Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong and What You Really Need to Know Paperback – 5 Sept. 2024

The author of this book, Emily Oster, is an economics professor from the University of Chicago. I first heard about her on the Radio 4 programme 'More or Less', when someone was describing this book. She starts with the idea that in order to make sensible decisions about what to do and not to do when pregnant, you need information on the risks, combined with your personal information about what the pros and cons are.I think this is an excellent book. It doesn't set out the dos and don'ts, so if you're just looking for a list of rules to follow, or something that deals with every possible question, you're better off with 'What to Expect'. But if you want to know *why* you are being told to conform to so many rules, and the evidence behind them, this is a book for you.It's well written, and with a sense of humour as well as an analytical mind. It probably helps that I have a bit of an analytical background myself, and work with economists, but I think the language is easily understandable. It also includes plenty of anecdotes from her personal experience and that of her friends, which makes it very approachable, without compromising the information about evidence.She seems to have received most attention for her chapter on caffeine and alcohol, where she tries to separate out the risks of heavy consumption (bad in both cases) from the risks of low but not zero consumption. For instance, I had no idea that although caffeine consumption is linked to miscarriage, women who are nauseous are less likely to be drinking coffee, and nausea is a symptom that means you are less likely to miscarry. So it's possible (at least at low levels) that the women drinking coffee are just less likely to be the ones feeling sick.She seems to have received some criticism for saying it's OK to drink. She is emphatically not instructing anyone to behave one way or another, but instead presenting the evidence and the risks in a way that allows someone to decide for themselves. Personally, I really appreciate someone explaining what is going on, and what the evidence is for why you should do something - it makes much more sense to me than a simple rule that applies to everyone, when everyone is different.

I suspect that most readers of this UK edition of Emily Oster's book will come to it having read the official guidance to pregnant women (and their partners!) from the NHS, and found it lacking in both reasoning and detail. Emily Oster goes back to the fundamental source of all our information about the causes of harm in pregnancy -- clinical studies and trials -- and presents concise summaries of the current state of medical knowledge on each subject, giving prospective mothers the information they need to make their own decisions about the key issues affecting them and their future child. It does not overturn all "conventional pregnancy wisdom" as the cover might imply, but it does (rightly, in this reviewer's opinion) challenge the conventional presentation of information to expectant women, and in some cases presents evidence that official information is over-simplistic, or not based on the latest reliable information.This UK edition of the book has been largely updated to reflect the British readership, with a certain amount of detail about common NHS practice in addition to simple but important changes such as replacing the emergency number "911" with "999". Some sections would have benefited from further work, however: the information given about midwife qualifications is still USA-specific, for example, and the appendix on medication in pregnancy describes the position of the US Food and Drugs Administration regarding each drug rather than presenting a British or international perspective. That said, these are minor issues and in no way affect the relevance of the main thrust of the book to British readers, or indeed to readers of any nationality.The information set out in this book is nuanced, presenting the decisions that expectant mothers and their partners need to take as they are: a balance of risks and rewards for both mother and child. It will be of most use to readers who are confident at understanding statistics and want the detailed information they need to make informed decisions. If you want a simple list of rules to follow that will keep mother and child as safe as possible in most circumstances (and there's absolutely no problem with that), then the NHS makes that information readily available for free.

This book is informative and reassuring - but mostly just makes you grateful that we have the NHS with its central and well evidenced guidance, versus what appears to be the Wild West of healthcare in the US. All guidance seems to be pretty in line with what the NHS tell you, however a digestible and easy to read way to read up on academic research into pregnancy and childbirth. Limited adaptation evident for the UK market. Not a book to prioritise if you’ve got a long list!