Gina (Host): Welcome to Iowa Specialty Hospitals and Clinics, ISH DISH Podcast. Practical health advice from Iowa Specialty 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. Okay, part two!

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes.

Host: In the studio with us today, we have Karen Semans and if you haven't listened to Part 1, we would highly encourage you to do that before listening to this one. However, they really are different, different material. Welcome.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Thank you. Thank you for having me.

Host: Absolutely. Um, if you want to do a Part 3, you know, come on over. So originally, we had talked about kind of your role as breastfeeding.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Lactation consultant.

Host: Lactation consultant, thank you.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes.

Host: And just kind of went through your journey to get where you are today. What it is that you offer at the hospital, breastfeeding education. The history of the International Board of Certified Lactation consultants.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Correct! You got it! Yay!

Host: So we went through the history of that and just the breastfeeding classes, the assistance that we give to new moms. Just a, general overview.

Today we're going to get down to the nitty gritty.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: A little bit more, yes.

Host: Yeah. And talk about the benefits of breastfeeding, what skin to skin is all about, and how that benefits both mom and baby. How the body produces the milk, how the baby latches on. All the things, right?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: All the things, yes.

Host: So this is really a good course, like a quickie course for anybody who wants more information on actual breastfeeding, but was afraid to ask.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes, yes. And also just to remind listeners that we do have a breastfeeding class if they would like to take that. It is a two hour class and it is free to anybody whether you're delivering here or not.

Host: I would say, as a mom my baby is 31 now, but back in the day, you just, it seems like a natural event. The breastfeeding, but it is not.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is sometimes a struggle for some moms, yes.

Host: Yes. And what happens right away versus when I get home versus in maybe six months. So I would highly encourage anybody to take that class. The two hours would be worth it.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: I feel it is, yes.

Host: I'm sure you do. So, without further ado, I'll let you have it.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Well I'd like to start off by talking about benefits of breastfeeding today. We know that the human milk contains antibodies, that help to prevent infections and things like that. It also provides the optimal nutrition to help babies grow and develop. It reduces their risks of infection, gastrointestinal, respiratory, or ear infections. And it's easier to digest and reduces allergies. Yes, it's also been linked to reducing the risk of being overweight and obesity in childhood and also later in our lives.

It improves intelligence and cognitive outcomes have had some linkage to the length of breastfeeding that moms do for their babies. And it also is being shown to reduce the risk of developing what we call non communicable diseases. So things that we can't, like, catch. Such as asthma, diabetes, or cardiovascular diseases.

Host: I just want to go back to the beginning and ask a quick question. How, what is the link between breastfeeding and lowered risk of ear infections?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It could be part of that antibody piece that you are creating antibodies in your breast milk and then you're passing some of those antibodies on. It's also partly baby's positioning they feel as when they're at the breast, that kind of a thing. And it just kind of all works together really well.

Host: It seems like that is a huge issue for babies, new moms, babies. It's always recurring ear infections.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Some do have a lot more struggles than others, yes.

Host: Yeah, so that just stuck out to me as maybe worth the price of admission. Which, by the way, the admission is free for breastfeeding.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Pretty much. Yeah. Yeah. there's a special bond that develops with Mother ma, with mom and baby when they're breastfeeding. And it also helps reduce maternal or mom risks for certain cancers like breast, ovarian, and also for diabetes. There is a beneficial benefit of reducing osteoporosis for the mom and it helps moms recover more quickly from childbirth. We all want to get back to our pre pregnancy form.

Host: Yeah, that's a real thing too. Um, it seems like breastfeeding moms get their shape back more quickly.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes. Yes, there is a higher caloric output, so to speak, in the mothers who are breastfeeding. Their body is constantly working to produce milk and so it's in a constant state of higher caloric need. There is a lot of things out in different books and podcasts like this and apps and things like that that say increase your dietary intake by 500 calories per 24 hours so that you can have enough caloric intake for baby.

Unfortunately in the United States, we tend to overfill our plates anyways, so I'm not necessarily sure we really need.

