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Share your dilemmas and get honest opinions from other Mumsnetters.

Emily Oster on Breastfeeding - minimal benefits.

822 replies

IamOvercome · 14/03/2022 13:02

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.

OP posts:
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EarlGreywithLemon · 16/03/2022 11:26

@Bizawit she doesn't understand the data. She didn't understand the limitations of the studies she was looking at (for example that symptoms of FAS usually manifest themselves after the cut off age of the study, which means it's not relevant for what she's trying to argue). You need to be a medic to know that.

Somethingsnappy · 16/03/2022 11:28

@BertieBotts. I couldn't access that article as I'm not on Facebook. Can I find it anywhere else, or are you able to summarise at all?

Bizawit · 16/03/2022 11:32

[quote EarlGreywithLemon]@Bizawit she doesn't understand the data. She didn't understand the limitations of the studies she was looking at (for example that symptoms of FAS usually manifest themselves after the cut off age of the study, which means it's not relevant for what she's trying to argue). You need to be a medic to know that.[/quote]
Likewise there will be limitations of studies that medics won’t have ready expertise in, probability sampling, questionnaire design etc. @TheKeatingFive already pointed out a major limitation in the evidence presented by your favoured expert to support her (much more absolute) conclusions.

BourbonVanilla · 16/03/2022 11:33

I haven't RTFT but I read that book.
Emily Oster also says there is no proof that crying it out is bad for babies, but this just sounds wrong to me.

Most of her book is basically "there is no clear evidence to support either choice". It wasn't as useful to me as I hoped it would be.

RedWingBoots · 16/03/2022 11:33

@Angrymum22

My DF, a statistician in the chemical industry, where risk analysis in the design of chemical manufacture is essential, taught us that statistics where to be treated with caution. You can use statistics to support both sides of any argument.
Or as the saying goes:

Lies, damn lies and statistics.

Somethingsnappy · 16/03/2022 11:35

@Parker231

There is no difference in the bonding between parent and baby with bf or formula if anything the bond with the parents is greater with formula as the father can give an equal number of feeds.
Breastfeeding is a gorgeous bonding experience. As, I'm sure, is bottle feeding. As are many other aspects of baby care that fathers too can do, such as playing, cuddling, bathing, talking, carrying in a sling, sleeping near their babies, etc, etc. . Just as it is silly to claim that BF babies are better bonded with their mothers than FF babies, so is it silly to claim the fathers of FF babies are better bonded than fathers of BF babies.
EarlGreywithLemon · 16/03/2022 11:37

@Bizawit my "favoured expert" is someone who specialises in FAS and works with it every day of her life. I'm sorry to say that she might know a bit more on this than EO. Who doesn't actually refer to "mild drinking" and is very specific on "one drink a day" being safe.

EarlGreywithLemon · 16/03/2022 11:39

And if it's about the reported consumption issue - that's an issue with EO too. What is "one drink a day" exactly? It could be a 0.5l glass of wine or a 125ml. Or half a pint of shandy vs a pint of strong ale. Huge difference.

BertieBotts · 16/03/2022 11:44

[quote Somethingsnappy]@BertieBotts. I couldn't access that article as I'm not on Facebook. Can I find it anywhere else, or are you able to summarise at all?[/quote]
Well it was the bit on FB that I wanted to share but it's Amy Brown and she linked to this article that she wrote. I will include her text. The rest of the post is not my words!

Feeling the need to share this today after reading something online that failed to see how the conclusions of many infant feeding studies are underestimated / inaccurate / plain wrong.

Sometimes it feels like some studies have been designed by someone who has never encountered a baby let alone is an expert in feeding.

And certainly they often get interpreted by people who might have a good understanding of research methods but no understanding of infant feeding and how variables should be measured / the limitations of certain measurements.

I often see research being misused in a way that is unfair to those who haven't been able to breastfeed. One the one hand you have suggestions that breastfeeding will prevent anything bad happening and babies who are formula fed will immediately become unwell which simply isn't true. It's about the likelihood of something happening not a definitive.

But on the other hand you have a whole load of studies that underestimate how breastfeeding can protect babies as they take incomplete / odd measurements and then conclude things that often aren't related to the actual data at all.

