#178 – What the evidence actually says about pregnancy and parenting (Emily Oster on the 80,000 Hours Podcast)

We just published an interview: Emily Oster on what the evidence actually says about pregnancy and parenting. Listen on Spotify or click through for other audio options, the transcript, and related links. Below are the episode summary and some key excerpts.

Episode summary

I think at various times — before you have the kid, after you have the kid — it’s useful to sit down and think about: What do I want the shape of this to look like? What time do I want to be spending? Which hours? How do I want the weekends to look? The things that are going to shape the way your day-to-day goes, and the time you spend with your kids, and what you’re doing in that time with your kids, and all of those things: you have an opportunity to deliberately plan them.
And you can then feel like, “I’ve thought about this, and this is a life that I want. This is a life that we’re trying to craft for our family, for our kids.” And that is distinct from thinking you’re doing a good job in every moment — which you can’t achieve. But you can achieve, “I’m doing this the way that I think works for my family.”
- Emily Oster

In today’s episode, host Luisa Rodriguez speaks to Emily Oster — economist at Brown University, host of the ParentData podcast, and the author of three hugely popular books that provide evidence-based insights into pregnancy and early childhood.

They cover:

Common pregnancy myths and advice that Emily disagrees with — and why you should probably get a doula.
Whether it’s fine to continue with antidepressants and coffee during pregnancy.
What the data says — and doesn’t say — about outcomes from parenting decisions around breastfeeding, sleep training, childcare, and more.
Which factors really matter for kids to thrive — and why that means parents shouldn’t sweat the small stuff.
How to reduce parental guilt and anxiety with facts, and reject judgemental “Mommy Wars” attitudes when making decisions that are best for your family.
The effects of having kids on career ambitions, pay, and productivity — and how the effects are different for men and women.
Practical advice around managing the tradeoffs between career and family.
What to consider when deciding whether and when to have kids.
Relationship challenges after having kids, and the protective factors that help.
And plenty more.

Producer and editor: Keiran Harris
Audio Engineering Lead: Ben Cordell
Technical editing: Simon Monsour and Milo McGuire
Additional content editing: Katy Moore and Luisa Rodriguez
Transcriptions: Katy Moore

Highlights

Doulas

Luisa Rodriguez: It sounds like you very strongly recommend a doula. I have this association with doulas as being kind of hippie-ish, and I also have this association with you of being super data-driven. Do you find any tension between being this very data-driven person and the kinds of hippie-ish vibes that doulas seem to give off?
Emily Oster: I am driven by data, and there is a lot of data about doulas. I think you’ve got to find a person who’s a good fit. But I think the reality is that this profession, despite the sort of associations that we all have in our heads, has actually moved in a much less hippie-dippie way. And there’s a lot of evidence that this works, even if you assign people random doulas when they arrive at the hospital. So there’s a fair amount of data there.
It relates to a question that I think crosses a lot of both pregnancy and childbirth and child rearing, which is this sense of people wanting to be a “type” — like, you want to be an evidence-based mom, and evidence-based moms don’t have doulas. And I think it’s really important that we not hew to those things, and that we say, “I could be a person who is going to try breastfeeding but isn’t totally wedded to it, but I could be someone who co-sleeps,” right? “I could be a co-sleeping formula feeder” — and that’s not a type we associate. We’re like, well, you have to do all the attachment parenting: you ought to breastfeed and wear the baby all the time. No, you can pick. It’s your parenting. You don’t have to be a “kind” of parent.
Luisa Rodriguez: Yes, that really speaks to me. And then just on the specifics of the evidence behind doulas, what kinds of outcomes is it?
Emily Oster: I think the main thing is C-sections. This is a pretty dramatic reduction in the risk of C-sections. And this is, I think, why this matters from a policy standpoint: we actually see these impacts. Even if you randomly assign the doula when the person arrives at the hospital, and even if you basically train their friend as a doula — that’s not as good as having somebody who’s been around births before, but just the idea of a support person being there is really important, it seems to reduce the C-section risk. It reduces the use of epidural, actually.
So there’s a bunch of pieces of this, and it turns out — and this is something I’ve talked to policymakers about — it actually would be cost effective for Medicaid to pay about $1,300 for every doula, for everyone on Medicaid to have a doula, because that is the money saved from having a doula, in terms of C-sections are much more expensive, all this kind of stuff. So this is a case in which there’s just like free money on the table. A doula doesn’t cost $1,300, right? Like, no chance. I mean, some places, but not most of the places. It’s an example of something where I just don’t understand why we’re not doing it. And it’s got to be the answer is the patriarchy. But I’m not sure what aspect of the patriarchy is at play.
Luisa Rodriguez: Got it. And then what exactly is the mechanism by which the doula is reducing those risks? Is it something like they’re like, “You can do it, I’m going to coach you through X”?
Emily Oster: I think it’s hard to tell. I think some of it is coaching through changes in position. Some of it is general encouragement. There’s some specific stuff around moving around that might matter, but I’m not sure there’s something you could point to and say, it’s this thing.

