Review: Expecting Better

Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-and What YouReally Need to Know by Emily Oster is the result of an economist (Oster) wanting to understand the actual risks behind the common advice given to pregnant women during her pregnancy. She doesn't just present to the reader her own view of the various recommendations, she presents the data so that the reader can decide on the risks and trade-offs on her own.

The largest take away theme is that many of the common recommendations to pregnant women are based on sparse or inconsistent data, often because it is difficult or unethical to do true randomized studies during pregnancy. Because Oster is exploring the data herself and because she does not take recommendations at face value, this book provides the reader with a framework for deciding which advice to take at face value and which to take with a grain of salt.

It's worth noting that there are a lot of negative reviews of this book on Amazon from people who are outraged at the suggestion that a very moderate amount of alcohol during pregnancy may not be harmful. I'll just note that Oster does not advocate for drinking during pregnancy. Rather, she points out some weaknesses of some of the studies that have shown harm and points out other studies that showed no observable harm. She personally concludes that a small amount of alcohol during pregnancy is OK, but she agrees that there is also no reason to drink if you are worried about the risks.

For women drowning in a sea of inconsistent advice — or who just want to understand why they are told to do or not do certain things, Oster's book is an incredibly valuable resource. While, of course, this should be paired with a book that is more detailed about pregnancy itself, I highly highly recommend this book as one to look at if you are pregnant or interested in the topic.

Review: Cracked Open

Cracked Open: Liberty, Fertility, and the Pursuit of High Tech Babies by Miriam Zoll is not my normal sort of book. In fact, I kind of disliked it. It's in the genre of self discovery memoir, in this case centered around the author and her husband's quest to have a child.

What I disliked about it is that while emotions are important in a book exploring the emotional roller coaster of excessive promises and failed expectations that are so common — and so rarely talked about — in the fertility industry, Zoll rather overdoes it. Do we really need the long diversions into the author's childhood or her brother's ongoing life as a deadbeat? Do we need to hear about her journey to find her animal totem? While some mention of the author's background is necessary to understand the emotional process the author was going through, it seemed like every chapter was more than half general musing about the author's past, family, and insecurities. The book could have been half the length and still have painted an effective, personal, and emotional picture of the author's journey.

That said, the book contained a lot of information that is valuable to anyone who is curious about the fertility industry — and since my husband and I have been trying for a year and a half to become pregnant with no success, we certainly had curiosity.

The largest lesson is that the media and general societal attitudes have hugely misinformed women when it comes to their fertility. A woman's fertility drops dramatically after her mid-thirties, precipitously after age 40, and even the best technology relies largely on luck for a woman whose body is just no longer going through the right physiological processes to support egg production and pregnancy. Birth is not impossible — not even uncommon — but it is much more difficult. The various fertility assistance techniques, in vitro fertilization (IVF) and donor eggs in particular, have a much lower success rate than our societal folklore would lead us to believe.

The second largest lesson is that the fertility industry is just that, an industry, and it does not — or at least did not for Zoll and her husband — do a good job of supporting the emotional experience of the couples involved.

Overall, this was a worthwhile read, although I suspect that there is a book out there — written or to be written — which can convey much of the same experience without being so annoying.

Review: Ina May's Guide to Childbirth

Although this book contains much factual information about pregnancy and childbirth, Ina May's Guide to Childbirth by midwife Ina May Gaskin is just as much a book on childbirth philosophy as it is a book about the process of birthing a baby.

The heart of the book is a number of birth stories, sometimes in the words of the women who gave birth and sometimes in the words of Ina May. While some of the women further toward new age woo than I think is quite reasonable, for the most part, these are powerful stories of women finding in their bodies and minds the power to give birth in a way that doesn't treat birth as a medical problem to be fixed. One thing I appreciate about these stories is that they don't exclusively describe normal, uncomplicated births. A good handful of the stories contain births that were difficult.

One thing Gaskin does well is demonstrate how many of the birth interventions that are sold as conveniences can hamper birth and lead to further interventions that the woman did not originally want. For example, the labor inducing drug Pitocin (synthetic oxytocin) can force the body into labor before the pelvic region has finished preparing for birth which, in turn, leads to higher levels of cesarean sections. This isn't to say cesarean sections are bad. The point is that a woman may choose one intervention — induced labor — and end up with another which she may not have personally wanted — a cesarean section. Another example is epidurals to kill the pain of birth can lead to higher levels of perineum tears because the woman giving birth is unable to feel when she is pushing too hard or too fast.

Because of this, Gaskin advocates letting women's bodies do their work and turn to interventions only as needed. The medical interventions that doctors have available to them today are wonderful lifesavers, but by treating them as conveniences that can standardize birth, we start down a chain of interventions in way that are not always desirable.

Beyond the philosophy, this book also contains a lot of information about the birth process that emphasizes how to let the process of birth happen in its own way: let the birth take time; stand up and move around to help the baby into the right position and let gravity help you push it out; laugh or let your partner sexually stimulate you to relax you and help to loosen your muscles; etc. These aren't magical incantations to make the birth process pain free and fast, but they are ways of working with the birth process rather than against it.

You shouldn't read this book expecting a neutral presentation of non-medical birth, but you should read it if you want a book that focuses on birth as a normal process not something to be medicated away.