by Emily Oster
When Penelope was born, the decisions didn’t stop—they just got harder. There was now an actual person to contend with, and even as a baby, she had opinions. You want your kid to be happy all the time! And yet you have to balance this with knowing that sometimes you need to make hard choices for them.
Consider, for example, Penelope’s affinity for the Rock ’n Play Sleeper, which is a rocking bassinet-seat contraption. In the wake of the swaddle, Penelope decided that this was her sleep location of choice. This was at best inconvenient—we dragged that sleeper everywhere for months, including on a somewhat ill-planned vacation to Spain—and at worst generated a risk for a flattened head.
And yet extricating ourselves from that required not just us, but her. When we decided one day that we were done with it, she didn’t nap for an entire day, leaving her a cranky mess and our nanny distraught. Penelope won that round; we returned to the sleeper the next day, only to finally be forced to give it up when she was above the weight limit.
Now, you could say we just gave in, but really, we made a decision to prioritize family harmony over moving Penelope to her crib exactly at the moment the books recommended. There are lines you shouldn’t cross with young children, but there are many more gray areas. Thinking about our choices in cost/benefit terms helps take some of the stress off a decision.
In thinking about these decisions, I again, as I had during pregnancy, found there was comfort in starting with the data. For most of the larger decisions we had to make—breastfeeding, sleep training, allergies—there were studies. Of course, the trouble was that not all of these studies were very good.
Take breastfeeding. Breastfeeding is often hard, but you’ll hear endlessly about the benefits. Breastfeeding is made out to be an absolute must by the medical establishment and a host of online voices, to say nothing of your friends and family. But are these benefits all real?
It’s actually not so easy to answer that question.
The goal of studying breastfeeding is to see if children who are breastfed are different later in life—healthier, smarter—than those who are not. The basic problem is that most people do not choose to breastfeed at random. In fact, people think carefully about this choice, and the kind of people who choose to do it are different from those who do not. 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. How can we know if it is the breastfeeding or the other differences among women that causes the better school performance and lower obesity?
One answer is that some of the data is better than other data.
In thinking about these decisions, I used my economic training—especially the part where I try to tease causality out of data—to try to separate the good studies from the less-good ones. Causality isn’t simple. 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.
A large part of my approach here was to try to identify which of the hundreds of breastfeeding studies provided the best data.
Sometimes when I did this, the best studies did support a relationship—breastfeeding does, for example, seem to consistently reduce infant diarrhea. But at other times, the best studies didn’t show these effects; the idea that breastfeeding has dramatic effects on IQ, for example, isn’t as convincing.
In the case of breastfeeding, there are studies to rely on, even if they aren’t all great. But even this isn’t always true. When my kids were a bit older and I wondered about the effects of screen time, I found precious little data that really addressed the questions I had. IPad apps to teach a three-year-old letters simply haven’t been around long enough to have prompted lots of research papers.
This was occasionally frustrating, but it is comforting, in its own way, to know there are some questions data just cannot answer for you. At least you can go into this with an understanding of the uncertainties.
As with the meal preparation question, data is only one piece of the puzzle, and we can’t stop there. When I saw the data, I made one set of choices. But the same data does not always lead everyone to the same decision. Data is an input, but so are preferences. In deciding whether to breastfeed, it is useful to know what the benefits are (if any), but it’s also crucial to think about the costs. You may hate breastfeeding; you may plan to return to work and hate pumping. These are reasons not to breastfeed. Too often we focus on the benefits at the expense of thinking about the costs. But benefits can be overstated, and costs can be profound.
These preferences, it should be noted, should consider not just the baby but also the parents. In thinking about the right caregiving setup for your child—stay-at-home parent, day care, nanny—it’s useful to look at the data, but it is also crucial to think about what works for your family. In my case, I was committed to getting back to work. Perhaps my children would have preferred I stay home (I doubt it), but that wasn’t going to work for me. I did get some data to think about this decision, but ultimately, my preferences played an important role. I made an informed choice, but I also made the choice that was right for me.
This idea—that what parents need or want will play a role in choices—can be hard to admit. In a sense, I think this is at the core of a lot of the “Mommy War” conflicts.
