Welcome to Crafted Birth

We offer comprehensive group Childbirth Education, Breastfeeding, and Newborn Care classes in Western Massachusetts, and private classes anywhere in Western and Central Mass.


Please take a look at our current class schedule to find that class that is right for you. We also have a Resources page with great online and local resources for Pregnancy, Birth, Postpartum Care, and Breastfeeding.


Thank you taking the time to prepare for your birth. I'm so excited you've found your way to Crafted Birth, and I hope to help you hand-make your best birth experience.

~ Mollie Hartford, CCE

Serving Adams, Agawam, Amherst, Ashfield, Athol, Barre, Becket, Belchertown, Bernardston, Blandford, Brookfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Colrain, Conway, Cummington, Dalton, Deerfield, East Longmeadow, Easthampton, Erving,Florida, Gill, Goshen, Grandby, Grandville, Great Barrington, Greenfield, Hadley, Hampden, Hardwick, Hatfield, Hawley, Heath, Hinsdale, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery. New Braintree. New Salem, North Brookfield, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Petersham, Phillipston, Pittsfield, Plainfield, Richmond, Rowe, Royalston, Russell, Savoy, Shelburne, Shutesbury, South Hadley, Southampton, Southwick, Springfield, Stockbridge, Sturbridge, Sunderland, Tolland, Tyringham, Ware, Warren, Warwick, Warwick, Washington, Wendell, West Brookfield, West Springfield, West Stockbridge, Westfield, Whately, Wilbraham, Williamsburg, Windsor, Worthington

How cancer is sort of like having a baby

Mollie Hartford

May 25, 2018

On March 27, 2018, I found out I had breast cancer. The lump that was “probably a clogged milk duct”, which turned into “probably just a cyst”, which turned into “most definitely a dilated duct”, turned into Invasive Ductal Carcinoma, one of the more common forms of breast cancer. Genetic testing, two MRIs, three oncologists, and seven weeks later, I had a bilateral mastectomy at Brigham and Women’s Hospital in Boston.

Did I mention that I’m only 35 years old? I have a two young boys, two and seven years old. I was still nursing. My husband and I had just bought our first real house with a real yard and a real furnace that needed to be replaced. I run a small non-profit that provides free postpartum support to families in Western Massachusetts, and was about to spearhead my first fundraising appeal. I was starting to look into training to be a Lactation Consultant. I had a plan.

Cancer was not part of the plan.

But lucky for me, and unlucky for this cancer (whom I named Phyllis), I’m a big fan of:

1) planning (even if it’s a brand new plan that I didn’t want any part of),

2) telling people to sit still and let others help them, and

3) taking my own advice. … ok, that last part is a lie. I’m terrible at taking my own advice. But to set a good example, I set into motion Mollie’s Cancer Postpartum Recovery Plan.

I know postpartum. I am a certified childbirth educator and trained as a doula, and my day job is supporting other parents while they navigate their postpartum journeys. “You deserve support” and “Let people help you” are heard several times a day at my workplace. I also had two of my own babies, with two VERY different postpartum experiences -- the first filled with isolation, loneliness, and depression, and the second filled with meal trains, competent care providers, and a Village of helpers.

So when it came time to tackle cancer, I did what I know -- I planned for a baby. I soon discovered a few similarities between the two which, while not making this process easy by any stretch, translated it into a language I could understand.

1. Doctors are human, every hospital is different, and your OB/Oncologist is not your friend.

I always tell my Childbirth Ed students the story of a couple I met while pregnant with my first. It wasn’t until 39 weeks that they discovered their hospital would not allow them to use most of the pain-relief techniques they had been practicing. I was shocked that they hadn’t been on their hospital tour until their 9th month, and hadn’t confirmed with their OB that everyone was on the same page with their birth preferences. Because of their experience, the rules in MY Childbirth Ed classes are:

1) Go on that hospital tour early, be the annoying one who asks a lot of questions, and then do it again at a different hospital. Learn what’s out there and available to you;

2) Interview your OB or Midwife, and then interview a few more. See what makes one different from another;

3) Make your care provider show their work. Ask questions, and make sure you understand WHY they’re recommending certain treatments, tests, or interventions. If you don’t like their answer, ask someone else. It’s OK to get a second opinion, or even switch providers, because this is YOUR birth, not theirs. They are not your friend, and worrying about offending them does not need to be part of the decision-making process.

After I got home from the appointment with my first oncologist, I turned to my husband and said, “I can’t figure out why I don’t like him. Was it because he kept saying annoying things like ‘You have cancer’, or was it because he didn’t seem good at his job?” The doctor did not know how things worked at the hospital -- he didn’t know where the gowns were, and kept giving conflicting instructions to his medical assistant. We dug into it a little, and found out that he was a locum tenens physician, basically a temp doctor, who wouldn’t be at this hospital for very long. Not really a comforting fact, considering I was 35 and would be dealing with continued cancer screenings for, hopefully, the next 50 years.