Host: Not 500 over that.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right, exactly, exactly. And so really just focusing on your nutrition as far as lots of fruits and vegetables on your plate. Think of your plate as, four different sections and you want fruits and vegetables to be on like half of your plate, taking up half of your plate. Proteins are taking up a smaller percentage, maybe a quarter of it or so and then you've got fats and others that are taking up that other quarter and so if you think of your plate that way maybe it might help make some of those decisions. Also snacks that moms should have are going to be your fruits, vegetables, and protein type snacks. Stay clear of those sugary snacks, which we all love.

Host: And you know, that's one of the things that, they talk about when the baby's in utero, the baby is eating what you're eating. Same thing with breastfeeding?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah, pretty much. Yeah, baby's eating what you're eating. You're the one that's providing those nutritive building blocks that are being passed on to baby.

Host: So healthy mom, healthy baby. I'm not seeing a lot of disadvantages yet.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: I can't think of one.

Host: Okay good. Let's keep going then.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: All right. Like we said, it is cost effective. It takes about 2,000 dollars or so to feed a baby formula. And relatively speaking, breastfeeding is free. I mean, yes, we do have to have a few little things like maybe a breastfeeding bra or three just to help make that a little bit easier to do and then a couple little accessories here or there. But really for the most part you can probably get away with breastfeeding roughly 500 dollars and, and you're done for the year. So I feel like for the most part,

Host: Very cost effective.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Very cost effective. Yes, yes. Skin to skin is something that we do promote here at the hospital, and we want moms to do that. Skin to skin is when we bring baby right up onto mom's chest, their cheek is touching mom's chest, their body is naked except for a diaper, and mom is also got no clothing in between her and baby. And so

Host: Is this initially or during?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah, we like to, we like to have this initially happen when the baby's first born and then progress out from there too.

Skin to skin is not just beneficial for that first hour of birth. It is also beneficial for that baby and mom bonding pair. It's great for bonding for baby and dad.

Host: I was going to say that.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And we do encourage moms and parents to do that skin to skin with their babies. The benefit, extra benefit that moms get is that it is triggering a hormone release in moms that is actually helping their milk production.

And we'll talk about hormones and how they play some roles in milk production just a few minutes. But skin to skin will help stabilize that baby's temperature initially. Their breathing and their heartbeat kind of slow down just a little bit and it helps stabilize some of their blood oxygen levels when they're first born. We like the babies to do that. And we'll keep baby with mom as much as we possibly can.

Host: Plus it's just so precious.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is, it's very, it's a very soothe. It's very, it releases all the good feels when you're doing skin to skin with baby.

Host: Well you haven't seen this baby yet, you know, except an photo.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It's their first

Gina (Host): photo and, Yeah. Yeah.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It's the first meeting to, yeah. So it's very nice. It's very nice. The skin to skin reduces postpartum bleeding from mothers also because of that, again, hormonal release that happens. And it can help with some of that, again, just getting baby to latch on can also help with some of that postpartum bleeding.

Host: Childbirth in itself is just a miracle. And now talking about all of this, is too. It's crazy because you can't see all those hormones doing all the work, but you sure are getting the benefits from it.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right. Right. Yes. Yes, definitely. We're definitely getting lots of benefits. So, as our body is experiencing all of these different things, we have a couple of things that are happening. When mom gets that stimulation to her breasts, there's hormones that are released that I just said, and they're released from the pituitary gland, which is found in your hypothalamus up in your head or your brain. And that pituitary gland releases two different things. One's called oxytocin, one's called prolactin.

Think of oxytocin as the calming, soothing, hormone. And it also lets down milk. Okay? It does that just like it does for our contractions. So oxytocin is the hormone that helps our uterus to contract. And so when it helps with the uterus to contract, it is actually helping that uterus to strengthen those contractions and to expel some of that postpartum blood and everything. And then in addition to that, it is affecting the muscles around each of the milk sacs and squeezing those milk sacs. And so not only is it giving a good squeeze on that uterus, but it's giving a good squeeze on the milk sacs.

And so moms will experience some after pains or some small little crampings. The more children you have, unfortunately, sometimes those crampings can get a little bit more intense. And then that pushes that milk into the milk ducts and then down to that baby. And that's what we call the letdown reflex.

