Transcript

Cold open [00:00:00]

Emily Oster: When I was a kid, Mikey Bright’s mom made these cupcakes for bake sales. They were chocolate cupcakes, and she would dig out the top of the cupcake and put in whipped cream, and then put the top back on. And like, man. Grace Bright, if you are listening to this, I remember those cupcakes so well. And my mom was always like, “Sign up for plates. Make sure you sign up for plates or soda. And if you have to do something, box brownies, but really, you’ve got to get the sheet first so you can get the plates.”

And I remember being like, “When I have kids, I’m going to be the mom who makes the cupcakes.” And then I had kids and I was like, “Sign up for the plates!” Because you can’t actually be the… You can’t. And that’s no shade on Mikey Bright’s mom, that’s no shade on my mom. It’s just there isn’t time in the day for most of us to be both hand making cupcakes and also working a full-time job. Figuring out what are the things that you feel you need to show up for, and that are the ways that are going to serve why you became a parent, and what you want to be showing up for for your kids, I think that’s the most important thing.

Luisa’s intro [00:01:10]

Luisa Rodriguez: Hi listeners, this is Luisa Rodriguez, one of the hosts of The 80,000 Hours Podcast.

Today’s guest, Emily Oster, is a bit of a celebrity among the parents at 80,000 Hours, who say Emily’s books were really the only books about pregnancy and parenting that took an evidence-based approach to what feel like the extremely high-stakes decisions that come up constantly when you’re expecting a kid, and then even more so when you’re raising one.

Questions like:

• Lots of doctors will warn you about taking antidepressants while pregnant, but what reason is there to think that doing so has negative effects on your child?
• Tonnes of women, myself included, have the belief that getting an epidural during childbirth is somehow bad, either for the mom, or for the baby, or both. How bad is it really?

To answer these questions, Emily looks only at high-quality published studies — so ideally experiments, and if not, natural experiments — and she doesn’t come in with preconceptions about whether, say, exclusively breastfeeding is beneficial, or drinking alcohol during pregnancy is harmful.

Spoiler: Emily’s take is that lots of people probably obsess a bit too much about how individual parenting decisions affect kids’ outcomes — with only a couple of exceptions.

In addition to questions about pregnancy and parenting, we also talk about the impact of children on your career and relationship:

• Do parents work less? Earn less? How much less?
• Does delaying childbirth reduce the negative impacts on your career? And if so, how does delaying childbirth affect your chances of getting pregnant?

So this interview is especially for folks who are already parents; expectant parents; people who want to have kids; and people who might want to have kids, but who are unsure and want to know the empirical evidence on how kids can affect your personal life, and how much impact you can have with your career.

But it might also be of interest to anyone who wants to have an opinion on the “Mommy Wars” and enjoys research conclusions that run starkly against conventional wisdom and what people will hassle you and tell you to do.

OK, before we dive in, I wanted to briefly mention that the 80,000 Hours advising team currently has capacity to speak to more people one-on-one about their career decisions — I’ll share more details after the interview, but if you can’t wait until then, you can learn more and apply at 80000hours.org/speak. Applying takes just 10 minutes.

All right, without further ado, I bring you Emily Oster.

The interview begins [00:04:04]

Luisa Rodriguez: Today I’m speaking with Emily Oster. Emily is an economist at Brown University and the author of three hugely popular books — Expecting Better, Cribsheet, and The Family Firm — which provide evidence-based insights into pregnancy and early childhood, really kind of challenging conventional wisdom, and offering parents data-driven guidance on important and incredibly divisive questions that parents and soon-to-be parents face all the time.

Thank you so much for coming on the podcast, Emily. It’s really a pleasure to have you.

Emily Oster: Thank you for having me. I’m really excited to talk.

The Mommy Wars [00:04:37]

Luisa Rodriguez: Cool. So I hope to talk about the impacts of having kids on your career, and then also the impacts of pursuing an ambitious career on your kids. But first, I’m not a parent yet, though I do hope to be in the next few years. But a thing that I’ve heard a lot about and that makes me very nervous to become a parent is the “Mommy Wars.” Can you explain what the Mommy Wars are?

Emily Oster: The Mommy Wars, I would say, is a catchall term for the pressure and judgement that parents put on themselves and each other. So if you think about the canonical idea of the person in the playground who says, “Oh, I see you’re using formula. Is that a bottle?,” or says, “Your kid is three and they’re still not potty trained?,” or says, “Your kid is three and you force them to be potty trained?” — those are the Mommy Wars. It’s all of the again, judgement, shame, talking about the ways that we’re doing this and telling each other that we’re doing it wrong. It’s that.

Luisa Rodriguez: I guess as a nonparent I find it — and I’m sure this will all feel silly feeling this way in retrospect — but I find it kind of hard to imagine becoming really judgemental of other parents, because I have this feeling of like, it seems extremely hard. I don’t think I’m going to do an amazing job; I think I’m just going to barely be doing enough. But maybe it just happens to everyone once you experience parenthood. Did you become more judgemental of other parents after you became a mom?

Emily Oster: Oh, for sure. Everyone does. And I think that the way I would describe it is: when you have a kid, and you’re trying to figure out what to do with them, you have never wanted to get something right so much. And it’s in a way that’s difficult to describe. I was thinking, as you were saying that, could I give you an example of a thing that might help you understand how much you care about getting it right? But it’s like, no, there isn’t anything like that. It feels high stakes in a way that almost nothing else in our lives has.

And it’s that desire to get it right that I think is what underlies the desire to judge other people. It is, “If you’re doing it differently from me, and I want to get this right so much, it must be that you’re wrong — because it has to be that I’m right, and that I’m just the rightest, and my right is the right for everybody because it’s so important to do this thing.” And I think that’s where it comes from. In some ways it comes from a good place. It comes from wanting to be the best parents that we can be. It’s hard to accept that your right is not everybody else’s right.

Luisa Rodriguez: Yeah. Is there anything in particular that you were like, “I don’t love that I’m a part of this whole judgemental thing, but I’m super judgemental of X when I see other parents doing it”?

Emily Oster: I think that there were more of those things when I was less in it. At this point, I’ve talked to so many parents who are doing things so many different ways, and I’ve spent so much time in that literature, that there aren’t many things. I mean, there are few cases, like I don’t think that physical punishment is a good idea for kids: I don’t think it achieves what people aim, and I don’t think it’s right in an ethical sense. That’s a personal belief. It’s not so much that I would judge other parents for doing that, but if you asked me, “Is there something that you don’t agree with?,” that is an example. But the broad range of things in the world, now that I’ve spent enough time in this space, I would say mostly no.

Luisa Rodriguez: Yeah, OK. The closest I’ve gotten to having a sense of what this feels like — and I’m worried it’s going to be maybe the wrong thing to say — but I recently got a puppy, and I care loads about making the puppy happy, helping the puppy flourish, and just becoming a good dog that isn’t anxious and that doesn’t have separation anxiety when we leave.

And I’ve learned a bunch of things, like positive reinforcement training is great, and negative reinforcement training is terrible; and if ever someone negatively reinforces their dog in some public space, I’m like, “Don’t they know that’s terrible for them?” And obviously a dog is very different from a human baby, but I do feel like I get a tiny bit of the high-stakes-ness of it: it’s going to affect this dog for the rest of their life.

Emily Oster: Absolutely. I think it’s not as dissimilar as people might think. What you have described is very much what it is like to parent. There is a difference in the stakes, probably, and there’s a difference in the number of things. So you described a couple of things, but there are many aspects of dog ownership which are just, you just do it that way.

And in parenting, every single thing is subject to this: what you feed them, when you feed them, when you introduce solid foods, where they sleep, what they sleep with, who sleeps in the room with them, when do you sleep train them, at what age? What are you doing while you’re breastfeeding them? If you’re breastfeeding them and you’re texting, somebody asked me that the other day: Is it bad to breastfeed and be on my phone? Apparently that’s called brexting. Is brexting bad? So it’s the whole range of things. A million of those dog examples. But imagine higher stakes for every single one, and there are 50 times as many, and that’s parenting.

Luisa Rodriguez: Yeah, that makes sense. It sounds terrifying. It is funny that you mentioned brexting, because I just asked my dog trainer friend, “Is it bad that I’m texting while I’m playing with my puppy? Will my puppy feel neglected?” So anyways, again, a million differences, I’m sure, but maybe there’s a bit to that.

Emily Oster: You’re going to be so ready. In my house, we only have snails. I have two kids and a lot of snails, and snails are not like children.

Luisa Rodriguez: Nice. And I bet you’re very judgemental about other people’s snails.

Emily Oster: How other people raise their snails. Absolutely, 100%. Feeding them carrots instead of cucumbers, which obviously they like more.

Luisa Rodriguez: Obviously that’s going to screw them up for life.

Emily Oster: Totally.

Luisa Rodriguez: OK, well let’s dive into some of your books. Maybe one final thought before we get into it: it is just wild to me, in reading them, how often the advice or the views people have, they’re not just like, “Is this a bit better, or is that a bit better?” — it’s like, “Is this thing good, or will it ruin your child’s life?” I feel like that is part of the high-stakes-ness of all of these questions that we’re about to talk about.

Emily Oster: It’s such a good instinct. And you’re exactly right that when we talk about these choices, there’s two different things you might ask of the data. One is: Is one of these things directionally, in a statistical sense, better than the other? And the second question you would ask is: Is it a big effect? And in almost no case is it a big effect.

We’re arguing about is there any effect, and when we argue about it, people want to say that if there’s any effect, the effect must be infinitely large — they sort of miss the second question about how big it is. And so every debate is like, “If you do this, either your kid is going to be ruined forever or be an unyielding genius.” And it’s like, well, actually, it really doesn’t matter very much. Even if it matters a little bit, it’s not enough to not be outweighed by other things in many cases. So it’s a very good insight.

Luisa Rodriguez: Totally. Well, hopefully we’ll come back to it, but I’m curious which things do have big effects. But yeah, good to keep in mind that for lots of these, we will probably be talking about small differences.

Pregnancy [00:12:24]

Luisa Rodriguez: OK, let’s talk about your book Expecting Better, which is about conception and mostly pregnancy, what to expect when you’re expecting. And I should note that a bunch of my questions here are actually coming from my colleague Keiran and his wife, who are about to have a baby in less than a month.

I’ve heard warnings about taking antidepressants during pregnancy and while breastfeeding. This is of particular interest to me; I’m on an antidepressant, and it makes my life so, so much better. What’s the evidence on this?

Emily Oster: Antidepressants are what I think is a really tough but good example of where we don’t talk enough about tradeoffs, and where the data isn’t that good. So there are a lot of women who are on antidepressants during pregnancy. On the one hand, we know that this is a medication that can pass through to the placenta. That’s true of almost any medication — there are a few exceptions — but there is no systematic evidence to suggest that this would cause problems for the foetus.

The data is not so extraordinary that I would say we could rule it out. It’s not that you could say, we know from large randomised trials that all SSRIs are completely fine. I think the data is reassuring, but it’s not perfect. For some people, they will look at that and say, “I can’t be sure, and so I’m going to go off the antidepressant.” And some doctors, I think, will say, “To be as safe as possible, you should go off your antidepressant.” What I think that misses is the fact that people aren’t taking antidepressants for shits and giggles: they’re taking them because they make them feel better.

And there is a really important conversation to be had for every individual about should I stay on these or not? I think most doctors realistically will tell you that you should stay on them if they’re working for you. And sometimes people will try to dial down the dose a little bit, if that seems feasible. But it’s a really good example of where nuanced, joint decision making is kind of necessary to make the right choice, and where this phrasing of, “to be as safe as possible” really misses something — because it’s kind of putting an idea of safety, like having a single vertical about safety. It’s like, actually, what’s safe for me as a person is to be on this medication, because that is what is helping me, helping my mental health, doing all this other stuff for me. So that’s a part of safety, too.