I set up an appointment with another oncologist at a different hospital, someone my dad knew. The difference in what he said was staggering -- we discussed MRIs, lymphedema, and his recommendation that I would need chemotherapy regardless of what they found, all things that the first doctor had not even mentioned.

The vast difference between my first two oncology visits convinced me I needed a third. By the time I saw my third surgeon and oncologist, I had my questions ready, and when they told me something that differed from what a previous doctor had said, I made them tell me why. I made them show their work. I left those appointments truly understanding my cancer, and what options were available to me. I weighed the pros and cons of each doctor and hospital, making sure to NOT factor in that surgeon #1 kept calling to see how I was feeling, or that oncologist #2 was a friend of the family. I decided on my care team based on what was best for ME and what made ME the most comfortable.

2. People want to help. They just don’t know how.

“Let me know how I can help” can be one of the most infuriating phrases to anyone recovering from birth. Not only did I just expel a fully-formed human from my body, am now solely responsible for keeping this human alive with juices secreted from my glands, am currently healing a massive wound inside my uterus from a placenta (which, by the way, I made from scratch) that was ripped from my body, and am dealing with a the myriad other potential ailments such as an abdominal incision, perineal stitches, and a pelvic floor that’s straining to keep all my internal organs where they’re supposed to be, but yes, let me check what we need from the store, Karen. I’ll get right on that.

The good news is that most people WANT to help, they’re just a little clueless about HOW to help. That’s where some planning comes in handy. I tell parents to keep a list of the household staples they often need on the fridge, so if someone offers, the list is ready for them. If you’re uncomfortable asking others to buy those items, have a gift card to the local grocery store loaded and ready for them to use. Websites like Mealtrain.com and Lotsahelpinghands.com make it pretty easy to organize meals, childcare, and other responsibilities among the (hopefully) vast network of people who like you. Also, tell people AHEAD of time that it’s ok to visit after the first week (or two or three, whatever you’re comfortable with), because you’re going to need help. I recently told a family friend how much it meant to me that she had come over after my second baby was born, that she had brought dinner and held him so I could take a shower. “How did you know that’s exactly what I needed?” I asked her. “Well,” she replied, “you TOLD us that’s what you were going to need, so I knew that’s what I needed to do.”

The main difference between planning for recovery from birth and planning recovery from cancer surgery is that I had nine months to plan for postpartum, and maybe 4 weeks to plan for surgery. Again, that’s where other people can come in handy. A dear friend said she wanted to be in charge of childcare -- we needed after-school dates for the big kid, and daytime childcare for the toddler in the weeks immediately following surgery. I gave her a list of my older kid’s friends, and SHE contacted their parents to set up play-dates. SHE created the childcare appointments in our lotsahelpinghands.com calendar, and all I had to do was share it around. SHE called people when she noticed there was a day that wasn’t covered. I was lucky that my husband was able to take time off work to be home with me immediately after the surgery (why I consider this lucky and not simply part of our healthcare system is a topic for another rant, er, I mean essay), but had he not been able to be home, many of the tactics I had used postpartum would have been just as useful post-surgery: label the kitchen cabinets so helpers know where to put away clean dishes, write instructions for the washer and dryer so anyone can do your laundry, and set some clear boundaries on when visit time is over (my husband and I came up with a code word: “Isn’t it time to check my drains?” was the signal that I was DONE and he needed to get rid of any visitors who had overstayed their welcome).

I think my cancer scared people. I was too young, too healthy, and dare I say too nice, to have cancer. There was nothing they could do take my tumor away, but they could make me dinner. They just needed to be told when and where (and that I really don’t like kale).

3. It’s ok to feel ALL the feelings.

To describe the variety of postpartum feelings would take up so much internet space, I’m not sure there would be room left for anything else. Joy, sadness, resentment, elation, guilt, pride, regret, relief, rage, loneliness, selflessness, unconditional and unending love, along with unconditional and unending fear. Some parents immediately fall in love with their babies, and for others it takes months. Some never want to leave their babies, and some can’t wait to get back to their previous lives. Some have an emotionally “easy” postpartum, some are tortured by depression, anxiety, and debilitating mood disorders, and the rest fall somewhere on the spectrum between the two extremes.

And those are all ok.

