- Hardcover: 313 pages
- Publisher: Penguin Pr (20 August 2013)
- Language: English
- ISBN-10: 1594204756
- ISBN-13: 978-1594204753
- Product Dimensions: 16 x 2.8 x 23.6 cm
- Boxed-product Weight: 522 g
- Average Customer Review: 2 customer reviews
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Expecting Better: How to Fight the Pregnancy Establishment with Facts Hardcover – 20 Aug 2013
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About the Author
Emily Oster is an associate professor of economics at the University of Chicago Booth School of Business. She was a speaker at the 2007 TED conference and her work has been featured in The New York Times, The Wall Street Journal, Forbes, and Esquire. Oster is married to economist Jesse Shapiro and is the also the daughter of two economists. She has one child, Penelope.
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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.
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.