When you are part of an ever-growing industry like fertility, you make it your job to always be researching and fact-finding about the latest advice people give. I’m always speaking with interesting individuals, and professionals in the health field that intrigue me and challenge my current mindset. One such individual was a client of mine who resides in Singapore – a single gay man hoping to find a surrogate and create a family of his own. We immediately clicked when we met and were aligned with the same values and mutual respect in regards to achieving his dream. During one enlightening conversation on the phone one day, we were talking about common do’s and don’ts of pregnancy and he told me a friend of his recommended a book by Emily Oster, called Expecting Better.
Emily was an award-winning economist that was pregnant with her first baby when she began to evaluate the data behind the ‘rules of pregnancy’ conventional mindsets considered mainstream. But is it even true? She dove into hundreds of medical studies to debunk many widely common dictates: no alcohol, no caffeine, no sushi or lunch meats, and what is the big deal about cat litter? I ordered the book immediately and couldn’t get enough of her approach to asking the tough questions and being real with readers about what the actual risk factors during pregnancy are.
I wanted to share some of the information that I found the most fascinating with pregnant moms, surrogates, and anyone thinking of having a baby in the near future. The things Emily talks about in her book won’t come as a surprise, but the research she uncovers might. I know I was certainly surprised at some “don’ts” my doctors had always told me when I was pregnant with my children that had absolutely no factual foundation. Why is general advice so different depending who you talk to? Why do we fear so much while pregnant? At the end of every chapter of the book, Emily gives us what’s called “The Bottom Line”, which outlines the general outcome of her research. Come with me on this fascinating journey and learn a lot about how to advocate for your own pregnancy with actual facts. Keep in mind this research is based out of the USA. These stats vary in different countries around the world.
The advice is galore on how to get pregnant when you are finally ready to try. I’ve been a part of conversations on birth control, ovulation predictors, and pregnancy tests so many times. But have you ever wondered what the truth is? Does being on birth control really affect your chances of getting pregnancy later in life? Does the time you have sex really matter? Well let’s answer those questions now. According to the research Emily does we can note these things:
- Timing Matters! Pregnancy rates are high if you have sex on the day before or the day of It is possible to have sex up to five days before ovulation and get pregnant but your chances seriously decrease.
- There are no long-term effects after taking birth control pills, but it may take up to 9 months to get a regular menstrual cycle after stopping the pill.
- There are many effective ways to detect ovulation, but the higher-tech methods such as ovulation pee sticks, are very accurate compared to temperature charting etc.
Drinking Alcohol and Coffee
Who hasn’t had a good cry about giving up both alcohol and coffee during pregnancy? I know back when I was pregnant with my first baby 12 years ago, I was told NO alcohol ever, but not much was said about coffee. I am a coffee drinker normally, but nothing crazy – a few cups a day. But when I get pregnant one of the nasty side effects of the first trimester is not being able to stomach coffee at all, so giving it up wasn’t a problem. But I switched to black tea instead which from what I’ve read has as much caffeine in some cases.
So what’s really the truth behind it all? Is having a glass of wine here and there going to have any negative consequences to your baby? I hope not, as I had more than a few drinks on my wedding day before I even knew I was pregnant with my first. Oops!
- There is no good evidence that light drinking during pregnancy negatively impacts your baby. Basically this means you can have 1-2 drinks a week in the first trimester and up to 1 drink a day in the second and third trimesters.
- Heavy drinking absolutely has dire consequences to the development of a fetus. Do not go drinking vodka shots. Use common sense. A social drink of wine with friends is acceptable without feeling the Mom-guilt, but the consumption speed of alcohol matters.
- In moderation, coffee is fine. All evidence supports having up to 2 cups a day. Much of the evidence supports having 3-4 cups a day. Evidence on more than 4 cups a day is mixed, so think smart and keep it under 4 cups a day.
A Caffeine chart for General Interest:
|Starbucks brewed coffee, 8 oz: 165 mg|
|McDonald’s brewed coffee, 8 oz: 100 mg|
|Starbucks latte, 16 oz: 150 mg|
|Black tea, 8 oz: 14-61 mg depending on the strength|
|Green tea, 8 oz: 24-40 mg depending on the strength|
|Coca-Cola, 12 oz: 35 mg|
|Mountain Dew, 12 oz: 50 mg|
The bottom line with this one is simple. It is dangerous for your baby. Period.