Luisa Rodriguez: Totally. Yeah. And even broadening the definition of safety for the foetus, where me being a well and happy person might have other impacts on how I’m able to live and thrive as a person, carrying a baby around and then raising one.

Emily Oster: Absolutely. And the same thing could be said about breastfeeding. Again, same thing: SSRIs pass through breast milk. Not any obvious reason to think they would be problematic for a foetus. Also super useful for treating postpartum depression, which is also not good for your baby.

So again, I feel like we’re often, in these conversations, pursuing the first best — and saying, “Well, the best thing would be if you were a person who didn’t suffer from depression.” It’s like, “OK, but that’s not available.”

Luisa Rodriguez: Right. I agree. That would be great.

Emily Oster: “I agree. And also, can I have a pony? But right now I need the antidepressant, I don’t have a pony. Where are we going to go from there?” And I think that part of the conversation is so often missing.

Luisa Rodriguez: Is there a specific mechanism by which people think that antidepressants might harm babies?

Emily Oster: Not really. I mean, it’s just we don’t know that. The antidepressant example, my sense is that we don’t know that much about how they work in the brain at all. And so it’s one of those things, we don’t know how they work in your brain, it’s just hard to know.

Luisa Rodriguez: Right. OK, so taking medications could be complicated. We especially don’t know how antidepressants work, and so we’re especially unsure if they’ll have an effect. But there is good reason to think that being very depressed with a newborn baby is bad.

Emily Oster: Yes.

Luisa Rodriguez: OK, good to know. Moving to another one, what’s the evidence on drinking alcohol while pregnant?

Emily Oster: So on the question of drinking heavily during pregnancy, it’s very clear that consuming a lot of alcohol, many drinks at a time during pregnancy can lead to physical birth defects. Foetal alcohol syndrome can also probably lead to behaviour problems, effects on cognition. That’s a pretty clearly established fact.

When we look, however, at occasional drinking — so even up to a drink a day in later trimesters — we just do not see evidence of the same kinds of impacts. So you can look at large studies, mostly in Europe, where this sort of drinking behaviour is much more common, and we just don’t see much — we don’t see anything, really — in the way of differences across kids when we look at cognitive test scores or we look at behaviour, which is where we’d be looking for these kind of impacts,

I write about this in Expecting Better. I talk through the data in a lot more detail than we can go through here. When I was writing the book, I spent even more time — so there’s a 50-page appendix behind the appendix behind the appendix, where you really try to dive in. And some of the studies are better than others, but I think the evidence is pretty compelling in the direction that there aren’t significant impacts at these lower levels.

Does that mean everyone is going to want to consume the occasional drink during pregnancy? No, I think for many people it’s like, “You know what? This isn’t for me.” And then there’ll be people who will say, “I would love to have a glass of champagne on my anniversary, and that’s something that would improve my life.” And those both feel to me like valid choices, given what we see in the data.

Luisa Rodriguez: So the data we have is primarily from areas where it’s relatively more common to have a moderate amount of alcohol while pregnant?

Emily Oster: Yeah.

Luisa Rodriguez: Can you say more about what’s being compared? Is it people in one country where some people drink, some people don’t, and we know very specifically who those people are, and collect data on those kids’ outcomes?

Emily Oster: Yeah. So it’d be something like this very large study in Denmark: it’s like 100,000 people, you’ve got information on their reported drinking behaviour in pregnancy and you have the outcomes in their kids for their kids later. And you have categories of people, some of whom are drinking quite a lot, some of whom are not drinking at all, and some of whom are drinking up to seven drinks a week, these sort of categories. And you can graph out things like cognitive scores or behavioural scores across these categories. That’s the kind of data we rely on for most of this.

Luisa Rodriguez: Yeah. And is it the case that there are enough people in the category of drinking moderately, but not super heavily, that we’d be able to pick up on some smallish effects?

Emily Oster: So these sample sizes are big if you aggregate across everything, and this is a pretty common level of drinking. The US is actually quite unusual in the sense that we have a much larger concentration of drinking behaviour — this isn’t about pregnancy; it’s just a general comment: we have a much larger concentration of people who are completely abstinent, and people who drink a tremendous amount. Much of the sample in Europe would be right more in the middle of this. As the sample size grows, you can rule out smaller effects. The smaller an effect you want to find, the larger your sample needs to be.

So in an ideal world, you would have a randomised trial of a million people in either treatment arm, and you could accept or reject very small impacts. We don’t have that, and that means there could be very small impacts in either direction. Actually, the directional effects of this go sort of, in some cases, go the other way. That’s probably also a selection impact, but it’s very difficult to rule out, in any case, to rule out small effects of anything. And I think that’s just the reality of evidence.

Luisa Rodriguez: That’s just the reality.

Emily Oster: And then I think, again, you want to ask, like if someone told you that having an occasional drink would on average lower your kid’s IQ by 0.00001 IQ points, you could say, “Well, I’ll take every .00001 that I can.” But I think you also have to accept there’s a lot of things you’re doing that are probably mattering at that scale. Like with everything we talk about in parenting, I think it’s worth thinking about the size of the impact, not just whether there is anything in the space.

Luisa Rodriguez: Right. OK, so we know heavy levels of drinking do cause negative impacts on a foetus, and so it would be kind of surprising if those negative effects just kind of cropped up at heavy levels of drinking. I’d personally expect it to be the case that there are big effects at heavy levels, and maybe more moderate ones at more moderate levels of drinking. And maybe it’s hard to pick those moderate effects up in a study because maybe there are reasonably small effect sizes, but they might still be there, and they might still be important and meaningful. Does that argument hold weight for you?

Emily Oster: So I think that there are biological reasons having to do with how you process alcohol that make that extrapolation a bit more complicated than you might think. So as your body is able to process this in your liver, it’s passing into your bloodstream; as you’re not processing it in your liver then that is passing in. So in some sense, there’s a relationship in the concentration that I think means that the argument you are making is not obvious in theory. The foetus is able to process some of these components as well. So I think it’s more complicated than that, but I think that idea is for some people, like, “You know what? That’s it for me. I don’t want to do this” — which is of course completely a matter of individual choice.

Luisa Rodriguez: Sure. Yeah, it’s interesting. It hadn’t occurred to me that there could be a thing where there is an amount of drinking that the body can just process before it starts having damaging effects.

Emily Oster: I mean, alcohol is generally a sort of complicated topic, but if you look at the relationship between drinking and health, there isn’t much relationship at low levels of drinking — if anything, some people would say in some cases it goes the other way — and then at high levels there is.

Luisa Rodriguez: Sure. OK, kind of similar. How about caffeine? This one scares me, because I very much depend on my caffeine.

Emily Oster: Caffeine is actually quite an interesting case, because the particular concern that’s raised with caffeine is miscarriage — concern that excessive caffeine consumption, in the first trimester in particular, might lead to increased risk of miscarriage.

First of all, I should say that reassuringly, almost no data suggests a link between like, two cups of coffee a day — and miscarriage. So if you’re sort of in that range, there’s basically nothing in the data that would suggest it’s an issue. As you extend up to six, eight cups of coffee a day, you do start to see some correlations with miscarriage risk.

And I say “correlations” there because there are a couple of things that make us very sceptical about there being a causal relationship between the caffeine and the miscarriage. One is there’s a very obvious confound with age, which is actually hard to completely control for. So older women tend to drink more coffee; miscarriage is also more common in older women for reasons that don’t have anything to do with coffee.

The second, much more pernicious issue is that women who are nauseous are less likely to miscarry. There’s a relationship between nausea and miscarriage risk. There’s a level of hormones that makes you, if you’re nauseous, you’re less likely. Not that people who aren’t nauseous are necessarily going to miscarry — I always want to say that — but there is a correlation there. One of the things that you avoid with nausea is coffee. It’s one of the most nauseating things, particularly because people often have it on an empty stomach first thing in the morning, and a very common way for nausea to appear is when you first wake up. You don’t feel good, and then you don’t just want to drink a cup of coffee on an empty stomach. So what we see is then people reduce their caffeine consumption if they’re nauseous, and then they don’t miscarry — but actually it’s like this thing in the background that has nothing to do with the coffee.

And when you try to suss all of those out, I think it’s just basically: coffee is fine.

Luisa Rodriguez: Right. Until maybe six to eight cups, which is a lot of coffee.

Emily Oster: It’s a lot. So if you’re at eight cups before you get pregnant, if you’re having eight cups of coffee, try to cut down. That’s too much coffee. I don’t want to be judgmental, but you could say, try to cut down a little bit. But if you’re having three cups of coffee a day, I don’t think you need to freak out.

Luisa Rodriguez: OK, yeah. Is there anything that someone definitely should or shouldn’t do while pregnant? Because it seems like a lot of the points in the book are like, “X is said to be terrible for your foetus. In fact, the evidence doesn’t support that that much.”

Emily Oster: In this category of behavioural stuff, I would say one thing is smoking. There’s pretty clear evidence that smoking cigarettes is bad, and for reasons that we understand. It kind of shrinks some of the vessels and makes less stuff go through the placenta, so it tends to be associated with lower birth weight. It’s probably the most significant impact.

And then there are some of the forbidden foods — not all of them, but some of them that you probably want to be somewhat careful about. Anything that’s currently linked to listeria, which is a very bad illness, is an example. Raw shellfish are not great for various reasons. So there are a few things like that, but it’s a smaller list than most people get.

Luisa Rodriguez: Do you mind listing those things?

Emily Oster: OK: rare meat and poultry — that’s linked toxoplasmosis. Unwashed vegetables and fruits –you should always wash your vegetables and fruits, but you should wash them more during pregnancy because they get dirt on them, they can have stuff. Raw milk cheese — raw milk cheese is one of the more consistent links with listeria, which is very bad. And then I have deli turkey on this list — of the deli meats, it’s the most listeria-linked because stuff likes to grow on turkey.

Luisa Rodriguez: So those are the things that actually likely have an effect?

Emily Oster: Well, yes. Those are the things that I would say there’s a legitimate reason to think you would want to be more cautious about during pregnancy. It’s still true, for something like listeria — which is the most significant of the risks during pregnancy — that it’s really, really rare. It’s really rare. So you wouldn’t say like, for sure, if you eat deli turkey, you get listeria. Almost nobody gets listeria. It’s very uncommon. It just shows up at random. But it is probably a little bit more risky in pregnancy than elsewhere. And all these things are just about tradeoffs.

Luisa Rodriguez: Makes sense. So it seems like there are a bunch of things you might not want to do when you’re pregnant, but there’s also a window of time when you’re pregnant, but you don’t know you’re pregnant yet. I’m curious how risky that period is for your baby, and if there’s anything you can do about it?

Emily Oster: People call this the “two-week wait.” Step back for a second: if you think about the way the menstrual cycle works, you get a period, and then about halfway through your cycle, which for most people would be around 14 days, you ovulate: an egg is released. If there is sperm available at the time and they meet up and they fertilise, there’s fertilisation. And then that travels down the fallopian tube and it implants in the uterus. And at that point, maybe around the time of your missed period, or shortly before, you will test positive for pregnancy.

There’s those two weeks between ovulation and when you miss your period, in that time frame, which people sometimes call this two-week wait, where you don’t know if you’re pregnant. All of the cells at that point are undifferentiated. So the way that this works is the egg is fertilised, it splits, it splits, it splits, and eventually the cells start differentiating. Some of them become the brain, some of them become the spine. That happens around two or three weeks. Until that point, they’re all undifferentiated.

What that means is if you kill some of those cells with a behaviour — and an example of this behaviour would be very heavy alcohol consumption during that period might kill some of those cells — one of two things will happen: either the embryo, or at that point it’s a blastocyst, will not implant and you will never become pregnant; or the cells will replace themselves, because all the cells are the same, and everything will be fine.

