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Kindle Notes & Highlights
by
Emily Oster
A WHOLE PERSON. Someone who will one day drive a car and have a job and tell you they hate you for ruining their life for not letting them go to a coed sleepover that everyone else is going to.
(Why is it half? Hard to know. Some people do this for religious reasons, others for medical reasons, some because the dad is circumcised and parents want their son’s penis to look the same as Dad’s.)
immediate skin‑to‑skin contact (more on that below) and toward leaving Mom and baby alone for a couple of hours right after birth. One of the benefits of skin‑to‑skin contact seems to be increased breastfeeding
It’s not clear why this arose; there are a variety of theories—my favorite of which is that some leader was born without a foreskin and therefore made everyone else remove theirs—and the practice might have begun for different reasons in different locations.
the US. Another risk is what is sometimes called “poor aesthetic outcome”—basically, residual foreskin that will require further surgery. There aren’t great estimates of how common this is, although it seems
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.
These tests are all done with a small heel prick, and there is no risk to the baby. If your child doesn’t have any of these conditions (by far the most likely scenario), you will not hear anything more about it. Medical staff will also do a hearing test on the baby, which
In the past few decades, we’ve seen the rise of “baby-friendly hospitals.” Obviously, one would hope that all hospitals are baby-friendly, but the baby-friendly hospital designation means something more specific. In particular, baby-friendly hospitals must follow a ten-point plan designed to improve breastfeeding.
can say that we can’t rule out some effects. But you’ll hear from hospitals who advocate rooming in that there’s no reason not to do this, so we should do it even if the benefits are uncertain.
In the days after giving birth, women are often very tired. Your hospital stay includes more support than you are likely to get at home, and sending your baby to the nursery could let you take advantage of their expert care of you and your baby. Knowing that the data is not definitively on the side of rooming in can make this an easier choice for some moms.
Another study reported that 14 percent of babies born in baby-friendly hospitals were “at risk of” falling from the bed, mostly due to their mothers falling asleep while nursing.
I was alone, bleary and confused, and ill-prepared to make a decision about this. The lessons from this are that you shouldn’t let your husband go home to sleep, and, possibly secondary, that it’s good to know this is a risk.
Here is the first thing to know: nearly all infants lose weight after birth, and those who are breastfed lose even more.
of milk. Colostrum may or may not be the magical substance that lactation consultants fantasize about, but there isn’t much of it (especially with your first baby). The fact that this weight loss is expected means you want to be careful about this issue, but you also want to make sure not to overreact to the design of the
would come up that I didn’t expect. For example, we failed to buy any clothes that would leave the umbilical cord exposed while it healed.
it’s easier to feel like you know what you’re doing. Before Finn, I felt prepared. I had the correct clothes. I had the bassinet. I was even ready with my weight loss data in case that came up (it didn’t). Surely I wouldn’t unexpectedly face some medical or other issue with no preparation. Obviously, this was ridiculous. Two days after we arrived home,
out in the gut where it gets reabsorbed back into the bloodstream. In high concentrations, bilirubin is neurotoxic (meaning it can poison the brain), so jaundice is potentially very serious
Jaundice is also very common, especially in breastfed newborns: about 50 percent of newborns will have this condition to some degree.
so they’ll typically use a heel prick to get a drop or two. The test results are reported in a number (11.4, say, or 16.1); higher numbers are worse. Just as with weight loss, interpreting this test depends on the age of the
doctors will compare your baby’s test results with the normal range for the number of hours old your child is. The key
Jaundice is more common in some babies than others. Exclusively breastfed infants are more likely to develop it. Babies of Asian heritage are at higher risk. It is also more common when mothers and babies have different blood types.
states and have no known downsides. 2 Wait, You Want Me to Take It Home? Ihave two incredibly vivid memories from Penelope’s first weeks at home.
My mother had already lost some credibility earlier in her visit by insisting (in contrast to my doctor’s advice) that I should limit how frequently I walked up and down the stairs. It is beyond the scope of this book (or probably any book) to address
And there are some questions I cannot answer—for example, is there any way to get infant poop stains out of white onesies? It’s a question for the ages, and one we won’t answer here.
Let me suggest you learn from the mistakes of those of us who have come before. If you want to swaddle, you cannot use a regular blanket. The nurses in the hospital can, but not you.
