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.

@Peanutbuttercupisyum

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

See? This is the kind of judgement women who don’t breastfeed encounter all the time. It’s unkind and unnecessary.

The whole point of the book is it’s based on fact not opinion. As someone who is used to analysing similar papers what she says is correct.

Have you never heard the expression:
"Lies, damn lies and statistics"?

You can manipulate statistics to show all sorts of things. I'll put bets that with the raw figures she has used another mathematician can prove the opposite.

Medicine is an inexact science, because human bodies react differently to the same thing. If she has found that all the studies (or the vast majority) show the same thing, then the chances are she has an axe to grind.
I'd find her far more convincing if she'd found a mixture of results.

If she genuinely has a case then I'm sure that there are plenty of formula companies that will be delighted to publicise it for her.

Yes, there’s definitely some weird morality at play with breastfeeding. I can’t stand that breast is best religious type mantra I really doubt there’s any difference between the two in the western world.

I breast fed for a few months then switched to mixed with both of mine against the dire pronouncements of my health visitor. Medical professionals don’t know everything and bring their bias to every situation especially when it comes to childbirth and babies.

No it just sounds like she’s an intelligent woman peanut, you however…

@Divebar2021

I’ve seen several posts on MN over the years from women saying they we advised that breastfeeding would be cheaper but they didn’t feel that was actually the case once they had factored in things like the cost of breast pumps, lactation consultants, etc etc

Who says you need breast pumps and lactation consultants? And what’s the etc etc? Of course it’s more convenient and less hassle to breastfeed and I would assert cheaper too once you’ve factored in bottles, teats, sterilisers (of some description) before you get to the actual formula. I also remember threads during lockdown when posters couldn’t get hold of formula so breastfeeding also spares you that anxiety.

I've had 2 babies and both have been unable to latch. I've spent a fortune on hiring hospital grade breast pumps, on lactation consultants, on a private tongue tie specialist (as the NHS misses DD's tongue tie), on cranial osteopaths, nipple shields etc. I know many women who've needed to take similar steps. I know very few women whose babies fed straight away without any help of the type listed above.

@Peanutbuttercupisyum

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

She did breastfeed!

@MargaretThursday she does provide a mix of studies. You should check out the the book!

Sorry I lost track of messages there - but someone said after reading do I still intend to breastfeed and yes I do and I will be trying and getting a lactation consultant etc if needed. My point is that in the class I had it was strongly put forward that you’d be harming your child and their health and outcomes if you didn’t breastfeed but in reality this doesn’t seem to be backed up anywhere and good studies (such as those examining siblings) actually find no difference in health and other outcomes for breastfed v formula fed babies.

this book sounds like an analysis of outcomes, based on cold, hard data.

Which is a shame, because that is exactly what Oster DOES NOT DO . Not in her popular books, anyway.

What she does is cherry pick, choose only some evidence, chosen by inconsistent rules, combined inconsistently.

There are gold standard rules how you combine different types of health (or economic) evidence. She's not following those rules. She's writing pop-science high opinion books & blogs. Seemingly by herself. To do the gold standard evidence synthesis you need to work in teams -- sometimes big teams. And then you submit your results to peer review so that people who don't like you can check you really kept to high standards.

Her conclusions may be right, by the way. I am amused that she's taken a disrupter role. But don't think for a moment that she has somehow looked at evidence in a superior way no one else has, is somehow telling you a truth no one else can understand because she's especially qualified to see the truth. Opposite is true. She is winging it according to her gut, and decisions she makes ad hoc, only held accountable by her personal powers of persuasion. Not according to the least biased scientific methods.

Oster is good at persuasion. So was Gillian McKeith...

@AliceAbsolum

What about caffeine and miscarriage please?