So at that point, there’s a little bit of an all-or-nothingness to this, which is that either it doesn’t result in a pregnancy because of some behaviour, or everything is fine. Once you get past that, then some kinds of behaviours — heavy drinking being a classic example — can impact the foetus in the long term, because as things differentiate, they can’t replace each other. So if a part is damaged, then it may be damaged forever. So that’s the two-week wait science.

Luisa Rodriguez: OK, that makes sense. So it’s basically like you might think you never became pregnant is the worst case — and if you’re trying really hard, that might mean that drinking heavily is maybe not worth doing for you, even though it wouldn’t directly result in a foetus with major issues.

Emily Oster: Yeah, exactly. And I mean, we talk a lot about drinking, and there’s other reasons why you shouldn’t be binge drinking that’s not good for you — like, full stop, as a person. But there are other things in that space.

Luisa Rodriguez: Cool.

Recent developments in pregnancy [00:30:29]

Luisa Rodriguez: Is there anything you’ve learned about since publishing Expecting Better that relates to pregnancy that you’d now put in if you were writing it again?

Emily Oster: I have written it again many times. Expecting Better came out in 2013, and I’ve revised it a bunch of times. And sometimes that’s updated studies — there’s a bunch of updating to our recommendations about sleep — and then there are technological innovations. Relative to when I was publishing this book, our technologies for prenatal testing have improved tremendously, so the newer versions of the book are different on that dimension just because the technology is different. But most of the technology for having babies is pretty much the same. They’re coming out of the same area as before.

Luisa Rodriguez: Any of those technological changes worth highlighting? Anything feel like, “I really wish I’d known that,” or, “If I were pregnant now, I’d really want to think about this”?

Emily Oster: Genetic testing is the most interesting space. Before about 2015, if you wanted to detect Down syndrome or one of these more common genetic issues, you had like two options. One was a series of ultrasounds and blood tests that would tell you some information, but weren’t perfect — they were sort of measuring different neck folds and using that as a signal; they had a lot of false positives, a lot of false negatives. Or you could do an amniocentesis or something called the CVS test — both of which are kind of invasive tests which carry potentially some risk, but would tell you for sure; they let you sequence the genes.

In the 2014/2015 era, they made a huge advance in something called cell-free foetal DNA technology. Basically, in the mom’s bloodstream, there are foetal cells moving around. You share blood with your foetus, and some of your foetal cells are in your bloodstream. And they advanced the technology such that they can take some of mom’s blood and basically isolate those cells.

Luisa Rodriguez: Wow.

Emily Oster: “Isolate” them isn’t quite the right word: they can do things with the blood. That’s also not a technical term. They can do things where they can learn things about the foetal genome from the mom’s blood.

I think the simplest way to explain that is to say, if you wanted to know if you were having a boy or a girl, mom’s got two X chromosomes — if there’s a bunch of Y chromosomes floating around, I guess it must be the baby. There’s a more advanced version of that for figuring out this other stuff. So that has totally changed how we do this pseudo genetic sequencing stuff, because you can tell much more from a simple blood test than you could from these noninvasive tests before. So that’s kind of a big advance, and it’s led to a lot of quite interesting discussion, because initially it was used only for detecting gender, but also Down syndrome, and there’s two other common trisomies that are relatively common.

Now they’re using these tests to detect a lot of other rare, potentially not even meaningful, genetic conditions resulting from different kinds of microdeletions. And there’s a bunch of companies basically taking advantage of the anxiety-prone pregnant people to do these tests. The tests have an enormous amount of false positives for reasons that just have to do with how testing is constructed, and so there’s a lot of controversy around this particular space.

Luisa Rodriguez: OK, so it’s something like some of these companies are offering tests that might show that the foetus has some kind of disease, but there are enough false positives that it might be wrong. But then that’s going to cause loads of anxiety and different questions.

Emily Oster: Exactly. And because these things that they’re now looking to detect are very rare, even if you tested positive, there’s still a 99% chance your kid doesn’t have it.

Luisa Rodriguez: Wow.

Emily Oster: Right. So it’s not like there’s still a 10% chance they might have it. It’s like almost everybody with a positive test is actually fine, because the thing is so rare and there’s some small false positive rate, it kind of multiplies up the people who don’t have it. So that’s an application of Bayes’ rule, my favourite of the statistical rules.

Luisa Rodriguez: Love it. Is there advice you’d want to give to parents thinking about these kinds of tests? I guess some tests, it seems like, are accurate and meaningful — but it sounds like you’re talking about a subset that are likely to give false positives. How do you know the difference, and then what do you do with the information?

Emily Oster: I think basically all these tests in some ways are very valuable, in the sense that if you tested positive on this, maybe now the risk that your foetus is affected by this is, say, one in 100, and previously it was like one in 10,000. So a huge amount of information has been provided. I think the key is not to avoid information because we think we’re going to react to it badly. It is to understand what is being provided by this.

So if I think about the goal of Expecting Better, it’s not so much to tell people, “Don’t think about this,” or “Everything is fine,” or “Tell your doctor to F off,” or whatever. None of that’s the goal. It’s really to say: if we have a better understanding of what’s going on, of what these numbers mean, of what the data says, then we can make better choices, we can process that information well. So I would tell people not to do these tests, but think about what you’ll do with the information, and make sure you understand what the information is actually going to tell you — not just taking it at face value without understanding what is actually there.

Childbirth [00:36:05]

Luisa Rodriguez: OK, let’s move on to childbirth, which is a thing I’m very scared of, so the more information I can have on it, I think at least the more I’ll feel in control.

Emily Oster: I’m not sure that that’s actually going to be right, but OK, let’s see what we can do.

Luisa Rodriguez: Maybe I’ll be wrong and then this will just be bad for me, but maybe good for others. Are there any really key decisions to make about your birth? Any decisions that really matter?

Emily Oster: There are many decisions that are made in childbirth. It’s hard to think about the things that really matter in advance. It’s like a little bit of a complicated question, because of course there are moments in the birthing process where it is possible that it’s tremendously important whether they decide to do a C-section, because that’s actually what’s going to save your baby. That’s not something you can prepare for in advance other than by having a provider that you trust.

There are some things that I would tell people. If they ask me, “How should I prepare for this?,” one thing I would say is get a doula. A doula is like a birth support person. There’s a lot of evidence that having a doula makes people happier with their birth experiences, lowers the risk of C-section potentially by like half. So really this is the one. If you told me, “Give me one piece of advice about my birth experience,” it would be to get a doula.

Luisa Rodriguez: Interesting. Are there any reasons not to get a doula?

Emily Oster: No. I mean, not really. This isn’t something where there’s a risk of this: it’s just a person; you can always tell them to leave. And even for people who have planned a C-section, there are actually some people who will say it’s very valuable to have somebody to come afterwards. It’s a sort of support space. So that’s probably the place where it’s the least valuable, is if you know you’re planning, “I’m planning to go in on this date, I’m going to have a C-section, we’re going to be here” — that may be less valuable. For almost anyone else, I would say yes.

Luisa Rodriguez: Get a doula.

Emily Oster: Yes.

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: What the mechanism is.

Emily Oster: What’s the patriarchy mechanism there? I know that that’s the answer.

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.

Luisa Rodriguez: OK, thank you for drilling into that with me. And I think my association with doulas is not… I’m sure it’s very unfair.

Emily Oster: No, I think it’s a potentially appropriate historical association, but it turns out…

Luisa Rodriguez: Not the case now.

Luisa Rodriguez: I’m interested in the C-section question. A lot of people really want to have a vaginal birth. And maybe you can start by saying, 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.

Luisa Rodriguez: I don’t.

Emily Oster: 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, 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.

Luisa Rodriguez: Exactly. Right. And I think with one exception, I haven’t really heard anyone say, “I’m terrified about how painful and how long I’m going to be in pain for.”

Emily Oster: I think part of the reason you don’t hear that is because our pain relief options are really good.

Luisa Rodriguez: OK, that’s reassuring.

Emily Oster: 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.

Luisa Rodriguez: Sure.

Emily Oster: I don’t know. I mean, I think it was pretty painful. But an interesting fact is that my husband was there for both of our kids when I had them, and I had no epidural with either one, and the second one, I think we both agreed, was not that big a deal. It was very fast. Like, we made it to the hospital. We got, like, 15 minutes from arriving in the hospital to birth. So we waited a bit long. Second labours are faster than first labours: noted. But the first one was like hours of pushing. It was awful. I remember it. It wasn’t that bad. And my husband, he was just like, “I thought you were going to claw your face off.” So you really do, you do forget. And the pain relief is really good.

Luisa Rodriguez: All right. I find that extremely reassuring. On the other hand, I have this deeply ingrained sense of it’s bad to get an epidural.

Emily Oster: Oh no, that’s not true.

Luisa Rodriguez: Yeah. I don’t know where… It’s not a belief about the facts. It’s that kind of ingrained, judgement-y thing. Lots of people say they would prefer not to get an epidural, and you did it without. Maybe part of it is this internal monologue, where I’m like, “I would like to be the kind of person that can endure pain and have a childbirth without pain relief.” Well, first: why not get an epidural?

Emily Oster: There aren’t a lot of practical reasons not to do it. You look in the data and the pushing stage of labour is, on average, a little bit longer if you’ve had an epidural than not. And it’s a little bit more medicalised — like, you couldn’t be in the tub if that was important to you. But on the whole, it’s difficult to outline any real downsides. And there’s this very clear, obvious upside, which is pain relief.

I think it gets wrapped up in this idea of, I don’t know, an opportunity to prove ourselves as “I’m willing to suffer the most for my baby,” which is something that comes up all the time. The idea that somebody once mentioned there could be a bad thing about an epidural. So even though it’s not really there in the data, “I wouldn’t want to put my baby at any risk. And so I’m going to do it because this is my…” And I think that’s crazy, and really a very toxic approach to this.

If you asked me why I didn’t have an epidural, the answer is the same reason that I’m trying to run a marathon: I just wanted to see if I could do it. Really, it’s like I thought, “That seems like an interesting experience. I would like to see if I could do that.” Like trying to get to the end of the interval of the running. Can I keep this going for another mile of the tempo run? It’s like that, right? That’s the whole thing.

Luisa Rodriguez: Why do people climb mountains?

Emily Oster: Why do people do crazy stuff? Why are these guys on Everest with the oxygen masks on their face when you know that a lot of people… I don’t know. People are insane. I think that’s just the answer. And I’m glad I did it, for the same reason that I’m glad I finished the tempo run, or these guys are glad they got to Everest — but it isn’t like, I’m glad I did it because now I know I’m a good mom. It’s just that that was an interesting personal challenge. That I achieved for stupid reasons.

Luisa Rodriguez: Right. I like the sense of humour about it. Also, it sounds like it had a real sense of accomplishment for you, and that is great.

Emily Oster: Yeah, that was good.

Luisa Rodriguez: But as someone who doesn’t really expect to try to run a marathon, as someone who doesn’t value intense pain for the sake of seeing if I can do it, that kind of person shouldn’t feel too much guilt or confusion?

Emily Oster: No guilt. You should feel no guilt about getting the epidural. One of my best friends had her baby like three months after me, and she called me from the hospital the next day, having gotten her epidural and had her baby, and basically the first thing she said was, “You are an idiot.” And I think that was right.

Luisa Rodriguez: Right. OK, so for someone who decides they don’t want an epidural, if they’ve made that call, what options are available to them? Is there data on nonmedical pain relief for childbirth?

