Das einzig wahre Schwangerschafts-Handbuch: Was an den meisten gut gemeinten Ratschlägen falsch ist und was Sie wirklich wissen müssen

by Emily Oster, Andrea Kunstmann (Translator)

Während ihrer ersten Schwangerschaft erhielt Emily Oster immer wieder Ratschläge, die einander zwar widersprachen, aber alle mit beeindruckender Vehemenz vorgebracht wurden. Also ging sie das Problem systematisch an. Sie sammelte Daten, sie analysierte und wog ab.

So ist dieses Buch entstanden: der erste große Schwangerschafts-Ratgeber aus der Feder einer Ökonomin. Emily Oster räumt auf mit zahlreichen weit verbreitete Mythen zu Ernährung während der Schwangerschaft, Alkohol und Bettruhe.

Auf Basis aktuellster Studien erhalten werdende Mütter so das Wissen, das sie wirklich brauchen.

Genres: Parenting, Nonfiction, Health, Science, Audiobook, Self Help, Family

352 pages, Paperback

First published August 20, 2013

About the author

Emily Oster is an American economist and bestselling author. After receiving a B.A. and Ph.D. from Harvard in 2002 and 2006 respectively, Oster taught at the University of Chicago Booth School of Business. She later moved to Brown University, where she holds the rank of Professor of Economics. Her research interests span from development economics and health economics to research design and experimental methodology.

She is the author of two books, Expecting Better and Cribsheet, which discuss a data-driven approach to decision-making in pregnancy and parenting.

Reviews

[Sarah · Rating 2 out of 5]

I am an obstetrician and I was very interested to read this book, hoping to find an accessible resource that would resonate with my patients. Dr. Oster set out to do a very difficult task and I appreciate what she hoped to accomplish. Unfortunately, while there are sections of this book that provide practical advice, as a whole I was disappointed and cannot recommend it.

As an economist, Dr. Oster has an understanding of statistics that can help her make good decisions for her pregnancy, but she does not have the medical knowledge to fully understand what outcomes are important. This is evident throughout. This book would sorely benefit from an OBGYN as a co-author or editor.

Expecting Better has been rightly criticized for its conclusion that a couple drinks a week in the first trimester and one drink a day later in pregnancy is safe. This is incorrect, and propagating this message is harmful. This has been covered in detail elsewhere by people with much more expertise in FASD than me, so I will leave this particular topic to them.

This book also oversimplifies complex medical issues. The book says you should likely have another C-section if you had one before, without discussing the risks of a repeat C-section. In practice, many women are good candidates to have a vaginal birth after C-section, and 70% of women who try will be successful in delivering vaginally. Oster writes that taking extra antibiotics is not a big deal, when we know that unnecessary antibiotic use is a major problem that contributes to the development of antibiotic resistance. In another section, she states that epidurals increase the risk of vacuum/forceps delivery; this association has not held up in more recent studies using modern dosing of epidural medications. Another chapter opines that women don't need to worry about gaining too much weight in pregnancy and rather they should worry about gaining too little, because most would rather have a C-section than a baby with breathing problems. She does not include any discussion of the risks of C-section including infection, increased bleeding, injury to other organs, blood clots in the legs/lungs, more pain, longer recovery, and impact on subsequent pregnancies. She also does not address that excessive weight gain in pregnancy means more weight to lose postpartum to return to pre-pregnancy weight. In a world with rising obesity rates and all its health implications, this is not something to dismiss.

Some chapters miss critical information that should definitely be covered to help women make better health decisions. In the section on preparing for pregnancy, she does not include the importance of taking prenatal vitamins, an easy intervention that reduces the risk of birth defects. When she reviews the possibility of vaginal birth after Cesarean section (VBAC), she does not discuss uterine rupture, which is one of the major risks of VBAC. While she mentions that women may be induced after their due date, she neglects to explain that the rationale for induction is to reduce the risk of stillbirth, which increases in post-dates pregnancies.

Other information she presents is simply false. In one section, she states that exercise in pregnancy is not important and has no benefits. Research shows that exercise in pregnancy reduces complications including gestational diabetes, high blood pressure, depression, and macrosomia (excessively large babies). She states that 300 calories you burn on treadmill is extra 300 calories you can eat, when there are countless other factors affecting weight gain and loss including genetics, metabolic rate, what you eat, and other environmental and social factors.

Perhaps the most puzzling part of the book is the author's perception of risk. She calculates her risk of having a false negative NIPT (non-invasive prenatal testing, with cell-free fetal DNA) result is 1/35,000, and so she decides to have an amniocentesis for definitive testing, which carries a risk of miscarriage between 1/200 to 1/800. By comparison, the odds of death in one year by motor vehicle accident in the US is around 1/8000. If a risk of 1/35,000 is too high for you, do you ever leave your house? 

Later in the book, she declares that a 1/10,000 risk of maternal mortality is "very, very rare". So which is it? Is 1/35,000 too risky, or is 1/10,000 very rare? She also asks women to do the impossible -- to determine if she should have an amnio in the context of a negative NIPT result, she needs to figure out if having a miscarriage is 44x (35,000/800) worse than having a child with Down's Syndrome. No one can calculate that.

I was not a fan of the ableist language she uses in discussing Down's Syndrome. For example, she repeatedly alludes to a test result showing no aneuploidy as a "good" result. This kind of language reinforces prejudice.

I was annoyed by Dr. Oster's fixation with recommendation cutoffs. Dr. Oster takes issue with the weight gain recommendations in pregnancy. She asks, if the recommended weight gain is 25-35 lbs in pregnancy, then what is the problem with 36 lbs? I'm sure anyone can understand that there is not a massive change in outcomes between pregnancies with 35 vs 36 lbs of weight gain, but there is need to have a cutoff somewhere in order to have a useful recommendation.

I wonder about the experiences that Oster has had with the health care system given the level of concern she has about being forced to do something she does not want. She is worried about someone pressuring her to have an epidural. She is worried about someone "forcing" her to be induced. In my practice, I let my patients know what options they have for pain control in labour, and then they decide what they prefer. I will tell my patient that I recommend induction for her, but it is always ultimately her decision. I hope Dr. Oster has a health care provider with whom she can build a healthy relationship, so that these concerns can be addressed. There are many things to worry about in pregnancy, and I would hope these would not be among the already long list.

This review is based on the 2013 version of this book, which was available at my library.

