Expecting Better

This approachable, entertaining, well-researched book provides clear and useful summaries of medical studies on a wide range of important pregnancy-related topics: the pros and cons of various pre-natal tests, epidurals, induction, doulas, and home birth; foods that are best to be avoided, and those that are less dangerous than conventional wisdom might have us presume. It is an excellent resource-- it's like a friendly encyclopedia of pregnancy- and childbirth- related medical research! The author emphasizes the fact that medical recommendations come from studies, not from thin air-- and that with a little guidance (which Oster provides), women and their partners can understand those studies, and how to interpret the results in the context of their own lives. Oster shares her own choices (with much self-deprecating humor), but makes it clear that this book is about providing information, not prescriptions. I greatly appreciated her discussions of the origins and evolution of different recommendations (eg. pre-natal testing after 35, bed rest, fetal heart monitoring during labor, episiotomies); it's really informative to see how best practices change from one generation to the next, and how sometimes practices lag behind research. The introduction is available online at the Huffington post; I'd suggest checking that out to get a feel for the book. It's a lot less controversial than many of the reviews below would have you believe. Edit: All the hoopla around the "pregnancy vices" chapter is overshadowing some of the other important contributions of this book. In the interest of helping you decide if the rest of the book is something you might find valuable: One of the main themes of this book is that if you want to act in the best interest of your child, you need to figure out what "best" is. Your doctor can guide you, but you can and should have responsibility and agency in these matters. To a lot of pregnant women, choices about alcohol, coffee, and food are easy-- err on the side of utmost caution. Yet one thing Oster highlights is that most pregnancy-related choices aren't so easily dealt with-- in part because the costs and benefits aren't always clear, and in part because even when they are, the alternatives *all* have costs and benefits worth weighing. Expectant parents have to make choices, choices that involve real tradeoffs for both baby and mother. Non-invasive prenatal screening, amnio, or CVS? Schedule the induction, or not? Epidural, or not? Home, or hospital? This book does fantastic job of presenting the most credible, up-to-date estimates of the costs and benefits associated with each of these choices, and pinpoints particular things about your situation that that might make you weigh the costs and benefits differently than your friend, your OB, or Emily herself. I think this is where the book excels, and really fills a void: chapters about topics that are less inherently buzz-worthy than booze, but perhaps even more difficult to navigate in a sea of murky data and misinformation. The prenatal testing chapter is particularly good.

This was exactly the kind of book I needed. I have a biology degree, so I hate it when doctors talk to me like I don't know anything about how science or the human body works. Some doctors are better about that than others. Unfortunately my obgyn is one of the usual kinds that just gave me a list of drugs I'm allowed to take and foods I'm not allowed to eat with no explanation. My husband and I immediately started wondering how they arrived at this list. Are these drugs that have been proven to be safe, or ones that haven't been proven to not be safe? Are these foods especially dangerous during pregnancy, or just foods they think are unhealthy in general (my do-not-eat list even included pasta, refined sugar, fast food, etc.). So this book gives you the actual evidence for all these recommendations. I found the section on drugs especially interesting, because they're actually put into several categories based on how much evidence they have for their safety. Class A and B have evidence showing they are safe, Class C don't have much evidence one way or the other, Class D have evidence they are unsafe, but they treat a serious condition that is also unsafe for your pregnancy so it might be worth taking them if you have that condition, and Class X are drugs that are unsafe and not worth taking under any circumstances. And it turns out that some of the "forbidden foods" aren't any more dangerous to eat when you are pregnant than when you are not pregnant, while some of them really are more dangerous when pregnant. Maybe my doctor doesn't think that's an important distinction, but I do. The book didn't even mention pasta, but when I had morning sickness, starchy foods like pasta and bread were some of the few things I could easily eat, so I think my doctor just had pasta (and sweets, and fast food) on the list because eating too much might make me gain too much weight. I can't find anywhere else that says that pasta is especially dangerous to eat when you are pregnant, and then this book even goes on to say that gaining a little too much weight isn't that bad, so I'm still eating pasta. I am avoiding the foods that are on the list because they are more likely to contain bacteria that can make you sick, even though the book says Salmonella isn't any worse for you when you are pregnant than when you aren't (but Listeria and toxoplasmosis are). Salmonella poisoning is no fun, and I don't need that extra stress on top of being pregnant, so I'm avoiding those foods even though the book says I'd probably be OK if I ate them anyway. I also gave up alcohol completely, even though the book said an occasional drink is probably OK, but I just couldn't give up coffee, so I just cut back. As others have said, this book is great if you want to make your own informed decisions, instead of being treated like you are stupid and incapable of understanding nuance and uncertainty. It's also reassuring to know that if you drank that one class of wine, ate a little blue cheese, took a Class C drug, or gained 5 pounds above the recommended amount, you probably haven't done serious harm to your fetus. Being pregnant is stressful enough already without having to add any unnecessary worry on top of that. After reading this book, I'm definitely ordering Cribsheet next, before the baby arrives.