It’s ok to feel any and all of the feelings (though of course, mood disorders and feelings that get in the way of functioning need to be brought up with your care provider, so you can get support in managing them). Anyone who says, “No, don’t feel that way!” can go to hell. Feel it. These feelings are real, whether they’re socially acceptable or not, and they deserve to be recognized. If you dislike your baby today, that’s ok. If you think your baby is the greatest baby in the history of babies, tell the world. If you are loving being pregnant, basking in the beauty of breastfeeding, or stoked about your squishy postpartum belly, call me up and tell me. If you resent this parasite sucking every last ounce of energy out of your body, are “touched out” by this tiny human on you all day, and sobbing over the sight of your sagging figure, tell me that too. Because it’s all true for you.

About four days after my surgery, I lost it. I had been riding a wave of relief and oxycodone, much like the postpartum person rides the wave of adrenaline and oxytocin. But that day, just as the drugs wore off, the realization of what had just happened hit me. I had just cut off both my breasts. I had stitches across my chest, and tubes under both arms draining blood and fluid out of my body, because it had been cut open, scooped out, and sewn back together. I couldn’t hug my kids, couldn’t even snuggle with the toddler, because I had let these doctors mangle me. Oh, and did I mention the drugs had worn off? Between sobs about how I was a terrible mother because I needed other people to take care of my kids, how I was weak because clearly I needed more medication, and how I was somehow to blame for letting this happen to me, my husband (who, bless him, is not always the best at this “feelings” stuff) said, “It’s ok to not be ok. In fact, I’d be worried if you were totally fine with all this.” I had to get used to feeling relief and regret in the same breath, just as before the surgery I had been cycling between denial, anger, bargaining, depression, acceptance, and then back to denial again about my diagnosis. I was simultaneously brave and terrified, fierce and fragile. The same people calling me a survivor also had to see that I was also scarred. And I needed people who understood these feelings first hand, which leads us to our last point.

4. You’re going to need your Village.

It really does take an entire Village to raise healthy families. Babies are a 24-hour a day job, and it’s simply unreasonable to expect a parent to be able to care for themselves and a baby at the same time all by themselves. They need help. They need neighbors bringing food, extended family taking shifts of childcare, and people who have survived this journey nearby to show them the way. Part of the issue with families being alone in their nuclear bubbles is that not only are they managing the practical responsibilities of a parenting on their own, but they are also navigating the emotions of their lives in a vacuum. Parents need peer-to-peer support, to be heard and understood by someone who “gets it”. This is why “Mom Groups”, “Baby Playgroups”, and “Tummy Time” groups exist; it’s less about socializing the baby as it is about giving mom the chance to see other adults who understand her.

When I first got diagnosed, I felt a sudden isolation; not only did none of my friends really understand what I was going through, but every piece of information I was given felt like it was geared toward someone 30 years older than me. Late one night I was searching for articles about handling the responsibilities of parenting young children while going through cancer treatment. The only articles I could find were about how to TALK to kids about cancer, or how to manage when your child has cancer, but nothing about how to, say, get your toddler into his car seat when you’re not allowed to lift anything over 10 pounds. Finally, I found ONE article that profiled a young mother with breast cancer, and in it she mentioned the Young Survival Coalition, an organization dedicated to the critical issues unique to young women who are diagnosed with breast cancer. Finally, I had found my people. These women were young, some had young children, were early in their careers, and discussed things like fertility and breastfeeding.

In the Young Survival Coalition private Facebook group, I finally found the answers to those questions only a young woman with cancer can answer. Just as experienced mothers tend to send more practical baby shower gifts (“This is what you REALLY need”), these young survivors shared their recently-learned tips for dealing with cancer treatment as a young parents (“Yes, you WILL need childcare for the toddler for the first 6 weeks after surgery”). Better yet, I found a group of people who understood when I posted, sobbing over my keyboard, how it broke my heart that I couldn’t hold my child. They shared their stories, sent virtual hugs, and were there for me when I felt alone. There’s a special kind of support that can only be given by someone who’s been through it too.

My post-cancer-surgery bedroom looks a lot like my postpartum bedroom -- a nest of pillows, snacks and water bottles everywhere, a toddler being “gentle with mama”, and friends popping their heads in to say hi as they drop off dinner. The only thing missing is the baby, the squishy lump that I made from scratch, the happy ending to the pregnancy and postpartum journey. All I’ve got is a tumor in a jar … which, actually, I did make from scratch.

Mollie is the Co-Executive Director of It Takes a Village, a non-profit organization that provides free postpartum support to families in Western Massachusetts, and is the owner of Crafted Birth Childbirth Education.

Holiday Giving and Small Business Saturday

As the holidays get closer and closer (and as my son's toy collection gets bigger and BIGGER!), more and more I appreciate gifts of experiences, education, and time with others (or just myself). There are so many wonderful small businesses in Western Massachusetts that provide pregnant women and new moms with body work, birth services, postpartum support, and family-friendly classes and events. Please consider supporting a local business this holiday season, and give a pregnant family or new momma a gift she can use to have fun and feel great.

