It is a Yiddish expression, meaning roughly “an old woman’s superstitions.” Here are three pieces of advice given to my daughter concerning the recent birth of our first grandchild that struck me as bubbe-meisis.
1. If the fetus is below the 10th percentile in estimated weight at the 8th month, the risk of still birth is sufficiently elevated that labor should be induced immediately.
2. If you want your milk to come in, you must not allow the baby to drink any formula.
3. If you allow your newborn to sleep on its stomach instead of its back, the risk of SIDS (sudden infant death syndrome) is very elevated.
If your grandmother said such things, you would probably ignore her. Unfortunately, these opinions were rendered by my daughter’s obstetrician, lactation consultant, and pediatrician, respectively. Hence, they had the force of Authority.
(1) does not take into account: the huge margin of error in fetal weight estimates; the fact that still birth is such an unusual event that unless the fetus is showing clear symptoms of acute distress it is very difficult to find factors that have reliable correlations with still birth; and the fact that different women tend to give birth to infants of different weights. I would bet that our grandson was in the 50th percentile of the weight that was expected for a child of his parents. So his low estimated fetal weight was not a signal of any distress whatsoever.
(2) strikes me as more ideology than science. If the mother is nursing correctly, how soon her milk comes in (or whether it comes in at all) depends on many idiosyncratic factors. Denying the infant any formula at all will mostly serve to starve a baby if the mother’s milk is not available.
(3) Again, we are talking about a rare event where we do not know the causal mechanism. If there is any effect of sleeping on the stomach, it is not materially significant. There has been a small decrease in the rate of SIDS death since the back-sleeping advice started to be given, but there could have been many other factors that changed over this same time period. Meanwhile, as soon as he is put on his back, our grandson wakes and cries, while on his stomach he sleeps like, well, a baby–but he is not allowed to do that.
These bubbe-meisis deal with phenomena that have what James Manzi calls causal density–there are too many potential causal forces at work to have a definitive theory of the process. Many factors can cause still birth. Many factors can cause a mother to be unable to supply enough milk to a newborn. Many factors might be implicated in SIDS.
Nonetheless, most people would rather listen to an Authority who offers a specific causal theory rather than one who says “we don’t know.” So economists who dispense Keynesian bubbe-meisis are listened to, and those of us who say that we don’t know how to create patterns of sustainable specialization and trade are not.
By the way, so far our grandson is doing fine. Our daughter compromised with Authority. She refused to be induced in week 37, and only caved in at week 39. She limited her infant’s intake of formula, but she did not eliminate it altogether. As for sleeping, because he cannot sleep on his back, he tends to fall asleep on someone’s chest (face down, of course). If an Authority knew this, would he or she give the parents a pass to let the baby sleep on its stomach in the crib?
There is enough going on with the formula/milk problem that what I can say is that formula enters into a number of complex feedback loops where it may be needed in acute cases but certainly will complicate and likely dysregulate systems in normal cases. Pump and store is also problematic. Understanding the system is still sufficiently distant that it is easier to just focus on working with it, for the moment.
Congrats on becoming a grandfather, Arnold, and congrats to your daughter.
Bubbe wasnt clueless, she occasionally knew a thing or two.
Better to get advice from close blood relatives with lots of experience raising health, successful kids, aka first order approximation to personalize medicine.
For example, I have a lot of kids. My recommendation: get an extra big, extra cushy bathmat. Babies love to lay down on then, helps calm and quiet them and they often fall asleep. Fieldcrest brand from Target is a good example.
With regards to sleeping position, we ended up laying our son down on his side. Assuming the studies are true, there didn’t seem to be a meaningful difference in SIDS risk between sleeping on the side vs. on the back. Our concern with back sleeping was that, if he spat up, he wouldn’t be able to turn over and spit it out. Thus we put him in the “recovery position” where his lower arm is out in front of him, so that if he did roll over it was onto his back rather than front.
We had our first baby recently. (1) we never heard, but (2) and (3) we did.
There seems to me some sense to (2) in that milk production seems to be gauged a lot on demand (eg, how frequently the milk ducts are emptied, which stimulates various hormones that regulate production). However, that is what it would have to mean, to nurse until production was stimulated. That would not necessarily be the same thing as the baby never having formula if he were still hungry after nursing all that he could.
For example, imagine it would take 4oz for the baby to be full and satisfied, and for whatever reason, only 3oz was available nursing. To nurse for 3oz, and then supplement with 1oz of formula would accomplish both goals (modulo some debate about the frequency of nursing.) The complication is that in day-to-day life, that would difficult to gauge, and overfeeding on formula could “underfeed” as it were on breast milk.
My guess is (2) is stated as an admonishing absolute, but it really only means: “If you feed your baby formula, you baby won’t need to nurse as often, which will probably result in a lower milk supply. If your goal is to breastfeed your baby, formula is unlikely to be of any help to that goal.”
