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.

I'm another mum who mixed fed from day one. There was absolutely no confusion. The cynic in me thinks that the confusion message was peddled by midwives knowing full well that by 6 weeks you'll have a bottle refuser.
Also extended breastfeeding. This is of very little benefit other than comfort. There is a reason the WHO give this blanket advice. It's because some countries don't have clean water. By the time your child is 3 it will hopefully be a lot more robust.

Quoting studies is fairly meaningless, there are lots of rubbish studies and research and people also misconstrue what is said, some things are also impossible or very difficult to study.

I'd take HCP advice over a book not written by a HCP, but feel free to justify your guilt for not breastfeeding with it

I'd take HCP advice

I'm not sure why, there are enormous knowledge gaps among HCPs on this topic.

…and we’re now at the point of the thread where people come on, not having read it - but keen for everyone to know their searing insights (some countries don't have clean water, apparently!).

Which have been raised over and over on the thread….

Regardless of whether you agree with Oster's analysis or not, it's a little worrying that people have ultimate faith in HCPs in terms of data analytics. I don't think it even features in their training (or very minimally).

Why do people think the change to make up bottles fresh is a recent change? They have been saying that for at least 15 years if not longer. (I didn't know anyone with babies earlier than this). It seems to go in circles - in the mid 2000s most people were making up for the day in batches, which NHS didn't like so changed the focus to always make up fresh. Then people stopped using hot water, as assumed make up fresh was more important than make up with hot water. So the focus shifted again to emphasise the hot water.

What it's actually said for at least as long as DS1 has been alive (so 13.5 years) is that making up fresh with hot water is ideal and storing in fridge up to 24 hours is second best. Again I don't know exactly what it said before this.

I do think the risk of nipple confusion is overblown and it shouldn't be some big secret or taboo to do both, but early formula/bottle introduction can scupper getting breastfeeding established for some mums, and it's not true that if they haven't had a bottle by X age they'll never take one. There's no evidence for that. Some babies simply stop accepting bottles once they lose the sucking reflex, whether they've had one before or not. What generally happens is that a mum will have this happen with their first or second baby, or hear of a bottle refusing baby from a friend and everyone will say oh, it's because you/they didn't get the bottle in early enough. They will introduce a bottle earlier with the next baby and hey presto, they don't refuse it and it seems like it "worked". But really that baby probably wouldn't have rejected bottles anyway. Most of them don't, it's a sizeable and stubborn minority who do!

The problem with bringing in bottles while you're establishing breastfeeding is that once you've got past about 4-6 weeks, if you are not already producing enough then it's really hard to increase milk production from then on. It can be done but it's much easier if you can get everything set up to the amount you need in the early weeks, and that means feeding direct from the boob as much as possible.

@TheKeatingFive

Regardless of whether you agree with Oster's analysis or not, it's a little worrying that people have ultimate faith in HCPs in terms of data analytics. I don't think it even features in their training (or very minimally).

In an ideal world, HCPs would take the instruction of NICE guidelines and in this case RCOG guidelines (which should and do trickle down to Trust policies). No single HCP should be making it up as they go along. So they might not "get" the data, but that shouldn't matter. I'm aware that plenty of them go rouge though.

I'll be having a baby in the next month and am under the care of two midwives and a consultant and no one has asked me at any point in the last 7/8 months how I intend to feed let alone pushed breastfeeding on me. And yet, plenty on this thread have mentioned the BF comments from their antenatal teams. So we know there are large differences out there.

What it's actually said for at least as long as DS1 has been alive (so 13.5 years) is that making up fresh with hot water is ideal

How long do you have to wait for it to cool down to a drinkable temperature?

I didn't reply on hcps for advice but biology. And the comparison with animals and moving on with the times with formula isn't a positive. Yes, it's great to have an alternative but it's not an alternative, formula is the main nutrition now for newborns and babies and I don't think that's progress at all.

@Owieeee - it is progress as it’s gives us choice. Some choose to bf, I chose to use formula . Sounds positive to me.

@luxxlisbon

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.

Highly unlikely that education for midwives, feeding specialists etc has all been updated and they haven’t bothered to update the nhs guidance on the website.

You know they currently make and store formula in the fridge in maternity wards and children’s ward?
If it was at all not advised that would be the one place to stick to the guidance.

Attached from the booklet on infant feeding I received from hospital in late 2019. I hope it’s clear now that I haven’t made this up.

@Parker231 the fact that the vast, vast majority of mothers feed their newborns and older babies highly processed milk from a different species is definitely not progress but we'll agree to disagree on that.

[quote Owieeee]@Parker231 the fact that the vast, vast majority of mothers feed their newborns and older babies highly processed milk from a different species is definitely not progress but we'll agree to disagree on that.[/quote]
Don’t you agree with parents having a choice has to how to feed their DC’s?

