Why Our Rules for Pregnant Women Could Be a Feminist Issue

young woman drinking red wineIn 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.

Oster writes,

“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.

Image via iStockphoto/marcstock

  • In my experience, the OBs are reasonable, but other women, especially mothers, are judgemental about my decision to have a glass of wine, a cup of coffee, or a medium rare steak. Maybe that’s because I had old school OBs, from the “Eh, it’s fine.” era.

    My husband is a research scientist and my mother is a Director of Nurses and an infection control expert, so I had knowledgeable and pragmatic people close to me during pregnancy supporting my reasonable choices. Some people only have their doctor, and are likely to listen to the rigid suggestions, even in the face of the statistics.

    Great piece, Jessica. Very thoughtful and informative!

  • I agree that pregnant women should be able to have access to all the data available and make informed decisions about their actions and choices during pregnancy. I think the difficulty is this type of research is inherently unethical, and therefore sometimes incomplete – no one could get approval to do a study giving varying amounts of a drug, or alcohol, or whatever, to pregnant women and then study their infants to determine the level of impact on the child (which is why so many OTC meds are in the category B and C gray area for pregnancy). While I certainly think that it’s okay for a pregnant woman to have an occasional small glass of wine late in pregnancy, I think it’s hard when we just say “light drinking.” What does that mean? I rarely drink, so light drinking, to me, is maybe one drink a week. But light drinking to someone else might be one drink a night. It can become a slippery slope, and we don’t really know (as far as I know, though I confess I haven’t read this book yet) where the line is between non-harmful drinking and harmful drinking, so in some ways I can understand the worries of those concerned about fetal alcohol syndrome that some people may take this the wrong way and assume that there is a green light for drinking during pregnancy. I know that is obviously not your point, for you are arguing for women to make informed decisions, but unfortunately not all women read the research or even pregnancy books and blogs, and could make harmful decisions about this. I guess that’s why so many ‘experts’ and women themselves err on the side of caution.

    I do agree with you about the paternalism of pregnancy advice. It brings us back to the feminist debate over society being able to proscribe certain behaviors for pregnant women when, while she is pregnant, the fetus still has no separate legal existence and it is her body.

    And a huge “Hell yeah!” on getting better prenatal and medical care for all in our country!!

    Lots to think about here, Jessica. Thanks for sharing your perspective on this.

  • K.

    I find it ironic how that article states “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 should go find the statistics and show her how many of those issues are linked to FASD.

    The average IQ in FASD is between 75 and 85, with the full range in FASD being between 20 and 140+ (intellectual mental handicap is IQ <70).

    Overall, 94% of affected individuals with a diagnosis
    of FASD have at least one mental health diagnosis in adulthood.

    Overall, according to the Secondary Disability Study, 35% of those aged 12 and over with FASD have problems with drugs and alcohol.

    Limited studies indicate up to 60% (or 60 out of 100 people with FASD) are in trouble with the law.

    For those adults with FASD over the age of 21, fully 80% are unable to live independently.

    Research has documented that fully 80% are unable to obtain or retain a job, regardless of IQ.

    The economic costs of FASD are enormous. Estimates for cost range from a low of 1.5 million dollars to a high of five million dollars US (2.9 million ++ Cdn) per individual over the course of a lifetime. These figures do not include the costs of incarceration.

  • Marti Teitelbaum

    I have a doctorate in public health and paid attention to the studies when I was pregnant.
    1) the issue for me is not “it also seems like there are many who think that it is a pregnant woman’s obligation to avoid all risk during pregnancy,” and it’s not paternalism — it’s avoiding preventable bad outcomes for selfish reasons. I already had a child with severe disability, so I had an intense desire to make sure that I didn’t do anything that might have bad effects on fetal development.
    2) I worked on a study of alcoholism in families and reviewed the literature on Fetal Alcohol Syndrome. This was a long time ago, so I may be out-of-date, but even then, the most compelling evidence (and this is always the most compelling evidence for causal relationships in health) suggested a dose-response relationship. That is, as drinking increased, severity of fetal alcohol syndrome increased. Light drinking carried very little or no risk, just as you say. However, it is easier for many women to just rule out alcohol than to pick and choose and request at every occasion how much and what they want to drink.
    3) cat boxes. Toxoplasmosis is one of those diseases you want to avoid at all costs when pregnant because the outcome of getting it can be catastrophic for your child. Even though I had cats as a child and cleaned plenty of cat boxes growing up, I had never contracted toxoplasmosis (I was tested while pregnant). I stayed away from cats during my pregnancy especially after reading a book by a woman who had a child severely disabled by the toxoplasmosis she got while she was pregnant. It’s a tiny sacrifice to stay away from rare meat and cats in order to make sure you don’t spend your life caring for and worrying about a very disabled child.

Why I Wrote “Trumping And Drinking”
Get Over Yourselves. We’re All Rory Gilmore
Hillary Clinton, Shake It Off, Taylor Swift, Hillary Clinton Campaign song
Six Reasons “Shake It Off” Should Be Hillary Clinton’s Campaign Theme Song
Nancy Reagan dies, Just Say No, Ronald Reagan
A Not-So-Positive Ode to Nancy Reagan’s Frothy “Just Say No” Campaign
I Married for Health Insurance
Why I Wrote “Trumping And Drinking”
A Case of Nixonian Deja Vu
Post-Election Munchies: What is Your Grief Snack of Choice?
Why I Wrote “Trumping And Drinking”
A Case of Nixonian Deja Vu
Trump Reality Check, Now with Actual Facts!
Fascism Facts
I Married for Health Insurance
Get Over Yourselves. We’re All Rory Gilmore
Post-Election Munchies: What is Your Grief Snack of Choice?
Women’s Elections Rights in Saudi Arabia: A Token Drop in an Abysmal Bucket & the Plight of Women Under Sharia Law
Maybe It Wasn’t Rape: Emerging Matriarchy and the Altering of Women’s Past Sexual Narratives
Paris attacks, Paris terrorism
Is Paris Burning?
Chinese government and women's reproductive rights, adopting Chinese girls, international adoption
Dear Xi Jinping, I Am Writing to You as an American Mom of a 19-Year-Old Chinese Daughter
The Vital Voice of Hillary Clinton: Part 1
Maybe It Wasn’t Rape: Emerging Matriarchy and the Altering of Women’s Past Sexual Narratives
The Eyes Have It!
Ashley Madison, Jared Fogle, sex, rape, sexual affairs
Ashley Madison vs. Jared Fogle: Rape, Sex and Hacking in America
women's viagra, Viagra, Flibanserin, sexual arousal, women's desire, sex after menopause
That “Little Pink Pill” Isn’t All It’s Cracked Up to Be

Get our new weekly email
Broadly Speaking

featuring our best words for the week + an exclusive longread