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 had to go back to work when my children were 6 weeks old. I struggled to breastfeed them at all. The guilt that i was made to feel was enormous, from websites like this one and people who made me feel i was a very bad mother who didn't care about her children's health at all.
I was self employed at the time and had the main income in our family, so I didn't have much choice and without all the constant criticism I could have been very content with it. I now don't think it made a blind bit of difference DS1 went to Oxford and DS2 would have done if they had offered his course. They are now both well thought of professionals in their respective fields.
For what its worth I found doing half the night feeds with bottles was preferable to doing all of it myself. This was obviously some years ago, it saddens me to see the same pushing of an agenda that will not be right for everyone, or even a majority, constantly being inflicted. Some people might want to EBF for 12 months but even if I'd been able to BF at all I would not have wanted that and I should not bhave been made to feel a failure for that.

@3cats4poniesandababy

Almost all the the 'benefits' of breastfeeding are actually socio-economic. It has been well recorded for a long time just many people don't seem interested in a balanced debate.

Yes, this in spades.

When you compare studies in populations where breastfeeding is not so correlated with SES (lots of studies comparign outcomes in UK versus Brazil for example), this is evident.

@Goldbar, congratulations on your pregnancy!
I get the point you are all making. Yes of course there are times when breastfeeding is not relaxing, I too have been the mum with the newborn and the attention demanding toddler, it was extremely hard.
There have been times when I've had a list of 20 different things I had to do, and have had to postpone everything to breastfeed.
And yes, we are expected to juggle way too much, and are under valued.
Of course the mum's mental health matters, it is the most important thing.
No mum should be guilt tripped into breastfeeding.

No one is 'made' to feel guilty. You do not have to take that on. If you want or need to formula feed, just get on with it and be grateful you have the option. God sake

I mean, it’s kind of common sense that the milk the Mother creates is going to be best for her infant rather than mass produced powdered milk with added vitamins. You don’t really need stats to back that up, it’s just logical. We’re mammals, we create milk to feed our young as all other mammals do. Nothing created in a factory is going to be better than that. I know some Mum’s who had to FF or chose to try to make themselves feel better about it by claiming otherwise but it’s just basic common sense.

Interesting take OP. I'm a data scientist (with an economics degree) so was similarly happy to find Ostler's work. Unfortunately I found her via an article in the Guardian that had such a biased tone, it was hard to see anything impartial about what she had to say going forward, so it didn't do the trick for me. Having said that, her conclusions that breastfeeding is beneficial at a public health level not necessarily an individual level are hard to dispute. Whether the evidence is flawed or not, there's still evidence to suggest breastfeeding is "better" (who cares for who?) so of course it's going to be globally encouraged. I don't think any of the claims made are wrong just that they may have become over-emphasised over time.

This study does some work to look at socio-economic factors: www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

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

Obviously based on the conceptual metaphor TIME IS MONEY. That's not how I value my time, especially with my children.

@IamOvercome - it’s not really a valid point at all. Many women struggle to breastfeed and have throughout history. So many babies have to be fed with alternatives. It’s not a flawed premise at all to look at the evidence of the outcomes for those two groups.

Some breastfeeding advocates claim all women can breastfeed successfully. It’s not true. I couldn’t. Many women I know couldn’t. Many women throughout history couldn’t. Some people prefer their ideology to listening to women.

Some women find breastfeeding easy and convenient. Some don’t. Some can’t manage at all. Some find it good for their mental health, others find it the opposite.

But in this country we have access to clean water and can safely and effectively feed our babies whether or not we can breastfeed. So choose what works best for you when the time comes.

And congratulations on your pregnancy op! One thing I wish someone had said to me was not to let them guilt trip me on the breastfeeding. Best of luck and I hope it goes well however you choose to feed.

@holskey what's the alternative? Stop the clock on what a woman's time is worth the moment she has a baby? View having children as an unpaid hobby?

This isn't about thinking women should be earning money instead of being with their kids. It's about recognising that many women literally give up earning power in order to breastfeed, which means that it is not cheap or free. It might be a fantastic choice for her and her family, but it's not free.

