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I agree overall, but I think we should err on the side of rejecting whatever has corporate or other conflicts-of-interest.

Thus, be skeptical of all sorts of safety products (especially since they are sold by spreading fear).

But we should also be skeptical of those dismissing the significance of breast feeding because the baby formula producers are where the conflict-of-interest lies on that topic there (and that played out massively and horribly in recent history).

I'm sure formula is okay overall, and there are so many factors to health and success. But it's also far too easy for formula producers (historically mainly Nestle) to happily support the narrative that breast-feeding is an irrational privilege of the elite. But I find such arguments comparable to those saying that access to natural open space like woods and parks is an elite privilege. That many people lack these privileges isn't an argument that they aren't extremely valuable. It's a grotesque injustice that any kid anywhere grows up without access to a healthy outdoor environment.

Somehow we need to tease apart all these things. The hypersensitive shaming of parents (mothers especially) is so awful and wrong, as is the paranoia about perfect safety and reducing all risk. That stuff needs to die. But breastfeeding, play time, outdoor access, the trends toward positive parenting (and not corporal punishment) — those things are positive!

So, it's complex.

> But it's also far too easy for formula producers (historically mainly Nestle) to happily support the narrative that breast-feeding is an irrational privilege of the elite

I'm intrigued, and I think I've missed this narrative - from what I understand, aristocrats didn't much bother with breast-feeding their own children, and hired it out to wet-nurses. So common people would have been more apt to breastfeed their own children, particularly since there is at least some contraceptive effect.

I don't think there's a shred of evidence that it matters who breastfeeds the kids. Tons of cultures have situations where someone other than the mother does some (sometimes all) the feeding. The physical bonding is surely positive and the milk is the primary thing mammals have evolve to grow up on initially.

Here's a source about the whole Nestle history: https://en.wikipedia.org/wiki/Nestlé_boycott

The simplistic impression I have is that in many places (U.S. included, but most tragic in poorer countries), there was a strong marketing campaign against breast-feeding in the mid 20th century, driven entirely by formula producers. I personally find this appalling even if formula were equally healthy. I find it comparable to the bottled-water advertising that is about ripping people off by getting them to avoid resources they already have on hand (in the case of bottled water, the resource of clean tap water in all the places that have it).

The corporations here are more than happy if communities lose their capacity fo function independently. Dependence on the corporate products is the goal. And that's also the source of some of the safety products and other stuff being pushed through fear now.

(you can tell I've looked into this too much :p)

you're right about the wet-nurse history, so in some places breast feeding is taken to be culturally lower class (and many of the WHO type materials and studies imo on breast feeding are effectively predicated not on the benefits of breast feeding per se, but on the avoidance of not- breast-feeding substitute risks in a particular context).

but then there was a 'formula movement' just as large scale manufacturing of formula was invented and became viable, focusing on the 'sciencism' and benefits of formula (i.e. you can measure and ensure exactly how much baby is drinking, which can't be done as easily with breast).

then there was a counter- counter: a movement away from the cold/corporate providers and the science of formula to the warm/maternal side of breast feeding and a new science of breast feeding.

breast feeding then became associated in those places with the upper class, typically sharing some aspects/ popularity of attachment parenting, because in those cultures a woman being able to stop work (and spend their entire day breast feeding) is a sign of class.

which of these aspects one experiences depends on where one lives, and honestly there's probably even more breast feeding and nursing narratives out there...

> "and many of the WHO type materials and studies imo on breast feeding are effectively predicated not on the benefits of breast feeding per se, but on the avoidance of not- breast-feeding substitute risks in a particular context"

Sorry, what? This is... impenetrable.

Very quick summary, so apologies if my previous sentence or this one isn't sufficient or well put together: most studies tend to be statistical/high-level correlation searches.

With something like breast- feeding, an effect-size for breast-feeding must be taken implicitly in the context of what happens when you 'don't breast feed', given that basically everyone is still going to feed the baby, and there can't be a third state of neither breast feeding and not breast feeding.

I don't mean just statistical attempts to control for demographics, education, etc, although these also have a complex effect/interaction.

I mean here things like 'if you're not breast feeding, you're doing something else', and the mechanics of that something else are not constant throughout the world.