We all want to be good parents. We want our choices to be the right ones. So, after we make the choices, there is a temptation to decide they are the perfect ones. Psychology has a name for this: avoiding cognitive dissonance. If I choose not to breastfeed, I don’t want to acknowledge that there are even small possible benefits to breastfeeding. So I encamp myself in the position that breastfeeding is a waste of time. On the other side, if I spend two years taking my boobs out every three hours, I need to believe that this is what it takes to deliver a life of continued successes to my child.
This is a deeply human temptation, but it is also really counterproductive. Your choices can be right for you but also not necessarily the best choices for other people. Why? You are not other people. Your circumstances differ. Your preferences differ. In the language of economics, your constraints differ.
When economists talk about people making the “optimal choices,” we’re always solving problems of what we call “constrained optimization.” Sally likes apples and bananas. Apples cost $3 and bananas cost $5. Before we ask how many of each Sally buys, we give her a budget. This is her constraint. Otherwise, she’d buy infinite apples and bananas (economists assume people always want more stuff).
When we make parenting choices, we are also constrained—in money, yes, but also in time or energy. You can’t make up sleep out of thin air. If you sleep less, you’re giving up the benefits you may derive from a good night’s sleep. That time spent pumping in the lactation room at work could be spent working. You think about this, and then you make the choices that work for you. But someone who needs less sleep, or has more time to nap, or can pump and work at the same time—they may make different choices. Parenting is hard enough. Let’s take some of the stress out of parenting decisions.
This book will not tel
l you what decisions to make for your kids. Instead, I’ll try to give you the necessary inputs and a bit of a decision framework. The data is the same for us all, but the decisions are yours alone.
In thinking through the big choices of these early years, you’ll probably find that some of the data, on everything from sleep to screen time, is a surprise here. There is reassurance in seeing the numbers for yourself. People may tell you it’s fine to let your child “cry it out” to fall asleep, but you’ll probably feel better doing it once you’ve seen the data shows this to be true.
When I wrote Expecting Better, about pregnancy, there was a lot of data—on coffee, alcohol, prenatal testing, epidurals. Preferences played an important role there, but in many cases, the data was clear. For example: Bed rest is not a good idea. Relative to pregnancy, there are fewer things here where the data will tell you what to do or avoid. Your family preferences will be more central. This doesn’t mean the data isn’t helpful—it often is!—but the decisions that come out of data will be different, even more so than they are in pregnancy.
Cribsheet starts in the delivery room. The first part of the book will cover some of the issues—many of them medical—that will come up early on: circumcision, newborn screening tests, infant weight loss. I’ll talk about the early weeks at home: Should you swaddle? Avoid germ exposure? Obsessively collect data about your baby? This part of the book will also talk about the physical recovery from childbirth for birth moms, and about awareness of postpartum emotional issues.
Part 2 is focused on the big decisions of early parenting: breastfeeding (Should you do it? How does it work?), vaccinations, sleep position, sleep training, staying at home versus working outside the home, day care versus nanny. (Basically, the Mommy Wars.)
Part 3 will tackle the transition from baby to toddler, or at least a piece of it: screen time (good or bad?), potty training, discipline, and various educational choices. I’ll show you some data on when your kid will walk and run, and how much they will talk (and whether it matters).
Finally, the last part of the book talks parents. When a baby arrives, it necessarily creates parents, and a lot will change. I’ll talk about the stresses early parenting can have on your relationship with your partner, and the question of having more children (and when).
We know being a parent means getting a lot of advice, but this advice is almost never accompanied by an explanation of why something is true or not, or to what degree we can even know it’s true. And by not explaining why, we remove people’s ability to think about these choices for themselves, with their own preferences playing a role. Parents are people, too, and they deserve better.
The goal of this book is not to fight against any particular piece of advice but against the idea of not explaining why. Armed with the evidence and a way to think about decisions, you can make choices that are right for your family. If you’re happy with your choices, that’s the path to happier and more relaxed parenting. And, hopefully, to a bit more sleep.
PART ONE
In the Beginning
Regardless of whether you had the childbirth you always imagined or, in the words of a colleague, “got a little panicked at the end,” you will find yourself in a recovery room a few hours later. It’ll probably be pretty similar to your labor and delivery room, only when you arrived in that room, there was one fewer person along for the ride.
It is hard to overstate how different things are in the moments before and after the baby, especially when that baby is your first child. After Penelope was born, we were in the hospital for a few days. I sat around in a bathrobe, trying to nurse, holding the baby, waiting for her to be brought back from various tests, trying gently to walk around. Some memories of that time are very sharp and specific—Jane and Dave came with a purple stuffed bear, Aude brought a baguette—but the experience seems a bit like a dream.
