Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics' ISH DISH Podcast, practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest health care information that's understandable, relatable and useful to your daily life.

Host: So today in the studio, this is a huge topic and something that all women, childbearing years is really going to get a lot of good information out of. We have with us Karin Semans. Welcome to the show.

Karin Semans: Thank you.

Host: Thank you. I'm so excited to have you here. Karin is a-- and this is a long title, so I hope I get it right-- international board-certified lactation consultant.

Karin Semans: You did very well.

Host: Yay! Yay! So in simple terms, breastfeeding, that's what we're talking about.

Karin Semans: Lactation consultant, correct.

Host: Huge topic. We deliver a lot of babies in Clarion.

Karin Semans: Yes, we do. For a small rural hospital, we do do a lot of deliveries here, yes.

Host: Yeah. So, I don't know what the average is, if there's even, if you can attract that, of how many new moms walk out of here breastfeeding their children. But I'm assuming it's probably a fairly good number.

Karin Semans: It is. It is. We have room for improvement. And the actual number I don't have off the top of my head, but we do have, I know, a little room for improvement.

Host: Because obviously, it is a choice for the mom if they want to or they don't want to. But you are there to help educate on the good reasons why and maybe why it's a good thing.

Karin Semans: Yes, the benefits of the breastfeeding, why maybe they want to choose that. And, yeah, so we'll about a lot of those things.

Host: So, we'll back up a little bit so we've got your introduction. So, tell us a little bit about who you are and how you came to be here.

Karin Semans: So, first of all, I've been married for 30 years.

Host: Congratulations! That's awesome.

Karin Semans: Thank you. I have a wonderful husband. I've got two grown children and I did breastfeed both of my own children. One a little bit longer than the other. But again, I attribute that to more education and knowledge too. And I started as an RN in 1992. I progressed on to moving into like the OB department and working in labor and delivery right around 1997 or so, and have pretty much fell in love with the OB department. It's been a place that I've just really found my own niche.

Host: That's neat.

Karin Semans: Yeah, yeah. Towards the end of '97, I went and took a class in Minnesota up in the cities. And at that class, I didn't understand really what it was all about, but it was an IBCLC class. And at this class, I really fell in love with breastfeeding and supporting moms and the benefit that a breastfeeding support system can do for a mother.

Host: That's awesome.

Karin Semans: Yes. But it wasn't until really 2010 that I actually sat for the test. There's an examination that happens with your IBCLC, and I went through more education again. And then in 2010, I actually achieved my goal of my certification of IBCLC.

Host: Nice. That's awesome. Good for you.

Karin Semans: Yes thank you.

Host: And I'm just sitting here thinking about it. I have a 31-year-old daughter. And I did breastfeed her for a few months and then went back to work for my husband's family business at the time. And I kind of wish I would have known more about the benefits of it, because I had some issues and just quit. I'm like, "I can't do this. This is hard. I don't get it." The whole latching on thing kind of became a thing and just all of these things. And now, I see women today that pumping is just such a normal part of the whole process.

Karin Semans: It's just such a very important part of the process, yes.

Host: Yeah. And back then, I don't think it was ever really, I don't know, offered, talked about. It just wasn't as prevalent as it is today. And I just wanted to inform our listeners also, you're going to give us some education about your education and what this all looks like. And it could get a little long, so this is probably going to be a two-parter.

Karin Semans: Yes, most likely.

Host: Yeah, because there's a lot of information and we want everybody to come back for part two. So without further ado, I'm just going to let you take it away and give us the 411.

Karin Semans: All right. Well, as far as my education, I am an RN. I achieved or got my RN in '92, and went through Ferris State University, that's a college in Michigan. That's where I'm originally from. And then, the IBCLC portion is a certification that I went on and got further education for. It's a 90 plus hour credit education process. It was an online course that I was able to do. And then, I had to sit for an examination, like I said earlier. That examination was a sit-down examination, like in a big auditorium with many, many different people. A little intimidating, I have to say.

Host: Especially when you're little bit older and maybe not used to that.

