Expecting Better (Book review)

Expecting Better 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, a promotion for her new book Expecting Better, 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.

  • Tina

    An excellent review of Emily’s book – hope she sees this!

  • icastico

    Her assessment that daily drinking during the 2nd and 3rd trimesters is okay is not in line with the available evidence. For example of 2600 children diagnostically assessed for Fetal Alcohol Syndrome (FAS) by the University of Washington’s FAS DPN over the last 18 years, 1 out of 7 who received an FAS diagnosis experienced exposure of 1 to 8 drinks per week…essentially the exposure level Oster cliams “does not lead to pregnancy complications or long term impacts on children.” A diagnosis of FAS is not given without substantial cognitive dysfunction in at least three domains of functioning.

    • Jo

      And did they drink 1-8 in the FIRST trimester? Which she most definitely states is not ok. Not to mention 1-8 is a huge range. They should be breaking it down into smaller ranges to see where the true problem lies. I don’t know which study you are referring to so I don’t know any other possible flaws with it. But yeah… that does not persuade me she’s wrong in the least lol. I’m really tired of people throwing these numbers out there without sharing the details of the study.