So for instance, do you have to earn a wage (be away from baby) to buy formula to feed the baby, does the formula at a shop nearby and within its used-by date, what is the quality of it, do you have maternity leave and is there an inherent opportunity cost between breast feeding and work and providing the baby other things, do you have running and sanitary water, are they in day care/familial care, what foods are you giving baby, etc.

All those things effect whether breast feeding will show a statistical positive/negative effect.

Even something like "increased/decreased infections" isn't easily straight-forward: for instance, if the number of infections is related to the number of people baby is exposed to, and baby is in day care, then maybe its day care or N family members looking after baby that's the full story. And then even once you've got THAT, there's a real question as to whether the total number of infections a person gets is statistically static over their lifetime. Early day care could substitute infections earlier into the babies life. This too would appear in a basic study as a positive for breast feeding at home, because they don't measure the increase in infections after the breast feeding period ends once the baby starts to socialise.

Most studies are not vaguely done at this level of investigating or answering these questions/mechanics around why or how the effects are mechanically operating, so many of the findings are likely reporting on these.

Good word choice.

I think the GP is trying to say that the studies look at the benefits of avoiding the alternatives to breastfeeding. For example, breastfeeding is a good way to avoid feeding your infant the tainted water required to make formula.

That's pretty much what I thought as well. Most of the parenting advice is unsubstantiated claims written to make women feel guilty (over what, who knows?). As if your joy of having a kid needs to be tempered by giving up sushi. (What do people do in Japan?)

But generally the books don't even say where the claims are coming from, and everything is like you suspect, quite small effects if any, a priori.

Even the co sleeping thing seems to be fearmongering. Unless you're drunk, you're not gonna squash your kid to death. Plus the sleep benefits of letting the kid have boob on tap are enormous.

> giving up sushi. (What do people do in Japan?)

Depending on the stage, they actualy give up sushi ...

Apart from pregnancy/breast-feeding, Japan’s relation with raw fish is interesting, in that most people understand one day they’ll be unlucky and get food poisonned, but that’s just a fact of life, and nobody usually avoids raw fish just because of the risk.

The co-sleeping seems to stem from all the SIDS research / literature which when you go and read seems especially questionable. The topic of SIDS was hit so hard by our hospital and pediatrician. It scares the shit out of you. And then you go read the sources, and it's... well underwhelming at best.

SIDS basically means they have no fucking clue why the child died, so everything gets thrown into the SIDS bucket.

That's why they tend to talk about Sudden Unexpected Infant Death these days.

My understanding is that the primary concern is the ability of the child to breathe normally. Anything which restricts that ability can be life threatening.

Having their face covered (very easy to do when they sleep between two adults who pull the covers up when they're cold) or pushing their face up against a non-breathable material (windproof bassinets, pillows, soft toys) leads to a lack of air circulation which can lead to CO2 buildup. This is particularly a problem when their muscles aren't strong enough to turn their head or roll over.

"sleep benefits of letting the kid have boob on tap are enormous" this cannot be overstated. We co-slept with my youngest and the difference between that experience and our first who was strictly bassinet/crib can't be put in words.

Like most things parenting related, this is probably up for debate. Many leading baby sleep books suggest that co-sleeping leads to a baby who nurses all the time, long past the point where Mom wants the bed to herself. My own child sleeps 8ish hours in a row at 3 months, which I attribute to feeding him on a flexible schedule instead of on-demand. Not to say that your experience is invalid, just that it’s hard to draw any conclusions from the limited data we have.

My wife has an extremely difficult time going back to sleep if she is fully wakened. Our kids co-slept. She could feed them at night without having to get up, and still be able to mostly get some sleep.

As an additional benefit, she didn't have to pump for overnight, and I didn't have to get up to bottle feed. Which, I would have done! But I'm happy not to have to have done that.

I am a very hard sleeper. I can sleep through anything. But I can sleep in bed with a little kid next to me just fine. I think our unconscious minds/nervous systems must have enough awareness of those little blazing furnaces.

Is it really so horrible to give up sushi for 9 months? There are plenty of other things to eat under the sun.