[Jaclyn Day · Rating 5 out of 5]

There is so much hubbub about this book right now. I was really interested to read it and before I started it, I read a few news articles and some of the dozens of 1-star reviews on Amazon. It turns out people are really upset with Oster primarily for the chapter on drinking alcohol during pregnancy. There are other reasons people are poo-pooing the book too—like the fact that she hardly interviewed any medical professionals about the topics she covered and instead relied almost entirely on her reading and interpretation of medical studies conducted over the past century or so. This article, for example, takes issue with the fact that Oster (who holds a PhD in Economics) is reaching beyond her professional realm and looking to interpret highly complex medical studies. It also criticizes her “subtle and tricky biases,” namely that Oster felt patronized by her OB from the first visit.

Well, I read the book. And you know what? It’s not really that scandalous. The portions about alcohol are getting the most attention (she found that up to 1 drink a day in the second and third trimesters and a couple of drinks a week in the first is a “comfortable” amount—a statement that will obviously make waves). But, the other sections of the book contain information that probably won’t be that surprising if you’ve read a large number of modern pregnancy books or you had a progressive OB or midwife practice during your pregnancy.

Let me pump the brakes for a second here, though. Overall, I want to state how refreshing it was to read a book about pregnancy that examined all facets (from natural childbirth to epidurals to deli meats to inductions) without coming from a place of obvious bias. I found that unlike the Daily Beast article I cited above, I thought Oster wrote the book from a mostly detached, facts-based place. There was no preaching tone or demanding instruction (“you must do this!”). She establishes herself as someone who likes to have as many facts as possible at her disposal before making a decision and nothing in the book convinced me otherwise. The research and studies she used to draw conclusions are cited incessantly throughout and she is careful to note when there is not enough research to draw any meaningful conclusion. Is she irresponsible? Making bad recommendations? Endangering women or fetuses? I really don’t think so.

I think much of the criticism of this book is mostly coming from the Pregnant Women Need to Listen To Their Doctors First and Foremost place. What isn’t being mentioned in these critiques is that a lot of pregnant women don’t listen/trust/obey their doctors wholesale anymore. If they hear something they don’t like, they switch providers until they get the answer they were looking for. If they feel uncomfortable with their level of care, they’ll look for someone who can provide the care they need. They crowdsource medical questions on Babycenter. They google things like “mucus plug” and “lower back cramps” trying to figure out if they’re in labor or close to labor or can do anything to speed up their labor. They take childbirth classes their provider may or may not be aware of them taking. They write birth plans based on templates they saw on Pinterest and they may or may not discuss them with their provider before heading to the hospital or birth center. Whether you believe this trend toward a more medically-detached pregnant woman is a positive or a negative thing, IT IS A THING.

So, to look at Oster’s book and declare it dangerous or irresponsible is patently ignoring the fact that women have done and continue to do exactly what Oster did on a smaller scale. If Oster is irresponsible, then so is every mom blogger who has ever spoken with confidence to thousands (millions?) of readers about something on the medical spectrum. You get my point.

I think Oster’s book is a fantastic way to prompt questions with an OB or midwife. That’s the bottom line, and also one she makes clear several times over. It may annoy your care provider, but if going to an appointment armed with intelligent, thoughtful questions about topics that will affect you and your baby is something that annoys your care provider, well—that’s something else entirely, isn’t it? Since everyone from hospitals to a large number of medical doctors treat pregnancy as a medical condition, are we surprised that pregnant women often look to independent research? Most people diagnosed with any sort of medical condition will do some amount of research on their own. Depending on your point of view, this may seem to be a good thing or not. But in my opinion, women reading about pregnancy-related items and then clarifying with a care provider about whether something could be personally beneficial (or not) certainly doesn’t strike me as an irresponsible, dangerous move.

As far as Oster’s individual points are concerned: I think that if reasonably intelligent women read this book, then Oster’s research will—at the most—just give them a push to do things they were already considering or will further entrench them in a previously-held belief. If you read Oster’s book and say, “Hey! Great. I was already going to have one glass of wine per week during this pregnancy and this research shows that is okay,” or if you say, “Well, interesting research, but I’m still not comfortable with drinking alcohol during pregnancy,” then I think you would be having the mature, grown-up person reaction to this book.

Personally, I’m all for women being given more information rather than less about pregnancy and birth-related decision-making. Here are some things from the book I found really interesting or eye-opening or funny:

- "It’s not that complicated: drink like a European adult, not like a fraternity brother."
- "Don’t worry too much about sushi and raw eggs—they might carry bacteria, but these bacteria are no worse when you are pregnant than when you are not."
- The chapter on weight gain is especially interesting. Oster found that the amount of weight you gain while pregnant is less important than the weight you are when you become pregnant (in terms of being overweight or obese). “At a weight gain of 30 pounds we’d expect 10 percent of women to have very small babies and 5 percent to have very large babies. At a weight gain of 40 pounds, these figures are 7 percent and 11 percent. Yes, there is an increase in very large babies, but there is a decrease in very small ones. But because a very small baby is worse in terms of complications, is this maybe actually better? In order to really make the right recommendation [for weight gain], we need to think about what recommendation does the best job limiting the actual complications. And in this particular case, that might well be an argument for increasing the recommended weight gain, at least by a few pounds.”
- In terms of measuring amniotic fluid, “the deepest-vertical-pocket measure is much better. It captures the same number of truly problematic situations but is much better at not identifying cases where there is nothing wrong. It leads to fewer inductions and fewer C-sections.”
- For babies that have fallen asleep during a non-stress test (in which baby’s heart rate is monitored for a set amount of time to look at the baby’s heart rate in relation to its movement), clapping is a more proven method of getting them to wake up and move around than having mom eat or drink something sugary. (I sat through two non-stress tests in which Isobel fell asleep and they had me drinking this nasty sugary concoction to try and get her to move around. It didn’t work.)
- Nipple stimulation seems to be the MOST effective method of self-inducing labor. Oster looked at a study of full-term women that recorded whether they had gone into labor 3 days later. “Of the breast stimulation group, 37 percent were in labor by 3 days, versus only 6 percent of those without breast stimulation!”
- One review article Oster looked at found that women who underwent continuous fetal monitoring in the hospital were 1.6 times as likely to have a C-section.
- Oster found that oft-quoted caffeine limits for pregnant women seem to be somewhat low based on many studies she looked at. Her findings are that 3-4 cups of coffee per day are okay.
- The chapter on miscarriage has some eye-opening statistics that I hadn’t read before.

[Deana · Rating 4 out of 5]

After becoming pregnant, I quickly learned that there are two types of pregnant women (ok, there are a lot more than this, but keep reading). The first type says "Show me proof that this will NOT hurt my baby, and I will do it." The second type says "Show me proof that this WILL hurt my baby, and I won't do it". It turns out, I am the second type, which causes many of my friends and coworkers to be absolutely horrified at some of my behaviors (most of which involve ingesting things). Thankfully, my husband and I are on the same page.

