Emily Oster applies the basic principle of microeconomics – “that making good decisions . . . requires two things[: first obtaining] . . . all the information about the decision [and second] . . . weigh[ing] the pluses and minuses of the decision . . . personally” – to the topics of pregnancy, labor, and delivery; and she ends up rejecting several obstetrical “blanket rules” in favor of teaching women about the risks involved in certain decisions and understanding that “not everyone is going to make the same decision, even with the same evidence.”
Several aspects of the book really resonated with me. Oster’s clear, concise prose and knack for explaining complicated concepts (like comparing grocery shoppers using feel and color to guess at the ripeness of a melon to doctors using the nuchal translucency scan and a simple blood test to guess at the genetic normalcy of a fetus) make the book a quick and easy read despite the scientific subject matter. She generally lives up to her stated commitment to data and resistance of both bias and anecdote in a truly impressive manner. And some of Oster’s conclusions are downright revelatory, like when she debunks bedrest and distinguishes between food restrictions based on danger to the fetus (i.e., raw meat, unwashed produce, raw-milk cheeses, and deli turkey) and those based on bacteria that “are no worse when you are pregnant than when you are not” (i.e., sushi and raw eggs). I, for one, will be eating sushi standing up.
Unfortunately, I’ve got quite a few bones to pick with the book. First, Oster gets a little carried away with marketing her conclusion that “pregnancy rules are . . . sometimes flat-out wrong.” In the introduction, for example, she writes “pick up a cup of coffee or, if you like, a glass of wine, and read on” and only later – after I had downed a glass of wine during my first trimester – adds caveats like the glass should contain a modest pour, not be fortified, be drunk slowly, and less so in the first trimester than the second and third. Garr. Second, it appears that her own biases impact the “Bottom Line” summary section at the end of each chapter when the evidence is mixed; in the case of prenatal yoga, she recommends the practice, but when it comes to side-sleeping, she’s a bit more negative. Maybe there’s some nuance to the mixed data in each case that she didn’t explain (or I didn’t understand), but I got the impression that she didn’t quite maintain the level of objectivity she set out to meet. Third, Oster writes “large randomized studies have shown that vaginal delivery of breech babies is slightly riskier than a planned C-section” after complaining about vague and opaque statements from her doctor (“I asked my doctor about drinking. She said that one or two drinks a week was ‘probably fine.’ ‘Probably fine’ is not a number.”). How is a woman who is opposed to a C-section supposed to decide whether the risk to her breech baby justifies scheduling one based on “slightly”? I understand that she can’t drill down all the numbers on all topics, but then why address this one? Fourth, Oster too eagerly ignores nuance and divides folks into “natural childbirth people” and medicalized mamas, like by lumping routine episiotomies in with the latter despite her own statement that only an OB who hasn’t “read the medical literature in the last 20 years” would practice them. Fifth, I found the “Beyond Pain” chapter disappointingly anecdotal and out of step with the rest of the book. Finally, Oster should acknowledge that a lot of people don’t want the numbers or the responsibility of making a close call; yes, blanket rules can be seen as infantilizing of those who do, but there has to be room in obstetrics for both types of expectant mother.
Luckily for Oster, each of these problems could be fairly easily fixed in a second edition, and none of them take away from her tremendous accomplishment: writing a smart, informative, and easy-to-read guide to the decisions expectant mothers must make which I highly recommend, handful of warts and all.