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.

[quote EarlGreywithLemon]@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 .[/quote]
You can store it in the fridge for 24 hrs so in theory can make bottles once a day.

@luxxlisbon the advice has changed- they should be made up fresh each time:

www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/

"Even when a feed is kept in a fridge, bacteria can still survive and multiply, although more slowly. To reduce the risk of infection, it's best to make up feeds 1 at a time, as your baby needs them." (from the NHS link above)

@Floomobal I don’t think that’s a fair accusation - that she manipulates data. What basis do you have for saying that? I don’t personally agree at all with cry it out, but it’s certainly true that the balance of data based evidence says it’s ok/not harmful. I think the problem is these things (cry it out, breastfeeding) can’t always be assessed using the kinds of methodologies that have been implemented.

“ If made-up formula is stored:

in a fridge – use within 24 hours
in a cool bag with an ice pack – use within 4 hours
at room temperature – use within 2 hours”

From the nhs website.

www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/formula-milk-questions/

Plus pre made liquid formula can be stored for 48 hrs.

If you want to reduce the risk to pretty much 0 you can make fresh but in the uk the risk of storing it in a fridge in a sterile bottle and made with clean water is incredibly low so it is not advised against.

@VelvetChairGirl

'I like faff its free exercise. I do hope you dont pay for gym membership.'

This made me cackle out loud Rest assured that I also can't be bothered with the faff of either going to the gym or dealing with the small amount of admin that such a membership should require!

You know what else is free exercise? Breastfeeding

@luxxlisbon

“ If made-up formula is stored:

in a fridge – use within 24 hours
in a cool bag with an ice pack – use within 4 hours
at room temperature – use within 2 hours”

From the nhs website.

www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/formula-milk-questions/

Plus pre made liquid formula can be stored for 48 hrs.

If you want to reduce the risk to pretty much 0 you can make fresh but in the uk the risk of storing it in a fridge in a sterile bottle and made with clean water is incredibly low so it is not advised against.

I did an NHS feeding class at the hospital, a feeding class at NCT and discussed feeding with several midwives and the health visitor. It was confirmed by all of them: I’m afraid the advice really has changed - recently. Not all NHS pages are regularly updated unfortunately.

[quote EarlGreywithLemon]@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.[/quote]
She was not at all specific about saying “one drink a day is safe”. She said there's little good science to suggest that up to one to two drinks per week during the first trimester, and up to one drink a day during the second and third trimesters, harms babies. To counter that you have offered the expert opinion of a scientist who has:

1. pointed out some methodological limitations in the studies Emily oster discussions (totally fair!) but that doesn’t contradict or disprove her (above) conclusions.

2. offered an anecdotal account of one boy she knows with FAS who’s mother claims to have drank 1 beer a day for the first four months of pregnancy. This also is not sufficient to contradict EOs statement as above.

If there are only minimal benefits to breastfeeding, why does the NHS recommend that even smokers' breastmilk is better than formula? The NHS isn't exactly pro-smoking when it comes to babies!

I have little time for “advice has changed” arguments. Old advice worked fine for the babies for whom it was followed. The infant mortality rate has remained pretty much the same for the last 30 years, with the greatest cause for its fall being the reduction in SIDS. The fact is that ff babies were perfectly fine using the old advice.

If someone says to me, in EO’s exact words “ You should be comfortable with up to one drink a day in the second and third trimesters” that really doesn’t say “there’s no evidence, you do your own research”. It says “it’s safe”.
And the expert doesn’t offer one anecdotal example. She says: “1 out of every 14 children we have diagnosed with full blown FAS over the past 20 years had a reported exposure of just 1 drink per day”. This is a person who “ has diagnosed over 2,550 individuals with fetal alcohol spectrum disorders (FASD) over 20 years, and creator of one of the largest FASD databases”.

And before you jump on the “reported” - everything is based on “reported exposure”. The studies EO cites included, and also the advice she doles out - which refers to one drink a day but gives no indication if that’s a few sips or 500ml of wine.

I did an NHS feeding class at the hospital, a feeding class at NCT and discussed feeding with several midwives and the health visitor. It was confirmed by all of them

I've done consumer research on this for a formula company and in real life, this advice is followed by virtually no one. Making up for later refrigerating is how basically everyone does it, unless they have a perfect prep or ignore the guidelines entirely.

@Blossomtoes

I have little time for “advice has changed” arguments. Old advice worked fine for the babies for whom it was followed. The infant mortality rate has remained pretty much the same for the last 30 years, with the greatest cause for its fall being the reduction in SIDS. The fact is that ff babies were perfectly fine using the old advice.

There’s a big gap between mortality and getting a stomach aches or food poisoning! Surely we’re not aiming to just keep a baby from death’s door, we’d rather they were also comfortable and healthy?

Advice changes, mostly, because the science gets better (although there are of course mistakes). There’s every reason to pay attention to it.

@TheKeatingFive

I did an NHS feeding class at the hospital, a feeding class at NCT and discussed feeding with several midwives and the health visitor. It was confirmed by all of them

I've done consumer research on this for a formula company and in real life, this advice is followed by virtually no one. Making up for later refrigerating is how basically everyone does it, unless they have a perfect prep or ignore the guidelines entirely.

