In my adult life I’ve never been afraid of sharks. (Your lifetime risk of death is a little less than one in four million.) Or serial killers. (Only about 100 of the 15,000 people murdered in the U.S. are killed by a serial killer.) Or flying on airplanes. (Less than 750 people die annually in plane crashes, compared to about 45,000 in car accidents.)
I’m a rational, data-driven sort of person. Life is too short to be worried about tiny risks, anxiety about fears that have little likelihood of affecting my life.
As a society, I strongly believe that we’re afraid of the wrong things. We fixate on rare and sensationalistic crime rather than finding public solutions to huge crises, such as poverty, obesity, gun violence, income inequality, or climate change, problems that threaten to impact the lives of millions of people.
I thought that it would be easy to maintain this same relationship with risk and decision-making once I became pregnant. I was wrong. Boy, was I wrong. I was immediately confronted by a long list of items and behavior — from sushi to lying in bed on my side to kitty litter — that I should avoid. Right away, I became an ornery patient. I did not take well to be told what to do, in the way that you would issue edicts to a small child. From my caregivers, I wanted to know the question to a really simple question, “Why?” Why should I do — or not do — certain things when I was pregnant? What were the real risks? (“How dangerous was that deli sandwich, really?” “Why do so many European women drink moderately during pregnancy with no little effects”?) For the most part, my doctors couldn’t really answer those questions.
I went through my pregnancy, trying to find statistics and answers but in the end coming up with an improvised and somewhat cautious approach to risks that made me feel comfortable. (Yes, to caffeine, an occasional glass of wine, exercise. No, to changing kitty litter, labor induction, amniocentesis, my beloved sushi.)
So when a new book came out called Expecting Better: Why The Conventional Pregnancy Wisdom Is Wrong — And What You Can Do About It. I was thrilled. But then my excitement after reading the book itself quickly turned to dismay and anger. It’s written by economist Emily Oster, and its release has been marked by a flurry of controversy. (Check the book’s Amazon page for an idea about just how angry this book has made many people.) First of all, it’s a book that may make many expecting mothers like me — those who have questioned their doctors about the rationale for standard pregnancy rules — take a second look at their tattered copies of the pregnancy bible, What To Expect When You’re Expecting. And wonder if they should throw them away.
Its author, a health economist and Wall Street Journal contributor Emily Oster, is not an obstetrician nor any kind of medical doctor. But the medical community is surely paying attention, as she made the rounds last week on all the television and media outlets, from MSNBC’s Morning Joe to Time Magazine.
Most obviously, Oster’s book is controversial because of her conclusions about pregnancy and alcohol consumption. According to Oster, a data-cruncher by trade, the research evidence suggests that light drinking is fine for women during pregnancy. Fetal alcohol syndrome advocates have reacted strongly to Oster’s book, issuing press releases and flooding Oster’s Amazon reviews. The National Organization on Fetal Alcohol Syndrome called Oster’s book “deeply flawed and harmful.”
And that’s not all. Oster concluded, after diving deep into the studies themselves, that a great deal of the recommendations for pregnant women is based on inconclusive or “bad” research. Much of the standard advice for pregnant women confuse “correlation” with “causation” when interpreting statistical data.
As a pregnant woman herself, Oster became frustrated by the list of arbitrary rules and prohibitions given to her by the medical establishment. She wasn’t comfortable with this approach to medical care for herself and wanted to make more informed choices. She wanted to apply the “tools” of her trade — rational decision-making — to evaluate pregnancy data.
“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.”
In Oster’s view, the one-size-fits-all view of pregnancy does not fit with the way that informed people make good decisions in the rest of their lives. Rather than being handed a list of outdated rules, good decision-making is based on balancing your personal preferences, life experiences and tolerance for risk with the available research data.
Oster writes that standard pregnancy recommendations “increasingly seemed designed to drive pregnant women crazy, to make us worry about every tiny thing, to obsess about every mouthful of food, every pound we gained.” And for her, “actually getting the numbers led me to a more relaxed place — a glass of wine every now and then, plenty of coffee, exercise if you want, or not.”
What are more rules from the conventional wisdom about pregnancy that Oster debunks? Pregnant women may find her conclusions about bed rest, sushi, hair dye, caffeine, kitty litter, exercise and weight gain to be surprising and reassuring.
Oster’s book is a call for women to find the best information available on everything from miscarriage to epidurals and then make their own decisions about what’s best for them and their families. Most of all, she’s telling pregnant moms that they should learn more — get the facts — and worry less.
I’ve been fascinated by the comments left by readers of Oster’s own articles in The Huffington Post, Time, and The Wall Street Journal. Based on some of these reactions to the book, it’s clear to me that there are many who are still uncomfortable with this potentially confrontational and independent approach to women’s reproductive lives. Yes, there are valid questions to ask about the studies that Oster, or any researcher, cites. But it also seems like there are many who think that it is a pregnant woman’s obligation to avoid all risk during pregnancy. And that by simply recognizing risk and making choices that may involve some risk, however small, women may be demonstrating their unfitness for motherhood.
It is impossible for anyone — pregnant or not — to live a life without risk. By acknowledging that some women may be more comfortable with risk in certain areas — within reason, of course — than others may be, we do not have the right to judge any woman’s choices. You don’t have to be an economist trained in formal decision-making theory to want good information to make your own assessments about what the best decisions are for you and your family.
To me, the controversy surrounding Oster’s book reveals a deep paternalism in our society in the way that we treat pregnant women. There is no evidence that light drinking affects fetal development, but, yes, there is a great deal of evidence that heavy drinking does. The reaction by some to Oster’s book reveals how many people do not seem to think that some women are capable of making balanced decisions on their own. Rather than informing women of the true risks of a particular choice, which may be smaller than some activities or larger than others, every year women are given greater and greater numbers of prohibitions.
Stop beating up Oster for telling pregnant women that it’s okay to drink a glass of wine and to have a more relaxed attitude about their pregnancies. And start looking a little more closely at the reasons behind a more dangerous threat: why so many women receive such substandard care in our country. Yes, there are millions of fetuses at risk in this country, but it’s not from one glass of wine consumed with dinner by the woman receiving regular prenatal and adequate postnatal care; the risks are to the millions of women and children who do not receive good — or any — care. According to a report issued by Amnesty International, it’s more dangerous to give birth for women and babies in the United States than in 49 other countries. And that is really something to be both angry and anxious about.
Jessica is a freelance writer in Buffalo, NY and a mom to an active toddler son. She has a doctorate in educational policy/development and blogs about parenting, education, and her favorite books at School of Smock and about female friendship at The HerStories Project. You can also find her on Twitter @SchoolofSmock and Facebook.