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.

@icecreamss

I think it is fair enough for some to of questioned your motive OP, especially considering as a previous poster pointed out you have not really accepted any of the benefits that have been shown in various studies.

I also think it is fairly obvious - human milk for human baby. whilst formula has no doubt saved many many lives, questioning the benefits of breastfeeding is strange to me - unless you have some hang ups about not wanting to do it.

Yes, I think it's a bit of a bizarre argument. I find the whole attitude about breastfeeding bizarre. It's like nobody is allowed to say anything good about it without people trying to shoot it down as being "shaming" to formula feeding in some way. Then there is BS like this post that tries to poo poo on all the benefits and say it's fake news, to make people feel better about formula. But God help anyone that says anything about formula. Can you imagine if I wrote a post similar about formula? I may as well just volunteer to be hung drawn and quartered. Why are we still having this debate about what is best 🙈 I just wish people would just feed their babies the best way they can and stop trying to put down breastfeeding just because they couldn't do it, or didn't want to, or whatever the reason.

Not just on about this thread, but imagine if everyone who over the years has spent time getting defensive or whatever spent it on trying to address why the vast vast majority of women formula feed yet there's still a feeling of shame attached which not only makes people feel crap but also hinders reasonable discussions about breastfeeding. I have a feeling it falls

down mostly to not having enough support.

The way in which it's hammered home to you that breast is best does not match at all with the way you're treated once the baby's born and you find yourself needing help with it for whatever reason. Cynically, I think part of why breastfeeding support is so appalling in this country is that we know that we have the safety net of formula - I think midwives must go home at the end of the day pushing BF and think, 'But there's always formula if it doesn't work out', and completely ignore the fact that the knock on effects of guilt and feeling shit about not providing 'the best' for your baby are enormous.

I've never really dealt with formula so I don't know what it's like, but I've never thought it was an easier option for parents than just plugging the baby onto a boob and, as with so many of the 'inferior' choices women are accused of making (breast v bottle; vaginal v caesarean birth), it seems that we're just shamed without anybody really asking, 'Why are women making these choices and what aren't we doing to help them? What aren't we listening to?'.

(I'm trying to get a caesarean booked at the moment after a crap first birth - the key point that made it crap was the way I was treated by the midwives, and not the pain or the instrumental delivery I ended up with. If I felt I could trust the staff enough to labour naturally again, I would - but I don't, because they didn't listen to me then and I doubt anything's changed. I think that's kind of related to my point above, hence my saying it!)

@SpaghettiNotCourgetti I mixed fed until my DD decided she didn't like nipples at a year old, in the UK unlike many countries I wasn't counted in breast feeding statistics.

I had some very unpleasant hospital midwives before I was discharged from them, there as the community team didn't give a shit how my baby was fed. In my case it helped that I am related to and know child health care professionals so when the hospital midwives where unpleasant I ignored them.

During my labour I wasn't listened to. I said stuff and I was ignored. My DP said exactly the same things and was listened to. He's was and is still absolutely appalled. Funny thing was myself and DP were warned by the hospital antenatal team to stand up for me during labour.

@RedWingBoots I mixed fed until my DD decided she didn't like nipples at a year old, in the UK unlike many countries I wasn't counted in breast feeding statistics.

Yes - also this. DD had formula at four days old because my milk didn't come in until day five (I had a PPH). I've never told any health professionals this because, even though she was EBF from day five onwards, I gather that she wouldn't count in the EBF statistics, even though from that point on she didn't have anything but my milk until she was six months old. She was dropping weight and getting dehydrated and I was still being told to just put her to the breast, which was doing her no good at all because she was tiring herself out and getting no food.

It was shit.

And yes about advocating for yourself in hospital, as well. You basically have to yell in their faces to get them to listen. Perinatal care in the UK is, I'm afraid, a shitshow of many colours.

There is no evidence that formula feeding causes obesity

No but you can say that formula feeding is associated with higher levels of obesity. But this is by the by anyway, if you are going to look at a narrow definition of health impact of bf on babies then you can’t reasonably draw any conclusions given that research can’t and hasn’t looked at every health outcome. It’s not the only reason to breastfeed, many people do it for the convenience, cost, the bond, and now people are starting to think about the environmental impact.

As for the ‘breastapo’ maybe pps should remember that the UK has one of the lowest rates of bf-Ing in the world. Breastfeeding is a choice to defend and vehemently so when you are being told that ‘baby is not gaining weight on your breast milk’ ‘it’s not normal for baby to need another feed so soon’ etc etc coming not just from friends and family but also medical and health professionals.

I'd rather read research by medical experts on medical matters than an economist. There are plenty of research articles around breastfeeding

to all the women who've had poor care or lacked support. It's a crying shame. Pregnant, birthing, and nursing women, and mothers, should be showered with help and encouragement.

Breast is best. It's what they are designed for at the end of the day. It's personal choice and formula is perfectly acceptable but breastfeeding is optimum imo.

Oster is an economist and appears somewhat biased. There are limitations to her research and I don't find her to be particularly helpful in the debate. I'd rather listen to health professionals personally.

