Q&A with Emily Oster, author of Expecting Better

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Emily Oster
Associate Professor of Economics, University of Chicago and author of Expecting Better

Emily Oster is the author of “Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—and What You Really Need to Know” (The Penguin Press). After becoming pregnant, Oyster received conflicting advice from her doctors and leading pregnancy resources on basic things like drinking while pregnant, how much caffeine is safe, and how much weight to gain.

Confused by the advice, she put her training as an economist to work and dug into the data. According to her findings, moderate drinking has little or no affect on pregnancy or the children, it’s okay to drink a few cups of coffee every day while pregnant, and gardening is much more dangerous to a pregnant woman than handling cat litter. Her book release and controversial findings have been covered in national media including Slate, The Guardian, CNN, Wall Street Journal, New York Times, Huffington Post, and, and groups like the National Organization on Fetal Alcohol Syndrome (NOFAS) have put out statements condemning the book, calling it “deeply flawed and harmful” (read Bundoo’s Dr. Jennifer Lincoln’s response).

Here, Oster explains the story behind the book in her own words.

Bundoo: The book has been covered in media all over the country. What surprised you most about the reaction?

Emily Oster: There has been a lot of reaction, but I’ve received a lot of nice emails from women saying the book helped them. I wrote the book for other women who have the same questions I had and will find it helpful to have the data. One of the things I felt was missing in other pregnancy books was data. I wanted the data. So I tried to use my training to identify good studies and help people. But most of the public reaction in the media has been about the alcohol section. I wish the discussion was about the other stuff. Most pregnant women worry about weight gain, should they get an amniocentesis, other things. Not many are worried about, “Can I drink as much wine as I want?” It’s not surprising that people who work with fetal alcohol syndrome would be upset. That’s why I was very careful in the book to draw a distinction between moderation and drinking too much.

The book does cover a lot of territory besides alcohol, including caffeine, exercise, fertility and others. What finding were you most surprised about?

Bed rest. It’s not useful. There’s no evidence that it’s a good treatment for preterm women. Even the American College of Obstetrics and Gynecology (ACOG) says it’s not a good treatment. But in a recent survey, more than half of OBs said they would prescribe it anyway. That’s the kind of thing I think women should know.

Your findings are derived exclusively from studies, but in a way, it’s easy to read the book as an attack on the medical establishment. You write about how several recommendations don’t have good data to back them up. While you were writing it, did you even considering interviewing anybody from the professional organizations that made the recommendations, like from ACOG or the American Academy of Pediatrics?

I had a medical editor who went through the book because I wanted to make sure I understood the medical side of it. But ultimately this isn’t a journalistic undertaking. I wanted to approach it as someone who’s trained in statistics. It’s also worth saying that a lot of the stuff in the book isn’t something ACOG would disagree with. The alcohol findings, yes, but a lot of what I found was a disconnect between the data and what happens in everyday practice. There were multiple disconnects between practice and data, between recommendations and data.

In the beginning, you say you aren’t making medical recommendations for women, but then at the end of every chapter you have a section called “The Bottom Line” that reads like recommendations. What’s your thought on recommendations versus not making recommendations?

I think it’s hard. I was reading the “Bottom Line” section as if they are the bottom lines for me personally. But it’s hard not to read them like recommendations. It’s a tricky line to walk.

What’s the one thing you want a reader to take away from the book?

You need to make these decisions for yourself. There often is a tendency in women in this position to simply trust other people, especially their doctors. But I think they should have this information and make these decisions for themselves.

Reviewed by Dr. Sara Connolly, January 2019


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