Emily Oster: Yeah. Most of that doesn’t work too good. There are some ways to prepare, and this is a place, if you want to have a non medicated childbirth, you must get a doula. It is a totally nonnegotiable opportunity. I just think that is the situation in which that’s going to be the most valuable. Most of the stuff people talk about — acupuncture, weird smells, hypnosis, maybe some breathing exercises — kind of help, but at the end of the day, there’s really not much. There are some pain relief options that are more common in Europe, like nitrous oxide is a pain relief option that is sometimes available. That’s a little bit of an intermediate in the sense that it’s like you breathe in during a contraction, so it sort of lowers the intensity, but it leaves immediately. So it’s not a long-term thing, but that’s something that sometimes people will think of as an intermediate.

Luisa Rodriguez: Yeah. What did you do?

Emily Oster: Nothing.

Luisa Rodriguez: How did you manage your pain? Just experienced it?

Emily Oster: Yeah. I don’t know. There was some visualisation involving a hill.

Luisa Rodriguez: Can you say more about that?

Emily Oster: I mean, this was a long time ago. I don’t know. I think I had some idea that I would visualise hiking up this hill that we had sometimes hiked up in the past, but eventually… Whatever, we don’t have to get into this. By the end, I was falling asleep between contractions. I would have a contraction, I would fall asleep for a minute, then I would have another. The end is pretty intense. That’s why it was better the second time when basically he just like —

Luisa Rodriguez: Slipped out.

Emily Oster: Yes. I spent most of the time trying to get into the hospital, and then pretty much as soon as we got into the room, I was like, oh, he’s coming out now. There you go. That’s what I recommend: have your baby really fast.

Luisa Rodriguez: I did hear that recovery prospects were faster and C-section rates were lower with no epidural. Is that true?

Emily Oster: I think those effects, if they are there, are very, very small. Again, there’s a sort of limiting nature of this, which is it takes the epidural a little bit of time to wear off. You typically need a catheter. So there are some of these things where if your goal was to, 15 minutes after you gave birth, get up and walk around, that is probably only going to be possible if you had a nonmedicated vaginal birth. It is not clear why that would be a goal of interest to most people.

Luisa Rodriguez: Let’s say someone doesn’t have this desire to feel the pain for the pain’s sake, to see if they can handle it. What is kind of the best possible argument you could give for why someone should avoid an epidural?

Emily Oster: And again, you’ve pushed in a particular direction, so I’ll tell you I guess the one thing — although I really don’t think this should move many people’s decisions — but if the person who puts in the epidural does it wrong, and you get what’s called a “wet tap” where they basically hit the wrong part of the spine, you can end up with a really terrible headache like two days later. And most of the time they do the epidural right. Sometimes people get a wet tap. It can happen, and that would be a downside.

Luisa Rodriguez: So it sounds like, based on your read of the evidence, if someone is not interested in feeling a bunch of pain for the pain’s sake, there are some downsides to having an epidural, like needing a catheter and the potential risk of this complication that doesn’t happen to most people, but that could happen. But for the most part, recovery and C-section being more likely is not a big effect.

Last question on childbirth: During childbirth, when doctors are presenting you with a new recommendation or paths you could take, are there key questions you should be asking?

Emily Oster: This is very hard. Most of the time when there are choices to be made during childbirth, they are things that you probably want in the hands of your doctor. So I think rather than thinking that you’re going to be in a position, or your partner is going to be in a position, to litigate in the moment, you want those conversations to happen at the beginning. Like, how much time are we planning to wait? If you have a labour induction, you typically want to be pretty patient. Talking to your doctor about is there a point at which you will decide labour is too slow, and you will automatically go to a C-section? What is that point?

Having those conversations in advance, I think is good. In the moment, if a doctor says, “Labour is stalled out, we’re worried about the baby’s heart rate, you need a C-section,” very few people are going to be, like, “Let’s go to the evidence on that.” So I think those conversations really have to happen in advance.

Luisa Rodriguez: And if there were three topics to talk about with your doctor in advance, what are the top three you’d want to make sure you had discussed before?

Emily Oster: I think one is just talking about the speed of labour expectations. So this is something that’s updated over time. There was this idea for a long time that you should dilate one centimetre an hour, and that if you went slower than that, it meant that the labour was stalled. I think it turns out way less predictable and quite a bit slower than that for most people, particularly in first births. So just aligning on how we are going to think about stalled labour and where you are on that is one thing.

I would talk about episiotomies. Episiotomy is if you’re worried the baby is not coming out, you cut. That’s generally not recommended. It’s not that there are no situations in which that would ever be appropriate, but on the whole, that’s really not something that should happen routinely. I think that’s an example of something I’d just check in with my doctor about.

And then I think it is useful to have a level-setting conversation about what you are expecting, about where you are in the range of: How are you thinking about a C-section versus a vaginal birth? How do you feel about pain relief? Just making sure that they know what you’re coming into this with is valuable.

Luisa Rodriguez: Makes sense.

First year to toddlerhood [00:56:46]

Luisa Rodriguez: OK, let’s move to your book Cribsheet, which starts with the first year and goes through toddlerhood. For a soon-to-be parent, how many absolute must-know things are there to make sure that a baby survives and is kind of baseline happy?

Emily Oster: So there are very few individual choices that have this impact. If I had to pull out two, I would say putting your baby to sleep on their back — we have a lot of evidence that that is important, and that reduces the risk of SIDS by quite a lot — and introducing allergens early in life, which reduces the risk of allergies. That second one is small in the sense that it’s not hard to do, but the impacts are really big. Most of the others, like these choices that people spend so much time obsessing about — “Am I going to sleep train? And am I going to breastfeed? When am I going to potty train?” or whatever it is — they’re just not really that important.

I think it’s worth saying though that the first three years of life, or the first year, they’re really important for kids. But the things that are really important are having some kind of stable caregiving environment — whether it’s your parents or a stable daycare provider, whatever it is — some kind of stable environment, a safe place to sleep, enough food to eat, healthcare, protection from toxic stress — so no abuse, but also protection from the kind of instability that is rife in the world. Those things are really, really, really important — and they are not accessible to all people in the US or globally. But I think a lot of times these conversations get wrapped up in everyone’s assuming, like, of course those things — and then let’s obsess about this thing. It’s like, that thing doesn’t matter. You already have all the things, you already hit all the things, and then anything else you’re talking about is just kind of small potatoes.

Luisa Rodriguez: Got it. OK. So just to make sure I understood everything: babies should sleep on their back. I actually found the evidence for that one pretty interesting, because if I remember correctly, the reason we know that is because there was a period during which it was recommended that babies sleep on their front, and then there was a period where the advice changed — and when you compare those two periods, infants dying suddenly was much higher when babies were sleeping on their front. Which is really horrible and tragic, but very clear cut.

Emily Oster: Yeah, and I think there’s actually some fairly clear-cut mechanistic reasons why that would happen: basically, a fair amount of what happens in SIDS is babies, just the automatic breathing response that we have as people just stops. And that is more likely to happen if they’re very deeply asleep, and babies sleep better on their stomachs than on their backs. So when you have them sleeping on their back, they sleep slightly less deeply, but this response then is less common.

Luisa Rodriguez: Got it. And the other is this allergy thing. And we know that because it’s something like some countries do introduce allergens a lot to young kids, and then they have fewer allergies?

Emily Oster: So we know that because that’s the hypothesis generation paper. So there’s an early paper that basically compared kids in Israel to kids in Britain and showed that kids in Israel have much lower incidence of peanut allergies, and they have a common baby snack called Bamba, which is peanut based. And so that was the idea. And then actually the people who had that hypothesis initially ran a randomised control trial where they randomly assigned some kids to be exposed to allergens early and some kids not. And there’s like a 70% difference in the allergy development across groups. So the effect is really, really big.

Luisa Rodriguez: Got it, OK. But broadly your message here is something like the basics — like stability and getting basic needs met — is the thing that really matters. And a bunch of the questions I’m about to ask you, like breastfeeding and swaddling, are not that important to baby outcomes, and maybe it sounds like more important to just what the experience is like for the parent — which is something that your books really drove home for me, and the reason so much of what I took away from it is that the question is a personal preference, personal choice question. It’s like, “What is going to work best for you as a family unit?” — and less, “Are you going to ruin your baby’s life if they have to cry themselves to sleep?”

Emily Oster: Exactly.

Luisa Rodriguez: Well, just to drive that point home — and maybe we can go through some of these quickly, given that I’ve already given a bit of a spoiler — but how important is it to breastfeed?

Emily Oster: There are some small early-life benefits to breastfeeding. Lower risk of gastrointestinal illnesses. It’s pretty important if your baby’s in the NICU. And that’s about it. I think effectively all of the long-term stuff that people cite about the kids — like they’ll be smarter, they’ll be thinner, there’s long-term health benefits — it just does not show up in good data on this.

And so this phrasing you hear a lot, “breast is best”: in some sense that’s true, but when people say that, they’re not usually thinking like a 3% reduction in the risk of eczema. They’re thinking something bigger. So I think it’s an example of a place where I guess breast is best is right, but also probably overstates how much the “best” is.

Luisa Rodriguez: Right. It’s this point you made about how one question is, is there a difference? And another question is, what’s the magnitude of the difference? And in this case, we’re not talking about reducing a baby’s IQ by 40 points.

Emily Oster: We’re not.

Luisa Rodriguez: How about sleep training? It feels like one of the Mommy War topics I’ve heard the most about is the cry it out method — where you let your baby cry themselves asleep, and maybe that causes attachment disorders for the rest of their lives. What do we know about that?

Emily Oster: So this is one of the most effective ways to get babies to sleep on their own. And I should be clear, not everybody wants their baby to sleep on their own. There’s a bunch of discussion about co-sleeping in the book. And for some people, the co-sleeping with your kid forever, or some period of time, is what they want.

But there are a lot of people who would like their kids to sleep through the night in their own rooms, and an effective way to improve the amount of sleep that kids get is to do a cry it out, where you leave the kids — and there’s a checking version, a not-checking version; they all kind of involve the same thing — and the basic idea is that over some quite short period of time, kids learn to basically self-soothe, and then they can fall asleep on their own. And they tend to sleep better, and parents also sleep better.

The concern people often raise is: is this causing kids to lose their attachment or have some long-term impacts? And that is not there in the data. So there’s randomised trials where they randomised families into doing this or not, and they follow the kids and they see them later, and just don’t see any differences across the kids when they’re older at all — in attachment or anything else.

I think it’s worth saying that many of these randomised trials are run effectively with the interest in the outcome of the parents’ wellbeing. So they’re not trials to see whether this damages children — these are trials to see like, Can we improve postpartum depression? Yes. Can you improve marital satisfaction? Yes. Basically, can parents be made happier as a result of sleeping more? Because we know that depriving people of sleep is a form of torture, an actual form of torture that people use. So when parents are not functioning, they are potentially not good parents. I think we talk about sleep training sometimes as if there’s no other side, like this is just a selfish thing — like, why did you have kids if you didn’t want to be up all night? It’s like, well, actually, parent functioning is part of being a good parent, so we sort of missed that piece.

Luisa Rodriguez: Yeah. To the extent that different people will end up making different decisions on this, what end up being the considerations you think are important for them?

Emily Oster: I think some of it has to do with thinking about what’s the structure of your family life that you want to have. So there’s a version of this which is like, “I want my kids in bed at 7 PM, and I’m out of the room and they’re by themselves and I’m doing something else.” Maybe you want that. Then there’s a version which is like, “We all want to co-sleep, we want to be together. I’m not interested in my kid being in their own room. I don’t want to have that.”

And I think those are both completely reasonable — totally valid, reasonable family structures — but they’re pretty different. So that’s sometimes I’ll tell people: just think about which space you want to be in. And if you want your kid to go to sleep by themselves at 7 PM in their room alone, some kids that will work without any kind of sleep training. But often if you want to get there, you are going to need to have some kind of sleep hygiene system.

Luisa Rodriguez: OK, so there’s this kind of decision-making process that you want to go through, that really is looking at your values and what kind of family lifestyle you want to build.

Emily Oster: Exactly.