Haven't read the book in the OP, nor consulted the primary research. Always interested in another specialism's contribution though suspect as a PP pointed out that a statistician or economist's analysis of health research without sufficient understanding contributed by a HCP/specialist might not give a sound basis for a review. All specialisms see the world through a prism of their own expertise and rarely understand the limits of their expertise. As another PP said, perhaps the evaluation might be better compared with the benefits of the alternative unless there are non-breast-fed & non-formula fed methods I've not seen.

Haven't found a UK summary that is open to the public though have the following concerning breast feeding. Haven't looked at the studies it references.

www.hse.ie/file-library/evidence-for-breastfeeding.pdf

To be fair, for all I know, these might be some of the studies that the book referenced by the OP seeks to discredit.

[quote ReeseWitherfork]Interesting take OP. I'm a data scientist (with an economics degree) so was similarly happy to find Ostler's work. Unfortunately I found her via an article in the Guardian that had such a biased tone, it was hard to see anything impartial about what she had to say going forward, so it didn't do the trick for me. Having said that, her conclusions that breastfeeding is beneficial at a public health level not necessarily an individual level are hard to dispute. Whether the evidence is flawed or not, there's still evidence to suggest breastfeeding is "better" (who cares for who?) so of course it's going to be globally encouraged. I don't think any of the claims made are wrong just that they may have become over-emphasised over time.

This study does some work to look at socio-economic factors: www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext[/quote]
Thanks, I’ve bookmarked to read later

@sevensleeps

I think for the baby there are similar benefits that are difficult to capture and measure. You can see how instantly soothed babies are at the breast (most of the time haha!). How much they like breast milk. How peaceful it is for them. Toddlers also can often show or tell you more directly what it means to them. I don't want to talk too much about the IME very powerful bonding and emotional security (again instantly available when needed- invaluable IME on rough days for example) that are part of BF because it is so often taken as FF bashing or something. That's not how I intend it at all, but equally that doesn't mean that it's not the case that it means a lot to a baby

Mate a bottle instantly sooths a baby, I never had any trouble because I actually paid attention to the reaction and tried all the formula milks myself, if a baby rejects a bottle its because the formula tastes like crap nothing more.

SMA is acceptable to baby (tastes like cardboard).
Aptamil tastes like fish, baby hates it.
Hipp organic tastes like milk (makes a good cup of coffee too) baby loves it.

Breastfeeding clearly has huge benefits.
Natural, no manufactured milk can come close to human milk.
Sterile, No bottle feeding necessary- Plus antibodies in colostrum.

[quote Villagewaspbyke]@BattledoreAndShuttlecock every child gets loads of illness when they first go to nursery. So perhaps it was a coincidence that yours did abs that was the same time you stopped breastfeeding. Perhaps it was to do with coming into contact with viruses and bacteria from other children rather than no more magic breast milk.[/quote]
It doesn't matter what the specific cause and effect was in my DCs' particular case. The point is that D&V really sucks and can be serious so I don't consider a large reduction in that risk to be a trivial issue, especially in tiny babies.

@beattieedny

No one is 'made' to feel guilty. You do not have to take that on. If you want or need to formula feed, just get on with it and be grateful you have the option. God sake

They definitely are. I was and the “breast is best” agenda was far less aggressively pushed when I had mine. The guilt tripping was awful.

What a load of nonsense. When books say “there is no evidence for this” they usually mean that no one has carried out a procedurally acceptable double-blind scientific study of the issue. That is very common in anything to do with babies, because it’s usually unethical to follow standard science methodology. Eg you wouldn’t allow a scientist to take a happy group of breastfeeding babies, give half of them a bottle for two weeks then attempt to reintroduce the breast and see whether or not they refuse to accept it. Similarly you could only get great ‘evidence’ of the benefits of breastfeeding if you take identical twin babies, breastfeed one and bottle feed the other and see what happens.

Midwives push ‘breast is best’ because they know from their own experiences that this is true. I can look around a room and tell you which babies are on breastmilk and which are on formula: their skin looks different. Plus new antibiotics are being developed using breastmilk, it is well proven (with ‘evidence’) that breastmilk is not just food, it is also medicine, bespoke to the child as the mother’s body reacts to any infections the child may have and adds antibodies to the milk.