If you asked me a couple of weeks ago if I was interested in reading Yet Another Pregnancy Book, I would have laughed. Hardly! I read a couple early on, then turned to the almighty Google when I had questions or curiosities. Then about a week ago, my mom clipped an excerpt from the Wall Street Journal called "Take Back Your Pregnancy." Well, I took the bait. Emily Oster's article intrigued me. Definitely one for any subsequent pregnancy, I thought! 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.

It's a pity this book got caught up in a kerfluffle about alcohol, when that is about 1% of the books actual content (I've put *exactly* what the author says about it at the bottom of the review for all those negative reviewers who couldn't be bothered reading the actual book!). 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 actually read this book (unlike a lot of the negative reviews on here) and feel that I must add my positive review to counteract the reviews on here that are unfair and uninformed. You don't have to like the book, but I think you should have to read it first before you comment. Anyway, back to the book. Her writing style is very easy to follow and kept me very engaged. She's you're go to nerdy girlfriend, here to fill in all of the mystery behind "thou shall not eat soft cheese" and other restrictions. I think what I loved about this book is simply that she's giving you to chance to make informed decisions about your child and your body. This is a woman who was very involved in her pregnancy and wanted real answers, not just commandments. I liked her summaries at the end of the chapters where she gives you her take-away from the information but she also trust you to be a thinking, independent adult and doesn't expect you to agree with her. She points to many instances when she gave this information to friends and one would use that information to take action A, while another friend, given the same information, was more comfortable with taking action B. I also liked that she shares and breakdowns for you the scientific studies that doctors have been using for years to back up their "You can't do..." statements. Some still hold water and some do not. This book is not an anti-doctor or big medicine book. She had her baby in a hospital and got the epidural. Go girl! This is a book about being informed. That study about mothers drinking and hurting their unborn babies? Yeah, they were also far more likely to use cocaine. There are more modern studies that give more accurate information. She also just happens to cover far less controversial issues if you're interested. Drinking coffee, when to cut the umbilical cord, why you don't need to freak out if you were drinking heavily the night the baby was conceived, etc (although I know some people will find every single one of these issues controversial, they just can't help themselves when it comes to trying to tell other women what they have to do to be a good mother. This woman-on-woman competitive mothering game is completely out of control). Overall, I think any to-be mother could benefit from reading this book. I know I came away with some things to really think about and I hope she writes more.

My husband showed me an article on Emily Oster's book (published in the Wall Street Journal, August 9th) and once I read it, I could not wait to read her book. I am 12 weeks pregnant and could not understand the lack of data supporting all of the rules that pregnant women must adhere to. I saw 2 OB-GYN's and both doctors provided differing views, without providing sound data... was it just their opinion they were spouting off to me? That's what it seemed like to me. Women must make their own decisions, at the end of the day, and I am shocked with the negative reviews this book is receiving. This book is a MUST READ FOR ALL WOMEN!! The negativity is around drinking --- Emily Oster is NOT supporting drinking while being pregnant. This book provides multiple studies on women who drink and shows us that if you have a drink or two, you are NOT HURTING YOUR BABY. But if you don't agree with this philosophy, then don't drink and mind your own business! There are plenty of women around the world who drink while carrying a child. I highly doubt that the reviewers who are so concerned with FAS have actually read the book!! I loved the chapter on miscarrying since there is so much random information online. I too, like Emily's friend in the book, wondered the % of miscarrying at varying weeks. It is comforting to know that there are many reasons why women miscarry and you can't make a generalization as to your chances of miscarrying. Another chapter I appreciated was foods you really should avoid. Even though I'm pregnant, I don't want to feel like I can't live and enjoy food! Knowing the foods I must avoid brings me a peace of mind. In addition, I always wondered about listeria and did not believe it would be harmful to me or my baby. But Emily Oster opened my eyes to the seriousness of this bacteria. I am so thankful that this book came out during my 1st pregnancy. I felt very lost with all of the information that was provided to me and I kept wondering, "why is there such differing information out there?" This book is a god-send and every chapter is useful and to make it even better, she is HILARIOUS! This author is really funny and she adds personal touches throughout the book so you feel connected to her as well. You cannot disagree with data and please do not be influenced by the negative reviews. Please get this book and make your own decision. I am so thankful that I bought the book and I hope you enjoy it as much as I have!

