Interviews
A Q&A WITH EMILY OSTER
Author of the new book
EXPECTING BETTER: Why the Conventional Pregnancy Wisdom is Wrong—and What You Really Need to Know
Making the right decisions during pregnancy and birth isn't easy. Like many pregnant women I wanted to be sure I was doing the right thing, but I struggled to get good information about what that was. My doctor had a lot of rules about what I could and couldn't do, but rarely was able to back those rules up with any evidence. In the end, I found I had to use my training in economics and statistics to sort through the data and find the real facts. Because you can't make a good decision with bad information.
When I got the real facts I found that sometimes I agreed with my doctor's rules and recommendations, but not always. By getting the real facts - going back to the original medical studies and learning what the data really has to tell us - I was able to be more confident in my choices. And when friends came to ask about their own pregnancies, the data was able to help them be more confident, too.
How does an economist come to write a book about pregnancy?
Economics is basically about making decisions based on all the available data. So I was shocked when I became pregnant and was basically given a list of rules that appeared to be based on vague or conflicting evidence. It all felt incredibly oppressive. I ended up spending my evenings trawling through the medical literature in a bid to make more informed choices. This book was an attempt to look at all the evidence in a more analytical way.
So how is your book different from all the other pregnancy bibles out there?
You won't find any Dos or Don'ts in my book, for starters. I've read a lot of books that say don't touch caffeine during pregnancy, for example, and others that say a cup of coffee a day is fine, but I never found a book that explained the facts behind the recommendations. This book aims to bring women the facts so they can make their own judgment calls.
How much do you think the medical establishment is to blame for the fear culture surrounding pregnancy and birth?
There is a tendency to baby pregnant women. We're not trained in medicine, so it's hard to make certain decisions, but actually we just need the facts, not patronizing lectures. More doctors need to focus on the stuff that really matters. For example, there's a list of hundreds of foods for women to steer clear of during pregnancy, to the extent that even just eating becomes fraught. But actually from studying the research, I found that only six foods are really off limits. WHAT ARE THESE? Sushi and raw eggs are no more of a risk when you're pregnant than when you're not.
Any more myths you'd like to debunk?
Bed rest is prescribed for around 20% of expectant mothers in the US, for all types of complications. And yet there is zero evidence that this is helpful for anything. In fact, all the studies point to the contrary - staying in bed for weeks on end can lead to muscle wasting and increase risk of blood clots. The whole caffeine thing is interesting, too. I love coffee, so I looked into it thoroughly and actually all evidence supports having up to two cups a day, and much of it supports up to three or four cups.
Your book also concludes a glass of alcohol a day is fine in the second and third trimesters. Aren't you worried some women will take this as a green light to overdo it?
It's incredibly patronizing to assume that if you tell women it's OK to have a glass of wine every day they'll go crazy and have six margaritas. I think we can trust expectant mothers to use the same common sense they employed before they were pregnant. Blanket policies that make everything off limits are far more dangerous in my opinion; if you tell women don't drink, don't smoke, don't have coffee, don't do anything, they're more likely to think, ?well I won't drink alcohol, but I'll smoke. I have to do something.' Actually the only real don't is cigarettes. But then they're a total no no when you're not pregnant, too.
Why do you think pregnancy has become such a source of anxiety?
There's definitely more fear surrounding birth now thanks to the wealth of conflicting data, and hysterical reporting. A lot of it also stems from that whole competitive parenting thing that seems to have backed up into pregnancy. Parents so desperately want to get it right that they end up obsessing over every detail. But it's important to relax a little and enjoy your pregnancy. Although obviously it took a lot of me obsessing over countless medical studies to come to this conclusion!
