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.

@Nsmum14 - think you have it all wrong. No one is saying breastfeeding is a “bad use of womens time”. The issue is that womens time, effort and work is taken for granted and are not valued.

For example, Women who are having difficulty breastfeeding are told yo stay in a room and breastfeed for 24 hours on demand to establish supply. Never mind they may have other children. Never mind that they may have other things to do. Never mind that this would be exhausting at an already difficult time.

Ultimately exclusively breastfeeding babies is more time consuming and difficult for many if not most women. Often to the point where our lives with young children are utterly exhausting. We matter too. Our mental and physical well being is worth something.

I’ve seen several posts on MN over the years from women saying they we advised that breastfeeding would be cheaper but they didn’t feel that was actually the case once they had factored in things like the cost of breast pumps, lactation consultants, etc etc

Who says you need breast pumps and lactation consultants? And what’s the etc etc? Of course it’s more convenient and less hassle to breastfeed and I would assert cheaper too once you’ve factored in bottles, teats, sterilisers (of some description) before you get to the actual formula. I also remember threads during lockdown when posters couldn’t get hold of formula so breastfeeding also spares you that anxiety.

@Makeitsoso

I loved her books. So good and a breath of fresh air compared to paternalistic NHS. I bf mine and would again if I could but I appreciated the evidenced based approach. It’s I recall the problem is that middle class mums are more likely to breastfeed and therefore bf benefits get conflated with other things like reading, nutrition, parental education. It’s obviously very hard/unethical to have a blind study, random allocation etc. So overall the evidence for the benefits of bf are weak in a quantitative sense. Qualitatively, there are many benefits if it works well (as various people have attested to upthread). If it’s going wrong and mum is depressed and sleep deprived it may not be worth it. I don’t think that’s particularly controversial.

This is exactly it! I’m just amazed so many of these flawed studies made it into mainstream medical advice.

I found her book pretty rubbish. If you want medical data and research on breastfeeding, look up articles on the Lancet or consultant the WHO. I doubt that she knows better than the medical experts.

Just completely hypothetically, is there a benefit to pregnancy? If there were artificial wombs would you rather use one of those than your own?

@Teastheword -because there is so much pressure on women to breastfeed and so many suffer serious consequences to their mental health when they can’t. The fact that there is no good evidence for any of the supposed benefits adds insult to injury.

I haven’t read her baby book and don’t intend to, but here are a couple of links to medical explanations of why some of the findings in her pregnancy book are flawed (here re alcohol):
depts.washington.edu/fasdpn/pdfs/astley-oster2013.pdf
well.blogs.nytimes.com/2013/08/19/pregnant-and-disputing-the-doctor/
I’m afraid being a statistician isn’t enough when you evaluate medical research- you need to understand the medical background too.

Did you look at the actual studies she discusses? The omitted variable bias is outrageous.

OP have you looked at any other scientifically based books, to compare with Emily Oster's? Eg:

Why Breastfeeding Matters

Why the Politics of Breastfeeding Matter

Small, quick to read books that are very informative and scientifically based as well

@Goldbar

I've seen an interesting quote on here a few times - breastfeeding is only cheaper if we don't value women's time.

The problem I suspect is that most of us come at this from our own subjective experience and your likelihood of breastfeeding successfully is affected by how much support you have and socio-economic factors, which may translate into better outcomes for babies generally. So it's interesting to hear about someone looking at the statistics behind it.

It does depend how you look at it. I think one of the benefits of breastfeeding is women have to sit down and relax rather than letting other people sit and feed baby while they cook/clean or whatever.

@Teastheword

Why are so many people so desperate to "prove" that there is no benefit to breastfeeding?

I’m not even remotely against breastfeeding. I’m pregnant with no children and have already attended a breastfeeding antenatal clinic and gotten details of a lactation consultant if needed. But as someone who works in a data based field I’m amazed at the lack of data on the benefits of breastfeeding and how flawed the studies are. I presumed it would be extremely concrete given how much emphasis is put on Breast is best!