As an example, a few months ago much earlier in my pregnancy, I went to lunch with some ladies from work, and I ordered a roast beef sandwich. One lady gasps in horror and says "You aren't actually going to eat that, are you?!" To which, I look at her like "uh... der... no i just ordered it so i can throw it in the trash can over there." Yes, of course I was planning to eat it. She says "Aren't you worried about listeria? From the deli meat and cheese?"

Here's the thing about listeria. Yes, it would suck to get it (honestly, it would suck even if I weren't pregnant, but no one ever seems to worry about it then). And it's very risky during pregnancy, because it can cause miscarriages even when the mother shows no symptoms. But the last two US listeria outbreaks were in ... Ice cream (bluebell) and caramel apples ((source: cdc), and the biggest outbreak in recent history was in cantelope in 2011.

But you don't hear anyone freaking out if I want to eat some ice cream or apples or melon, do you?

The way I figure it, I take much more of a risk driving to work every day on I-95 than I do by eating a roast beef sandwich. So yeah.

When people started telling me all the things I cannot do (or eat!) while pregnant, my first question was always ... "why not?" And 9 times out of 10, they didn't really know. "Everyone knows" you can't have coffee while pregnant! "Everyone knows" you can't get massages while pregnant! "Everyone knows" you can't have sushi while pregnant!

Says who? What are the reasons for this?

If you are like me and ask these kinds of questions, this book is definitely for you.

Oster explains the reasons for all of the "no-no" things during pregnancy, as well as looking into their validity based on scientific studies. And she provides all of the references, so you can go look up the papers yourself if you want to draw your own conclusions (which I did in a few cases). She also looks into pre-pregnancy things (timing conception, trying for a specific gender, etc), non no-no pregnancy things (like genetic testing and medications for non-pregnancy related illness) and labor things (pros and cons of things like VBAC, epidurals and episiotomies).

While she says she tries to be neutral and just provide the facts so the reader can make their own decisions, I don't think she does a great job at this... I mean, she does provide the facts, but she also tells us exactly what she decided to do based on these facts. In most cases I came to the same conclusion, but there were a few things (which of course I don't remember off-hand) where I made a different decision. And that's ok.

Anyway, I thought this book was excellent. It answered a lot of questions (both directly and indirectly through the resources) I had at the beginning of this pregnancy journey, and made me feel a lot more comfortable with the decisions I am making. Highly recommended.

[Laura · Rating 1 out of 5]

I'm astounded that an economist who is not a maternal-newborn health care professional decided that being pregnant, reading an obstetrics textbook and reviewing some studies makes her qualified to decide she can tell women to ignore reputable health organizations' guidelines.

For instance, the researchers, physicians, midwives, and other health care professionals are reviewing the SAME research information as Emily Oster is, and have concluded that there is not enough quality or conclusive evidence to say that drinking any amount of alcohol during pregnancy is safe.

I'm not saying that new research doesn't come out, guidelines aren't reevaluated and recommendations don't change, but I am saying that a non-medical professional like Emily Oster is NOT qualified to speak with such authority on these issues. This puts women and newborns at serious risk.

For instance, the risks and inconvenience of avoiding deli meat and alcohol are tiny compared to the consequences if one contracts listeria during pregnancy or if it turns out that low dose alcohol does cause FASD or other health problems for newborns. The major health organizations like the World Health Organization and the American Society of Obstetricians and Gynecologists say that there is not enough quality research to ensure that drinking of any amount during pregnancy is safe, so why would we question that until the research is clearer?

TL;DR/LONG-STORY SHORT...
************************
PLEASE, if you are a pregnant woman or know someone who is, be smart and don't listen to an economist who is NOT a health care professional and thinks her interpretation of the research is somehow superior to large groups of maternal-newborn health care professionals and researchers looking at the same data. It is better to be safe than sorry.

[Alex K · Rating 3 out of 5]

As a physician, I was curious about this book, after a few of my friends read it during their pregnancy. First of all, I found much of the data that she presented was quite interesting, and I learned some of the more specific aspects of prenatal care.

However, more importantly, her tone smacks of privilege, and she falls prey to many of the biases she criticizes doctors and ACOG for. She skews how she discusses the research based on whether or not she agrees with it. She appears to be critical of physicians not knowing the exact data of the hundreds of articles she presents, without taking into consideration how little time we have to keep up with medical literature.

Most importantly, she seems to universalize her experiences and those of other upper middle class friends to the entire US. She projects her own belief that everyone should have access to minutia to make their own medical decisions, regardless of their ability to comprehend this level of detail.

I am glad I read this book for the information it had, but I'm glad I'm familiar with being able to detect cognitive biases and see through them for the actual data. But she's not writing a peer-reviewed article, she's writing a book for lay people. I just hope no one out there relies on this book more than they do their physician.

[Heidi · Rating 1 out of 5]

I did not finish this book, because although interesting, I found the author's personal bias to be too distracting to take her research seriously. I stopped reading once I got to the chapter about smoking during pregnancy. But let me back up -- the author is very open about the fact that this research began when she became pregnant out of a desire to learn more about WHY she should not take some risks and HOW to calculate those risks. She is open about the fact that she likes caffeine and alcohol and was curious to know more about their effect on pregnancy. My own personal bias is that those are also things I like and was interested in knowing more about their effects on pregnancy.

The author's bias appears subtly, but becomes more pronounced. For example, she mentions that one study shows IQ in children from mothers who had light, daily consumption of alcohol is slightly higher than non-drinkers, and notes that it is POSSIBLE that this is due to randomization and doesn't say if the difference is statistically significant. However, when caffeine consumption research showed a slightly lower birth rate, the author noted right away that it was NOT statistically significant and likely randomization. It's a subtle difference, but it's important. Author downplayed randomization and statistical significance when it validated her desire to do something "bad", but when it validated that something might be "bad", her emphasis is focused on the randomization in a subtle but unequal way when compared to the first.

I could have lived with this bias, because no one is perfect and everyone approaches life with some bias, no matter how hard we try otherwise, and she does make an effort to acknowledge some of this bias. However, the author's approach to the chapter about smoking is where I had to quit reading. My personal bias is that I think smoking is a disgusting habit that will kill you, but nonetheless, I expected the author to take a more scientific approach, even though it's clear from her first paragraphs that she is a non-smoker and believes smoking is terrible for the fetus, as well. Okay, fine to have personal views, but when it comes time to discuss and review the science, one of her studies shows no statistically significant impact on birth weight for smoking during the first trimester. When studies validated her behavior and preference for drinking, or threatened them, the author went out of her way to make painstaking differentiations between the effects of caffeine and alcohol at all different stages, attempting to isolate their effects and various stages. But when the issue was smoking (something she doesn't personally do), she completely glosses over a study that shows no impact in the first trimester and makes no effort whatsoever to determine if this is in fact the case, and whether the timing of smoking effects other side effects either. She simply dismisses all smoking at any time during pregnancy as bad, despite displaying one graph that shows contrary. The implicit assumption seems to be that no smokers are capable of only smoking during the first trimester -- they're all addicted and therefore, there is no point in differentiating and isolating the effects of timing for THEIR behavior -- that's only necessary for HER behavioral choices. That's where I stopped reading.