Host: Oh okay. Yeah, I've of that. Yeah.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: You can get a feel, a little tingly sensations in the breast from that. Not everybody does, but it is, it can happen and that is normal.

Host: Again, just amazing that the body knows what to do to make all of

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Correct.

Host: This happen.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: The other hormone that's released is called prolactin. Prolactin is kind of like putting in the order for the next meal. Okay? So it's telling your body, make more milk mama. Okay. And so like if you go to a restaurant and you order your drinks and then you also put in your order for your appetizer, when your appetizer comes, you put in your order for your main meal and then on to your dessert, right?

Those are all those, that's all what prolactin's doing. It's putting in the orders for the next thing to come. Okay. Those two work together to get that milk to be made and stay in supply.

Host: You know, this, popped into my head. It's funny how I've heard before, never happened to me specifically, but you're a new mom, you're breastfeeding, lactating, and then you hear a baby cry, and all of a sudden, you've got milk coming.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Correct, correct.

Host: What's what's the connection with that?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: That is also part of that same thing with the oxytocin and you, you have a stimulation has come in to the brain and the brain has now sent that stimulation response to your hypothalamus and you triggered the pituitary to release down that oxytocin and you had a letdown response. Okay. As moms get more used to their own children and they hear the cries, moms can distinguish between cries. They sound differently and she won't respond to other babies as much. If she sits there and thinks about her baby then,

Gina (Host): Mm mm-hmm.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Now she might actually have a letdown response because she's thinking about, Oh, my baby's probably needing to eat right now. And, Oh, that's such a nice. And then she can actually make herself have a letdown kind of response.

Host: Hmmm, fascinating.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is very fascinating. It's very fascinating. The babies, we want them to be showing us feeding cues or hunger cues. Babies are born with a very limited ability to communicate us, and so they bring their hands to their mouth, they lick their lips.

They, maybe are awake after a longer sleep period and then they also can cry. So that's pretty much all the ways they can communicate with us.

Host: all And we have to interpret all of that.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes, yes. And sometimes they use the same cue to mean multiple different things. And so, watching your baby for those cues and looking for these cues, we initially want you to assume your baby is hungry, and so we call them feeding cues or hunger cues.

Some places use the term hunger cues, some places use feeding cues. And so we really want you to use those cues and just assume baby is hungry. If you've tried baby at the breast and baby's just like, yep, nope, this isn't what I want, then try something else. Maybe she needs to burp, maybe he needs his diaper changed, something along those lines.

Host: You just kinda gotta go down the line and try them all.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right, right. Unfortunately, cry is the one that wakes us up in the middle of the night. And we really would love to have seen these other cues first. Probably did. They just weren't waking us up. Right. Right. We also have what we call satisfied cues. That's when the baby's body just kind of softens.

So your baby is all hungry and arms are uptight. Maybe the legs are uptight. Hands are right there by the mouth. And as baby gets more and more milk in their belly and their arms will kind of relax. Their fists will open. They won't be as tightly fisted. Their arms will relax and lower to their sides. Baby releases the breast or self detaches and is content after the feeding.

Host: Wow, very cool.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah, so moms can look for those feeding cues, but they also can look for those satisfied cues, too.

Host: cues. Good.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And then baby goes on to sleep maybe an hour, maybe a couple of hours. Every baby's going to be a little bit different, and every feeding's going to be a little bit different. We encourage moms to offer both sides. Not always is baby going to take both sides, but we do encourage moms to offer both sides with each feeding.

Host: How would the baby know the difference? It's they, yeah. Huh.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: With the side? They, they can. Sometimes, there are times when I encourage mom to keep baby in the same position. But just move baby over to the other breast and so it just kind of of fakes baby out that they haven't moved the breast. They, yeah. And then baby will latch onto that second side if mom's struggling with a particular side or something like that.

