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.

@Chocaholic9

The discovery of the benefits to the child's microbiome from breastfeeding is quite recent. Any book that covers breastfeeding should cover this topic; if Emily Oster's book didn't it's not worth the paper it's printed on.

Precisely.

@AliceAbsolum Not sure about this specific book, but I was very invested in this topic as I struggled with caffeine dependency in my last pregnancy (I was 40, working 60hr weeks, travelling and had two under-5s). My understanding is that the correlation is as follows: older mothers: more miscarriages. Also older mothers: higher caffeine consumption. So the correlation is with age, rather than just caffeine.

@mowglika

Breastfeeding has benefits beyond that to mother or child, as an economist she should be looking at the benefits to society too. When you look at the environmental costs of producing formula, producing it, bottling it, transporting it, disposal of bottles, tins, and environmental and agricultural waste from this industry, mass production from the dairy industry, it has a bigger impact than just that to mother and child.

I ff one of mine so I am not biased but clearly there are many benefits to BFing beyond biological factors, and surely these factor into the choices (if you have a choice) you make when deciding how to feed your child.

My thoughts entirely! Even the most diligent of reusers will be unable to find a use for all those empty formula tins. I see so many FB posts with people trying to find new homes for old baby bottles and all of the other paraphernalia too.

My take having breastfed two babies - comparing studies or looking at scientific stats only tells half the story which I think is a bit disingenuous. I breastfed because I genuinely liked doing it. After the first few weeks where it is hard, I found it very easy (I'm aware I'm lucky but so are many other women) and couldn't imagine having to faff with bottles, especially at night or when out.

Women should feed their baby however they like. But I sometimes feel in the narrative of "fed is best", positive experiences are ignored and the focus is on scientific benefit only. As in all walks of life their are benefits that can't be scientifically quantified. Ignoring this misses half the story

@Skt20

My take having breastfed two babies - comparing studies or looking at scientific stats only tells half the story which I think is a bit disingenuous. I breastfed because I genuinely liked doing it. After the first few weeks where it is hard, I found it very easy (I'm aware I'm lucky but so are many other women) and couldn't imagine having to faff with bottles, especially at night or when out.

Women should feed their baby however they like. But I sometimes feel in the narrative of "fed is best", positive experiences are ignored and the focus is on scientific benefit only. As in all walks of life their are benefits that can't be scientifically quantified. Ignoring this misses half the story

yes I agree but people shouldn't push any argument on the basis of non existent or invalid research.

@mowglika

Breastfeeding has benefits beyond that to mother or child, as an economist she should be looking at the benefits to society too. When you look at the environmental costs of producing formula, producing it, bottling it, transporting it, disposal of bottles, tins, and environmental and agricultural waste from this industry, mass production from the dairy industry, it has a bigger impact than just that to mother and child.

I ff one of mine so I am not biased but clearly there are many benefits to BFing beyond biological factors, and surely these factor into the choices (if you have a choice) you make when deciding how to feed your child.

I completely agree. This should also be emphasised, along with all the other benefits.

@Cherryblossoms85

I'm guessing "I'm too lazy to make bottles" is a bit tricky to quantify economically

Absolutely not, economists go mad for quantifying anything. Your time will have a value; the time spent buying and making up formula and sterilising everything would definitely be included in a (non health) pros Vs cons of BF study.

I read her book when I was pregnant and found it really interesting. I think a lot of things pregnant women do/mothers is judged with an element of moralising.

Interesting first post Emily OP.

For me breastfeeding wasn’t easier, I have big boobs so couldn’t breastfeed one handed, I always had to use 2, one to hold baby and another to hold my boob to stop her from suffocating, it was exhausting, I couldn’t do anything else and my harm hurt from holding my boob up constant, and that’s before the latching and supply issues.

I went back to a 50 hour week job after 2 months, I had to, couldn’t afford to live otherwise and that’s with savings too as majority of workplaces only pay basic, it makes sense why those who are better off are more likely to breastfeed.