The author clearly has a bias about the level of research required to prove or disprove something that is not a personal habit of hers, and the standard is not equally applied and thus the approach is no longer scientific in nature. The usefulness of this book is completely lost without the promise of a scientific approach.

Perhaps she had other research that showed smoking was still negative during the first trimester versus later trimesters and chose not to include it or her editors removed it. I will never know, but the point is that precisely because I will never know, I can't really trust this book as anything beyond an attempt to validate personal behavioral preferences of the author, and approach the rest of her aggregation and interpretation of others' research with caution.

[Richard Carozza · Rating 1 out of 5]

The author of this book is committing child endangerment. I did my graduate studies on fetal alcohol syndrome, my family has members afflicted with fetal alcohol syndrome, and between graduate and medical school I believe I have the authority to contradict the author and state unequivocally that no amount of alcohol is safe during pregnancy. None. Not during the first trimester, not during the second, not during the third. The effects of alcohol on babies tear apart families and ruin lives. I'm not sure how she manages to come to this conclusion given the enormous amount of evidence stating the clear teratogenic effect of alcohol on the fetus, and even the molecular mechanisms behind this. It's not like we've merely found a correlation between alcohol and birth defects. We know the exact mechanisms behind these effects. It is fact, and a great disservice is being done to prospective mothers who read this book and think they can drink and still protect their child.

[Renee · Rating 1 out of 5]

Cherry picked studies to enforce her own world view. Listen to your doctor; not this entirely unqualified woman.

[Tina · Rating 1 out of 5]

I like statistics. I read research articles for enjoyment - yeah I'm strange. So I thought this would be a really good pregnancy book. I was wrong. The author says she wrote it to help thinking women make their own informed choices but instead she is just telling them what to choose. Both in her tone and by the studies she chooses to highlight or ignore.

Skip this book - If you want to make your own informed choices - do the research yourself. If you want someone to tell you what to do based on their knowledge or expertise - listen to someone with actual knowledge and expertise in the OB/Gyn field.

[Meg · Rating 2 out of 5]

Based on the title, I expected to get more out of this book. I'd suggest that it should be renamed "Agenda-based Science: How to Mine Data to Support Your Favorite View". Oster likes to drink four cups of coffee a day, and the evidence magically supported her up to this amount of caffeine, although not above four cups. She likes deli meat, doesn't like to work out, and has a cat but doesn't garden, and her findings manage to support all of her lifestyle choices. The author is an economist and states several times that this background uniquely positions her to look at data and make decisions. This is a little insulting to any non-economist with training in statistical methods and the use of a critical mind to examine statistical findings. Oster's discussions of research can be somewhat patronizing: I think a general audience can understand Type 1 and Type 2 error, or what it means for a study to be poorly controlled, with pretty direct information rather than lengthy explanation and examples. My biggest issue with the book, however, is that the author insists on a scientific examination of facts (albeit a biased one) for the topics of most concern to her, but reverts to incorrect popular information for others. For example, she mentions the tendency of first-time mothers to go later in pregnancy before delivering when there is no concrete evidence to support this notion. She's also not personally interested in home birth, so she casually mentions stats from single papers and uses her personal judgments in the chapter on this while insisting upon broad analyses of data in areas of more interest to her.

[Kathryn Lucas · Rating 5 out of 5]

I'm now on my second reading of this book. It's so jam-packed with enlightening facts and information that every expecting couple should know, that I felt I should read it again, just so I can retain it all a bit better.

First, let me address the alcohol issue, since there's been a lot of backlash against this book (online and on talk radio) for suggesting that drinking a bit of alcohol during pregnancy is okay. It is my opinion that the anti-FASD (Fetal Alcohol Spectrum Disorder) crusaders out there in comments sections of articles discussing this book have not read the book, nor have they read the studies Oster cites in her discussion of the topic. Oster does NOT say that heavy or binge drinking during pregnancy is okay. The studies she cites clearly show that heavy/binge drinking is detrimental to fetal health. Those same studies, however, demonstrate pretty clearly that light drinking (up to 2 drinks PER WEEK -- not in the same day -- in the first trimester; up to 4 drinks PER WEEK -- again, not in the same day --in the 2nd and 3rd trimesters) has no effect on either fetal development or on intelligence of the child, even up to age 14. There's a world of difference between light drinking as defined here and heavy or binge drinking, and the most strident of Oster's critics seem not to grasp that difference. Oster presents the studies, the hard, scientific data, that backs up what she is saying. This is not her opinion; it's scientific evidence. Intelligent pregnant women can take that information and process it themselves; some women may decide that they'd rather not drink any alcohol during their pregnancy, while others may decide that an occasional drink with dinner is fine. The point is that women who choose the second option should feel vindicated by the fact that all medical evidence points to their choice being safe for their babies.

The alcohol discussion, however, is just one part of one chapter of the book. The rest of the book looks at everything you could possibly be concerned about with a pregnancy. Is deli meat okay? (Possibly not.) What about sushi? (Yes.) Hot yoga? (Depends on how hot it is.) Cleaning the cat litter box? (Fine.) Gardening? (Not fine.) All of the restrictions that pregnant women are told they must adhere to, Oster evaluates by going to the original scientific studies. Some restrictions are shown to be silly when viewed in light of the actual evidence. Others are affirmed, and you are given the precise reasons why the restriction exists. But you don't have to take Oster's word for it: for all of the conclusions Oster comes to, you can reach your own conclusions by simply going to the immensely valuable endnote section of the book and looking up the same studies she used to write the book. In addition, she combines information into very helpful graphs that express in one picture a wealth of knowledge. One example is a graph of where different types of fish fall on the scale of mercury content (bad for Baby's IQ) versus Omega-3 content (good for baby's IQ). This would be great to have in your purse when you're out to dinner and thinking about a fish entrée, so that you're not trying to look up this info on your smartphone, being rude to your dining companions. Additionally, Oster covers topics such as trying to conceive, nausea (what amount is normal, what treatments there are, both prescription and non), genetic screening and amniocentesis/CVS, risk of chromosomal abnormalities and detection rates of various procedures designed to find them, miscarriage rates broken down by age of the mother, weight gain and exercise during pregnancy, induced labor, epidurals, and more.