Crafted Birth offers gift certificates good for group and private classes. Click the Add to Cart to pay with a credit card or bank withdrawal via Paypal. If you prefer to pay with cash or check, please email Mollie to arrange an in-person transaction. Mollie will mail you or the recipient a gift certificate printed with your message.

Available Certificates	Price	Purchase
Full 6-Week Childbirth Education Series	$90.00
One Newborn Care or Breastfeeding Class	$30.00
One Private 2-Hour Session	$40.00
One Private 3-Hour Session	$60.00
One Private 4-Hour Session	$80.00
Custom Amount, good towards any Crafted Birth Class	You Decide

Other Local Businesses you support this season ...

Birthing Mama Yoga (Amherst) - Prenatal Yoga Classes in Amherst, or sign up for the online holistic pregnancy program. Gift Certificates available.

Grow (Northampton) - a community educational center with classes, services, and a retail shop for families.

Second Chances Kids' Consignment Shop (Amherst) - The retail store offers children's clothing, maternity and nursing clothing, toys, baby equipment, books, and movies. Their community room hosts classes and playgroups every day.

Music Together for Valley Families (Amherst, Holyoke, Hadley) - Music Together is an internationally recognized music program for children from birth through age 7—and the grownups who love them. Gift Certificates available.

Happy Holidays!

Childbirth Classes in Amherst, MA | Fall 2014 Schedule

(click here for Northampton schedule)

Fall 2014 Schedule - Amherst, MA

To sign up for classes, click here.

Series Description
This comprehensive Childbirth Education series covers all aspects of pregnancy, labor and delivery, and postpartum care. We focus on informed decision-making and evidence-based information, taking time to discuss the risks and benefits of all aspects of your birth preferences. This is not a "natural birth" or a "medicated birth" class series; rather we help you decide what kind of birth you want, guide you through the questions to ask yourself and your care provider, and give you the skills you need to achieve your birth experience. For details about class topics, please see our Class and Schedule page.

The class series runs for six weeks, followed by the Breastfeeding class and Infant Care class. Scheduling and billing these two classes separately provides flexibility and respect for all parents -- we won't make you sit through (or pay for) a breastfeeding class if you cannot or are choosing not to breastfeed, or attend a newborn care class if this is your second baby.

Classes are ideal of pregnant women in their second or third trimester (if you are due VERY soon, please contact Mollie to discuss a private session). We encourage partners or other support people (a parent, friend, doula, etc.) to participate in classes, and we respect and welcome all family structures.

Location

Second Chances Consignment Shop, Community Room

7 Pomeroy Lane
Amherst, MA   01002

6-Week Series

Dates: Thursdays, October 16 through November 20, 6pm--8pm
Cost: $90.00 per couple
Classes (2 hours each):

• Thursday October 16: Choosing Care, Anatomy and Physiology
• Thursday October 23: Labor and Delivery
• Thursday October 30: Pain Management
• Thursday November 6: Common Interventions
• Thursday November 13: Basic Newborn Care and Feeding
• Thursday November 20: Postpartum Care 

Breastfeeding Class

Date: Thursday December 4, 6pm--8pm
Cost: With 6-Week Series, $25.00 per couple
            Without series, $30.00 per couple
Topics:

• Anatomy of Nursing
• Latch
• Breastfeeding Positions
• Common Problems and Solutions
• Pumping and Bottle-Feeding Expressed Milk 

Newborn Care Class

Date: Thursday December 11, 6pm--8pm
Cost: With 6-Week Series, $25.00 per couple
            Without series, $30.00 per couple
Topics:

• Newborn Anatomy
• Bathing and Skin Care
• Diapering
• Calming and Swaddling
• Sleep Safety
• Car-Seats
• Babywearing 

Questions about the class? Interested but would prefer a private session? Ready to sign up? Please contact Mollie today!

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Serving Adams, Agawam, Amherst, Ashfield, Athol, Barre, Becket, Belchertown, Bernardston, Blandford, Brookfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Colrain, Conway, Cummington, Dalton, Deerfield, East Longmeadow, Easthampton, Erving,Florida, Gill, Goshen, Grandby, Grandville, Great Barrington, Greenfield, Hadley, Hampden, Hardwick, Hatfield, Hawley, Heath, Hinsdale, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery. New Braintree. New Salem, North Brookfield, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Petersham, Phillipston, Pittsfield, Plainfield, Richmond, Rowe, Royalston, Russell, Savoy, Shelburne, Shutesbury, South Hadley, Southampton, Southwick, Springfield, Stockbridge, Sturbridge, Sunderland, Tolland, Tyringham, Ware, Warren, Warwick, Warwick, Washington, Wendell, West Brookfield, West Springfield, West Stockbridge, Westfield, Whately, Wilbraham, Williamsburg, Windsor, Worthington

