Motherhood

08.26.13

Lean In to Pregnancy? No Thanks.

Why Emily Oster’s new book on taking back your pregnancy, ‘Expecting Better,’ is troublesome for mothers-to-be.

I’m the ideal audience for Emily Oster’s pregnancy manifesto, Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong— and What You Really Need to Know.

I’ve had a baby. I own duplicate Nespresso machines in case one fails. I take hot baths, highlight my hair, and sushi is probably 30 percent of my diet. So when an economist at the University of Chicago says she’s written a book disproving the standard restrictions on pregnant women—only two small lattes a day, no rosé wine for the first trimester, no bodega salads—in favor of a more informed and more relaxed approach to having a baby, it’s like preaching (with medical statistics!) to the choir.

Imagine my surprise, then, after reading Expecting Better and following Oster’s media blitz this past week. It turns out Oster isn’t relying on interviews with medical professionals or public-health experts. She doesn’t reach her conclusions after tons of conferences or meetings with scientists. She’s combed through and “debunked” the pregnancy research—personally, as an economist. And that’s a problem.

As most of us learn in our intro college courses, economics is the study of choice under conditions of scarcity, and it’s a social science, meaning it explores how individuals and societies make decisions when faced with said scarcity—not exactly, “the study of how we get what we want,” as Oster’s book jacket defines it. And yes, economists have extensive training in statistical analysis and econometrics.

But most medical researchers are quite hesitant to go outside of their field (or even subfield) of research, according to Dr. Marsha McCormick, a professor of maternal and child health at Harvard Medical School and the Harvard School of Public Health, who can’t, for example, imagine a medical doctor evaluating economic data and dispensing policy recommendations or financial regulations for the housing industry.

And with good reason. Frustrating as it may be from the patient’s perspective (all the more so for a pregnant woman), medical research isn’t like other major decisions we routinely make in our lives: it’s just not like choosing which job to take, what house to buy, and what school to send our kids to.

For one thing, there are more subtle and tricky biases at play. Oster, for example, feels patronized and condescended to starting from her first OB visit (“Being pregnant sometimes seems like being a child again”).

“I think it’s very difficult to come to any literature or research from a neutral standpoint,” explains McCormick. “This has been very true in the area of vaccinations for example, where some parents have had some source of skepticism going in, and then have gone looking for abstracts or research to reinforce their beliefs or what we call confirmation bias.”

When it comes to maternal and infant health, the downside, McCormick also reminds us—which doctors are exposed to in their clinical training—while extraordinarily rare, can be catastrophic. Good doctors make decisions with a very “true sense” of what can go wrong and what a complication means for a woman or child.

Telling parents with no scientific training to do it yourself can have dangerous consequences.

McCormick still recalls the single case of measles she saw during her residency. A statistic of 1 in 1,000 kids might not sound like anything to worry about, she says, but over time, those numbers can add up to an epidemic.

Oster doesn’t address health decisions after a baby is born, but encouraging every parent to partially become her own doctor and to evaluate data for herself on a case-by-case basis is troublesome. In fact, it’s that approach that has, in part, led to misconceptions about autism and vaccines—and arguably has allowed antivaccine advocate and model-actress (and soon-to-be cohost of The View) Jenny McCarthy to gain her following.

In 2007, McCarthy, who has an autistic son, published a book in which she correlated the increase in childhood vaccinations with the rise of autism. And while the seminal study she relied on was retracted and the lead author stripped of his medical license, McCarthy’s legacy lives on. According to National Geographic, “the percentage of parents who delayed or refused vaccinations rose from 22 percent in 2003 to nearly 40 percent in 2008. For the first time in decades, the U.S. saw outbreaks of diseases like measles, mumps, and whooping cough.”

Of course, Oster is no Jenny McCarthy. But telling parents with no scientific training to do it yourself can have dangerous consequences.

On a more basic level, I wonder whether Oster’s approach will make a woman’s life more relaxed or help her “take back her pregnancy.” In fact, her version of pregnancy seems all-consuming, as mothers are expected to sift through spreadsheets and academic journals for each and every decision. On her blog, she asks readers: Wouldn’t you like to be able to look at the pesky lady who asks if your drink is decaf and cite the “many, many” studies that show caffeine, in moderation, is fine for your baby?

Actually, no. I’d much rather roll my eyes at the annoying Starbucks customer, enjoy my drink while it’s still hot, and get on with my day.

To that end, Oster tells women, they need to “lean in to Pregnancy, too”—just like Sheryl Sandberg wants us to do in the workplace. But of all the pregnant women and mothers I’ve interviewed as a health and parenting reporter, I’ve never heard anyone say they want pregnancy to consume more of their time and energy. They’d much rather run their companies, write their books, and run after their toddlers, not do more baby-related research. Not to mention, most of us don’t know how to navigate Pub Med (much less analyze the articles)—so where exactly are we supposed to find this data?

Dr. Samuel A. Pauli, an ob-gyn and fertility specialist at the Reproductive Center of New England in Lexington, Massachusetts, says it’s important for women and the public to be involved in their care to educate themselves about pregnancy and any medical conditions they may have, and that occasionally patients will bring a copy of a specific article from a medical journal into his office.

Generally, he advises his patients to stick to medical websites such as those of the National Institutes of Health, the Centers for Disease Control and Prevention, American Congress of Obstetrics and Gynecologists, and the Mayo Clinic, as well as WebMD, and to avoid blogs or chat rooms for pregnancy guidance.

“What most patients don’t realize,” explains Pauli, “is that medical-research studies are often complex in nature and often contradict each other. [It] requires careful analysis: Looking at the type of study done, the patient population, interventions, outcomes, if the study is applicable to the general population, and how the study compares to all the other studies of a similar nature.”

On top of morning sickness and our day jobs, that doesn’t sound to me like something most of us are equipped or inclined to do. My best advice, as a nondoctor? Find a health-care provider who listens to your questions and is willing to talk to you about the pregnancy guidelines she’s recommending for your personal situation. In other words, one who doesn’t make you feel like a child.