Yeah. Yeah. initially moms have to be kind of taught what a deep latch is versus a shallow latch. A deep latch is when you have a lot of the breast tissue in your mouth. Shallow latch is when there's maybe just the nipple is in the baby's mouth. If we get shallow latches, shallow latches are what causes moms to get painful or get cracked nipples. And I don't want anyone to have that. Nobody does. No, nobody does. So when they start to develop some of that tenderness, that tenderness is okay with the first initial latch on, maybe lasting for like 30 seconds. But if it doesn't become, pain free within that first 30 seconds, it's ideal for mom to unlatch baby by putting her finger in the corner of baby's mouth, and, releasing that suction that baby has, and then readjusting baby and the latch and seeing if we can't get more breast in the mouth.

Waiting for that nice, wide, open mouth, and then bringing baby to mom. Mom doesn't lean into baby. Baby always comes to mom.

Gina (Host): Uh, And these are the things that you actually teach one on one after-

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: In the hospital when they're first delivered, yes. Yes. Or we can go over that with an outpatient lactation visit If, mom is struggling for different reasons at home. Yeah. We also want to see the, angle of the baby's mouth to be nice and wide for a wide, deep latch. We want to see most of mom's areola in her baby's mouth.

And we also want that nipple to be comfortable in that mouth and not be painful. Okay babies cheeks should be full. They shouldn't be like I call fishy look. You know how you suck in the sides of your cheek? If you're seeing that sucking in on the sides of the cheek, that's an indication that the baby is on shallow or again not enough breast in the mouth.

Okay there's a couple things we can do to correct that. We need to just kind of look at maybe, Identifying those hunger and feeding cues maybe a little bit sooner and not waiting until baby is crying if we can or offering baby your finger just prior to the feeding. Baby's all worked up you had to change her diaper and she's just really worked up.

Try burping her. She may have a burp in her from the crying during the diaper change. Settle her down, maybe even offer a finger to kind of get her to calm a little bit and then put her to breast sometimes that can help a little bit. And I say a finger versus a pacifier because your finger is tissue.

Gina (Host): Mhm.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And it reacts more like your breast tissue than the pacifier, which is more of a chomping suckle response versus cupping that tongue and pulling. Moms can also help themselves get that baby on a little deeper if they support the bottom side of their breast and they either use their fingers and thumb to form a U shape or a C shape, depending on where baby's nose and mouth are.

You want your fingers and thumb to be opposite the baby's nose and mouth and then compress the breast. By compressing it, I call it sandwiching. So if you've got a really big, juicy burger sandwich and you can't get your mouth around that sandwich, what do you do? You compress it so that your fingers and thumb are opposite your nose and chin and you make that a little bit narrower so that you can get a deeper bigger bite. Right. So that baby can get on a deeper latch. Okay. Okay? Hold that latch, or hold that breast for about a minute. Make sure baby's got on and got going. She'll probably pause for a couple seconds, maybe three to five seconds, and then she should start back up on that feeding. If she doesn't, you can, nudge her gently with your fingers. Your hand is right there by her chin because you're holding that breast and you can just wiggle her chin just a little bit and say, Hey, you've got a job to do. Keep going.

Host: Let's get it going.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah. Most of the time babies will get on real deep and they'll pull that breast in and they will continue and maintain that latch throughout the feeding.

Sometimes closer to the end of the feeding, they will become a little more lax and they won't want to continue that and they'll let some of that breast out of their mouth. So if moms just kind of watch that feeding a little bit and make sure that that breast is staying mainly in the baby's mouth or majority of it throughout the feeding will also help decrease some of that pain.

Host: Good.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Mom's nipple should look round when baby comes off, so take a quick look at that nipple, make sure it looks nice and round, and it shouldn't look misshapened. Like a new tube of lipstick is angle shaped, shouldn't look misshapened like that, or flattened with a white crease across it. Both of those say not enough breast in the mouth.

Okay, baby will typically come off on their own, and then will proceed to either continue to fall asleep or you burp baby and go to the other side. And again, not every baby's going to do both sides with every feeding, but majority of the time they should, and they should always be offered that second side. A couple of things that moms need at home, most likely it's going to be some sort of a breast pump and some supplies that they may want to have.

The Affordable Care Act or helps insurances to cover the supplies and the breast pump itself. So check in with your insurance and see what kind of coverage they will provide for you. There's a number of different websites and also medical care suppliers, that can help you get that breast pump for yourself from the insurance.