@sevensleeps

Tbh I found her books to be quite biased albeit in a more backhanded way (since they claim to be the opposite). Her other book for example made it sound as though getting an epidural objectively makes the most sense for labour. That's definitely not the outcome my own risk/benefit analysis would have yielded or what my priorities would have been.

I guess even though she is being 'objective' and 'scientific' she still has to make a choice about what variables to even consider as part of the analysis, and how to weigh them. I haven't read the second book but for me breastfeeding has had innumerable benefits and I would not have wanted to miss out on this experience. Just the feeling of being able to provide with my own body the perfect nourishment for my baby, at once what they most want and what's also healthiest for them, has been amazing. Invaluable at times of illness etc. I don't think these kinds of emotional 'benefits' would have even entered the equation

I agree. And also the (I suppose more sub-conscious) benefits to a mother knowing she is the one providing for her baby and her body can easily provide the perfect nutritional balance for her baby. As well as if/when a baby is unwell, they take comfort from breastfeeding so you don’t need to worry about them staying hydrated. Again in hot weather, not having to provide water like you would for a formula fed baby. Also when they are crying - teething/banged head etc whatever it is - a boob is instant comfort and happiness. And having breastfed 2 children myself, I cannot imagine how much more inconvenient it would be to formula feed for getting out and about/night feeds/long car journeys etc etc. the occasional times it’s seemed slightly inconvenient (mainly things like going to the hairdressers or a gym class or something) are far outweighed by it’s convenience, to me anyway. My first child I didn’t “feed to sleep” as kind of wasn’t aware of it really but my second I did and bed times are a million times easier. I feel like I was missing a trick with my first! Baby stirs, give them some boob and they are back to sleep again without waking up properly. In my experience it made nights so much easier. Again it means it’s tied to you as the mother I guess, but once you accept that and can feed them to sleep whilst partner tidies up or does dinner etc. Of course I think women should feed however they choose but I think whilst the health benefits would be so difficult to measure accurately - there are so many other benefits and it makes life so much easier.

@Teastheword

Just completely hypothetically, is there a benefit to pregnancy? If there were artificial wombs would you rather use one of those than your own?

If I could have given birth out of an artificial vagina rather than sustain a lifelong birth injury then yes, I would use the artificial womb (assuming it was as safe for the baby).

@Divebar2021 it was “more convenient and less hassle” for you to breastfeed. Not for me. Not for many women. Many women really struggle with it.

As someone who is working with a lactation consultant to increase my breastmilk supply so I can co tinue nursing my baby, my personal experience of both forms of feeding are that there is very little difference.
I put my first child on formula at 3 months and he met all his milestones early, is bright, no allergies and rarely gets sick.
Second child was exclusively breastfed until 1. She was late in meeting all of her milestones, has dermatitis and her doctor thinks she may develop allergies and asthma in the future. She comes down with every bug going and has missed more school than her brother due to sickness.
When breastfeeding , my body holds on to fat until I completely stop so the weight loss myth has been a lie for me!

I just love breastfeeding and find it a very satisfying experience. I do it for me, not because I think there is anything wrong with formula.

@Teastheword - many women do end up with birth injuries and even death from vaginal childbirth. Luckily we have modern medical science to help with some of that (although not yet artificial wombs).

@Divebar2021

I’ve seen several posts on MN over the years from women saying they we advised that breastfeeding would be cheaper but they didn’t feel that was actually the case once they had factored in things like the cost of breast pumps, lactation consultants, etc etc

Who says you need breast pumps and lactation consultants? And what’s the etc etc? Of course it’s more convenient and less hassle to breastfeed and I would assert cheaper too once you’ve factored in bottles, teats, sterilisers (of some description) before you get to the actual formula. I also remember threads during lockdown when posters couldn’t get hold of formula so breastfeeding also spares you that anxiety.

My expenses for breastfeeding was limited to decent bras. I'm not well blessed normally so pregnancy and breastfeeding was interesting from that point of view.

I've never worked out how people with big boobs manage to sleep on their back, I used to think I would die as I couldn't breathe due to the weight.

