If you'd asked me in March I'd have said I'd go to a year, easy, I have the systems.

And I want to stop so badly that I sat in my car in the Target parking lot on Thursday and cried about it, and then went inside and bought more milk storage bags. Lol.

Nobody is making me do this. That's what I can't get past. My husband told me to quit in May. He said it kindly and I snapped at him. My mom told me to quit. My best friend, who formula fed both of hers and whose kids are fine, tall, happy, told me to quit. There is not one single person in my life on the other side of this argument. It's me. I'm the entire opposition!

So I'm not asking how to wean off the pump. I know how. Drop a session every few days, watch for clogs. I've read all of it, I could write it. I'm asking when YOU stopped. And I think, being honest at 3am, which is the only time I'm honest, I'm asking somebody to say a number smaller than a year out loud so I can hear it and not fall apart.

Because here's what I can't say in daylight: I don't like her as much when I'm pumping. When she's crying at 3am and I'm attached to a machine and can't pick her up, I resent a five month old. And then I hate myself. And then I do it again the next night. Three hours a day of a thing that's making me a worse mother, so that she can have the good milk, from the worse mother.

I have 340 oz in the garage. That's twelve days. Twelve whole days of being someone who can just pick her up.

When did you stop? Did the guilt go away? Please just tell me a number.

Someone at a baby group said 'nursery water' like it was obvious and I nodded along and then googled it in the car. What else is everyone pretending to already know?

Fourteen weeks. That's how long this took. I'm writing it all down because I could not find this anywhere when I was in it, and if one person copies this and skips even four of those weeks it was worth typing.

Background: baby's six months, I'm in Tucson, back at work since April. I saw an IBCLC twice. Once at three weeks when my daughter wasn't transferring, once at six weeks for a pumping plan before I went back. $300 each. She's cash-pay. Most of them are, on purpose, which I did not understand at the time. She gave me a superbill.

The ACA says lactation support and counseling is preventive care. Zero cost share. No deductible. It's not a nice thing my plan does, it's required.

Round 1, denied. Submitted February 12. Denied March 3. Reason code 242, "services not provided by network/primary care providers." So: out of network, eat it.

The phone call that changed everything. I called Cigna and said: fine, give me the name of an in-network IBCLC within 30 miles of my zip code. Not a list of hospitals. A name.

She gave me four. I called all four. One was a hospital lab. A LAB! Two were OB practices where the front desk had never heard the word IBCLC and one of them offered to transfer me to billing. The fourth was a disconnected number. I wrote down all four names, the date, the time, and what each one said, verbatim, in a Google Doc. That doc is the reason I got paid.

Round 2, the superbill was wrong. My IBCLC's original superbill had only S9443 on it, a lactation class code, and Cigna's rep literally said "that's educational, that's not a covered medical service." She reissued it with diagnosis code Z39.1 (encounter for care and examination of lactating mother) and CPT 99404 for the counseling. Denied again March 20, but for a different reason, and I decided to read that as progress.

Round 3, the appeal. This is what worked. I used the NWLC Breastfeeding Toolkit template letter, which is free and which I wish somebody had put in my hospital discharge folder. Three things went in it:

1. I requested a gap exception (some plans call it a network exception). If there's no in-network provider who can actually deliver the covered service, they cover out-of-network at the in-network rate.

2. I cited the tri-agency FAQ, Part 54, which says in plain language that if a plan has no in-network provider who can provide lactation counseling, it must cover an out-of-network one with no cost sharing. Not at a discount. No cost sharing.

3. The Google Doc. All four names, dates, times, and the sentence "a lab" appearing in a document I sent to my insurance company.

Filed April 6. Paid May 22. $600, all of it, no cost share.

Nothing about this was clever. I was not smart, I was just annoying for fourteen weeks in a row while being sleep deprived and pumping in a supply closet. The denial is the opening offer. That's the whole trick. They deny because most people stop, and I have to assume it works, because I nearly stopped twice.

