I've always used the term industrial-grade, never hospital-grade because women thought you had to rent pumps from a hospital rather than some of the pharmacies and breastfeeding supply shops that were more accessible.  

I sometimes compare using a pump for establishing supply or increasing a supply that has been suppressed as using a compact car if you were moving the contents of your apartment versus renting a U-Haul truck.  

Here in New York City one mom was told by Blue Cross Blue Shield that she can only have a pump if her baby has cleft palate.  

Blue Cross Blue Shield is also telling women that they can only have lactation services covered by an MD.  So we are working with an insurance person to push for "in for out" exceptions since there are NO IBCLC MDs in Manhattan.  I no very few MDs or even DOs who can do a thorough assessment of a FULL FEEDING CYCLE -- which I really believe is should truly be the standard of care.  I have seen too many cases where someone watched a PARTIAL FEEDING CYCLE and made assumptions that, upon assessment of a FULL FEEDING CYCLE were incorrect.  As we all know a FULL FEEDING CYCLE can very well take more than an hour, especially if supplementation and expressing milk is also involved.  

Having also just had a round of women told to get the wrong size breast shields because of the "nipple sizer" which doesn't account for the stretching involved while expressing milk, I ALSO firmly believe that every woman who must express milk for a baby because her baby cannot complete feedings on the breast -- should be entitled to a FULL ASSESSMENT of an EXPRESSION CYCLE as well.  I am really tired of having to mop up after women who are told a bunch of different breast shield sizes from practitioners who never watched them express milk and hardly ever watch women express milk.

Sincerely, 

Susan E. Burger, 

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