As the article itself points out, there is much debate about Oster’s claims and many physician scientists disagree with her claims. Personally, having reviewed much of the same source material - around pre-natal diets in particular - I disagree with her conclusions as well. I’m not questioning her motives but it feels to me like there’s a certain amount of pop-sci hubris in her work.

I think there’s a difference on the local and global level here. From my point of view, if we ignore some doctor’s recommendation for pregnancy or child rearing, there’s a minuscule chance of an adverse effect. From the health experts point of view, a minuscule chance multiplied by billions of people is thousands or even millions of unnecessary birth defects or deaths.

A pregnant woman can rationally and morally choose to have a drink every once in a while —- there’s almost no chance there will be a problem, while at the same time, it’s a rational and moral for doctors to recommend not drinking at all — millions of lives are at stake potentially.

Thank you for pointing this out. Public health advice from the American Academy of Pediatrics is different than 1 person's lifetime of probabilistic events.

I haven't read her work, so its hard for me to comment on the individual. I think one area where i would disagree is alcohol, but that's because I'd include desire/normalacy of regular alcohol consumption as a cultural effect from our own societies (there's really not much evidence for positive effects of alcohol in anything, period). of course, this ignores the question of the value of the parents wants and wishes though.

On my own review of pre-natal diet recommendations, in my view the issue is about risk management rather than etiology of disease. for instance, my wife and I often joked that if we ate according to our countries health recommendations, we'd never eat out and only eat heavily processed foods, because it was the only place where the risk of various poisonings were near 0. But in practice, home kitchens aren't risk free, nor is or own non professional food prep or diet selection. And the mother needs to balance off sufficient variation in diet to be balanced and healthy, opportunity cost of other beneficial actions towards her and the child, etc, all of which are not accounted for, because science and medical research are not policy oriented documents. And it must be said that the relative risk of many of these things is very small from a clinical point of view.

A thousand times yes!

There's a great study using the NLSY data, where they first demonstrate 10 of the 11 oft-cited advantages to breastfeeding... And then do a sibling study with the same data and watch the effects disappear.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/

What bothers me most reading the source studies though, is that even if you take them as a 100% true - and this is a very rosy interprétation indeed - the effects they identify are tiny compared to the well documented effects of an emotionally stable home environment with a positive parental relationship. There may be a 95/5 chance of boosting the kid's IQ by 2 points, but that's nothing next to the boost they get with parents who can sleep 8 hours on alternating nights. It seems like most of these recommendations miss the forest for the trees.

There is an irony that some of the biggest breastfeeding supporters are so-called "attachment parents", taking a pop-sci view of early attachment theory... When real, grown-up attachment theory is clear that a healthy parental relationship is exactly the most important thing to show the child in the first year. That's where they learn healthy "attachment", hence the name of the whole theory!

Further, it really just smells like the patriarchy calling. The la leche League was founded to support traditional family roles - meaning mothers stay home. All of it is set up to force the mother into the primary caregiver role, which comes with a huge attendant career/income penalty.

So I say: Fuck the patriarchy. Show your kids a healthy, emotionally stable environment. Choose between bottle and breast based on your practical family life needs.

Unfortunately not sure how to help counter the enormous pressure put out by groups like LLL in hospitals, pop press, etc. They cause a lot of unnecessary suffering and guilt. Maybe https://fedisbest.org/ ?

> the effects they identify are tiny compared to the well documented effects of an emotionally stable home environment with a positive parental relationship.

To be fair the same selection bias that confounded the breast milk study probably confounded this study as well.

What do you mean 'anti-woman'? Do they say that we should get rid of woman and have an all male society or to strangle girl babies? Just curious since the phrase 'anti-woman' and 'misogynistic' seems to be loosely thrown around these days as a synonym for 'something more or less loosely related to the subject of women that I don't like'.

I mean they implicitly/explicitly give an image of child rearing that is neither factual, nor often physically possible: I joked that if we actually did everything that was recommended, we'd have no income, have no activities, and still fill all 36 hours in a day.

