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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.)
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 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.
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.
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.
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.
Jaundice is also very common, especially in breastfed newborns: about 50 percent of newborns will have this condition to some degree.
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.
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.
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”).
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.
My friends Hilary and John developed a complete statistical model, with graphs, of the relationship between eating and sleep length.
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.
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.
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.
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
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.
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
And the baby itself can also play a role; people with babies who are poor sleepers are at greater risk for depression, almost certainly due to the fact that they, in turn, get less sleep.
Although antidepressants are passed through breast milk, there is no evidence of adverse consequences (more on this in chapter 5). This means there is no need to choose between getting the help you need and nursing your baby.
This desire for shock and awe interacts poorly with most people’s lack of statistical knowledge.
For others, breastfeeding makes them feel like a cow. They hate lugging the breast pump
They told me about their “stupid tiny nipples” and the time they bought a “booby tube” (Google it). About painful nipples—bleeding, cracked, and, in one especially gory case, actually partially coming off.
The main downside of the nipple shield, other than that it is annoying to wash, is that it affects milk transfer. The shield reduces stimulation, so your body produces less milk.
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.
Smoking during pregnancy slows down milk production, as does obesity.
You’ll also find a variety of suggestions on the internet about how to increase your milk supply. These include herbal remedies—fenugreek is the most common, although others, like nettle tea, do come up—as well as particular foods (dark beer, for example) and a suggestion that you stay hydrated.
Beer!!!
To take fenugreek as an example, a 2016 review article covered two small randomized studies of the effect of fenugreek consumption on breast milk. In one study, milk production was increased. In the other, it was not. Evidence on other herbal remedies (shatavari, malunggay) shows similarly mixed results.
Shatavari!!!
In particular, the drug domperidone has been shown in a variety of randomized studies to increase milk production.
Can you return to your rare steak? Those unpasteurized cheeses you’ve been craving—are they still off-limits? And what about a glass of wine—or even a couple of glasses? Is that okay? Good news: mostly, breastfeeding moms have no dietary restrictions.
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.
When you drink, the alcohol level in your milk is about the same as your blood alcohol level. The baby consumes the milk, not the alcohol directly, so the level of alcohol they are exposed to is extremely low.
better. All antidepressants are secreted in breast milk, but there is little evidence of negative impacts on the baby. Postpartum depression is serious, and treatment is important.
The AAP says infants should sleep alone in a crib (or bassinet) and should be placed in the crib on their back to sleep. There should be nothing in the crib with the baby. Bumpers—pads that wrap around crib slats to prevent little hands or feet from getting stuck—should not be used.
Until the early 1990s, the most common sleeping position for infants—in the US and elsewhere—was on their stomach.
Child's pose
The risk of death for infants who do not bed share in the lowest risk group is 0.08 SIDS deaths per 1,000 births. For those who bed share, it is 0.22 deaths per 1,000 births.
Certainly, there is a correlation: moms who bed share are also more likely to be breastfeeding and to persist until the child is older.
The American Academy of Pediatrics recommends that infants be in their parents’ room through at least the first six months, and ideally the first year, of life as a guard against SIDS.
In a 2017 study, researchers evaluated whether a child’s sleeping in a room with a parent made for worse sleep. They found that it did. At four months old, total sleep time was similar for babies sleeping in a parents’ room and those sleeping in their own room, but sleep was more consolidated (i.e., in longer stretches) for those in the latter group. This makes sense: their own room will be quieter. At
