Tuesday, February 18, 2014

Book Review: Expecting Better by Emily Oster

I haven't been a pregnancy-book-reading sort of expectant mother. I think I knew I wouldn't be, going into this. I'd heard that the most common pregnancy books were either guides to what's going on with your baby and body during each week, or full of everything that could possibly go wrong. No thank you! My doctor gave me a book, and if I had a question, I looked it up there or asked her at my appointments.

But then I heard about Expecting Better. It's written by Emily Oster, an economist, and my opposite: she wanted as much information as possible on everything during her pregnancy. And she did the work to get that information, by going straight to the research when she realized many of the common rules and recommendations were not standard, and depended on whether you talked to your OB or consulted the American Congress of Obstetrics and Gynecology. It sounded to me like Malcolm Gladwell--dispelling common misconceptions through a hard look at the data--only for pregnancy. 

The author received a great deal of criticism for being (1) not a doctor, and (2) willing to challenge the common (American) wisdom about pregnancy, especially with regard to alcohol and caffeine. Neither of these two criticisms bother me, because (1) someone with a PhD in economics knows how to read and interpret research in order to use it for decision making, and (2) why shouldn't we be willing to challenge recommendations and assumptions that do not seem to be grounded in data?

Expecting Better, like many pregnancy books, is divided into trimester sections, with a separate section for labor. The first trimester section includes an examination of the common don'ts: alcohol, deli meat, cat litter, fish, and caffeine. Each sub-section concludes with a helpful "Bottom Line" summary of what the data said and what that means. She presents the results in a conversational, understandable way, but lists her sources in numbered notes for those who want to consult the original journal article.

My biggest problem with this book was the manner in which exercise during pregnancy was glossed over. Probably because the author is an economist, not an athlete, and a self-described reluctant exerciser. Covered in the same chapter as Kegels, prenatal yoga, and sleep, general exercise during pregnancy is brushed off as not harmful but not helpful for the mom or baby. In other words, it doesn't matter. I would argue with that conclusion, out of my own experience so far, and for athletes or anyone who wants to return to exercise soon after delivery. (I am not arguing with her assertion that women with certain conditions, like placenta previa, should not exercise much, and all women should listen to their doctors). Just like with time off from running during any other time, the longer you go without exercising during pregnancy, the more fitness you will lose and the longer it will take to regain that fitness. Not to mention labor is like one extremely long workout itself! Running while pregnant (or doing any other type of exercise) might not be easy or fun, but I do think it's probably good for the mother and baby the same way it's good for everyone else,  and I would think it helps prepare you for labor.

The best part of this book is hands down all the graphics used to helpfully display the information. There are graphs about the likelihood of miscarriage by week in the first trimester, a chart displaying which fish are highest in omega 3s and lowest in mercury (salmon is a good safe one), and a graph demonstrating the effects of Kegel exercises on incontinence. I borrowed this book from the library, and I almost want to buy it for myself just for the charts!

Despite not being a comprehensive or traditional pregnancy book, I really enjoyed it and I learned a great deal. I would recommend it to any pregnant or soon-to-be pregnant woman who wants to look at the data behind the conventional pregnancy recommendations.

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