Planning for Your Next Pregnancy with Emily Oster, PhD

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Emily Oster (2m 7s):

One of the phrases I often like to tell people is data is not bossy. If you're looking for data to answer your question, you are rarely going to get what you want. But what it can do is help you more directly frame the decisions you're making.

Katie Ferraro (2m 22s):

Hey there. I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning. Here on the Baby-Led Weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning. Pregnancy complications are well complicated, especially when they're called unplanned pregnancy complications. Like of course they're unplanned. Nobody plans to have a complicated pregnancy and this is coming from the mouth of someone who had a quadruplet pregnancy that wasn't planned, that was certainly complicated.

Katie Ferraro (3m 6s):

You're not planning to have a miscarriage or preterm birth or uncontrollable vomiting while pregnant. Today, Emily Oster is here on the Baby-Led Weaning podcast to talk about pregnancy complications and how you can use data in preparation for your next pregnancy. Emily Oster is a professor of economics at Brown University and she authors the email newsletter and is in charge of the website and social media accounts parent data. She's the author of pregnancy books such as Expecting Better, which I realized today that book is exactly as old as my oldest child who's just turning 10 and it's the only book I read when I was pregnant with her. I know you guys are subject to a lot of, so-called Parenting Experts and you're always hearing advice from this influencer or that thought leader.

Katie Ferraro (3m 51s):

And I just wanna say something about Emily Oster ahead of the interview and that is that she is one of the most genuinely kind, informed and well-intentioned people in our space. You are gonna pick up on some of this in the interview today, but Emily Oster is known as the parent data person, right? She's literally an economist trying to help us sort through data and does there, or does there not exist data to support this or that decision that we are making as parents, which are important decisions. And at the end of the day, as she's gonna say in the interview, data isn't bossy, okay? It's not going to tell you what to do or make the parenting decision for you about whether you should have another baby or if you should do Montessori preschool or whether or not you're gonna do spoonfeeding or do Baby-Led Weaning.

Katie Ferraro (4m 35s):

Okay? There is a personal element in all of the parenting decisions that we make. And Emily Oster reminds us that we're the ones who know our babies best, right? You have to choose the best doctor for your family or the best birth plan, but the data can help guide your decisions. And in this interview today we are talking about pregnancy complications, topics like stillbirth and preterm birth, miscarriage, and other events that may be hard to hear about, especially for some of those of you listening who may have been experiencing or have had in the past their own loss in their own grief. And if that's you, then you might wanna skip this episode. But if you did have an unexpected pregnancy complication and you are interested in knowing why it happened and whether it will happen again, and then what can be done to lower risk, I most certainly recommend Emily Oster's book called The Unexpected: Navigating Pregnancy During and After Complications.

Katie Ferraro (5m 30s):

It's co-authored by Emily Oster and Nathan Fox, who's a medical doctor. When you listen to podcasts, just heads up, spoiler alert, a lot of time the hosts, they haven't even seen the book, let alone read the book of the author that they're interviewing and not. So here I read every book of everyone I interview all the way through. I was cramming to finish the unexpected before this interview today, but I love the outline of it and the execution so much. The book is really succinct, it's to the point I like that it's co-written with a medical doctor 'cause that is important given the gravity of the pregnancy complications that the book covers. I personally could not read in depth the stillbirth and the episiotomy section. So I skimmed those. I still cried. But if you're planning another pregnancy, even if you didn't have complications in your last pregnancy, I do think Emily O's book The Unexpected is an important read if for nothing else other than learning how to talk to your friends and your family members and people you encounter in the world who will have gone through these pregnancy complications.

Katie Ferraro (6m 27s):

So with no further ado, here is Emily Oster talking about planning for your next pregnancy, especially if you've had previous pregnancy complications.

Emily Oster (6m 40s):

Thank you for having me.

Katie Ferraro (6m 42s):

Your newest book seeks to bring maternal health complications to light. And that's a hard task because of course nobody thinks of themselves when they're pregnant. It's like, oh, I wonder what's gonna go wrong. I like that you said that you hope that nobody has to read your book the unexpected for themselves, but that you want everyone to read it to better understand the experience of others. In what way does knowing about maternal health complications help us to be more empathetic to those who have experienced these situations?

Emily Oster (7m 12s):

It might be useful to start with why I wrote the book, which is almost an answer to that question, which is, you know, I wrote Expecting Better, which is my first book, like a, a decade ago. And I have been very lucky that a lot of people have read that book and they've reached out and they've talked to me about their experiences and there were so many of those conversations which were about, you know, I loved your book and this thing happened to me and will it happen again? And can you help me answer this? This question about I had a miscarriage or I had a, I had preeclampsia and I wanted an answer to those people. And so this book is, is written partly or largely to help the set of people who I think would like the answer to the question, I had a complicated pregnancy, will it happen again?

