What to Expect When You're Expecting meets Freakonomics: an award-winning economist disproves standard recommendations about pregnancy to empower women while they're expecting. From the author of Cribsheet, a data-driven decision making guide to the early years of parenting

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 them to make their own right choices.

When award-winning economist Emily Oster was a mom-to-be herself, she evaluated the data behind the accepted rules of pregnancy, and discovered that most are often misguided and some are just flat-out wrong. Debunking myths and explaining everything from the real effects of caffeine to the surprising dangers of gardening, Expecting Better is the book for every pregnant woman who wants to enjoy a healthy and relaxed pregnancy - and the occasional glass of wine.

* This audiobook includes a downloadable PDf of charts, graphs and an Appendix from the book.

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Releases March 09, 2021

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Product details

Listening Length	9 hours and 32 minutes
Author	Emily Oster
Narrator	Emily Oster, Jonathan Todd Ross
Audible.com Release Date	March 09, 2021
Publisher	Penguin Audio
Program Type	Audiobook
Version	Unabridged
Language	English
ASIN	B08SJDP2CW
Best Sellers Rank	#3,555 in Audible Books & Originals (See Top 100 in Audible Books & Originals) #9 in Motherhood (Audible Books & Originals) #19 in Sexual & Reproductive Health #47 in Pregnancy & Childbirth (Books)

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Fred Goodsell

Expecting Better from this Book

Reviewed in the United States on October 24, 2018

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I was excited to read this book - I bought it online when I found out I was expecting a child. There is a lot of hokum and pseudoscience surrounding pregnancy and health. I wanted a book that would cut through that and give an evidence-based survey of pregnancy-related topics, and hear the scientific community's consensus (as much as they have one) on those topics.

However, I was shocked seeing a review on the book talking about the "myth" that alcohol is inadvisable during pregnancy. Certainly the author isn't advising any amount of alcohol is advisable, given the overwhelmingly consensus on the issue from public health advocates?

I immediately read the entire alcohol part of the book. I soon learned not only would this book not provide me with the best evidence from health advocacy groups and scientist groups, they would provide evidence that directly contradicted it.

The author says it's fine to drink some alcohol during pregnancy, and details how much and why she thinks this. She walks through studies and literature on the topic that she examined. Given that the CDC, the American Pregnancy Association, the World Health Organization, National Council on Alcoholism and Drug Dependence, the March of Dimes, and others all agree and firmly say the best advice is to abstain from alcohol completely, I really needed an extraordinary explanation from the author as to why I should ignore those experts. Not surprisingly, I found her analysis underwhelming and unpersuasive, and not worthy of ignoring the consensus shared by experts in the field.

Ask yourself, who is a more trusted source? An economist writing a book to a mass audience for profit, or the March of Dimes, the CDC, WHO, American Pregnancy Association, the UK Health Ministry, Fetal Alcohol Syndrome scientists and advocacy groups? Do all those independent groups have a profit motive to give distorted and wrong health advice?

And fetal alcohol syndrome is not some one in a million risk that parents shouldn't really worry about. A recent study showed 1% to 5% of kids studied had fetal alcohol syndrome disorder, and it was being chronically under-diagnosed.

To be fair, while this has been the consensus for a while, you could find outliers when the author first wrote this book. For example, the UK's health ministry used not advise against very light alcohol use, but they have since examined emerging research on fetal alcohol syndrome disorder (FASD) and they now say the best advice is to abstain completely - joining the consensus among other health groups like CDC, WHO, etc.

So has the author been concerned about the emerging evidence since she wrote this book? I saw Dr. Oster was asked about recent studies showing that even light alcohol use was unsafe during pregnancy by a health journalist, and her answer was illuminating. Dr. Oster basically said for those studies she'd want to see them be replicated and more details about the links between behavior and harm. That's fine (we should fund lots of replication studies!), but note when she looked at studies that didn't find a danger for pregnant women to drink moderately - she didn't say "well I'm going to wait to see if these can be replicated and more detail provided" - she took them to the bank and said you can make conclusive decisions about your child's health outcomes based on these studies.

I would agree there is not an abundance of studies showing that a tiny amount of alcohol will lead to significant medical risks. But there have also been no similar studies showing that having one cigarette (or two, or three) during your pregnancy is a significant risk. So in this book, does the author similarly suggest smoking a very small amount of tobacco is perfectly acceptable, given the absence of studies? No, she follows the scientific consensus here. Why the double standard?