If you want to know the facts behind the recommendations your doctor has given you, this is the book for you. You'll have the actual data from the original studies, along with Oster's explanation of the statistics you need to know to make the best decisions for you personally. I strongly recommend this book.

[Katie · Rating 1 out of 5]

This book has provoked a surprisingly strong response in me. I have not read it cover to cover, but I've read enough. Her leaps in logic are... stunning. I thankfully skipped over the alcohol portion, though I see a lot of reviews referencing the dangerousness of her assertions there, and that's kind of the theme throughout. Okay, so she doesn't make explicit recommendations, but she does a lot of "you should feel comfortable doing x." It's ultimately the same effect.

Her assertion that the data on caffeine is all over the place, therefore mothers should feel comfortable drinking 3 to 4 cups of coffee a day is quite a leap (yes, I know I'm simplifying.) In an unrelated chapter, she mentions that headaches increase in pregnancy, and she thinks it's from cutting down on caffeine. Where's your data on that, Oster? Like, truly. What gives her any authority to assert... pretty much any of her assertions? Asserting that all lunchmeat other than turkey is fine because the only relatively recent listeria outbreak was in turkey ignores the painfully obvious factor that the slicer is part of the problem. (Hence the cantaloupe outbreak she mentions.)

I don't doubt that she's a good economist, but she lacks perspective. Her lack of experience within actual medicine is painfully obvious throughout, as is her lack of experience in any kind of field where you have to work with people. Of course doctors give general guidelines. Of course they're always going to err on the side of caution. The stakes are really freaking high, people are litigious, and they don't follow guidelines anyway. I understand that for some people, all this data is soothing, and someone telling them they don't have to worry about xyz is a relief. For me, I feel pretty chill about the restrictions (it's temporary, who cares?), but I feel more panicky about an unqualified person holding herself up as an expert analyst without any background in what she's actually analyzing.

[Elizabeth · Rating 5 out of 5]

As heard on Planet Money.

The New York Times appears to also have a review, but they seem to have completely missed the point.

***

10/20/13: I'm only partway through this book, but I cannot contain my exuberance. This is finally the book that I had just assumed other pregnancy books would be, but was sadly disappointed to discover they were not.

For a given risk factor (such as caffeine, alcohol, or tobacco), she lays out the studies that have been done, highlights the strengths and weaknesses of each study, shows what they found, and then leaves the reader, now armed with data, to decide her own appropriate course of action.

For example, caffeine. There are a number of studies linking caffeine to miscarriages, which have led different doctors to give their different recommendations: some doctors say up to three cups of coffee per day is ok; others say two; still others say absolutely no caffeine at all. The problem with most of these studies is that it turns out that nausea is actually a sign of a healthy pregnancy, and the more nauseous you feel, the less likely you are to miscarry. Of course, if you're feeling nauseous, you want to drink coffee less than you otherwise might. So any study comparing coffee-drinking to non-coffee-drinking women might not be studying the effects of caffeine, they might actually be studying the effects of nausea.

Fortunately, there was one study in Denmark (that paradise of public health data) that issued free instant coffee to a large cohort of coffee-drinking pregnant women, and instructed them to replace the coffee they would normally drink with the free instant coffee, which was either caffeinated or decaffeinated. The women assigned the caffeinated coffee consumed on average 200 mg more caffeine per day than the women assigned the decaffeinated coffee, but when the researchers looked at birth weight, length at birth, gestational age at birth, or head circumference, they found zero (zero) difference between the two groups of babies. It's pretty clear that caffeine has zero impact on the outcomes measured.

Now, of course coffee has a lot more in it than just caffeine (I could have sworn I had a molecule of the day post on cafestol and kahweol, but I can't find it now), so after reading that study, you might still decide that for your own pregnancy, you might prefer to err on the side of caution and cut down on coffee anyway, and that's fine. But perhaps you might think twice before hassling someone else for the choice she's made for herself.

Like Emily Oster, I find this kind of information a lot more useful for decision-making than simple rules like "only one cup of coffee per day".

***

10/20/13 (later that day) update:

"My best estimate, based on the data, was that avoiding ham sandwiches would have lowered my risk of Listeria infection from 1 in 8,255 to 1 in 8,333. Would you want to do this? Maybe. Someone certainly could make a case for doing so. However, this change is really, really small. For me, it wasn't worth it."

I LOVE THIS BOOK.

[Rosie Piper]

as an anxious pregnant girlie - this book was super helpful for my anxiety!

[Chris · Rating 2 out of 5]

This book really seems to have polarized a lot of people. Topics like kids seem to do this. First off, I'm certainly not the target audience for this book. I'm a single guy with no kids in his mid thirties. I doubt I'll ever have kids. But I do love reading about pop science, and normally books of this genre are right in my wheelhouse.

They usually come in one of three flavors, a scientist or pop-science writer explaining some topic in an accessible manor, a crackpot author explaining their theory, or this example, where an "expert" goes outside of their field and publishes "contrarian" takes on the topic. Or as it is known on twitter, the #slatepitch.

So, back to the topic on hand my main problem with this book is that I really didn't like the author. She blends in the science and statistics with anecdotes of her and her friends pregnancies. Again, I'm not the target audience here but I came away just detesting the woman based on her biases and personality. Not fair I suppose, but I'm only human. It really colors her take on the data as well. Something may be not ok for her if it's only a tiny one in several thousand risk, but as she notes that's fine for most people.

I have no idea if she gets the numbers correct in the book. Look to other reviews by people qualified for that. My guess is that this is a sloppy mess of kludged together numbers. She herself seems to pick and choose what studies she likes, and frequently states that she is better trained to say what is a good study because she is an economist, not a doctor. While that may be true for the average doctor, there are specialists out there to do this for a living, I trust them much better then the author.

I don't know if I'd recommend this book to anyone, but if you do read it take it with a huge grain of salt. It's not bad per se, but it's certainly not a good read.

[Zach · Rating 1 out of 5]

Expecting Better From This Book:

I was excited to read this book - I bought it online when I found out I would be a parent. There is a lot of pseudoscience surrounding pregnancy and maternal health. I wanted a book that would cut through that and give an evidence-based survey of pregnancy-related topics, and hear the scientific community's consensus (as much as they have one) on those topics.

However, I was shocked seeing a review on the book talking about the myth that alcohol is inadvisable during pregnancy. Certainly the author isn't advising any amount of alcohol is advisable, given the overwhelmingly consensus on the issue from public health advocates?

I immediately read the entire alcohol part of the book. I soon learned not only would this book not provide me with the best evidence from health advocacy and science groups, they would provide evidence that directly contradicted it.