(3) I got the most, especially when looking at mattresses and bassinets and things. The more I read, and after looking up more on SIDS, the more I came to discount it. It seemed so much more insistent not the least of all because there was so little real evidence. Our daughter usually prefers to sleep on her back, but if she rolls over and is still comfy and happy, we just let her sleep.
My mom mentioned regarding (3) that they were told by the child experts of their day that it was imperative that babies sleep on their stomachs.
If (3) turns out to be true–and as I mentioned, I have serious doubts about that–it means that the experts a couple of generations back were emphatically insisting that people do precisely the wrong thing.
That at least gives me pause on any “you must do it *this* way” child care expert advice.
When my wife was pregnant, something that frustrated me was that doctors would tell us what to do without giving us any data. When they would tell me, “X increases the risk of Y so we should do Z”, I would ask, “by how much is the risk increased? And what is the baseline risk? And how do we know these numbers?”. Most doctors were not helpful on this (Emily Oster’s book was, though). It was important to me because I’d rather choose tradeoffs myself than have my doctor choose for me using their own views of appropriate risk aversion.
I am not sure what listening to those that don’t know would mean. Often these operate by avoiding what hasn’t worked.
“3. If you allow your newborn to sleep on its stomach instead of its back, the risk of SIDS (sudden infant death syndrome) is very elevated.”
When my first kid was born in the early 90s, a nurse tore me a new one because I was letting her lie on her back while we were still in the hospital (she wasn’t even sleeping). The supposed SIDS risk then was choking on vomit. A little later, the profession did a complete 180 and decided that smothering from stomach sleeping was the real danger. I think at one point they were pushing for side-sleeping, but the problem with that is it is unstable, and you don’t know which way baby’s going to roll. But, in any case, the lack of actual research data never weakened the apparent authoritative certainty of the professionals (often wrong but never in doubt) — not even in the case where they’ve had to reverse their previous position recently. I don’t suppose the fact that the medical profession has had to backtrack on the value of low-sodium and low-fat diets will induce any humility either. Another fun one — there’s apparently no data backing the value of RICE (rest, ice compression, elevation) for sprains. But they don’t stop recommending it because they can hardly say, “Actually, we don’t know for sure if it does any good or not”.
Um… A 50% drop in SIDS deaths isn’t a “small” decrease
Actually, a 50 percent drop is small in this context. It is numerically small, because the baseline death rate is small. More important, there are many other factors that changed that are not controlled for. Medical epidemiology is notorious for findings that do not hold up.. See the Sarewitz article referred to in the next post.
Imagine that “putting the infant on its back” had to go through the FDA approval process in order to be allowed as a treatment. In that case, you would need to run controlled experiments. Because the rate of SIDS is so low, you would need thousands and thousands of subjects.
No one is going to pay for such experiments.
Small numerically? Hmmm, I suppose so. But SIDS was and still is the leading cause of death in infants in the US. So I think it’s rather ridiculous to poo poo the “back is best” policy unless you’re going to be just as cavalier with all other leading causes of mortality in an infant.
Congrats on the grandkid, by the way. I’m a long time lurker on here. But as a dad of a 2.5 year old and a 5 month old who is married to a (non-pediatric) physician, I wanted to chime in. I think you really need to Google the stats again at the very least.
Chris has the better side of this argument, I think. A 50% decline is large for any public health intervention. And, of course, while any public health intervention will have confounds, it’s not like there’s just one study that suggests benefits of back sleeping or risks of stomach sleeping. Reductions in SIDS have been associated with harm reduction campaigns in several countries. And more than one epidemiological study has associated stomach sleeping with risk. Here’s the first paragraph from the task force discussion:
Prone sleeping has been recognized as a major risk factor for SIDS, with odds ratios ranging from 1.7 to 12.9 in various well designed epidemiologic studies.6,,1418–21 The plausibility of a causal association between prone sleep positioning and SIDS is made most compelling by the observation that in countries, including the United States, in which campaigns to reduce the prevalence of prone sleeping have been successful, dramatic decreases in the SIDS rates have occurred. The association is further strengthened by observations that in cultures in which prone sleeping is rare, SIDS rates historically have been very low.22,,23In addition, several studies have documented that the statistical relationship between prone positioning and SIDS often strengthens when corrections are made for confounding variables.6,,24,25
Now, I am not a fan of epidemiological studies when the alternative is a randomized, double-blind clinical trial. But for many settings epidemiology is the best one can do. When the evidence across multiple studies all points one way. It seem *very* unjustified to rubbish this because it wouldn’t meet the standard for a drug. Correct. But it’s not a drug. Epidemiology can be done poorly, and carelessly. But there is no evidence that this is such a case and much evidence the other way.
Heart felt and sincere Mazel Tov on the birth of your grandchild.
First, congrats to the whole family, Arnold. As for the etymological discussion, I’ve always heard it as “bubba meinses” (pronounced MINE-sys) with an “n”.
Our lactation consult said the exact opposite!
Babies gotta eat. Feed him/her. Relax and the breast feeding will come.