With things that pose a serious risk to children (like lead paint), we may not ever know exactly where the line is between what is harmless and what will irreversibly harm a child. When the activity is something that is avoidable, the scientific community generally urges avoiding it entirely.

I'm sure Dr. Oster is well-intentioned, but this is a book about health written for profit to a popular audience, and even in the best circumstances that is a fraught situation. There is a profitable market for people with academic credibility to sell a message that, while it goes against the consensus of the public health community, it's something many people want to hear. I hope the book gets updated with the many advances in our understanding of FASD, or at least explains why they have a double standard on very light tobacco use.

443 people found this helpful

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AU-AU

My #1 go-to pregnancy book! Does not treat you like an idiot.

Reviewed in the United States on July 10, 2014

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It's a pity this book got caught up in a kerfluffle about alcohol, when that is about 1% of the books actual content (I've put *exactly* what the author says about it at the bottom of the review for all those negative reviewers who couldn't be bothered reading the actual book!).

This book was hands down the most useful pregnancy book I read, not because it tells you what to do, but because it calmly presents the data on every major decision you'll need to make during pregnancy, and then encourages you to form your *own* opinions based on it, instead of treating you like an idiot who can't be trusted to understand anything other than black-and-white 'rules'. As the author says:

"I teach my students that making good decisions requires two things. First, the right data. Second, the way to weigh the plusses and minuses of the decision *to you personally*...So naturally, when I did get pregnant I thought this is how pregnancy decision making would work too. Take something like amniocentesis. I thought my doctor would outline the plusses and minuses...She'd give me the data I needed. She'd then sit back, and my husband and I would discuss it and we'd come to a decision that worked for us. This is not what it was like *at all*".

Every pregnant woman knows this feeling.

This book has the missing data that thinking parents need to help them make many of those decisions, including:
- What *really* happens to your odds of conception after 35?
- What is the evidence that having a cup of coffee will harm your baby? or 2 cups? 3 cups? Why is there so much conflicting advice on this?
- Same for alcohol, by trimester
- What is the likelihood of miscarriage each week? (I found this super reassuring)
- What is the statistical likelihood of issues arising from eating deli meats, eggs, fish, shellfish, soft cheeses, and sushi? How do you weigh up the omega 3 vs mercury risk for fish?
- What % of women are still experiencing morning sickness each week? Are your morning sickness symptoms 'worse' than the average woman and how risky are the drugs for it?
- What should you know before you make a decision to get antenatal testing for downs syndrome? Does amniocentesis really have a 1 in 200 risk of miscarriage? Is CVS more or less risky than amnio? (We ended up having the non-invasive test, while getting our results the doctor told us 'you seem really well informed on this!'. Thanks Emily :-)
- Is emptying the cat litter box as dangerous as gardening?
- Exactly how much airplane travel is risky?
- What are the real risks (and benefits!) of gaining more weight than the recommended amount?
- Is there anything that will help you correctly guess the gender?
- What's the evidence on whether Kegels help?
- How can I understand the data on which drugs are safe during pregnancy?
- What is your chance of a pre-term birth, week by week? And what % of pre-term babies at each week will survive? (also reassuring)
- For full term babies, what is the chance of the baby arriving each week, if it didn't come last week? Are there any studies than show symptoms the baby might come soon? Is there anything safe you can do to bring on labor if you are overdue?
- What are the risks and benefits of induction? Do you really need to be induced for 'low amniotic fluid'?
- How long does the average labor really take?
- What, statistically, are the pros and cons of a c-section or an epidural? What about cord-clamping, homebirth, doulas, types of fetal monitoring, episiotomy, and cord blood storage?
- An example of an evidence-based birth plan is included, but emphasis given to choosing what works for you.

So, in summary, the data need to make your own important decisions along the way. Recommended read!

--------
Appendix: *Exactly* what this book says about alcohol during pregnancy:

"There is no question that very heavy drinking during pregnancy is bad for your baby. Women who report binge drinking during pregnancy are more likely to have children with serious cognitive defects. In one Australian study, women who binged in the second and third trimester were 15 to 20% more likely to have children with language delays than women who didn't drink. This is repeated again and again in other studies. Binge drinking in the first trimester can cause physical deformities and in later trimesters, cognitive problems.