Found Brooke's post from the winter and it's exactly what's happening to me. 5pm to 10pm, continuous. Knowing it has a name and other people survived it is doing a lot of work right now.

Flying next month with frozen milk and I've read the rules and I still don't trust that the person at the front will have. Has anyone actually been through with a cooler bag? What happened?

Second baby, he's five weeks, and I have a 2yo who is currently eating dry cereal off the floor while I type this, so forgive the typos!

Around week two my nipples were creased flat coming out, like a lipstick, that shape everyone describes, and the pain was making me dread the letdown. With my first I never had this. I assumed second baby, easier, I know what I'm doing. I did not!

So I booked with a "lactation consultant" who does appointments out of a boutique baby store here in Sacramento. Her website said lactation consultant. Her sign said lactation consultant. She said lactation consultant on the phone. $225, cash, no superbill, and I paid it happily because I was in pain and I wanted help.

She watched maybe four minutes of a feed. Did not weigh him before or after. Did not put a gloved finger in his mouth. She looked under his tongue for a couple of seconds with her phone flashlight and said "posterior tongue tie, that's your problem," and handed me a card for a pediatric dentist who does laser releases. $700, cash, and he had an opening that Thursday.

I almost booked it. I was one tap from booking it. My husband, who is not a nervous person and does not usually push back on medical stuff, said something like, is she a doctor? And I said no, she's a lactation consultant, and he said okay, but what IS that. And I couldn't answer! i had paid this woman $225 and I could not tell you what her training was.

Here's what I found out. "Lactation consultant" is not a protected title in the US. Anyone can print it on a sign. The credential is IBCLC. Board certified, hundreds of supervised clinical hours, an exam, recertification. What she actually had was a weekend "lactation educator" certificate. Which is not nothing! It's a real thing that helps real people! It is also not the person who should be pointing at my son's mouth and sending me to a laser.

I found an actual IBCLC through the ILCA directory. $250. MORE than I paid the first woman! And it was ninety minutes. She weighed him before the feed and after (he transferred 2.7 oz in 18 minutes, which she said was great). She watched me latch him three different ways. And then she pointed out that I was doing the whole feed hunched sideways on the couch with one arm out, because my 2yo was climbing me, and my son was getting a shallow latch because I was physically not able to bring him to me.

She said, and I'm quoting: "I do see some restriction under his tongue. I'm not the person who diagnoses that. If we fix positioning and you still hurt in ten days, I'll send you for a functional assessment. A lot of what I see under tongues never needs releasing."

Six days of side-lying and a rolled towel and the pain is gone. Gone! My son still has whatever is under his tongue. He doesn't need a laser, he needed his mother to not be feeding him at a 45 degree angle while refereeing a toddler.

I'm not writing this to trash the first woman. I'm writing it because I have a graduate degree and I could not tell those two job titles apart, and I was four minutes and $700 from a surgical procedure on a five-week-old. How is anyone supposed to know this?

Bought a hands-free set, put a windshield shade up, and now I pump on the drive home. It's the most efficient 25 minutes of my day. Slightly bleak? Yes. Working? Also yes. What's your unglamorous solution that actually works?

Six months next week and everyone's telling me something different. Purees, baby led, both, neither. I'm mostly scared of the choking part. What did you actually start with on day one?

I said Monday I was wrecked. It's Friday, I have a glass of wine, and here's the actual reason.

Setup, so you can triage me properly. LO is 19 weeks. EBF. She nurses when I'm with her, morning, evening, and once MOTN, and I only pump at work. Spectra S1, 24mm flanges, four sessions a day: 8:30, 11:30, 2:00, 4:30, twenty minutes each.

Daycare sends home a bottle log, so I know the number exactly. She takes 11 oz across the day, three bottles, paced. So I need 11 oz.