Okay. Some insurances even have links on their web pages to go here to get that breast pump and that kind of thing. The one that I tend to encourage people to use is Aeroflow. com. Aeroflow walks you right through it, works out really well, and requests that prescription if needed by your insurance directly from your doctor and you don't have to do too many extra hoops, which is nice.

Host: Do you find that most people do pump along with their breastfeeding because it's a necessity? Because they're maybe overproducing?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Well, it's become a necessity more because most of our moms actually go back to work. And these babies need that breast milk at least through six months of life for, for exclusively breast milk, and then they should be, continue to be offered breast milk until they're at least a year to two years old, and so moms have the commitment that they're doing by providing that nutrition for their infant.

Host: Yeah. It's a hard job. I've just witnessed my daughter in law going through this, and for the first year of our grandson's life, and it was always, well, he's coming over, and we were going to watch him, here's the whole pile of breast milk to put in the freezer, and it's a whole production, you know, and it's, wonderful, but it's also just a huge commitment. Well worth it, it is very worth it.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And for the mom, if she's a a stay at home mom or somebody that works from home and baby's with her all the time, there's not a whole lot of pumping that she really needs to do other than for an occasional extra feeding here or there if somebody's going to be watching baby and she's not going to be available for that feeding.

 The insurance plans can cover replacement pump parts, sometimes they'll set them up on like, every three months kind of a thing. It just depends on what your insurance has, chosen to do.

Even though the Affordable Care Act is out there, and we have that, there's loopholes in everything, right? And so sometimes the Affordable Care Act hasn't really achieved what we really wanted it to do when it has come to lactation and breastfeeding support for our moms. And so there are some insurances that don't provide as much coverage as other insurances, and so I can't just make this generalize Hey, this is what you're going to get.

You may choose that this is the pump that my insurance is going to give me, but I really want this other one. And so, some of these pumps can be kind of pricey. And if you really want to have a different type of pump, that kind of thing, sometimes they'll say, well, we'll put so much money towards one, and then you can pay the additional pricing of that.

Host: So are these breast pumps pretty self explanatory? Is that something that -

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: They are for the most part. They come with a little instruction book.

Host: Open the directions and?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah, they do. There is some that will say you should measure your nipples and do all this to make sure you got the right fit. But for many years we never measured nipples. And we just looked at how that pump part fit on the breast. If you are seeing a white ring, kind of like if you're blanching or squeezing your fingertip and turns the nail bed white. And if you're seeing a white ring on your breast tissue during the pumping cycle, that's probably too small of a flange and you need to go up a size. Conversely, if you're seeing a lot of your breast tissue being pulled way down into that tunnel, I call it, from the flange down to the end, It kind of narrows down to a tunnel, and if you're seeing a lot of your breast tissue being pulled way down in there, probably too big, let's go down a size on that flange.

And flanges are usually right around the 24mm is sent with every pump, and then you can go up from there, 27, 30s or go down to a 21 if you need to.

Host: So that's good to know it's not a one size fits all.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is not a one size fits all. It's also not a one size fits both sides. You may need to have a different size on one side versus the other also a different time of day. You might start off with a certain size in the morning but by evening you need to have a smaller size or something like that too.

Yeah, so always taking a look at that and reassessing and seeing, hey, do I have the best fit is always a good idea.

Host: Yeah and it's so nice too now with way of the world that pumping is

so much more, normalized, and there are, HR policies around it now at different workplaces. have to have a place for mom to lactate, you know, you have to give her the time to do the pumping, which is amazing because back in the day, it used to be just go hide in a corner or they didn't do it at all.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right, right. Or moms stopped the breastfeeding. They just didn't do it at all. They stopped and they didn't do that. And then their milk supply dried up and they had to move over to the formula.

Host: Right.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And it is a good idea for moms who are pregnant to connect with their HR, not only to figure out what their family medical Leave Act will provide for them at their HR or at their company. But also, what services that they have at their own own employee area and where they can do that pumping.

