Expecting Better than “What to Expect…”

Well, I just got back from my first real ultrasound and now the internet/world knows that we’re expecting a little Fiat.Luxury Jr. in 6 months!  So naturally, I’ve been reading–and hate-reading–a lot of pregnancy books.

There are a lot of pregnancy books out there, you guys.

And a lot of them are condescending, fear-mongering, and almost useless.   I won’t be reviewing all of them because I have other, better books that I want to review, but anyone who’s ever picked up a pregnancy book will be familiar with the tropes:

One book assures readers, without one inkling of humor, that, don’t worry, you won’t be pregnant forever, even if it feels like it.   Many answer women’s questions, especially the common “Is X bad for me/my baby?”, with vague platitudes: “Well if you’ve already done it, don’t worry, but don’t do it anymore, just to be safe!”  (“Safe from what?” one wonders.  Are the negative effects of feta cheese and espresso compounded exponentially with every bite?)  “Don’t eat this!” lists can be anywhere from 10 items with all the usual suspects–wine, sushi–to two full pages that include foods you’ve never heard of and foods you consume on a daily basis that you should just “be aware of”; one book included ramen, which was literally the only thing I could keep down one week.  Which of these lists is right?  What if you cook those soft cheese, then are they ok?  Why did some foods make the cut when others did not?  These books don’t tell you. They just say that you should be on the safe side and stick to the lists.   (I eventually found that ramen was on the list not because it’s dangerous but because it’s potentially fattening and “not as healthy as other fast food options,” to which I say, hahahaha, pleeeeeasssse.)  One very popular book lists basically every possibly thing that could ever go wrong with your pregnancy, no matter the risk of that actually happening to you: “Your [symptom] could be totally normal or it could be a sign of this extremely rare life-threatening condition that you should immediately see your doctor about.  Good luck!”  One book gave all the usual advice but in a “chick lit” format (their words)–easier for womenfolk to understand, I guess.  I get why a conversational, girlfriends-only style would appeal to some women who are not me!  But the advice in this particular book was not substantially different from the many other books I’d read: “many doctors advise that pregnant women…”  with no numbers, no reasons, just some cute anecdotes about pregnancy and deliver that weren’t remotely related to the “rules” the book laid out.  (Also, my personal opinion: I’ve officially signed up for a bloody, arduous, possibly life-threatening, undertaking of creating a human life.  I need more than “chick lit.”)

Expecting Better is the book I wanted these other books to be.  Oster is an economist at the University of Chicago who, during her first pregnancy, was equally frustrated by the lack of information behind the recommendations.  She decided to look at the actual studies that the recommendations were based on and give that information to women so they can decide for themselves the risks vs. rewards of pregnancy decisions, whether it be to eat that deli sandwich or sign up for an default episiostomy.  After the stream of condescending articles and books, this felt the first book that treated me like the adult that I am.

I’ll give two examples that I found helpful.  First, the one this book was apparently heavily criticized for:  alcohol.  She looked at the reports that claimed that women who drink wine during pregnancy have kids with behavior issues and lower IQ.  In two of the most frequently cited studies, the women drank wine, yes, but they also did cocaine. Cocaine! So maybe, JUST MAYBE, it wasn’t the wine, it was the cocaine–or at least, the combination of the two.  Moreover, other countries (France, Australia) have much less restrictive attitudes about wine during pregnancy.  If a small amount of alcohol consistently harms fetuses and babies’ IQ, behavior, etc, we would expect to see many more developmental issues in newborns and children in France and Australia.  But French and Australian children of mothers who occasionally have a glass of wine do just as well as American children of mothers who abstained.   Also: France and Australia have actual studies comparing drinking pregnant ladies with non-drinkers, since the ethical issues with that are much different (studies that would be impossible to conduct in the US due to the ethics of telling women to drink during pregnancy, obviously!)