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.
The first few hours or days in the hospital, and then the first weeks at home, can have a kind of hazy quality. (This might be the sleep deprivation.) You’re not seeing many other people (unless you’re hosting unwelcome family members) or leaving the house much, you’re not sleeping or eating enough, and there is all of a sudden a demanding person who wasn’t there before. 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.
But while you’re staring at the baby or contemplating the meaning of life, some stuff might come up that you have to make decisions about. Better to think about it in advance, since this will not be your most functional period. The days right after giving birth are a confusing time, and can be made more so because of the often conflicting advice you will receive from your care providers, your family and friends, and the online world.
The first chapter in this section discusses issues that may come up at the hospital—either procedures you could have there or complications that could arise early on. The second chapter talks about the first weeks at home.
There are a lot of big decisions about parenting—breastfeeding, vaccination, sleep location—which you’ll also probably want to make early on (or, in some cases, before birth). But since these affect much more than just these first weeks, I’ll leave them for part 2.
1
The First Three Days
If you have a vaginal delivery, you’ll probably spend two nights in the hospital. If you have a caesarean section, or any complications during birth, this might be three or four nights. There was a time when women would stay in the hospital for a week or even ten days to recover after giving birth, but that time has decidedly ended. Insurance can be so strict about this that one friend suggested we try to wait to have the baby until after midnight to get another hospital overnight. (This presumed a level of control that I definitely didn’t have, although sometimes doctors will check you in late for this reason.)
Depending on your temperament (and the hospital), this can be a nice way to start out, or it can be a little frustrating. The big advantage of the hospital is that there are people around to take care of you and to help you figure out things with the baby. There are usually lactation consultants, if you want to breastfeed, and there are nurses around to make sure you aren’t bleeding too much and that the baby looks like it is functioning normally.
The disadvantage is that the hospital is not your home. You don’t have any of your stuff, it can be a little stifling, and the food is typically terrible. With Penelope, we spent the requisite two days at a big hospital in Chicago. We have one truly appalling photo of me from this period in which Jesse thought it would be funny to hold up a copy of Us Weekly, which had an article about Britney Spears entitled “My New Life,” next to me and take a picture. Let’s just say I was starting “my new life” with a really puffy face.
Most of this time, you’ll just be sitting around, staring at your baby, posting status updates to Facebook. But occasionally someone will come in and want to do things to the baby. They’ll roll in a giant machine for a hearing test. They’ll do a heel prick to test the baby’s blood. And sometimes they’ll ask you what you want to do.
“Do you want us to circumcise him while you’re here?”
How do you make a decision like this? It isn’t an obvious one for many people. It’s not a medically or legally required procedure. It’s really up to you.
There are many ways to make choices in this situation. You can do what your friends do, or what your doctor recommends. You can try to figure out what people on the internet say they did, and why. Of course, in a situation like circumcision, this probably won’t help you. About half of male babies in the US are circumcised, and about half are not, which means you can find plenty of people on either s
ide of the issue. (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.)
This book is going to argue for a more structured approach to making this choice. First, you get the data. You really confront—in an open-minded way—the question of whether there are any risks, and what these risks are. Are there any benefits? What and how big are they? Sometimes there are benefits to a choice, but they are so vanishingly small that it may not make sense to think about them very much. Likewise, sometimes there are risks, but they are infinitesimal relative to the other risks you take every day.
And then, second, you combine this evidence with your preferences. Is your extended family strongly in favor or not? Is it important to you that your son have a penis that looks like his dad’s? There is no data to tell you the answers to these questions, but they’re an important piece of the puzzle.
These preferences are why you really can’t rely on that lady on the internet. She doesn’t live with your family, and honestly, she has no idea what the right thing is for your kid’s penis.
For the decisions you can plan, it’s helpful to have thought them through in advance. The early period in the hospital is overwhelming, and not a great time for decision-making (although just wait until you get home!). It’s good to be prepared so you know what’s going on while you adapt to your “new life.”
Usually, things go smoothly, and a couple of days after delivery, you’ll be packing your baby into their car seat and heading out. But this is also a time when some common newborn complications creep in—jaundice, excess weight loss—and you may have to deal with them. These complications are good to be aware of in advance, which can help you be a more active participant in decisions related to them.