Emily Oster on Breastfeeding - minimal benefits.

[IamOvercome]

I am pregnant with my first and am an economist so I was recommended books by fellow economist Emily Oster. The books don’t give advice. They review the statistical studies underlying pregnancy advice and whether they are any good or not.

It’s been such an eye opener. For example it is pushed pushed and pushed some more that breast is best. But when you review the evidence there is minimal evidence for benefits of breastfeeding for babies. The strongest evidence is actually for mothers that it can marginally reduce chance of breast cancer in later life.

Same with not introducing babies to bottle to confuse them when breastfeeding. Literally no concrete evidence for it.

Yet this is all pushed as clear cut facts by midwives and other health professionals.

@NurseBernard

Breastfeeding is the biological norm. Nothing more, nothing less.

Human milk is designed for human babies.

If you don’t want to breastfeed - all good, you’ll be in great company.

Hardly anyone does breastfeed, especially in the UK.

Formula feeding is the prevalent means of feeding infants, babies and toddlers. The one thing you will not be, if you choose to formula feed, is alone.

In the UK it is.

@IamOvercome

I just want to say I didn’t start this thread as a breast v formula feeding thread.

I went to a breastfeeding antenatal course and it said breast is best, listing off benefits from reduced ear infections to intelligence etc for the child.

I then read this book and saw that the data underlying these pronouncements is massively flawed and even where it is correct for reduction of ear infections/diarrhoea it was something like a 6% chance of it happening versus a 13% so pretty marginal.

I was just surprised there is so little proper evidence yet breastfeeding is given as only correct choice and honestly it was really really pushed as the only choice for the child. But most of the benefits even on this thread and in the research are more for mothers than babies.

It's an insanely divisive subject OP. I couldn't believe it. So freaking controversial, so much us vs. them. You'll shy away from ever mentioning it! God help you however you end up feeding your baby, someone will tell you either way is wrong.

I bought the Oster books too. I don't think she's right on this. Breastmilk has components that formula does not have. They support the infant microbiome. There is evidence of breastmilk being beneficial for tiny babies and we're only just beginning to understand the underlying mechanisms.

I think she looked for studies comparing babies who were breastfed with those who were not, but not at wider studies looking at nutrition and how breastmilk is fundamental in encouraging a healthy gut which can determine all sorts of health outcomes in later life.

There are NICU units around the country where they try their very best to give premature babies colostrum and breastmilk because it has clinical benefits. It's about the bacteria that populate the gut, breastmilk has HMOs that help establish good ones, formula-fed babies have higher levels of the bad ones.

I do think that the stress of breastfeeding not going according to plan can sometimes outweigh the benefits and should be taken into account. But it's really not true to say formula and breastmilk are equally beneficial for babies.

@ReeseWitherfork agreed!! I would definitely be wary of discussing it with other people or other pregnant women given some of the crazy reactions to this thread!

@IamOvercome

I just want to say I didn’t start this thread as a breast v formula feeding thread.

I went to a breastfeeding antenatal course and it said breast is best, listing off benefits from reduced ear infections to intelligence etc for the child.

I then read this book and saw that the data underlying these pronouncements is massively flawed and even where it is correct for reduction of ear infections/diarrhoea it was something like a 6% chance of it happening versus a 13% so pretty marginal.

I was just surprised there is so little proper evidence yet breastfeeding is given as only correct choice and honestly it was really really pushed as the only choice for the child. But most of the benefits even on this thread and in the research are more for mothers than babies.

You went to a breastfeeding antenatal class and think it's odd that they promoted breastfeeding? How was it "pushed"? Breastfeeding IS the best choice in most circumstances for most mothers and babies. Saying that and encouraging mothers to breastfeed isn't "pushing" it.

Breastfeeding IS the default way of feeding your baby. The low breastfeeding rates in this country is all to do with culture. The breasts of women who live in the UK are no different to breasts in the rest of the world.

@GrendelsGrandma

I bought the Oster books too. I don't think she's right on this. Breastmilk has components that formula does not have. They support the infant microbiome. There is evidence of breastmilk being beneficial for tiny babies and we're only just beginning to understand the underlying mechanisms.

I think she looked for studies comparing babies who were breastfed with those who were not, but not at wider studies looking at nutrition and how breastmilk is fundamental in encouraging a healthy gut which can determine all sorts of health outcomes in later life.

