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In the US most mothers will have switched to pumping milk after they return to work after week 6

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Although CMS sent a memo to state Medicaid directors about this designation in 2016 (CMS, 2016e) and updated Chapter 16B of the Medicare Managed Care Manual (CMS, 2016b) to include more description of the category, few of the states or plans with which we spoke during our case studies or at our in-person meeting reported that they understood how these plans worked or why it might be beneficial for them to pursue this designation

Some protocols move toward 0.5 mg per day under close medical supervision if a provider determines a higher dose is appropriate for a specific patient