Hi Debbie,
Yes 2/3 to 3/4 of mothers at the hospital where I used to work were as you described.
But they still had the same belief set about breastfeeding that you described. Then just try to get them to use a pump (for a NICU baby) effectively when they have no real knowledge of how their breasts make milk.
However there were a few moms who just "knew' about breastfeeding and just breastfed - and it worked! Imagine that!
I have to admit, I don't know exactly how our Medicaid covers. It has been in such flux the last several years as the state govt tried to keep the state from going permanently in the Red. So who was covered and what services were covered changed and were loudly argued about in public forums that it was hard to track.
But within the hospital, because the OBs required a decision be made on birth control prior to discharge, it still boiled down to The PIll vs Depo as standalone, or as a Bridge to an IUD. (hmmm - who paid for that?)
I never looked at their insurance info when I reviewed the chart for birth / health info prior to seeing mom.
And the IUD was commonly the Mirena. That's another one where observations say it affects milk supply within the week of placement but M&MM says it's Acceptable; it's not on the Avoid list.
Phyllis
---- debbie farb <[log in to unmask]> wrote:
=============
Hi Phyllis,
I am wondering if you are speaking about the indigent, pregnant US
population not covered by Medicaid, which is mostly undocumented
immigrants. These folks get Emergency Medicaid to cover just their delivery
time period, and you are correct that their postpartum checkup /
contraception appt is not covered.
However, for citizens and a few other types of folks who have actual
Medicaid for Pregnant Women, in my state they get at least two (and
sometimes closer to three) months of insurance coverage postpartum. Their
postpartum appt and birth control is covered 100% during that time period.
So in theory they could be offered a first depo injection either
immediately postpartum or at their postpartum checkup appt - around six
weeks postpartum.
For me, this is a tricky and discouraging topic overall. I work with these
populations prenatally/postpartum, and do let moms know prenatally about
the risks of depo given immediately postpartum in terms of milk supply.
However, most of these moms are not at all convinced about the importance
of breastfeeding and/or do not have adequate breastfeeding support, and
many plan to do a combo of breast and formula from the get-go.
Additionally, many say they are planning to breastfeed but yet do not even
attempt to nurse or express at the hospital. In these common scenarios, I'm
not sure how much the potential supply dip from early depo matters...
Debbie Farb, RN, BSN, MPH, IBCLC
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--
Phyllis Adamson, BA, IBCLC, RLC
Glendale, AZ.
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