There are NICU units around the country where they try their very best to give premature babies colostrum and breastmilk because it has clinical benefits. It's about the bacteria that populate the gut, breastmilk has HMOs that help establish good ones, formula-fed babies have higher levels of the bad ones.

I do think that the stress of breastfeeding not going according to plan can sometimes outweigh the benefits and should be taken into account. But it's really not true to say formula and breastmilk are equally beneficial for babies.

Re NICU yes this point is made in the book that research shows there are clear benefits of breastfeeding in premature infants.

I’d be interested to read some studies on the microbiome if you could link - I’ve read some on impact on adults but haven’t seen any in breastfeeding improving microbiome over formula feeding

@bebanjo

Not read the whole thread so apologies if I’m repeating. I am always amused that we are told to eat whole foods, cook from scratch and avoid highly processed foods. Yet when it comes to babies, highly processed food is just dandy and no different at all to fresh natural food. Feed your baby how you want and eat as much highly processed food as you like as well.

I made that point but I'm glad you've made it again because it's worth repeating, it's almost never acknowledged.

[quote IamOvercome]@luxxlisbon I wonder if anyone has ever compared the environmental impact of formula feeding to environmental impact of nappies. The stats on nappies are fairly shocking but there isn’t this drive to push reusables on women in the same way as there is with breastfeeding.[/quote]
People make money out of disposable nappies and reusable ones, so it's not a fair comparison.

Also, your nappy choice has very little do with long term health.

@IamOvercome

I am pregnant with my first and am an economist so I was recommended books by fellow economist Emily Oster. The books don’t give advice. They review the statistical studies underlying pregnancy advice and whether they are any good or not.

It’s been such an eye opener. For example it is pushed pushed and pushed some more that breast is best. But when you review the evidence there is minimal evidence for benefits of breastfeeding for babies. The strongest evidence is actually for mothers that it can marginally reduce chance of breast cancer in later life.

Same with not introducing babies to bottle to confuse them when breastfeeding. Literally no concrete evidence for it.

Yet this is all pushed as clear cut facts by midwives and other health professionals.

Emily Oster has been quite open that a reason why there may not be so much evidence for breastfeeding is because breastfeeding by itself hasn’t been studied yet. This is happening right now and there are a few ex-Googlers etc who are investigating breastfeeding and have found links to a few other things. It should be noted that this is brand new research.

In relation to BFing ....Another issue that I don't see being spoken about enough is tongue tie.

Firstly - it's agony and causes many women who WANT to BF to give up.
Not nearly enough support is available to diagnose it and then treat it.

Seems really unfair. We're debating the benefits of BFing here, but seems to me the first step is to help women to experience it as a positive bodily feeling/bond.... if they want to.

The reality is we have a terrible -useless aftercare system for new mothers.

Can you put a £price on sheer convenience though?? Literally nothing else about having a baby was convenient. Just the portable milk machinery.

I enjoyed BF ing, the feeling of closeness, spent £0 on consultants..!?! …

I mix-fed my eldest at points and the nipple confusion was only minimal… Each to their own - but mix-feeding was definitely the most convenient option for me.

Also, ask any dairy farmer and they'll tell you how important colostrum is for the newborn ( yes I know we're not cows)

YANBU, it's pushed by health professionals who don't have the resources to support new mothers who then end up feeling shit if they fail. If you want to and you can then great but the superiority you encounter from breast-feeding mothers is awful.

I think that the most important part of breastfeeding is the first few days when they're drinking colostrum. After that, probably not a huge advantage long term. A lot of the so called risks of formula feeds are also nonsense, and the studies they are based on are poorly designed and don't stand up to any critique. Although it's the 'natural' way to do things, I think the reality is that when parents/carers can share feeding then it allows more time for things like sleep, having a shower or a proper meal! The narrative around women 'failing' if they can't breastfeed needs to get in the bin.

@CoalCraft

On the "breast milk contains everything your baby needs" line, this is wrong, or at least it was for me. My baby was prescribed a fortifier based on cow's milk that was added to my breast milk to assist with weight gain, and later she was prescribed a multivitamin plus additional folic acid, vitamin D and iron as my breast milk just wasn't nutritious enough for ideal growth and development. She had no formula whatsoever - it was my breast milk that didn't contain what she needed to grow well.

She was prem, but vitamin D is recommended even for healthy term babies that are exclusively breastfed.