If you don't want to breastfed then that is fine don't do it... you don't need to pretend it isn't the best option though for your baby. This is surely just confirmation bias? Trying to find evidence to fit into your choice.

@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.

I wish the medical team and midwives in my maternity hospital took this approach. I was getting so much pressure to BF that I ended up kicking off at them because I know that with this pregnancy I run the risk of PND and MH difficulties. I don't want the additional stress of BF to ruin my bond with my baby and I also want to be able to access medications (if necessary), without having to wean baby onto formula.

Maybe more than anything else it's shocking how little research there is on this. A lot of the studies seem to be decades old.

I wish I had the research links relating to this, but there were countless amazing benefits stated by professionals in a seminar I watched during World Breastfeeding Week last year. How your milk adapts to time of day to produce varying hormones to promote energy vs sleep, how the water content of milk changes depending on hot vs cold weather, antibodies tailored to your child's current illness, variation in milk for first born children vs subsequent born children and also differing calcium content in breastmilk produced for boys vs girls. Easier to go on holiday without packing extra equipment, cheaper if you dont need to pump, etc. Almost all my friends who are mothers breastfed/breastfeed and as a result barely any of their babies use dummies so you could argue potentially better for teeth development. Also for mothers postnatal health doesn't breastfeeding help to contract the uterus back into place quicker as well as supporting bonding/mental health and reducing cancer? I breastfed my son for 20 months and the benefits were endless in my experience, but that is not quantitative data. I remember the first time I left the house alone with him for the day and although it sounds stupid I felt quite powerful knowing that because I had my boobs with me we would be ok no matter what 😂

So well put, @Twizbe.

@greenpotatoes456

Studies aiming to show the 'benefits of breastfeeding' are looking in the wrong place though. It's like trying to prove the benefits of a natural limb over an artificial one. Of course a prosthetic is excellent in some circumstances but it's not as good as a real leg/arm and why would you need a study to prove it? Breastfeeding is just the ordinary baseline and you measure everything else against it, its not some gold-standard 'best'. Formula being cow's milk based is never going to be as good, objectively, as the ordinary bog-standard biological process which every baby is born expecting to receive. Of course, of course there are many situations in which formula is absolutely the right choice but it is disingenuous to suggest that you can even begin to compare 'benefits'.

But… if using my leg meant a massive fight each time, if it was incredibly painful and difficult and causing me to become depressed, if I spent hours and hours at a time just trying to use my leg then… yeah, would totally get a prosthetic.

@mowglika this struck me from what you said: "‘it’s not normal for baby to need another feed so soon’". I got this from my mother, who did breast feed me, but 40 years ago when she was told to do it on a strict schedule. She was convinced I was doing it all wrong by feeding on demand, and tried in every way to convince me of this - some quite sneaky and unfortunate. Luckily she lives in a different country, so I only got a week of this when she visited. Also luckily I'm a bit older, have done a lot of research and classes, and I'm quite stubborn . I imagine some might be swayed if hearing this stuff with such force as a vulnerable new mother. I wonder if there is a tension between the fact that in the early days you do need to feed a lot to establish supply vs the old mantra that every 3 hours is "the right way". Incidentally my mother did have to top me up with formula from 4 months due to supply. Absolutely fine of course, but if demand had been allowed to stimulate supply, it might not have been needed.

And yes to uninformed comments from medical professionals. An (otherwise lovely and competent) GP advised me to give our 2 month old EBF baby with suspected reflux water from a bottle. I told him she doesn't take bottles and he replied "well, you'll have to get her onto bottles soon anyway." Why? I never did. I also happened to know water for EBFs babies under 6 months is not recommended so I ignored him.

A paediatrician we saw had a mantra that babies should start solids from 4 months. I ignored him too. My HV tried to shame me for breastfeeding my one year old and told me it would stop her eating solids. My husband was all ready to believe her "because she's a professional", but luckily I knew better and resisted. She'd be horrified that now 2 year old DD still has a little breastmilk (very much at her very vocal demand!!)

OP, breast milk is a live substance, full of live cells, including white blood cells, antibodies and stem cells. Look it up (if you haven't already). We are only just beginning to understand the composition of breast milk, from a scientific point of view. It simply cannot be compared to a powdered, processed food. There are some well established and accepted differences in health outcomes. Breastfed babies have fewer ear infections, gastro-intestinal illnesses and respiratory diseases and fewer hospital stays. However, you are absolutely right that other claims made by (and sold as fact) for example, the NHS, have not been proven yet, such as those claims made about obesity, IQ, allergies, asthma etc. There are correlations, but as you and others have pointed out, this is not the same as causation and needs further research.

That said, women must let go of any negative feelings about using formula. The vast majority of babies are fed formula at some point, and a very large percentage of my own generation were formula fed. It is a fine and safe option and babies thrive on it. It must also be remembered that breast milk is far from the only influencing factor in health and immunity. There are countless other very important influences. Growing up with pets, for example is understood to be excellent for kids' immune systems and results in fewer allergies etc. Yet no parent is made to feel guilty by health professionals for not having dogs or cats!