Research is difficult. It can be really tricky (and costly) to do very high quality research into feeding outcomes. This doesn't mean that research with limitations should not have been conducted but rather the research should have been accurately reported.

Examples of inaccurate research / misreporting include things like lumping all babies who have ever been breastfed into one 'breastfed' group. So the baby who has one feed is grouped the same as the child who feeds for three years.

Comparing groups where there isn't that much difference at all in how they were fed despite labels of 'breastfed' or 'formula fed'. Most were mixed fed.

Or studies being misinterpreted and then inaccurately shared. The PROBIT trial is often rolled out as an example of breast versus formula feeding when most babies were breastfed.

One odd study counted babies as not breastfed if they weren't exclusively breastfed for 10 weeks. They could have breastfed for 5 years but because it wasn't exclusive then they were thrown in a not breastfed group.

And don't get me started on sibling studies as a claim that it's only parental background that matters - when often the 'breastfed' sibling was only fed for a few days or there was no data at all on duration.

And studies that claim there's no impact of breastfeeding at all because there was no difference in child behaviour when they were school aged 🧐

We need accurate data to be collected and reported so that parents can judge it for themselves. And we need studies to show the full impacts because then (she says dreaming) we might end up with more investment in supporting breastfeeding.

But also, although it's useful stuff from a science and policy perspective, I'd rather see research conducted that actually leads to stuff that helps women breastfeed for longer. Research that explores how they feel... what helps them feed... what they need etc. And that goes for bottle feeding and mixed feeding too.

What research is actually helpful? It's certainly not research that is poorly designed or interpreted in an inaccurate way.

professoramybrown.co.uk/articles/f/the-strangely-inaccurate-world-of-breastfeeding-research

VelvetChairGirl · 16/03/2022 11:52

[quote EarlGreywithLemon]@VelvetChairGirl I'm not in any way arguing how people should feed their babies- let's be clear on this. It's not my place. I'm also being extremely careful here as I know many people want to breastfeed and can't or find it very difficult for a number of reasons- so I don't want to come across as smug.

But to breastfeed I needed nothing: no bottles, steriliser, milton, cartons, anything. No logistics, no planning. So I'm afraid to me that does sound a faff.

I'm now pregnant again and well aware that breastfeeding might not work out or might not be as easy this time. If I have to formula feed then I have to and I'll do it, of course. But I do know it would be a faff compared to the previous time.

I'm also extremely aware that I just struck lucky with DD- she latched well, my milk supply worked, and that was that. No merit, or effort, or work on my part at all. It's a bit like birth - I believe it's sheer luck if you have an easy or tricky one (I had a tricky one). It's a lottery and I feel really guilty saying I got a good ticket on the feeding, and well aware many didn't.[/quote]
yes but like many things its no bother, people are making out that its some massive hardship its not.

its like nappies, you could let them roam free its natures way, but you accept all the faff (and its way more faff then formula feeding) of dealing with nappies and stinky bags and sore bums etc.

we all do things in life that some think is a faff, but its just life its routine you dont see it as anything else.

I am sure theres plenty on here who think washing up by hand is a faff because they have a dish washer, or they think walking to the shops is a faff because they have a car etc.

I honestly dont buy the faff argument tbh because of that.

EarlGreywithLemon · 16/03/2022 11:57

@VelvetChairGirl we put them in nappies because washing mountains of soiled clothes, sheets, and cleaning up carpets soaked in poo and wee every day is a faff, surely?
I do find washing up by hand a faff too, I’m afraid - sorry!

SpaghettiNotCourgetti · 16/03/2022 11:59

But to some people it is a faff. I have a very low faff threshold. I resent the amount of effort that goes into making a cup of tea. Breastfeeding involved less walking, cleaning, buying and preparing and seemed, therefore, less faffy TO ME. Nappies - faffy as they are - are less faff than constantly cleaning piss and shit off the floor. If they weren't, I might have had a nappy-free policy.

Nobody's saying that preparing formula is overly arduous, but there is a difference in the amount of para-feeding activity that it comes with. That's all.

