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

Emily Oster

4.32 · Rating details · 15,848 ratings · 1,449 reviews

Pregnancy—unquestionably one of the most profound, meaningful experiences of adulthood—can reduce otherwise intelligent women to, well, babies. Pregnant women are told to avoid cold cuts, sushi, alcohol, and coffee without ever being told why these are forbidden. Rules for prenatal testing are similarly unexplained. Moms-to-be desperately want a resource that empowers th ...more

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Paperback, 336 pages

Published June 24th 2014 by Penguin Books (first published August 20th 2013)

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Aug 26, 2013 Jaclyn Day rated it it was amazing · review of another edition

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 ...more

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Aug 28, 2013 Alexis rated it it was ok · review of another edition

Shelves: pregnancy

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 Amazon rev 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 Amazon 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, more akin to Henci Goer's Obstetric Myths and Research Realities (only less biased and more 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 OB/GYN.

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 frequently 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. ...more

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Apr 07, 2015 Deana rated it really liked it · review of another edition

Shelves: read-library, 2015, 4-5stars

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, ...more

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Sep 02, 2019 Sarah Fung rated it it was ok · review of another edition

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 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. ...more

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Jun 23, 2014 Alex rated it liked it · review of another edition

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 o ...more

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Oct 02, 2013 Kathryn Lucas rated it it was amazing · review of another edition

Recommends it for: pregnant women, women trying to conceive, partners of those women

Recommended to Kathryn by: NPR

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 t 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. ...more

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Sep 17, 2013 Elizabeth rated it it was amazing · review of another edition

Shelves: npr, science-and-medicine, nytimes, parenting

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 ea ...more

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Apr 01, 2017 Richard Carozza rated it did not like it · review of another edition

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 ...more

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May 25, 2017 Gianna rated it did not like it · review of another edition

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 evide ...more

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Aug 20, 2013 Amanda rated it it was amazing · review of another edition

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 studie 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. ...more

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Jun 08, 2017 Margaret rated it really liked it · review of another edition

Shelves: nonfiction

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 boo 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 ...more

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Aug 22, 2013 Tina rated it did not like it · review of another edition

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 ...more

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Nov 28, 2013 Rachel rated it it was amazing · review of another edition

Shelves: women, parenting

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 avoi 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! ...more

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Sep 14, 2013 Marya rated it it was amazing · review of another edition

Shelves: adult-nonfiction

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 su ...more

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Jan 19, 2014 Chris rated it it was ok · review of another edition

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 theor ...more

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Sep 28, 2013 Jennifer rated it did not like it · review of another edition

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. ...more

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May 29, 2014 Heidi rated it did not like it · review of another edition

Recommends it for: no one

Shelves: not-fluff, non-fiction, kindle, parenting

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 alcoho 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. ...more

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Oct 27, 2017 Sara Lorenz rated it really liked it · review of another edition

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 ...more

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Sep 06, 2013 Maryann J-D rated it it was amazing · review of another edition

Excellent book. I've been half-consuming all sorts of pregnancy books lately, and this was the most satisfying. I previously read Origins, which had somewhat of a similar premise, but instead of calming me down with information, it just threw a bunch of studies at me and had me convinced that, when we do get pregnant, I need to just cloister myself until the child is born. (And even then?!)

In contrast, Emily Oster lays out all the data, with some handy visual aids (like the mercury to omega-3s f ...more

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May 22, 2019 Cara Winter rated it it was ok · review of another edition

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 situation ...more

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Jun 16, 2015 Meg rated it really liked it · review of another edition

Shelves: read-2015, non-fic-pregnancy-and-parenting, non-fiction

So here's the thing: pregnancy is terrifying. Like, going into it you kind of know that things are going to be different, but nothing really prepares you for the amount of anxiety you will experience. Don't eat this! Don't do this! Don't touch that! You are constantly bombarded with rules, some of which seem completely arbitrary. And, well, some of the are. This book was really refreshing in that it wades through a lot of the misinformation out there. Facts, facts, beautiful facts! Data! Evidenc ...more

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May 04, 2017 Renee rated it did not like it · review of another edition

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

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Apr 13, 2018 Lisa rated it it was amazing · review of another edition

A great guide to understanding myths vs science. Very conversational language - highly recommend for those newly pregnant - especially those like me who tend to be anxious.

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Aug 13, 2013 Caroline Niziol rated it really liked it · review of another edition

If you asked me a couple of weeks ago if I was interested in reading Yet Another Pregnancy Book, I would have laughed. Hardly! I read a couple early on, then turned to the almighty Google when I had questions or curiosities. Then about a week ago, my mom clipped an excerpt from the Wall Street Journal called "Take Back Your Pregnancy." Well, I took the bait. Emily Oster's article intrigued me. Definitely one for any subsequent pregnancy, I thought!

Then the furor struck on the Interwebs. Because If you asked me a couple of weeks ago if I was interested in reading Yet Another Pregnancy Book, I would have laughed. Hardly! I read a couple early on, then turned to the almighty Google when I had questions or curiosities. Then about a week ago, my mom clipped an excerpt from the Wall Street Journal called "Take Back Your Pregnancy." Well, I took the bait. Emily Oster's article intrigued me. Definitely one for any subsequent pregnancy, I thought!