Monday I brought home 9. Wednesday I brought home 8. Thursday, 7.5. And on Saturday, on my own couch, pumping once in the morning after she'd already nursed, I got 5 oz out of one sitting.

Five oz on my couch. Two in the closet. Same pump, same body, same week. I have maybe 40 oz in the freezer and I'm eating into it every single day. Two weeks, roughly, before this stops being a bad feeling and turns into a real problem.

Where it happens. There's a storage closet on the second floor. No window, one outlet behind a shelving unit, a box fan someone left in 2019, and a wall of toner cartridges and copy paper. No lock. I taped a piece of printer paper to the door that says PLEASE KNOCK - PUMPING, and on Tuesday a guy from facilities opened it anyway, at 11:40, while I was topless and attached to a machine, and said "oh, sorry." And then STOOD THERE for a beat like he was waiting for me to tell him it was fine.

I asked my manager Monday. He is not a bad guy. Somehow that's worse. He said this, and I wrote it down afterward because I wanted the exact words: "Yeah, of course, whatever you need. Can you try to line it up with your lunch, or before the 11 standup? I just don't want it to look like you're gone all the time."

Look like. To who. There is nobody counting except him, and now me.

I said milk doesn't run on the standup schedule and he laughed like I'd made a joke.

Then Thursday the closet was full of chairs for an all-hands, so I pumped in my car in the parking garage, level 3, hoodie over my chest, hazards on. And that's what made me cry. Not the guy walking in. The hazards. I was sitting in a Honda in a concrete garage making food for my daughter with my hazards on, like I'd broken down.

What I want to know from people who've done this:

Does the work number ever come back up, or is 2 oz just what work is now? Because if it's permanent I need to know while I still have a stash, not in two weeks when I don't.

And did anyone actually make their employer give them a real room? Or did you all do the closet for a year and let it go? I keep drafting an email to HR and deleting it. I can hear myself sounding difficult in my own head.

STM, so I should be better at this. First time around I was home. I nursed on the couch and never touched a pump in my life. Nobody warned me the hard part of baby two would be a door.

Everyone told me the guilt would be the hard bit. It isn't. It's the logistics. Pumping three times, washing parts in a communal sink, and pretending I'm fine in a 2pm meeting with letdown. Does the logistics part get easier or do you just get better at it?

I don't post much. I'm posting because I did the math this morning and it made me sit down.

We're rural. Nearest town is 20 minutes, nearest anything else is not. My LO is 8 months now but this was back at three weeks, when she wasn't gaining and my milk hadn't come in properly and I was losing my mind about it.

The nearest IBCLC, the actual credential, not a class, was 2 hours and 40 minutes away. I know because I called everyone closer first. There's a hospital 50 minutes from us with a lactation program but it's inpatient only, so unless you're currently admitted you can't be seen. There's a "lactation educator" 30 minutes away who I did see, and who was kind, and who told me things I later found out were wrong. I don't blame her. She wasn't trained for what I brought her. I just didn't know there was a difference between what she had and what I needed, because nobody tells you the letters mean something.

So we drove. My husband drove, I sat in the back next to the car seat, we stopped once each way to feed. Five hours and 20 minutes of driving for a 50 minute appointment. She weighed her, watched a full feed, found a posterior tongue tie that two other people had missed, and told me my flange size was wrong. Which was the single thing that changed everything and took her about 90 seconds to spot.

We did that drive four times.

What I'm actually angry about took me eight months to be able to say. That was never presented to me as unusual. Everyone I spoke to, my OB's office, the pediatrician, the nurse line, talked about it like driving five hours to get a baby weighed was just what you do out here. And it is what you do out here. But it being normal is not the same as it being fine.

I read that something like a third of US counties don't have a birthing hospital or an OB at all, and that people out here travel almost three times as far for care. When I read that number I cried, honestly, because I'd spent eight months thinking I'd handled something badly.