Karin Semans: Right, right. Now, it's on a computer. So, back in 2010, they didn't quite do it all on that. It was only offered once a year. Now, it's offered twice a year and it's done on a computer. So, you would go to a testing center or something along those lines, yeah. There's ongoing education. Just like with my RN degree, there's online education that I have to take, what we call CERPs. It's like CEUs for other businesses or other types of degrees. And every five years, I need to achieve so many CERPs. And those SERPs then help me to be recertified or continue my certification. And then, I need to have an examination every 10 years.

Host: Wow.

Karin Semans: Yes. Unlike my RN degree, I don't have to get re examined every 10 years. But with my IBCLC, I do need to have that re-examination.

Host: Well, they take this very seriously.

Karin Semans: They do. And I just did my re-examination in 2020. So, it was my first time on computer. And I have to say I liked it. I did it, I did like that much better. So, I am also a member of ILCA, which is the International Lactation Consultant Association. So, it's our professional association, that's the word I was looking for. And then, I'm also a member of the Iowa Breastfeeding Association, so here in the state of Iowa.

Host: Okay. You know your stuff.

Karin Semans: Well, thank you. I hope I do.

Host: Yeah.

Karin Semans: And then, a little bit about the IBCLC history, our background just a little. We function and contribute as members of the maternal child health team. So, I'm not just a standalone healthcare provider or just a nurse. I am part of that team. I work with the doctors. I work with the nurses to help your breastfeeding experience be the best it can be. We can be in a variety of settings. We can come into homes at times. Some people have more of a private practice and they go out to homes or they work in the health department and they come out to homes. So, every place is a little bit different. Your community is a little different on what they have to offer.

Host: So, this segues a little bit into a question I was just thinking about. When you give the education on breastfeeding, do I have to already have been a patient here and have delivered? Or is it open to anybody?

Karin Semans: Absolutely not. It is open to anyone.

Host: That's amazing.

Karin Semans: Yes. Yeah, it is open to anyone.

Host: Okay. Good.

Karin Semans: So, the international Board of Lactation Consultant Examiners was formed in '85. They are responsible for those standards and holding us accountable to our education. They went through an accreditation process to get the certification accredited and they use the NCCA accreditation process. It is a certification program that they have held since the late '80s or they've continued in the late '80s. It's one of the few that have continued with them for that long, and it is a sign of excellence regarding the IBCLC program. So just a little background, people that do understand some accreditation stuff back there might be appreciative of.

Host: Absolutely.

Karin Semans: So, you don't need to be an RN to be an IBCLC. You can be a dietician. Doulas, midwives, some physicians hold it, some therapists will hold an IBCLC as a certification in addition to their already degree that they'd earned.

Host: Okay. Good to know.

Karin Semans: Yeah. We can be in different places. You can find us in hospitals, birthing centers, private practice, health departments, home health agencies, all of those places, and we are even in research settings too. So, there's a fair amount of research that goes into breastfeeding too.

Host: This is way bigger than even I would have thought.

Karin Semans: It was for me too, way back in '97 when I went through that first class. I sat there and I thought, "This is more than just some lactation education. This is a bigger piece that I didn't even know was missing from a puzzle."

Host: And I'm assuming that now that you know it all, that it makes sense.

Karin Semans: It does. It does.

Host: But to me, I'm sitting here thinking, "It seems so simple." But obviously, there's more to it.

Karin Semans: Right. We, as a culture, you'd think, "Okay. We've been delivering babies," for years, obviously. So, it's the way we have and raise our population, right? And so obviously, we've had to breastfeed these babies. But through the years, we've come up with new and better ways to feed those babies. And all stemmed out of the need to decrease the mortality rate on our infants. We had really high mortality rates back in the 1600, 1700, 1800s. And stemming out of that people wanted to decrease those mortality rates. And one of the things they were seeing is that these babies were not having the correct nutrition for very different reasons. I could go into a whole different podcast just on that alone.

However, we developed formulas. We used different milk other than human milk. We didn't use the milk that was provided for the baby already from the mother. Some mothers just didn't make it. Other mothers, for cultural and society type of reasons, they chose to have their babies wet nursed. Well then, that nurse or that baby that was part of that mother's thing was maybe shipped out to another family member, or something along those lines. And it was just a really troublesome thing in easier terms maybe.