Luisa Rodriguez: And then it probably is some experimentation to be like, Can I actually tolerate hearing my baby cry? If not, does that mean this isn’t doable for me, or do I want to find some way to block out the sound of my baby crying?

Emily Oster: Yeah. And I think some of this is also to what extent can you help yourself understand that this is not damaging, and that there is a reason to do it? Sleep is important for kids too.

Luisa Rodriguez: Yeah, right. Another one that I don’t think is quite as controversial is swaddling. Any evidence about swaddling one way or the other?

Emily Oster: Swaddling is good. So swaddling, you wrap your kid up like a burrito, and early on, it’s sort of an infancy-related thing, but it does tend to improve their sleep, let them sleep for longer periods. This is a case where there’s some fun evidence, where they have babies in these videos and put these sensors on them so you can see why it’s working. And basically the answer is that when babies start to wake up, the swaddle kind of keeps them from waking all the way up. So they have kind of like a reflex, and the swaddle dampens down the reflex, keeps them tucked in, and then they’re more likely to connect sleep cycles and go back to sleep rather than having the reflex, the sort of startle turn into this, and turn into a yelling.

Luisa Rodriguez: Yeah, makes sense. So there are just tonnes of strong pieces of advice in the space. Is there an official recommendation for parents of infants that you disagree with most? So less of a myth, but like an actual recommendation in guidelines somewhere?

Emily Oster: I think we push people too hard on breastfeeding. I think that the high-pressure “breast is best” narrative is not really serving people well. I would prefer that we would maybe say some more realistic stuff about that, and help people achieve breastfeeding rather than just assuming that if we make them feel enough shame, that will somehow effectively help them breastfeed. Which there’s no evidence for that.

Luisa Rodriguez: Right. Thinking about this really practically — and again, I’m not a parent yet — but I am a perfectionist, and again, I have this puppy and I really want them to have a flourishing life. And I’m already noticing that I’m holding myself to extremely high standards for whether I’m doing all the right things. I wonder if — even if we undercut some of these myths or things that are a bit overblown, even if I believe that intellectually — I might not believe it deeply, emotionally enough that I can feel OK about not breastfeeding. It seems like from your reaction that this is kind of common?

Emily Oster: Yeah.

Luisa Rodriguez: How can a mom handle that? Or a parent?

Emily Oster: I think it is. I think it is, and I think part of it is, for many people, people are putting a lot of the pressure on themselves. I think it is therefore perhaps especially bad if we also put a lot of pressure on them in societal ways. It’s already easy to feel like you’re failing, and if we then tell you you’re failing, that’s pretty problematic. So I don’t disagree, in the sense I think often it’s the case that we almost are judging ourselves before other people are judging us. And it is also true that there is a lot of pressure and judgement from the outside.

Luisa Rodriguez: Yeah. I guess I’m curious if you have any advice for people who find themselves being like, “Breastfeeding is proving extremely difficult for me for various reasons. I think I need to introduce formula. I feel horrible about this, because this has all been ingrained in me that this is super important. And intellectually I know that it’s probably fine, but I feel like I want to give them the best possible start and that I’m going to fail to do that.” If you ever had this, was there anything that helped you feel less like a failure?

Emily Oster: No. I mean, this was awful. So I feel for the people who tell me that, because I am that person. My daughter, my first kid, didn’t really like breastfeeding. It wasn’t for her. It took a long time for my milk to come in. She just preferred the bottle. She liked to eat a lot. She always likes to eat a lot. And then she just didn’t like one of my boobs. And the only way that she would nurse on the left is if I was walking up and down and also bouncing her at the same time, which is really hard to do when you’re trying to get the boob in the mouth and you’re bouncing and you’re walking. It was terrible.

And when I look back on that time now, I can’t believe how much I thought this was important. Do you know what I’m saying? I feel so bad for my former self, and I wish I could just go back and be like, “Listen, your kid is 12. There’s more hard stuff coming. There’s shit down the road. This isn’t that important. Just let it go.” But it’s very hard when you’re in it to give yourself that grace.

This is why sometimes people’s partners will write, or people will write to me and they say, “I read your chapter, and I read it and read it and read it, about breastfeeding. And I read it over and over again whenever I felt like I was doubting myself, basically just convincing myself.” And I think that those are the messages that are the most meaningful for me. Because if I could pull somebody else out of that, and be like, “Don’t walk up and down your hall with your baby! Just sit in a chair, give them a bottle of formula” — which, frankly, would be much nicer for them too. Nobody likes to be bounced up and down and have the boob stuck in their mouth when they’re not interested in it. That’s not fun.

Luisa Rodriguez: Yeah, nobody was enjoying that. No additional IQ points were gained.

Emily Oster: Nobody was having a good time. No points were gained. Nothing was gained. Nothing was gained.

Luisa Rodriguez: I’m just now musing on what might help me, and I wonder if, before having the baby, I’ll do a lot of, “Under which conditions am I going to try to accept the fact that I might not breastfeed?,” and kind of almost expose myself to that decision in advance.

Emily Oster: In the 1980s, there was a Dr Spock — 1970s and 1980s had Dr Spock — and Dr Spock writes about breastfeeding. And he’s writing about it at a time when it was sort of coming back, right? Breastfeeding kind of hit its nadir in the early 1970s, and then during the 1970s it kind of starts coming back. So we’re in a space where people are thinking about it very differently than they do now. And he has this thing that says, “You might try breastfeeding because you might like it. Some people do.” I always think about that, because it wasn’t like, “You have to do it” — it was just like, “Hey, some people enjoy this.” And that’s true.

Like with my second kid, this was great. It worked great. It was super convenient. He totally liked it fine. I had plenty of milk. It was super convenient. It worked really well and I was glad I did it. And if I framed it like that, I would have said, like, “Try it again. You might like it.” I did like it. That’s great. Whereas the first time, if I had thought like, “Try it, you might like it” — “I don’t like it. It’s bad. I wish I wasn’t doing this.”

Luisa Rodriguez: Right, yeah. Another one from my colleague Keiran: What’s the biggest common mistake made by new fathers, specifically?

Emily Oster: I think it’s pretty hard to be a new dad, actually, because I think there’s less that you can do than you would like to. I think the more that both parents can spend alone time with the kid that is unscaffolded by the other person, the better. So I think taking five hours by yourself — and of course that’s hard if people are exclusively breastfeeding — but the more responsibility people can take early on, the less you get into this range of like, “Only Mom can do everything, and Dad isn’t able to do stuff.” So I think just finding time, if you can, to not just be there as the second person, but be there as the first person, that’s pretty important.

Luisa Rodriguez: Nice. Yeah. Any kind of concrete suggestions for how to do that?

Emily Oster: Just plan it in advance. Almost every answer to how do I do something that I want to do in the first two weeks of my kid’s life is just schedule it out in advance. Plan to have a family meeting two weeks in, where you talk about how things are going. You will not do any of those things if you haven’t thought about them before the baby comes, because it’s just going to be a totally overwhelming tsunami. But if you’ve kind of put in place, from the first day we get home, here’s a sense of when different people might be in charge — or at least have said in advance that one of the priorities in the first four days is to make sure that Dad gets several hours of time in which they’re in charge of the baby — I think that’s going pretty far in the direction of making it happen. It’s like planning to vote or something, right? Like, tell me your voting plan.

Luisa Rodriguez: Right, right. Yes, that makes total sense to me.

Careers and kids [01:15:13]

Luisa Rodriguez: Moving on to another topic, 80,000 Hours typically aims to help people do good with their career. And a lot of our listeners take very seriously the idea that doing good with their career should be a major priority in their lives, including myself. So I’m interested in how big of a hit a person’s career takes when they have children. And I imagine this differs loads by gender and probably by where you live, so maybe we can talk about those things separately. But I guess starting with women: How does having children affect women’s careers on average?

Emily Oster: Negatively, on the whole. Again, I think here it’s really important to distinguish between what socioeconomic group we’re talking about, and having children has negative impacts on earning potential across the wide range.

The place I think we understand it best in some sense is in women who have advanced degrees, have college degrees, where there’s a career path aspect. I think the issue is that when you have kids, we see the earnings for women tail off relative to men. So if you look at a graph of earnings over time, they’re sort of moving, tracking together. If this were a video, you could see that I’m moving my hands together, that they’re tracking together — and then they start to diverge around the time of the first kid.

And that’s for a bunch of different reasons. I think in some ways, the best explanation work on this comes out of Claudia Goldin, who just got a Nobel Prize. In her most recent book she talks about the idea of “greedy work,” and the idea that a lot of high-income, high-status jobs will always take more hours. I think that it becomes very difficult for both people to be investing in that way in a partnership, and when one person has to choose to step back, it’s more likely to be the woman for a bunch of different reasons. So we end up in a situation in which there’s a difference between men and women in wages. Actually, men tend to do better after having kids than before.

Luisa Rodriguez: Wow. OK, I have a bunch of questions about that. Just because it’s the last thing you said and it took me by surprise, do we have any idea why men earn more after having kids?

Emily Oster: I’m not sure we have a great sense. This isn’t, to be fair, a space that I do research in. My casual sense from reviewing some of this research is it’s probably some combination of their partner is stepping back and so they are stepping out, and the incentives are greater because you have somebody to support.

Luisa Rodriguez: Right, that makes sense. I can see that being true. So then are women’s wages relatively less than men’s, even holding constant the fact that women might work less? Or is it a mix of things, including something like women work less?

Emily Oster: One thing I think you have to understand is that most jobs are not divisible in an hourly manner. So if you thought about all jobs as being piecework — basically you work for this number of hours and you complete this number of units and then you get some money — then it would be the case that if you work 20 hours a week that you make half as much as if you work 40 hours a week. Most or many professional jobs — like lawyer, accountant, investment banker, doctor, professor, whatever — most of those jobs have the feature that if you work for 20 hours, you don’t make half what you do when you work for 40 hours.

So it’s a little difficult to think about the question of, is it that people are working few hours? Well, it is that they’re working fewer hours, but it’s also that moving from 40 to 20 isn’t half: it’s much less than half. And within this space, there are jobs that are more divisible and jobs that are less divisible. But that basic idea that there just isn’t a sense in which you can adjust on the intensive margin in quite the way that you might hope. That’s a big part of the story.

Luisa Rodriguez: OK, that makes sense. How big is the effect on wages?

Emily Oster: Interestingly, the fact I know the best is about retirement savings. So there’s about a 30% gap in retirement savings, which is of course an accumulated number over a long period. You see these numbers like women get paid $0.77 on a dollar, $0.85 on a dollar relative to men. That’s conflating a lot of different things. That’s not just about differences in hours, not just about differences in jobs. So I think that question doesn’t have a very direct answer.

Luisa Rodriguez: Do we know things about the effects besides wages? I guess I’m curious about seniority: are women getting less senior roles?

Emily Oster: I think in a sense that’s a huge share of the wage gap. So if you think about that, and I think that’s a very tricky thing to think about, because 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.

Luisa Rodriguez: Does the difference widen over time? Does it shrink over time? Does it stay the same?

Emily Oster: It widens.

Luisa Rodriguez: It widens. Really?

Emily Oster: It widens the most, 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.

Luisa Rodriguez: Totally. Yeah. I’m actually curious if you have other specific policies, either at the organisational level or at a higher level, that make a difference here?

Emily Oster: I think any kind of requirement for facetime is pretty tough for parents. If you think about the lifestyle that you have with a little kid, they go to bed at like 7:30. So the hours between 5:30 and 7:30 are really valuable, because that’s like: they’re home from daycare, you have dinner, you put them to bed. It’s not that those hours are always so great — that’s usually when your kid is the biggest jerk — but that’s your time to see your kid. That’s your time. So a job that requires you to be there until 6:30 is much worse than a job that lets you go at 5 PM and asks you to be back on for an hour at 8 PM. I think just recognising the value of moving time, and being able to say, “We’re going to let you prioritise this” is something we’re missing. That at least some employers, I think, miss.

