Eight evidence-based pregnancy books for science-savvy ladies

The Plain English Overview

The first book is From the Hips, by Rebecca Odes and Ceridwen Morris, one of the first pregnancy books anyone recommended to me. It does a fantastic job of capturing both variety of experience and the need for you to be able to make your own decisions about what risks you are and aren’t comfortable taking.

Instead of telling you “pregnancy will feel like x” or “you should be experiencing these symptoms now”, From the Hips talks about a range of possible pregnancy symptoms that some women experience and some women don’t, and provides you with short blurbs where real women describe what actually happened to them. Instead of telling you that one type of birth scenario or one method of caring for an infant is good and others are bad, From the Hips helps you understand why different women made different choices, puts that into context with evidence, and helps you figure out what choices are going to be the right ones for you.

Not a big list of stuff to freak out about, From the Hips offers easy-to-understand overviews about why some foods and activities are considered dangerous by some people, what the actual risks are, and what you can do to minimize the risk if this is something that concerns you. It does the same thing for all the different tests you might be offered and, all the way through, the book emphasizes a key point: You are not going to somehow “win” at pregnancy and parenting by eliminating all risk and being more virtuous than other people. In fact, trying to do that is likely to drive you just a little bit insane.

Which, speaking of, brings me to another thing I really liked about this book — it gives a damn about your feelings. Women’s expectations, fantasies, and fears about pregnancy — and how we deal with those things — play a big role in From the Hips. That matters, because those things are inextricably tied up in the healthcare decisions we make, from why we choose the medical team we choose, to which risks we’re comfortable living with and which we aren’t, to how we approach the early days of parenting after the whole pregnancy thing has come to an end. This book did a better job of incorporating those feelings and helping readers process them than anything else I read.

The Q&A Session

The U.S. edition of Bumpology, written by New Scientist writer Linda Geddes, isn’t out yet; I read the British version (available from U.S. Amazon). It’s easy to navigate and allows you to jump around through the text quickly finding answers to the questions that happen to be bugging you the most right now. That can be very useful, given the fact that you’ll probably run into more than one random query that would otherwise keep you up at night during the course of your pregnancy. Bumpology, which actually cites its sources and discusses things like quality of evidence, is a much better place to take those questions than random pregnancy websites … or, even worse, web forums.

That said, some the questions here are better answered than others. For instance, in response to the question of whether mother’s intuition can correctly guess the sex of a fetus, Geddes cites one study of 108 women, which was never actually published or peer-reviewed. It’s interesting that this study found women could correctly guess the sex of their babies with better-than-chance results. But, to me, it leans more towards “interesting, if true”.

It would have been more persuasive with an answer that came from looking at the results of several published studies, rather than a single, unpublished one. Of course, part of the issue here is something that Geddes acknowledges and that you’re going to run into with any pregnancy FAQ — there’s just a lot of stuff that’s either not been studied at all, or not been studied very well. At least this book will tell you what data the answer is based on, even if it’s weak data, rather than just confidently blurting out an answer that’s made to sound like it has the full weight of science behind it no matter how flimsy it really is. (Something that, in my experience, the pregnancy websites do A LOT of.)

The Nerderiffic Evidence Analysis

Emily Oster's Expecting Better is similar in some ways to Bumpology, but (I think) does a better job of really breaking down the data and getting into why we know what we know and don’t know what we don’t know.

Partly, Expecting Better gets away with that because Oster seems to have made a decision to not tackle subjects that don’t have much evidence behind them — so you get fewer questions answered, but those questions are usually answered in greater depth. It’s also reads more like a book than an FAQ, making it less convenient for quick checks of the facts, but more useful as a story about how data gets translated (or mistranslated) into medical advice … and how that advice gets translated/mistranslated into “common sense”.

This is a really good story to have in the back of your mind if, for no other reason, than the fact that it will make you more skeptical of the buckets of conflicting and often crazy-making information that will be dumped on you by well-meaning friends, family, medical personnel, gurus, etc. You’ll come away from this book better equipped to ask questions about those “facts” and better able to make evidence-based decisions.

The Biology Textbook You Wish That You’d Had in High School

A lot of “biology of pregnancy” reads will hit on the same collection of basic information that, by your second trimester, will start to feel completely repetitive and dull. Making Babies: The Science of Pregnancy covers that stuff — collectively, I like to call this information “Meet Your Gametes!” — but earns a spot on this list by going deeper into the wild, weird world of reproduction and pulling out some truly mind-blowing facts.

For instance, you’ve probably heard of parthenogenic lizards — species that are capable of reproducing without the help of males. Mothers effectively naturally clone themselves. And you’ve also probably heard of chimeras — people who carry around the genetic information of two people. In 1995, researchers identified a human kid in Scotland who is both. Seriously. Half his cells are male. Half are parthenogenic female.

As far as anybody knows, it’s a completely unique case that’s probably the result of an egg that began to randomly divide on its own and only then encountered a sperm. Already split into two cells, one got fertilized and the other didn’t. Both kept dividing and eventually became a single fetus. Nature is crazy, you guys. This book will show you just how crazy.