C-sections

Luisa Rodriguez: A lot of people really want to have a vaginal birth. Why is that so important to so many people?
Emily Oster: I don’t know why it’s so important to so many. It’s an interesting question. I think we can talk about why that would be, from a doctor standpoint, the outcome that they were hoping for. I think the answer there is that the recovery in the short term is on average much easier from a vaginal birth than from a C-section. So a vaginal birth, it’s not major surgery. You can have a very long recovery, so there’s a range. But a C-section is major abdominal surgery. It limits your mobility initially — there’s a reason people spend four days rather than two days in the hospital. You’re guaranteed somewhat of a complicated recovery. For vaginal birth, you may get a very complicated recovery, but I drove us home from the hospital after my first kid. There’s a range of ease of vaginal delivery that isn’t there for C-sections.
Interestingly, the long-term outcomes for kids and mom from those two are the same. There’s really nothing in the data that would distinguish them, except if you want to have many more children, there are added complications in later pregnancies from a C-section, and in particular from multiple C-sections. So if your goal is to have five kids, it’s actually really complicated to have five C-sections. So that’s a place where having a vaginal birth is going to make it possible to do this more, because there are placental complications in later pregnancies that become much more common if you’ve had C-sections. So in some sense, that choice and that desire or that preference for vaginal birth, a lot of it is effectively rooted in what’s going to set you up better for future pregnancies.
Luisa Rodriguez: Interesting. I didn’t know that. And that does feel really relevant to me. I have this really intense fear of vaginal birth. It just sounds like it’s going to be so painful. My mom had a lot of vaginal tearing during her vaginal birth, and I’m just terrified. And part of me is like, hmm, a C-section. I’ve had a surgery before. Maybe I can just do that, and not have all that pain in the immediate experience of it.
Emily Oster: Well, one thing is that an epidural is pretty effective. So definitely you don’t seem like a person who wants an unmedicated birth. And I think that what you describe, the fear of birthing, is quite real and is quite common and is not very widely discussed. There’s an interesting example of something where the world kind of expects you to be like, “What I’m really hoping is to give birth in the tub, and to be pulling my own baby out when they’re crowning.” Are you kidding me?! Do you know where it comes out of? Like, I want to be effing asleep, and then I want you to hand me my baby after you clean me up, like the 1950s. Like, where is my twilight sleep option for this? Because it sounds terrible.
And I think that’s a very common fear that we almost don’t allow enough of in the world, where you’re supposed to talk about this as some kind of magical thing. I will say that in the moment, like with many things in parenting, it kind of seems more normal than… You have some time to work up to it, you know?
Luisa Rodriguez: Right. Can you say more about that? I’m curious, and I think it might help me to hear, because it’s true that I don’t feel like I’ve heard many people talk about the fear of it. I’ve heard loads of people talk about what the experience of being pregnant is like; I’ve heard lots of people talk about their childbirth after the fact, and usually by then there’s a kind of magic about it.
Emily Oster: Oh, you’ve forgotten. Yes, totally. So actually, I think for almost everybody, you ramp that epidural up, you’re good. Not that it’s not uncomfortable — there’s pressure and so on — but this intense pain of an unmedicated childbirth, you can turn a lot of that off. There’s also a fair amount of adrenaline and forgetting, which there’s some self-preservation there.