If breastmilk isn't nutritious enough for baby, it's because you are not eating enough nutrients while breastfeeding or you went into pregnancy with nutrient deficiencies.

When you're nursing a baby, your milk will always provide enough protein, trace minerals, calories and folate even if your current diet isn't providing these nutrients to you.

But you do need to be eating B vitamins, vitamins A, D and K, choline, DHA, selenium and iodine while breastfeeding in order for your baby to get these, and some of these nutrients are crucial for his/her brain development.

This is from Lily Nichols' book, Real Food for Pregnancy.

Bottom line, what you eat during pregnancy and breastfeeding, matters, and if you eat a balanced, healthy diet and you eat enough food, your milk will be nutritious in most cases.

Hey OP

for example
www.nature.com/articles/s41598-020-72635-x
www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/epigenetics-microbiome-research/
www.ncbi.nlm.nih.gov/pmc/articles/PMC6400986/
www.cambridge.org/core/journals/journal-of-developmental-origins-of-health-and-disease/article/early-microbial-contact-the-breast-milk-microbiome-and-child-health/BAC428C08779F804DB06D55426AC1DAC

It's not purely about breastmilk, it's about how the environment shapes the infant's microbiome so things like mode of birth, diet of mother and early diet, whether there are pets etc in the home. But breastmilk is an important part of the picture.

The infant's gut is colonised by an initial set of bacteria - in vaginal birth this is from the mother's poop, charmingly enough. Breastmilk then provides HMOs that the baby can't digest, but that feed certain bacteria in the baby's gut. The early bacteria communities in the infant have lifelong effects. They can be impacted by things like antibiotics and environment.

This is all emerging stuff so I'm not sure it would have been available to Oster at the time of writing.

As a HP working in this field this thread is so interesting. From professional experience I can say there really is such a thing as nipple confusion though as I see it in baby’s in every week.

The narrative around women failing definitely needs to go in the bin.
But to be replaced by a narrative around women being supported and empowered to breastfeed should they want to do so. If we supported and empowered all the women who want to breastfeed adequately we would have a massive impact on breastfeeding stats.
And the benefits to a woman being empowered in that manner are simply unmeasurable. And definitely worth it.
Regardless of studies or evidence etc.

So, OP. why do you think the WHO, Unicef, the NHS and all the other medical bodies recommend breastfeeding, if there's no evidence to back up its recommendation?

Is it out of pure hatred of the multimillion pound formula business?

@IamOvercome For interest, now you have carried out this research, would you still be interested in breastfeeding?
You mention yourself there are still benefits - not necessarily to the child, but to the mother/the environment etc. I know until your child is born you can't possibly know which you will do as it is circumstantial, but would you still consider it?

Statistical evidence is purely quantitative. Other types of evidence are available.

• here is the Lancet series on breastfeeding:

www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

'Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer.'

Very interesting indeed and something I have thought all along. I recall the horrid midwife calling me 'mean mummy' in the hospital with my first dc for not wanting to breastfeed at all. Good job I was confident and assured in my choice to FF as this I'm sure could have had a very negative impact on others. The whole subject is so loaded, we do need to just let women decide quietly and leave it at that.

@IamOvercome

It’s not about finding research that supports her view it’s about showing how outrageously flawed a lot of the research is and how the conclusions are not valid.

If someone came into my university/ workplace with a paper on how caffeine causes miscarriage but didn’t control for sickness which is correlated with high HCG and thus healthier pregnancies or a study on the benefits of breastfeeding v formula that didn’t match on familial charactierierics they would be laughed out of the room and absolutely slaughtered for presenting such flawed results yet somehow much of it has been accepted into mainstream.

But nobody has studied the benefits of breastfeeding in a scientific way in the same way that formula has been studied. That’s the point Emily Oster has made. She wants to see more scientific research on breastfeeding.

Going from a 13% chance of a diarrhea type illness in the first year to a 6% chance doesn’t sound that marginal to me. It’s over a 50% reduction. That seems hugely significant.
When they do get sick, I find breastfeeding is hugely reassuring. A couple of times when my toddler was ill and refusing all food and all liquids other than breastfeeds, I did feel like the breastmilk was the only thing keeping us out of A&E with dehydration. I would be interested to know if breastfeeding helps avoid hospital treatment for dehydration in the case of gastro-intestinal illness or things like hand foot and mouth and tonsillitis.