On Pregnancy, Doctor Doesn’t Always Know Best

Pregnant women shouldn't be afraid to think for themselves

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Last week my book, Expecting Better, was published. It’s a data-driven look at pregnancy in which I take my training, in economics, to look at many of the decisions and rules that come up while pregnant. With a few exceptions (don’t smoke!) the book doesn’t make any real recommendations. What it does do is outline the data and decision process women could use to make decisions for themselves.

In the week or so since my book has come out, one of the most common pieces of criticism I’ve gotten—though, surprisingly, usually not from doctors themselves—is that doctors know best. Pregnant women, and patients in general, should just do what their doctor says, the refrain goes. He or she is the expert.

Unfortunately, this attitude misses the point. There is often significant disagreement among doctor—not to mention between individual doctors and national or governmental recommendations. The simple rule of just doing want the doctor says will lead to quite different behavior depending on who that doctor is.

In pregnancy, in particular, this disagreement can be extensive. Consider just a few examples:

Bed Rest. A 2003 bulletin on the prevention of preterm birth from the American Congress of Obstetricians and Gynecologists (ACOG) states: “Bed rest…should not be routinely recommended.” However, in a 2009 survey, 71% of obstetricians said they would recommend bed rest for women at risk of preterm labor. In fact, more than a quarter of doctors surveyed disagreed with the ACOG view that bed rest has few benefits. Another 43% agreed that there are limited benefits, but said they would prescribe it anyway. Only 29% would simply go along with the ACOG recommendation.

Prenatal Testing. Historically, invasive prenatal testing (amniocentesis or CVS) was suggested only for women over 35. In 2007, ACOG changed their recommendation to suggest that all women, regardless of age, be counseled on the same options. Despite this, a 2009 survey of obstetricians found that while 92% of them offered amniocentesis to patients over 35, only 15% offered it to patients under 35. Again, there is disagreement among doctors and between at least some doctors and the national organization.

Alcohol. ACOG makes a clear statement that no amount of alcohol has been proven safe in pregnancy and suggests that women abstain while trying to conceive as well as during pregnancy. In a 2010 survey, when asked about the safety of drinking in pregnancy, 40% of obstetricians reported that—in their opinion—women could “consume some alcohol during pregnancy without risk of adverse pregnancy outcomes.” In a 1999 survey of female doctors (not all of them obstetricians), 44% of them reported drinking alcohol in their own pregnancies.

My OB fell in this 40%, and told me it was fine to have a couple of drinks a week in later trimesters. What was missing for me from that advice was any understanding of why she thought that. What was the underlying information she had read differently from ACOG? It didn’t take long to then realize that recommendations—hers and theirs—were based on studies. The disagreement, therefore, stemmed at least in part from different readings of these studies.

What this disagreement suggests is not that women shouldn’t trust their doctors. But we should recognize that, in many cases, recommendations are coming from their doctor’s interpretation of research data. That data is often incomplete (this is certainly true in both the bed rest and alcohol cases above) and individual doctors and national organizations are left to make the best recommendations they can. Those recommendations are valuable, but they’re also subjective.

In the best case scenario, one which I know plays out in many doctors’ offices, the uncertainty around these recommendations is made clear, and doctors and patients can work through the reasoning behind the advice together.   But when there is not time for this, and when the decision really matters to the patient, the only way to settle the question may be to go to the source.

Pregnant women shouldn’t be afraid to think for themselves. And doctors shouldn’t be afraid to help them sort through the complexities of the data.

14 comments
flamethrower.97038
flamethrower.97038

Keep in mind folks, there is a Business to being born. The more invasion prodedures and more C sections and induced labors a doctor can get a patient to agree to gives the hospital or clinic they work for that much more money. The more money they have, the more money they are willing to pay the doctor and the bigger the bonus the doctor gets. Its the same way with feeding you the line that formula is better for your baby then breast milk. Doctors get paid very well to push those bottled of chemical laced formulas for you to buy, and they get paid extremely well for the effort.

Its not always about your best interest, but theirs. Don't ever think otherwise, do your research and find out what's best. Its not always in your best interest to follow the doctor's advice blindly.

amaproject
amaproject

We agree that pregnant women can think for themselves and should ask intelligent questions of all who provide them with prenatal care. There needs to be a true dialogue versus a prescription. WIth the large demographic shift of more women waiting until they are ready to have children at age 35 or better, the medical community should be ready for those intelligent questions from mature women and have answers. Most importantly for all women, physicians should be able to look at the evidence - published and credible data and the personal medical history of their patient - before making a recommendation. Prenatal care is not one-size-fits-all. We know because interview women and write about this and related topics for our nonprofit Advanced Maternal Project (http://advancedmaternalage.org/wish-list-for-healthcare-providers/).

rebeccapistiner
rebeccapistiner

I hire professionals in my life so that I don't have to study the subject matter in order to make decisions. Accountants, lawyers, doctors and even plumbers, roofers, and computer technicians. If I can't trust their opinions I need to find another professional whose opinion I do trust. I just don't understand why I should pay someone a lot of money to give me an opinion I don't trust. Maybe some can explain it to me. 

sac12389
sac12389

As far as alcohol goes- why risk it? Yeah maybe it's fine but if I'm expected to refrain from drinking for 21 years (lol) you can do it for 9 months.

