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.

She's good at looking into data and extrapolating information from research that's relevant, you don't need to be medical to do that.

I’ve not read her books so I’ve no idea what conclusions she’s draws about various things but if you’re going to go down the route of analysing all the data, you also need to find out what Oster’s criteria was for including and excluding studies on various topics. She can’t have included everything so what was excluded and why, how did she decide what was relevant? I’m not saying she has an ulterior motive or anything, just that if someone (particularly a non-medical person) is saying “I’ve looked at a bunch of studies and found X”, I’d want more information if I was going to listen.

I couldn’t be arsed to look into it that much, which is why I didn’t read her book, and I breastfed because it was the option that meant I didn’t have to get out of bed.

I agree though that support for women post-birth is poor. Breastfeeding is pushed during pregnancy but then support/help once the baby is here is minimal. I had good support in hospital, but then had a GP who didn’t know how to treat thrush (in DD’s mouth and on my breast) which led to more pain and discomfort, and a HV who was frankly laughable.

I haven’t read the book you mentioned - but I found ‘The politics of breastfeeding’ by Gabrielle palmer a very interesting read and I recommend it to anyone thinking about breastfeeding.

Have there actually been any large scale studies into outcomes for breast or bottle fed following infants through to adulthood?

@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.

I honestly think all the pushing for natural childbirth and breastfeeding is about saving money more then anything else.

NHS doesnt have to get so many of those little disposable pre filled milk bottles in, pay for as many painkillers etc

I never understood the push for natural births we don't push dental patients or amputees to grin and bare it, women fought so hard for better maternity care and now we are encouraging women to go drop a sprog behind a tree and telling them its liberating.

@Uttoxerley

Reading this makes me feel a little less guilty - I was unable to produce enough milk to sustain either of mine. No idea why I feel guilty as the signs were there that my boobs just weren’t normal, it’s not my fault. It just feels like a weight off my shoulders that I haven’t necessarily doomed my kids to a life of ill-health, obesity and the rest because I couldn’t breast feed.

It’s all nonsense. Actual proven benefits of breastfeeding were a 6% chance of child having one episode of diarrhoea in 1st year compared to 13% for non breastfeed and a slightly lower chance of ear infection in first year.

No impact on health, obesity, IQ etc.

OP - just wanted to say you're very brave!

Interesting I do wish society encouraged dual feeding more. I had it in my head that once I gave formula in a bottle my baby would stop breastfeeding. I wish someone had talked to me at the time to tell me combo feeding was perfectly fine. I think my mental health wouldn't have suffered as much. Theres all this stuff about exclusive bf and your supplying drying up its terrifying for new mums

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

@twosticksandanapple

I thought it was well known that the benefits of breastfeeding are minimal at the individual level, it is at the societal level where they are important.

I also suspect that Emily's assessment is influenced by her own difficulties with breastfeeding.

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.

If I had had any of those studies presented to me at work I would’ve said they had huge omitted variable bias.

The most amazing was studies about caffeine and miscarriage not controlling for naseau in pregnant women. Such a huge omission.

@Hankunamatata

Interesting I do wish society encouraged dual feeding more. I had it in my head that once I gave formula in a bottle my baby would stop breastfeeding. I wish someone had talked to me at the time to tell me combo feeding was perfectly fine. I think my mental health wouldn't have suffered as much. Theres all this stuff about exclusive bf and your supplying drying up its terrifying for new mums

Yes there is no evidence of so called nipple confusion.

@VelvetChairGirl She’s in the US, and although the version of Expecting Better I read has been edited somewhat for a British reader there are some things, like attitudes/expectation of an epidural that definitely are from a US perspective where cost and the routine denial of epidural is not even a consideration.

Interestingly though; based on her own research she decided not to have an epidural which is v. unusual for natural births in the US.

