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.

@RedWingBoots thank you, that makes sense. For what it’s worth that was my impression too, and felt EO was actively pushing it a bit. I didn’t drink and am not drinking (pregnant now). But before anyone jumps at me, I’m not saying this to pontificate to anyone!

@Franca123

Yeah I loved bottle feeding. No idea why people think it's so faffy. You wash them up and stick them in the steriliser. Takes minutes. We made extra and stuck them in the fridge for overnight. They only night feed for a few weeks so it's hardly a big deal. I think we were on to one dream feed by maybe week 6 if I remember correctly? Plus you can share it. My mother in law looked after our second baby the first night we came home from the hospital so we could catch up on sleep. And if you can't be bothered to store a bottle correctly to take it out, buy pre made and pour into a bottle when needed. There's so many options to make it work if you want to bottle feed. Why make such a fuss about it being so hard. There's a certain technique to slow the bottle down when the baby is first born which is a bit tricky and needs to be taught. But after that any idiot can do it. The family loved feeding our two.

Well, it is faffier than BF as there is nothing to buy, wash or sterilise if you BF. And you don't need to remember to buy more.

[quote Scooby5kids]@Twizbe exactly. I maybe shouldn't have used Ukraine it was extreme. But my point was more like what you're saying. Breastfeeding has a lot of practical benefits if people are able to get onto a good start with it.

I completely understand that formula does have it's important place. I had a premie baby who had to have formula feeds for the first few days until my milk was established and wasn't able to actually breastfeed for 2 weeks because he had to be tube fed, so I am thankful we have it because without it my son would have died unless there was donor milk available. I've had 5 babies and had different breastfeeding journeys, some more successful than others but I'm a great believer that if you can, you should, because it's a great feeling knowing you're providing for your baby [/quote]
You should bf if you want to - many of us don’t want to and I didn’t try but used formula from day one.

@IamOvercome I can't comment on the breastfeeding statistics, but I can absolutely vouch for the bottle thing. Both my DDs had a bottle of expressed milk not long after coming home from hospital (approx day 3/4) and I never had any issues with either DD switching between bottle and breast.

[quote RedWingBoots]@NurseBernard but statement is illustrating your cultural beliefs and ethics due to the society you were brought up in.

BTW a PP pointed out Oster breast fed her children.[/quote]
I know she did. It’s been mentioned several times throughout the thread.

I think you missed the point.

Oster has, seemingly, gone into the evidence on the benefits of breastfeeding, and argues there are no real benefits to the baby (there may be some for the mother, the environment, etc).

But she sleep/trained her baby to cry it out at 10 weeks.

Culture aside (I’m not in the UK, or the US), I’d be interested in any evidence that says this is beneficial for the baby.

Of course it is beneficial to the mother - in this case Oster in the US - probably because she had a matter of weeks of maternity leave and had to get back to work. Crying it out isn’t a cultural phenomenon in the US. It is a practice taken up by some parents who want their baby to sleep through the night, nap during the day, etc.

I’d go further and say there is evidence that being left to cry for nearly half an hour at 10 months is not only not being beneficial to the baby, but that it’s not recommended.

@EarlGreywithLemon I should start by saying that I'm not a professional - I do literature reviews for researchers - so not an expert in foetal alcohol syndrome but I recently looked at the impact of various teratogens on later ADHD diagnoses.

Your first link obviously is from a professional (I couldn't access the NYT one) and says what I would expect. FAS certainly can be diagnosed in the children of low drinking pregnancies. Here's the biological part: when the brain is developing in utero, neurons go through five main developmental stages - alcohol interferes significantly with three of these (in very crude terms, it stops neurons producing as much as they should, it interferes with them travelling to where they are supposed to go and it interferes with them learning how to do their specific jobs). It also causes excessive cell death in the brain (cell death is absolutely normal during brain development, but not too much of it!) - as a result babies exposed to alcohol in utero have, on average, significantly lower overall brain volumes and specifically lower volumes in a number of brain regions, including the areas involved in 'executive function' - emotional control, planning, inhibition etc.

Long story short - I had a few glasses of bubbles during each of my pregnancies; I wouldn't do if I was to get pregnant again. Personally I just don't feel it's worth the (albeit potentially miniscule) risk; I wouldn't evangelise about it but I certainly don't think it's very responsible to sell books claiming to provide impartial, balanced evaluation of research without actually covering vast swathes of the research, whether that's on alcohol consumption or infant feeding.

