The best pregnancy book I have ever read hands down. Oster started writing her book when she came to the realization that:
"Pregnancy seemed to be a world of arbitrary rules. It was as if when we were shopping for houses, our realtor announced that people without kids do not like backyards, and therefore she would not be showing us any houses with backyards. Worse, it was as if when we told her that we actually do like backyards she said, 'No, you don't, this is the rule.'"
This was very similar to my experience during my first pregnancy. I tried to engage my OB office in intelligent discussion about the pros and cons of aspects of my care and they just wanted to lay down rules. Finally I stopped sharing with them any sign that I was an intelligent person who sometimes had questions about my care. For most of my pregnancy this was fine because it was pretty simple and complication free and I don't live a wild and crazy lifestyle that would be harmful to a developing fetus.
As I approached and passed my due date and my child still was not ready to come out though, this narrow-minded view of the "right" way to do pregnancy, labor, and delivery, started to cause problems. The rest of my story is fodder for another blog post, but for now let's leave it at the fact that I wish I had been more well-informed about the risks and benefits of induction when a child is otherwise happy and healthy in the womb.
With a doctorate in economics, Oster is not a medical professional, but is used to evaluating evidence in order to make complex decisions. In this case she evaluates the evidence surrounding common pregnancy advice given by obstetricians. As someone in an also heavily researched based profession (librarianship) I appreciated her focus on facts. A little surprisingly she finds that a lot of common pregnancy advice is not supported by the evidence.
The biggest bombshell is that the total ban on drinking during pregnancy is based mainly on an assumption that Americans in general can't be expected to drink moderately. I completely agree when she responds, "I'm not crazy about the implication that pregnant women are incapable of deciding for themselves - that you have to manipulate our beliefs so we do the right thing. That feels, again, like pregnant women are not given any more credit than children would be in making important decisions."
Looking at studies of women in countries where pregnant drinking is perfectly acceptable (most of the developed world aside from the U.S.), researchers generally discovered that as long as women weren't binge drinkers or heavy drinkers their babies were at no greater risks for birth defects or lower IQ scores. Some studies even showed slight (although statistically insignificant) improvements for women who drank moderately during their pregnancy, especially if, after the first trimester, they drank about the same as they did before getting pregnant.
Unfortunately for me, I had such terrible heartburn during my first pregnancy that even after the nausea passed, I still didn't feel like drinking, so depending on if the heartburn repeats itself, I don't know if this revelation will change my behavior much the second time around. Still, knowing that I have the option to savor the occasional rum and coke guilt free during future pregnancies does make me feel a little better.
She covers less controversial topics as well, from best ways to ensure quick conception (there aren't any aside from the obvious "have unprotected sex repeatedly") to how common morning sickness is (very) and the best ways to treat it (Unisom and Vitamin B6) to decisions about pain relief in labor and the safety of various kinds of labor (it turns out living in the developed world, we're pretty safe, no matter how you end up delivering your baby).
In general I love her fight against the all too common attitude in the pregnancy establishment that expectant mothers should be coddled like children and simply told what to do while they're pregnant because they've got enough to worry about. Unfortunately, needless rules cause a lot of unnecessary worry. I found out relatively late that I was pregnant the first time and had eaten some sushi shortly before finding out and had no clue what risk I had put my baby at, only to realize that the main risk was that food poisoning can be especially unpleasant while pregnant. I hadn't developed food poisoning, so I was fine and should have had no reason to worry.
Also every woman and every pregnancy is different, so throwing out blanket rules that affect all of them the same seems stupid. There are certain drugs you'd rather not take during pregnancy, but if they treat a serious medical condition that could also affect the quality of your pregnancy, then it seems like an argument could be made for taking it, or not, depending on the variety of factors involved. And opening up this kind of dialogue between pregnant women and their healthcare providers is what I love so much. In general I'm in favor of more information (again, librarian here), so conversations with experts about the risks and benefits seem like a good thing.
It's funny that I like this book so much when my previous go-to pregnancy book was The Mayo Clinic Guide to a Healthy Pregnancy, which Oster criticizes a couple times. While her criticisms, to the best of my knowledge, are accurate, this, sadly, was the most evidence based pregnancy book I could find during my first pregnancy. If you are planning a traditional doctor-assisted hospital delivery it also gives you a pretty accurate picture of what to expect and what most doctors will do if something goes wrong. Still, as for diving into the evidence behind their recommendations, they are a far cry from Oster's analysis not only of the evidence, but why it may or may not be good evidence.
If you are pregnant, thinking about getting pregnant, or even working on your 2nd, 3rd, or subsequent pregnancies, this is a great book to explore the advice we give pregnant women and to give you the tools to make more informed decisions as a potential mother.
Check out an excerpt of the book at the Huffington Post to see if it might be something you're interested in.
Edit 10/3/17: I'm playing around with my new Amazon Affiliate status. So if you've read this review and want to buy Expecting Better would you mind clicking on this link below so that I get a (very) small kick back. Thanks.
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