The impact of kids on women’s careers

Emily Oster: When we talk about a wage gap, you sort of have in your mind like two people with the same job and one of them gets paid less — the straight-up discrimination story. And that happens some. Probably a much bigger part — and again, these things are hard to separate in the data — but it’s likely that a much larger part of what we see as a gender wage gap is basically a gender seniority gap.
So I’ll give you a very concrete example. In academia, a bunch of research universities in the last year or so have tried to figure out what gendered male and female professor wages look like. And when you do that, you find that women get paid less: 100% of that is about differences in rank, and the fact that women are less likely to be full professors or they have been full professors for less time. It’s much more strongly true in the older generation, where basically women were promoted more slowly or whatever. And you could say that some of that in the past was about discrimination — it’s a very reasonable view — but the reality is that all of the gap is explained by things you can see about seniority.
I think that’s true in a lot of these spaces. If you’re an associate at a law firm, you take some time off, it takes longer to get to partner. Even if you are a partner, you haven’t been a partner for as long, or you’ve been promoted in a different way — there’s this idea of the “mommy track.” There are a lot of reasons why wages are different, probably most of which are about differences in things you could see. And again, I want to emphasise that doesn’t mean they’re not discrimination — it’s just that if you want to look for a discrimination explanation for that, you need to go back to why this happened in the first place.
It widens the most [early on], and then it kind of stays about the same. If you look at the time path of people’s wages, eventually they stagnate or growth stops, and at that point, there’s not as much space for widening.
Luisa Rodriguez: Yeah. The story about hours makes sense to me, about how much harder it is to go half time, but still pursue the same levels of seniority. Are there other things going on? Like, is some of it just choice? Are some women choosing to take on this responsibility because they would prefer to trade off a more senior role for more time with their kids?
Emily Oster: Totally, yes. Some people choose. And it’s an interesting policy question, because when we say we want to have more women with kids in the workforce, which is something that gets expressed a lot, I think we want to think about how there might be two reasons you might leave the workforce when you have kids.
One is that you might not want to be in the workforce anymore. That’s a completely reasonable, appropriate preference that some people have. And we wouldn’t want to say, let’s force everyone to work if they would prefer to work at home by taking care of their kids — which is also, by the way, a job that’s quite hard.
Then there’s a second piece, which is people who basically would want to maintain a foot in the workforce, or would prefer to work, but something else is keeping them out of the workforce. And I would put in that category the recognition that some people would like to work less for not four months, but several years. I think one of the biggest challenges when we think about further developing women’s role and leadership positions in the workforce is to recognise that there may be periods in which people want to be less engaged, and it would be a shame to lose that human capital for that period.
So thinking about how we know from the data that women put more value on flexible work arrangements if they have small children. There was a recent Brookings report that showed the labour force participation rate for college-educated women with children under five is the highest it has ever been post-pandemic — and that is because those people are able to work remotely, and the value of being able to work remotely when you have little kids is really high. So thinking about some of those people we really want to keep in the workforce, and being able to keep them, and then eventually your kids go into middle school and they don’t care about you anymore and you have time to work more. So I talk a lot about this, and I think it’s really important to think about how we can provide the kinds of flexibility that people need in the short term.

Kids are a marathon

Emily Oster: People spend so much time thinking about the first two years. And of course, that’s what’s in your mind before you have a kid. It’s like, “I’m going to need to be there for breastfeeding. I’m going to need to be there for this and this and this and this.” And yeah, OK, those things are important. If you talk to people with older kids, one of the things they will often say is, “I was really substitutable when my kids were babies. Yeah, I provided breast milk, but fundamentally they were happy to sleep. There were many, many people who could serve the needs of my kids when they were babies. There are many fewer people who can serve the needs of my kids now.”
As your kids get older, I think for many of us, the stakes feel a little higher and the value of being there feels almost greater than it did. And I think that’s both important to recognise because you don’t want to conceive it as like, “There’s going to be two years of investment and then basically I’ll be done. They’re going to some English boarding school.” The need for you is not going to disappear. But also in those first years, there’s a lot of people who are substitutable.
Luisa Rodriguez: Interesting. I feel like I am, again, one of the people who needed to hear that. I think I have some, like, “I’ve got to prepare for the sprint of the first two years, and then somehow it gets easier.” But it is a marathon.
Emily Oster: It’s a marathon. And the first two years, those are like you’re kind of slow, you’re not picking up the pace. I’m in the middle of training for a marathon, so I really have a lot of this in my head now. Those you keep it controlled those first couple of miles, because it’s getting hard in the last 10k. It’s hard.
Luisa Rodriguez: Right. Interesting. Well, that is frightening to me. Preparing for a sprint sounds easier to me than preparing for how to have a productive career while raising kids when it’s actually a marathon.

Evidence on childcare

Emily Oster: So basically the childcare choices that you make — either choices about whether to work or not, even the choices about what to do with your kid during the day — for the most part, those don’t really impact their test scores very much in any direction. So some of these things may be a little bit positive or a little bit negative. Actually, the stay-at-home/not-stay-at-home parent stuff is pretty minor. So none of these things are very big. Even when you have effects — which are, we could argue, are almost always overstated, because they’re really correlations: they’re not really causal; we don’t have any randomised data — even those numbers are so small for the most part that they wouldn’t be an important part of a consideration set.
Luisa Rodriguez: Wow, OK. They’re that small. Are there exceptions? Are there types of childcare or an amount of time a child might spend at home alone that do make a difference?
Emily Oster: You can’t leave your baby home alone. That’s not allowed. I mean, we look at childcare, and people ask me, “Is daycare good or daycare bad?” Low-quality daycare does seem to show up sort of negatively. And by “low-quality” I mean the kids are not safe, they’re not getting any attention, which is unfortunately characteristic of some childcare settings. But beyond that, there isn’t something where you’d say this is the worst childcare structure.
Luisa Rodriguez: So there are small differences, but they are really so small that you wouldn’t think they’d be particularly important considerations?
Emily Oster: Yeah. Basically, group daycare improves cognitive performance a bit. Maybe it worsens behaviour a little bit. Both effects are pretty small. Having one parent be part time sometimes shows up in test-score data as a positive. But probably that’s just about correlation and about what kind of families they are. And again, it’s all very complicated, because if people are working, they have more income and can buy stuff. So I don’t know.
Luisa Rodriguez: Yeah, it’s just surprising. And I think I do want to push on it, even though I just totally believe you, but I think I want to push on it because I have this feeling that society tells me that my child going to the best possible preschool or daycare during their early years is incredibly important. And there are 12- to 18-month waiting lists for preschools for eight-months-olds. Is that really mostly hype?
Emily Oster: Yup.