Parker231 · 16/03/2022 12:02

Thank goodness for microwave sterilisers and perfect prep machines - lifesaver for new parents.

EarlGreywithLemon · 16/03/2022 12:06

@SpaghettiNotCourgetti you’ve put it much better than I could have. I also have a “very low faff threshold”. Especially when tired and trying to also keep an eye on a little one.

Somethingsnappy · 16/03/2022 12:11

@BertieBotts, thank you so much! Really interesting. Amy Brown is great; I have two of her books x

luxxlisbon · 16/03/2022 12:15

Bottle feeding is marginally more faff then breastfeeding, you have to put the formula into your shopping trolly, washing a few bottles a day or stack your dishwasher with a few extra items and pop them in a steriliser. Plus boil the kettle a few times.
Probably 10 minutes extra faff a day.
The obvious difference is that, plus the work of feeding can be split. So if you have a partner they can do the admin but plus split some of the feeds, or even anyone you have who can support you can do a few feeds whereas obviously the entirety of breastfeeding is on mum.
It is one of the pros of bottle feeding - that the job can be split. Breast feeding has some of its own pros but I don’t know why people want to deny that any benefit to bottle feeding exists and that it’s so much harder.

EarlGreywithLemon · 16/03/2022 12:35

@luxxlisbon

Bottle feeding is marginally more faff then breastfeeding, you have to put the formula into your shopping trolly, washing a few bottles a day or stack your dishwasher with a few extra items and pop them in a steriliser. Plus boil the kettle a few times. Probably 10 minutes extra faff a day. The obvious difference is that, plus the work of feeding can be split. So if you have a partner they can do the admin but plus split some of the feeds, or even anyone you have who can support you can do a few feeds whereas obviously the entirety of breastfeeding is on mum. It is one of the pros of bottle feeding - that the job can be split. Breast feeding has some of its own pros but I don’t know why people want to deny that any benefit to bottle feeding exists and that it’s so much harder.
That’s if your partner is at home. My husband was working. There was plenty to help with when I was breastfeeding - and he did at weekends and Fridays and Saturday nights. Changing the nappy, burping and settling after a feed was the big one. It took ages, far longer than feeding, and when he did do it on Friday and Saturday night I slept so much better. I didn’t regularly wake him on a weeknight or he would have been a zombie at work ( though I did a couple of times when I truly was struggling). So I don’t think bottle feeding would have helped us particularly.
oblada · 16/03/2022 12:41

@luxxlisbon

Bottle feeding is marginally more faff then breastfeeding, you have to put the formula into your shopping trolly, washing a few bottles a day or stack your dishwasher with a few extra items and pop them in a steriliser. Plus boil the kettle a few times. Probably 10 minutes extra faff a day. The obvious difference is that, plus the work of feeding can be split. So if you have a partner they can do the admin but plus split some of the feeds, or even anyone you have who can support you can do a few feeds whereas obviously the entirety of breastfeeding is on mum. It is one of the pros of bottle feeding - that the job can be split. Breast feeding has some of its own pros but I don’t know why people want to deny that any benefit to bottle feeding exists and that it’s so much harder.
Whether it is marginal or not depends on your set up and your perspective. For me having to buy formula, buy bottles, clean bottles etc is quite a lot of faff. Especially when I consider night feeding (all of mine required feeding at night until 2yrs old at least, including my youngest who is bottle fed for medical reasons), going out and about and travelling. I can assure you that dealing with bottle feeding with my youngest is a lot faffier than breastfeeding my older 3 ever was. I do express for her which is more faff in a way and less in a other. The plus side is that my husband does bedtime with my youngest whereas the others were more reluctant for him to be involved in that. But I'd give that away no question to be able and to breastfeed her 'properly'.

Ultimately it is about what a woman truly wants and about the sense of empowerment and contentment breastfeeding brings to many mums. For that alone it must be strongly supported. I don't care about any of the other benefits. It is to support women in achieving what they want that i volunteer on a breastfeeding helpline. No other reason.

