Expecting Better ePUB Ò Hardcover

Expecting Better What to Expect When You're Expecting meets Freakonomics an award winning economist disproves standard recommendations about pregnancy to empower women while they're expectingPregnancy—unuestionably 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 wrongA 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 oftenPregnant 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 gardeningAny 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

10 thoughts on “Expecting Better

  1. Jaclyn Day Jaclyn Day says:

    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 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 visitWell 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 pregnancyLet 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 soI 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 critiues is that a lot of pregnant women don’t listentrustobey their doctors wholesale any 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 uestions 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 medically detached pregnant woman is a positive or a negative thing IT IS A THINGSo 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 pointI think Oster’s book is a fantastic way to prompt uestions 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 uestions 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 moveAs 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 bookPersonally I’m all for women being given 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 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 16 times as likely to have a C section Oster found that oft uoted 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

  2. Alexis Alexis says:

    After 2 moderately complicated pregnancies and multiple thrown pregnancy books I wanted to like this I was attracted to the concept of applying decision making principles to pregnancy It's a great concept and not enough pregnancy literature emphasizes the risk and tradeoff model or if it does presents inaccurate risks The book has already gotten a backlash for daring to suggest that the zero tolerance approach to alcohol in pregnancy is not backed by evidence prompting 1 star reviews accusing the author of not caring about FASD This particular criticism is in my opinion overblown Unfortunately the book itself doesn't measure up to the concept A full treatment of the problem would be a weighty tome akin to Henci Goer's Obstetric Myths and Research Realities only less biased and up to date To her credit Oster doesn't even pretend to have attempted that Even so the treatment verges on the cursory and would have benefited from closer collaboration with an OBGYN The book is structured as a journey through pregnancy using Oster's own pregnancy low risk with an unmedicated vaginal delivery as a base narrative This makes the book easy to follow but also has its pitfalls Given that a large number of women will have a relatively low risk pregnancy and delivery this isn't entirely invalid Many of the things she covers especially in early pregnancy are common to all the true risks of cat litter and tuna and the probabilities used in prenatal screening have widespread relevance However it also means she completely ignores almost anything outside of her experience Rightly she decided that most of the complications of pregnancy are between you and your doctor although she provides some bullet points but this also means that C sections get no discussion at all Strangely VBACs do and her discussion is surprisingly skewed She leans towards VBACs being too risky while not mentioning the most freuently discussed concern uterine rupture and doesn't mention the downsides of planned repeats at all At times it comes off as actually slapdash There's a short discussion of non stress testing in the section about later pregnancy and the potential value for delivery but never mentions the possibility that a biophysical profile will be done There's no discussion of the actual risks involved of routine induction at 40 vs 41 vs 42 weeks which is a fairly common topic of discussion and a natural fit for the chapter Her treatment of home birth is sure to rise some hackles Nor is it helped by a throwaway comment about higher home birth rates and lower infant mortality rates in Europe although on the next page she discusses the difference between perinatal and neonatal mortality Wherefore art thou editor? The section on drug classifications is helpful but not entirely so the potential benefits of Category D medications aren't really mentioned It's a short breezy read and provides some interesting food for thought particularly with the early pregnancy risks but is of limited practical use

  3. Deana Deana says:

    After becoming pregnant I uickly learned that there are two types of pregnant women ok there are a lot 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 pageAs 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 of a risk driving to work every day on I 95 than I do by eating a roast beef sandwich So yeahWhen people started telling me all the things I cannot do or eat while pregnant my first uestion 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 uestions this book is definitely for youOster 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 okAnyway I thought this book was excellent It answered a lot of uestions both directly and indirectly through the resources I had at the beginning of this pregnancy journey and made me feel a lot comfortable with the decisions I am making Highly recommended

  4. Kathryn Lucas Kathryn Lucas says:

    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 betterFirst 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 heavybinge 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 babiesThe 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 I versus Omega 3 content good for baby's I 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 amniocentesisCVS 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 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

  5. Elizabeth Elizabeth says:

    As heard on Planet MoneyThe New York Times appears to also have a review but they seem to have completely missed the point102013 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 notFor 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 actionFor 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 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 nauseaFortunately 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 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 measuredNow of course coffee has a lot 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 herselfLike Emily Oster I find this kind of information a lot useful for decision making than simple rules like only one cup of coffee per day102013 later that day updateMy best estimate based on the data was that avoiding ham sandwiches would have lowered my risk of Listeria infection from 1 in 8255 to 1 in 8333 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 itI LOVE THIS BOOK

  6. Alex Alex says:

    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 uite interesting and I learned some of the specific aspects of prenatal care However 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 than they do their physician

  7. Gianna Gianna says:

    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 ualified 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 uality 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 ualified to speak with such authority on these issues This puts women and newborns at serious riskFor instance the risks and inconvenience of avoiding deli meat and alcohol are tiny compared to the conseuences 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 uality research to ensure that drinking of any amount during pregnancy is safe so why would we uestion that until the research is clearer?TL;DRLONG STORY SHORTPLEASE 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

  8. Amanda Amanda says:

    A little background I'm 29 weeks pregnant for the fourth time so I probably have interest in pregnancy than your average JoeWhen 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 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 reuest She also evaluates conflicting studies based on the uality of the research which is something laymen are not always skilled at and she has a PhD inI 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

  9. Margaret Margaret says:

    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 uestions 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 choiceI 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 uestions about pregnancy but thankfully I have access to medical research journals through the university I teach at so I'm conducting my own research455

  10. Richard Carozza Richard Carozza says:

    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 uneuivocally 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

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