Those mortality rates were high. We needed to bring those down and some people thought, "Hey, if we give cows' milk, if we give this, let's make a powdered formula that we can give to a baby that will sustain baby." And yes, our powdered formulas, they do sustain those children at times. But we have a really good milk supply that's wonderful, it's called human milk. Why not give that to the baby? You know, that is what the baby was designed to ingest, and that's what we need to be giving to our children.

And we found that there's a lot more to the human milk than just providing carbohydrates, proteins and sugars. There is a lot more to it. The milk that we developed and everything, more and more people started using that. And many babies were given formula and we started losing some of that knowledge of breastfeeding, because less and less people were breastfeeding and more were giving formula. And so, we lost a lot of that knowledge that got passed down from mother to daughter, from grandmother to granddaughter, and how to latch a baby, and you'd think it would be instinctive, but it's not.

Host: It isn't.

Karin Semans: No, it's not.

Host: And it's not instinctive to the baby.

Karin Semans: Not always. There is some instinctive properties or reflexes that babies are born with, but it's not necessarily always instinctive. And so, as time moved on, and we lost some of that knowledge, we had to try to regain it as we started to determine that, "Hey, these kids really do need human milk to thrive, to really do well." And then, Le Leche League developed. A lot of people have heard of that, or other types of support groups, but Le Leche League is the most well known support group out there. And as Le Leche League developed, they got some really good leaders in that league. And out of that came financial support and a group of people that said, "We need to have what we call a lactation consultant." And that's how that profession was actually developed and was born in like 1985. So, it's a fairly new profession in that sense.

Host: Well, there's so many benefits to breastfeeding. And obviously, women are not going to stop having babies. So, right there just tells you that there's a need for this.

Karin Semans: Yes. Yes, there is. And the IBCLC can do so much for that mother baby couplet. We call them a mother-baby couplet. Couplets, yes. Or a mother-baby dyad, it's another word that some people might come across if they're reading things online or reading a book or something like that, they might come across that, especially in the more of the professional area. We can help improve breastfeeding outcomes. We help reduce healthcare costs by improving those breastfeeding outcomes. We help to improve the patient and our client satisfaction how they're feeling about their own birth experience, and then also their feeding experience. And then, we also just improve the overall health of the community by having these healthier babies fed with human milk, it just helps improve the overall health of the community.

Host: This reminds me too, there's a lot to be said for breastfeeding your baby and the longer you do it and the health benefits for the baby. And I think, and I'm sure you guys address this, but I would feel like if you were a new mother and you were unable to get this done. There's a little sense of feeling like a failure. Because the expectations are high that this happens, and if you can't, what kind of conversation does that lead to?

Karin Semans: It is a conversation that I do have often with moms about what their goals are, what they wanted to have out of their breastfeeding experience. Some moms come in with "Absolutely nothing given to my baby. I want exclusive breastfeeding all the way." You know, "I'm going to do this for two, three years. That's my goal." Other moms come in and say, "Well, I was just thinking I was going to do it while I was at home. Once I go back to work, I'm going to switch over to formula." Okay, if that's your goal, that's where I want to help meet you at, okay? If your goal changes during your breastfeeding experience, whether you were that adamant, "I'm going to do this for three years," "You know what? I think I'm done at one year," that's okay. I'm there for you for any and all of that breastfeeding experience. So, it's really just trying to see where mom and dad are on their decision on the feeding of their child.

Host: Right. And I feel like once you give the education, it kind of takes the high pressure off of the mom. And then, you just support what she feels after she's been fully educated on the pros and cons and all of the things. And then, we just go about our day.

Karin Semans: Correct. Yes, we just go forward from there. And sometimes just allowing mom and dad to express what their goal was and then say, "Okay, but our goal has to change" because maybe the baby had an issue or something like that, that they had to adjust their goal for, whether that was a latch issue that we had to work through, or if it's maybe a respiratory issue and they had to go spend some time in the NICU somewhere or something like that. And it just morphed their goal a little bit. Maybe we can help them get back on goal or help them adjust to a new goal setting and figure out what that goal setting is.

Host: Completely non-judgmental zone.

Karin Semans: Oh yes. At least I hope I am.

Host: I can see it. That's wonderful.