They may have already figured this out through other people, that they've seen some other co workers, that kind of a thing. And depending on the size of the company, this is where the Affordable Care didn't really work well for us. Part of those things, they do or do not have to provide some space because of the size of the company. How many people are there? If you are working in retail and you have one person, covering that bit. How is she going to?

Host: Exactly. Yeah.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: So there is, some issues still that we need to work out and for those employers out there, I would really encourage you to take a look at your HR, um, policies and what's going on and then act accordingly keep those babies in mind when you're making those policies.

Host: Yeah, and depending on the amount of time that it's going to take to do that, I mean, you don't want to just sit in the public restroom.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is not a clean environment. Do you want to eat your food in your public restroom? No. Mm mm. No. So, don't make our babies do the same thing. Right. Right. Right. The parts, after you're done with pumping, they should be sanitized once a day.

There's a couple different ways to do that. You can boil up some water and sanitize them that way. Some of our dishwashers now have sanitizing cycles on them. Or there is sanitizing bags that can purchase. Medela makes a nice one. And then you put all your pump parts in there, put a little bit of water, throw it in your microwave, and microwave it for the the amount of time that you need to.

They're reusable. You can use them, I think, like 20 or 30 times, something like that. Yeah, so, it's kind of nice to be able to do that.

Yeah. Breast milk is pretty safe. There's long life to its, shelf storage so fresh pumped milk will be okay to use anywhere from four to six hours at room temperature, like 70 degrees. Okay. And then putting it into the fridge, you can keep it in the fridge four to six days, and then in the freezer of your refrigerator, six months. If you had a deep freezer, a dedicated freezer, then it's good for up to 12 months.

Host: Really?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes.

Host: That's crazy.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: So it's got a long, long life to it, right? The, breast milk once it's thawed, so you've stored your breast milk, you froze it, and now it's thawed, is good for 48 hours in the fridge. So It doesn't have as long a life once it's thawed, but it does still a significant amount.

There's a couple of different collection devices out there that we have available to us now. I didn't have these available to me when I had my children and, they sit like either in the breast and as you are breastfeeding, your body releases that oxytocin down. It doesn't know to just go to the left breast. It doesn't, so it goes everywhere, right? And so the right breast will then start leaking.

And as you're seeing that, we just kind of, let it go into a diapy cloth and let that be for the day and, that's what I did. And now we can try to collect that a little bit. Some moms will have a half ounce. Some moms will have a few ounces in that leaking, depending on where they're at in their milk production and how much they're actually producing.

So there are other devices out there that actually kind of like suction to your breast and they kind of create a little bit of suction. So they're actually pulling some milk out. So increasing that a little bit, and that can be helpful for some moms who really want to increase their milk production a little bit.

That's one way that she can try to increase that milk production. The more milk she gets out, the more milk she has to make. So it, it perpetuates that cycle. Some other accessories would be like the breastfeeding pillow. A lot of people like the boppy pillow. They like how it looks.

I'm not necessarily a fan of it myself. I prefer a pillow that's a little bit flatter across. Your bed pillows work just fine. You don't have to go out and buy any of these accessories, and those sofa pillows that we all like to have as decorations, they work just fine.

Anything that's going to give some support to baby and to mom's arms is going to be fine. But if you really want to put something on a baby registry or something like that, then of course I would really like to have you look at the breastfeeding pillows that are designed more for breastfeeding versus just baby support.

And that's what the boppy pillow was kind of developed for more. It was more, when it first came out, was more of just supporting the baby, not really for breastfeeding. The types of pillows that actually kind of wrap around and gives mom some lumbar support and then buckle on the side, and they're flat They don't have a high end to one side like the boppy does is a little bit more user friendly for mother and it doesn't create a valley where the boppy creates that valley and the baby kind of gets stuck down in that valley. And it does, it makes it a little bit more difficult. Now, using that boppy pillow with that older child, like a month old.

Not a problem. Seems to work just fine. It's that newborn that it really doesn't work so well for. And that's who I work a lot with is that newborn. So if you have one out there, don't worry about it. But, if you're in the market of looking for one, I would look for something that's a little bit flatter.

