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.

NRTFT, but I really like her work and have given her books to relatives who are new parents. Lots of her content is available for free on her substack site and she has a daily email newsletter you can sign up for.

emilyoster.substack.com/

Breast isn’t best.

Breast is the biological norm - human milk for human babies.

*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.”

This is a very good point that is rarely mentioned.

[quote LittleGwyneth]@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.[/quote]
Many, many women take MAT leave without breastfeeding.

Many women express and continue to work.

Any woman who gives up their earning power solely to breastfeed (and I don't think this is the majority of breastfeeding women) might view breastfeeding as expensive. But I don't think breastfeeding is only cheaper if we don't value women's time is generally true. I value my time and breastfeeding was entirely free for me, as it is for a lot of people.

@luxxlisbon

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 😂

Yes. It’s like people who reckon they can recognise smokers just by looking at them - complete bullshit.

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

Yes because we don't live in a sunny country. Not because our breast milk is inept.

We should all be taking vitamin D because we all lack sunshine.

Breast feeding isn't necessarily cheaper at all by the time you've factored in the difficulty of detaching yourself from baby and going to earn a crust. Expressing takes time and isn't always possible.

@luxxlisbon

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 😂

Absolutely and just the kind of comments that can push a mother with PND due to ‘failing’ at breastfeeding and the pressure and grief of it over the edge. When I was struggling to bf I tormented myself reading all the threads and articles about how much better breastfeeding was and how disadvantaged my 2 week old child now was. Emily osters book actually made me cry relief at a time when I was so so low.

I do agree with the poster who said breast fed babies look different. They very often do. Bottle fed babies are often more pale and stolid looking. I do not see this as a problem.

There are a lot of weak studies in many fields, largely pushed by how current funding and work practices in these areas are.

It can be very strange how many very weak studies are then widely promoted as the truth, though a lot of that is the media likes a good firm headline and then people run with it. The amount of news stories on science where if you go to the actual study says nothing of the sort and then it gets lost in transmission the further out, often getting more certain and absolute as they go.

This is kinda standard in a lot of areas, annoying, but not really surprising.

Again that’s a benefit to you not the baby.

Things that benefit the mother can also benefit the baby indirectly, much as things that benefit the baby can also benefit the mother indirectly. They don't need to be in neat categories of one or the other nor do they need to be put into a hierarchy as if thing that benefit the mother are less important.

I didn't get much of the benefits talk when I was pregnant with my first. No antenatal breastfeeding clinics or anything was offered to me. There was some talk about increased risks with formula feeding, but in very vague terms and it was generally believed that as a teen mother that it would be too much on me to breastfeed correctly so it wasn't really discussed. Socially, other than my spouse, I was largely told that I probably wouldn't be able to and if I did I shouldn't do long because it's disgusting. If anything, I probably ran on spite to get me through the sleep deprivation those first few months and gum pearls which they say shouldn't bother a baby, but my oldest disagreed strongly.

Breastfeeding fit into my lifestyle which is a large part of why I could do it for so long. It doesn't fit into many women's lifestyle, we're not in a society built around that or anything else to do with women's bodies and as mixed feeding isn't promoted and many who can breastfeed biologically can't pump, there are a lot of social and biological barriers. Trying to go on about the benefits of breastfeeding doesn't tend to do much good and often ignores the social issues involved and instead just blames women for either not doing enough or for doing too much whichever way a baby gets fed.

Without even looking at the details for me it is obvious that:
There are significant environmental benefits to breastfeeding at population level
There are significant benefits for mum and baby that are hard to quantify but are very important indeed - the comfort for baby, the ease for mum once things work well, the sense of empowerment for mum, dealing with illnesses/hospital stays/traumas in a much smoother fashion.
For those elements alone i view breastfeeding as vastly superior to formula feeding.

And of course my usual approach is to go with the way things were meant to go and only to seek an alternative when it is clearly not working out. That's why it's obviously fine to turn to formula if required, but it doesn't make sense (to me) as a first option.

My DS had 2 vomiting bugs before he was 18 months. I mixed-fed from 10 weeks. He vomited up formula and kept down the breastmilk.

Obviously anecdotal but there are benefits on an individual level as well as population. The main benefit to me as a mother was the freedom that came with mixed feeding. I really think it should be talked about more but nope, it always comes back to supposed nipple confusion.

@luxxlisbon

*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.”

This is a very good point that is rarely mentioned.

I agree and that’s why I wanted to breastfeed - but I also don’t think women should be made to feel guilty about the environmental impact of formula feeding. There’s enough pressure on mothers of babies and plenty of better targets for environmental campaigning.

I didn't have a plan for feeding beyond 'attempt to breastfeed; if that doesn't work, bottle feed'. DD took to it beautifully and it worked really well for us - my favourite aspect of it was that I didn't have to take any feeding stuff with us anywhere because my tits would be coming along anyway.

I'm planning the same for number 2 (coming soon!).

