Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong - and What You Really Need to Know

( 11 )


What to Expect When You're Expecting meets Freakonomics: an award-winning economist disproves standard recommendations about pregnancy to empower women while they're expecting

Pregnancy—unquestionably one of the most pro­found, meaningful experiences of adulthood—can reduce otherwise intelligent women to, well, babies. We’re told to avoid cold cuts, sushi, alcohol, and coffee, but aren’t told why these are forbidden. Rules for prenatal testing are hard and ...

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Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong - and What You Really Need to Know

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What to Expect When You're Expecting meets Freakonomics: an award-winning economist disproves standard recommendations about pregnancy to empower women while they're expecting

Pregnancy—unquestionably one of the most pro­found, meaningful experiences of adulthood—can reduce otherwise intelligent women to, well, babies. We’re told to avoid cold cuts, sushi, alcohol, and coffee, but aren’t told why these are forbidden. Rules for prenatal testing are hard and fast—and unexplained. Are these recommendations even correct? Are all of them right for every mom-to-be? In Expecting Better, award-winning economist Emily Oster proves that pregnancy rules are often misguided and sometimes flat-out wrong.
A mom-to-be herself, Oster debunks the myths of pregnancy using her particular mode of critical thinking: economics, the study of how we get what we want. Oster knows that the value of anything—a home, an amniocentesis—is in the eyes of the informed beholder, and like any compli­cated endeavor, pregnancy is not a one-size-fits-all affair. And yet medicine often treats it as such. Are doctors working from bad data? Are well-meaning friends and family perpetuating false myths and raising unfounded concerns? Oster’s answer is yes, and often.
Pregnant women face an endless stream of decisions, from the casual (Can I eat this?) to the frightening (Is it worth risking a miscarriage to test for genetic defects?). Expecting Better presents the hard facts and real-world advice you’ll never get at the doctor’s office or in the existing literature. Oster’s revelatory work identifies everything from the real effects of caffeine and tobacco to the surprising dangers of gardening.
Any expectant mother knows that the health of her baby is paramount, but she will be less anxious and better able to enjoy a healthy pregnancy if she is informed . . . and can have the occasional glass of wine.
• *
Numbers are not subject to someone else’s interpretation—math doesn’t lie. Expectant economist Emily Oster set out to inform parents-to-be about the truth of pregnancy using the most up-to-date data so that they can make the best decisions for their pregnancies. The results she found were often very surprising…
·        It’s fine to have the occasional glass of wine – even one every day – in the second and third trimesters.
·        There is nothing to fear from sushi, but do stay away from raw milk cheese.
·        Sardines and herring are the fish of choice to give your child those few extra IQ points.
·        There is no evidence that bed rest is helpful in preventing or treating any complications of pregnancy.
·        Many unnecessary labor inductions could be avoided by simply staying hydrated.
·        Epidurals are great for pain relief and fine for your baby, but they do carry some risks for mom.
·        Limiting women to ice chips during labor is an antiquated practice; you should at least be able to sneak in some Gatorade.
·        You shouldn’t worry about dyeing your hair or cleaning the cat’s litter box, but gardening while pregnant can actually be risky.
·        Hot tubs, hot baths, hot yoga: avoid (at least during the first trimester).
·        You should be more worried about gaining too little weight during pregnancy than gaining too much.
·        Most exercise during pregnancy is fine (no rock climbing!), but there isn’t much evidence that it has benefits.  Except for exercising your pelvic floor with Kegels: that you should be doing.
·        Your eggs do not have a 35-year-old sell-by date: plenty of women get pregnant after 35 and there is no sudden drop in fertility on your birthday.
·        Miscarriage risks from tests like the CVS and Amniocentesis are far lower than cited by most doctors.
·        Pregnancy nausea may be unpleasant, but it’s a good sign: women who are sick are less likely to miscarry.

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  • Expecting Better
    Expecting Better  

Editorial Reviews

From Barnes & Noble

Dr. Emily Oster is an award-winning social scientist, but she is also a mother. When she became pregnant, she listened to the same litany of prohibitions and restrictive instructions that every expectant mother hears: No caffeine, alcohol, and sushi; narrow prescriptions for bed rest, induction, weight gain and fetal testing. As a trained, independent-thinking economist, she began testing these ironclad guidelines and, sometimes to her own surprise, discovered that they were sometimes downright wrong and almost always oversimplified. This groundbreaking book is bound to generate both interest and controversy.

