Economist Writes Book on Pregnancy Stats, Myths, Realities-Rational Thinking Ensues

I just listened to an interview with an economist author who happened to have undergone a recent pregnancy and realized that most of the advice given to women these days is either spotty, or egregiously over conservative – flat out wrong in many cases.  As a guy who writes about finance, you’re probably wondering what this has to do with my blog.  Well, I’m also a husband to the wife who went through this 3 times and found the experience to be very similar (and she had “the best doctor” – don’t we all?). And since this book is written by an economist, it really reminded me about how shockingly naive people are in how they view risks and decisions in life.  Even if you’re a dude, a woman who’s done having kids, or never intend on having kids, read on; you’ll learn something about causality, correlation, and urban legend still being propagated in doctors’ offices today.

The author of Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-and What You Really Need to Know is Emily Oster.  Without delving into her background, credentials and such, I was struck by her sheer – rationalism.  People sometimes recoil at my lack of “emotion” when discussing an issue that I believe requires rational thinking over fear.  You know, things like the fear of flying from people who have no fear at all of commuting 2 hours a day in a car which is much more dangerous, the fear of vaccinating children when there is no evidence whatsoever that any of them cause autism (even though the misguided scaremongers have jumped from theory to theory since the fraudulent British doctor falsified data to kick off the whole conspiracy theory), and the irrational fear of your child being swiped away the minute they’re out of sight even though the world is probably no more dangerous than when we grew up – but the local news keeps people living in fear of virtually everything.  So, when you hear someone in a matter of fact way dispel fears and urban legends and back up an assertion with pure data, it’s refreshing.  Here are some of the topics she takes on in the book:

• Is It OK to Drink Alcohol During Pregnancy?  I’ll just say that our doctor told my wife it was OK to have a glass of wine with dinner now and then and there would be no impact to the fetus.  One glass per day is what he said specifically.  So, she took him up on it now and then.  If we were out to dinner and I was ordering a beer, a server would often assume she wanted water.  When she was showing and ordered a glass of wine, she always felt like she needed to explain herself and say, “My doctor said one glass a day is fine and I could really use one after the day I’ve had” or something along those lines, often being met with a raised eyebrow or awkward reaction.  Well, what does the data show?  The author goes on to show that there is literally no difference whatsoever (some studies show a slight benefit in populations of a single glass a day drinkers actually) in outcomes for a drink a day versus those who abstain.  Now, the typical answer many opponents would offer is, “why risk it?”, “why take any chances?”.  Well, duh – because it’s NOT a risk.  This is what decades of studies from Europe and many from America have shown consistently.  It’s not a risk.  So, expectant moms should stop feeling guilty and stop being judged for basically doing something that any guy would do if presented with the same choice.  She goes on to say that binge drinking IS a problem as demonstrated by fetal alcohol syndrome, not to be ignored and that is obviously a different situation than a single glass of wine.
• Must You REALLY Give Up Coffee When Pregnant? This one was near and dear to my wife, especially by kid #3.  The first two sure did tire us both out and yes, we exhibited third child syndrome where we weren’t as uptight about a lot of things like the first one especially.  So, she DID give up the coffee begrudgingly because the doctor recommended it.  Turns out, she didn’t have to – at all.  Evidently, the data on 1-2 cups a day shows absolutely do risk and at 3-4, the data isn’t entirely clear but definitely no red flags.  By not clear, sometimes the studies conflict or the statistically significance of a claim is not very strong at all.  Then, at 5-6 and especially when you hit 8 (who the heck drinks 8 cups of coffee a day??), the data becomes clear that there is risk of miscarriage and to fetus.  So, if the real danger zone is at 5 or even possibly at 3, why are doctors telling women to give up coffee altogether?  Are they children that can’t stop at 1?  Well, it’s one of those myths that just because something is dangerous in large amounts, it must be dangerous at all levels.  She goes on to say something quite intriguing as well.  What about when studies don’t control for ALL the variables?  If I just make a claim that women drinking 3 cups of coffee per day have more miscarriages than women who don’t drink any, you might think coffee drinking is bad in general.  Well, what about some other variables which are known to be true but I never even thought about?  Who is more likely to drink coffee?  Older women tend to be more habitual coffee drinkers than younger women (neither my wife or I started drinking coffee until our mid 20s).  Older women are also at much greater risk for miscarriage.  Whoops!  There’s an automatic bias in the data maligning coffee as a risk when it might really be another factor – age.  She goes on to cite a few other factors that probably influence these studies against coffee more than a perfectly controlled experiment.
• Does the Man REALLY Need to Change the Litter Box? We have cats. Aside from the fact that they’re really annoying and selfish creatures, I hate changing the litter box.  They are my wife’s cats after all.  But there’s the fear of miscarriage due to toxoplasmosis which can be found in cat turd.  So, a common ritual upon pregnancy is the proclamation that there will be no further litter changes for the expecting mommy.  Her book turns this on its head.  Gardening presents a much higher risk than cleaning your litter box.  Who knew?!
• Epidural – Extends Labor Time – But By Only How Long? Another thing men and “natural” childbirth advocates like to guilt people like my wife about is that they didn’t use an epidural.  My wife did.  The doctor told her there’s no impact to the child or mother other than a slightly longer labor.  It turns out that’s true but many women say they don’t want to prolong their labor unnecessarily, so why do it.  Well, it turns out, it prolongs labor by only about 15 minutes on average which might not deter many women if they knew the relatively short duration in which their labor may be extended.  6 hours? Sure.  A few minutes?  Probably not worth basing a decision on it.

Again, I’m surprised I was this intrigued by the content, given that we’re totally done having kids (check my post on the economics of a vasectomy for a good chuckle and some sticker shock).  But rational thinking rules the day for me.  One of the things that resonated with me most is how judgmental other people can be and how frustrating it is that aside from judging something which isn’t their business, they are actually WRONG in their assumptions based on the facts. I do look forward to her next book.  If you’re curious about the handful of other major pregnancy topics that I didn’t touch on above, check out her book’s table of contents here.