Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool (The ParentData Book 2)

by Emily Oster

When we look at recent data from the US, breastfeeding is more common among women with more education and higher income. This is partly because these women are more likely to have the support (including maternity leave) that affords them the ability to breastfeed. It also may be partly because they’re more aware of the recommendations that say that the choice to breastfeed is a crucial part of raising a healthy and successful child. But regardless of the reason, the fact remains. This is a problem for learning from the data. Studies of breastfeeding show time and again that breastfeeding is associated with better outcomes for kids—better school performance, lower obesity rates, and so on. But these outcomes are also linked with a mother’s education, income, and marital status.

It can look like there is a strong relationship between two things, but when you dig a bit deeper, you find they aren’t related at all. For instance, people who eat Clif Bars are likely healthier than those who don’t. This probably isn’t because of the Clif Bars, but rather that the people who choose to eat them are engaging in other healthy behaviors.

In Jesse’s notes about the first few days of Penelope’s life, he wrote, “Emily wants to stare at the baby all the time.” It’s true. Even when I tried to sleep, I could see her behind my eyes.

“Do you want us to circumcise him while you’re here?”

So a bath isn’t a terrible thing, but there is also really no reason to bathe your kid other than some gross-out factor. Most of the blood can just kind of be wiped off. I should perhaps not admit this, but they never bathed Finn in the hospital at all, and we still waited the family-standard two weeks to actually give him a bath at home.

The newborn blood screening is used to test for a very wide variety of conditions. Depending on the state, the exact number varies; California (for example) is on the high end, with sixty-one. Many of these conditions relate to metabolism and test for inability to digest particular proteins or produce enzymes.

In a person with PKU, protein can build up in the body, including in the brain, and cause extremely serious complications, including severe intellectual disability and death.

These tests are quite good at detecting hearing loss (they catch 85 to 100 percent of cases), but turn up a lot of false positives. By some estimates, 4 percent of infants will fail this test, while only 0.1 to 0.3 percent actually have hearing loss.

But in addition to advice and avoidance of formula, one of the requirements of baby-friendly hospitals is that they must practice “rooming in.” That is, unless there is a medical reason the infant has to be out of the room, mothers and babies should be together in their room twenty-four hours a day.

Here is the first thing to know: nearly all infants lose weight after birth, and those who are breastfed lose even more.

The authors of this paper created a website, www.newbornweight.org, where you can enter the time of birth of your child, method of birth, method of feeding, birth weight, and current weight and learn where they are in the distribution.

Supplementation would rarely be recommended before 48 or 72 hours, so it’s useful to pay attention to your baby’s weight before that. If she’s losing weight quickly, trying to figure out why may make sense.

Severe untreated jaundice can lead to a condition called kernicterus, a form of long-term brain damage. This is scary, and it’s the reason jaundice is taken very seriously, but in virtually all cases, jaundice will not progress to kernicterus, even if untreated. Jaundice is also very common, especially in breastfed newborns: about 50 percent

As there is for determining risky infant weight loss, there is also a website that will tell you if jaundice treatment is recommended given bilirubin levels: www.bilitool.org. It’s for doctors, but it’s accessible to anyone who is curious.

For premature infants, there is very good evidence that you should delay cord clamping.24 Randomized trials have shown improvements in blood volume, less anemia, and less need for transfusion as a result, among other outcomes.

For babies who are not premature, the evidence also largely favors delayed clamping, although it is slightly more mixed.25 In particular, delaying cord clamping lowers the risk of anemia later and increases stores of iron, but also slightly increases the risk of jaundice.

There are, therefore, no known risks to a vitamin K shot, but clear benefits from it.

The reasons for this treatment are increasingly less common, as all pregnant women are now tested and treated for STIs. And if you know you are not at risk, the antibiotics are unnecessary. You can opt out of this treatment in many states—easier in some than others—and this may be an option for you.

These risks arise if the baby’s legs are not able to flex at the hip, so it is crucial to swaddle the baby in a way that allows them to move their legs around.

as long as you are putting the baby to sleep on its back (which you should do regardless).6

can roll over, you definitely want to have them out, since you do not want them on their stomach while swaddled.

It is also important to say that this is “self-limiting”: colic will go away, typically around three months. Not all at once, but things will start to improve.

Two treatments have some known success with colic. One is supplementation with a probiotic, which a number of studies have shown to reduce crying. These effects seem to show up only in breastfed infants.

The standard recommendation is the elimination of all dairy, wheat, eggs, and nuts, so this means a pretty dramatic dietary change.

There is some evidence that warm compresses on the perineum during the pushing stage of labor can prevent very severe tears.

Over the first hours after birth, the uterus should contract toward its pre-pregnancy size. If this doesn’t happen, there is an increased risk of bleeding. Uterine, or “fundal,” massage has been shown to assist this process and lower the risk of bleeding. A strong nurse will come around occasionally and push hard on your stomach. This is uncomfortable at a minimum.

For the first day or two, this bleeding—in particular, the clotted blood—can be a little scary. You’ll sit down to pee or get up out of the bed and there will be an enormous blood clot in the toilet or on the pad. The doctors will tell you to watch out for clots “fist size or larger” (other doctors will use fruit metaphors—a plum- or small orange–size clot, they want to know about). By extension, this means that clots smaller than that—but not much smaller—are common. Passing these isn’t typically painful, but it is jarring.