And fortunately, this turns out not to be very difficult to study, since sleep is a very short-term outcome. Researchers can look at the same baby swaddled and unswaddled. This avoids a lot of our concerns about different parents doing different things with their babies.
This paper also identified the mechanism: swaddling improves sleep because it limits arousals.3 Swaddled babies are equally likely to have the first stage in arousal—measured with baby “sighs”—but are less likely to move from this to the second stage (“startles”) or the third (“fully awake”).
syndrome (SIDS). To the extent we have data, this concern does not seem valid, as long as you are putting the baby to sleep on its back (which you should do regardless).6 Infants who are put to sleep on their stomach and are swaddled
By the time I had Penelope, I was thirty-one. Up to that point in my life, there had been surprisingly few instances in which I could not defeat a problem with hard work.
If you have an infant who cries a lot, whether it is true colic by the formal definition or not, the most important thing is to try to take care of yourself. Infant crying links to postpartum depression and anxiety, and parents—both parents—will need a break.
The obvious downside is that this change in diet is no fun at all for Mom and can make it hard to get enough calories, so there is some appropriate caution around making this
is reason to give it a try. Regardless of what you do, your baby will still cry, sometimes for what seems to be no reason at all. It may not feel like it at the time, but this will go away,
log feeding and pooping. Mom wasn’t really as good as Dad at keeping track of minutes. She liked to round to more even numbers.” Please remember, we are two economists married to each
My friends Hilary and John developed a complete statistical model, with graphs, of the relationship between eating and sleep length.
data. Keeping track of when the baby is eating can be valuable early on since it’s easy to forget when they last ate. There are some nice apps that let you record from which breast they ate last. I know what you’re thinking: How could I forget that? Trust me, you will. I used a system
the illusion of control, not actual control. GERM EXPOSURE There is a broad theory called the hygiene hypothesis, which states (I am paraphrasing here) that the increase in occurrences of allergies and other autoimmune illnesses over time is a result of decreased germ exposure in childhood, and that exposure to more microbes and germs as a child can help
Basically, if your otherwise well-seeming six-month-old gets a fever—even a pretty high one—and you go to the doctor, they’ll probably look them over, tell you they have a virus, and send you home with instructions to give them Tylenol and fluids. In fact, many doctors’ offices will tell you not to bring this child in at all unless you are very concerned.
In contrast, if your two-week-old has even a low fever, you’ll need to take them to the hospital, where they’ll be subjected to lab tests—likely including a lumbar puncture (spinal tap)—given antibiotics, and admitted as an inpatient.
on your baby is fun! But not necessary or especially useful. Exposing your infant to germs early on risks their getting sick, and the interventions for a feverish infant
the world is oddly lacking in discussions of what happens, physically, to Mom after the baby arrives. Before the baby, you’re a vessel to be cherished and protected. After the baby, you’re a lactation-oriented baby accessory.
are concerned about anything. The lack of discussion of what to expect in terms of your post-childbirth body can make it seem like anything you’re experiencing is fine, but it’s not. There is no shame in asking. (I should add a caution here, for which you can thank my friend Tricia:
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.
this is to ensure that you can have a bowel movement after what is basically major abdominal surgery. It is not unusual for it to take several days for this to happen.
weeks later. The rest of you might be feeling pretty normal at this point (minus the pudgy tummy, the exhaustion, and the enormous boobs),
and any particular complications from it. There are a few specific red flags to look out for: Fever Severe abdominal pain Increase in bleeding, especially bright red blood Bad-smelling vaginal discharge Chest pain or shortness of breath In addition, it is important to pay attention to any changes in vision, serious headaches, or increasing swelling (say, in your ankles), especially
were at risk for preeclampsia. These instructions can be hard to remember in the haze of new parenting, though. If something doesn’t seem quite right to you, call your doctor. EXERCISE AND SEX While you are struggling to roll over in bed for a drink
that there was some biological reason why you need to wait this long, no more, no less. In fact, this is completely fabricated. There is no set waiting period for resuming sex after giving birth. The six-week rule appears to have been invented by doctors so husbands wouldn’t ask for sex. This somewhat odd tradition persists. When
by eight weeks postpartum. For those with an uncomplicated vaginal delivery, the average is about five weeks, versus six weeks for caesarean and seven for those with significant vaginal tearing.4 Having said this, it takes
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.
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
