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Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to Know Paperback – June 24, 2014
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"Expecting Better gives moms-to-be a big helping of peace of mind! Oster debunks many tired old myths and shines a light on issues that really matter."
—Harvey, Karp, MD, bestselling author of The Happiest Baby Guide to Sleep and The Happiest Baby on the Block
"It took someone as smart as Emily Oster to make it all this simple. She cuts through the thicket of anxiety and received wisdom, and gives us the facts. Expecting Better is both enlightening and calming. It almost makes me want to get pregnant."
—Pamela Druckerman, New York Times bestselling author of Bringing Up Bébé and Bébé Day by Day
"This is a fascinating—and reassuring—look at the most important numbers of your pregnancy. It will make parents-to-be rethink much of the conventional wisdom: think bed rest is a good idea? Think again. This may be the most important book about pregnancy you read."
—Steven D. Levitt, New York Times bestselling co-author of Freakonomics
"Expecting Better is a fascinating and reassuring tour of pregnancy and childbirth, with data leading the way at every juncture. From start to finish, Oster easily leads us through the key findings of the extant pregnancy-related research. My only regret is that my wife and I had three children without the benefit of this insightful approach."
—Charles Wheelan, New York Times bestselling author of Naked Statistics
"The only antidote to pregnancy anxiety is facts, and Emily Oster has them in spades. Disarmingly personal and easy to read, this book is guaranteed to cut your freaking out in half. Pregnancy studies has a new heroine. Every pregnant woman will cheer this book—and want to take Oster out for a shot of espresso."
—Rachel Simmons, New York Times bestselling author of Curse of the Good Girl
About the Author
Emily Oster, the daughter of two economists and the wife of a third, is an associate professor of economics at the University of Chicago Booth School. She lives with her husband and daughter in Chicago.
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This book was hands down the most useful pregnancy book I read, not because it tells you what to do, but because it calmly presents the data on every major decision you'll need to make during pregnancy, and then encourages you to form your *own* opinions based on it, instead of treating you like an idiot who can't be trusted to understand anything other than black-and-white 'rules'. As the author says:
"I teach my students that making good decisions requires two things. First, the right data. Second, the way to weigh the plusses and minuses of the decision *to you personally*...So naturally, when I did get pregnant I thought this is how pregnancy decision making would work too. Take something like amniocentesis. I thought my doctor would outline the plusses and minuses...She'd give me the data I needed. She'd then sit back, and my husband and I would discuss it and we'd come to a decision that worked for us. This is not what it was like *at all*".
Every pregnant woman knows this feeling.
This book has the missing data that thinking parents need to help them make many of those decisions, including:
- What *really* happens to your odds of conception after 35?
- What is the evidence that having a cup of coffee will harm your baby? or 2 cups? 3 cups? Why is there so much conflicting advice on this?
- Same for alcohol, by trimester
- What is the likelihood of miscarriage each week? (I found this super reassuring)
- What is the statistical likelihood of issues arising from eating deli meats, eggs, fish, shellfish, soft cheeses, and sushi? How do you weigh up the omega 3 vs mercury risk for fish?
- What % of women are still experiencing morning sickness each week? Are your morning sickness symptoms 'worse' than the average woman and how risky are the drugs for it?
- What should you know before you make a decision to get antenatal testing for downs syndrome? Does amniocentesis really have a 1 in 200 risk of miscarriage? Is CVS more or less risky than amnio? (We ended up having the non-invasive test, while getting our results the doctor told us 'you seem really well informed on this!'. Thanks Emily :-)
- Is emptying the cat litter box as dangerous as gardening?
- Exactly how much airplane travel is risky?
- What are the real risks (and benefits!) of gaining more weight than the recommended amount?
- Is there anything that will help you correctly guess the gender?
- What's the evidence on whether Kegels help?
- How can I understand the data on which drugs are safe during pregnancy?