Emily Oster (7m 57s):

How can I navigate it? How can I make things better on a second time around? But then also to help other people see this in a way that I was able to see it when I was hearing from people about their experiences. Because I didn't have any of these experiences myself.

Katie Ferraro (8m 12s):

I was just thinking about your book Expecting Better. So my oldest daughter turns 10 on July 28th and your book came out like a month before that. And I remember like a month before having the baby, I was like, oh crap, I haven't read any books. So I know most people say like, oh I read all the books like yours was literally the only pregnancy book that I read and I really appreciated it 'cause oh I did try to start one other one about natural childbirth and I was like, I cannot do this. This is not for me. But I loved your data based approach so I also can't believe that that was 10 years ago. So congratulations on a a decade of writing these books. But I love that you're also, okay, we need to talk about the fact that not everything is beautiful and turns out perfectly in pregnancy. And I think you guys did a really nice job of writing that. And I also wanna add that you have a co-author who is a medical doctor.

Katie Ferraro (8m 55s):

How was that experience? 'cause I can imagine coming from your economic side and the data that maybe doesn't always match up with exactly what the they're doing in practice, how was that experience of having a co-author?

Emily Oster (9m 6s):

So I love my co-author on this book. I wish he was everyone's doctor and he and I are in many ways very aligned. He was super easy to work with. His name is Nate Fox. He's like a genius and incredibly empathetic and like one of the nicest people you could possibly ever hope to meet. And when I decided to write this book and I I, it was pretty clear that I needed a doctor. And as we sort of worked through the book, what really became clear is actually like from the standpoint of answering the question, you know, will this happen again? You know what happened to me? That's a data question and that's something I'm very comfortable with. That's my expertise. You know, what is the, what did the large data sets say about treatments and about, you know, recurrence risks?

Emily Oster (9m 48s):

What Nate really brings here, and I think it's so incredibly important, is the question of how to have the conversation with your doctor. Like where is your doctor coming from? What are the questions you should ask? And he's just gifted at that. And so working with him was super fun and I think makes the book much, much better than could possibly much more useful than it could possibly be if I did it alone.

Katie Ferraro (10m 12s):

I love that you're co-author Dr. Nate Fox and you both provide scripts and templates for conversations to have with your provider. You're like, okay, you gotta ask what happened and then why did it happen to me? And then is it going to happen again? And what could have been done to prevent this from happening again? Do you have any tips though for actually starting these discussions with your care provider? They just always seem to be in such a rush.

Emily Oster (10m 35s):

Yeah, so this is a tough question because I, the answer is like find someone you can talk to, which of course isn't like is a place of privilege that some people have and some people and some people don't have. I think some of our goal with the scripts is to get to a place where you can have a more productive conversation in a shorter amount of time. So, you know, when we think about what's hard about these conversations, it's almost always the amount of time you have that like you don't, you really need, you know, an hour to talk about this and you have 15 minutes and if you spend those 15 minutes kind of trying to get to the question you're trying to answer, then your time is all gone.

Emily Oster (11m 16s):

So coming in with a little more knowledge, a little more preparation, a little bit more of a script can at least make those that time more productive. If your provider is just not listening to you, that's much more of a thing where we'd say like, you kind of, maybe you need to think about is there, does it make sense to switch to somebody else?

Katie Ferraro (11m 33s):

Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (13m 10s):

What about switching providers? How do you know if it's time to select a new provider? Is there like national level provider data that you can look up as to like your OBGYN's performance-based outcomes? Does that even exist?

Emily Oster (13m 23s):

Not really, but also I, I wouldn't ask the question like that because I think that gets people into a question of like, is my doctor a good doctor? And actually your doctor could be a great doctor but not for you. And I think the question should really be, is this the right person for me? And that framing is important because this is a hard relationship to end. So if somebody delivers your your baby, you had this whole like even if you didn't like them that much during the pregnancy, like it's hard to be like, ma, you're not for me because it sounds like you're, you're a crummy doctor and in fact that's not what you're saying. Say this is not the the doctor relationship for me. And so I think when people are feeling like, you know, I, I didn't feel listened to or I didn't have the experience I wanted, that's a place where at least you wanna explore.

Emily Oster (14m 6s):

And sometimes that means exploring like a midwife if you wanna really a sort of slightly different kind of experience or exploring other doctors or there's like a whole range of this. But just coming into it as like not my goal is to find out if my doctor's a good doctor because who cares. The question is are they a good doctor for you?

Katie Ferraro (14m 23s):

I read in your book that about 8% of US infants are delivered by midwives and midwives are of course wonderful allies and partners for low risk pregnancies. But what sort of risk factors in a pregnancy might make one consider using an OBGYN instead?

