Work Life

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.

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, which I now understand is a choice most of them make on purpose, and 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, which is 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, which I decided to read as progress.

Round 3 — the appeal. This is the part that 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.

Three weeks in daycare, three illnesses, and now I have it too. Is this just the tax? Does it end or is this the rest of the year?

Bought a hands-free set, put a windscreen 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?

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, which gives me about two weeks before this becomes a real problem instead of a bad feeling.

Here's 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, which is somehow worse. He said — 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 the part that 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, because 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 that 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'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 I want to say up front: intake is not the problem, because 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 in Grand Rapids, 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, which we have already paid the deposit on.

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.

The part that'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 for 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 genuinely take anything. Thank you for reading all of that.

My office has a 'wellness room' which is a converted stationery cupboard 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?

Sorry, this is long, and I know it's probably the hundredth version of this question. Feel free to skip me.

FTM. LO was born January 29, so she's just under five weeks old. She has been to all six of these tours in a car seat. I go back April 27 — I'm a dental hygienist, pediatric office, so there is no WFH version of my job, I can't clean a four-year-old's teeth over Zoom — and that's eight weeks from now.

Denver. Six tours, a spreadsheet with 14 columns, and I think I've made myself dumber rather than smarter. Here's what I've got:

Center A — big national chain, infant room 1:4, licensed, NAEYC accredited. $2,485/month. That is not a typo. That is more than our mortgage. Waitlist: I was told to get on it "ideally in the first trimester," and when I said the baby is already here, in this car seat, the woman did a face. She offered me October.

Center B — smaller, local, infant room 1:4 on paper. I counted while I was standing there and it was one adult and five babies at 10am. When I asked, she said someone was on break. $2,180/month. Available in September.

In-home C — licensed, six kids total, two of them infants, one provider plus her adult daughter part-time. $1,340/month. Spotless. She's done this 19 years and was the only person on any of six tours who asked me a question about my baby instead of about my billing preferences. Available April 20, which is suspicious to me? Why is she available.

Nanny share — found a family through a neighborhood group, roughly $1,750/month each for two babies, but they want to start April 1 and we'd be paying most of a month for nothing.

My actual questions, and I apologize for how many there are:

1. Is 1:4 the real number for infants, or is that just Colorado? Everything I read gives a different figure and I can't tell what's law and what's a recommendation somebody wrote in a blog post in 2019.

2. Center B was over ratio while I was standing there, on a scheduled tour, when they knew a prospective parent was in the building. Is that a walk-away, or is that just what a break looks like and I'm being naive?

3. In-home vs center. Every center person implies in-homes are unregulated, every in-home person implies centers warehouse babies, and I have no way to referee that.

4. Is $2,485 normal?? I keep saying the number out loud to people and they don't react, and I can't tell if that means it's normal or if they're being polite. My take-home is $4,900. I've run the numbers on quitting and the math is close enough that it's frightening, and I don't want to quit, and I feel guilty for not wanting to quit.

5. Nobody warned me you're supposed to do this while pregnant. Nobody. My OB asked about car seats. Not one person in nine months said "call daycares at 10 weeks." How is that not on a list somewhere.

I know I'm spiraling. She's five weeks old, she's asleep on me right now, and I'm supposed to hand her to a stranger in eight weeks and I can't tell anymore whether I'm evaluating these places or just hunting for a reason that none of them are good enough.

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

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?