Common Sense Pregnancy

Meh, this was fine.

I found the most valuable section to be the postpartum/”what to do with your new little blob” stuff - that is, what to expect in terms of the process of recovery from giving birth, the proper care and feeding of your newborn, and the logistics of pumping breastmilk. The labor and delivery section was also pretty helpful; quite detailed in, e.g., the stages of labor, how an epidural gets inserted, and so on. The pregnancy stuff was fine.

I didn't love the tone though, and I still WAAAY prefer Emily Oster's Expecting Better for a number of reasons:
- I have a small professional connection with Oster (I did some work for her and a co-author), but, more importantly:
- We come from the same domain (economics) and speak the same language about risk, uncertainty, statistical significance, and hypothesis testing.

One thing I did NOT realize before getting pregnant and visiting those godawful “fourth ring of Dante's Inferno” online pregnancy forums is that there (a) is such a thing as “Mommy Wars” and (b) there are deeply entrenched ideological camps - akin to the polarization in US politics - related to the topics of breastfeeding, labor + delivery, and (most notoriously and radicalized) vaccines. I missed the memo on all of this, and I STILL don't understand why I'm supposed to despise the C-section rate in America, value a natural (i.e. pain medication free) childbirth, or create a “birth plan”.

(A note about C-sections: the rate in the US is about 1 in 3, which is widely considered - on online forums, in blogs, in this book, at the midwife meetup I went to - to be very terribly bad. I'm not a physician, but I didn't understand why: do these C-sections result in bad outcomes? It was often implied, but - what bad things? How often? Why? I wanted to know, and it's been hard to get straight, statistical information about it. At the midwife meetup, they implied it was caused by a lack of widespread midwifery, and its effects were to increase maternal mortality (!). I looked it up: the C-section rate in Germany, where midwives deliver babies, epidurals are rarer than in the US, and OBs are only on hand in emergencies, the rate is 31% - while, in the US, it's 33%. In Italy, it's 36%. The US's maternal mortality is a lot higher than other developed countries (e.g. Germany and Italy) - 26.4 deaths per 100,000 live births, or 0.02%, as compared to all the other European countries, which are all under 9 per 100,000 live births (0.009%). But it sounds like some of the causes of the US's maternal mortality rates have to do with the way hospitals and staff react to complications (e.g. a hemorrhaging), rather than the prevalence of complications. I'm not a public health researcher or physician, but the way these issues are talked about is always in SCREAMING ALARM AND JUDGMENT, and it's been hard for me to get to the facts! Just the fax!)

Heennnyyway.

So yeah, this book was written from the point of view of a highly experienced nurse who has worked extensively with midwives and OBs, and also maintained an online blog answering pregnant women's questions, and thus the tone of the book is geared towards addressing the online pregnant woman anxiety phenomenon: slightly skeptical of the medical mainstream, but not super granola so, and with limited statistical evaluation of the research evidence. While the book states very often that it means no judgment of, e.g., NOT doing a natural childbirth, or choosing to bottle- instead of breastfeeding, I still felt that it had quite a bit of judgment, not enough science and not enough COLD HARD FACTS, MA'AM. Again, I preferred Oster for that reason. Like, Oster - and economics research! ahhh, cold, dismal economics! - ascribes no special moral weight to breastfeeding or bottle-feeding, epidural or not, delayed cord clamping or not. She just evaluates the medical literature, applies statistical know-how to evaluating the believability of the research claims, and then applies decision theory from economics to evaluating what to do with those claims. To me, that's all reassuringly rational, understandable, and clear.

I mean, I don't want to overly critique this book - because it really is basically fine, and I even recommended it to some pregnant friends - but some stuff just rubbed me the wrong way. OKAY, ONE EXAMPLE: in the section on group B strep (GBS) - a vaginal infection that can sometimes be a bit of a risk to the baby while it's on its way out - Faulkner writes about how it's normally treated with antibiotics via IV. Since some womens' birth plans forbid the use of IVs in the pursuit of as low-intervention a birth as possible, she reassures these readers that the IVs are minimally invasive, and you can still walk around/be mobile during your labor. She then notes that the American Pregnancy Association estimates that only 1 in 200 babies even get GBS anyway when the mom has it and doesn't take antibiotics. But, if she takes antibiotics, this risk is reduced to 1 in 4,000. Fine, fine. BUT THE THING THAT DRIVES ME CRAZY is that she then notes, in the next paragraph, that - for those that reeeeally wanna stay “all-natural” while ALSO addressing the GBS - Faulkner writes:

“Some midwives and homeopaths offer garlic, acidophilus, or herb-based or other nondrug therapies and report good outcomes.”