- What is your chance of a pre-term birth, week by week? And what % of pre-term babies at each week will survive? (also reassuring)
- For full term babies, what is the chance of the baby arriving each week, if it didn't come last week? Are there any studies than show symptoms the baby might come soon? Is there anything safe you can do to bring on labor if you are overdue?
- What are the risks and benefits of induction? Do you really need to be induced for 'low amniotic fluid'?
- How long does the average labor really take?
- What, statistically, are the pros and cons of a c-section or an epidural? What about cord-clamping, homebirth, doulas, types of fetal monitoring, episiotomy, and cord blood storage?
- An example of an evidence-based birth plan is included, but emphasis given to choosing what works for you.
So, in summary, the data need to make your own important decisions along the way. Recommended read!
Appendix: *Exactly* what this book says about alcohol during pregnancy:
"There is no question that very heavy drinking during pregnancy is bad for your baby. Women who report binge drinking during pregnancy are more likely to have children with serious cognitive defects. In one Australian study, women who binged in the second and third trimester were 15 to 20% more likely to have children with language delays than women who didn't drink. This is repeated again and again in other studies. Binge drinking in the first trimester can cause physical deformities and in later trimesters, cognitive problems.
If you are binge drinking, stop.
However, this does not directly imply that light or occasional drinking is a problem. When I looked at the data, I found no credible evidence that low levels of drinking (a standard glass of wine or so a day) have any impact on your baby's cognitive development"
(The author then goes on to review a number of studies in more detail, including an analysis of whether those studies correctly separated causation from correlation).
I did not read that as a licence to go drinking while pregnant. In fact, I read it and chose not to drink anyway (I was too morning sick to want anything to do with alcohol!). And I respected the author for giving me the evidence, and not blindly repeating something others had said.
Here's to being treated with respect when you are pregnant, not like an idiot.
Then the furor struck on the Interwebs. Because Oster draws the conclusion from a variety of studies and data that it's fine to indulge in the occasional alcoholic beverage during pregnancy, she has been excoriated in a variety of articles and in the responding comments. Current Amazon.com reviews are skewed by those who take issue with an economist (not a medical doctor) who will, in their minds, increase the number of children born with FASD (Fetal Alcohol Spectrum Disorder). Several comments made nasty remarks about the author's 2-year-old daughter, Penelope, implying that it was only a matter of time before she would begin to fail IQ tests and demonstrate signs of FASD herself.
Was Oster truly that horrible and conniving? Did she write her book to cause birth defects and emotional trauma? I had to know the truth, and while 40 weeks and two days pregnant, I picked up Expecting Better and read it carefully.
Spoiler alert: it's really not that bad. I love authors who examine evidence, explain scientific studies and methodology, and draw logical conclusions about the data. Oster isn't an ob/gyn, but she's a well-trained economist whose job is interpreting data. Her analysis is thorough even as she keeps her writing accessible, humorous, and sympathetic. As she points out in the introduction, advice about pregnancy tends to be either black and white--don't have any drinks, ever--or vague--drink coffee in moderation. Instead of relying on the hearsay, she reviews the actual data and comes to her own conclusions. Oster doesn't demand that women drink during pregnancy despite their own reservations. Not at all! She just presents the evidence that light drinking has been shown to be not harmful, and lets the reader make her own choice.
The knee-jerk reactions to the book and Oster's approach are misguided because they don't realize that telling women what to do during pregnancy is exactly the opposite of Oster's intentions. Rather, she wants all the data laid out so women can make informed decisions during pregnancy based on their own assessment and comfort levels with varying amounts of risk. That is far more empowering and practical than a notarized list of what to do and not do. She gives examples in the text, citing instances where her review of the data prompted her to chose one path and a friend reviewing the same data to chose another path. That is fine. The goal is seeking knowledge to inform personal decisions.
Pregnancy in the U.S. is fraught with judgment from family, friends, and total strangers that add extra stress in an already anxious time. Expecting Better steps back from the hysteria and offers women up-to-date, relevant information about the choices they will need to make during pregnancy. I'll definitely be recommending this one to pregnant friends in the future.