Luisa Rodriguez: Totally. That seems huge. Does anything else come to mind?

Emily Oster: I think almost every idea I have involves flexibility. So also, your kid is sick. And thinking about what’s valuable about the possibility of remote work, even if remote work is not your norm, the idea that you could work remotely so when your kids were sick… We know that kids get sick all the time, and that’s just part of having a kid. Just the more we can recognise the things that people need to combine the parenting they want to do with the work that they want to do, the better.

Luisa Rodriguez: Does delaying childbirth reduce the negative impacts one’s career at all? Do the wage or other career impacts of having kids vary?

Emily Oster: They happen when you have the kid.

Luisa Rodriguez: I see. OK.

Emily Oster: Partly it’s a little tricky to answer that because, again, a lot of the data we have from this is about women who are having kids a bit later, who are in these professional jobs. And I think it’s an interesting question: Would it be better to have your kid when you’re 20, and then they’d be old by the time you were trying to lean in? This is not the way it works.

Luisa Rodriguez: Though I guess if it happens whenever you have a kid, it could be the case that by delaying, you kind of progress further in your career before you start taking this hit. And maybe that overall reduces the impact?

Emily Oster: Could be. Yeah, could be. I don’t know. I think it’s just hard to tell.

Luisa Rodriguez: So what’s your advice to someone who wants to have kids, or who already has kids, who wants to stay on a productive and ambitious career trajectory?

Emily Oster: Get help. I think it’s useful to recognise that your kids will take time, and be deliberate about thinking about how you’re going to combine those things. I think it’s useful to recognise that there are only 24 hours in a day, and you are not going to be able to be a stay-at-home mom and also a full-time working mom, because those are both full-time jobs. And sometimes people come in with expectations which diverge from the possibilities of reality, and I think that’s when there’s more chaos. So just recognising some of the limitations upfront.

Luisa Rodriguez: Yeah, that does sound like something I need to hear. I very much, I think, am in the camp of, “Somehow I’m going to be a very present and available parent, while also working the exact same amount and having the same ambitious career.”

Emily Oster: And again, I don’t want to imply to people that they can’t, because in some ways, I absolutely think you can. I just think sometimes we have in our mind a way of being present that’s ridiculous.

So I’ll give you my most specific example: when I was a kid, Mikey Bright’s mom made these cupcakes for bake sales. (Mikey Bright was in my elementary school.) They were chocolate cupcakes, and she would dig out the top of the cupcake and put in whipped cream, and then put the top back on. And like, man. Grace Bright, if you are listening to this, I remember those cupcakes so well. And my mom was always like, “Sign up for plates. Make sure you sign up for plates or soda. And if you have to do something, box brownies, but really, you’ve got to get the sheet first so you can get the plates.”

And I remember being like, “When I have kids, I’m going to be the mom who makes the cupcakes.” And then I had kids and I was like, “Sign up for the plates!” Because you can’t actually be the… You can’t. And that’s no shade on Mikey Bright’s mom, that’s no shade on my mom. It’s just there isn’t time in the day for most of us to be both hand making cupcakes and also working a full-time job. Figuring out what are the things that you feel you need to show up for, and that are the ways that are going to serve why you became a parent, and what you want to be showing up for for your kids, I think that’s the most important thing.

The other thing I will say is that 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.

Going back to the thing that you said, which is that probably we need to think about what our values are, and the ways we want to show up for our kids, and then let the rest go if we’re in the position of wanting to have some significant part of our lives be spent on our careers. I guess guilt has already come up, but it feels really likely to me that I’m going to be on board with, like, “It’s just not that important to fill my kids’ cupcakes with whipped cream. If I had the time, and that is the thing I want to do most in the world, that would be great. But I don’t, and it isn’t. So I’m not going to do it.” I still think I’m going to feel like an inadequate parent if I don’t do that kind of thing. To what extent have you had that? And does anything help?

Emily Oster: Oh, no. Everybody feels inadequate. That’s part of parenting, right? It’s really hard to feel like you’re doing a good job, which is part of why I spend so much time on the internet telling people that they’re doing a good job, because they mostly are. But it is not a feeling one has. Like, there was a recent time when I did think I did a good job, and it was so notable that I wrote to my husband. I was like, “I did a good job this morning!” It’s like teaching evaluations or something: you just hang on to the mistakes, and the good parts are easy to forget. So that is to say, some fraction of the time you will feel like you’re doing a poor job.

And I would make a distinction between the feeling of sometimes thinking, “Boy, I would have managed that situation differently” — which is unavoidable — and the feeling of, “I’m doing my life wrong. This isn’t the life I wanted.”

And I talk about this a lot in The Family Firm, but 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.”

Luisa Rodriguez: Right. Yeah. I can imagine it being, maybe not 100% comforting, but at least somewhat comforting when you’re feeling a bit of guilt about not making the cupcakes, being like, “This was the plan. I never planned to make the cupcakes.”

Emily Oster: “I didn’t plan to make the cupcakes.” And yeah, you’re never going to avoid the feeling, when you see the other family with the cupcakes, you’re never going to be like, “Those cupcakes suck.” You’re going to be like, looks like a good cupcake, with the whipped cream in the middle and everything. But you can think, “No, I made a plan, which did not involve making the cupcakes.”

I may tell you a followup to that story, which is that our current babysitter, our current nanny, is trained as a professional chef, and her last job was chocolate modeller at a bakery. This is totally random, like, the luckiest thing. We found her during the pandemic. She’s the most wonderful person. She’s the only reason I’m able to do anything. And at the last bake sale, which was animal-shelter-themed, she made cupcakes, each of which was decorated with a different animal on it. And then you find that you can be the parent with the cupcakes, but you have to give the credit to somebody else. So thank you, Claire, for those amazing dog cupcakes, which were extraordinary.

Luisa Rodriguez: Right. And then we’re back to: get help.

Emily Oster: Then we’re back to get help, and then we’re back. I think it’s both very important to recognise the need to get help, and very important to say… Sometimes people ask me things like, “How do you balance the career? How do you do the thing? How do you have this job and also have your kid?” The answer is I have a lot of help. I have a lot of help at work, I have a lot of help at home, and my kids are big. Those are kind of the answers.

Luisa Rodriguez: Yeah. I want to ask you a tiny bit more about that anyways, even if that is the key answer. I also want to come back to childcare and get more concrete with how hard is it actually to get all that help? You have had all this help both with your kids and in your career, but to what extent has being a parent affected your career, as far as you can tell?

Emily Oster: It’s a funny question to ask, because my entire life is 100% completely different than I ever could have imagined because I have my kids, but in a way that I think is almost not helpful for other people. So I was working as a professor, I had a kid, I wrote a book about pregnancy, like, on a whim. And I wrote the book because I had my kid, and then I wrote the second book because I had my kid. And so what do I do now? I write about parenting, I talk about parenting, I write about data on parenting and pregnancy — that is 100% about my kids. And it’s true I’m still an economics professor, but my day-to-day is completely different.

To answer the underlying question of to what extent was your basic career as an economist affected by your kids? It was affected. There’s a productivity gap associated with my kids.

Luisa Rodriguez: How much do you notice that?

Emily Oster: You can see it. I mean, it’s hard to… A lot of stuff happens at the same time. Causality is difficult. But there’s no question that I don’t have as many hours to work as I did before the kids. You do get more productive per hour. I would say the productivity per hour went up. But I used to work a lot more hours.

Luisa Rodriguez: Is there anything else you notice besides productivity?

Emily Oster: I think a lot about my kids at work, and not just because it’s part of my job, but there’s a lot of sort of child-oriented multitasking that occurs, and I think is something people talk about, this idea of “invisible labour.” But I think a lot about my kids’ doctors’ appointments, when camp signup is, and stuff like that — at a time that I usually would have been working.

Luisa Rodriguez: Right, yes. Have you noticed any change in your level of ambition? I wonder if I’m going to have a thing where, once I have kids, I’m really excited to prioritise them even more than I expected. If it might mean that I end up feeling less ambitious, being less motivated to work a bunch, being less motivated to apply for more senior roles…?

Emily Oster: Maybe? I don’t know. I think it varies. Your ambition maybe is finite, and some of it goes into your kids, and you’ll see you’re tired because you don’t sleep as much. But I also think that ambition is what it is, and there are a lot of people who are very excited about continuing to pursue whatever ambitious… Certainly in my case, my professional ambitions are a lot larger than they were before my kids.

Luisa Rodriguez: Cool.

How much to work [01:39:30]

Luisa Rodriguez: Let’s turn to the topic of how people can make decisions about how much to work when they have kids. So you frame this question as having three parts: one is what is best for your child; two is what do you, as a parent, want to do; and three is what are the implications of your choice for the family budget?

To start, you argue that lots of people don’t spend enough time on the question of what they actually want to do. Can you explain what’s going on there?

Emily Oster: I think many people frame this as simply what is good for my kid? And this is true across so many of the choices we make as parents: that the first and only thing you think about is, is there any tiny impact on my kid in any direction? And then for sure, I will just go with whatever is that answer. And by putting this idea of what do you want to do first, I think part of what I’m trying to convey is that, yeah, you should think about what works for your kid — but actually, this shouldn’t be an afterthought. This is the first question to ask yourself: What do I want? Do I want to be at my job? Do I not want to be at my job?

So we talked before about the idea that some people would like to leave the workforce when they have kids, and that’s their preference, and that’s great. And that should be part of your question. I think that the societal pressures actually go in both directions. So people will say, “Everyone just assumed as soon as I had kids, I would quit the workforce.” And then you will have people who will be like, “Everyone assumed that as soon as I had the kids, I would get right back into it, but I didn’t want to do that.”

And I think you’re thinking about that both in the immediate term actually, then even longer term. So I would often tell people to think about this again later. I’ve had friends who went back to work when their kids were little, and then basically quit when they were eight, and were just like, “You know what? This is the point at which I feel like I want to be home with them, and that’s how I want my life to be structured now.” And those are all very reasonable choices to make, and things which should reflect, or at least should be influenced by, how you feel about what you want to be doing with your day.

Luisa Rodriguez: Right. It’s funny, because I was literally going to say, “Let’s start with what’s best for the child” — but it sounds like you think we should start with what parents want. And a lot of our audience, again, is in this category of people who want to use their career to do a bunch of good in the world, so figuring out how to keep the career piece really strong is important to a lot of them. What advice do you have for people trying to think this through for their own family?

Emily Oster: We have this idea, before you have kids: “I have my job, and I go there for the hours of the workweek, and I answer my emails. What do you mean, ‘How do I want my job to look like?’ That’s the job.” And I think we could use an approach to be a little bit more flexible in our thinking. This is an opportunity sometimes to be a little more flexible to say, “Let me just think about if I’m going to be at work for these hours, how would my day look once I have the kid? How is that going to be structured? How does that feel?”

It’s hard to know, because you don’t know how you’ll feel when you have a kid, but just to sort of think about, How does this actually work? How is my life going to work if I work? What is the other option? Is there literally just all or nothing? Is there an option to come back at half time? Is that available? Probably you’ve never thought about that, right? Many people with standard full-time jobs haven’t actually thought about what it would look like if they worked half time. Is that even something that you could do?

So both being flexible in your mind about what are the possible ranges of employment hours for you and for your partner, and literally, what would that map onto in terms of how is your life going to operate? I think that’s pretty valuable. It’s also a question you’ll want to revisit over and over again as you figure out what kind of childcare solution is working for us and how we want to structure this. I think it’s just a mistake to never take those moments and step back. And this is one of them to step back and say, what are the possibilities? What do they look like?

Luisa Rodriguez: Yeah, right. Yeah, right. So let’s say you’re taking that step back. As a woman, what are some of those possibilities?

