There is no lack of pregnancy books out there, so when I heard about one more book expounding on the "newest" recommendations for prenatal health, I was skeptical. When I saw the post on Slate.com that it was about debunking myths about eating sushi and drinking alcohol and coffee, I scoffed - doesn't EVERYONE know that it's ok to drink alcohol once in a while, a few cups of coffee won't hurt, and sushi won’t make you any sicker than it would for a non-pregnant person? Then my dear husband had to remind me, as he so often does, "Babe. No, they don't. No one else reads pregnancy books for fun like you do." He had a point. And when I went on to actually READ the post on Slate, I learned that the author, Emily Oster, is an economist, not a doctor or a childbirth educator, and the book was about the actual studies that lead to the common recommendations about food, drugs, and general health during pregnancy. I was intrigued -- I do so love evidence-based care.
I picked up Expecting Better from the library when it was released. Again, I was surprised to find my name at the top of the list for it -- weren't other people as excited as me to find out the methodology that went into studying the effects of deli meat on pregnant stomachs?! Apparently not. Their loss, because this book was wonderful.
The author takes the reader through the story of her own pregnancy -- from stopping birth control through delivery day -- and discusses the research behind many of the common recommendations she received. For example, when asking her doctor when she would expect to resume a normal menstrual cycle after stopping hormonal birth control, the doctor gave her “vague reassurance” that it would not take long. Ms. Oster, a planner like myself, found phrases like "a little while" and “everyone is different” to be inadequate answers. She used her training as an economist to pull the studies associated with this “data”, dissect them, interpret them, and (lucky for us) explain them in simple, easy-to-digest language. (Turns out, 60% of women have a normal period the first month off the pill, and nearly 100% of women will have resumed normal cycles by nine months).
The author does a great job breaking down statistical theories in an easy way. For those of us who have forgotten (or blocked out) our last high school or college statistics class, she explains concepts such as false-negative and false-positive, how researchers arrive at those numbers, and why they are important when calculating your own risks. She also explains some of the more complex reasoning behind certain medical recommendations. For example, she briefly explains the different classes of drug restrictions, including how the Class C classification is pretty un-helpful. This information is a particularly useful nugget for a mother to have in her arsenal, even after the birth. Imagine a doctor prescribes a nursing mom a drug and says "This is a Class C drug, so you have to wean immediately." Wouldn't it be nice to know before going to the doctor that a Class C means there have not been any well-controlled human studies for this drug, instead of thinking it means it will immediately harm your baby?
Ms. Oster walks a fine line between giving us the data we need and making any true recommendations herself. She makes a good effort to explain HOW one would go about making a decision with all the facts, and gives examples of the decision SHE made vs. the decision her friend made with the same data and the same risk factors. While her personal interpretations come out at times (for example during the discussion on home birth), she stay mostly neutral on "controversial" topics, such as breastfeeding and pain management. To her credit, she guides the reader through the problems with the study responsible for the standard (negative) recommendation about home birth from the American Congress of Obstetricians and Gynecologists, pointing out where the flaws are and how their published infant mortality rate may not be accurate. Overall, the author’s tone is one of respect – mothers CAN be trusted to make informed decisions as long as they have the correct information.
My one issue with the author’s interpretation of the data is regarding epidural use and breastfeeding. Though it hard to argue with her data analysis (since that’s her job), I feel like perhaps she did not extend her analysis far enough. She states convincingly that getting an epidural does not delay the onset of lactation or cause babies to be lethargic (there is some anecdotal evidence that babies born after epidurals do not latch as well, though according to Ms. Oster there is not enough randomized data to conclude this). However, her conclusion that “there is no affirmative evidence that nursing is impacted by the epidural” is simply not accurate – lactation does not automatically equal breastfeeding success. She goes on to describe that a major complication of getting an epidural is maternal fever, and that the standard care for an infant in that case is to be given antibiotics. In addition, the infant is usually SEPARATED from his or her mother and placed in the NICU for observation. The simple act of separating a baby from its mother directly impacts their ability to breastfeed. So while an epidural may not keep a mother’s milk from coming in, it may lead directly to a practice that damages the breastfeeding relationship – a huge factor for many moms contemplating their pain management.
Overall, this book is a great resource and one that should be on any educator’s bookshelf (not to mention in a gift-bag to your newly pregnant friend). The studies used are current and well-interpreted, and Ms. Oster’s writing style is friendly and accessible. In order to give informed consent, one first needs to be informed. This book is a great way to get your questions answered and begin the process of making well-informed decisions about your care.
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