From the Publisher
New York Times:
"Expecting Better will be a revelation for curious mothers-to-be whose doctors fail to lay out the pros and cons of that morning latte, let alone discuss real science. And it makes for valuable homework before those harried ob-gyn appointments, even for lucky patients whose doctors are able to talk about the rationale behind their advice."
New York Magazine:
"Emily Oster combs through hundreds of medical studies to debunk many widely followed dictates: no alcohol, no caffeine, no changing the kitty litter. Her conclusions are startling… Expecting Better walks women through medical literature surrounding every stage of pregnancy, giving them data to make informed decisions about their own pregnancy. "
New York Post:
"It seems that everyone—doctors, yoga teachers, mothers-in-law and checkout ladies at grocery stores—are members of the pregnancy police. Everyone has an opinion. But not everyone is Emily Oster, a Harvard-trained economics professor at the University of Chicago … To help the many women who reached out to Oster for advice, she compiled her conclusions in her new book, Expecting Better, which she describes as a kind of pregnancy 'by the numbers.'"
Associated Press:
"[Oster took] a deep dive into research covering everything from wine and weight gain to prenatal testing and epidurals. What she found was some of the mainstays of pregnancy advice are based on inconclusive or downright faulty science."
Daily Mail:
"Economist and author Emily Oster contradicts conventional wisdom and advocates a much more relaxed approach to pregnancy."

“She’s such a brilliant researcher and wordsmith.”

The Times (UK)
"[Expecting Better] offers expectant mothers a new route to the delivery room."

Telegraph (UK) 
"A comprehensive and lively debunking of the myths surrounding pregnancy."

Harvey, Karp, MD, bestselling author of The Happiest Baby Guide to Sleep and The Happiest Baby on the Block:
"Expecting Better gives moms-to-be a big helping of peace of mind! Oster debunks many tired old myths and shines a light on issues that really matter."

Pamela Druckerman, New York Times bestselling author of Bringing Up Bébé and Bébé Day by Day:"It took someone as smart as Emily Oster to make it all this simple. She cuts through the thicket of anxiety and received wisdom, and gives us the facts. Expecting Better is both enlightening and calming. It almost makes me want to get pregnant."

Charles Wheelan, New York Times bestselling author of Naked Statistics:
"Expecting Better is a fascinating and reassuring tour of pregnancy and childbirth, with data leading the way at every juncture.  From start to finish, Oster easily leads us through the key findings of the extant pregnancy-related research.  My only regret is that my wife and I had three children without the benefit of this insightful approach."
Rachel Simmons, New York Times bestselling author of Curse of the Good Girl:
"The only antidote to pregnancy anxiety is facts, and Emily Oster has them in spades. Disarmingly personal and easy to read, this book is guaranteed to cut your freaking out in half. Pregnancy studies has a new heroine. Every pregnant woman will cheer this book—and want to take Oster out for a shot of espresso."

Steven D. Levitt, New York Times bestselling co-author of Freakonomics:
"This is a fascinating—and reassuring—look at the most important numbers of your pregnancy. It will make parents-to-be rethink much of the conventional wisdom: think bed rest is a good idea? Think again. This may be the most important book about pregnancy you read."

Library Journal
Frustrated during her pregnancy by unresponsive doctors, an associate professor of economics at the University of Chicago uses her analytical skills to build a better picture for expectant mothers.
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Product Details

  • ISBN-13: 9781594204753
  • Publisher: Penguin Publishing Group
  • Publication date: 8/20/2013
  • Pages: 336
  • Sales rank: 321,337
  • Product dimensions: 5.70 (w) x 9.10 (h) x 1.20 (d)

Meet the Author

Emily Oster is an associate professor of economics at the University of Chicago Booth School of Business. She was a speaker at the 2007 TED conference and her work has been featured in The New York Times, The Wall Street Journal, Forbes, and Esquire. Oster is married to economist Jesse Shapiro and is the also the daughter of two economists. She has one child, Penelope.

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Interviews & Essays


Author of the new book

EXPECTING BETTER: Why the Conventional Pregnancy Wisdom is Wrong—and What You Really Need to Know

Making the right decisions during pregnancy and birth isn't easy. Like many pregnant women I wanted to be sure I was doing the right thing, but I struggled to get good information about what that was. My doctor had a lot of rules about what I could and couldn't do, but rarely was able to back those rules up with any evidence. In the end, I found I had to use my training in economics and statistics to sort through the data and find the real facts. Because you can't make a good decision with bad information.