Host: I haven't done any shopping new moms or babies, but I am pretty there's a plethora of things that you could go crazy with if you really wanted to.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah, you're right. There is a plethora of them out there. Yes. In the first couple of weeks, everybody goes home and kind of goes, oh, now what do I do?

Host: Right. Hmm. Yeah. I

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yeah. And so we want to see your milk supply starting to come in. It increases each day, somewhere between day three of life and day five of life, your milk supply should have come in and you should start to see your baby give you back stools that have changed over to a yellow color and have kind of a seedy consistency.

And then also six to eight wet diapers in a 24 hour period. And then they become more heavy or more saturated. We all kind of remember those really heavy saturated wet diapers. So you want to start to see that. Newborns should be fed somewhere between 10 to 12 times in a 24 hour period. That's where we get feed your baby every two to three hours from because the average is 10 to 12.

Now they might clump some of those feedings close together in what we call cluster feeding. Most commonly in the middle of the night, somewhere between 10 o'clock at night and 4 a. m., babies will almost always do a cluster feeding where they feed every hour.

Gina (Host): No wonder moms are so exhausted.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: I know, I know, right? So if she can grab a couple extra sleeps during the day in between, especially in that first two weeks to a month of life is really beneficial, not only for her own mental wellbeing, but also for her own milk production too.

So that stress, that cortisol increase can also decrease milk production too.

Host: I remember telling my daughter when she had our granddaughter, just sleep when she sleeps. The house can be picked up later.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It's all fine. Or your community can come around and help like your family members, your friends, maybe even a close co worker that can come over and instead of bonding with your baby, they do some of your housekeeping for you. Maybe bring over a couple extra meals that are prepared, things like that.

So if you have some of those kinds of things already in place those people that you know that you can count on to come help you and dad. So that dad and mom can bond with that baby.

Host: And honestly, people like to be able to do that and be helpful, so don't afraid to ask.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right, right, don't be afraid to ask, exactly.

It is normal for babies to lose weight initially when they're in the hospital.

Host: Alarming, but normal.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It is normal. And it doesn't matter how they're fed. They all lose weight. They have to work at feeding now. Before they were connected with this umbilical cord that was giving them all their nutrition and now they actually have to work and expend energy.

So they do lose some weight initially when they're born but then they start to put that back on. We would like to see that weight back to what we call birth weight by the time the baby is about two weeks old and then continuing to gain. Babies on average should gain anywhere from half ounce to an ounce every day. Again, that's average.

Host: That seems like such a tiny amount, but they grow so fast.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes. And if baby gains more than that, it is okay. You're not overfeeding your baby.

Host: Good. There is such a thing?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Well, maybe with a bottle, but not so much with the breast. Yeah. Yeah. And once they're back to that birth weight, if you haven't needed to do any pumping prior to that for any kind of medical reasons to give baby extra milk, then you may go ahead and start to pump your breasts and after a feeding, choose it might be a morning session, you fed the baby, and then you do a breast pumping. And then you breastfeed baby, and breastfeed baby again, and then maybe in the afternoon, you do a breastfeed baby, and then pump. When you pump, we want you to pump for about 15 minutes, 15 to 20, somewhere right in there.

Research doesn't really show that going much longer than 20 minutes is anywhere helpful to your milk production than what you're already getting at 15 to 20 minutes. Once you get through your breastfeeding experience, whatever that looks like for you, if that was, I just wanted to get further than I did with my first, or if it's, I want to go all the way to two years of age, whatever that is. But once you get to that point where you're like, okay, we need to wean off of this a little bit.

Weaning can be problematic for some moms. Some moms it just kind of gradually decreases, right? But others can really struggle with it a little bit. It should be a choice between mom and the baby. So mom needs to remember that there's another person in this equation and even though it's her personal choice, whether she continues or not, it is also you need to have that baby on board with your decision,

Host: Sure, sure.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Is what I'm saying. If baby is not taking a bottle and is refusing any of the other avenues of being fed, then maybe this isn't the greatest choice at this point and we have to work on some of those other avenues first. If you're thinking of weaning because you're going back to work or something like that a little bit earlier in the child's life.