The author says it's fine to drink some alcohol during pregnancy, and details how much and why. Oster walks through some studies and literature on the topic. Given that the CDC, the American Pregnancy Association, the World Health Organization, National Council on Alcoholism and Drug Dependence, the March of Dimes, and others all agree and firmly say the best advice is to abstain from alcohol completely, I really needed an extraordinary explanation from the author as to why I should ignore those experts. I did not find this in the book, instead I found the analysis underwhelming and unpersuasive, and not worthy of ignoring the consensus shared by experts in the field.

Ask yourself, who is a more trusted source? An economist writing a book to a mass audience for profit, or the March of Dimes, the CDC, WHO, American Pregnancy Association, the UK Health Ministry, Fetal Alcohol Syndrome scientists and advocacy groups? Do all those independent groups have a profit motive to give distorted and wrong health advice?

And fetal alcohol syndrome is not some one in a million risk that parents shouldn't really worry about. A recent study showed 1% to 5% of kids studied had fetal alcohol syndrome disorder, and it was being chronically under-diagnosed.

To be fair, while this has been the consensus for a while, you could find outliers when the author first wrote this book. For example, the UK's health ministry used to not advise against very light alcohol use, but they have since examined emerging research on fetal alcohol syndrome disorder (FASD) and they now say the best advice is to abstain completely - joining the consensus among other health groups like CDC, WHO, etc.

So has the author been concerned about the emerging evidence since she wrote this book? I saw Dr. Oster was asked about recent studies showing that even light alcohol use was unsafe during pregnancy by a health journalist, and her answer was illuminating. Dr. Oster basically said for those studies she'd want to see them be replicated and more details about the links between behavior and harm. That's fine (we should fund lots of replication studies!), but note when she looked at studies that didn't find a danger for pregnant women to drink moderately - she didn't say "well I'm going to wait to see if these can be replicated and more detail provided" - she took them to the bank and said you can make conclusive decisions about your child's health outcomes based on these studies.

I agree there is not an abundance of studies showing that a tiny amount of alcohol will lead to significant medical risks. But there have also been no similar studies showing that having one cigarette (or two, or three) during your pregnancy is a significant risk. So in this book, does the author similarly suggest smoking a small amount of tobacco is perfectly acceptable, given the absence of studies? No, she follows the scientific consensus here. Why the double standard?

With things that pose a serious risk to children (like lead paint), we may not ever know exactly where the line is between what is harmless and what will irreversibly harm a child. When the activity is something that is avoidable, the scientific community generally urges avoiding it entirely.

I'm sure Dr. Oster is well-intentioned, but this is a book about health written for profit to a popular audience, and even in the best circumstances that is a fraught situation. There is a profitable market for people with academic credibility to sell a message that, while it goes against the consensus of the public health community, it's something many people want to hear. I hope the book gets updated with the many advances in our understanding of FASD, or at least explains why they have a different standard for light tobacco use.

[Marya · Rating 5 out of 5]

Emily Oster read the same "10,000 ways you can totally f- up your baby" pregnancy manuals I did and had the same level of disgust. Why was the doctor so obsessed with my weight gain? Why was the nurse telling me that I should rush to the hospital the second my water broke? Was all of this really necessary? Like me, she also wasn't comfortable with the extreme backlash response of home-birth in an inflatable bathtub (which turns out to be not an option where I live anyway). But Emily Oster has super-powers: a degree of economics and a teaching gig at the University of Chicago in that subject. That means she can look those fearmongers in the eye, say "prove it" and then actually analyze the studies to see if it is a good study and if so, what the data actually reveals. In this way, she finds that some advice is pretty solid (don't eat big fish high in mercury), while other advice has a lot more caveats (the sacred don't drink alcohol at all). Mostly, Oster can't accept the blanket bans and strict rules without knowing WHY those rules and bans were created in the first place. By giving the rest of us access to that information, she is giving us something the doctors, nurses, pregnancy books, and even new-age throw-it-all-to-the-wind people are not: the data we need to make up our own minds on the subject. Isn't that the point of a participatory democracy?

[Jennifer · Rating 1 out of 5]

I had high hopes for this read but all is does is ask unanswered questions. If you want to know absolutely that a glass or 2 of wine won't hurt your baby, don't expect your doctor to tell you that they tested this on pregnant women, just don't drink it.

[Amanda · Rating 5 out of 5]

A little background: I'm 29 weeks pregnant for the fourth time, so I probably have more interest in pregnancy than your average Joe.

When economist Emily Oster decided to have a baby, she wanted to make informed decisions and assumed the medical community would offer her the statistic-based information she is used to finding. Instead, she received a lot of "probably fine" and "low-risk" vagueness. Since her (and her husband's) profession is to find and analyze research, she started reading studies about pregnancy and drawing conclusions. The result is an easy-to-read story of her own pregnancy experience, the choices she made, and the research she found. Her object is to give readers the information to make their own informed decisions, taking into account what the research means and then to factor in their own "pluses and minuses" - the personal needs and preferences that influence any decision. There are a few cases where she drew conclusions (eg, there is no evidence that routine episiotomy is helpful and is often harmful instead, so you should skip it) but she always offers the research if you want to make a different decision.

I honestly loved this, more than I thought I would. It's incredibly complete - I thought it was mostly about the conflicting advice given (All alcohol is bad! 1-2 drinks a week is fine! Drinking in moderation is not a problem!) but in addition to that she covered pretty much every decision you have to make, even ones that aren't framed as decisions. Your doctor may not offer you all the prenatal testing options depending on risk factors, but Oster breaks down all the available knowledge to help you decide what to request. She also evaluates conflicting studies based on the quality of the research, which is something laymen are not always skilled at and she has a PhD in.

I would highly recommend this book to pregnant women or those considering it (there's a pre-conception section). If statistics offer you any comfort you'll enjoy the table detailing how likely you are to go into labor every week and your baby's chance of survival if you do. And if scare tactics and the routine treating of pregnant women like children annoys you, you'll be glad to have all the pertinent research to make your own decisions. I also think it's a good read for people interested in research and its interpretation. My only regret is that I bought a kindle book instead of a hard copy - I think I'll refer to it and wish I could loan it out.

[Margaret · Rating 4 out of 5]

I picked this one up after reading several reviews describe it as 'if you read a single book about pregnancy, this is the one you should read.' And I completely agree. THERE ARE SOURCES! I swear, it never occurred to me that the vast majority of pregnancy books would cite no sources whatsoever. I don't care if you're a doctor. Lots of people call themselves doctors and I'm not going to take their advice. On top of that, the books often say things like "Ask your doctor." I'm reading pregnancy books so I can go to my doctor's appointments informed about all the different pros and cons and possible issues with things. So that I can then talk to my doctor in an informed way. Don't just tell me to talk to my doctor. Why bother reading a book then???