What actually makes a difference in young kids’ lives

Emily Oster: There are two things that I think are simultaneously true but hard to hold in your head at the same time. One is that most of the choices, the individual choices that you are going to make about your kid when they’re little, do not matter at all. So most of whether you choose to breastfeed or sleep train or not sleep train, or whether they go to the Montessori preschool, or whether they go to the preschool down the street that has Reggio Emilia — these things, the effects are so small that they are very, very unlikely to matter.
It’s also true that the experience that kids have between zero and three is probably the most important that they will ever have to set them up for a life of success. And by the time you get kids at three, the difference between kids who are raised in poverty and kids who are not, it’s already there. Eva Moskowitz has a really nice thing in her book about the block achievement gap. When she gets kids at kindergarten, the kids who have grown up with fewer resources are not building block towers up: when she has them play with blocks, they build flat. And the kids who are raised with more resources are building up. So there’s so much that happens before five. And yet these things that you’re like, “How do I pick the preschool? This one has a master’s degree.” It’s like, that’s completely effing irrelevant.
The answer is that there are things that are relevant, and they are: having a stable place to come home to; having some loving caregiver who is paying attention to you — could be a daycare provider, can be a nanny, can be a parent, can be another parent, can be a grandparent — it’s like having somebody that feels stable, or several people who feel stable; having enough to eat every day; having enough sleep; having access to childcare; not being exposed to abuse and trauma and toxic stress. That’s the whole thing. And the thing is you’re not asking about those things, because that’s not a thing you’re thinking about choosing: that’s already something your kid is going to have, because of the privilege of where they’re going to be born into.
And so that feels to me so important, because we spend all this time in policy space. The people making the policy are spending all of this time in their heads with these decisions that feel really fraught — but actually are completely irrelevant. And we’ve sort of missed that there are things we could impact with policy — by having better paid leave for everybody, by having better childcare subsidies, by giving people all of those things we could be. And those things really do matter, and yet we’re not talking about them because they seem so obvious to the sets of people who are making the policy. Thank you for coming to my TED Talk. Sorry.
Luisa Rodriguez: No, it’s great. It’s very compelling and reassuring. Again, I do feel like a really big part of me believes you, and another part of me is like, “But I have so many stories about people remembering that their parents worked super late and felt sad or neglected by that!”
Emily Oster: I mean, you’ve really got to be careful with anecdotes because you’re also going to find people are like, “My mom quit her job so she could be home every minute with me, and then I was the repository for all of her failed dreams. And I wish she had had a job so she wasn’t constantly on me about how I had to be.” I think it’s tricky. Many people don’t like their upbringing, and one of the features of humans is that we’re always trying to fix the stuff that we feel that our parents messed up. And so I think we do want to be a little bit careful about that.
Like, my son the other day, I told him… I walk my kids to school almost every day. I’m home for dinner every single night. I rarely travel. I spend a lot of time with them. The other day I told my son that I would see him in the morning, but I wasn’t going to be able to walk him to school because I was going out on my long run, and I wanted to leave early enough to whatever. And he told me, “Do you care about your long run more than you care about me?” So no matter how much time you spend with your kids, sometimes they’ll ask you that. And you have to have the fortitude as a parent to be like, “I love you more. I would choose you over running, but for tomorrow I care more about my long run than I do about you. And so you’ll have to walk to school by yourself.”
Luisa Rodriguez: Yeah. I think you’re right. It totally sounds consistent with what I actually think about these anecdotes: that most people have complaints about their childhood, and mostly when people have really strong complaints, it is because things have gone more wrong at the level that you’re talking about — with stability and basic needs being met or not. I’m curious if there’s anything else that might matter, besides those basic things?
Emily Oster: Not spanking your kids. No physical punishment. Reading. Reading shows up. Reading to your kids, talking to them. But not talking in an obsessive, weird way, where you have to like narrate every diaper change. But we do see that it’s probably something like the number of words kids hear tend to show up. Those are kind of it.