Basically research she discusses on caffeine and miscarriage none of the studies discussed nausea. If women are v sick they are unlikely to drink much or any coffee. And we know sickness is correlated with high levels of pregnancy hormone HCG which is indicative of a healthy pregnancy. So if you have a study without controlling for this you are saying people who has one/no cups of coffee were less likely to have a miscarriage than those who had 3 or more when in reality it’s likely those having 1 or none were sick with high HCG and so more likely to have a healthy pregnancy and those having 3 or so felt fine, could’ve had low HCG and therefore more likely to miscarry. By not controlling for this omitted variable the research is not reliable. Another study using rats and miscarriage found drinking caffeine was associated with higher risk Of miscarriage but the amount of caffeine they were injecting into the rats was equivalent of a woman having >50 cups of coffee a day which is impossible.

Recommend Charlotte Faircloth Militant Lactivism - an anthropological study of long term breastfeeding in London and Paris. Don't agree with all of it, but it's really interesting. And she has this thread spot on!: 'When ‘science’ says something is healthiest for infants, it has the effect of shutting down debate; that is, it dictates what parents should do. Yet whilst science tells us much about the world, the meaning we ascribe to these ‘facts’ (i.e., how we should act on them) is hardly straightforward.' (p. 153).

Feed your baby the way you want. I see no reason for me to refuse my baby my own human milk and enjoy being close to them, it’s a very special bond and memories I have are amazing. It didn’t occur to me to search for scientific benefits of that lol

@kingsolomon

Recommend Charlotte Faircloth Militant Lactivism - an anthropological study of long term breastfeeding in London and Paris. Don't agree with all of it, but it's really interesting. And she has this thread spot on!: 'When ‘science’ says something is healthiest for infants, it has the effect of shutting down debate; that is, it dictates what parents should do. Yet whilst science tells us much about the world, the meaning we ascribe to these ‘facts’ (i.e., how we should act on them) is hardly straightforward.' (p. 153).

Thanks! Lots of great reading material from posters on this thread! Pity it got hijacked as it could’ve been an interesting discussion.

That quote that people keep throwing out about breastfeeding placing no value on mother's time - surely there is a time investment in anyone feeding a baby in any manner. I'd have thought it was dependent on the baby more than the method - some are pretty quick to feed and others aren't!

Is the argument that breast feeding takes longer than bottle feeding? Or that if a mother can share the feeding with someone else then it's no longer de-valuing their time when it's their turn?

Is feeding an older child placing no value on the parent's time? Making packed lunches and dinner takes more time than breastfeeding ever did - how does that feed in to the equation (pun intended!)?

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.

You can only pass on antibodies if you’ve already had something.
So unless your kids are less than 3 then they won’t have antibodies for covid but will have antibodies for other illnesses you may have had.

@Sarahcoggles

And as others have said, sadly books like this sound like "defensive formula feeding mother with a chip on her shoulder, trying to justify her choices", when in fact no one needs to justify their feeding choices. Live and let live!

You can't claim that Emily Oster and the women on this thread who value her research are 'defensive' and then say 'live and let live' - that's making an enormous judgement and then sticking a platitude on the end.

I could just as easily say that the women on this thread trying to discredit Oster, who is highly qualified and award winning, are desperately trying to rewrite the data to prove that breastfeeding is better, because they need to feel superior or like they're achieving something. Live and let live!

These outcomes are hard to measure in the population in question and the studies simply haven't been done.

Absence of evidence is not the same as evidence of absence

@DoubleHelix79

To anyone wanting to dive into the scientific evidence available on a particular topic (not just breastfeeding related) I highly recommend the Cochrane sstematic reviews. They take into account all evidence and consider the quality of the studies conducted, then summarise what is and isn't known. Not easy reading but an excellent resource for anyoone keen to understand a medical topic in quite a bit of detail. www.cochranelibrary.com/cdsr/about-cdsr

This

@Nsmum14

That quote,

breastfeeding is only cheaper if we don't value women's time.

What an ugly view of motherhood, and of life generally. As if when feeding / nurturing her baby, a woman is making a bad use of her time.

I have a PhD, I don't in any way consider the hours I spent studying better than the ones I've spent nursing my babies. I have travelled and read and worked for different organisations. None of that felt more important than breastfeeding.

I'm sure many women who have
nursed feel similarly.

Absolutely! Motherhood is not valued to the same extent as being economically productive.