Emily Oster: So first, I just want to step one thing back, which is, like, we talk so much about women. I think it’s appropriate because these issues come up more for women. But when I talk to individual families about how to navigate this, I will often tell them, don’t ask the question, should there be a stay at home mom or a stay at work mom? Or should mom go to part time? Or whatever. Ask the question, what is the optimal configuration of adult work hours in your household? Because actually, there’s a lot more flexibility than you think. And it may be that dad’s job or other mom’s job is the one where you could adjust a little more up and down. So I think we sort of get trapped in this idea that both we’re fixing this for women, but also that it’s somehow women’s job to figure it out. I don’t think that’s exactly right.

Luisa Rodriguez: Great point, totally fair. In that case, what kinds of nontraditional things should parents be considering, as a team?

Emily Oster: I think the first question you often have is jobs differ in their intensive margin flexibility — which is to say that they differ in the degree to which you could adjust the number of hours. So it’s worth it when you’re having this conversation, saying, well, which of us could adjust a little bit?

And I think that is going to influence how you think about this, because there are jobs where it’s like, I’m trying to make partner at this law firm, and we could wish the world was different, but this is an 80-hours-a-week job and either I’m in it or I’m not in it; there’s no going-to-30-hours-a-week situation. And that’s going to influence what you do. But there are a lot of jobs you have where both people could take some time.

And I think this extends to thinking about parental leave, and how we structure parental leave across families. The more we can have that flexibility across all the adults in the household, I think the better — rather than falling immediately into this “one person is going to keep going at exactly the way they were before, and the other person is going to adjust in some way” thing. There’s more ranges. Let’s say if you want to work 60 hours a week across two people, that’s 40 and 20; that’s 30 and 30; that’s 60 and 0 — and asking, “What are the different ways we could be at 60 hours?” is probably a good idea.

Luisa Rodriguez: Yeah. Right. So part one: think about what you, as a parenting team, actually want for yourselves. And that’s going to involve how much time do you want to spend with your kids during certain periods, and also how much do you want to be prioritising work, and how much do you have the flexibility to have this part-time kind of thing.

Then the next step you recommend is, to the extent that you can, thinking about what’s best for your child or children. So to start thinking about the evidence about what’s best for the child, what kinds of outcomes are we even talking about here? Is it like how well they’ll do in school or like their lifetime outcomes?

Emily Oster: It’s basically test scores. Maybe some behavioural outcomes. Some of these things maybe have some stuff about wages in the long term — all that tends to be pretty noisy. So I think to a first approximation, test scores are kind of, when we talk about how are kids doing, we mean test scores. Which is frustrating, right? Because it’s like, actually I care about many things that are not test scores. But unfortunately that’s all we can measure.

Luisa Rodriguez: OK, and do we think test scores reflect any of those other things? A thing I care about is just like, does my child feel loved? And maybe we think test scores are like a proxy for are they well adjusted, broadly?

Emily Oster: In a sense, I think that if you asked, “At the most basic level, what do kids need to thrive?” One aspect of thriving is performing in some way, like being able to read. The things that they need to thrive are things like having a loving, stable home; not being exposed to toxic stress; those kinds of things — which are things that you want for your kids in a very meaningful way. There’s a sense in which it’s picking up some of it, but it’s not everything. The difference between kids who are performing at the 87th percentile and the 97th percentile, that’s not about how loved they feel: it’s just like, whatever — that’s like whether the window was open. So you just want to be a little careful about what we learn from these.

Luisa Rodriguez: OK, that makes sense. So we’re talking about test scores, and what kind of evidence do we have about this?

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.

Luisa Rodriguez: Really? Wow.

Emily Oster: So here’s what I think it is. I was just writing about this, so it’s on my mind. So 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.

Luisa Rodriguez: OK, so then maybe most of the work is in making the decision that is right for you as parents, making sure that your kids’ basic needs are met, and then finding ways to deal with your guilt and panic about whether or not you’re doing the right things?

Emily Oster: Yes. That seems like the most important thing to work on.

Cost of childcare [01:56:46]

Luisa Rodriguez: Cool. I guess to the extent that some of our listeners will want to continue working many hours or full time after having kids, one of the big solutions is to have help, and that creates this huge financial consideration. How does the cost of childcare compare to the cost of the lost income caused by staying home with kids?

Emily Oster: It kind of depends on what your income is. This is something where I guess the way I would say it to people is like, “You actually need to write it down.” Because this is something where we’re just talking about numbers, and you could compare them. We know what after-tax income is, and you can work out what is feasible in different scenarios, different kinds of childcare costs different amounts.

The one piece people often forget that is worth thinking about is that kids get typically a bit cheaper over time. So once kids are in public school, that costs less money than childcare, and your income goes up over time. So there’s an immediate calculation — like what happens in the first year — and then there’s a slightly further calculation which I would encourage people to do. So do this on a five-year or 10-year window, and ask the question, “Are we coming out ahead on working, thinking about the fact that we get paid more overtime and kids get less expensive.” So it’s a mistake to do only the first year.

Luisa Rodriguez: OK, that’s helpful. I guess there are loads of different childcare options. So there’s daycare versus nanny. At the highest level, do those differ in what’s best for your child?

Emily Oster: Not in an especially meaningful way. With daycare, I think that again, focusing on having daycare that is high quality does matter. So that means that kids seem safe, that there are caregivers who are paying attention to them. These are mostly things you can see, basically, if you’re visiting. And then there may be pretty short-term but some positive cognitive benefits to enrolment in daycare when you get closer to school age — so above 18 months or two — and maybe some slight negative effects on behaviour from earlier on. But both numbers are pretty small, and if you aggregated over the whole, if you were going to be in daycare the whole time, is basically a wash.

Luisa Rodriguez: So then it’s basically what can you afford and what works with your lifestyle?

Emily Oster: Yeah. And I think with both of those, there’s a bunch of pieces of this that are actually pretty important.

One is that a nanny tends to be more expensive on average. It can be both more and less convenient: in some ways it’s quite a bit more convenient, but they can also be sick. I think in some ways for people the part of it that you don’t always reflect on, that I think is worth thinking about, is it’s a more complicated relationship than some. Basically the idea of having a single person who works for you, who also is with your kid all the time, and is sort of like a third parent but also is an employee — that is a dynamic that some people find more comfortable than others.

And I certainly think that there are many more people who feel more comfortable with the idea of daycare or a home daycare or something, because it feels a little bit more like there’s home and then there’s school.

Luisa Rodriguez: Right. Whereas with a nanny, it’s kind of blurred.

Emily Oster: And then there’s shades of grey in this: there’s home daycare, there’s nanny shares, there’s all kinds of good ways to structure your childcare arrangements.

Luisa Rodriguez: So what exactly makes people uncomfortable about the nanny setup?

Emily Oster: Your kid is going to call you by the nanny’s name some of the time. And that’s not the whole explanation, but I think it gives a flavour of the type of thing that makes some people… Like, they’re spending eight hours a day with this other person: more time than they spend with me, they spend with this other person. Then sometimes they’re going to call you the nanny’s name. And that, I think for some people, makes you feel like, “Wow, I’m really pretty second class here.”

And I think the truth is, what you need to tell yourself is like, “Wow, I am so lucky that my kid is so happy with this other person that they’re calling me by their name. When they need something, they’re asking by name. That is such a gift, and I’m so grateful for it.” But actually, that frame is pretty hard, and can be pretty hard in the moment for some people. I mean, this is like one thing, like a gift from my mother is that this is not the kind of thing that she ever felt guilty about. And so I just like…

Luisa Rodriguez: You don’t either.

Emily Oster: Yeah, I don’t know. They’ll cycle through the names with me. We’ve had a variety of nannies. They’re like, “Claire!” “I’m not Claire.”

Luisa Rodriguez: Yes. I can already tell I’m going to be the kind of person whose feelings get hurt by that. So that is something I never thought of before.

Emily Oster: Yeah. So I think that’s a good way to summarise what people will find difficult about this.

When to have kids and fertility considerations [02:01:58]

Luisa Rodriguez: Another topic that comes up for people thinking about how to balance their desire to have children with their desire to be productive and ambitious in their careers is when to have kids, so whether to delay. And I guess how long you delay can affect the odds of getting pregnant. But I’ve also heard a bunch of conflicting things about when your fertility starts to decline and what the impact of ageing is on how hard it will be to get pregnant. What data do we have on that?

Emily Oster: Your fertility begins to decline around 16, and then it’s just a slow roll of decline until menopause. So there’s this myth of 35 is a cliff. I think people interpret that like: up until 35, everything is the same as it was when you were 20; and then after 35, you’re basically dead. And neither of those things is true. It’s harder to get pregnant at 30 than at 20 on average, harder to get pregnant at 35 than at 30. But there isn’t actually a cliff, and there’s not even really a change in slope. At some point, you stop being able to get pregnant. Most people are in menopause, and the average age of menopause is 51. There’s a period before that, in the mid-40s, when it’s more difficult, not impossible.

And this is all happening because as your eggs age, they acquire mutations, and so your body is less likely to ovulate, and the eggs that it is ovulating are more likely to have chromosomal defects that would be inconsistent with birth. So you’re sort of fighting the biological clock changing, and also that when you’re 22 might not be the best time to have had a baby.

My guess is that people overthink the optimality, and there’s some idea that there would be some perfect time. And kids don’t disappear. Just because you got a good four-month break where you think things are going to be quieter at work, the kids don’t go away later. They’re still going to be around. And so it’s a much broader decision. In my profession, people will wait until they have tenure. And I can definitely see the value of that — really see the value of that, as somebody who didn’t wait to get tenure. But it does potentially impact fertility, and so it’s a tradeoff.

Luisa Rodriguez: I definitely feel like I’ve heard the myth of fertility falling off at 35. Is that just that meme got spread at some point, but is just empirically wrong?

Emily Oster: It’s based on some quite old data. And because they sort of chunk people in ages, you used to get this idea that because there’s a chunk of 35 to 40… I don’t know, it’s based on elderly data. Elderly data about elderly people.

Luisa Rodriguez: But what we do know is that it basically declines somewhat linearly, and that at some point it might get hard enough that you might not be able to get pregnant naturally, and then at some point after that, you might not be able to get pregnant at all.

Emily Oster: Yes.

Luisa Rodriguez: And then how much does IVF change this picture? Does it radically delay that period when it might be really hard to get pregnant naturally, but could be possible?

Emily Oster: This is a tricky question. So IVF is an incredible technology. It has enabled people to become parents who wouldn’t be able to. There’s so many aspects of IVF that are really extraordinary. It’s not a magic wand. And there are some fertility issues for which IVF is really good. So if you have someone who is not ovulating or has a blocked fallopian tube, that’s the most obvious one. If you have someone whose fertility issue is their fallopian tube is blocked, IVF has got a real good chance because there’s nothing else wrong. There’s an obvious reason why they’re not getting pregnant. If you could just take out the eggs and put them back in in the right place, that’s going to change success rates, right?

If we think about IVF as a way to deal with ageing, you’re hyperstimulating the ovaries, they produce a lot of eggs, and then hopefully some of those are good. But as you are older, the eggs that are coming out are still less likely to be good than they were when you were younger. So I think there’s sometimes this idea that IVF is a way to sustain your fertility forever, and that’s not quite true. There are things you can do with IVF that will sustain your fertility for much longer. For example, donor eggs. So your uterus’s ability to carry a baby doesn’t decay anywhere near the same rate as your eggs do. And so if you’re 55 but you got eggs from a 25-year-old, that’s cool. There’s ways to make that work.

Luisa Rodriguez: Does that mean that freezing your eggs young so that you can implant them later makes a big difference?

Emily Oster: Definitely means that’s a possibility as the thing that would make a difference. We actually don’t have a lot of long-term followup of those experiences. And the freezing of the eggs is different from the freezing of the embryos, and the stability… This is a new enough technology that I think it’s hard to say that’s the deal.