If you are binge drinking, stop.

However, this does not directly imply that light or occasional drinking is a problem. When I looked at the data, I found no credible evidence that low levels of drinking (a standard glass of wine or so a day) have any impact on your baby's cognitive development"

(The author then goes on to review a number of studies in more detail, including an analysis of whether those studies correctly separated causation from correlation).

------------
I did not read that as a licence to go drinking while pregnant. In fact, I read it and chose not to drink anyway (I was too morning sick to want anything to do with alcohol!). And I respected the author for giving me the evidence, and not blindly repeating something others had said.

Here's to being treated with respect when you are pregnant, not like an idiot.

1,021 people found this helpful

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Whitney

All these 1 star reviews are fricken nuts

Reviewed in the United States on April 16, 2018

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This book was amazing. It was factual, it had a TON of national/international research studies to better help you (or whomever is pregnant) make an informed decision about what to eat, drink, which meds are okay, labor, and delivery.

I literally can not understand how this book has 1 star reviews...Like, what? You don't like evidence based research? It just astound me.
I've cross referenced Oster's sources and found them to, in fact, be incredibly legitimate.

In the unknown world of pregnancy, Oster attempts to gather numbers/percentages/ figures and studies to give the reader OPTIONS. She is not saying, yeah--go drink a bottle of wine (like many naysayers accuse her of doing). She presents the evidence and lets the reader decide whichever approach is best for them. It's not pushy or biased at all, it simply allows the reader to see the science behind "no deli meats while knocked up..."

Seriously, read this book. I am so thankful I did.

207 people found this helpful

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Top reviews from other countries

Keywood

AWFUL and potentially dangerous.

Reviewed in the United Kingdom on August 4, 2020

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Mascarades as unbiased information when it is actually the extremely strong opinions of one woman backed up with mostly unreliable data. I grew increasingly frustrated with the book and ended up not finishing it when she discredited one study for being too small (118 women) as it disagreed with what she wanted to think and a few pages later used a study of only 58 women to back up her point. I think this book actually could be extremely damaging. The idea is great; the execution is appalling. The author wanted to carry on drinking and carry on eating certain foods so she sought information to support her hypothesis. She also completely dismisses c-sections, saying there is only one reason to have one and that is the baby is breach. This is categorically untrue.
PLEASE be careful reading this. It is not scientific. The author has no medical standing and I am astounded it ever got published.

17 people found this helpful

Customer

Disappointed

Reviewed in the United Kingdom on August 26, 2019

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I was hoping to find a good alternative to pro natural childbirth pregnancy books but was disappointed in the end. It is non-judgemental hence the 3 stars but for example I didn't like that the book seemed to treat both the US and UK maternity systems. They are too different in my opinion to be able to make useful comparisons, particularly about home birth. The UK has a well integrated public community midwifery system and also the distance to the hospital is bound to be much much shorter than in many places in the US.
Another thing that bothered me was the section on the evidence around epidural analgesia. Yes, the Cochrane review says that epidural analgesia increases the risk of instrumental delivery but it also very clearly says that since 2005, with low infusion concentration, that link doesn't seem as strong. I also think there is a chicken and egg situation whereby if your baby is malpositioned (back to back for eg) or very big or have a protracted labour (often the case with a back to back baby), you're likely to need better pain relief than in more straightforward scenarios which means that it may well not be the epidural that is the reason for an instrumental delivery but the conditions you find yourself in in the first place.
Finally, I also disagreed with Oster's view that caesarean section shouldn't be a first choice. If you're having one child only, it is the safest mode of delivery at full term. Risks between attempt at vaginal delivery and planned caesarean section are of a different type but in developed countries like the US and the UK, there isn't much difference in terms of outcomes.
Overall, this book is a bit better than much of what else is out there but I still thought it wasn't as neutral or well researched as I would have liked.

20 people found this helpful

Zuri

Pretty useless (UK)

Reviewed in the United Kingdom on February 13, 2019

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Other than now knowing a glass of wine wont kill me, nothing else was particularly useful.