Then the furor struck on the Interwebs. Because Oster draws the conclusion from a variety of studies and data that it's fine to indulge in the occasional alcoholic beverage during pregnancy, she has been excoriated in a variety of articles and in the responding comments. Current Amazon.com reviews are skewed by those who take issue with an economist (not a medical doctor) who will, in their minds, increase the number of children born with FASD (Fetal Alcohol Spectrum Disorder). Several comments made nasty remarks about the author's 2-year-old daughter, Penelope, implying that it was only a matter of time before she would begin to fail IQ tests and demonstrate signs of FASD herself.

Was Oster truly that horrible and conniving? Did she write her book to cause birth defects and emotional trauma? I had to know the truth, and while 40 weeks and two days pregnant, I picked up Expecting Better and read it carefully.

Spoiler alert: it's really not that bad. I love authors who examine evidence, explain scientific studies and methodology, and draw logical conclusions about the data. Oster isn't an ob/gyn, but she's a well-trained economist whose job is interpreting data. Her analysis is thorough even as she keeps her writing accessible, humorous, and sympathetic. As she points out in the introduction, advice about pregnancy tends to be either black and white—don't have any drinks, ever—or vague—drink coffee in moderation. Instead of relying on the hearsay, she reviews the actual data and comes to her own conclusions. Oster doesn't demand that women drink during pregnancy despite their own reservations. Not at all! She just presents the evidence that light drinking has been shown to be not harmful, and lets the reader make her own choice.

The knee-jerk reactions to the book and Oster's approach are misguided because they don't realize that telling women what to do during pregnancy is exactly the opposite of Oster's intentions. Rather, she wants all the data laid out so women can make informed decisions during pregnancy based on their own assessment and comfort levels with varying amounts of risk. That is far more empowering and practical than a notarized list of what to do and not do. She gives examples in the text, citing instances where her review of the data prompted her to chose one path and a friend reviewing the same data to chose another path. That is fine. The goal is seeking knowledge to inform personal decisions.

Pregnancy in the U.S. is fraught with judgment from family, friends, and total strangers that add extra stress in an already anxious time. Expecting Better steps back from the hysteria and offers women up-to-date, relevant information about the choices they will need to make during pregnancy. I'll definitely be recommending this one to pregnant friends in the future. ...more

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Sep 08, 2019 Jill rated it it was amazing · review of another edition

Shelves: nonfiction, self-help

This was one of the best pregnancy books I've read. Oster brings all the data you need to make informed decisions throughout your pregnancy and labor. She goes through all the common misconceptions and wives tales about everything. This helped ease my anxiety over causing harm from hair dye and drinking in the two week wait. It was also empowering to read about her no-meds natural birth story. Oster is so non-judgmental. A great read for moms to be. ...more

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Dec 18, 2017 Stephanie rated it it was amazing · review of another edition

The perfect book for expecting parents. Read this book, then have some sushi and a half glass of wine, and chill out; your baby will be fine. And if s/he isn't... it wasn't the sushi, 4 ounces of wine, or anything else you did wrong. ...more

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Aug 27, 2013 Meg rated it it was ok · review of another edition

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 st ...more

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Sep 11, 2013 Margaret Heller rated it really liked it · review of another edition

Shelves: babiesomg

This book spawned a huge amount of controversy due to the WSJ article that was played as "go ahead and drink all you like". That is, of course, not really what she's saying here. This is a combo of medical literature metaanalysis and pregnancy memoir--now if you've read any of the literature and are pretty smart, most of what she says should be no surprise. The message is throughout that there are levels of risks and of unknowns, and you have to read the numbers and decide with what you are comf ...more

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Jul 29, 2019 Shannon Weynand rated it it was amazing · review of another edition

Shelves: 2019, motherhood-birth

I loved this book - it provides tangible information (data, facts) about much of the advice you hear and receive as a pregnant woman. The author’s doesn’t take herself too seriously (I loved when she made fun of the doctor weigh-ins!), but she gives an unblinking eye to research, presenting what literature says in an easy-to-approach way.

Reading this made me feel more relieved and prepared than anxious and that is the sign of a good pregnancy book to me.

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Oct 19, 2015 Susanne rated it it was amazing · review of another edition

Shelves: genre-non-fiction

4.5 Amazingly Informative Stars

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About Emily Oster

Emily Oster

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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 experi ...more

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“...I'm not crazy about the implication that pregnant women are incapable of deciding for themselves- that you have to manipulate our belief so we do the right thing. That feels, again, like pregnant women are not given any more credit than children would be in making important decisions.” — 11 likes

“So why did my conclusions differ from theirs? At least two reasons. One is overinterpretation of flawed studies. But the bigger thing, I think, is the concern (which was expressed to me over and over again by doctors) is that if you tell people they can have a glass of wine, they'll have 3 (or one giant "bowl-o-wine"). Even if one isn't a problem, three are. Better to say you can't have any, as that rule is easy to understand.” — 4 likes

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