Karin Semans: Iowa Specialty Hospital does offer breastfeeding classes. I teach them. And our topics of the class are benefits and properties of breast milk, understanding the lactation process, latching and positioning, the pumping and storage and handling of the breast milk. And then, we talk about that first month, what to expect in that first month in relationship to breastfeeding. It is a free two-hour class. It's offered every other month on a Saturday. The other month is childbirth class. So, it's alternating monthly childbirth class, breastfeeding class, back and forth. That can be found on our web page, iowaspecialtyhospital.com. If you hover over the news and events, that drops down and then you can click on the event calendar. Once you're on the event calendar, just click on the class that's offered, or you can toggle through the different months to find one that works best for you.

Host: Okay. And again, is this just for new moms or...?

Karin Semans: No. It's not necessarily for just new moms. Any mother can sign up for breastfeeding classes or childbirth classes. It will walk you through, like I said, all of those topics. And some moms need a refresher course, so to speak, or it's like, you know, I tried it with my first, we got a few weeks in, but I think I just really want to listen to it again. And by all means, you can come again, that's not a problem. So, it's not necessarily just for new moms.

Host: And I'm assuming that both parents are welcome to come and encouraged to do so.

Karin Semans: Yes, I do encourage them to bring their support person. Whoever that person is going to be for them, I encourage them to bring that support person with them so they can hear the same knowledge here and then help mom remember some of that stuff too. They're given a book.

Host: So when they're both crying in the middle of the night, we know that's okay. We'll get through.

Karin Semans: Yes. "She said this was going to be okay."

Host: Been there, done that.

Karin Semans: Me too, me too. You're not alone.

Host: Right, exactly.

Karin Semans: Yeah. So, having that support person be on the same page with you is halfway of the goal, right?

Host: Yeah.

Karin Semans: I would recommend that once mom gets to about 20 to 25 weeks, somewhere right in there, she starts looking at that schedule and trying to figure out when she wants to take her breastfeeding class and her childbirth class. The classes, those weeks go by quickly. Once you hit 20 weeks, I know it seems like, "Oh, I got 20 weeks more to go," but they do go by quickly. And when the classes are offered every other month, it goes by so much quicker. You're like, "Oh, but that one's after my due date." So, yeah, I would recommend getting on and taking a look at that sooner rather than later.

The hospital also offers in-hospital breastfeeding assistance. I mean, that kind of seems like, "Yeah, of course," but it is fairly new for our hospital. We've had wonderful nurses that have breastfeeding experience from their own children, but also have some education over the years, but bringing in an IBCLC that's got that education behind me to do that. So, I've just been transitioned into this role.

Host: That's nice.

Karin Semans: Yeah, I have worked for Iowa Specialty Hospital since 2016 as a staff nurse. And all of the patients that I took care of benefited from my extra knowledge. But now, just everybody gets to have some benefit from that.

Host: Considering the number of babies we've been having, I'm sure you're busy.

Karin Semans: The need went up significantly. Yes, the need went up significantly. Each mom is seen by me for a feeding. If you have breastfed in the past and everything was fine and your baby's doing well. Sometimes I don't always see that baby feet. If mom's doing well and she's doing great and she's giving me all the great responses to my questions, I don't actually have to see that feeding. But if it's your first time or you struggled in the past with something, then yes, I do want to see that feeding. And moms usually call me back into the room when the baby's getting ready to feed. So yeah, if they just get ahold of their nursing staff and nursing staff helps them.

Host: It's a great like value added service, really. It is, it's just wonderful,

Karin Semans: Yes, yes.

Host: Good for you. That's awesome.

Karin Semans: And then, I also give a followup phone call to the moms after they go home from the hospital. So, during that phone call, I will ask how mom is doing also, as far as her recovery from the delivery process. And then also, how is baby's feedings, wet and dirty diapers, we kind of go over that; milk coming in; kind of some of those generalized questions. And then, I ask if she would like a two-week followup call too. That baby tends to lose weight while they're in the hospital immediately after delivery. All babies do. It does not matter how you feed your baby. All babies lose some weight immediately after delivery. They're born with a little extra fatty weight on them. It's kind of called a brown fat or whatever. And then, that baby uses that to help sustain itself a little bit and then loses that weight. So, the weight that the baby puts back on is kind of growth, okay? So, you have to give the baby a little bit more time to put that back on than just a couple days or so. So, we give the babies up to about two weeks to put that weight back on. Most babies should have achieved birth weight by two weeks of age. So, just kind of a good milestone, one of those first milestones to reach.