I found the two opposite attitudes I got really interesting. I had midwives who basically refused to even discuss formula - deeply unhelpful - and then friends who refused to be around me if I breastfed, describing it as 'Spaghetti's just wapped her bap out!' (I didn't wap my baps anywhere, but there we are). There wasn't a lot of middle ground.

But really, I breastfed because it worked for me. If it hasn't, DD would've been bottle fed - as I was - and I wouldn't have felt bad or worried about that decision. Anecdatally, my brother was breastfed, and he's the one who spent half his childhood sitting things out because of asthma and various other allergies and health problems. I've always been nauseatingly robust. Not a data point, really, but something I bear in mind.

Breastfeeding is the biological norm and formula is a perfectly acceptable alternative. We don’t need to convince everybody that breastfeedings not as great as they think it is to justify formula feeding. The fact that the topic comes up so often and is so emotive makes me wonder if there is more to it than just pressure from midwifes making women feel guilty to stop. I think there is possibly a biological urge/ instinct/need to breastfeed which causes this deep rooted pain when not met which leads to the guilt and shame and the defensiveness that some formula feeding mothers feel. I don’t think finding studies to tell them it’s not so great anyway is going to fix that.
In an ideal world there would be plentiful support for all mothers to breastfeed if they wish and part of that support should be the recognition of grief when this doesn’t work out. Women should also be supported more holistically and it be widely discussed that feeding needs to be balanced within the rest of the mother/baby/families needs and this will sometimes mean that breastfeeding isn’t best for them.
It sounds quite simple to me but probably quite expensive for the health service to provide such individual care.

Not read the whole thread so apologies if I’m repeating.
I am always amused that we are told to eat whole foods, cook from scratch and avoid highly processed foods. Yet when it comes to babies, highly processed food is just dandy and no different at all to fresh natural food.
Feed your baby how you want and eat as much highly processed food as you like as well.

@IamOvercome
So if we accept that breastfeeding is normal and has no benefits, and the correct research question of “are there risks to mothers and babies of feeding formula, and if so that are they and to what extent do they matter”. Is formula safe for mothers and babies?
That’s how the research should be framed, analysed and presented.

Essentially her book is saying that based on many flawed (in her own words) studies that don’t control for the correct variables (again her own words) formula is shown to be only slightly less safe than breast milk.

This absolutely would not meet the criteria for deeming any drug or new food stuff “safe” for mothers and babies. The evidence base for the safety of formula doesn’t stack up at all (not because it’s not safe, but because, as you say, the evidence just isn’t there).

Of course we can use our own eyes and senses to see that formula is safe, but if you are holding this book up as a scientific sacred cow, well, it isn’t. It’s answered the wrong question entirely.

Breastfeeding is the biological norm Well quite. Whatever any economist says, feeding our babies is the reason we have breasts. To me it seemed as natural as how we made our baby in the first place. No cold statistics can take away the joy and wonder of creating and nurturing my babies. So what if that is just a benefit to me as a mother? Mothers matter too!

it is only 'free' if you value the mothers time at nothing

Nipple confusion is definitely a thing! My baby would consistently have more difficulty latching in the days following a day of having expressed bottles. I had to stop giving him milk via bottles because it wasn’t worth the faffing afterwards.

@bebanjo

Not read the whole thread so apologies if I’m repeating. I am always amused that we are told to eat whole foods, cook from scratch and avoid highly processed foods. Yet when it comes to babies, highly processed food is just dandy and no different at all to fresh natural food. Feed your baby how you want and eat as much highly processed food as you like as well.

I don’t think anyone’s saying that. It’s not black and white. If you couldn’t get enough fresh whole foods to the point that you were hungry then surely you would top up with processed foods. If you were struggling and unable to cook the foods I’m sure you would accept the processed foods as an alternative.

Are you on commission to sell this book?

Personally I would rather go with the advice of medical professionals than economists.

I just want to say I didn’t start this thread as a breast v formula feeding thread.

I went to a breastfeeding antenatal course and it said breast is best, listing off benefits from reduced ear infections to intelligence etc for the child.

I then read this book and saw that the data underlying these pronouncements is massively flawed and even where it is correct for reduction of ear infections/diarrhoea it was something like a 6% chance of it happening versus a 13% so pretty marginal.

I was just surprised there is so little proper evidence yet breastfeeding is given as only correct choice and honestly it was really really pushed as the only choice for the child. But most of the benefits even on this thread and in the research are more for mothers than babies.

@luxxlisbon I wonder if anyone has ever compared the environmental impact of formula feeding to environmental impact of nappies. The stats on nappies are fairly shocking but there isn’t this drive to push reusables on women in the same way as there is with breastfeeding.

6% chance of it happening versus a 13% so pretty marginal

On the scale of an individual baby this kind of statistic is marginal.

On the scale of public health then you are actually talking many. many thousands in this country and many millions across the world.