Anyway, Expecting Better is written by an economist. Seem odd? Sure. But she was similarly frustrated by the lack of evidence given in pregnancy advice books, or even by her doctors. So she decided to research all the main questions so she could make informed decisions. In each chapter she presents multiple case studies and weighs all the different decisions new parents can make. Her premise is that parents need to make informed decisions. She doesn't tell you whether you should or shouldn't get on epidural, or drink coffee, etc, but rather what research shows so parents can make their own decision. She argues that there's no 'right' or 'wrong' answer, only informed decisions. Thus, based on her research, she decided against an epidural. Based on the same research, I'm going with an epidural. Neither of us are wrong in our decisions; we're making the choices that are best for us after researching the effects of that choice.

I wish everyone did this with everything--waited to make an opinion about something until they'd researched multiple scenarios.

So far, this is the only pregnancy book I've read worth reading. She didn't research all my questions about pregnancy, but thankfully I have access to medical research journals through the university I teach at, so I'm conducting my own research!

4.5/5

[Rachel · Rating 5 out of 5]

Loved it! If you are the type of person that likes data and statistics, and wants to know WHY all these conflicting "rules" about pregnancy exist, this book is for you. I wish I had read it at the beginning of my pregnancy rather than in month 9 -- but it wasn't out yet!

Oster's big idea is that women should be trusted with specific, accurate data so they can make their own decisions based on the risks vs. rewards.

For example, perhaps you have seen all the lists of foods you're supposed to avoid while pregnant. None of these lists agree, nor do they identify which foods are more risky than others. Oster dives deep into the existing studies that have been done, examines different foods and identifies exactly which foods have risks of causing which illness, and which are more likely to cause an illness than others. You might wonder: Why take any risks at all when it comes to your baby? Well, when you are 8 months pregnant, your feet and hands are swollen (or any number of other unpleasant pregnancy symptoms), you can barely muster enough energy to get up and down from the couch, and you're ravenous for a sandwich, it may be helpful to know that your risk of getting sick from eating deli meat is actually REALLY low overall, but slightly higher for turkey than for other meats. When you know that the odds are EXTREMELY low that this sandwich will be detrimental to your baby, but there is a 100% chance that the sandwich will be the highlight of your otherwise long and uncomfortable day, along with providing protein and carbs and veggies while helping you avoid the fried chicken sandwich you might have otherwise eaten, the choice is clear. (At least, it was clear for me - another woman may decide that no risk is worth the reward, and that's fine too.)

I found the discussion about the caffeine/miscarriage link really fascinating. It makes total sense - it's likely not that caffeine causes miscarriage, but that hormones cause both a lack of desire to drink caffeine (due to nausea) and successful pregnancy. And it's difficult to prove otherwise.

And then there's alcohol. If you're like me and you enjoy knocking back a few (or at least you did, pre-pregnancy), you'll read this section with great interest. Oster's "study of studies" points to a green light for up to one drink a day in late pregnancy. Now, I didn't drink that much, but in month 9 when trying to make it through another work week, it was such a relaxing treat to have a guilt-free half-glass of wine once in a while. Again, for some moms, they may not enjoy drinking that much and so the reward isn't worth the perceived risk. For me, having a drink here and there helped me carry my baby to nearly 42 weeks with a positive, relaxed attitude.

The only section I wasn't totally on board with was the one about exercise. Oster seems to conclude that it makes no difference if you exercise while pregnant or not, though she grudgingly acknowledges that yoga has been proven to be helpful. Perhaps there's just a lack of data here, but I wish she'd been more positive about the effects of exercise in general and yoga in particular. I personally found that exercise, especially yoga, clearly gave me more energy, reduced leg cramps, improved my strength and balance as my body changed drastically, and improved my mood, with effects only becoming more noticeable as the pregnancy wore on. I'm sorry that women might get the impression from this book that exercise during pregnancy is unnecessary or unhelpful.

Again though, the main point is that women should have the information and be trusted to make their own decisions, with guidance from their doctor. The prevailing attitude that women should blindly follow vague recommendations to avoid everything from soft cheese to lukewarm hot tubs is supremely unhelpful and condescending. Some have argued that Oster is an economist, not a doctor, and has no business writing a book about pregnancy. I would counter that no one in the medical profession in the U.S. has written such a sensible, respectful and comprehensive book about pregnancy based on evidence-based medicine that answers the questions that women most want to know. Until they do, I'm sticking with Oster!

[Cara Winter · Rating 2 out of 5]

I didn’t read every single chapter, but what I did read seemed really biased and skewed toward the author’s personal experience as a white, well educated person with access to high quality, affordable medical care, and a completely uncomplicated pregnancy and birth. She barely touches on issues she didn’t personally face. But the most irritating part of this book was that it totally ignores what it actually FEELS like to make decisions, especially in high pressure, high risk, emotional situations. We aren’t robots who compile data and make choices purely based on statistics. In pregnancy and childbirth there is so much individual variation. It’s definitely a good idea to find as much evidence as you can to support the choices you make, that I agree with her on, but her approach is so cold and calculated and yet weirdly skewed to her own personal circumstance. Skip this and read Angela Garbes’s Like A Mother instead.

[Jennifer · Rating 1 out of 5]

This was an absolutely painful read. I can’t believe i actually finished it. The fact that Ms Oster touts herself as having any authority to be giving medical advice is completely asinine. While there are a handful of places she seems trusting of the medical community, the overall theme is- screw what your doctor thinks about your very personal pregnancy and specific circumstances, follow my teachings based on reading a few studies and you will be fine. Never mind the 4 years of undergrad, 4 years of medical school, 4 years of residency and then possibly additional fellowship training that your doctor has. Boy am i glad i didn’t have to take care of this lady.

[E B · Rating 1 out of 5]

First I'll say that I am not keen on giving any book a 1 star. In of itself most books even slow, boring, poorly written, etc. often still earn enough attention or have points of interest to keep it out of the gutter of 1 star.

The major issue I have with this book is that its written in a way that the author is claiming authority over an industry that she has not authority over. This has massive consequences to those that might read it and make decisions based on this book. Its dangerous; plain and simple. The section on alcohol alone should find this books sales banned.

Moreover, its written in about the most bias a book could be written while claiming to be unbias. She feels certain ways and then sets out to prove herself right that certain things haven't been proven to be bad, so must be good and reasonable to do. You have 10 months to carry a baby and in that time the author doesn't want to sacrifice anything, coffee, alcohol, etc. I don't know her personally, but based on the writing she seems rather entitled. I don't say this to be mean or insensitive, but its painful to read through at times.

I had to take several breaks from the book as I just found myself unable to continue. Please save yourself the time, energy and effort and don't buy this book. There are a tremendous amount of well written books on pregnancy, this is not one of them.