Oster’s conclusion is basically: half a glass with dinner is fine if you want and there are no studies to support the claim that “No amount of alcohol is considered safe during pregnancy.”  But, of course, if you read the studies and think, well I’m still not comfortable with any amount of alcohol, and I know that such-and-such in my family history means I’m more at risk for such-and-such, or whatever, then more power to you for your informed decision-making!  And also–think twice about judging another pregnant lady you see having a sip of her friend’s Cabernet at dinner.  She might have made a similarly informed decision!

The second: weight gain. Oster said that her doctor chided her regularly, at almost every appointment, to watch that she didn’t gain so much weight. This is something I have heard from almost all of my formerly pregnant friends, too: the constant policing of every pound, to be sure that they don’t gain five or ten pounds too many.  Oster researched the effects of “too little” vs “too much” weight gain and found that — surprise — every woman is different and in most cases, your body finds it’s own equilibrium.  But more than that, she compared the risks of under-gaining vs over-gaining. Both gaining too little and gaining too much have potential health consequences for baby, not for their eventual adult weight (there are too many other factors that go into that) but for their birth weight. And the consequences of a very big baby (difficult delivery, c-section) are far preferable to the consequences of a very small baby (breathing difficulties and possible neurological problems in baby).  Here’s Oster: 

“As I thought more about this, I wondered whether these recommendations that everyone is so obsessed with are even right. Looking at the numbers carefully, it’s clear that they were made with the goal of maximizing the chance of having a “normal for gestational age” baby–not too large, not too small. But this logic seemed flawed. The complications associated with a very small baby are, on average, more severe than those associated with a very large baby… In order to really make the right [weight-gain] recommendation, we need to think about what recommendation does the best job limiting the actual complications. In this particular case, that might well be an argument for increasing the recommended weight gain by a few pounds.”

This seems eminently reasonable to me!

There are a few parts I think could have been more thorough–the section on exercise seemed under-researched, honestly, and I would have liked a little more information on how to find studies that she didn’t include in this book–but maybe that’s asking too much and on the whole, I found this book extremely reassuring.

I am always interested to read one star reviews of books that I enjoy.  As you might expect for a book that doesn’t tell pregnant women to make the least risky choice possible, there are quite a few one star reviews for this on Amazon (interestingly, there are fewer on Goodreads.)  Most of them boil down to: “Why take the risk?!  Oster’s not even a doctor!”

Which…yes, duh, that’s exactly the point.   “Why take the risk?!” I guess works for some people who are happy to put down their deli meats and stop sleeping on their back, no questions asked, or who feel comforted by having a list to stick to.  But there are others of us, who were handed a list of Things Not To Do and thought, “But…why?”  The point is not that we’re selfish mothers who would gladly sacrifice a few of baby’s IQ points for one bite of goat cheese.  We just want information!   Some lists tell you not to smoke and then, in the next line, not to sleep on your back.  Is sleeping on your back really in the same category as smoking, for Pete’s sake?  (The answer is no.)  Is the risk from soft cheese vs. the risk from a soft-boiled egg the same?  How much is the risk, and what should you do if you accidentally eat some ricotta at brunch?  I am an American lady living in Africa–can I continue to eat delicious biltong; can I put the imported brined feta on my salad?  Knowing the “why” behind the recommendations helped me answer these questions for myself because, unsurprisingly, biltong is not addressed in American pregnancy books!  (The answer, if you’re wondering: I’m forgoing biltong for the next 6 months.)  This is important information that reduces the amount of time and stress you spend worrying–because you’re already worrying plenty, let’s be real.  And of course, you can/should follow up with your OBGYN or other doctors if you want to know more, because you are an adult who can do that!  Although I’ve found, as Oster did, that doctors simply don’t have the time or resources to direct you to the actual studies and help you understand where the recommendations come from.  They have a lot going on!  That’s why this book exists.

Knowledge is power.  When you know the reason for the recommendation, you, as a a capable adult person who has signed up to birth another human being, can make smart decisions and go forth with confidence!  I will be recommending this book to every pregnant lady I know.