I call it anti-woman because the implicit philosophy underlying the advice is to view the woman as a failure, because she must inevitably break some of the rules and parenting is framed in a 'how far are you from a mythical optimal', even though this optimal is rarely empirically measured, stated or demonstrated, and often assumes an implicit (read diminutive and insulting) view of womanhood/motherhood roughly analogous to domestic housekeeper willing to sacrifice everything.

lastly, it downplays the validity of the woman's own desires, and the utility of her experiences, skills, hobbies, feelings, desires into a cult of 'physical and emotional devotion to the child'. The number of women at our parent group and that we've met on our short journey undergoing sleep deprivation and psychological issues, calling out for help, was eye opening to me, especially because from my own perspective from the data point of view was simply 'empirically that's barely an issue, if its causing your family that much distress, just change and do this instead', whereas there is an undercurrent in parenting that says a mother's role is to suffer...

Our experience back in 2000 was of be breast police forcing my Wife to feed a sleeping 4 hour old baby, telling her that if she didn't feed it it the baby would die then standing over her and telling her that everything she was doing was wrong. Not a good start. This is after a 36 hour labour and I'd run away home for some sleep.

This was our first baby so everything was new and unfortunately everything in the hospital was high pressure with an undercurrent of "why don't you know how to do this?".

After a few days we managed to escape the hospital. Once we were home the pace slowed down and amazingly enough we started to discover what made this little fella tick.

Feeding was still a lot of pain and tears, so we finally in desperation purchased some bottles and formula. Was amazing how much of a difference taking the stress of feeding away was. The baby was happy, the mother was happy, I was happy and we never looked back.

He's now a healthy 6 foot 18yr old working his first job.

It was amazing how much of a different reception we got on subsequent babies. The midwifes tended to just leave us to it. In both subsequent times we managed to get out of the hospital within 24 hours of the birth, allowing us to get to know the new member of the family without everybody trying to tell us how to do it.

I agree with the anti-woman sentiment as a father, and I will give you a few examples. As soon as a woman is pregnant, there are countless things off the table: no cheese, no caffiene, no wine or drinking of any kind, no deli meats, no sushi, etc. Some of those are nebulous and out of date - deli meat and cheese in particular. They are recommended to be avoided because of listeria risks, but how often have you heard of listeria outbreaks in cheese or deli meat? This was more common in the 50s when standards were lower. Now I see listeria outbreaks more often in packaged salads that are processed en masse. But the restrictions never go away, just added. The reigning idea is "why risk it"? This applies to almost everything from day one of pregnancy through childhood.

Pregnant women are told to avoid countless things (including most medication) and heavily modify their behavior (avoid milk, tomatoes, grains etc.) for infinitesimal or non-existent benefits. When you dig into the source of the advice, most of the time it comes from the fact running studies on pregnant women is very litigious so drug companies simply recommend "avoid" and wash their hands of the problem. Other countries have very different guidelines and procedures.

that's just the tip of the iceberg in the U.S. The entire birthing experience is built around saving the baby and the mother is an afterthought. This is shown in statistics where the death rate rate of mothers is higher than in many 3rd world countries. We keep finding more ways to keep babies alive (healthy or not) and force babies to be born (wanted or not). Very little thought is given to the holistic and human goal of the entire enterprise of having children and that is extremely damaging for not just mothers but fathers and the extended family and communities in general.

I don't think there is a law against eating cheese while pregnant, though. Not even drinking alcohol seems to be illegal?

Everybody is free to google and make up their own mind.

Not sure about the listeria, btw, if the risk is simply higher for embryos, or if the concern really is a general listeria infection like any adult could get?

Maybe you don't hear a lot about listeria infections because for non-pregnant people it is not a big deal that would be newsworthy?

Depending on the parents, even small risks to the unborn may be deemed unacceptable. Like a three in thousand risk of miscarriage? I've seen many doctors recommend a blood test with those risks, and many parents deciding against it because of the high risk.

To me personally, a risk of 1:1000 of dying would seem rather extreme, too. I guess it depends on how you think about unborn life.

I read it as meaning that women are expected by a “western” culture to sacrifice their happiness or sanity and the GP disagrees, saying that parental happiness is associated with infant happiness.

If their happiness depends on drinking alcohol and eating raw cheese, that is. Not all cheese is raw milk based, so you don't even have to give up cheese completely.

based on extremely unlikely/ minimal outcomes.

I often get the same feeling, but there's _so few numbers_ in these articles. Where do you get them / how do you come to that conclusion?