Well, this whole issue has sure opened a can of worms, hasn't it? Many of
you have talked about the issues of why insurance companies should reimburse
healthy mothers & babies for providing the baby's food, why to do so would
be further medicalizing what is essentially a normal process, etc. Some have
talked about "getting" the doctor to "prescribe" the pumps under various
premises, or even getting a doctor to prescribe expressed donor milk from a
milk bank. Well, I have to agree with those of you who expressed concern
about this kind of manipulation of the system; at the same time, I recognize
that people have to do whatever they can to "get around the system"
sometimes.

But it got me thinking. Here's what really bothers me about the "get your
doctor to precribe..." line of thinking; if I'm way off, I know I will be
set straight. But what I have seen in our medical system is that
lower-income, less-educated, non-white, etc. women are treated significantly
differently by most of the health care pratitioners than are the ones who
are more "like" the doctor her/himself. So my concern is that the
articulate, well-informed Cornell professor (for example, here in Ithaca)
who goes to the same church & whose kids attend school with the doctor's
kids will be more likely to get a positive response on this kind of approach
than will the woman who serves the doctor a hamburger at the local fast-food
joint or cleans the bathrooms in the hospital or even does nothing so
"positive" at all.

Is it understandable that 1) the more privileged woman will be more likely
to bring the whole question up with her doctor in the first place and 2) the
doctor will be much more willing to "help her out"? Sure - it's part of
human nature; we are more positive, helpful, & friendly with those we
perceive as being "like us" rather than "one of them". And those polite,
well-spoken, articulate, well-educated mothers are often easier to interact
with, and so they get more positive reinforcement, and the world rolls along
pretty smoothly when we're all playing from the same rule book.

BUT does that mean that her baby is "more entitled" to the benefits that
Mrs. Smartenrich & her doc are able to conspire to wangle from the system
than the baby of Miss Youngpoor, who is none of the above? NO!! If anything,
Baby Youngpoor probably needs the help more. But she's less likely to get
it, because mom is 1) too intimidated from years of difficult dealings with
"the system" to even bring it up, and/or 2) not even aware that such a thing
*might* be an option, and/or 3) young or poor or has dirty fingernails or
uses bad grammar or......, so the doc thinks she's "just trying to take
advantage of the system at *our* expense", so s/he quickly rebuffs the whole
idea.

I'm NOT flaming doctors here. I'm just very concerned that there's an
uncomfortable amount of wiggle-room for the inequities between the have &
the have-nots to open even wider if insurance companies get into the
practice of providing electric pumps for perfectly healthy breastfeeding
moms & babies so mom can go back to work. I'm a consumer of the health-care
system; I honestly can't say that I'd be real happy about my health care
dollars going for this. And I think that we veer into real evil if the
system can be manipulated so that the inequities are exaggerated rather than
eliminated, and I see a big potential here.

Cathy Bargar, RN, IBCLC Ithaca NY (enough pontificating - I must get outside
to my garden & enjoy the glorious day)

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