As baby gets older, we start giving more and more solids, so you're still breastfeeding baby first, then giving the solids, offering the fruits, vegetables, proteins, that kind of thing, and as baby gets older and older, those become their main source of their nutrition, and that breast milk is, their secondary source.

Host: So then it's kind of just a natural slow -

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: A kind of a natural slow progression and as that happens, baby's feeding less and less frequently, your milk supply goes down a little bit, baby feeds less and less frequently, your milk supply goes down a little bit.

If mom is a pumping only. Some moms choose to just pump and feed their baby by a bottle. And then if you're doing that and you need to start weaning down, I usually recommend that moms drop maybe one or two pumping sessions, or decrease the length of their pumping session initially, depending on what would work best for her.

So she can either decrease the length of her pumping session, and so instead of doing 15 20 minutes, maybe she only does 7 to 10 minutes of a pumping session. And then that's telling her body, hey, don't make so much milk. Didn't need so much. And then after a couple of days, she can start dropping some of those pumping sessions.

And after her body adjusts, then she drops a few more and just keeps dropping those down. It can take a couple of weeks for that to completely dry up and go away.

Host: It feels to me like when I did that, it's just scary. The whole idea of just being done.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes.

Host: And weaning, and how is this going to go over with the baby, and am I going to be okay, and -

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Right.

It can be, it can be overwhelming. So reaching out to those people like a lactation consultant to, to review, to go over some of those things. Yes, we might talk about it a little bit in a breastfeeding class, but that's two years down the road before you have to use that in some of that information.

Host: And it's okay for them to reach back out you some guidance and hand holding, perhaps?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes. Yes, not a problem, not a problem. Just as a reminder, I think I did mention it in the first podcast, but I do do a phone call to all our moms who deliver from, at the hospital here and just check in with them, see how things are going within the first few days of discharge.

Host: That's wonderful.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: And then again, at about two weeks of age, if you're breastfeeding your baby, I do check in with you again and make sure that baby's back to birth weight, that you don't have any questions about pumping. We talk about growth spurts and just some generalized answering of questions that you might have.

Host: Your milk came in, but it's not coming out. Oh my gosh!

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yep. All right. And then if you do feel that you want to set up an appointment with me, then you can easily call the office and we can set that appointment up. Again, it's charged through the mother's insurance, not the baby's insurance. It's charged through the mother's insurance. And depending on your insurance, there might be a copay or something like that that you have to pay when you first arrive.

Host: You want to remind everybody what that phone number is?

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Yes. It's (515) 602-9811.

Host: Okay, 602-9811 is the number to call to set up an appointment. Oh my goodness, this has been a lot of information. It's, it happens so naturally with new moms and babies it seems, but when you talk about it like this, it's like, ah, my mind is blown. It's just a lot of information. Yeah,

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: I can't keep all this straight. And then all of our mothers going home from the hospital have a book. It's like their handbook or their, guidebook, right? And it's a postpartum and baby and newborn care. It has things about mom, things about baby, and then also about breastfeeding in it too.

Host: It's a lot of work.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: It's It is. It is. But it's so worth it like you said before.

Host: It is. Yes. It's a miracle. Just all of it. And you know, you look at your own children and you think, I wouldn't have traded that for the world, no matter what your situation was.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Correct.

Host: It's all worth it. So, okay, once again, we are going to take all of this information. We had part one.

So if you are listening to part two and you haven't listened to part one, you might want to go back and check that out. It's only about a half hour long.

Huge, just a plethora of information from Karin about all the things surrounding breastfeeding. And if you have more questions, again you can call her at 515 602 9811.

We are putting a link to the podcast on our maternity center page of our website, iowaspecialtyhospital.com. And we are also in the process of building out from that page, just this information that you've given us in the podcasts. So all of that will be available for anybody to read as well.

The podcast will be also listed under our podcasts on the website. So all over the place, we'll put it on social media.

Karin Semans RN, IBCLC, Lactation Consultant, OB RN: Wonderful.

Host: If you can't find it, well, I don't know what to tell you.

Thank you for listening to Iowa Specialty Hospitals and Clinics ISH DISH podcast. For more information on the topic 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.