I love healthy debates about books. It's one of my favorite pastimes. However, I'm quite discouraged by all of the 1-star, negative reviews on here that seem to take issue with 12 pages of this 281-page book that cover the topic of alcohol while pregnant. I don't believe the author states anywhere in this book that women should go out and drink while pregnant, nor does she minimize the struggles of those affected by Fetal Alcohol Syndrome. This book was written for educated, intelligent women who want the facts about a wide range of topics so that they may make decisions for themselves based on evidence and research. She would be remiss if she wrote this book and left out any mention of alcohol. In fact, on page 40 Oster writes: "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 deficits." I think her stance is pretty clear on that. I am a healthcare professional who happens to work in a city where many of the residents are low-income and the majority have not finished high school. I completely, wholeheartedly believe that it would be irresponsible to go around hanging up posters telling moms-to-be to "Go ahead! Get wasted!" This is not who this book was written for. In fact, at no point did I feel that Oster was imposing her opinion on her readers; she says over and again in more or less words, "Here are the facts, here's the research, the choice is yours to make." She does, however, candidly share the choices she's made, and instead of criticizing her for that, we should be applauding her for her honesty. So -- who is Expecting Better for? It's for women like me who are sick and tired of getting "coloring your hair probably is fine" from one doctor and "you should probably wait until your second trimester" from another doctor. Or reading one popular website that says, "Put down that turkey sandwich!" while another says, "as long as you're getting it from a deli that changes their meats quickly you 'should' (there's that's word again) be fine..." I want facts and figures. I want peer-reviewed research. I want to know WHY it's a risk to drink too much caffeine, and why I'm not going to (hopefully) do major damage if I have to take a Tylenol. I'm happy for my friends and family who seem to be floating through their pregnancies without a care in the world. I've never been that kind of person who can just trust everything will be fine so long as I maintain a positive outlook. On the contrary, I have always been the person who believes in informed consent and carefully weighting risks and benefits before making choices. I do my research, then make my decision knowing that whatever consequences I face are a result of carefully thought-out decisions. Above all, I appreciate that the author treats pregnant women as responsible adults who are capable of making their own decisions. Too much of maternal fetal medicine in the U.S. resorts to directing the expectant mothers towards test, after test, after test with results being reported as "everything looks fine," without even so much as explaining what was done and why. This is my body and my baby and I'd like to have more of a say with what's going on, and I'd like to be armed with the most current research. Expecting Better will the THE book I recommend to every pregnant friend of mine from this point forward. It's a must-read. Take the information and make your own choices based on what's best for you. And, by all means, if you're that opposed to the Alcohol section (or any other section of the book), skip it. Great book!