Not the formula feeders I know!

Not the formula feeders I know!

I am not lying when I say I didn't come across a single one doing it like this.

@Blossomtoes

I have little time for “advice has changed” arguments. Old advice worked fine for the babies for whom it was followed. The infant mortality rate has remained pretty much the same for the last 30 years, with the greatest cause for its fall being the reduction in SIDS. The fact is that ff babies were perfectly fine using the old advice.

You are making the presumption that formula is exactly the same as it was 30 years ago. Manufacturers do change their formulations of products.

@TheKeatingFive

Not the formula feeders I know!

I am not lying when I say I didn't come across a single one doing it like this.

And I’m not lying when I say my two NCT friends who FF and also my close friend made them fresh. I was in the same courses with all my NCT friends and we heard the same things, and discussed them amongst us after.
I know my close friend got a perfect prep machine at a few months old. By the way, they were not recommended either, but I know many people use them.

@EarlGreywithLemon

If someone says to me, in EO’s exact words “ You should be comfortable with up to one drink a day in the second and third trimesters” that really doesn’t say “there’s no evidence, you do your own research”. It says “it’s safe”. And the expert doesn’t offer one anecdotal example. She says: “1 out of every 14 children we have diagnosed with full blown FAS over the past 20 years had a reported exposure of just 1 drink per day”. This is a person who “ has diagnosed over 2,550 individuals with fetal alcohol spectrum disorders (FASD) over 20 years, and creator of one of the largest FASD databases”.

And before you jump on the “reported” - everything is based on “reported exposure”. The studies EO cites included, and also the advice she doles out - which refers to one drink a day but gives no indication if that’s a few sips or 500ml of wine.

To answer your points:

1. then you to take more responsibility for thinking about what you read.

2. this scientist offers no details here on what is meant by one drink a day, at what stage of pregnancy this drinking took place, and she provides no source evidence for this claim.
   
   more specifically mentions one boy who’s mother claims to have drunk one beer a day for the first four months of pregnancy, and she presents this as a very rare case.
   I’m not saying what the scientist says isn’t true, it may be, but her claims , as reported in this format , do not meet a threshold of constituting good scientific evidence.

3. sure, absolutely, all the studies rely on self reported drinking. This is a limitation in the evidence. This again does not contradict EO conclusions that there is no good science that says xyz is harmful.

And I’m not lying when I say my two NCT friends who FF and also my close friend made them fresh.

I'm sure you're not, but that isn't comparable with Nat Rep samples (500 quantitative, 50 qualitative).

You are making the presumption that formula is exactly the same as it was 30 years ago. Manufacturers do change their formulations of products.

I’m not. But seriously, how much can it have changed realistically in a couple of years? Because that’s all we’re talking if the NHS website hasn’t been updated!

It's tricky though, I think it's important to look at this stuff, but also important to think about the extent to which something can be captured by studies. Because they can't show things that haven't been studies, and some things are extremely difficult to study even if you want to. Children's diets being one of them. Another being long term effects on wider health over a lifetime.

Context makes a difference too, the benefits of breastfeeding have a whole different slant if you live in a place where water isn't always safe or the supply chain is unreliable.

The question of introducing a bottle early is also tricky. I tend to think the problem can be very over-blow but I also think experience working in an area like that with struggling patients can yield insights that can't be captured in a study. Introducing a bottle may make little or no difference with most infants learning to breastfeed, but have enough effect of newborns struggling for certain reason that it's worth avoiding. But this might not be captured statistically.

@EarlGreywithLemon additionally 2,550 divided by 14 is 182 cases. I think that alone indicates how vanishingly rare this problem is and how anecdotal the evidence. Compare this to statistics on how many women report drinking in pregnancy…

Human milk not beneficial to human babies, tiny infants left to cry, pregnant women in the second and third trimesters drinking every night. All according to the research. This woman sounds absolutely deranged.

@Bizawit I take plenty of responsibility thank you- hence why I looked into EO’s claims very carefully and decided they are “wishful thinking” (I’m being polite).

For what it’s worth, EO doesn’t give examples from any of the studies she cites either- we have just her word for them, unless we look them up. Anyone can also look up the scientist and her database. And I’ll say it again- EO also offers no indication f what she means by one drink a day, which can span anything from a glass of fortified wine , or half a bottle of wine, to a glass of shandy.

I’m not sure there’s much point continuing this discussion to be honest, especially as it’s derailing away from breastfeeding. I can’t convince you, you can’t convince me, and we’re just going round in circles.

[quote Bizawit]@EarlGreywithLemon additionally 2,550 divided by 14 is 182 cases. I think that alone indicates how vanishingly rare this problem is and how anecdotal the evidence. Compare this to statistics on how many women report drinking in pregnancy…[/quote]
She alone diagnosed 2250 - she’s not the only FAS specialist in the US! She’s not even the only one in her department if you look at her wording.
One in 14 is not negligible odds to me.