Emily Oster (14m 40s):

So it's actually up to about 12%, which in the last couple of years, so, so there's been actually even more of a shift to midwife births. And I think one thing that's important to be clear on here is the vast majority of midwife, midwife assisted births are in hospitals. So a lot of people when you say like consider a midwife, people are like, will I be birthing in a tub in my basement? And it's like, actually that's that most of those births are attended by midwives, but the vast majority of midwife attended births are just in hospitals. It's just with a different kind of provider and there are some circumstances, some complications which would mean that you wouldn't wanna, this wouldn't be a good consideration.

Emily Oster (15m 21s):

So someone who has very high blood pressure coming into a pregnancy or uncontrolled diabetes, those are the kinds of conditions which you're gonna need a doctor to sort of manage. Actually a pretty wide range of people who would potentially be eligible for a midwife birth, particularly for midwives who work with an obstetrician group. So if you thought you might need a c-section that obstetricians are there, but you can get prenatal care from from a midwife. And some of that is just about kind of what's the, what's the feel that people want. Midwives often have more time and sometimes that can be helpful, you know, particularly if you had actually complications before and you want someone who's gonna just give, have a little more time to spend talking about what's going on.

Katie Ferraro (16m 1s):

Preparation is an important subtext in your book and a lot of our listening audience has had at least one baby, some of them are gonna be done with their families, but I would guess that a lot of the others who are listening may be considering expanding their families. Just curious how can parents and future parents use data to help them in the preparation phase before they even conceive and especially so if they've had a previous complicated pregnancy.

Emily Oster (16m 24s):

One of the phrases I often like to tell people is data is not bossy. So it's, if you're looking for data to answer your question, you are rarely going to get what you want. But what it can do is help you more directly frame the decisions you're making. So I tell people like, your decision is probably, should I have another baby now or later, you know, or should I wait to decide or should I have another one or not at all. So you're kind of explicit about your question and then there's, there is a bunch of data that you want from that which for that which is, you know, things like will it happen again? That's for a complicated pregnancy. That's almost always the number one question people ask me is just what's the chance of this happening again?

Emily Oster (17m 5s):

And a lot of the book is spent on the question of like what's the recurrence risk and what could you do to treat it? Those are kind of the two key data pieces in anything is like what's the chance of it'll happen again and is there anything I could do I could do about it? And then with that, then you have to make a decision and, and always very hard to make decisions because none of these are gonna have an answer that's like for sure you should do it for sure you shouldn't do it. It's gonna be about your preferences and your values on top of the data.

Katie Ferraro (17m 34s):

I have a colleague who had such insanely bad vomiting throughout the entirety of her one and only pregnancy. She vowed she was never gonna have another baby and everyone says that but like this one, she actually did not do it. For moms who experienced hyperemesis in their previous pregnancy, is it for sure going to happen in their next?

Emily Oster (17m 54s):

It's not for sure gonna happen again. There are a lot, there's a lot of variation in kind of what we'd estimate as the recurrence risk. So in like a hospital data where you're basically asking the question, do you end up with another diagnosis of hyperemesis, that recurrence risk is about 25%. If you talk to, and this is like a place where Nate would say, you know, if you like sort of think about what this is experiencing in practice, his view is like whether it's a diagnosis or not, if you've had hyperemesis in a first pregnancy, it's you know better than 50% you'll have at least significant nausea while it, whether and vomiting, whether it will be as sort of technically hyperemesis or not is less clear. So in the book we put this in a category we call like sort of more like more likely than not.

Emily Oster (18m 36s):

Like it's, if it doesn't happen to you, that's lucky but you should expect it. And the thing about hyperemesis though is people often do figure out some things that help in a first pregnancy. So not everybody, but for some people there's a kind of like, you've sort of gotten dialed in a little bit and so being ready in a next pregnancy to dial that in immediately is one thing that's that's really valuable.

Katie Ferraro (19m 1s):

I love the vignette in your book, the woman who's hospitalized and receiving fluids for profuse vomiting during pregnancy and she got a text from her friend that said, oh I was nauseous too, just try the ginger gummies from Whole Foods. It's

Emily Oster (19m 12s):

Trader Joe says ginger gummies. And it was just like, you're not listening.

Katie Ferraro (19m 15s):

Everybody has that friend. Like, but if you experienced or are experiencing pregnancy complication, any tips on how to deal with insensitive comments like that? Like do you block her forever? I mean that's, she's in the hospital for god's sakes.