@Babdoc

The real benefits of breast feeding only apply in the third world, where formula is made up with dirty water from unchlorinated sources, causing diarrhoea and deaths in infants. Here in the UK, it makes damn all difference, and as a doctor I am delighted that a credible statistician has finally published this. Perhaps we can now see the end of poor depressed mothers beating themselves up for “failing” to breast feed. A mafia of midwives and breast feeding mothers has controlled the narrative for far too long, to the detriment of women. Feed your baby by whatever method best suits you, secure in the knowledge that your way is as good as any other. And don’t let anyone guilt trip or pressure you.

oh I dont know about that, mine was on hipp organic and when the health visitor came round she wanted to see my kitchen and looked in the fridge and quized me about how to properly prepare the milk.

she said she did it now after seeing so many people batch fill 2 litre bottles and store them in the fridge unaware of the bacteria risks of doing so.

@SickAndTiredAgain

She's good at looking into data and extrapolating information from research that's relevant, you don't need to be medical to do that.

I’ve not read her books so I’ve no idea what conclusions she’s draws about various things but if you’re going to go down the route of analysing all the data, you also need to find out what Oster’s criteria was for including and excluding studies on various topics. She can’t have included everything so what was excluded and why, how did she decide what was relevant? I’m not saying she has an ulterior motive or anything, just that if someone (particularly a non-medical person) is saying “I’ve looked at a bunch of studies and found X”, I’d want more information if I was going to listen.

I couldn’t be arsed to look into it that much, which is why I didn’t read her book, and I breastfed because it was the option that meant I didn’t have to get out of bed.

I agree though that support for women post-birth is poor. Breastfeeding is pushed during pregnancy but then support/help once the baby is here is minimal. I had good support in hospital, but then had a GP who didn’t know how to treat thrush (in DD’s mouth and on my breast) which led to more pain and discomfort, and a HV who was frankly laughable.

She eliminates studies based on their quality - so best is RCTs for example or studies that follow siblings therefore controlling for mothers education/ income etc. studies on outcomes from breastfeeding v formula that lump in all women in together ignoring that more educated and wealthier women are more likely to breastfeed can’t be taken seriously as that’s a huge omitted variable bias.

Tbh I found her books to be quite biased albeit in a more backhanded way (since they claim to be the opposite). Her other book for example made it sound as though getting an epidural objectively makes the most sense for labour. That's definitely not the outcome my own risk/benefit analysis would have yielded or what my priorities would have been.

I guess even though she is being 'objective' and 'scientific' she still has to make a choice about what variables to even consider as part of the analysis, and how to weigh them. I haven't read the second book but for me breastfeeding has had innumerable benefits and I would not have wanted to miss out on this experience. Just the feeling of being able to provide with my own body the perfect nourishment for my baby, at once what they most want and what's also healthiest for them, has been amazing. Invaluable at times of illness etc. I don't think these kinds of emotional 'benefits' would have even entered the equation

Armchair epidemiologist?
So many into data with no understanding of process. Jeremy Howard is another data scientist just like her.

afaik, she also has these views, I mean if you want to consider more than just one topic.

Schools never should have closed to prevent covid spread
Cry it out/ sleep training methods are fine, do no harm
Alcohol is fine to have in small or moderate amounts in pregnancy

i wonder what she'll be spouting off about menopause in a few years

On one hand she has insisted that lack of RCTs mean we can't draw conclusions about whether breastfeeding is better than formula, but her observational data analysis about Covid transmission proves that schools should stay open.

I mean, she's kind of going for evidence that agrees with what she already wanted to believe. She works in economics & never seems to have done a meta-analysis. It's not looking like unbiased data analysis. Her assessments amount to 'expert reviews' which are the bottom of the evidence hierarchy... she must know that, right?

@WouldYouIo

Have there actually been any large scale studies into outcomes for breast or bottle fed following infants through to adulthood?

I wonder about this too. If, for example, you are diagnosed with IBS at 40, would anyone ask if you were breastfed/for how long? And record the information? Same with cancers (from a mother and child pov).

I have no issues at all with people choosing to FF, and gave both my children formula at times, but I struggle with the idea that there is no 'downside' to having a completely processed diet for the first 6 months of your life. It wouldn't be recommended at any other time in life.

