Writing on pregnancy...from the economist's point of view.
18 September 2013
As with most books about our American health "care" system (which I would say breaks down to about 5% "care" and 95% "system"), I can't say that I really enjoyed reading Emily Oster's Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-And What You Really Need to Know. But I can say it was quite interesting.*
Oster is an associate professor of economics at the University of Chicago, so she may seem like an odd choice to write a book about pregnancy and obstetric care. But she researched and wrote it for a very good reason: she became pregnant, and as an academic who works with a lot of numbers and research herself, she found herself frustrated by recommendations from doctors who assume all pregnant women have never been in the same room with critical thinking skills.
Oster covers the entire process, from conception through labor, and tackles many subjects on which there are conflicting guidelines and theories, including ingesting coffee and alcohol, all the prenatal tests women are expected to undergo without being given time to ask questions about them, and what is now standard operating procedure even at "low intervention" hospital births.
Of course the only thing that anyone can talk about in reviews or mentions of this book is how Oster suggests that, indeed, having a glass of wine every now and then, particularly during the second and third trimesters, has not been proven to be detrimental to the fetus (and how dare she?). And yes, you may not want to take all of your pregnancy health and safety recommendations from an economist. But what I liked best about this book was her approach to information gathering and decision-making, which she explains by explaining how she starts teaching her economics students:
"Ultimately, this is what microeconomics is: decision science--a way to structure your thinking so you make good choices.
I try to teach them that making good decisions--in business, and in life--requires two things. First, they need all the information about the decision--they need the right data. Second, they need to think about the right way to weigh the pluses and minuses of the decision (in class we call this costs and benefits) for them personally. The key is that even with the same data, this second part--this weighing of the pluses and minuses--may result in different decisions for different people. Individuals may value the same thing differently." (pp. xii-xiii.)
That approach in a nutshell is what seems to be missing in obstetric care particularly, and in health care generally, although I realize doctors mostly don't have the time to explain stuff to us like we have brains, and frankly, a lot of people don't have the time or interest to look into their own health issues or options for addressing them.** A case in point: when I had an ultrasound when I was pregnant, the doctor who spoke to us at the end spent about 30 seconds telling us they didn't see any evidence of chromosomal abnormalities, but then spent another five minutes telling us the test doesn't see everything and, as an old mother (or a "geriatric pregnancy," to use their charming terminology), I still had a high risk of Down Syndrome or other issues. Even for a "cover your ass" disclaimer, it was really long and disconcerting. On the other hand, if he'd just shown me the chart Oster showed me, on p. 100, I could have seen for myself the Down Syndrome odds (like at 35 the risk is 1 in 374; at 40 it's 1 in 106). He could have saved us all some time and just made that fairly basic information available. But I digress.
As you would expect from an academic, the book has a lovely and informative section of endnotes and an index, as well as handy charts and informative tidbits throughout. If you're looking for a slightly less combative book about pregnancy than Jennifer Margulis's The Business of Baby, this might be the one for you.
*And should by all means be read by both women AND men, although I'm sure no man will touch it with a ten-foot pole.
**As a friend of mine, an ER doctor, once told me, laughingly, after I asked him some questions about patients and whether they ask him questions based on their reading or research: "CR, people don't read." (This same lovely doctor also provided the insight that most people who come into the ER with a hangnail scream "30!" when asked to rate their pain on a scale of 1 to 10, so, when you go to the doctor, don't downplay your pain, as doctors just aren't used to that sort of thing.)