I felt so guilty (and still do) that I couldn’t breastfeed her, I tried and failed, luckily I had a supportive HV who didn’t make me feel shit about it but a lot of women aren’t so lucky…

@TopCatsTopHat

The trouble is that decent statistical evidence for anything breast feeding related is hard to come by because large scale studies of the kind, that are scientifically valuable like double blind, controlled etc are ethically impossible to conduct so as an analyst you are always dealing with data which is likely collected for another reason and contaminated by uncontrolled variables.

This is absolutely true.

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.

I agree that the milk will be nutritious with a typical diet, though I want to add that there can be concerns about how much stores the mother will have left if she's not considered as well. More so if she goes through multiple pregnancies in a row, and even more if she also breastfeeds for years.

Getting enough Vitamin D from food is very difficult and is not the main way humans get enough so I feel wary of sources that go on about eating enough. We mostly make it as a response to sunlight and at certain times of year in the UK that isn't possible. Some people struggle to make Vitamin D even in the best of times. There is a lot of discussion that UK recommendations on amounts needed are too low and concerning about of rising levels of deficiencies & the health issues that come with them.

Also, for nutrients like iodine, there is a known decline in how much is in food. There are recommendations in adding it to salt and to some foods, but the UK government has chosen against this - last I heard on it, the argument was we consume enough dairy that it isn't an issue though that fucks over people who don't. The WHO recommends pregnant women in countries who don't add iodine be mindful about it and consider supplementation.

Really, I think along with the usual bloods taken, pregnant women and long-term breastfeeders should get a full nutritional panel - not just iron - and if deficiencies guidance on appropriate guidance including specifics on supplements for them especially for those with recurring issues (not just take a multivit which I got for years) because while the baby will likely be fine, it's the mothers health and wellbeing that needs more consideration. I think this would help mothers and with the data, we might get better nutritional guidelines and maybe even in my wildest dreams get more consideration on it from the government.

@Rinatinabina

I read her book when I was pregnant and found it really interesting. I think a lot of things pregnant women do/mothers is judged with an element of moralising.

Why would WHO, Unicef, the NHS and other international healthcare organisations recommend breastfeeding if there was no evidence of its benefits? To what end? To what purpose?

The fact is that there is an enormous amount of research, metastudies, data etc conducted on infant feeding.

Unsurprisingly - it's a hugely important area for human health, and also a multi million dollar industry for formula manufacturers.

Don’t believe everything you hear just because it’s written in a book - look at how many diet books are out there showing studies of completely opposite data.

Formula companies will be paying millions to do research so they can try and claim it’s as good as breast milk - so far they’ve not been successful which is why on the adverts they’ll say themselves that breast is best.

Breast is best - no one can deny that.
But that doesn’t mean you should feel guilty about not doing it.

Just don’t breastfeed - you don’t need to justify yourself or find something to back you up.

@Lockheart the evidence Oster examines actually demonstrates that the difference IS NOT there even at a population level.

OP I loved her books. I really like evidence and the ability to make my own risk assessments and so appreciated that Oster’s only agenda is science!!

I found the information in Crib Sheet around SIDS risks also really helpful, the NHS has a lot of advice (don’t let your baby ever sleep when you’re not in the room) that is not supported by any high quality studies and also is not recommended by other big scientific bodies in other countries.

I would strongly encourage and new and expectant parent to read her books with a truly open mind, she’s just trying to give you the evidence and then you can make your own assessment of the risks/benefits and what is important to you. For me case in point what her assessment of honey for under 1s, I came away thinking it was no big deal of my under 1 accidentally had some honey, a friends’ assessment was that she was in no way comfortable with honey. Neither was wrong, we just both had the information to decide on our own.

Parenting is such a bewildering onslaught on conflicting advice and judgement, it’s wonderful to feel you can make some decisions with real information.

[quote Cherryblossoms85]@AliceAbsolum Not sure about this specific book, but I was very invested in this topic as I struggled with caffeine dependency in my last pregnancy (I was 40, working 60hr weeks, travelling and had two under-5s). My understanding is that the correlation is as follows: older mothers: more miscarriages. Also older mothers: higher caffeine consumption. So the correlation is with age, rather than just caffeine.[/quote]
Her argument about the ‘safety’ of caffeine comes from her completely anecdotal idea of how women with morning sickness will swerve coffee.

