Book Review: Expecting Better

By Brianna
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Expecting Better, by Emily Oster

It’s been a while since Ariel and I came across a parenting book that we just had to read. When we heard the premise of Expecting Better, by Emily Oster, we knew it bore checking out. 

Summary:
Emily Oster is an economist (as is her husband). In a nutshell, what economists are pros at is analyzing information, evaluating the quality, and synthesizing it into reports to help people in key positions make decisions. In Expecting Better, Oster aims to use her economist skills to breakdown the data around the most common, thorny issues encountered in pregnancy, to help you decide what's best for your family.

Some of the topics tackled include the risks around foods (caffeine, alcohol, lunch meat, sushi), medicines (birth control, pain killers, antidepressants), and exercise. Oster also details risks of and protocols around genetic testing, common pregnancy conditions (such as pre-eclampsia and gestational diabetes), bedrest, and the options available during birth. 

Review:
In general, I loved Expecting Better. A lot of the information surprised me, and much of it helped illuminate the many “rules” one encounters while pregnant which rarely come with an explanation. Oster does an excellent job of breaking down the numbers into plain language that can be easily understood by anyone. 

Perhaps most admirable is that she is very clear on the fact that she is providing all of these data points to help the reader make the decision that is best *for their specific family.* Other pregnancy books read like The Encyclopedia of Everything that Can Go Wrong (scary), or they’re very bossy about what to do or not do with very little evidence. Still others try to be unbiased, but in their quest to present both sides, fail to convey solid numbers which might support one side or another. Throughout Expecting Better, in almost every instance, Oster tells us what the numbers lead her to do, but also tells us about friends who used the same numbers and came to different conclusions.

If you’re the kind of person that just wants the rules presented to them and doesn’t want to stress out over making decisions, this book is probably not for you. But if you want to feel some modicum of control in pregnancy (or at least be reassured by how rare the worst-case scenarios are), then you need to read Expecting Better. Once you've read Expecting Better, if it gave you the answers you needed, by all means read Oster's follow-up book, Cribsheet. It starts where Expecting Better ends, in the hospital after your baby has been born.

Note: This book is a quick read in print, and well-suited to flipping straight to the sections that most concern you. The audiobook (while well executed) is maybe not a great choice for two reasons, but like Oster we’ll tell you why and then let you decide.
1) It’s pretty heavy in statistics and graphs, so there’s a portion of information that will be hard to process without those visuals.
2) Like many books about pregnancy, it uses terms you (or others around you) might not want to hear out loud very much; such as “cervical mucus” or “amniotic fluid.”

Conversation:
Brianna: Some of the classic pregnancy books are admittedly informative, but tend to leave expecting mothers with more anxiety than answers. My gut tells me that’s not the case with Expecting Better, but I didn’t read it while pregnant. How about you?

Ariel: I did read it while pregnant, and I am going to have to go with "yes AND no." Though Oster helped me tease out my reasoning for continued caffeine consumption while pregnant, she left with me with new fears. Fears that never crossed my mind! For example, she spends, what I felt was an excruciatingly long time discussing how nausea in pregnancy is corelated with risk of miscarriage. Here I was just innocently thinking that I was one of the lucky few with a stomach of steel. Do I need to worry now? If you are prone to anxiety, like me, no pregnancy or parenting book will assuage your mommy guilt and anxiety, but Expecting Better does a phenomenal job of presenting what research is currently available, the quality of the studies available and the conclusions that can be drawn. What did you think, Brianna? Did you appreciate that Oster broke down the quality of every study in order to better understand why we can dismiss some conclusions and stick by others?
Brianna: I think Oster did a great job of explaining which studies were old or new, and which were conducted under rigorous conditions regardless of age, as well as synthesizing years of studies into big meta analyses. That’s what I wanted to see when I was pregnant and looking for answers. Like you, though, there were times when I saw gaps where there could have been even more data. You’re asking what a lot of people ask, “Ok, nausea can be a good sign, but is no nausea a bad sign? How bad?” I wanted to know more about that and:

• Fish. Oster spends a LOT of words on which fish are safe or not during pregnancy, so this criticism might seem strange. However, for all that info we get about fish, we don’t receive any notes that fraud is rampant in the fishing industry. That is, fish which are common or cheap (but less safe) being sold in grocery stores and restaurants as the “safer,” recommended fish. Or is this less of an issue than the internet would have me believe? I just don’t know!
• Meconium. When I gave birth, my hospital was supportive of delayed cord clamping, unless there was meconium (prenate poop) present during pushing. Is this a big deal? Is there room for pushback?
• Extra ultrasounds. With the prevalence of private imaging offices, I’d like to know if there is any increased risk from having more ultrasounds. If there is, this might be another factor for the over-35 to consider when they’re immediately dubbed “high risk” based solely on their age. In that case, are more ultrasound sessions really necessary, and what are the risks?

We’re talking a lot about data and numbers. That makes this book sound very dry and boring. Do you think the average Pregnancy Brain™  sufferer would find this book a dull read?
Ariel: Honestly? Maybe. While Oster does her best to interject life and humor into each chapter, she is analyzing the quality of research studies and summarizing the results. With that being said the information is one-hundred percent worth it! I listened to the book as an audiobook. While I found the chapters on conception nausea-inducing - there are only so many times you can hear the word cervical mucus without losing your lunch - I was able to quickly identify what sections were important to me and tune out any that weren’t. I would recommend using a variety of media to enjoy the books. Listen to the book with a physical copy as a back-up. This way you can go back and reread sections important to your current pregnancy. Due to its popularity, though this may seem extravagant, it shouldn’t break the bank. Both the audiobook and book were available through my local library. Don’t wait to request this one, though! I waited two months for both the audio and eBook. 
Brianna: In every book review, we ask ourselves if we would recommend this book to a friend, and which kind of people should avoid it. I am already finding myself recommending it to friends who are pregnant or trying to get pregnant (it’s surprising to me how often we neglect to read about big life situations until we’re already in the thick of them!). I think in general most parents would benefit from more information, but every now and then I run into someone who is not as fond of making their own decisions as they are of following rules. If more information just stresses you out, skip Expecting Better. Everyone else who’s pregnant or thinking about becoming pregnant should get their hands on a copy a.s.a.p.
Ariel, would you recommend Expecting Better to other people who are pregnant or trying to get pregnant? Are there some people for whom this book is maybe not a good fit? 
Ariel: I am already recommending Expecting Better! Though I agree, Brianna. If too much information stresses you out? Then spend more time finding a doctor or midwife (or even a knowledgeable, experienced doula) that you trust and let them guide you. Though I haven’t yet read it, I also find myself guiding people toward Oster’s second book, Cribsheet. As you pointed out, Brianna, Cribsheet starts off where Expecting Better leaves off - in the hospital in that crucial 24-48 hours when many many decisions will be lobbed at you and your partner. And P.S., neither one of you will be ready for them! Chances are both of you will be physically drained and emotionally spent. Read up on them now when you have the bandwidth! 
But my succinct answer to your question? Abso-freaking-lutely!

Order your own!

Click on the pictures below to check out Expecting Better and Cribsheet​ on Amazon.