I regularly enjoy Emily Oster's informative, witty, and incisive columns on fivethirtyeight.com, so when I heard she'd written a book on pregnancy, I was excited and went to Amazon to buy it. Wait... only three and a half stars? I would have expected better (no pun intended). Then, when I looked more closely at the reviews, I saw something odd: two-thirds of the reviews were five-star, and one-third of the reviews were one-star. What was going on? Now that I've read the book and a large percentage of the reviews, I know that the negative reviews are almost entirely due to disagreement with the chapter on alcohol consumption during pregnancy. Unfortunately, the majority of the one-star reviewers have not read the alcohol chapter (or any of the book, for that matter). Rather, they follow a straightforward line of reasoning: "This author says alcohol during pregnancy is OK -> I know that alcohol during pregnancy is not OK (because I have a child with FASD / I work with disabled kids / my doctor said not to drink / etc.) -> This is a terrible book and you should not buy it." The problem with this reasoning is that Emily Oster did not actually say "alcohol during pregnancy is OK." Rather, she painstakingly reviews the evidence for harm resulting from different amounts and timing of alcohol consumption. Her data clearly show that moderate to heavy drinking, and/or binge drinking, can be very dangerous to a developing baby - especially in the first trimester. Fetal alcohol spectrum disorder (FASD) is a devastating diagnosis, and Oster unequivocally recommends against any level of drinking that has been implicated in FASD. She does, however, point out that there is no good evidence linking occasional light drinking (1-2 drinks per week) to FASD. This makes biological sense. Although many reviewers have stated that "Alcohol is a poison and no amount of drinking is safe in pregnancy," we know that a single drink, slowly consumed, has very little effect on the mother's blood alcohol content, and thus a negligible amount of it passes to the fetus. By contrast, with binge drinking, the mother's ability to detoxify alcohol is overwhelmed, and the fetus can receive a devastating dose. Oster concludes that abstaining completely from alcohol is a reasonable choice for mothers who want to be completely safe. She also says - and the data solidly back her up - that a pregnant woman who wants to have the occasional glass of wine with dinner does not need to feel guilty about it. Some reviewers have protested, "But women will use this book as an excuse to drink as much as they want." Perhaps, but that pessimistic conclusion seems to demean the intelligence of pregnant women. Despite the impression you may get from reading the reviews, alcohol is only a very small section of the book. Oster discusses everything from food safety issues to the (lack of) benefits of bed rest to the pros and cons of epidural anesthesia. On each topic, she provides a careful review of the data, enlivened by personal anecdotes and insights. I am baffled by the reviewers who say that Oster comes across as patronizing, egotistical, and neurotic. I would say exactly the opposite. In the introduction and throughout the book, she makes it clear that her goal is to lay out the statistics and let readers decide their own course of action. She does talk about the pregnancy decisions that she herself made, and why, but she repeatedly states there can be many other valid decisions based on the same evidence. It depends on one's individual preferences, and that's not something that statistics can or should dictate. I found this book's approach refreshing and illuminating, and I will recommend it to my pregnant friends. I'm a scientist myself, and with my first pregnancy, I found all the yes/no, black/white advice condescending and infuriating. I'd much rather see the data and decide for myself. Thank you, Emily Oster! PS. I have a friend who's raising an adopted son with FASD. I have seen first-hand how devastating and tragic that diagnosis is, especially because it is completely preventable. I realize that there are deep and heartfelt emotions involved. Nonetheless, I don't think it's helpful to personally attack and demean the author - I'm sad to see so much vitriol in these reviews. We all want the same thing: healthy children, healthy families. And better data will help us get there.

Es el único libro que me he leído para embarazadas porque está completamente basado en datos. Esta bien para desmentir algunos mitos y ayudarte con consejos importantes

I really enjoyed reading this book. It's exactly what I was looking for, as so many people tell you so many similar, yet sometimes conflicting insights during the course of a pregnancy. This book takes a lot of anecdotal points back to evidence, and sharing where research is really dated but still being referenced for modern day advice. I found the presentation of this information to be exactly what I was looking for, and filled me with comfort and confidence. I will state that I think some of the references are starting to get dated themselves now though. Labour statistics in the US and UK have changed drastically in the past 15 years, whereby the book states the c-section rate in the UK was c.25%, and now this year we know that rate is over 50%. It would be great to see these current stats reflected in the book (and analysed if possible). I also found the chapter on home birthing to be too dated to draw any conclusions from. Home births in the UK are now attended by 2 professional midwives, with the hospital prescribing medications for the home birth (same as you'd get in the Birth Centre), and midwives bringing gas and air, etc. What was written from 10+ years ago is no longer an accurate reflection of the current UK home birthing landscape. It would be great to see this updated in line with the changing regulations and stats over the years. Otherwise, I still highly recommend this book to anyone who just wants to cut through the faff, be equipped with the data, and understand pregnancy/ labour recommendations and procedures more for themselves.

acquistato per la mia prima gravidanza da un sacco di informazioni basate su papers scientifici dandoti la possibilità di prendere le tue decisioni in modo informato. raccomandato ai genitori che ne sentono una più di mille da parte di tutti

Adorei esse livro - nos deixa muito mais seguras a respeito de várias decisões durante a gestação. Também é bem escrito, de fácil leitura.

Every woman should be given a chance to read this book - the author explains that every pregnancy is different and different women faced with the same information may make a different choice which is right for them. Oster debunks various pregnancy myths in a way that is informative and not alarmist. She does give you her opinion but also arms you with the information you need to form your own. You do need to have some interest in the research and data but she brings everything together in a way that is relatively easy to understand. I would say about half the book deals with conception and the first trimester so it makes for an excellent read even pre-conception. I feel much less freaked out having read it, which is no small feat. Highly recommend.