When I got the real facts I found that sometimes I agreed with my doctor's rules and recommendations, but not always. By getting the real facts - going back to the original medical studies and learning what the data really has to tell us - I was able to be more confident in my choices. And when friends came to ask about their own pregnancies, the data was able to help them be more confident, too.

How does an economist come to write a book about pregnancy?

Economics is basically about making decisions based on all the available data. So I was shocked when I became pregnant and was basically given a list of rules that appeared to be based on vague or conflicting evidence. It all felt incredibly oppressive. I ended up spending my evenings trawling through the medical literature in a bid to make more informed choices. This book was an attempt to look at all the evidence in a more analytical way.

So how is your book different from all the other pregnancy bibles out there?

You won't find any Dos or Don'ts in my book, for starters. I've read a lot of books that say don't touch caffeine during pregnancy, for example, and others that say a cup of coffee a day is fine, but I never found a book that explained the facts behind the recommendations. This book aims to bring women the facts so they can make their own judgment calls.

How much do you think the medical establishment is to blame for the fear culture surrounding pregnancy and birth?

There is a tendency to baby pregnant women. We're not trained in medicine, so it's hard to make certain decisions, but actually we just need the facts, not patronizing lectures. More doctors need to focus on the stuff that really matters. For example, there's a list of hundreds of foods for women to steer clear of during pregnancy, to the extent that even just eating becomes fraught. But actually from studying the research, I found that only six foods are really off limits. WHAT ARE THESE? Sushi and raw eggs are no more of a risk when you're pregnant than when you're not.

Any more myths you'd like to debunk?

Bed rest is prescribed for around 20% of expectant mothers in the US, for all types of complications. And yet there is zero evidence that this is helpful for anything. In fact, all the studies point to the contrary - staying in bed for weeks on end can lead to muscle wasting and increase risk of blood clots. The whole caffeine thing is interesting, too. I love coffee, so I looked into it thoroughly and actually all evidence supports having up to two cups a day, and much of it supports up to three or four cups.

Your book also concludes a glass of alcohol a day is fine in the second and third trimesters. Aren't you worried some women will take this as a green light to overdo it?

It's incredibly patronizing to assume that if you tell women it's OK to have a glass of wine every day they'll go crazy and have six margaritas. I think we can trust expectant mothers to use the same common sense they employed before they were pregnant. Blanket policies that make everything off limits are far more dangerous in my opinion; if you tell women don't drink, don't smoke, don't have coffee, don't do anything, they're more likely to think, ?well I won't drink alcohol, but I'll smoke. I have to do something.' Actually the only real don't is cigarettes. But then they're a total no no when you're not pregnant, too.

Why do you think pregnancy has become such a source of anxiety?

There's definitely more fear surrounding birth now thanks to the wealth of conflicting data, and hysterical reporting. A lot of it also stems from that whole competitive parenting thing that seems to have backed up into pregnancy. Parents so desperately want to get it right that they end up obsessing over every detail. But it's important to relax a little and enjoy your pregnancy. Although obviously it took a lot of me obsessing over countless medical studies to come to this conclusion!

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Customer Reviews

Average Rating 3.5
( 11 )
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Sort by: Showing 1 – 10 of 11 Customer Reviews
  • Anonymous

    Posted August 26, 2013

    Let's just say I've read a few pregnancy books before, and I rea

    Let's just say I've read a few pregnancy books before, and I really can not say this loudly enough: This is the BEST one that I have read so far. Sure, Emily Oster is an economist and yeah, that means that she didn't go to medical school. But! She's clearly incredibly intelligent and she's a mom, so she's been there, and she doesn't tell you what to do. She simply goes over the research behind the recommendations she heard from her doctors and gives you the information you need to make an informed choice. That's what economists do these days (forget about Wall Street - that's a different type of economics). They pull information from random bits of data and put it together to try to make sense of this crazy world. They know what types of research are reliable and which ones should be taken with a grain (or ten) of salt. And man, the world of pregnant ladies sure could use a lot less crazy! Emily Oster tackles an incredibly emotionally charged subject with wit and charm, and manages to tell a great story in the meantime. I might not do all the things that the data indicates is okay to do while pregnant, but armed with Expecting Better, I sure can make an informed choice about the things that are important to me.

