Even Economists Can't Tell Us What to Expect When We're Expecting
I'll admit that I'm a little bit of a health nerd. I sometimes read through studies on websites such as PubMed and Cochrane Reviews to discuss medical decisions more intelligently with my doctor. (These sites post reputable medical information and analyses, with much less speculation and snake oil than many health websites.)
During my first pregnancy, I occasionally checked my doctor's advice against the most current recommendations of the American College of Obstetrics and Gynecology. When she told me to monitor my heart rate during exercise to ensure it did not go over 140 beats per minute, I nodded my head but continued to follow the more current ACOG recommendation, which didn't list a specific heart rate but instead indicated that I could exercise moderately. On the whole, however, I trusted and followed my doctor's recommendations—even a few that turned out not to be supported by the newest and best research. Oh, well.
Emily Oster, an associate professor of economics at the University of Chicago whose work was featured in Steven D. Levitt and Stephen J. Dubner's second book SuperFreakonomics, has written a new book, Expecting Better, that urges women to wrest control over their pregnancies from the partially incompetent hands of their doctors and other conventional sources of pregnancy advice, from the American College of Obstetrics and Gynecology to the omnipresent and imperious What To Expect When You're Expecting.
The subtitle of Oster's book—Why the Conventional Pregnancy Wisdom is Wrong—And What You Really Need to Know—might lead you to expect something along the lines of Ricki Lake's Business of Being Born, but Oster does not wage war on the medical establishment to the point of suggesting that you eschew doctors entirely.
Instead, she contends that the typical American pregnancy is "a world of arbitrary rules." She uses her training as a health economist to sift through the medical literature, attempting to separate the wheat from the chaff of pregnancy advice; to help women "take control and to expect better."
As an economist, Oster contends that women should simply be presented with the evidence and statistics to make decisions for themselves. This is a tough claim, because no matter how hard this English/biblical studies major tries to make sense of peer-reviewed medical studies, the bottom line is that it takes serious chutzpah to believe that a few hours' online research is going to put me in a position to decide that's superior to my doctors'. Further, it's hard to ignore the direct advice she herself dishes out in her own book. Each chapter of Excepting Better includes bullet-pointed "bottom line" list that clearly runs counter to this claim, plus countless arguments colored by Oster's own biases and preferences.
To wit: according to Oster, it's okay to drink a fair bit of caffeinated coffee; exercise won't hurt but probably won't help much either; tests like chorionic villus sampling (CVS) and amniocentesis don't carry quite the risk of miscarriage that you might have assumed; epidurals are generally harmless to the baby but complicate the birth process "and probably makes the recovery a bit harder (on average)." Oddly, her points carry the same degree of vagueness Oster, who loves hard numbers, purports to disdain: "probably," "a bit," and "on average" are not exactly clear guidelines. Still, she doesn't advise against epidurals, though she herself didn't have one. To her, "knowing the evidence doesn't make the decision for you. It just lets you make the decision in an informed way."
The biggest surprise in this book—the one that gave rise to a 1-star review bombing on Amazon.com—is that Oster, reviewing the studies on alcohol during pregnancy, finds current recommendations from organizations like ACOG far too cautious. She writes:
In moderation, pregnant women should feel comfortable with both alcohol and caffeine. For alcohol, this means up to 1 drink a day in the second and third trimesters, and a couple of drinks a week in the first. In fact, for the most part studies fail to show negative effects on babies even at levels higher than this.
Again, we note the vagueness of a phrase like "for the most part." Does it indicate, for example, that some studies do show negative effects of alcohol on babies? Some do: Oster finds them "very deeply flawed." Naturally. It's striking that Oster does not appear to have consulted with a single medical professional in making such a claim—perhaps because none wanted to be cited as supporting a view no official medical body endorses.
Anyone who has ever asked older women about their pregnancy and birth experiences knows that doctor's recommendations have changed drastically over the years, and that they were occasionally tragically off base: Doctors used to advise women to drastically curtail their weight gain and smoking and drinking were not off limits. My petite grandmother was advised by her physician to continue smoking so that she'd have a smaller baby.
Furthermore, it was doctors who prescribed drugs like thalidomide and DES to pregnant women—the former caused severe birth defects and the latter continues to cause cancers of the reproductive system of the daughters of women who took it. There's no question that the advice given by doctors to patients on any given day may not be supported by the newest and best research, and that's why being a thoughtful consumer of health care matters. That's also why a book like Oster's is attractive: it seems to promise that we can take control of a process that's ultimately so uncontrollable.
Yet the irony is that most, if not all, of the people who will buy Oster's book will likely to be getting good healthcare already and will have the education and financial means to take care of themselves during pregnancy. Some of the issues she raises (Can I dye my hair? I've got gray! Do I really have to give up sushi?) are worse than trivial considered alongside the USA's comparatively dismal maternal health outcomes, especially among women who are poor or who are racial minorities.
Fretting over whether you really have to give up that Starbucks grande latte or glass of wine and sushi while women in my country of residence, Malawi, die from ridiculously preventable causes like anemia or suffer the lifelong horrors of obstetric fistula seems, frankly, selfish and silly. Pregnancy is the most direct way to love your little unborn neighbor as yourself, to suffer for the sake of another's life. And at-risk pregnant women and their babies—in developing countries, but in the U.S., too—are certainly in the category of the least of these.
I think Jesus would expect better.
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