Floomobal · 16/03/2022 13:12

@Bizawit

Just to add to my PP, the point of Oster’s book is not to provide women definitive answers about what they should or shouldn’t do, but rather to present information about what the evidence is saying about the level of risk.
But she manipulates data to present her “evidence”. Maybe the point of her book is purely to clear her conscience about drinking in pregnancy, eating whatever she likes, leaving her tiny baby to cry themselves to sleep for 25 mins etc etc. A justification of what many would see as unnatural mothering. Just because something chimes with you, doesn’t make it factually true.
luxxlisbon · 16/03/2022 13:15

That’s if your partner is at home. My husband was working. There was plenty to help with when I was breastfeeding - and he did at weekends and Fridays and Saturday nights. Changing the nappy, burping and settling after a feed was the big one. It took ages, far longer than feeding, and when he did do it on Friday and Saturday night I slept so much better. I didn’t regularly wake him on a weeknight or he would have been a zombie at work ( though I did a couple of times when I truly was struggling).
So I don’t think bottle feeding would have helped us particularly.

Most partners are working but coming home at some point, being out at work in the day doesn’t stop a partner washing/ sterilising all the bottles in one go early in the morning or in the evening. Or making a few up and putting them in the fridge. Granted if your partner works away they can’t do that, but then they can’t help with anything.
A partner can still change nappies, rock baby, bath baby AND do feeds in the evenings, the night and the mornings so of course bottle feeding allows them to do more.
If it wasn’t worth it to you totally fair enough, but the reality is parenting can be split more when bottle feeding since it is one more task the other person can get involved with.

RoseGoldEagle · 16/03/2022 13:37

Conducting studies with meaningful results is hard, and there are so many un-measurable benefits when it comes to breastfeeding anyway. I do sometimes think people get a bit too obsessed with the stats (that can only ever tell us so much), and lose a bit of basic common sense.

Of course if you can't or don't want to breastfeed, that's fine, and formula is great. But come on, do you really need to read up on every research paper going to try and convince yourself one way or the other? Is there any one who just trusts their own instincts any more? It's such an emotive subject and so many stakeholders with huge amounts of vested interest, so just be wary of placing too much of your decision making on data, data, data, and listen to your own instincts, too. This is NOT formula bashing, am just amazed that the simple idea of feeding a human infant human milk from the breast of his or her own mother is something that some people STILL feel the need to prove isn't really necessary.

Parker231 · 16/03/2022 13:56

Only on Mn do people defend their choices. In real life no one is interested. I’m just glad we have a choice - never wanted to bf - didn’t try and used formula from day one.

Although we don’t have any family living in the U.K., they travelled over often and were more than happy to do feeds, day or night. Don’t think I did a night feed for the first six weeks after DT’s were born. Friends also have bottles when they called to visit

EarlGreywithLemon · 16/03/2022 13:59

@luxxlisbon absolutely fine also if it is worth it to others!

To me, the hardest and most time consuming task related to feeding was by far, far and away burping and settling. And a partner can do that - if they're at home - whether you're breastfeeding or formula feeding.

Also, from what I recall making up bottles in advance is no longer recommended .

VelvetChairGirl · 16/03/2022 14:06

@SpaghettiNotCourgetti

But to some people it is a faff. I have a very low faff threshold. I resent the amount of effort that goes into making a cup of tea. Breastfeeding involved less walking, cleaning, buying and preparing and seemed, therefore, less faffy TO ME. Nappies - faffy as they are - are less faff than constantly cleaning piss and shit off the floor. If they weren't, I might have had a nappy-free policy.

Nobody's saying that preparing formula is overly arduous, but there is a difference in the amount of para-feeding activity that it comes with. That's all.

I like faff its free exercise. I do hope you dont pay for gym membership.
RedWingBoots · 16/03/2022 14:06

@EarlGreywithLemon

And if it's about the reported consumption issue - that's an issue with EO too. What is "one drink a day" exactly? It could be a 0.5l glass of wine or a 125ml. Or half a pint of shandy vs a pint of strong ale. Huge difference.
Glad you mentioned that.

A unit of wine is depends on the strength of the wine and wine glasses have got bigger over the years, so at home you can comfortably fit a third or half a bottle into lots of glasses