Formula is a great solution for those who can’t breastfeed, but to compare the two as somehow equal is pure nonsense and I’d throw away any book that tried to sell me such patronising idiocy.

@Peasock

Having seen how miserable my babies were with D&V when I stopped BF to send them to nursery I don't think any other incentive is needed

Do you think breastfeeding would have stopped them getting D&V?

Maybe, maybe not. But if a whole bunch of women were in that situation then the ones who breastfed would have significantly fewer babies with D&V. And that's not nothing.

Thank you for sharing, OP.
It is frustrating that so many PP, intentionally or not, seem to miss the point of your posts.
I am very happy to read about these findings as hopefully it helps women feel less guilty and more relaxed about their individual choices and circumstances. Well done to the posters who breastfed, and well done to those who formula fed. People can do whatever works for them and it does not really matter either way. I think it's awful how much stress and pressure (and condescension) can be around feeding - as if having a newborn is not tough enough anyway..
(I am saying as someone who breastfed my children, though I did not hesitate to also give formula when it was needed or helpful in some cases).

@Thewindwhispers I've had midwives tell me not to get the covid vaccine, to get the covid vaccine, that my heart rate impacts the baby's heart rate, that getting upset will distress the baby, that getting distressed won't upset the baby, that I can have hot baths, that I can't have hot baths, that a c-section is dangerous, that a c-section is safe. There is no cohesive midwife message, they're not one body and IME they mostly speak from personal experience which is massively varied.

On the "breast milk contains everything your baby needs" line, this is wrong, or at least it was for me. My baby was prescribed a fortifier based on cow's milk that was added to my breast milk to assist with weight gain, and later she was prescribed a multivitamin plus additional folic acid, vitamin D and iron as my breast milk just wasn't nutritious enough for ideal growth and development. She had no formula whatsoever - it was my breast milk that didn't contain what she needed to grow well.

She was prem, but vitamin D is recommended even for healthy term babies that are exclusively breastfed.

I can look around a room and tell you which babies are on breastmilk and which are on formula: their skin looks different.

Oh come on! This is just absolute garbage 😂

@Holskey

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

Obviously based on the conceptual metaphor TIME IS MONEY. That's not how I value my time, especially with my children.

But it's how the rest of the world values it. And most people can only stay home with their babies to breastfeed if someone else is earning the money to facilitate it. If you're the main wage earner for your family, it's very tough unless you have a good amount saved.

I think my main point though isn't that breastfeeding is not worthwhile but that, for most women, it is additional labour on top of everything else. It's not an either/or situation - either spend your time on the sofa breastfeeding and having relaxing bonding time with your baby OR do the school run OR care for your toddler OR work. Often women have to do all these things. It's not uncommon at my DC's nursery to see women sitting on the wall outside breastfeeding in the cold and rain before handing over their children and heading off to work. They've often come from dropping other children off too.

Breastfeeding has benefits beyond that to mother or child, as an economist she should be looking at the benefits to society too. When you look at the environmental costs of producing formula, producing it, bottling it, transporting it, disposal of bottles, tins, and environmental and agricultural waste from this industry, mass production from the dairy industry, it has a bigger impact than just that to mother and child.

I ff one of mine so I am not biased but clearly there are many benefits to BFing beyond biological factors, and surely these factor into the choices (if you have a choice) you make when deciding how to feed your child.

@Thewindwhispers When books say “there is no evidence for this” they usually mean that no one has carried out a procedurally acceptable double-blind scientific study of the issue. That is very common in anything to do with babies, because it’s usually unethical to follow standard science methodology. Eg you wouldn’t allow a scientist to take a happy group of breastfeeding babies, give half of them a bottle for two weeks then attempt to reintroduce the breast and see whether or not they refuse to accept it. Similarly you could only get great ‘evidence’ of the benefits of breastfeeding if you take identical twin babies, breastfeed one and bottle feed the other and see what happens

Ehhh well yes that’s pretty much the point of the book. Yet somehow everyone is told breast is best despite lack of evidence.