@Owieeee

It was invented but only used on a widespread basis since the 1960's/70's, it was more evaporated powder substitutes before. So bizarre that ppl are adement in posting how the benefits of bf are overstated, look around you and the evidence in the UK and Ireland ; it's a tiny proportion of mothers who bf anyway. Formula is the dominate way to feed a baby.

You couldnt get it because of WW2 and it took a long time to come back into the shops thats why my brother got carnation milk mixed with brown sugar, it was the best they could do at the time.

They often don't have a choice though; many mothers want to breastfeed and don't get the right support to do so.

@NurseBernard

What it's actually said for at least as long as DS1 has been alive (so 13.5 years) is that making up fresh with hot water is ideal

How long do you have to wait for it to cool down to a drinkable temperature?

When we were mixed feeding DS2, we made the bottle about an hour in advance and left it on the side, it was the right temperature by then.

Going by food hygiene rules, this is probably not ideal, but it worked for us.

You can cool it down faster by plunging into iced water or holding under a running tap (which is a ball ache because it makes your hand freezing and your sleeve wet if you're not careful).

@Parker231 of course I do and obviously the vast majority choose formula. I am allowed an opinion though on what I believe and know to be better nutrition like anyone is ,especially when it concerns babies. The op says there's minimal difference, I and science disagree. In fact her whole tone was superior and condensing to many mothers on this and probably coming from a place of fear over her future.I've read that author also and the studies and she are not infallible by any stretch.

*condescending

Or actually there's a gadget you can buy now which allows you to mix hot water with formula and then it instantly cools it for you. However I'm not sure it allows the hot water to stay hot long enough. If it had a delay function for 5 min I would think that would be perfect. Nuby Cool something.

When we were mixed feeding DS2, we made the bottle about an hour in advance and left it on the side, it was the right temperature by then.

I assumed that was the case.

It just doesn’t seem overly responsive, in terms of an unpredictable, hungry baby. Especially in the middle of the night, or caught on the hop, while out.

But it must work - even be preferable - since the vast, overwhelming majority of women opt to formula feed.

Im also really glad I had a mum who bf in the 80's and who was really knowlegable on the subject , I also lived abroad for one baby and the bf knowledge and expertise was great. Back in Ireland they actually offered formula post labour to get babies bowels going so a big lack of education ( formula does the opposite and I was bf a newborn with no issues....). But grateful I had the information passed on from previous generations who bf.

@NurseBernard

When we were mixed feeding DS2, we made the bottle about an hour in advance and left it on the side, it was the right temperature by then.

I assumed that was the case.

It just doesn’t seem overly responsive, in terms of an unpredictable, hungry baby. Especially in the middle of the night, or caught on the hop, while out.

But it must work - even be preferable - since the vast, overwhelming majority of women opt to formula feed.

From what I’ve heard from friends who did follow the guidance, it was stressful for them with a crying baby. But we just heard from a PP that many don’t follow the guidance - so either make them up in advance or top them up with cold water. There are also the Perfect Prep machines; the NHS don’t recommend them because the water doesn’t stay at the right temperature for long enough, but it seems lots of people use them.

@Owieeee

Im also really glad I had a mum who bf in the 80's and who was really knowlegable on the subject , I also lived abroad for one baby and the bf knowledge and expertise was great. Back in Ireland they actually offered formula post labour to get babies bowels going so a big lack of education ( formula does the opposite and I was bf a newborn with no issues....). But grateful I had the information passed on from previous generations who bf.

You are lucky - my mother breastfed me in the 80s, but on a strict 3 and then 4 hour schedule. That meant by 4 months she had to top me up on formula (not an issue, but probably not necessary if she’d fed on demand). She visited from abroad for a week when DD was 6 weeks and went on and on about how I was doing it all wrong and shouldn’t feed on demand. Lucky I’m stubborn and had a lot of info on breastfeeding and I ignored her. But she flat out refused to believe me, and doesn’t to this day!

Also one last point and then I'll shut up. Bf releases oxytocin, the love hormone which is obviously thrown in there by evolution to help a mother bond with her baby ( absolutely not saying anything re bond and formula as loads of ways to bond with a baby), this is a fact. And re all the " my kids are older and it doesn't matter a jot now", just give another view ; some of my elderly mother's favourite memories were bf us as babies and I'm v glad she did and some of my happiest memories ( I'm lucky to have many) were of bf my 3 Dcs. That's just my experience though so yes it can matter to others even with older kids. Bf was and is an important part of my parenting life and it was more than food in my experience and something I look back on really happily.

@Owieeee
I also look back so fondly of the children I breastfed and those I bottle-fed - feeding your child is a magic moment. Oxytocin is released not just by breastfeeding. I’m not sure why people are getting so defensive, I can only see people being negative about ff, and I can’t understand why? Nobody has said bf is bad.