At many hospitals, they’ll give you a squeeze bottle of water, the idea being that you squeeze water on while you pee so the urine is diluted and not as painful. This works okay, although—here’s a pro tip—definitely make sure you do not use extremely cold water.

It is common to give women stool softeners to improve the first postbirth bowel movement. It may be a couple of days before you actually have that first bowel movement, which is good. Also, this may not be as bad as you think. And anyway, you have to do it.

With a complicated caesarean (or even a complicated vaginal birth), it might be weeks before you feel like you can get up and shower alone.

Most people do not plan babies ten months apart, so unless you have, make sure you are using some kind of birth control. (And think carefully about what type: some kinds of birth control, specifically some birth control pills, can interfere with milk production.)

A final note: Sex after childbirth can be painful. Breastfeeding promotes vaginal dryness and lowers your sex drive. In addition, injuries during birth can have persistent effects. Many women, after having a small person attached to them nearly constantly, really do not want to be touched. Most women need some lubrication the first few times they have sex after giving birth to deal with vaginal dryness. And you want to take it slow at the start. And, of course, this all focuses on penetrative vaginal sex. Other activities—oral sex, either given or received—may be easier to restart, and could be more enjoyable early on.

In the first days and weeks after your baby arrives, you will experience a wave of hormones. Most women find they are emotionally sensitive during this period. This is not, for example, the time to watch the first fifteen minutes of the movie Up.

The prevalence of postpartum depression, even if we focus only on diagnosed cases, is high. An estimated 10 to 15 percent of women who give birth will experience it.5

It may be helpful to remind yourself that addressing your depression is valuable for your baby, too, not just some kind of selfish personal indulgence.

But women with postpartum anxiety also tend to find themselves fixated on terrible things that could happen to the baby, unable to sleep even if the opportunity is there, and engaging in obsessive-compulsive behaviors around infant safety. This can be treated with therapy or, in more severe cases, with medication.

One of the things on every pro-breastfeeding list is “saves money.” This really depends. Yes, formula is expensive, but so are nursing tops, nipple creams, nursing pads, and the fourteen different breastfeeding pillows you need to make it work. And, more important, there is your time, which is valuable.

Breastfeeding changes some aspects of the cells of the breast, which makes them less susceptible to carcinogens. In addition, breastfeeding lowers estrogen production, which in turn can lower the risk of breast cancer.

First, there is some randomized evidence on the success of skin-to-skin contact at improving breastfeeding success rates. Skin-to-skin contact is the practice of having women hold their naked (or diapered) baby against their naked chest, typically right after birth. The idea is that the smells and the proximity will encourage the baby to start feeding immediately.

It may simply be helpful to have someone to strategize with, ideally someone who has slept in the past few days and can provide some perspective. (This can, by the way, help with a lot of decisions about your newborn.)

If you are not getting the help you need, keep asking to see if you can find the right person. If you can manage it, getting this help from someone you know and trust—a doula, or perhaps a lactation consultant you’ve talked to before the birth about what you want—may be the most helpful.

How do you know you have a good latch? Once you have done it for a while, you’ll just know. You’ll also learn to recognize a kind of weird sigh that many babies have when they get it right. Before that . . . it is useful to have someone else look and tell you. The internet will tell you that if you have a good latch, nursing will not hurt. More on this later, but for now, know that early on, this is often not true. For many women, breastfeeding will hurt for the first couple of weeks whether the baby is latched well or not, so you cannot reliably use pain as a signal.

Nipples can become cracked and sore, or bleed. There is no magic solution to fix this problem. Many women swear by lanolin cream or various gel packs and pads, but there is no randomized evidence suggesting that any of these things are successful.11 The only thing with any support in randomized trials is the practice of rubbing breast milk on your nipples regularly. I will caution, however, that this data comes from just one trial, and it is small.12

La Leche League can often connect you with a lactation specialist over the phone if you do not want to go as far as seeing someone in person.

generally, the recommendation now is to nurse on demand, at least early on, since this establishes a plentiful milk supply. Schedules, to the extent we get them, come later.

In particular, the drug domperidone has been shown in a variety of randomized studies to increase milk production.23 (Unfortunately, it is not available in the US,

Let’s start with the food part. The only food women are medically advised to avoid during breastfeeding is high-mercury fish.26 That’s it! No swordfish, king mackerel, tuna. But other fish are fine, as are unpasteurized cheeses, sushi, rare steak, deli meats, and on and on.

A final note is on caffeine. Most people find it’s fine to have caffeine while nursing, and there is certainly no literature suggesting risks to the baby. However, some babies are quite sensitive to caffeine and get very fussy and irritable. If you find this is the case, you may have to avoid it.

Many women report that it works well to choose one feeding—likely in the morning, since that is when the milk is most plentiful—and just pump after that feeding. You’ll get a bit of milk each time, and if you start early, over a week or two you’ll get enough to give a bottle. Then while the kid has that bottle, you can pump another bottle during that feeding.

It is possible to work while pumping—in some cases—and I strongly suggest you get a hands-free pumping bra. At a minimum you want to be able to read something on your phone. Many people suggest you try to relax, look at pictures of your baby, and generally wind down while pumping. The idea is that this will increase supply. There is no direct evidence for this; one study of moms pumping for babies in the NICU showed that being near their babies increased milk production, but this is pretty distant evidence. 36