Book Review: Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family

La Leche League released a book about breastfeeding and bed-sharing. They suggest that it is the first infant sleep book directed solely to breastfeeding families. There is one thing I do love about very topic-specific books like these: they don't waste time apologizing. They don't need to spend any time on "Well, breastfeeding is best, so if you can ...", or "We're not making any judgement if you formula-feed, because every mother is different and every situation is different ...", blah blah blah. They jump right in with Given #1: You're breastfeeding, and breastfeeding is awesome. They assume you've already done your research and decided that breastfeeding matters to you. Because, really, are you going to reach out to La Leche League if you're dedicated to feeding with formula? Probably not.

The next "given" they talk about is an interesting one. The introduction describes how they started out writing the book intending to discuss ALL types of sleep arrangements including those where the baby sleeps alone, down the hall. But in combing through the research, they could not rationally make that suggestion, that bed-sharing showed such clear benefits to both mother and baby, the entire focus of the book shifted. Given #2: Bed-Sharing is awesome. (They also define "bed-sharing" in a scientific way, forgetting the too ambiguous term "co-sleeping".)

Getting those out of the way in the first few pages really set a great tone for the book. This is not a wishy-washy, "whatever works best for you" kind of book. It makes it clear that bed-sharing IS SAFE, and sleeping separately poses greater risks to the baby and to the mother-baby breastfeeding relationship.

I liked the layout of the book (and not just getting the "givens" out of the way right off the bat). The first chapter is, not kidding, two pages long. It is basically a 1-sheet for "I need to get some GD sleep right effing now" ... a "I'm tired as hell and I'm not going to take it anymore" cheat sheet. This is brilliant. How many of us have dragged our tired selves (and our tired babies) to the bookstore to find a solution -- any solution -- that will get everyone to sleep better TONIGHT? And in that state, I don't have time to read through a 450-page book (cause this book is pretty long). I need that cheat-sheet. It covers the very basics of the "Safe Sleep Seven", their criteria for bed-sharing:

If a mother is:

1. A non-smoker

2. Sober

3. Breastfeeding

And her baby is:

4. Healthy

5. On his back

6. Lightly dressed and unswaddled

And they:

7. Share a safe surface

Then the baby’s risk of SIDS is no greater than in a crib, and any breathing hazards have been hugely reduced.

The next page is the emergency "make your bed a safe surface tonight" guide, including having your partner and pets sleep somewhere else, remove everything except your pillow, the fitted sheet, a top sheet, and a light blanket, and place baby in the middle of the bed on his back. They make it clear that they'll get into more detail in Chapter 2, but for now, get some sleep. I love this. It's so real, and acknowledges the desperation many parents feel when they haven't slept in days (and this theme of desperation and real-life dilemmas came up a few times, which was refreshing).

Chapter 2 covers these criteria in more detail. They cover nearly all the nitty-gritty details you need to set up your bed-sharing safely -- mom is sober, non-smoker, and breastfeeding; baby is full-term and on his back; and bed is a bed (not a sofa or a chair) with no big blankets, cords, or gaps. Presumably, if you meet all these criteria, you'll be fine. If you've got more time (or are reading this book before the baby comes), the following chapters go into tremendous detail about the mother-baby dyad, "normal" sleep patterns for adults and babies, different arrangements for naps and nights, and infant personalities (and how that translates to calming and sleep).

Chapters 13 through 17 go through the baby's development and how that affects sleeping and nursing -- these chapters were chocked full of great, practical tips for calming babies, setting up patterns, and getting adult things done. I wished these chapters had been earlier in the book, maybe before the chapters detailing sleep gadgets (and why they're all terrible), and specific parenting situations like working outside the house, adopting, etc.

Interestingly, the chapters on Sleep Training and SIDS and Suffocation were at the very end of the book. Readers (including me) may have preferred them to be earlier, since these are big, real-life topics that come up most often: "She cries unless she's in your bed? You've just got to let her cry-it-out and she'll get the hang of sleeping alone" and "But the APP says a baby in your bed will die of SIDS. I don't know why, but that's what they say. Don't do it." But these chapters HAD to be at the end, because everything we learned throughout the whole book led up to these arguments. We needed to learn what normal sleep behavior looked like and what safe bed-sharing looked like BEFORE tackling sleep training and SIDS.

