Expecting Better, published in 2013 and written by economist Emily Oster, is one of the first new pregnancy books to become popular in quite some time. For me, the most fascinating thing about the book is what I see in it as a cultural signpost, which I discuss in a blog post for those interested. This review focuses more on what the book can and can’t do for you during pregnancy.
Expecting Better is a book about decision making. Between-the-lines, it is also about appropriate degrees of maternal sacrifice for the wellbeing of a baby – both very relevant themes for egalitarian women living in the information age. Navigating advice and information during the childbearing year has become a hallmark experience of pregnancy. It’s hard to know what to do as a pregnant woman today. We have so much information and yet, so much of it is transferred in fear-based and disrespectful ways which makes it very hard to know if its true or not. Expecting Better helps pregnant women overcome some of this confusion because it brings the hype back to a simple review of numbers. It won’t solve the issues though because it fails to encourage confidence in self, and in some ways it contributes to the double bind women sense: neglectful if I risk my baby’s safety to any degree, but unenlightened if I refuse modern comforts for the optimal safety of my baby.
Oster’s primary impetus for writing Expecting Better is a feeling that being pregnant in today’s world is patronizingly similar to being a child. There is an ever-growing laundry list of rules a “good pregnant woman” follows, and follows blindly without evaluation. Many of these rules (such as no caffeine in pregnancy), are based on sensationalized data which drives a cultural belief that pregnancy is a weak and vulnerable time in a dangerous world. This book aims to help women and their partners be informed participants in information sifting. If you want evidence-based insight into common pregnancy questions such as drinking caffeine or alcohol, prenatal testing, epidurals and doulas, read Expecting Better. You will like it. You will appreciate getting some straight answers about why the science isn’t black and white, what we actually have evidence about, and what topics are inconclusive.
Oster also brings attention to the way risk language and fear are commonly thrown around. She discusses the way pregnant women are spoken to and the culture of abstinence without evidence. This is important material. The judgement which is passed on women who partake in behaviors with scanty evidence of risk is unacceptable. There is a two-faced nature in how the risks of medical interventions are cloaked in reassuring language, while life-style behavior risks are cloaked in guilt-laden exaggeration.
I appreciate Expecting Better because Oster calls out our culture on the use of language around risk discussion. Words are not neutral and there is a sheepskin effect on how we discuss pregnancy risks. She finds it unacceptable to talk to women like they are children who can’t think on their own, or engage self-restraint without threats. I agree. She is also making a call for evidence-based practice, which is every human’s right, and also a key component to empowering partnership in healthcare between provider and personal responsibility.
A shortcoming of Expecting Better is in its limited scope. It covers only basic pregnancy questions. The book would have far more impact if it addressed more critical and modern questions. For example, things like exposure to microbes, safe and unsafe work conditions, stress, disparities, maternity and paternity rights, pitocin, or consistency of care in various healthcare models. Autism, ADHD, allergies, colic, obesity and celiac disease are on the minds of pregnant women today, and there may be prenatal factors that can impact these conditions. A discussion of the evidence around these issues would make this a more cutting edge book.
Expecting Better’s Author, Emily Oster
Emily Oster is an associate professor of economics at the University of Chicago Booth School and writer for slate.com. She has a B.A. and Ph.D. from Harvard in 2002 and 2006 respectively. She lives with her husband and daughter in Chicago.