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by
Emily Oster
depression. These fall into two categories: predisposition and situation. By far the biggest risk factor for postpartum depression is predisposition, or prior
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.
your baby, too, not just some kind of selfish personal indulgence. Beyond sleep, some type of cognitive behavioral therapy, or other talk therapy, is a usual first-line
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.
different, or the way they measure variables is skewed. Sometimes there will be a really big study, but it will be deeply flawed, and I’ll end up relying more on a smaller study that has a better design. And, sadly, for those of us who love data, the data will never be perfect. In confronting the questions here, we also have to confront the limits of
seems hungry, just let her keep trying to nurse. Your supply will catch up!” But she was clearly starving (at least, that’s what it seemed like). At the same time,
she was napping? What if she woke up right after I finished and needed to eat again? And worst, Penelope seemed to hate breastfeeding, and getting her to latch on was a struggle every
some basis in evidence, just not always especially good evidence. In particular, as I mentioned in the introduction, most studies of breastfeeding are biased by
makes it very difficult to infer the causal effect of breastfeeding. Sure, there is a correlation between nursing and various good outcomes—but that doesn’t mean that for an individual
authors adjust for these variables, they can get closer to comparing two identical children. I’ll often call these variables controls. The more things we control for—meaning, the more variables we can hold constant across children
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.
have a harder time nursing are more likely to supplement. You will then find that infants who are
Smoking during pregnancy slows down milk production, as does obesity.
milk. Our general knowledge of the biology of lactation suggests this could be helpful,
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.
now a product called the Freemie, which is a pumping system where the cups effectively fit inside your bra and also collect the milk. The key, I think, is that the pump motor itself is quite small so you can store it in
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.
and doesn’t start again. It is more common in vulnerable infants—premature babies, for example—and in boys. Among the most haunting aspects of parenting is the vulnerability
Until the early 1990s, the most common sleeping position for infants—in the US and elsewhere—was on their stomach.
Child's pose
SIDS deaths are thankfully rare, so some of the more standard research techniques are difficult to implement. Even a very large randomized trial or observational study is not likely to have enough
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.
up. This is certainly true, at least for some babies, and probably
Certainly, there is a correlation: moms who bed share are also more likely to be breastfeeding and to persist until the child is older.
randomized trial that evaluated the relationship between breastfeeding and having an infant in an attached cot rather than a separate bed fails to find any link between bed sharing and breastfeeding.19 This doesn’t mean there are no benefits for your family to bed sharing, just that it probably isn’t a panacea
Beer!!!
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. The theory is that parents can be more attentive to the baby if they are in the same room. The evidence on room sharing and SIDS is substantially less complete than the evidence on bed sharing. The studies have the same basic structure, but they are smaller and there are fewer
Shatavari!!!
caveat, we can review the studies we do have. To take one concrete example, consider a study published in the British
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
But to tell people they need to keep their child in their room for a year, sacrificing both short- and long-term sleep success with no clear benefit in the process, may not be a good policy. The Sofa Across virtually all studies of sleep location, the one thing that jumps out as really, really risky is babies sharing a sofa with an adult. Death rates as a result of this behavior are twenty
is not difficult to see why: an exhausted adult falls asleep holding an infant on a cushiony sofa, and it is easy for the infant to be smothered by a pillow. The unfortunate thing is that in at least some of these sofa deaths, the parent involved is trying to avoid the risks associated
(aside from the baby) your child’s crib should be empty, with no toys, no bumpers, no blankets or pillows. Nothing.
One is that infants should not have blankets. This conclusion is based on the results of a number of the studies discussed previously. Infants who die of SIDS are more likely to be found with blankets over their heads than control infants.
of the recommendation regards crib bumpers, which are forbidden by the AAP. In fact, some cities (Chicago, for example) have disallowed the sale of bumpers. The concern is that these can cause suffocation.
If you are going to bed share, start by making sure you are not smoking or drinking and that your bed is not full of covers and pillows.
one, but it is smaller than some of the risks you are likely taking regularly. With my own children, bed sharing wasn’t appealing, but neither was room sharing. My daughter was in
at around nine months, the third nap disappears; at a year to twenty-one months, the second nap disappears; and at three to four years, the final nap disappears. On these latter two transitions in particular, these ranges are wide. A year to twenty-one months is a long time!
day one. We stuck to the schedule we’d used with Penelope, and he actually got there much faster than she did. The other thing you realize with your second child is that the unscheduled mess of the first year does end. Your baby will, eventually, arrive at a more predictable sleep schedule.
In May 2017, for example, there was a measles outbreak in Minnesota, with at least fifty cases. The outbreak was concentrated in the Somali immigrant community, where antivaccination activists had made efforts to convince the population that vaccines were linked to autism.
For most health outcomes—heart disease, obesity, diabetes—more educated people tend to be healthier. But in the case of vaccines, the correlation often goes the other way.
In 1986, in response to this, Congress passed the National Childhood Vaccine Injury Act, which protected companies from being sued over mandated vaccinations. People who claim to be injured by vaccines can appeal to the federal government for compensation, but they cannot seek damages from the vaccine manufacturer.
some of this in the following pages. Indeed, a vague case study of twelve children is hardly strong evidence in the first
Child's pose