I especially appreciated how SIDS and suffocation were addressed, because they were addressed separately. The main issue in bed-sharing recommendations is that they combine SIDS and suffocation risks (or confuse the two), so parents don't know what they're protecting their child from. The authors separate these issues in a clear and concise way. Any baby is at risk for suffocation (which includes smothering, entrapment, strangulation, and choking), and we CAN prevent it by removing soft bedding, pillows, toys, wires and cords, ribbons and ties, and small objects from the baby's sleeping area, making sure the parents are sober (or not taking any sedative medications), and keeping other children and pets separated from the baby's sleep space. They also handle the discussion of SIDS -- which is an incredibly frightening topic -- with tact, making it clear that only vulnerable babies (with an underlying cardiorespiratory or brainstem problem) in that vulnerable time period (0-6 months) who are exposed to outside stressors (smoking, stomach sleeping, etc.) are at risk for SIDS. They lay out the four biggest risk factors (smoking, stomach-sleeping, unattended sleeping, and formula-feeding), hit on the other correlations (overheating, prenatal care, obesity, etc.), and address other popular theories and (off-gassing of mattresses). I finished that chapter with a much calmer and straightforward understanding of the real risks of SIDS and the real ways we can prevent it -- even when we can't detect which babies are "vulnerable".

The "Bedsharing Controversies" chapter was interesting, but really only relevant to professionals, since I'm not sure most moms care about research methodology or financial influences. Also the references index was 22 pages long, in size 6 font, which made my heart happy.

The main problem I had this with book was one that I have found in other LLL publications (and at meetings, sometimes). While the un-apologetic "just nurse the baby to sleep" advice was refreshing (and backed up with scientific discussion of hormones), the authors did not always fully address the real life issue that comes up in different family dynamics -- namely, Dad (or other non-breastfeeding caregiver) putting the baby down to sleep. Partners are only mentioned in context of "My husband doesn't want the baby in our bed" or "Partner can hold baby while you take a nap". There is a brief mention of "nudging" child to fall asleep without mom, but only after her is a toddler. And even then, when suggesting "substitutions" such as extra stories or a later bedtime, they negate the premise by stating "On the other hand, are you substituting something that actually takes more time and energy than just nursing?" (p. 188) In answer to the question about traveling without the baby for a business trip, they suggest taking the baby with you, instead of figuring out how baby can be cared for by dad. The tear-sheet for daycare providers was helpful -- suggesting a bottle and lots of rocking for the breastfed, bed-sharing baby -- but the chapter about working outside the house and having the child in daycare spends more time emphasizing how babies in daycare are at greater risk of SIDS and how their stress hormones may stay elevated through preschool if they go to daycare. Bottom line: it's best to delay it as long as you can. While this is probably the best evidence-based advice they can give, it's not exactly practical, and probably only serves to create more anxiety for mom.

I feel like LLL often falls back on the "just nurse the baby, and everything will be fine" argument, when sometimes that is just not practically going to happen. I was surprised that this book ignored the very real question of "but what if I want my partner to put the baby to sleep?", since the rest of the book responds to similar, popular questions (e.g. "My MIL says he's never leave our bed" or "Will co-sleeping ruin my sex-life?") with real suggestions ("try saying this" and "see if you can move baby to the pack n play after she falls asleep"). Additionally, the authors make a wonderful case for realistic policy recommendations -- since the majority of breastfeeding mothers ARE going to fall asleep with their babies, let's make it safe. Why can't we extend that logic: since the majority of mothers ARE going to leave the house someday, let's give some practical tips for someone else putting this breast-fed child to sleep.

Overall this is a great book to have on the shelf, and a great read for any breastfeeding parent. Even if you do not PLAN to bed-share, it's worth a look. Studies show that 60-75% of mothers will bring baby into bed with them at some point, even if they didn't plan to bed-share. One study found that 44% of mothers who nurse on sofas or recliners fall asleep there, which is not safe. Odds are you'll end up nursing your baby in bed -- why not make it safe now, just in case?

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.
Follow Crafted Birth on Facebook for updates and birth-related resources.

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"Oh, you'll have to wean immediately"

**This is a personal story, and is not meant to substitute medical advice. Rather it is an example of weighing risks and benefits, gathering evidence-based information, and coming to a care decision in conjunction with medical professionals.**

In December of 2012, I went for a routine checkup with my Primary Care Physician. My son was 20 months old, and in true mother-of-a-toddler fashion, I was exhausted. I worked full-time outside the house, was still nursing a few times a day when we were home, and spending my free time chasing this very mobile child around our New York City neighborhood. Overall I felt fine, though it had been a rough year. The previous January, when the kiddo was about 10 months old, we ALL got a horrible stomach bug, which left me about 11 pounds lighter. Normally, vomiting- and diarrhea-related weight loss comes right back after you get better, but for me it stayed off. Awesome! I attributed it to the kid learning to walk, still nursing on-demand, still pumping during the day, and generally not stopping to take a breath. Ever. Then over the next few months, I had several recurring throat infections -- not strep, just a nasty tonsil infection that kept coming back. They would get so swollen that I couldn't eat, and FIVE times in FOUR months I put myself on a liquid diet for at least 2 days each (and bought stock in Jamba Juice). Each time, there went another 4 or 5 pounds. By the fall, I was down 35 pounds from that January starting point. I didn't complain, because it had been so (relatively) easy! I was eating everything in sight, and STILL maintaining this "normal" weight -- because according to the BMI, I was right on track.