@Scooby5kids

Yeah I "brought Ukraine into it" because why not? It's a good example. The fact of the matter is if there was suddenly no way to get formula tomorrow, here in the UK, or anywhere, there would be a lot of babies health in jeopardy. I'm not saying people "have a choice". I've very aware some people can't do it. Formula literally saves lives! But the fact of the matter is, if formula suddenly became hard to get, my baby is still gonna get fed because I don't have to rely on circumstances of other people to feed my child. It's not a flex! It's just pointing out another reason breastfeeding is good. People can roll their eyes and be like "As if you mentioned Ukraine" all they want. But I've got a good point.

It’s not as simple as that. Breastfeeding isn’t some failsafe - I don’t imagine the women of Mariupol without access to food or water for themselves are finding it that easy to breastfeed. Feeding in a war zone is indeed an extreme example, and if we are talking about other extreme situations, having a baby that won’t take a bottle causes all sorts of problems if the mother is ill. A friend of mine had a stroke when her baby was very young, and trying to feed a hungry baby that only wanted the breast while her mum was on a ventilator was an additional source of stress to the father when had they been bottle feeding, it would have been easy.

Most women don’t make their decisions based on these unlikely situations, and nor should they.

I breastfed so I have no idea whether bottle feeding is “faffier” or not. Likewise someone who never breastfed has no idea whether it is “faffier” than bottle feeding.

@RichTeaRichTea

I breastfed so I have no idea whether bottle feeding is “faffier” or not. Likewise someone who never breastfed has no idea whether it is “faffier” than bottle feeding.

What do you mean ‘no idea’?

You don’t always have to have done something to have ‘some idea’ about what is involved.

@lifeuphigh thank you so much, that’s really helpful. It makes perfect sense to me. And I do agree with you it’s irresponsible.

Here’s the relevant section in the NYT article. I think her theory on drinking slowly is so clearly crackers, it’s worth calling out:

“ Dr. Oster’s thoughts on drinking alcohol while expecting have already generated controversy. In her view, there is no good scientific evidence that light drinking negatively impacts the fetus. Pregnant women can be comfortable with “1 to 2 drinks a week in the first trimester” and one drink daily afterward, she writes.

Similar assertions have long been made, but her explanation may be unique: a woman who drinks slowly lowers the amount of alcohol and acetaldehyde, its toxic byproduct, reaching her fetus.

Most government agencies and the American College of Obstetricians and Gynecologists say that no amount of alcohol has been proved safe for the developing fetus, a position Dr. Oster calls “draconian.”

Bill Dunty, a program director of the division of metabolism and health effects at the National Institute on Alcohol Abuse and Alcoholism, called her explanation “oversimplified” and said it could “potentially mislead women to think they are not exposing their fetus to alcohol.”

Women vary in their ability to absorb and metabolize alcohol, according to Dr. Dunty. “It is unrealistic to believe that an individual can inherently control the amount of alcohol or its metabolites that reach her fetus by taking longer time to drink an alcoholic beverage,” he said.

Dr. Oster contends that acetaldehyde is processed “by the baby’s liver and doesn’t get into the brain.”

However, the fetal liver is not formed until at least week 20, and it doesn’t become fully functional until just before birth, says Jacquelyn Bertrand, a senior scientist at the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention.

What’s more, ethanol crosses the placenta and becomes part of the amniotic fluid, said Dr. Bertrand, who has a Ph.D. in psychology and has studied the neurodevelopment of children with prenatal alcohol exposure. Even with very slow drinking, ethanol builds up in the amniotic fluid. which bathes fetal tissue for a considerable time, she said, adding that all fetal organs, especially the brain, are very vulnerable because sometimes they are in direct contact with amniotic fluid.”

I mean it certainly sounds crackers! And as though it has been debunked by, well, the actual experts.

*What do you mean ‘no idea’?

You don’t always have to have done something to have ‘some idea’ about what is involved.*

I made a similar comment because I wouldn't presume to tell someone that something I'd never done was more or less trouble than something that I have.

@SpaghettiNotCourgetti

*What do you mean ‘no idea’?

You don’t always have to have done something to have ‘some idea’ about what is involved.*

I made a similar comment because I wouldn't presume to tell someone that something I'd never done was more or less trouble than something that I have.