It is always a genuine fear that in the first trimester the chances of miscarriage are higher. But what are the actual facts of why we fear it so much? Is there any way to prevent it?
- The reality is that 10-15% of all pregnancies that are developing normally at 6 weeks will end in miscarriage. The rate of this does decline quickly over the first trimester and falls to around 1-2% by 11-12 weeks. Sometimes you don’t even know you are pregnant when you lose a fetus. It is not perhaps comforting, but it is a normal part of conception. As women, we don’t always drop perfect quality eggs and sometimes men’s sperm, while might be the fastest swimmer, isn’t the most perfect specimen.
- Older age and previous miscarriage increase your risk.
Pregnancy Off-Limits Food List
We are all familiar with the general list of foods we aren’t supposed to eat during pregnancy. I’m sure you’ve all wondered why some of them are even on the list though and what the big deal is with eating deli meats or sushi. So let’s take a look at what Emily discovered in the actual data.
General DO NOT EAT list:
|Raw eggs – Risk: Salmonella|
|Raw fish – Risk: Salmonella, campylobacter|
|Raw shellfish – Risk: Salmonella, campylobacter, toxoplasmosis|
|Unwashed vegetables and fruits – Risk: toxoplasmosis, E.coli|
|Raw/rare meat – Risk: salmonella, toxoplasmosis, campylobacter, E.coli|
|Smoked fish – Risk: listeria|
|Paté – Risk: listeria|
|Unpasteurized milk – Risk: listeria, campylobacter|
|Raw milk soft cheese – Risk: listeria|
|Deli meats – Risk: listeria|
Salmonella and E.coli are by far the most common cause of food-borne illness. Campylobacter is similar in its effects, although less common. All three bacteria cause basic stomach-flu symptoms: diarrhea, nausea, and vomiting. Toxoplasmosis is harmful but largely avoidable.
- Don’t worry too much about sushi and raw eggs (not that anyone really eats raw eggs other than maybe in mayo). They might carry bacteria, but these bacteria are no worse when you are pregnant than when you are not. This one made me so happy! Sushi is one of my fav meals ever and I love to treat myself when I can. So I just make sure I go to reputable places where the sushi is prepared properly and the risk is minimal.
- Toxoplasmosis infection during pregnancy can be damaging to your baby. The risks are small and you can cut your risk in half by thoroughly washing your vegetables and by not eating raw or rare meat.
- The most dangerous food-borne bacteria is Listeria. But unfortunately a lot of source outbreaks are random. It could be a melon, celery, sprouts. Avoiding Listeria is a good idea, but it’s difficult on most levels because of the random nature of the outbreaks. Based on past outbreaks, probably just avoid queso fresco and turkey sandwiches.
- Extra tidbit: When it comes to fish, mercury is bad for your baby. Omega-3 fatty acids are good for baby. Fish contain both. Your best option is to pick fish with a lot of omega-3s and limited mercury risk, such as salmon, cod, catfish, mackerel, or sardines (bleh). Do not avoid fish because you are worried about mercury. Fish are so good for you and baby! People who eat a lot of fish have smarter kids on average! Just learn which fish to pick overall to lessen your exposure to mercury.
Prenatal Screening and Testing
With the science today to be able to test in the very early stages of pregnancy, many people are opting to find out if there are potentially any chromosomal issues with their baby. There are several tests now optional (some you still have to pay for). I didn’t do any testing with any of my own pregnancies, because ultimately I wasn’t prepared to have an abortion. I would have dealt with whatever hand was given to me. So keep that in mind when making the decision to do all this testing. Is it worth it to you to know early if there is a problem? How accurate are these tests?
- Cell-free fetal DNA testing (MaterniT21, Harmony, and others) are very accurate and can detect about 99% of Down Syndrome cases.
- False positives are rare, but they do happen.
- If these tests are not available, first trimester screening with ultrasound and blood tests can detect about 90% of Down syndrome cases but with a higher false positive rate.
- Miscarriage rates from both amniocentesis and CVS are small.
There are a bunch of common practices that people think they should avoid, but it might surprise you what the data actually says. Can you dye your hair? What are the actual risks of changing cat litter?