So I see my PCP, who doesn't comment on my weight loss (I find out later that they had lost my chart, containing the previous year's check-up info, so she didn't have the numbers from a year ago, and therefore didn't notice I had lost 35 pounds). She said I looked great, and would see me again in a year. "And don't forget to get your blood work done downstairs", she said over her shoulder as she hustled from the exam room.
Routine blood work -- I'm pretty used to it, and didn't expect any sort of follow up (since my doc doesn't follow up ... are you noticing a pattern?). But a few days later I get a call from her office: "Mollie, it's Dr. F. Something came up on your blood work, call me back immediately. Here's my cell number."
[insert panic attack here]
So I call her back on her cell number, which she answers while in the room with another patient (what?!)
Dr. F: "I can't talk right now I'm with a patient"
Me: "But you made it sound like this in an emergency!"
Dr. F: "Well, it's serious, but I can't talk right now. I'll call you back when I'm done here."
Me: [panic for the next 5 hours]
At 6:00pm or so she calls me back, from her cell phone, while walking ON THE STREET (oh, she's so fired).
Dr. F: "Your TSH is nearly 0, so you need to see an endocrinoogist right away."
Me: "Wait, what does that even mean?"
Dr. F: "It means there's a problem with your thyroid, and you need to see an endocrinologist right away."
Me: "But what kind of problem?"
Dr. F: "I can't really get into that right now. If you want to know more, just Google it."

...

... oh, she is SO FIRED!!!

After a few minutes of a combined panic attack over probably having some sort of thyroid cancer and sheer rage over my PCP telling me to GOOGLE MY SYMPTOMS, I get a hold of an endocrinologist who can see me in a few days.
[In the meantime, I also do what any good daughter does -- I call my dad, who happens to be a PCP, who assures me that it's almost definitely not cancer, to NOT GOOGLE ANYTHING, and to have a glass of wine and chill out -- I am not going to keel over between now and my appointment on Tuesday. Love you, dad.]

So Tuesday comes and I go to see the endocrinologist, Dr. B., who is supposed to be very good, though lacking in "bedside manner" -- whatever, I just want to know what's wrong with me. He takes one look at my chart, one look at me, and says, "You have Graves disease." Short explanation -- it's an autoimmune disease that attacks the thyroid -- making it churn out thyroid hormone -- and breaks the "thermostat" in your body that tells the thyroid when to turn on and off -- therefore letting the thyroid churn out hormones to its heart's content. This turns up your metabolism (hello, weight loss), can cause jittery-ness and shaking (which I figured was just from drinking a lot of coffee, cause I'm exhausted from working full time raising a toddler), and fatigue -- not general lethargy, but exhaustion from being turned up to 11 24-hours a day (which, duh, I'm a working mom, isn't that just called 'life'?).  He tells me he's prescribing Methimazole to suppress the thryoid. At this point, I'm trying to keep my head on straight and remember my Informed Decision-Making Questions. "Is this an emergency?", "Why is this being prescribed?", "What are the risks?", "Are there any alternatives?"
We talk through everything, and as he's about to send me home he asks "Oh, and you're not pregnant or planning to get pregnant soon, right?"
"No, we're good with the one we have for now," I say, laughing, thinking that now baby-making is the last thing on my mind. "But I am still nursing."

"Oh," he says, "You'll have to wean immediately."

Now, as difficult as that postpartum year-and-a-half had been, breastfeeding was probably the only thing that had been easy. One teeny tiny latch issue in the 2nd week, a weird vasospasm thing at 8 months, but otherwise we were golden. My life pretty much revolved around nursing, even now at 20 months. It was home. It was grounding. It was his way of checking in, of saying "Hi Mummy," and "Good morning, I missed you". It was Our Time. I wasn't going to let that go without a fight.

"Is there another option?" We discussed the other thyroid-suppressing drug, which is safer for babies but has more serious and more common side-effects for mom. "Are you sure it's necessary to wean?" Dr. B pulls out the Physician's Desk Reference, and looks it up. "Yeah, it says it's not safe with breastfeeding, I'm sorry." He sends me out the door with an Rx in my hand and a hole in my heart.

