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Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What… (2013)

de Emily Oster

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2129100,479 (4.17)2
Pregnancy--unquestionably one of the most profound, meaningful experiences of adulthood--can reduce otherwise intelligent women to, well, babies. We're told to avoid cold cuts, sushi, alcohol, and coffee, but aren't told why. Rules for prenatal testing are hard and fast--and unexplained. Are all of these recommendations right for every mom-to-be? Here, the author shows that pregnancy rules are often misguided and sometimes flat-out wrong. Pregnant women face an endless stream of decisions, from the casual to the frightening. Expecting Better presents the hard facts and real-world advice you won't get at the doctor's office or in the existing literature.… (mais)
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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. ( )
  arosoff | Jul 11, 2021 |
Finally an opinion free, data driven look at everything you've ever heard about pregnancy but never got an explanation of. Beginning with conception and following the development of new life through delivery, Oster offers an easy to understand take on academically sound studies and distills overwhelming research into bite sized sentences at the end of each chapter that guide one to making their own, well informed decisions around how to shepherd forward a new life. Questions about how much coffee is safe to whether one drink in 9 months is going to have an impact are all answered. A much anticipated relief of a read. ( )
  VictoriaBrodersen | Mar 13, 2021 |
Ruoxi
  Jazzycat37 | Feb 12, 2021 |
A bit heavy handed on how great economists are at understanding research evidence. Useful book for those who want to understand the evidence underpinning many of the recommendations provided around pregnancy. ( )
1 vote brakketh | Jun 3, 2020 |
When economist Emily Oster became pregnant with her first child, she soon found herself frustrated with the lack of and quality of data behind the pregnancy rules her obstetrician gave her to follow. For example, who decided pregnant women shouldn’t eat deli meat and why? Emily set out to find the answers.

Oster explains in layman’s terms how to interpret study results without talking down to the reader. She addresses things like sample size and correlation versus causality.

I liked that she framed her conclusions in terms of risks verses benefits and recognized that what is an acceptable level of risk for her may not be an acceptable level of risk for the reader and vice versa, for a variety of reasons. It was surprising how many pregnancy don’ts are based on either outdated research or studies with very small sample sizes.

I appreciated Oster’s logical approach to issues that come up in pregnancy and that she didn’t present her conclusions as black and white. She has a new book out called Cribsheet about the early years of parenting that I am very much looking forward to reading as I am due to have my fourth child in a few weeks. My youngest is almost nine so the early years of raising a baby are a distant blur in my memory! I highly recommend Expecting Better for anyone who is pregnant or thinking about becoming pregnant in the future. ( )
  mcelhra | Jun 2, 2019 |
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To my sweet Penelope, who inspired this book, and to my mormor, who would have loved to meet her.
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Informação do Conhecimento Comum em inglês. Edite para a localizar na sua língua.
In the fall of 2009 my husband, Jesse, and I decided to have a baby.
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As unpleasant as it is, nausea is a sign of a healthy pregnancy. Miscarriage rates are much lower for women who are nauseated than for those who are not. In early pregnancy the differences can be quite large: one study showed that the overall risk of first-trimester miscarriage was 30 percent for women without nausea, versus just 8 percent for those who were nauseated.

Knowing this, the sicker I felt in the morning during my first trimester, the happier Jesse was. There is nothing quite like waking up, feeling terrible, and having your spouse tell you how excited he is that you feel bad. I don't think I've ever seen him quite as happy as the one day I actually threw up.
Pregnancy seemed to be a world of arbitrary rules. It was as if when we were shopping for houses, our realtor announced that people without kids do not like backyards, and therefore she would not be showing us any houses with backyards. Worse, it was as if when we told her that we actually do like backyards she said, "No, you don't, this is the rule." You'd fire your real estate agent on the spot if she did this. Yet this is how pregnancy often seemed to work.
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Pregnancy--unquestionably one of the most profound, meaningful experiences of adulthood--can reduce otherwise intelligent women to, well, babies. We're told to avoid cold cuts, sushi, alcohol, and coffee, but aren't told why. Rules for prenatal testing are hard and fast--and unexplained. Are all of these recommendations right for every mom-to-be? Here, the author shows that pregnancy rules are often misguided and sometimes flat-out wrong. Pregnant women face an endless stream of decisions, from the casual to the frightening. Expecting Better presents the hard facts and real-world advice you won't get at the doctor's office or in the existing literature.

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