- Sorry ladies, but changing cat litter isn’t that risky at all. Toxoplasmosis infection through cat litter is very specific. The cat has to actually be eating a raw diet that gives them the parasite. The first time they are exposed they excrete the parasite eggs in their feces for several weeks; you can be infected through exposure to these. But once a cat has been exposed (let’s say your cat goes outside and mouse hunts), they typically have immunity and are not exposed again. This means you are only at risk if it’s the first time your cat has been exposed. Old cats who have spent their lives outdoors and indoors have almost always been exposed to it. The short answer is, just wash your hands regardless after changing cat litter and you are fine.
- Interestingly enough, gardening has a higher connection to toxoplasmosis than cat litter. This is an activity that actually should be avoided. There is a strong association to the bacteria and soil. So if you plan to do some gardening, wear gloves for sure and possibly a mask to avoid inhaling any particles
- Hair dye is safe. Concerns about hair dye are overblown and no actual substantial research has shown evidence it is an issue.
- Getting too hot during your first trimester can lead to an increased risk of neural tube defects like spina bifida. So hot tubs are out. Personally public hot tubs always grossed me out for the bacteria anyhow, but any excessive heat is a big no no.
Eating for Two?
I love that no matter how many times I get pregnant someone always tells me it’s okay to eat more because I’m eating for two. Myself, I eat more in the first trimester because it actually helps me greatly avoid nausea. But once the second trimester comes along, I eat less than I would normally. That’s my body, but everyone is different. Some poor women vomit half their pregnancy and can’t keep anything in their system. But what is the actual truth about weight and calories during pregnancy?
- No matter what you put on, you have to take off after the pregnancy. So yes, if you gain 30 lbs, you can’t blame that all on baby. Only 10-15 lbs is actually attributed to the baby, placenta, and fluid. So if you don’t want to be left with a lovely gift of extra weight after the baby, try to keep the weight gain to a minimum.
- On average if you gain more weight, your baby will be larger. If you gain less weight, your baby will be smaller.
- Both very large and very small babies face additional risks, although too-small babies face greater risks. You should be more concerned about gaining too little weight than too much weight.
Exercise During Pregnancy
I know that many people prefer to just chill during their pregnancies, while others obsess over their weight gain and work out just as much as before they were pregnant. I’ve always been an active person so I just consistently stay active and don’t find it a problem. But should you start a new exercise or should you be careful of some workouts? What about kegels during pregnancy to strengthen your uterus?
- General exercise during pregnancy is fine. Not exercising is also fine. Want to pick up some prenatal yoga for the first time, go for it. Studies actually suggest it is fabulous for you. If you have never worked out before, don’t go lifting weights at a new gym, thinking you are Rocky… that’s just going to hurt you regardless of being pregnant. Ultimately there isn’t much for exercise that is going to be risky during pregnancy.
- Kegels prevent urinary incontinence and can improve your pushing ability in labour. I did some further research on this issue, because I recently read some information about this that was contradictory. What I found was that Kegels were fine for the first 5 months, but in the last 16 weeks should NOT be done. If your pelvic floor is too tight you can damage your vagina during birth. Everything needs to be soft inside the baby canal to give birth. Nobody wants a broken vagina. I think there needs to be further research about this. In general, Kegels are advised before and after pregnancy. Maybe skip the Kegels – I know I will be. What’s a little dribble when you sneeze? No biggie.
Medications – What’s Safe?
I think for the most part during pregnancy many of us feel that no drugs is safer regardless. I have always suffered through sinus issues during seasonal changes and stick to naturopath remedies instead. But what is really safe to take during some of the more nagging issues that can occur during pregnancy?
- Insomnia and allergies– Unisom is a brand name for diphenhydramine that can be taken to help with sleeping difficulties. It is also commonly used in allergy medications. It’s safe to take during pregnancy for both ailments. You can also take Claritin, Benadryl or Reactine for allergies.
- Headaches – Tylenol or acetaminophen
- Drugs in Category A or B – always consult with your doctor
Method of Delivery & Labour Options
With all the options for giving birth now, it’s no wonder first time moms-to-be get so stressed trying to decide. Midwife or OB, homebirth or Hospital? What is considered safe for one may not apply for another. In my personal experience, I’ve done it all except C-section. I’ve had a homebirth, hospital birth, natural birth, and an epidural. I’ve had spontaneous labour and had an induction. I know from my experience what was better, but let’s take a look at the actual evidence.