Host: Yeah. And then, making sure that mom is not alarmed when this happens, that it's nothing she's doing wrong.

Karin Semans: Correct, correct. Yeah. So when I go in, I usually let mom and dads know where their baby's weight is, that kind of thing. Nurses weigh the babies in the middle of the night at some point. And then, if that weight is too great, then maybe we would need to get mom giving extra. So mom would breastfeed, she would give some extra to the baby. First, we'd have her pumping and see how much milk that we are able to collect and then give that back to baby.

Host: Sure. Side note, but I think about this every now and then when friends and I or whomever are talking about having babies and you think, "That just has to be an extraordinarily insane experience for this baby. You know, they've been in the womb for nine months and coddled and sloshing around. And then, they come out and now people are weighing them and they're feeding them and all the things, it has to be traumatic.

Karin Semans: Yes, yes, yes. And because of that, we actually put babies right up on Mom's bellies. If they come out and they're doing very well and mom is doing well, we put that baby right up on mom's belly and allow dad if he wants to or whoever to cut that cord after a little bit of a delay, we also do delayed cord clamping here. And we allow that baby to nuzzle in with mom. We call that skin to skin. And that skin to skin contact helps to stabilize baby, helps to bring baby back to center.

Host: Right, yeah.

Karin Semans: Baby is laying there with mom, has a blanket over it.

Host: Because that's traumatic how, you know, they came into the world. That's a lot.

Karin Semans: It is a lot for the little ones.

Host: Poor baby.

Karin Semans: Yeah, yeah. We kind of think that, don't we? But they're designed for it. We've got to remember that those little ones, they are designed for that and it's a wonderful design.

Host: It is. It's amazing. It's just amazing.

Karin Semans: Yes. It is, it is. I also offer outpatient lactation services here. So once mom goes home with their little one, if they're struggling with anything, if they've had to use a nipple shield here in the hospital, which is a device that kind of goes over top of the nipple and helps when moms have maybe flat or inverted nipples and helps with that breastfeeding that helps with that latch, and if she's using something along those lines and then, we can maybe bring mom and baby back into the hospital for what we call a lactation outpatient visit. That visit, I can help with that latch. I can do what we call a milk transfer evaluation, which is another term is a weigh-feed-weigh. So, we would weigh the baby, feed the baby, weigh the baby again. Once mother's milk is in, that milk is one gram of weight per mL. So, there's kind of an equal one-to-one ratio. So, I can see how much baby's weight increased if I have a very accurate scale. Your home scale is just not accurate enough. We need to have that go out to the thousandth. And so, the scale here at the hospital goes out that far and I can get a very accurate weight on that baby.

Host: Nice.

Karin Semans: Yeah. So, we have that to offer to parents if baby is a slow weight gainer. I can have them come into the hospital and maybe their physician has said, "Hey, baby is just not gaining as quickly as what we would like little one to do. We're not going to achieve that two-week back to birth weight or we're just slightly under." So, we consider that like a slow weight gainer. He's gaining weight, just not quick enough, right? They can contact me so that I can get referrals from the doctors, or I can have moms and dads call me directly and say, "Hey, we'd like to come in and have a little assistance with this breastfeeding. Our doctor says that the baby's a little slow. I noticed that you guys offer a lactation service. And we'd like to take you up on that."

Host: I just think this is wonderful because I remember as a new mom and you go home and I remember putting our daughter into her bassinet and just looking at her and thinking, "Now what?" Now what? And then, what happens? You're just not prepared for all the little idiosyncrasies and all the things that could happen. And it's nice to know that there's somebody like you available and willing to give that voice of reason and say, "Hey, let's just start over. Let's do this. Let's try what we haven't done yet."

Karin Semans: And maybe let's try a new position, something along those lines.

Host: That's comforting to know.

