Expecting Better by Emily Oster made a splash when it was published in 2013. When she got pregnant, Dr. Oster, who is a well trained and accomplished economist, decided to take a look at the data behind many of the ‘rules’ that are given to pregnant women by their doctors. You know, the do’s and don’ts of pregnancy.
An interesting hook for a medical advice book. Dr. Oster decided to pick through and analyze hundreds of studies on the various pregnancy tests and procedures and come to her own, economics-minded, data-driven conclusions about which pregnancy rules were grounded in the literature and which weren’t. She covers conception, all three trimesters, and labor and delivery, talking about everything from your second daily cup of coffee to epidurals. It makes for an interesting read that challenges some conventional pregnancy wisdom. Dr. Oster’s literary instincts proved successful, drawing many readers and selling a lot of books, as it is currently #26 in Amazon’s best sellers for pregnancy and childbirth books.
Flaws in the Thesis of Expecting Better
Dr. Oster breaks down each topic in her book by looking at specific studies that support or do not support her conclusion and explains how she draws her conclusion from the data. I think this is an interesting way to formulate recommendations but certainly not flawless. Even if we give Dr. Oster the benefit of the doubt that she reviewed the entire medical literature on each topic, in reality, academic studies are only part of the information used by experts to craft their conclusions. This is especially true considering the fact that not all data, even the coveted double blind placebo controlled type that Dr. Oster loves, can even be replicated. In fact, a recent study suggests that up to 70% of data from scientific studies, like the ones analyzed in this book, could be replicated, putting the book’s conclusion in serious limbo! Maybe relying exclusively on the data might not be the best way to decide what is best for pregnant families – especially if what’s at stake is the health and well-being of your baby. Sometimes judgement and experience need to be factored into recommendations which Dr. Oster cannot do since she is economist and not a practicing physician.
The Pros and Cons
Now for the pros of this book. Expecting Better takes an approachable and informative look at the current ‘rules of pregnancy’. This is useful to get expectant families thinking about the decisions that they are facing. If you’re not one to want the gritty details, Dr. Oster also gives a few summary bullet points at the end of each chapter with the major take-aways. This is great for anyone who has limited time or just wants to see her conclusions quickly. Empowering moms by providing thoughtful information is also a pro of this book; giving pregnant mothers a jumping off point for conversations with a their doctors. Additionally, Dr. Oster does a good job of breaking down medical jargon and making the data behind traditional pregnancy rules accessible to future moms.
Now for the cons. Some of the conclusions the author makes about pregnancy risks, particularly involving alcohol consumption during pregnancy, I feel are irresponsible and dangerous. Her dismissive conclusions about the risks of alcohol to a developing baby caused some outrage from physicians when the book was published– and rightfully so. Physicians have a duty to provide the best and safest advice to their patients and are held to a very high legal standard when doing so. It makes sense that physicians on expert panels , epidemiologists, and public health officials would tell pregnant women to abstain from all alcohol consumption during pregnancy, since fetal alcohol exposure can have such devastating consequences for a baby. Does that mean that all alcohol consumption during pregnancy will harm developing babies? Of course not but being ultra-cautious only makes sense to me since we are unable to tell which babies will feel alcohol’s deleterious effects.
Now for my conclusions. Reading Expecting Better would be a great way to get a look at the decisions that pregnant couples must face, but Oster is not a medical practitioner, she has no experience providing medical care, and her conclusions shouldn’t be used as a substitute for the real medical advice given by your doctor. Overall though, the book is well written and fun to read, especially if you’re the kind of person who is always asking the question “why”. So I give Expecting Better 4 out of 5 stars.
If you are now interested in reading Expecting Better, help support Portable Practical Pediatrics and get your copy through the link on our website. You will get the book at Amazon’s lowest price and at the same time help support our blog. Thanks.
Many thanks to Sonya Williams, my wonderful research assistant, for her help in writing this book review. Thanks Sonya!