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Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to Know (The ParentData Series) Paperback – June 24, 2014
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"A book . . . that pregnant women won't want to miss." —Parents Magazine
“Emily Oster is the non-judgmental girlfriend holding our hand and guiding us through pregnancy and motherhood. She has done the work to get us the hard facts in a soft, understandable way.” —Amy Schumer
"Oster's advice cuts through the emotion, myth, fear of malpractice litigation and looks at the numbers. A mother herself, Oster's interest isn't just curiosity, it's the same thing that motivates every new mom . . . and Oster's ability to break down the data into informed analysis is a refreshing break from the hysterical hearsay that often dominates the conversation. —Babyzone
"Gives moms-to-be a big helping of peace of mind!" —Harvey Karp M.D., bestselling author of 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
About the Author
- Publisher : Penguin Books; 1st edition (June 24, 2014)
- Language : English
- Paperback : 352 pages
- ISBN-10 : 0143125702
- ISBN-13 : 978-0143125709
- Item Weight : 9.6 ounces
- Dimensions : 5.4 x 0.8 x 8.5 inches
- Best Sellers Rank: #564 in Books (See Top 100 in Books)
- Customer Reviews:
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Top reviews from the United States
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However, I was shocked seeing a review on the book talking about the "myth" that alcohol is inadvisable during pregnancy. Certainly the author isn't advising any amount of alcohol is advisable, given the overwhelmingly consensus on the issue from public health advocates?
I immediately read the entire alcohol part of the book. I soon learned not only would this book not provide me with the best evidence from health advocacy groups and scientist groups, they would provide evidence that directly contradicted it.
The author says it's fine to drink some alcohol during pregnancy, and details how much and why she thinks this. She walks through studies and literature on the topic that she examined. Given that the CDC, the American Pregnancy Association, the World Health Organization, National Council on Alcoholism and Drug Dependence, the March of Dimes, and others all agree and firmly say the best advice is to abstain from alcohol completely, I really needed an extraordinary explanation from the author as to why I should ignore those experts. Not surprisingly, I found her analysis underwhelming and unpersuasive, and not worthy of ignoring the consensus shared by experts in the field.
Ask yourself, who is a more trusted source? An economist writing a book to a mass audience for profit, or the March of Dimes, the CDC, WHO, American Pregnancy Association, the UK Health Ministry, Fetal Alcohol Syndrome scientists and advocacy groups? Do all those independent groups have a profit motive to give distorted and wrong health advice?
And fetal alcohol syndrome is not some one in a million risk that parents shouldn't really worry about. A recent study showed 1% to 5% of kids studied had fetal alcohol syndrome disorder, and it was being chronically under-diagnosed.
To be fair, while this has been the consensus for a while, you could find outliers when the author first wrote this book. For example, the UK's health ministry used not advise against very light alcohol use, but they have since examined emerging research on fetal alcohol syndrome disorder (FASD) and they now say the best advice is to abstain completely - joining the consensus among other health groups like CDC, WHO, etc.
So has the author been concerned about the emerging evidence since she wrote this book? I saw Dr. Oster was asked about recent studies showing that even light alcohol use was unsafe during pregnancy by a health journalist, and her answer was illuminating. Dr. Oster basically said for those studies she'd want to see them be replicated and more details about the links between behavior and harm. That's fine (we should fund lots of replication studies!), but note when she looked at studies that didn't find a danger for pregnant women to drink moderately - she didn't say "well I'm going to wait to see if these can be replicated and more detail provided" - she took them to the bank and said you can make conclusive decisions about your child's health outcomes based on these studies.
I would agree there is not an abundance of studies showing that a tiny amount of alcohol will lead to significant medical risks. But there have also been no similar studies showing that having one cigarette (or two, or three) during your pregnancy is a significant risk. So in this book, does the author similarly suggest smoking a very small amount of tobacco is perfectly acceptable, given the absence of studies? No, she follows the scientific consensus here. Why the double standard?
With things that pose a serious risk to children (like lead paint), we may not ever know exactly where the line is between what is harmless and what will irreversibly harm a child. When the activity is something that is avoidable, the scientific community generally urges avoiding it entirely.
I'm sure Dr. Oster is well-intentioned, but this is a book about health written for profit to a popular audience, and even in the best circumstances that is a fraught situation. There is a profitable market for people with academic credibility to sell a message that, while it goes against the consensus of the public health community, it's something many people want to hear. I hope the book gets updated with the many advances in our understanding of FASD, or at least explains why they have a double standard on very light tobacco use.
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.
I literally can not understand how this book has 1 star reviews...Like, what? You don't like evidence based research? It just astound me.
I've cross referenced Oster's sources and found them to, in fact, be incredibly legitimate.
In the unknown world of pregnancy, Oster attempts to gather numbers/percentages/ figures and studies to give the reader OPTIONS. She is not saying, yeah--go drink a bottle of wine (like many naysayers accuse her of doing). She presents the evidence and lets the reader decide whichever approach is best for them. It's not pushy or biased at all, it simply allows the reader to see the science behind "no deli meats while knocked up..."
Seriously, read this book. I am so thankful I did.
Top reviews from other countries
PLEASE be careful reading this. It is not scientific. The author has no medical standing and I am astounded it ever got published.
Another thing that bothered me was the section on the evidence around epidural analgesia. Yes, the Cochrane review says that epidural analgesia increases the risk of instrumental delivery but it also very clearly says that since 2005, with low infusion concentration, that link doesn't seem as strong. I also think there is a chicken and egg situation whereby if your baby is malpositioned (back to back for eg) or very big or have a protracted labour (often the case with a back to back baby), you're likely to need better pain relief than in more straightforward scenarios which means that it may well not be the epidural that is the reason for an instrumental delivery but the conditions you find yourself in in the first place.
Finally, I also disagreed with Oster's view that caesarean section shouldn't be a first choice. If you're having one child only, it is the safest mode of delivery at full term. Risks between attempt at vaginal delivery and planned caesarean section are of a different type but in developed countries like the US and the UK, there isn't much difference in terms of outcomes.
Overall, this book is a bit better than much of what else is out there but I still thought it wasn't as neutral or well researched as I would have liked.
The things mentioned from a medial perspective aren't a secret or (like she eludes to in the book) are beyond the outdated medical profession. The NHS appear to be well aware of majority of what she references but with things like drinking, why would they say anything other than stay abstinent? Things about epidurals making labour longer and inductions making labour more painful aren't new pieces of information for most.
If you want some figures to support what is already out there without the leg work or just want another book for that little bit more information, go for it.
Reviewed in the United Kingdom on September 26, 2020
My partner's comment on the book was "it's reassuring", and that alone is worth the price of the guide. Being armed with facts and figures gives us both confidence that the strategies we choose to take both during her pregnancy, and in the years following, will be based on science, and not on the well-meaning, but possibly harmful, advice of friends and family who may simply be parroting unchallenged myths that have no basis in reality.
Highly recommended for any new parent-to-be.