No morning sickness = will drink coffee and this leads to studies where high caffeine consumption leads to miscarriage.

She argues that in the case of these MCs, the pregnancy was not viable and not progressing as indicated by lack of symptoms, which was why the women consumed coffee as usual.

I liked her book but there is a lot of opinion and anecdotal evidence muddled in.

@BiBabbles

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.

I agree that the milk will be nutritious with a typical diet, though I want to add that there can be concerns about how much stores the mother will have left if she's not considered as well. More so if she goes through multiple pregnancies in a row, and even more if she also breastfeeds for years.

Getting enough Vitamin D from food is very difficult and is not the main way humans get enough so I feel wary of sources that go on about eating enough. We mostly make it as a response to sunlight and at certain times of year in the UK that isn't possible. Some people struggle to make Vitamin D even in the best of times. There is a lot of discussion that UK recommendations on amounts needed are too low and concerning about of rising levels of deficiencies & the health issues that come with them.

Also, for nutrients like iodine, there is a known decline in how much is in food. There are recommendations in adding it to salt and to some foods, but the UK government has chosen against this - last I heard on it, the argument was we consume enough dairy that it isn't an issue though that fucks over people who don't. The WHO recommends pregnant women in countries who don't add iodine be mindful about it and consider supplementation.

Really, I think along with the usual bloods taken, pregnant women and long-term breastfeeders should get a full nutritional panel - not just iron - and if deficiencies guidance on appropriate guidance including specifics on supplements for them especially for those with recurring issues (not just take a multivit which I got for years) because while the baby will likely be fine, it's the mothers health and wellbeing that needs more consideration. I think this would help mothers and with the data, we might get better nutritional guidelines and maybe even in my wildest dreams get more consideration on it from the government.

You make some good points. I totally agree.

I completely forgot about the iodine because here in NZ we have no iodine in the soil so we have to supplement.

Also there is the loss of iron when a woman loses blood when giving birth. I read that if you lose 500ml of blood while giving birth, you're 38x more likely to have post-natal anaemia (again that figure came from Lily Nichols' book) which I'm thinking must impact on iron stores and perhaps iron content of breast milk.

@DomesticatedZombie unicef and the WHO make global recommendations, breast feeding IS safer for the nearly 1 billion people who don’t have access to clean water and for whom an infant diarrheal illness could mean death so formula isn’t a safe option, likewise breastfeeding for longer when infant food & water can’t be safely prepared and refrigerated. They do not exist to make recommendations only for the relatively small percentage of the world population with good choices.

In case anyone is interested, Lily Nichols, who specialises in nutrition for expectant mothers, recommends eating plenty of oysters and organ meats (such as liver and heart) to avoid anaemia in pregnancy or afterwards. There's much more iron in these foods than in foods like beef steak. Interestingly, these are the foods that the government tells us not to consume, with very little evidence to back it up.

Do what you want. But personally, a highly processed food is not the optimum choice for a babies only source of nutrition. Better than no food. Not as good as a natural, organic food.

Sounds to me like she’s trying to outwit the fact that she didn’t breastfeed…

Just passing that on because of the poster above who mentioned not having enough iron in her breast milk to be able to breast feed.

My son was bottle fed as I was too sick after a near death birth. He’s very rarely sick. Has had to go to school throughout COVID and, despite me having twice through work, he’s never caught it.
My breast fed friends kids all got COVID and generally seem much sicker than my son. It’s sort of thrown the ‘makes their immune system stronger’ comments out the window for me. Obviously that’s my anecdotal evidence 😂😂

[quote Happyhappyday]@DomesticatedZombie unicef and the WHO make global recommendations, breast feeding IS safer for the nearly 1 billion people who don’t have access to clean water and for whom an infant diarrheal illness could mean death so formula isn’t a safe option, likewise breastfeeding for longer when infant food & water can’t be safely prepared and refrigerated. They do not exist to make recommendations only for the relatively small percentage of the world population with good choices.[/quote]
Okay. So here is the Lancet series on breastfeeding in 'industrialised' nations.

'The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. 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. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.'

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

@GrendelsGrandma

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.

Thanks!! Bookmarked!