[Kate Duval · Rating 3 out of 5]

This is as close to an online pregnancy announcement as I am capable of.

[Angela · Rating 2 out of 5]

There was a lot of hubbub on some of the pregnancy subreddits about this book, so I wanted to read it to see if it was worth all the hype. Conclusion: eh.

My corrections and comments:

1. You can't run studies on many things in pregnancy. It's unethical and there aren't ways to set up proper controls. She should have mentioned this in the intro, but waited until a later chapter to very briefly explain.

2. OPKs are not expensive unless you buy the big ones in stores, and they are most accurate when paired with temperatures, not alone.

3. With regard to alcohol consumption during pregnancy and child behavior problems, she doesn't specify who decides if the behavior is bad or good.

4. P 51 evidence and proof are different. You cannot say X amount has been proven safe because it hasn't, and it varies person to person.

5. Nausea is not a magical measuring stick for how safe you are from miscarriage, but the way she talks about it suggests so, and she doesn't provide actual numbers until the next chapter. She really should explain things the first time she brings them up, not the second or third time. It makes it hard to believe the thing she's trying to back it up with, which was precisely her annoyance with doctor recommendations and why she said she wrote the book!

6. She talks about how much she is bothered by inconclusive words and phrases, yet she uses them throughout the book instead of actual numbers sometimes.

7. No mention of Ramzi or Nub Theory in the gender chapter. Also no clarification on what "unknown gender" meant. 2/77 seems extremely high for that.

8. She says there are no benefits to exercise, but that is false. On average, it makes for an easier/better birth (stronger, more endurance). Also, for diastasis recti, there are certain abdominal exercises to avoid because they make it worse, and certain wants to do, because they make it better. She does not mention this distinction.

9. It's interesting that the author owned and used a fetal Doppler when those are contraindicated.

10. For natural induction of labor, she doesn't mention orgasm, just sex. Orgasm dilates the cervix and causes uterine contractions, so it should help encourage labor. Additionally, pelvic rest (avoiding sex) is prescribed if you're at risk for preterm labor.

11. Her "labor problems" are perfectly normal and not problems; they just require patience (slow dilation and pushing). She makes no mention of the fact that C-sections are much too common in the U.S.; that it's recommended to be at 5-10%, not 30. She also mentions driving home from the hospital after her C-section, which is incredibly dangerous and irresponsible (zero or inadequate abdominal tone, making her physically incapable of responding appropriately to an impending accident). Though she didn't actually have a C-section, so that needed to be worded better. Still shouldn't be driving that soon after birth.

12. She also discourages VBACs and brings up randomized evidence, which is impossible to have for that situation. Multiple C-sections are much riskier, especially if you want more children.

13. There are more risks to the baby if you get an epidural than what she mentions. Also, it does cross the placenta.

14. Unmentioned points about episiotomies: you're more likely to tear farther than without it, and it's easier to re-tear with subsequent kids, even when it might have otherwise stayed intact.

15. Baby does not need to leave Mom's chest to have newborn exams done. That can wait for 2 hours, the prime breastfeeding initiation window when baby is alert and acting on their first instincts.

16. There are downsides to antibiotic eye ointment: overuse of antibiotics, baby can't see Mom clearly during initial meeting and bonding, etc.

17. I'm mentioning this out of order, but she spends a lot of time on the section about things that are unsafe and safe to consume or do during pregnancy, and a lot of it came off as her trying to find a way to justify or excuse her behaviors. It is better to try to improve your health than to find excuses to keep your current habits.

[Phoebe · Rating 3 out of 5]

3 1/2 stars. Not pregnant but I am an economist and I found this an interesting read. I also learnt quite a lot, although after skimming some of the reviews on here from actual medical professionals I’d be inclined to take some of Oster’s recommendations with a grain of salt, as she is (like me) an economist and not a medical professional.

I agree with others that her personal bias comes through strongly in some chapters, and even though Oster says she is against do/don’t rules, the book then gives Oster’s hot takes in boxes at the end of each section. Some of these work in my favour because, like Oster, I also love coffee, wine and ham sandwiches. However it is surprising and disappointing that in a 280-page book, the entire chapter on “miscarriage fears” is shorter than 6 pages, and the next chapter, mostly on fish you can/can’t eat, is over twice as long! This is, I presume, because Oster has never experienced pregnancy loss but loves tinned tuna, and so spent more time researching the latter.

There is also a fair bit of ableist language in the antenatal screening chapter, and quite a few minor typos throughout the book - both of which surely a good editor would have been able to assist with.

Despite the obvious issues here I would still recommend this book to friends. One of the things I found most frustrating about being (briefly) pregnant in recent months is that my GP treated me like I was an idiot and was reluctant to give me factual information when I asked for it. So I can certainly empathise with Oster’s scepticism and her desire to hunt down and dig into the data (no-one else is going to give it to you). Reading a book like this certainly helps to build up your base level of knowledge for when you need to advocate for yourself in the health system. However, I would still trust a medical professional over this book if I was faced with conflicting advice.

[Pankaj Singh · Rating 3 out of 5]

The Good:
- this seems to be the most evidence based book on pregnancy I’ve come along.

The Bad:
- a classic example of someone who is an expert in one field who assumes they are an expert in another as well. Just because Ms. Oster is an economist and can interpret data doesn’t mean she is the go to advisor on all things obstetrics. It’s painful to read the conclusions she draws, especially when she draws smug conclusions on things that are well established for decades.

- way too US centric. Most of the advice seems to be around a private health care system where things are done just to make more money. Fortunately in the U.K., we follow genuine evidence based medicine rather than what makes most money.

The Ugly:
- God, this author is smug. Stop being full of yourself just coz you can interpret data. A lot of educated people can.

[Kim Nelson · Rating 4 out of 5]

baby nelson soft launch

[Sara Lorenz · Rating 4 out of 5]

This is the 2nd pregnancy book that I’ve read.
I wanted to read this one in particular because 1) it was one of my good friend’s best pregnancy book recommendations (thank you Brandi!) and 2) the author is an Economist and as an Econ major I was intrigued to see how she would apply an Economist’s way of thinking to the topic of pregnancy.

I really liked this book. It’s different. The author lays out all the data, statistics and research and gives you a better understanding of why there is so much conflicting information out there. This is something I’ve struggled with in my pregnancy - just being confused about why the recommendations are sometimes so different between the US, the UK and Sweden (the three countries where I’ve lived). You get a better understanding of why there are so many different “rules” out there.

This book is also very non-judgemental, which I loved (as this is an area where there is so much judgement - about everything). She lays it all out for you and then basically says “do what YOU think is best based on the facts that you now have”. Great read. I really don’t understand why so many people are so upset with this book and the author.