Exactly. I have an idea of what is involved with bottle feeding but as it isn’t something I have had to fit into my own life I don’t know whether I personally would have found it more of a faff than I found breastfeeding. I was one of the lucky ones who found breastfeeding very easy and it worked very well with our lifestyle and manner of parenting, I don’t even presume to tell other women who breastfeed what it is like because sadly I think my experience is quite unusual.

I wasn't saying bottle feeding is less faffy than breast. I was saying that people trying to make out bottle feeding was really difficult were being a bit disingenuous.

This is really well written, and addresses some of the points made here really well.

www.facebook.com/breastfeedinguncovered/posts/3045295695732090

@Teastheword it's not strictly true that there is nothing to buy if you breast feed unless you never leave your home. You need to wear clothes that you can breast feed in easily, quickly and comfortably in.

I only wore my maternity clothes for about 2.5 weeks after giving birth then realised I needed to buy clothes specifically tops I could easily breast feed in. So while the clothes I bought were cheap thanks to blogs telling you what normal clothes to wear I still had to buy some.

@RichTeaRichTea

I breastfed so I have no idea whether bottle feeding is “faffier” or not. Likewise someone who never breastfed has no idea whether it is “faffier” than bottle feeding.

They both have their pros and cons.

However in the UK mix feeders are only considered to be formula feeders so what do we know.

@RichTeaRichTea

However in the UK mix feeders are only considered to be formula feeders so what do we know.

Which is a ludicrous state of affairs, given that the NHS describes it as a way of both mother and baby getting the benefits of breastfeeding.

But it's all part of the same mixed, inconsistent messaging around breastfeeding. Given that it does provide both mother and baby with the benefits of breastfeeding, why doesn't it count with the breastfeeding stats?

[quote EarlGreywithLemon]@lifeuphigh her conclusions are:
“ There is no good evidence that light drinking during pregnancy negatively impacts your baby. You should be comfortable with :

• Up to one drink a day in the second and third trimesters.
• One to two drinks a week in the first trimester.
• Speed matters: no vodka shots!
• Heavier drinking could have negative impacts, especially in the range of four or five drinks at a time. This should be avoided.”

These quick links explain my thinking shoot that: depts.washington.edu/fasdpn/pdfs/astley-oster2013.pdf

well.blogs.nytimes.com/2013/08/19/pregnant-and-disputing-the-doctor/?mtrref=www.google.co.uk&gwh=63F549BCFFDAB33E09E120D62676D167&gwt=pay&assetType=PAYWALL
I pasted the NYT link because it discusses her bizarre claim that if you drink slowly enough the fetus is not exposed to alcohol (?!). I’d be very curious to hear your professional opinion about that (whilst hoping not to derail ).[/quote]
It doesn’t sound like a bizarre claim to me? Drinking more slowly means that your body will be breaking down the alcohol as you drink, keeping your blood alcohol levels lower and reducing impact on the foetus..

[quote RedWingBoots]@Teastheword it's not strictly true that there is nothing to buy if you breast feed unless you never leave your home. You need to wear clothes that you can breast feed in easily, quickly and comfortably in.

I only wore my maternity clothes for about 2.5 weeks after giving birth then realised I needed to buy clothes specifically tops I could easily breast feed in. So while the clothes I bought were cheap thanks to blogs telling you what normal clothes to wear I still had to buy some.[/quote]
I’ve exclusively breastfed two babies and never had to buy special clothes

@Bizawit if you read the section I pasted in my other post, you will see that it isn’t, in fact, accurate. At all.

@lifeuphigh

I mean it certainly sounds crackers! And as though it has been debunked by, well, the actual experts.

Quite. But people are reading this stuff and believing it.

[quote EarlGreywithLemon]@Bizawit if you read the section I pasted in my other post, you will see that it isn’t, in fact, accurate. At all.[/quote]
I did read it and it didn’t Contradict what I said at all . And it’s a well known fact that drinking slowly reduces your blood alcohol concentration.

www.csbsju.edu/health-promotion/alcohol-guide/understanding-blood-alcohol-content-(bac)

Even with very slow drinking, ethanol builds up in the amniotic fluid.

Extracted from EarlGrey’s previous post. Either way - it sends a rather dangerous message - that if a woman controls her blood alcohol level by slow drinking then she can also control her baby’s alcohol exposure within safe/unsafe parameters.