The Cross-Cultural Journey

A book about the anthropology of a biological process, Our Babies, Ourselves looks at how different cultures approach the idea of babies and parenting and how we all fit the biological needs and evolutionary demands of infants into our social understanding of how the world ought to work. It’s not a perfect book. But I do think it’s one that’s worth reading.

Here’s what’s wrong with Our Babies, Ourselves: It’s old. Like, 15 years old. So you should not read this book assuming that it represents the totality of what we know now about infant behavior and biology. This is a flaw that particularly affects the book’s first chapter, which is meant as a summary of what we know “now”. You can find all that information, in a more up-to-date form, in other places. So I’d recommend skipping it here and going straight to the second chapter, where the anthropology kicks in.

Here’s why I think you should read Our Babies, Ourselves: It’s going to get you thinking meta-critically about why you make the parenting decisions you make. Author Meredith Small takes you on an ethnographic tour of parenting in several different cultures, both traditional and industrialized, and compares the different ways those cultures deal with universally recognizable stuff like, say, the fact that infants have very different cycles of sleeping and eating than adults do. It’s probably not a spoiler to tell you that the American way of doing things — especially ideas like tightly scheduled feeding times and putting babies down to sleep in their own bed in a separate room — does not really come out of this analysis looking so hot.

But neither is Small trying to tell you that you’re totally going to damage your kid beyond all repair if you don’t raise him or her using the values and infant care techniques of the !Kung. Instead, what she shows you is that there’s a lot of variation in how we care for babies, even between different traditional societies. It’s not really about who is doing this “right” and who is doing it “wrong”. It is about the trade-offs we make between biology and culture. You’re not going to mess up your child for life by putting them down in a crib in a nursery, rather than co-sleeping.

Small makes a persuasive case that, when we use this system, we might gain the benefits of privacy and certain kinds of convenience at the expense of contributing to the creation of stereotypical problems of infant rearing (like, say, colic and parental exhaustion) — problems that might have more to do with culture than with biology.

The Histories

There have been several popular histories of birth published in the last few years. If these two books are any indication, there’s value in reading more than one. Even though they cover the same general ground — and sometimes end up telling the same stories — Get Me Out and Birth Day relate history in ways that are different enough that I didn’t feel like I was just plowing through the same book twice. Both were fascinating — for different reasons and in different ways.

Get Me Out might be the better of the two. This book does a really good job of telling the story of how the biological process of birth has been influenced over the centuries by the forces of culture — social pressures, class conflicts, racism, sexism, family expectations, personal fantasies, political ideologies … they’ve all played a role.

Randi Hutter Epstein focuses on how women have experienced that history (rather than telling the story of medicine) and she does a good job of relaying the historical nuance that makes it clear that practices, ideas, and tools we value today have not always come from people and situations we would want to celebrate and respect. And vice versa. She also does a good job of showing how the desire for a feminist sense of autonomy and power over one’s own birth process can lead different women to make very different decisions about what the ideal birth should be — and how those decisions can be (and have been) taken up, promoted, and twisted by people with completely different agendas.

One of the highlights is a section on the surprisingly controversial history of ultrasound, which turns out to be a complex tangle involving the variously conflicting and coalescing desires of parents, doctors, birth activists, independent entrepreneurs, and research scientists. Is ultrasound a good idea when there’s a medical reason to warrant doing it?

Most would agree it is — though there are still drawbacks, not the least of which are readings that can be either falsely reassuring or falsely fear-inducing. But that’s not the same thing as saying that it’s a good idea to go down to the mall and get your fetus “photographed”, something that’s increasingly available because of popular demand and despite legitimate medical concerns.

Birth Day, in contrast, is more of a history of medicine and how medical norms affect women (rather than a history of how women have experienced and influenced changes in medicine). It’s got some really amazing stories, though, including the tale of the first well-documented successful C-section that both mother and baby survived, which was performed in 1826 by James Miranda Stuart Barry.

Barry was an eccentric doctor and Crimean War veteran who, upon his death in 1865, turned out to have secretly been a biological female. This book is also one of the first places where I got a chance to read an in-depth look at the use of nitrous oxide for pain relief during birth — a safe and well-liked option that’s widely available in Canada and Europe, but almost unheard of in the United States. Finally, the book provides a really interesting perspective on how medical thinking about birth has changed over the last 30 years.

In the early chapters, author Mark Sloan talks about his experiences delivering babies in medical school in the 1970s — experiences that sound, frankly, horrific for the laboring women involved — and how changes in evidence and culture (but mostly culture) have drastically altered the way he and his colleagues approach birth today.

The Book to Read When Things Go Wrong

Pregnancy doesn’t always mean birth. I’ve talked here before about how important Coming To Term was to me when I was dealing with my own miscarriages, and I want to reiterate what a damn fine book it is. Jon Cohen does an amazing job of explaining what happens in the early stages of pregnancy and how that delicate system can fail.

More important, though, this is a book about why we know so little about such a common aspect of women’s health and why “normal and healthy” encompasses a much broader (and less pleasant) range of outcomes than most of us realize.

It’s also a book about why, in the face of a lack of knowledge, doing something can be a much worse idea than doing nothing. At this point, one of the best treatments we have for recurrent miscarriage isn’t high-tech medicine or any mystical alternative therapy — it’s a quiet, personalized treatment called “Tender Loving Care” that focuses on simply providing mental comfort.