After much wondering if it was even possible, hubby and I are expecting. And while I’d done quite a bit of research on the process and probability of conception, I’d done virtually no research on what to do after you managed to succeed (mostly because I didn’t think we would). Days after my second positive test, I stared at the coffee pot, vaguely remembering my pregnant friends abstaining from caffeine, fish, deli meats and a hoard of other things. I stood in a first-trimester fatigue cloud. Can I have a cup of coffee? Can I have smoked salmon on a rice cake for breakfast? Will it harm the tiny fetus if I eat the ham and cheese Chef’s salad I was thinking of making for dinner?
The internet can be a terrifying place, and a quick search had all kinds of confusing lists warning off caffeine, deli meats, soft cheese, alcohol, and many others. Tuna is verboten, but salmon is great! Sushi is BAD. Feta cheese is rife with bacteria, but cheddar is awesome. The only beef to eat is shoe leather, but eat as much protein as possible. There was very little explanation for why any of these foods were off limits. Cue Expect Better. Based on several stellar CBR reviews for this book, I decided to give it a try, and I was not disappointed.
Like me, Oster found herself at the same crossroads during her own pregnancy. And as an economist who’s used to data allowing consumers to make their own choices based on factual risk assessment, she was infuriated at the way pregnant women were blanketly told everything. The book is broken down from conception to labor/delivery, and in each section she discusses the biggest questions of each phase. From caffeine to alcohol to mercury riddled fish, she tackles every blanketed no-no a pregnant person faces. In later chapters she covers the safety of airplane travel, our doctors’ seeming obsession with pregnancy weight gain, and the pros and cons of natural vs. medical birth.
Each subject is outlined with several studies and their conclusions, to which Oster summarizes with helpful charts and accessible, and at time humorous, anecdotes. She never tells readers what to do (except for smoking while pregnant, don’t do it), but leaves all the research out there so that readers can decide based off the actual sliding scale of risk what they’re personally comfortable doing during their pregnancy.
As an example, for the fish argument (I LOVE me some sashimi tuna) Oster gives a comprehensive chart for the mercury levels of commercially available fish. Mercury has been statistically proven to be very toxic to the fetus. The reason salmon (and shrimp) are touted as excellent pregnant food is that it’s very high in omega-3 (great for fetal brain growth), and fairly low in mercury, making it a great choice to eat several times a week. Tuna, on the other hand, (and any large ocean fish like sword fish, etc.) are in the mid to high mercury range due to their size. Oster’s research didn’t conclude that complete avoidance was necessary, per say, but tuna shouldn’t be your go-to dinner three times a week. If you’re really gunning for some tuna, having sushi-grade tuna once in a while won’t harm your baby (canned stuff was pretty mercury-riddled, though). Oster also calls upon a little use of common sense. If you’re really craving some sushi, she suggests, obviously don’t buy gas station sushi – that crap is certainly rife with who knows what. But if you have a local sushi spot that you know and trust, there’s nothing wrong with having a few rolls once in a while. And if you’re still really concerned, vegetarian or cooked rolls are perfectly safe alternatives.
Likewise for her alcohol section, she compared several studies from Europe and Australia with studies from the U.S. What she found was the U.S studies didn’t use alcohol as a control in their group, and women in the studies who were drinking alcohol were also doing large amounts of cocaine. Therefore, in the study’s conclusion, figuring out which symptoms the newborns suffered from alcohol consumption were impossible to distinguish from the cocaine use. Comparatively, in the European and Australian studies, where alcohol was a control, there was no correlation between low baby birthweight, cognitive skills, etc. from light alcohol consumption during pregnancy. Oster does caution her readers that ‘drinking like a frat boy’ is not what these studies are suggesting, and will certainly lead to feta alcohol syndrome, etc. But if one feels that they would like a 4 oz glass of wine or beer with dinner a few times a week, there are pretty much zero risks to the baby.
This book was fascinating, even if I got in the weeds a couple of time with all the stats. Towards the end, I found myself skimming through a lot of the data to get to her bottom line, but that’s just because I’m not really a numbers/statistics person, and not because Oster does a bad job. This book is definitely a must-read for first-time pregnant people.
Knowing the risks and having the personal decision to decide what risk is too much has been very liberating.