Just for interest OP, if you are an economist, how much economics and practice has an evidence base as rigorous as health and science would accept? I know social 'science' has a different context.

[quote IamOvercome]@DomesticatedZombie I read the full paper. It doesn’t control for many factors that affect obesity. So you can’t rely on the conclusions.

@RedRobyn2021 but you don’t know the counterfactual. If you hadn’t breastfed you may have felt exactly the same about your daughter. You just attribute it to breastfeeding.

@Caneparrot Breast is best. Mixed feeding is fine. Exclusively FF is not equal to BF no matter how many studies you do what are you basing that on?[/quote]
You're right I can't compare to formula feeding, but I'm not saying that I would LOVE her any less if we formula fed, I would still love her, obviously.

But I do know when I say we are symbiotic I mean, I need her to empty the milk and she needs me to feed her. I know that if we had formula fed my partner and my mum would have helped me with feeding. I would have had more time to myself from the beginning. But because we have soldiered on through all the difficulties and the sleepless nights and the feeling that it's all on me, well, it has bound us together. When I say she has helped my mental health, I mean, I am quite a worrier and this has continued into motherhood, breastfeeding her releases hormones which soothe me as they soothe her. Which I needed particularly in the early days of adjusting to it not just being me anymore.

She was in hospital at one point as a newborn and it was horrendous, just constant poking and prodding from myriad of different nurses and consultants. Breastfeeding provided a huge comfort for her and made me feel like I could do something in such a horrible situation, I was so grateful we had kept going when this happened. She was getting plenty of fluids and she was being soothed during some difficult procedures.

From about 3.5 months she started waking very frequently in the night and by 5 months we had started bed sharing and I would feed her laying down barely waking myself. I wouldn't have been able to do this if I had formula fed, I would have had to get up and make up a bottle or rock her back to sleep. I don't know how I would have coped with this, but it would have been incredibly hard.

I wanted to add as well, that I was raised very differently, my mother went back to work when I was 6 weeks. I was breast fed a bit initially but quickly formula fed. I was put in my own room virtually from birth and had many people feed me who weren't my mother. But we are close, we have always been close through my childhood too. Possibly because she only had me but also because of the choices she made about the kind of parent she wanted to be.

So although I personally place a huge amount of value on breastfeeding because of my experience as a mother, I KNOW that it isn't the be all of parenthood and certainly doesn't mean that a mum won't have a close relationship with their child.

My heart goes out to those women that beat themselves up over this. They shouldn't. The problem isn't that they formula fed, the problem is when women formula feed but wanted to breastfeed, but weren't given the support, practically, financially, emotionally to do what they wanted. I mean I think we all know that really, but it makes me sad the way we end up arguing amongst ourselves when the real problem is the people in charge making the decision that we're not worth investment.

Sometimes I wonder if it were men birthing babies how different things would be.

That's weird, I just googled "sickness rates bottle Vs breast" and the first two pubmed studies that came up overwhelmingly showed a benefit for breastfed babies - wonder where she got her data from and if it was cherry picked?

@FudgeSundae are you honestly suggesting that if using your leg caused you discomfort for a period of a few months you would amputate that leg and use a prosthetic? Perhaps you didn't think your analogy through.

@katnyps

That's weird, I just googled "sickness rates bottle Vs breast" and the first two pubmed studies that came up overwhelmingly showed a benefit for breastfed babies - wonder where she got her data from and if it was cherry picked?

Nobody's denied that bottle fed babies get sick more often than bf babies, not Ostler, not the OP. It's extremely well-evidenced.

@katnyps

That's weird, I just googled "sickness rates bottle Vs breast" and the first two pubmed studies that came up overwhelmingly showed a benefit for breastfed babies - wonder where she got her data from and if it was cherry picked?

Judging by her pregnancy book, she does cherry pick. And because she's not medically trained, she doesn't understand the limitations of what she's picking.

The studies she uses for alcohol consumption - though valid studies - don't say what she thinks they say. I won't go into it in too much detail so as not to derail the thread, but the Danish study includes preschoolers only, whereas some of the effects of alcoholic consumption in pregnancy won't have shown up by then.

Some flaws in the pregnancy book are glaring from a mile off. She says pregnant women are no more likely to get food poisoning than non pregnant - not true. Among other things pregnant women are immunosuppressed in the third trimester, which does mean that infection is more likely on exposure.

Others have pointed out the flaw in her caffeine /miscarriage theory - not everyone who has pregnancy nausea goes off coffee and tea. I did in my first pregnancy, but didn't in my second for example.

On the other hand she cites stats on the risk of instrumental deliveries from epidurals which are flawed or outdated. To me, it all reads like a big list of justifications for Emily's own choices!

"To me, it all reads like a big list of justifications for Emily's own choices!"

Completely agree with this. I read the pregnancy book and found bit of it helpful but I really disliked the idea that it was supposed to be an objective look at the research. It wasn't.