    And a side note about all the negative reviews here - as has been said before, many of them did not read the book and are merely writing reviews about what they've seen in the media or on certain websites. If you actually read the book, you'll find that the stance on alcohol while pregnant is very clear and supported by solid research. She also explains the difference between saying 'no amount of alcohol has been proven safe' and the idea that a glass or two of wine during your pregnancy is not going to be harmful. Want to know what she said? Buy a copy of the book and read it yourself! You won't be sorry!

    6 out of 8 people found this review helpful.

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  • Anonymous

    Posted August 20, 2013

    This writer you has grossly neglected her responsibility to rese

    This writer you has grossly neglected her responsibility to research and confirm the validity of her sources and there has been widespread international concern expressed about the study in the UK that she specifically references. The study stopped following children at age 5 when behavioral and learning disabilities have not had a chance to be identified. Alcohol is a teratogen. We have used it as a sterilizing agent for centuries precisely because it is so good at killing cells. Whatever is currently developing in the baby when alcohol is consumed prenatally (and postnatally, if breastfeeding) can be affected. Recent genetic and epigenetic studies are just beginning to understand why some individual cells may be affected and others not, why some babies are more affected and others less. So, while it is theoretically possible drinking a certain amount won’t cause severe intellectual disability, or neuro-behavioral issues in one woman’s baby the very same amount or less might in another’s. There is no way to know at this point if a woman has “good” genetics or “bad” genetics. Perhaps someday there will be tests to determine the genetic fragility of the cell wall in all areas that are growing in a baby and to determine a truly safe amount for a specific woman to consume …..but for now there is no safe kind of alcohol, no safe time during pregnancy for alcohol, and no safe amount of alcohol. The author, publisher and booksellers carrying this book should all be ashamed for being so totally reckless and irresponsible in promoting alcohol consumption by pregnant women.

    5 out of 12 people found this review helpful.

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  • Anonymous

    Posted October 3, 2013

    As a physician, I can tell you that the curriculum in most medic

    As a physician, I can tell you that the curriculum in most medical schools does not have the ability to give students a comprehensive background in statistics simply because there is not the time alotted. The ability to understand and decipher statistics is integral to one's ability to evaluate the scientific literature and I can tell you that most MD's have a poor understanding. So my first point is that our MD's do not have the extensive backround in statistics. Familiarity with the science of healtcare does not allow you to evaluate the quality or validity of studies.  Secondly,our current healthcare system relies on multiple patient visits  to generate the revenue needed to support the average OB. Your OB does not have the time to sift through all of the new studies to decide if his or her recommendations for behavior during pregnancy are backed by the literature. Generally, recommendations are made based on history and overall concensus from the ACOG, which like any such entity takes a long time to make any changes. Case in point is the American Heart Association which only recently changed his recommendation regarding prophylaxis despite over 10 years of research showing the prior recommendation was not justified by the literature. Thirdly, an OB has to carry some of the most expensive malpractice insurance in all of healthcare. In the US, we are particularly litigious and MD's rightfully want to avoid being sued. Therefore the recommendations err very far to the overly cautious . The risk to a pregnant woman and her fetus is actually greater from a motor vehicle accident than many of the standard list of "no's" during pregnancy. Finally, to the point about there being no randomized controlled clinical trials looking at safety levels of some things well, think about it. One, studies like that really aren't done anymore without informed consent and certainly, we are not willing to risk injury to a research subject. The same is true in all aspects of medicine, not just obstetrics. Two, there would never be funding for a study like that. There isn't money in it. The money is in new drugs that pharmaceutical companies can increase their profits with. In short, this was an AWESOME book and is truthfully how we should be looking at life. Evaluate the evidence, make the call. 

    4 out of 5 people found this review helpful.