Luisa Rodriguez: Yeah. So broadly, what advice do you have for people trying to decide? The kind of person I have in mind is someone who’s like, “My career is super important to me. I feel like it’s not the right time for me to have kids, but I am also scared that I won’t be able to later on. Should I rely on IVF to make it possible for me to wait?” How should people be thinking about this at all?

Emily Oster: I think that there are a set of people for whom I would say maybe you try to freeze some eggs, try to do something that has the potential to preserve fertility. But I also think there’s no secret Option C here. The choices that you’ve outlined are like, I could have a career hit right now to have a kid, which is something I want to do, or I could wait and run the risk that it will be more difficult to have a family. Those are the two options, both of which have good things and not good things, and there’s no secret Option C. So you’ve kind of got to pick.

Impact of kids on relationships [02:08:41]

Luisa Rodriguez: Maybe pushing on to our final topic, which is moving away from the intersection of children and careers, you talk about the impact of children on people’s relationships in your book. Maybe starting out, the stereotypes I have are just that having kids makes marital or nonmarital relationships between parents worse. What does the data say? Are people less happy?

Emily Oster: Yeah, people are less happy after kids. There’s a sort of decline after you have your kids. It’s the worst in the first year of the first kid, and then it kind of slowly rebounds, but very slowly.

Luisa Rodriguez: Does it recover fully?

Emily Oster: Yeah, by the time you have grandchildren. So it’s a lot, but it gets much better. Like, it recovers a lot in the first few years. The first year of parenthood tends to be really, really challenging for people. And I think partly that’s because people are tired, partly it’s because there’s just so much more to have conflict about than there was before. And that’s just the way it is.

Not everybody, I think it’s worth saying. And I read a really nice essay in ParentData a few weeks ago from someone who was like, yes, it’s true that things decline, but doesn’t decline for everybody. So this idea that it’s inevitable: it’s both that we want to be prepared for the possibility that this will happen, and you want to think about how you could scaffold it, but also, not everybody hates their husband after they have kids, as the title of the book suggests.

Luisa Rodriguez: Right. OK, nice. And it’s pretty clear that it’s not just that people become less happy in their relationships over time?

Emily Oster: No, it’s quite discrete.

Luisa Rodriguez: Because it happens right when people have kids?

Emily Oster: Yeah. It’s quite discrete at the time of having kids.

Luisa Rodriguez: And is it a big effect?

Emily Oster: Yes. Yeah. I mean, yes, it’s a big effect. I don’t know, it’s a little hard to tell how you measure happiness, but yeah. You definitely notice it.

Luisa Rodriguez: Got it. OK. And the things that cause it are at least partly more things to have conflict about. Can you say what that looks like?

Emily Oster: Yeah. So first of all, you could ask what’s protective. People who are happier in their marriages before are likely to have smaller declines, and people who have planned: when the kid is planned, that’s associated with smaller declines. So you can see from that some of what’s going on, which is like, if we find ourselves in a circumstance that we hadn’t planned to be in, that leads to some resentments.

I think in general though, there is more to do when you have a kid than there was before. So all of a sudden, you’ve introduced a lot of new tasks; you have less money because you’re spending all this money on childcare, as discussed, so there’s just way more constraints; and then all of a sudden, doing the right thing about this baby is more important to you than anything has ever been in your whole life — but you have no idea what to do, but you feel very strongly about your opinion. And I think that’s, for many people, this sort of moment of like, “We don’t agree on what to do. Neither of us has any idea what actually we should do, because we have never done this before, but we’re both 100% sure that our idea is correct. And we’re arguing about something that nothing has ever been more important.” And I think that’s a recipe for conflict.

Luisa Rodriguez: Yes. Put that way, that sounds incredibly hard.

Emily Oster: Yeah. And oh, you haven’t slept. Also, you’re tired.

Luisa Rodriguez: Oh god, yes. Basically, the main conflict between me and my partner ever is just I haven’t slept well enough.

Emily Oster: Right. Us too. Or my feet were cold. Basically, if I haven’t slept or my feet are cold or I’m hungry, that’s like… But you sort of learn those things. It might be like, stuff a sandwich in your partner’s face. But this is kind of new. You’re tired, you don’t remember about the sandwich.

Luisa Rodriguez: And it’s the most important thing you’ve ever done.

Emily Oster: It’s the most important thing that ever happened. Exactly.

Luisa Rodriguez: You’ve already said some things that are kind of protective. Let’s say people have already achieved some of those. So this thing is planned, and we hope we like each other in advance. Is there another single big thing that you could do to counteract some of the negative impacts of having children on a relationship?

Emily Oster: One is to try to sleep. I sort of harp on this, but it’s really difficult. Everyone’s pretty sleep deprived. But thinking about things you can put in place to try to get a little more sleep tends to be helpful. Actually, when you sleep train your kids, that enables parents to sleep more — and actually, one of the main outcomes in randomised trials is an improvement in marital satisfaction. So sleep.

The other thing I would say, which is much more concrete, and something you probably can do, is marital checkups — there’s some evidence, I think most of the data is about every six months or something — a time when you talk about what’s going well, what’s not going well, what could we do differently, sometimes with a therapist, sometimes not. That shows up as improving satisfaction in marriage. I think there are versions of that which you can implement pretty quickly.

I was talking to somebody the other day who just had a kid, and I was like, “The thing I would do is right now put biweekly meetings on your calendar for after the baby to talk about what could happen differently.” Because it’s very easy to only have interactions in a hot state when you’re upset. And just to have a moment that you’ve planned in advance to sit down and be like, “How are things going? What’s going well? What’s not going well? What could we do differently?” — that’s kind of a short-term version of these larger checkups.

Luisa Rodriguez: Yeah, nice. That sounds great. I like it. It’s concrete. I feel like I can do it.

I guess zooming out: it feels to me like so many of these decisions for your relationship, for your child’s wellbeing, and for your professional life have much less to do with a thing having really measurable huge negative impacts on your child or even your relationship, and much more to do with thinking about this big picture that you talk about in The Family Firm, about what you want your lives to look like. Do you want to explain why zooming out and thinking about that big picture is so important?

Emily Oster: I think there are a couple of reasons. When I talk about the big picture, I mean two different things. One is trying to state in some way what are your values, what’s your mission statement? There’s different ways to conceptualise this, but thinking about what is a touchstone that we can agree on. The book is about running your family like a business. There’s a thing in your business where it’s really valuable to be like, “This is what we’re trying to do. We’re all rowing in the same direction.” And then when there’s conflict, there’s both a touchstone of recognising that we don’t agree about this, but we’re all trying to get to the same place. So there’s a way in which we know we’re aligned, and things that we can come back to in making decisions that we’ve said. These are our three most important values. These are the things that are linking our family.

So I think there’s that piece, and then I think there’s a piece about just thinking about what you’d want your day to look like, and what you want your weekends to look like, your Tuesdays to look like. And there, it feels so in the weeds in a sense, but if you’re unhappy every Tuesday, that’s one-seventh of the days. And if it’s also on Thursday, that’s two-sevenths of the days. So thinking about this is about scaffolding something where most of the days you will enjoy what you do.

And it’s an opportunity. Both of these things are an opportunity with your partner, if you’re parenting with someone else, to have conflict early and have conflict in a cold state. So if we have a disagreement about what our weekends should look like: if you think that your ideal weekend with your kids is like two soccer games and three birthday parties, and your partner thinks the ideal weekend is like kayaking with the family in a cabin in Maine, those things are not the same. And every time you come up on a weekend and he wishes he was kayaking and you’re dragging people around to these soccer games, that’s a recipe for conflict, because he’s going to be mad that he’s not kayaking, and you’re going to feel like, “Why am I always driving to the soccer games?” He’s like, “But I didn’t want to go to the soccer games. I want to be kayaking.” You’re eventually going to fight about it.

All of this advice is just bring that fighting in the front, where you can explain to them why you think soccer is really important and he can explain why he thinks kayaking is really important. And it’s not necessarily that you’re going to come to… Like, maybe there’s a compromise: half the time you kayak on Sundays, I don’t know. But there’s a sense in which you’ve been able to discuss it when you’re not fighting. I think sometimes people are reluctant to have these conversations because they think they’re hard, and they think that they’re not going to agree. People have told me, “I don’t want to talk about this stuff with my partner, because I know we won’t agree.” That’s exactly when you should talk about it! If you know you’re going to agree, who cares? If everyone is super aligned, maybe you don’t need to have this conversation. It’s when we disagree that it is most valuable to have these discussions.

Luisa Rodriguez: Yeah. And not talking about it isn’t going to make it go away.

Emily Oster: Not going to make it go away. You don’t get to not fight.

Luisa Rodriguez: Yeah. I’m actually really keen to do this with my partner. We’re getting married next year, and we plan to have kids soon after. Are there prompts you recommend for thinking about what you want your big picture to be, and what you want those day-to-day things to be like? Should I just journal?

Emily Oster: In The Family Firm, I have a bunch of worksheets. I like a good worksheet. And I think some of it is about separating. There’s a trick people use in family therapy, where you write stuff down separately and come together. So if I asked you, “What is the mission statement you imagine for our family?” Could you write it down? Could he write it down? What are the three most important things? And some of this I try to get really practical — like, “Here’s a calendar: what do you want it to look like?” Or, “Here are the three most important things to me to do every day during the week, or every day on the weekends,” whatever. And so rather than be like, there’s a temptation sometimes I like a mission statement, but there’s a temptation sometimes to be like, don’t be evil. Okay, but don’t be evil is a fine mission statement, but it’s not like recipe for a search engine. You got to also do the recipe for the search engine.

Luisa Rodriguez: Great. OK, so The Family Firm is where we’ll go for that.

How Emily can best contribute to the world [02:19:38]

Luisa Rodriguez: We’ve just got time for one final question. I’m curious, what’s the biggest way you’ve changed your mind over the last few years?

Emily Oster: That’s a good question. I think for me, the biggest mental change has been about how I see what I can contribute to the world. I spent a long time trying to be an economist. I’m still an economist, but I spent a long time thinking my best contribution to the world is going to be through papers and journals. I think I’ve realised that that’s not true, and there’s a lot there in thinking about, “What can I bring to the world that’s going to help the most people, and how can I invest in doing that more of the time?”

Luisa Rodriguez: That’s a great answer. And yeah, just from the fact that so many people on my team have given me very, very specific examples of how you’ve made a huge difference to how much guilt they feel, or how worried they feel about a particular parenting decision they’re making, that is clearly working very well.

Emily Oster: Oh, that’s awesome.

Luisa Rodriguez: Thank you so much for coming on. My guest today has been Emily Oster.

Emily Oster: Thank you so much. Thank you for having me.

Luisa’s outro [02:20:53]

Luisa Rodriguez: If you enjoyed that, you should definitely check out Emily’s own podcast. It’s called ParentData with Emily Oster, and to give you a flavour of what to expect: the first two episodes of 2024 explore how children learn to speak, and how to ease back into exercise postpartum.

And as I mentioned at the start of the show, the 80,000 Hours advising team has capacity to speak to more people one-on-one about how to have an impactful career — this could be great for anyone just starting out, or wanting to change careers, or who maybe has a big decision and wants to talk through their questions or uncertainties. On a call, our advisors can help you review your options, make connections, and find a fulfilling job that does good in the world.

You can learn more about what to expect and apply to speak to an advisor at 80000hours.org/speak.

All right, The 80,000 Hours Podcast is produced and edited by Keiran Harris.

The audio engineering team is led by Ben Cordell, with mastering and technical editing by Simon Monsour and Milo McGuire.

Additional content editing by myself and Katy Moore, who also puts together full transcripts and an extensive collection of links to learn more — those are available on our site.

Thanks for joining, talk to you again soon.