I am hopeful that our professional organization(s) can play a strong role in 
lobbying for health insurance coverage for outpatient lactation services for 
any mother and baby who is so very fortunate to have health insurance 
coverage at this time in the United States.

When a stroke patient or a patient recovering from a traumatic brain injury 
receives care from an occupational therapist who assists the patient in re-
learning self-feeding techniques, I presume Medicare, Medicaid, and private 
forms of health care coverage are rather willing to pay for such skilled care, 
since one must eat to live.

When a BABY of any age and of any gestational age/preterm/fullterm is helped 
by a speech pathologist for sucking and/or swallowing concerns, I presume 
health coverage is a given, should the baby be so fortunate as to actually 
have some form of health coverage in the United States at present.  After all, 
one must eat to live, and further, the quality of one's life is that of greater 
health when one receives a species-specific milk.  In giving such milk, the 
mother's health and wellbeing is enhanced as well.  

It appears to be a form of discrimination against babies who are nourished at 
the mother's breast and/or who are nourished with their mother's milk by any 
feeding method not to have health care coverage extended to them, as it is 
for their human relatives across the lifespan - - whether preterm or aged - - 
in regard to health issues related to any any form of feeding, motor learning, 
and motor control.  

How odd and tragic that a grandparent can receive health coverage for 
physical therapy in treatment of a painful heel spur (my own recent 
experience, and may I say such care is worth every penny), while across town 
and across the country, another grandparent's grandbaby cannot be assured 
of routine health coverage for feeding issues, as well as the mother of the 
baby for any lactation concerns.  

Skin wounds on a human being's body are presumed to be eligible for insurance 
coverage here, no? That should certainly apply to a mother's nipple wounds, 
which can be just as excruciating - - and often times more so - - as many 
other types of skin wounds.    

While I am stunned by the AAP's response to LactNet re: Dr. Jay Gordon's 
satirical post on April 1st, the July 2008 issue of the AAP's pediatric coding 
newsletter gave its members valuable information in highlighting the lactation 
coding for peds care providers.  Dr. Christina Smillie is listed as the original 
author of "Supporting Breastfeeding and Lactation: The Primary Care 
Pediatrician's Guide to Getting Paid," and Dr. Jenny Thomas contributed to 
that July '08 article with helpful and insightful vignettes re: lactation 
management.  It seems to me that another female physician very well known 
in our lactation community also contributed to the lactation coding document, 
but I cannot presently locate her name.  I am also having having difficulty 
getting the AAP coding document to link to this post - - I can read the July 
2008 coding newsletter today but can't find the entire peds/lactation coding 
document now.  

While driving in my car yesterday/running errands, I listened to a powerful 
interview on C-Span with Supreme Court Associate Justice Ruth Bader 
Ginsberg.  A number of questions asked of her were in regard to her early 
career as an advocate for equal citizen status for women and men as a 
constitutional principle, and she recounted some of the poignant cases in 
which served as a lawyer with the American Civil Liberties Union (ACLU).  
(Wikipedia's article on Ginsberg mentions that her work with the ACLU was as 
a volunteer attorney.)  In the C-Span interview, Ginsberg recounted how, in 
her pregnancy with her second child, she wore her mother-in-law's clothes to 
disguise her pregnancy (her mother-in-law was a size larger than Ginsberg)- - 
fearful that her position would be in jeopardy if her pregnancy were revealed.  
Her position was an academic one then, and the academic year was ending in 
May.  She was to be away from that academic position due to the summer 
break, and stated in May to her superior that by September, when the fall 
term would resume, there would be an additional member in their family - - 
without stating she was pregnant.  She stated with irony that her pregnancy 
and her subsequent fears about her job security occurred AFTER protection 
through Title VII of the Civil Rights Act had been written into law.  Title VII 
includes protection in regard to pregnancy and employment discrimination.    

Attorney and IBCLC Liz Brooks and anyone else who may care to comment,  
what say ye on this discrimination issue against breastfed babies and their 
breastfeeding mothers?  Would this be an issue appropriate for the American 
Civil Liberties Union to address?  

Debra Swank, RN IBCLC
Ashburn, Virginia USA
  

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