Careful_mom
Careful_mom

I would never take pregnancy advice from an economist over my doctor. I have done a lot of reading on pregnancy and birth defects and although her daughter is healthy now, many birth defects become apparent in later years - behavioral issues, heart defects, etc. Is having an occasional drink really worth the risk, however small? Also, amniocentesis is becoming outdated as many new blood tests are available to test for Down syndrome, trisomy conditions and more. The fact that she doesn't mention this in the blog above tells me she isn't the one to be asking about medical matters.  

NOFAS
NOFAS

We are NOFAS, the National Organization on Fetal Alcohol Syndrome. We work with people who have been harmed by prenatal alcohol exposure. We know that no amount of alcohol is safe for the baby.

Emily Oster’s Alcohol and Pregnancy Advice is Deeply Flawed and Harmful

If Emily Oster wants to tolerate the risk of alcohol on her own baby, that’s her choice, but she has no right to advise pregnant women to expose their unborn baby to even a small amount of a substance that can cause brain damage.

She is clearly less concerned with protecting the health of newborns than she is with protecting expectant mothers from health messages she deems bothersome.

Emily Oster has no medical training or expertise and is unqualified to write a book which provides advice and guidance about alcohol use and pregnancy.

She cherry picks studies and ignores the research showing light drinking to be associated with miscarriage, stillbirth, preterm delivery, spontaneous abortion, and sudden infant death syndrome (SIDS).

Emily Oster thinks that the way to relieve women of the worry and guilt from having a few drinks during pregnancy is to tell them: Don’t worry, it’s fine. Enjoy a glass of wine. In fact, the best way to relieve women of this worry is to encourage pregnant women to avoid alcohol, including wine, and therefore have no reason to worry whatsoever.

Liberation for expectant mothers doesn’t come from drinking wine while pregnant. Liberation comes from never having to worry that you might have done something to harm your child by drinking alcohol

Emily Oster claims that her 2-year old daughter is perfectly healthy, yet the full impact of the alcohol exposure on her child will not be evident until the adolescent years.

Sadly, Oster’s statements will likely influence some pregnant women to drink alcohol, who then could tragically give birth to offspring with lifelong brain damage from the effects of prenatal exposure to alcohol, including Fetal Alcohol Syndrome.

flamethrower.97038
flamethrower.97038

@rebeccapistiner  Keep in mind its a business to those professions. The more services they can get you to agree to, even if they aren't needed, the more money they can put into their pockets.

Its not always about your best interest, but theirs. Don't ever think otherwise, do your research so you don't wind up with all your hard earned money going to someone else's bank account.

Interwebhobo
Interwebhobo

@NOFAS What you say may or may not be true, but for some organization claiming to debunk this article written using statistics and other various sources, you fail to cite a single source. You are NOFAS, a so-called national organization. Please at least do the national organization you represent justice by backing up claims with research. Even non peer-reviewed research is better than nothing. Finally, stop attacking the author. It debases your argument and comes off as pretentious. 

On topic, the author specifically mentions that the 40% of doctors who said a little drinking in the later trimesters was okay were using published research to support their suggestion. This suggests that, while lacking from a short opinion piece, there is a source that she most likely cites in her book. 

Regardless, please act like the professional organization you so claim to be and instead of ranting like a concerned mother, take a step back and address this as though your whole organization is built on facts and not suppositions.

JocastaBryan
JocastaBryan

@NOFAS Show me a study where women had exactly one glass of wine during a pregnancy and delivered a child with Fetal Alcohol Syndrome. Then come back and tell me what you purport to know about, well, anything. You are manipulative liar, making up your own facts, and your behavior is shameful. FAS rates are identical (1%) in both the US and UK, despite UK doctors not encouraging a complete prohibition on alcohol consumption during pregnancy. 

mamamcwill
mamamcwill

@JocastaBryan @NOFAS  Jocasta, alcohol is so clearly harmful that no responsible researcher would conduct a controlled study.

But perhaps you will drink during *your* pregnancy since you do not believe you will be poisoning your babies brain. if you drink enough, the poisoning will be visible at birth. If you drink lightly, as Ms. Oster suggests, you won't see it until they are school aged and can not control their impulses, distinguish cause and effect, or think abstractly in any way. let us know how that works out, ok?