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Short White Coat

‘Expecting Better’ from your doctors during pregnancy

Adapted from the Short White Coat blog on Boston.com.

Of all the pregnancy taboos I’ve heard in my 34 weeks of this surreal, at times ache-inducing, but ultimately incredible state, caffeine has caused me the greatest chagrin. Strangers in line at Coffee Central offered helpfully: “You’ll get decaf, of course.” My nephew looked at a cup of tea in my hands, his brow furrowed with reproach: “But you’re pregnant!” My obstetrician-gynecologist drew the line at one or two coffees a day. My personal literature review allowed me a more nuanced approach in which I count milligrams of caffeine per day, adjusting for my hydration level and professional obligations.

So when friends forwarded me an article in The Wall Street Journal by University of Chicago economist Emily Oster that purported to dispel myths of pregnancy, I was intrigued. I’ve since read her book on the subject, “Expecting Better,” and have come away with mixed feelings.

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I share some of Oster’s frustrations with conventional wisdom on what women can and cannot do when pregnant, especially when such statements aren’t supported by evidence. I applaud her instinct to dig up primary sources for answers.

But putting aside some legitimate concerns raised by others about how Oster interprets the data, I found the premise of her book unsettling. “ ‘Expecting Better’ presents the hard facts and real-world-advice you’ll never get at the doctor’s office or in the existing literature,” promises the dust jacket blurb, and the pages inside perpetuate the notion that doctors only deal in black and white rules.

Obstetrics is a field famously wanting for hard evidence because it is ethically challenging to subject pregnant women to the gold standard of studies: a randomized controlled trial in which you can truly nail down cause and effect. But doctors should, and the good ones do, understand the evidence that is available. More importantly, they are in a unique, and critical, position to frame it for their patients. I concede that this doesn’t happen often enough. Prenatal visits are incredibly short. Some of the nuances of the studies likely become blurred over time. That’s something we need to work on.

At the same time, doctors aren’t just in the business of summarizing studies, we are also charged with tailoring that evidence to individual patients and promoting public health.

So, what about caffeine? I found Oster’s literature review helpful, particularly the observation that correlations between early coffee drinking and miscarriage are confounded by the fact that women who are nauseated are more likely to have healthy pregnancies and less likely to stomach coffee. I don’t share Oster’s practice of drinking four cups a day.

Read more of this blog at Boston.com/
ShortWhiteCoat.
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