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  • Anonymous

    Posted August 20, 2013

    Emily Oster has no medical training or expertise and is unqualif

    Emily Oster has no medical training or expertise and is unqualified to write a book which provides advice and guidance about alcohol use and pregnancy.She cherry picks studies and ignores the research showing light drinking to be associated with miscarriage, stillbirth, preterm delivery, spontaneous abortion, and sudden infant death syndrome (SIDS).If Emily Oster wants to tolerate the risk of alcohol on her own baby, that’s her choice, but she has no right to advise pregnant women to expose their unborn baby to even a small amount of a substance that can cause brain damage.She is clearly less concerned with protecting the health of newborns than she is with protecting expectant mothers from health messages she deems bothersome.Sadly, Oster’s statements will likely influence some pregnant women to drink alcohol, who then could tragically give birth to offspring with lifelong brain damage from the effects of prenatal exposure to alcohol, including Fetal Alcohol Syndrome.Emily Oster thinks that the way to relieve women of the worry and guilt from having a few drinks during pregnancy is to tell them: Don’t worry, it’s fine. Enjoy a glass of wine.  In fact, the best way to relieve women of this worry is to encourage pregnant women to avoid alcohol, including wine, and therefore have no reason to worry whatsoever.Liberation for expectant mothers doesn’t come from drinking wine while pregnant.  Liberation comes from never having to worry that you might have done something to harm your child by drinking alcohol.Emily Oster claims that her 2-year old daughter is perfectly healthy, yet the full impact of the alcohol exposure on her child will not be evident until the adolescent years.What Oster calls the “pregnancy police” are in fact public health professionals, doctors, OB-GYNs, and researchers, dedicated to improving the health outcomes of women and their children.  NOFAS, and the overwhelming majority of people actively promoting the message that no amount of alcohol is safe during pregnancy, purposely avoid scare tactics so as not to alarm women who may have had a drink before they knew they were pregnant.

    4 out of 11 people found this review helpful.

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  • Anonymous

    Posted August 20, 2013

    Ms Oster has created a well written and readable book that does

    Ms Oster has created a well written and readable book that does a reasonable job of critiquing available research on various pregnancy risks. What she has not done however is discuss WHY there are no definitive studies available on these topics. Think about that for a moment. Not one single longitudinal study done delivering calibrated doses of alcohol to pregnant woman en measuring the impact against a non-drinking control group. Why? Because there are no scientists or medical professionals willing to take that risk with unborn children. Anyone reading this book would be wise to cast a very critical eye on the conclusions and recommendations it gives.

    4 out of 7 people found this review helpful.

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  • Anonymous

    Posted September 10, 2013

    As a Registered Dietitian, I applaud Ms. Oster's efforts to shar

    As a Registered Dietitian, I applaud Ms. Oster's efforts to share the science supporting the numerous benefits of eating seafood during pregnancy. The omega-3s in seafood are essential for optimal baby brain and eye development. Her advice for pregnant women to eat more fish is spot on: "The worst thing you can take from mercury advice is the idea that you should avoid fish. Fish are great! People who eat a lot of fish have smarter kids on average, even with the greater mercury exposure."

    Her advice for pregnant women to limit canned tuna, however, is flat-out wrong. As a RD who consults with the National Fisheries Institute, I have extensively reviewed the science around mercury and seafood, particularly canned tuna. The USDA's Dietary Guidelines for Americans include canned tuna as a fish that is low in mercury. According to the FDA, there are only four fish that pregnant women need to avoid: shark, swordfish, king mackerel and tilefish. All other commercially-caught fish (including canned tuna) and shellfish can--and should--be enjoyed during pregnancy.

    Despite the Dietary Guidelines recommendation that pregnant women should eat at least 8 ounces and up to 12 ounces of seafood every week, the average pregnant woman in the U.S. consumes less than 2 ounces of seafood per week. This dangerously low amount of seafood puts pregnant women at risk for omega-3 deficiency, which could greatly impact their child's cognitive outcomes.

    Misguided dietary advice and nuanced nutrition messages leave pregnant women confused. I know this first-hand, both as a mother of two young children (who was frustrated during both pregnancies by confusing tuna advice) and as a consulting RD (who helps individuals sort out real science from nutrition myths).

    While the author's intent to encourage pregnant women to increase seafood consumption was positive, Ms. Oster missed the boat on helping these women make informed decisions about fish. Exhaustive research shows that expecting moms can safely and confidently enjoy canned light and white albacore (up to 6 ounces each week) tuna, both of which are an affordable and convenient way to help pregnant women meet their protein and omega-3 nutrient needs. - Rima Kleiner, MS, RD

    1 out of 2 people found this review helpful.

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    Posted March 18, 2014

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    Posted June 17, 2014

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    Posted November 27, 2013

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