Karin Semans: Yeah. I think it is for a lot of mothers. The services that I have, if you're struggling with pumping, some moms, once the baby's doing well, "I am breastfeeding just fine, but I am just not collecting a lot of milk," we can talk through some things. Some of that can just be a phone call. "Hey, try this, this, this," some of those kinds of things. Or I can have you come in and I can actually see how the pumping is working, that kind of a thing, okay?

I also got moms that will call. They've been put on a new medication. They just want to make sure that it's safe for lactation. Many of the doctors already know that the mom is breastfeeding and they've already gone over some of those things or she's got a cold and she doesn't know if she can take this or that because she's breastfeeding, she can easily call into the office and I can give her some of that information too.

As far as the outpatient services go coming into the hospital for a visit, we can charge insurance that's part of the Affordable Care Act. It is a billable service, so to speak in that sense, being that it's part of the Affordable Care Act. It's interesting. Insurances like to play the game, right?

Host: Of course.

Karin Semans: And so, we are still kind of working through that a little bit with this and getting all of those pieces worked out. But it is a billable service. It kind of goes through the mom's insurance though, not the baby's as much. And some people think, "Well, it's my baby that's got the problem. My baby's the slow weight gainer. Why are we not charging the baby?" But it really kind of works through the mom's insurance. So, moms can look back at their insurance or call their insurance and find out what services they have available to them as far as their lactation goes and lactation services they can call in to their insurance and be a little bit more informed when they come in.

Host: So, I am going to ask you then, this is a lot of information and we have so much more to cover. So, give us a little synopsis of what-- we're going to do part two. We have to.

Karin Semans: No, I get it. There's a lot more here.

Host: Yeah. And so, I think in the next segment, we are going to get into more of the nitty gritty of the actual breastfeeding itself, the benefits, if you want to highlight a couple of the things.

Karin Semans: So in part two, we will talk about the benefits of breastfeeding a little bit more in depth; we've just skimmed the benefits just now. Skin to skin, we'll talk about how the body's actually making that milk and what's the process going on there. We'll get into how to know when your baby's hungry, how to know when your baby's satisfied. How do I know when she's had enough or he's had enough? We'll talk about the latch. What's a deep latch? What's a shallow latch? Why you want to achieve a deep latch versus a shallow latch.

Host: Never heard of those things. So, this is interesting, yep.

Karin Semans: And then, I also would love to talk about some breast pumps, supplies, things like that. And then, things that you might want to get ahead of time, okay? And then, if we have time, some of what happens in that first two weeks and you first get home.

Host: And let's also cover what happens when we want to stop.

Karin Semans: Yes. Weaning of the baby.

Host: Because that's a whole process. Yeah, the weaning. Not always a good thing.

Karin Semans: it can be an avenue that's got a lot of branches down that. You can branch out and go many different ways with weaning. So yeah, we can definitely talk about some weaning, too.

Host: And I'm sure there's going to be pros and cons, benefits for both mom and baby in that scenario.

Karin Semans: Yes. And it has to be kind of a mutual agreement between the two.

Host: Right. Yeah, it's not like throwing the pacifier in the garbage, you know, and bribing them later.

Karin Semans: Correct. You can't throw that away.

Host: Right. No, we wouldn't want to do that. Okay. So, thank you so much for this amazing information, Karin. Like we said, we are going to stop at this point and then we are going to pick up and we're going to do a part two so stay tuned for that. If someone wants more information in the meantime and wants to get a hold of you, your number is 515-602-9811. Again, 515-602-9811. That is the Iowa Specialty Hospital Breast Feeding Center phone number for more information. And Karin has told me that you can leave a message and somebody will get back to you.

Karin Semans: Correct. I will get to those messages as soon as I can. If it's the middle of the night, it's 2 o'clock in the morning, you've got that question, by all means call. You're not going to disturb anybody. It's just in the office there. And in the morning, I'll get back to that phone call. I am at the hospital Monday through Friday, mainly 8:00 a.m. to 4:00 p.m.

Host: Okay. And I promise we won't leave the listeners hanging too long, so we will try to get part two recorded as soon as we can. But for now, we just didn't want to make this extremely long for people to want to listen. So, part two, coming up next.

Thank you for listening to Iowa Specialty Hospitals and Clinics ISH DISH Podcast. For more information on the topics we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH DISH Podcast, I'm Gina. Thanks for tuning in.