- Caesarean sections are a good option in an emergency, but shouldn’t be your first choice of delivery.
- Induction at full term is safe, but increases labour pain and the possibility of C-section
- Red Raspberry Leaf Tea, Evening Primrose Oil, and Sex, are all myths to induce labour. There is no statistical evidence showing they work, but they certainly don’t hurt. Acupuncture has mixed evidence. Nipple stimulation does work! And of course membrane sweeps work!
- Epidural positive impacts: PAIN RELIEF
- Epidural negative impacts: Greater chance of forceps or vacuum delivery, greater chance of C-section for fetal distress, longer pushing time, higher chance of baby facing up at birth, greater use of Pitocin in labour, greater chance of low maternal blood pressure, less able to walk after labour, greater chance of needing a catheter, increased chance of fever during labour
- Broken water: induce if labour doesn’t start on its own within 12 hours
- Eating and drinking during labour: probably should be allowed, although most hospitals still will not let you have solid foods, and you probably aren’t going to want them anyway. You can drink Gatorade to keep your energy up.
- Doula: Having a doula decreases the chance of a C-section and of using an epidural. Highly recommended. I’ve never had one, so I’m really thinking this time around I will definitely explore this option.
- Continuous fetal monitoring: there’s no evidence it’s effective. Personally with my hospital births it was greatly annoying and uncomfortable to be constantly hooked up to monitors. But during my homebirth, my midwife only checked intermittently which is what should be done in most circumstances.
- Labour augmentation: (Essentially helping along spontaneous labour when it doesn’t progress fast). In truth, stimulating the uterus this way can progress slowly, and does for many women. The 1-CM-per-hour rule is probably a bit optimistic. But there are limited downsides to augmentation; both breaking the water and use of Pitocin tend to speed up labour without increasing C-section rates or other complications.
- Episiotomy: Not a good idea
- Pitocin after birth: Useful in preventing postpartum hemorrhage. Recommended.
There are a lot of mixed thoughts about some choices after the baby is born. When my kids were born many years ago, I didn’t know enough to question some of these choices. But I want to share this information so that women know more about the choices that seem to be taken away from them by doctors when their baby is born. What’s important to do and what’s just done as a routine with no particular evidence to support?
- Delayed cord clamping: a good idea if the baby is born before 37 weeks. It roughly halves the need for a blood transfusion for anemia, and has an even bigger effect on the need for blood transfusions for low blood pressure. Basically pre-term babies need more blood, and this is an easy, natural way to get it to them. If the baby is full term, the evidence is more mixed, but seems to favour delayed clamping. It is associated with higher iron levels that persist for at least 6 months. But on the downside, some studies have shown it to be associated with an increased risk of jaundice. It’s up to you to trade off the (possibly) higher risk of jaundice with the lower risk of anemia. Either way both risks are treatable and so whatever decision you make won’t be wrong.
- Vitamin K shots: effective at preventing bleeding, and the claims that they increase the risk of cancer are unsubstantiated.
- Eye antibiotics: probably not necessary if you don’t have an untreated sexually transmitted infection.
- Cord-blood banking: very unlikely to be useful for your family given the current technology. Future technology is difficult to predict.
- If you don’t want any pain medication, there are some pros to home birth. There are fewer C-sections, less instrument delivery, easier recovery for Mom and less tearing.
- If you haven’t done this before, there is about a 30% chance you’ll end up in a hospital anyway.
- Some studies suggest that mortality rates are higher with home birth, others do not. Risks are low in any case.
Regardless of the studies, the beauty is you have choices. They are made better when you have actually factual evidence. But read the book.
This is just a synopsis of the information I gathered. The book goes into more detail and depth as to what the evidence says and why. The book Emily spent years gathering information for, is a great resource for anyone pregnant. It doesn’t matter if it’s your first baby, fourth baby or a surrogacy pregnancy. Information is powerful and we should all have the ability to make choices during our pregnancy and birth.
You can order it on Amazon: Expecting Better (Updated for 2019) by Emily Oster. She also wrote a book called “Cribsheet”, that dives into the research you should know about raising your baby once you give birth. It’s my next read!