Luckily, there are a few things in life that get me mama-bear fired up: my kid, anyone's birth, and anyone's breastfeeding relationship. I call my husband and say, "I'm not taking this Rx until I get a second opinion. Dad said I wasn't going to keel over waiting for my appointment, I'm not going to keel over in the next day or two waiting for more information."

I call the pediatrician and leave a message.

I email Rebecca, my doula-friend from college, who had just finished her IBCLC. She calls me back with her copy of "Medications and Mother's Milk", and we talk through what it says -- that Methimazole has not been shown to have any impact on the infant's thyroid function up to 20 mg daily dose. And my son is not an infant anymore, is not getting all his nutrition from breastmilk anymore, and his more mature system can handle medications better than an infant's.

I go on KellyMom.com, which sends me to LactMed, which shows me the studies done on breastfed babies and mothers on Methimazole. There is also a link to the AAP list of approved drugs, which includes Methimazole (though as a Class C drug, it's in the "Probably Compatible" category). The KellyMom article also explains why the Physician's Desk Reference (and the FDA) said it wasn't safe. (Hint: it has to do with lawyers.)

I call the Infant Risk Hotline, and a lovely women with a delicious Texas accent talks to me about dosage and half-life.

I'm feeling so much better ... until the pediatrician calls me back. I get the on-call doc, Dr. R. I've already had one bad experience with her, when she told me to wean the baby at 15 weeks because he had teeth (wrong).
Me: "I've just been diagnosed with Graves Disease, and the endocrinologist put me on Methimazole, but I'm breastfeeding, and I just wanted to che--"
Dr. R [interrupting] "Oh, you'll have to wean immediately."
Me: [deep breath] "Ok, but I've spoken to a few other people and the data seems to say that the dosage--"
Dr. R: "No, if you take this medication while breastfeeding you'll damage the baby's thyroid."
[now, notice I haven't actually told her the dosage yet, and there was no pause when she would have looked up any of this information]
Me: "Ok, but I just spoke to an LC, called the Infant Risk hotline, and checked on LactMed, and they all say a dose up to 20 mg a day is fine for infants, and I figured since he's almost two--"
Dr. R: "Well, it seems to me that you're going to do it anyway, regardless of what I tell you, so I guess it's up to you if you want to risk damaging your baby."

...

Oh, she's ALSO SO FIRED!!!

Anyway, I get an email from the endocrinologist the next day, saying my additional lab work came back, it's definitely Graves Disease, and 20mg is a good dose. I reply "Thank you very much, and by the way, I've reached out to a few people regarding breastfeeding and Methimazole, and the data suggests that a 20 mg dose is considered fine for infants (I'm linking to the site below so you can see), so I am comfortable continuing breastfeeding my toddler. Just wanted you to know, and should we need to increase the dose at any point, we can revisit."

He replied with, "Ok."


My son self-weaned just after his second birthday, so only a few months after my diagnosis. Some may hear this story and say, "Well, it was only a few months more, was it really worth getting so upset about it?" Yes, yes it was. We weaned in the gentlest way I can imagine, because neither of use really noticed until it was over. One day he stopped asking for "boo-boos" when I got home from work. A few weeks later he stopped asked for it at bedtime. A few weeks later he stopped asking for it in the morning. And then we were done. Imagine if I had had to take it away from him, without any notice, when he wasn't ready? When I wasn't ready. On top of dealing with a disease I didn't know I had, realizing that these symptoms were NOT just "motherhood" intensified, do you really want to throw in "Now you're not allowed to comfort your child in the way that works best for both of you?" No thank you.

A few months later I wrote to every doctor in the Pediatrician's office, including Dr. R., detailing my encounter, and encouraging them to invest in some time in breastfeeding education for those doctors who need it. I included all the resources I could think of, including LactMed. The next time my child was sick, I specifically asked which doctor was on-call, and when it was Dr. R., I respectfully asked to be connected with someone else, because I did not feel comfortable with her treating my child. I fired Dr. F., and still intend to write a letter to the practice about the "google" incident. I hope that Dr. B. looks for more resources next time he makes recommendations to lactating women, though I understand that it's not his specialty. I can only hope that more women know their options and are not afraid to ask those questions and get other opinions. It's not only our right but our RESPONSIBILITY as patients to make sure we understand our course of treatment, give our doctors all the information we can, and ask the questions and do the research to come to an informed decision about our care. We are the ones who have to live with the consequences after our treatment is done, not the doctor.


**This is a personal story, and is not meant to substitute medical advice. Rather it is an example of weighing risks and benefits, gathering evidence-based information, and coming to a care decision in conjunction with medical professionals.**

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