Not really asking anything. I want to know who else is out here. How far is yours? Not your worst-case story. Your actual normal. The drive you don't think about anymore because you've done it so many times.

I'm sorry in advance for the length. I've been drafting this in my head at 3am for a week and I think if I don't put the whole thing down somewhere I'm going to lose it in the parking lot at work.

LO was born January 29, so six weeks tomorrow. 7 lb 2 oz at birth, dropped to 6 lb 9, back to birth weight at day 11, and at her one month she was 10 lb 4 oz. 45th percentile and tracking her own curve. EBF since about day four. The first two weeks were bad, my right side cracked and bled and I white-knuckled through it, but the latch is fine now and has been for a month. We're at 8 or 9 wet diapers and 3 to 4 dirty. So, up front: intake is not the problem. I know that's the first thing people ask and I don't want anyone to waste a reply on it.

The problem is that I go back to work on April 27. Pediatric dental office here in Denver, 8:30 to 5, and I'm a hygienist so my day is columns of appointments. There is no "I'll just run home." Daycare starts April 20 for a transition week and it's $1,340 a month and we have already paid the deposit.

I started offering a bottle at five weeks because everything I read said four to six weeks is the window. First attempt she took maybe a quarter of an ounce, made a face like I'd handed her a lemon, and then arched her whole back and screamed until she was purple and sweating. Eight days later we are worse, not better. Now she cries when she sees it. Not when it's in her mouth. When she SEES it!

What I've tried, because I have absolutely over-researched this: Dr. Brown's Level 1, Comotomo, Lansinoh mOmma, milk warmed to 99 degrees with an actual thermometer because I am unwell, milk straight from the fridge in case she wanted it cold, offering drowsy, offering when she was starving (catastrophic, do not do this!), offering after a full nursing session, a dream feed around 10pm, my husband trying while I hid in our bedroom, my mom trying while I hid in our bedroom.

What's actually getting me is that she looks at me while she's screaming like I am doing something to her. Like I've betrayed her. And then twenty minutes later she nurses like nothing happened and falls asleep on me and I sit there feeling like a monster. Over a bottle.

I have 9 oz in the fridge and about 90 in the freezer and none of it is worth anything if she won't drink it. i keep finding threads where people say some babies just hold out and reverse cycle and nurse all night once you're back... and I do not know how to be a person who cleans teeth for eight hours after a night like that.

So. Have I made this worse by pushing eight days in a row? Should I stop entirely for a week? Did anyone's baby actually turn the corner on this, and how long did it take? I will take literally anything at this point! Thank you for reading all of that, sorry again!

My office has a 'wellness room' which is a converted stationery closet with a chair. No fridge, no lock that works. What did you actually ask for, and how did you ask without it being A Whole Thing?

My supply is dropping and I've decided to stop. Logically I'm at peace with it and emotionally not at all. Nobody tells you that you might grieve it. Did anyone else find the end harder than the start?

Starting daycare in six weeks and they've asked how many bottles a day. She's EBF and I have no idea how much she takes because, well, I'm not a bottle. How did you work this out?

Following up on the Southeast batch: our thinnest coverage right now is IBCLCs in the Midwest and Mountain West. If you had someone who helped you, even virtually, I'd love their name. These are the searches we're failing most often.

She took a bottle happily from about 8 weeks. I go back to work in six weeks and now she screams at it like I've betrayed her. Same bottle, same milk, same everything. What on earth changed?

My 4 month old feeds basically continuously from 5pm to 9pm. Not a growth spurt, it's been three weeks. I can't cook, can't hold the toddler, can't do anything but sit there. Is there a name for this or is this just what evenings are now?

What's the best bottle to transition to for an exclusively breastfed baby who will be 5 months old when I go back to work? I've seen a lot of recs for Dr. Bronners bottles, but is it worth dealing with all the different parts?

We are seeking more lactation specialists on the West Coast. If you know of any great providers, drop their links below!