@Bunnycat101

A lot of the evidence picks up associations but can’t prove causation. That’s particularly true when you start to see longer term outcomes. There are also studies that can find benefit at a population level but not an individual one.

A lot of people are saying this.

Could somebody please explain to me what this means, please? Benefits at a population level as opposed to individual?

I’ve seen several posts on MN over the years from women saying they we advised that breastfeeding would be cheaper but they didn’t feel that was actually the case once they had factored in things like the cost of breast pumps, lactation consultants, etc etc

I agree.

I breast fed both my children and although it was easy with my first, it was an absolute nightmare with my second.

Between pumps, bottles, nipple shields, nipple creams, lactation consultant appointments, 2 x tongue tie repairs and four sessions of cranio-osteopathy, it must have cost me about £650 to get to a point where breastfeeding could be done successfully with my second. Never mind the cost on top of that of all the vegan food I had to pay out for for 13 months as he also had a dairy and egg allergy.

Breast feeding him absolutely wasn’t a cheap option!

@Foxglovers - no more need to provide water for formula fed than breastfed babies. Also once I got over the guilt I was happy to formula feed my dds and they took comfort from me feeding them that way. Also one huge benefit to bottle feeding is that it doesn’t always have to be the mum who does it.

Breastfeeding and bottle feeding both have benefits in my opinion abs do what works for you. I am tired of the judgement and faux science. No real difference between breastfed abs bottle fed babies has been shown in any study once other factors are controlled for. Let’s stop punishing women.

[quote Villagewaspbyke]@Nsmum14 - think you have it all wrong. No one is saying breastfeeding is a “bad use of womens time”. The issue is that womens time, effort and work is taken for granted and are not valued.

For example, Women who are having difficulty breastfeeding are told yo stay in a room and breastfeed for 24 hours on demand to establish supply. Never mind they may have other children. Never mind that they may have other things to do. Never mind that this would be exhausting at an already difficult time.

Ultimately exclusively breastfeeding babies is more time consuming and difficult for many if not most women. Often to the point where our lives with young children are utterly exhausting. We matter too. Our mental and physical well being is worth something.[/quote]
But what is most conducive to a mother's mental and physical well-being is very individual, no? For me personally my mental health was greatly helped by BF as opposed to FF. I didn't want to do anything other than being available to my baby in the first 24 h. That breast milk is instantly available at all times to me was invaluable in the early days and meant I could follow my baby's rhythm rather than having to stress about getting them into a routine and are they feeding the right amount etc etc. I found breastfeeding very soothing myself too in that emotional time. With FF I know I would have stressed myself crazy about sterilising, correct temperature etc

I don't like when people make it out as though FF is automatically the better option from a mental health perspective as I think it really depends on individual circumstances.

No real difference between breastfed and bottle fed babies has been shown in any study once other factors are controlled for

This is key. Well no study I have come across. If someone has found one I’d love a link to have a read.

I'd love to know where this pressure to breastfeed is coming from.

I combi fed my first and EBF my second. No pressure to breastfeed but a shit ton to formula feed.

My daughter is now 3 and ever single one of her dolls came with a bottle for milk. She doesn't remember being breastfed so I've actually had to explain to her that she refused bottles and had milk direct from mummy. If I'd not told her that, her view of how to feed a baby would have been bottles.

@sevensleeps again this is a benefit to you not to the baby.

Thanks for the book recommendations. Just downloaded them to my kindle.

Also something that concerns me is the nonsense that if a baby is breastfed it must be “getting all it needs”. Clearly that not true. Breastfed babies can be dehydrated or hungry like any other babies (and indeed as it’s more difficult to see what they have had, probably it’s more likely)

Makes sense to me. Ideally you’d breastfeed but I don’t have any concerns that it didn’t work out for me. What you eat in pregnancy and how you wean baby matter far more.
There ought to be health benefits but there are significant downsides and if mums are exhausted then it’s not going to go well. There are a lot of posts on here about babies feeding through the night well past 6 months - I’m just incredulous. How on earth can you function normally ?