I have plenty of friends who breastfed. Their babies include ones who have been ill far more than mine. Yes, I did express a bit for the first few weeks but they overwhelmingly had formula.
DS1 slept through at 8 weeks from midnight to 7. I slept well and enjoyed my maternity leave. My baby had a happy well rested mum. And yes, he had cow and gate. Clearly the ideal is to breastfeed easily - I wouldn’t dispute that - but there is no way I could have coped with months and months of broken nights. And I’ve read too many posts on here by mums who are utterly exhausted by babies latching on in the night.
I didn’t face much pressure to breastfeed - the only pressure came from me. Fortunately I had great community midwives and HV who recognised that DS1 was a refuser and didn’t try to make me battle on. Thank god I didn’t have a militant ‘breast is best’ community midwife .

the whole breast is best thing is bollocks anyway as everyone is an individual at least formula has the correct amount of vitamins and minerals in it, very unlikely most mums do frankly plus people take medications, smoke/vape and take drugs and all that will be getting in the milk.

I am rather interested to hear from the people who say human babies should drink human milk, if they drink cow milk, surely you wouldnt as its not meant for you?

@VelvetChairGirl

the whole breast is best thing is bollocks anyway as everyone is an individual at least formula has the correct amount of vitamins and minerals in it, very unlikely most mums do frankly plus people take medications, smoke/vape and take drugs and all that will be getting in the milk.

I am rather interested to hear from the people who say human babies should drink human milk, if they drink cow milk, surely you wouldnt as its not meant for you?

I have vitamin d deficiency and anemia. My breastmilk was analysed (bloody expensive but that’s another story) and it had high levels of both which is what my mw said it would say (but I knew better so I paid £££ for the tests). This idea that women with nutritional deficiencies have lesser milk is just not true and has been fed by pediatricians who extoll the measurable benefits of formula over common sense.

I breastfeed primarily for convenience and so I get sleep! Not having to mess around with bottles when you go out, can just whip a boob out in the night, have even perfected an ability to stay asleep and the baby just latches on. So am not bothered about the health benefits although I do agree with why would the WHO etc recommend it if no evidence? I have also noticed it tends to be the more ‘middle class’ very health conscious mums who seem obsessed with breastfeeding, (obv a massive generalisation) so that effects the research outcomes as people who breastfeed, being middle class and health conscious, tend to be in a position where they can make other healthy choices for the child (fresh fruit, lots of sport, education etc), so long term their children are healthier due to this as well

@VelvetChairGirl

the whole breast is best thing is bollocks anyway as everyone is an individual at least formula has the correct amount of vitamins and minerals in it, very unlikely most mums do frankly plus people take medications, smoke/vape and take drugs and all that will be getting in the milk.

I am rather interested to hear from the people who say human babies should drink human milk, if they drink cow milk, surely you wouldnt as its not meant for you?

LOL - "breast is best" is bollocks because some people take drugs. There you have it OP.

No pediatrician has ever extolled the virtues of formula, its completely the opposite, I was pressured by the NHS to breastfeed, they wouldnt explain anything about formula at all when asked.

(and they completely ignored my complications of birth and accused me of being hysterical really, fobbing me off saying oh its just first baby nerves theres nothing wrong with the pregnancy)

by the time I had my C-section no one in the hospital cared how the baby got fed as long as it did and kept it down, and it was 3 weeks later they found out he had a severe tongue tie and said oh well its a good thing you formula fed him because he wouldnt have been able to breastfeed anyway.

yeah thanks for that NHS you gave me zero help with formula feeding in the first place, I asked my mum, she told me how to sterilize bottles properly etc. no help from the NHS/health visitor etc they all just said we are not allowed to talk about that.

I liked the Emily Oster book I read.

But there isn’t a “peer reviewed study” in the world that will say that breast worked best for my babies and me, any more than it will say that formula works best for any other individual mother and child. First define what you mean by “benefits” and so on. There were enormous benefits to me and my children via my breastfeeding them. I will never know what benefits there might have been to formula or mix feeding them.