The things mentioned from a medial perspective aren't a secret or (like she eludes to in the book) are beyond the outdated medical profession. The NHS appear to be well aware of majority of what she references but with things like drinking, why would they say anything other than stay abstinent? Things about epidurals making labour longer and inductions making labour more painful aren't new pieces of information for most.

If you want some figures to support what is already out there without the leg work or just want another book for that little bit more information, go for it.

24 people found this helpful

Lee

Reassuring, and a good weapon against potentially dangerous myths

Reviewed in the United Kingdom on November 20, 2017

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I'm a big fan of the Freaknomics series, so it was reassuring to see a review by Steven D. Levitt, signing the praises of this book. This is almost an exact corollary for pregnancy, in fact. It takes an statistics-based approach to challenge conventional pregnancy wisdom, and debunk the myths that tend to accumulate on parent forums and get echoed anecdotally through the generations.

My partner's comment on the book was "it's reassuring", and that alone is worth the price of the guide. Being armed with facts and figures gives us both confidence that the strategies we choose to take both during her pregnancy, and in the years following, will be based on science, and not on the well-meaning, but possibly harmful, advice of friends and family who may simply be parroting unchallenged myths that have no basis in reality.

Highly recommended for any new parent-to-be.

9 people found this helpful

darkwitch_dyres

I just can not recommend it to anyone

Reviewed in Germany on June 11, 2018

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I did not like this book for several reasons. I actually would rather recommend Bumpology to anyone that came to this book looking for scientific basis on pregnancy and related topics.

I felt the author exaggerated often, like buying a doppler to check that her baby was fine because she did not feel it move sometimes. Somehow she did not seem to be able to understand certain biology concepts, and instead wanted numbers to understand them, like the likelihood of having a child at a particular week. No one can tell your particular likelihood of that because the birth is determined by a cross talk between your body and your baby's. To me, it seems this book was more of a therapy for her and her inability to control or understand what was happening, by trying to put everything in graphs, or putting together numbers from certain studies and analyzing them.

On another issue, It is true that in some cases after having the information we need to make a decision, different people will make a distinct decision, BUT some of the information that she talks about should not be up to interpretation, some of it are facts and should be treated as such.

Then, for all her talk on being very analytical, and wanting to have all the information, most of the book is the opposite. She focuses shortly in the data she looked at from studies, while most of the writing is repetitive or a recount of anecdotal recounts of how she felt about this or that. Those anecdotes used a short introduction could have been fine, but it was too much for my taste. Of course, some people might enjoy this kind of writing, I was expecting the analytical part and that was rather short.

She also does not seem to take the consensus in science but rather pick studies here and there. There is something called the Cochrane review, which collects all studies that can be compared to inform about the consensus in science at the moment on a particular health related topic. She never talks about it or refers to it. She probably does not know about it, since biology or medicine are not her field. One study citing something is not a definitive evidence of something in science, reproducible outcomes and proper controls on experiments are key to get to a consensus. From the way she talks about the studies, she seems to have no idea of this and other concepts related to experiment design.

Then, the writer seems to have a problem with doctors and their instructions in general, and paint them in a rather negative light. I can sympathize with someone that does not feel at ease with one dr and his/her answers to her concerns, I have been there personally; but she did not look for another doctor where she got the answers she looked for. Instead, she often refers to medical staff, or doctors in a rather negative way, inferring that they do not think women are smart enough to understand, or make decisions. Many of those doctors and staff are women too, and it is exaggerated to think that every doctor is the same.

I think she is rather irresponsible to make certain statements without the understanding or physiology, or biology. Like when she talks about gaining weight, and how it is not important, nevertheless it is known to be a factor in the likelihood of getting pregnancy diabetes, which she makes sound rather innocuous even for the child. Or when she talks about which medications you can take or not during pregnancy. The lack of current evidence does not mean you can take it. Recently a long term study showed how a painkiller thought to be fine for pregnancy, showed that it is not. She even recommends a medication for allergies, that during pregnancy it is NOT recommended. I think to explain how the FDA carries out the clasification was a good idea, if she had saved the negativity about the FDA and how they think we are all stupid (which I do not agree on), but she should leave the recommendation of specific medication to a doctor. Not only, because no matter what she thinks she is not qualified to judge this, but because with new research guidelines change, and she might be recommending there things that are not fit for pregnancy.

I just can not recommend this book to anyone.

33 people found this helpful

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