@sevensleeps

Tbh I found her books to be quite biased albeit in a more backhanded way (since they claim to be the opposite). Her other book for example made it sound as though getting an epidural objectively makes the most sense for labour. That's definitely not the outcome my own risk/benefit analysis would have yielded or what my priorities would have been.

I guess even though she is being 'objective' and 'scientific' she still has to make a choice about what variables to even consider as part of the analysis, and how to weigh them. I haven't read the second book but for me breastfeeding has had innumerable benefits and I would not have wanted to miss out on this experience. Just the feeling of being able to provide with my own body the perfect nourishment for my baby, at once what they most want and what's also healthiest for them, has been amazing. Invaluable at times of illness etc. I don't think these kinds of emotional 'benefits' would have even entered the equation

As I said she concluded benefits of breastfeeding are larger for the mother than the child. The Bernie’s you describe are for you not your baby. How do you define ‘healthiest’ re breast milk v formula? In concrete terms I mean when studies show mo impact difference in terms of babies health, intelligence etc

I read a similar article approx 10 years ago in the statistics magazine, Significance. Really few benefits. Certainly for women with access to clean water.

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.

@Lockheart

First of all, how you choose to feed your baby is your business and your business alone.

Secondly, I think breast is best but the benefits are marginal and only observable at a population level. Whether you bottle or breast feed will not make a material difference to you / your child. If you take a class of pre-schoolers, teenagers, or a university cohort you will have no way of telling who was breast or bottle fed.

Breastfeeding is great, but it doesn't guarantee your child will get into Oxbridge any more than bottle feeding condemns your child to a life of crime.

I agree with every word of this

It might be worth also reading up on some of the issues with research into breastfeeding and its biases e.g. Professor Amy Brown and Informed is Best or this article blogs.wellesley.edu/vanarsdale/2015/05/21/anthropology/breast-milk-isnt-magic-it-is-an-important-evolutionary-feature-in-humans/
I don't think Emily Oster is correct, although she is right that mothers shouldn't feel guilty or shame if they don't end up breastfeeding. There needs to be much better non judgmental postnatal support for all mothers.

[quote NotYourOscarSpeech]@VelvetChairGirl She’s in the US, and although the version of Expecting Better I read has been edited somewhat for a British reader there are some things, like attitudes/expectation of an epidural that definitely are from a US perspective where cost and the routine denial of epidural is not even a consideration.

Interestingly though; based on her own research she decided not to have an epidural which is v. unusual for natural births in the US.[/quote]
hmmm well they have it the other way dont they the massive distrust of big pharma out to fleece you rather then help you, or demanding your moneys worth.

tbh I dont blame them having that attitude.

@Hankunamatata

Interesting I do wish society encouraged dual feeding more. I had it in my head that once I gave formula in a bottle my baby would stop breastfeeding. I wish someone had talked to me at the time to tell me combo feeding was perfectly fine. I think my mental health wouldn't have suffered as much. Theres all this stuff about exclusive bf and your supplying drying up its terrifying for new mums

I agree in essence, but I think it comes from a place of worrying that once a bottle of formula is introduced you can fall into a trap of giving more and then producing less milk etc and so on.

If a woman wishes to combi feed from birth then she should be supported in this with careful management to preserve supply/paced bottle feeding etc.

I’ve not read her books so I’ve no idea what conclusions she’s draws about various things but if you’re going to go down the route of analysing all the data, you also need to find out what Oster’s criteria was for including and excluding studies on various topics. She can’t have included everything so what was excluded and why, how did she decide what was relevant? I’m not saying she has an ulterior motive or anything, just that if someone (particularly a non-medical person) is saying “I’ve looked at a bunch of studies and found X”, I’d want more information if I was going to listen.

This. It is fairly easy to find research to back up whatever your point of view is.

Does she talk about the higher risk of SIDS for formula fed babies? (By which I mean exclusive formula feeding rather than mixed feeding.) That's a pretty important one.

Ok so I’m really shallow, but does she mention anything about the fact that if you have huge babies like me that are constantly feeding they suck off so many calories you are back to pre pregnancy weight in three weeks?
(Ducks and runs for the hills)