Emily Oster (19m 27s):

I mean I think that one may, yes, but you know, I, I mean I think this is part of like, part of my advice is just for the, for the other person like hey your friends have like there's somebody you know who's experiencing some of these pregnancy complications. Like it's good for you to know what that means and you know this book, other resources are a good way for for you to to like just be a little aware before you open your, before you open your mouth.

Katie Ferraro (19m 49s):

And I think having the conversation is part of it. Like books like your book and other experts actually talking about this, it does for people who do wanna talk about it kind of opens the door to that. I know I'm the oldest of six kids, my mom and her best friend who has four kids, they would always talk like, oh we had 10 pregnancies, no problem, no miscarriages. And I was like, did you really like first trimester miscarriage? A lot of times, I mean she's like, and even if we did, we would never talk about it like you guys do. So with regard to first trimester miscarriage, how common is it? What tends to cause it and do you think that public figures discussing their pregnancy losses is helpful to other women who've experienced the same? Or is it sometimes like it's just causing a lot of noise that's causing even more hurt and grief and trauma?

Emily Oster (20m 29s):

The first trimester miscarriage is extremely common depending on, you know, where you would date like, so some estimates would suggest that sort of from like fertilization it's like 50%, but from kind of initial like when you'd be able to detect, detect a pregnancy, it's perhaps 25%. So you know as you go along in pregnancy, and this is actually part of why historically I think people might have coded this as less common. It's like if you can't detect a pregnancy until six weeks, actually you're down quite a bit like a, a pregnancy that's viable at six weeks actually quite a bit lower miscarriage risk than a pregnancy that's detected at four weeks. We start detecting them, you know, five days before your missed period, then we are gonna see more, we're gonna see more losses.

Emily Oster (21m 12s):

The vast majority of those like 90% are a result of chromosomal abnormalities. So something which a sort of a chromosomal issue. Too many chromosomes, not enough chromosomes, things crossing over which would be incompatible with life. And that's, you know, more common is people age. There are a few other factors that can make that more likely, although age is by far the most important and I think that 90% like that's really important because it is so, so common for people to be like, what did I do? You know? And I had a conversation with someone once who like had gotten pregnant sort of unexpectedly with a later child, like they weren't planning for it. And then, you know, I think she had some, was ultimately excited about it but initially had some feelings of ambiguity and then she, and then she miscarried and she said, you know, I can't, like I know I know that it's, it's chromosomes but I can't help a feeling that maybe I just didn't want it enough.

Emily Oster (22m 6s):

And that feeling like that's basically like made me cry talking about it like that is what I think we need people to, we need to try to combat that feeling

Katie Ferraro (22m 15s):

And that again it, that's not gonna show up in the data, that feeling right there. And so it's, it's the combination of being educated about science and facts but also understanding that like this is like a highly emotional hormone

Emily Oster (22m 27s):

Driven experience And she, I mean she's in front of me, I was like, I, you know that's not true. And she's like, I know, I know it's not, but it's, it's almost not about knowing, you know, it's about, it's about feeling.

Katie Ferraro (22m 36s):

Hey, we're gonna take a quick break but I'll be right back. When I was pregnant with my quads, which 50% chance of major handicap in a quadruplet pregnancy. And it was certainly not what we had planned for. Ironically it wasn't, I didn't even transfer, I had was doing medications for IVF having a bad round. The doctor's like, listen, you're not even gonna get any embryos outta this 'cause I'm not seeing hardly any eggs. I see three eggs here on your ultrasound. And I was like, well gimme that medicine that tells me exactly when I'm gonna ovulate. And she's like, you know, you diagnosed infertility, you're not gonna get pregnant. Sure but be careful there's three eggs on that ultrasound. You might get pregnant with triplets. Yeah whatever went to Santa Barbara like got pregnant the old fashioned way and then there was four eggs there and they all stuck and they, they all stayed.

Katie Ferraro (23m 23s):

And I remember when I went back for the 12 week follow up, I was praying that they would've reduced on their own because then there's a discussion of well now we want you to reduce down to two. And that was the recommendation. And when all four were still there, I remember feeling guilty about feeling bad that they were all still there and that wishing that they had reduced on their own 'cause then I wouldn't have to make this decision and you're like, like I didn't want this in the first place. Now I have, it's like the emotions that are surrounded by it, but at the end of the day I didn't really have any control over that. And so I think sometimes for parents that's where science can be really helpful. It's like listen, you don't actually have control over this or if this like you said is a chromosomal abnormality that it kind of took care of itself. Which I don't think that's a very medical term but I think for a lot of parents that that can be really comforting to know,

Emily Oster (24m 7s):

To know it's not something you did.

Katie Ferraro (24m 8s):

I mean I think exactly. But then of course you always think, you know, with with that glass of wine with with the coffee, the tuna, all the things that we worry about, especially early on in pregnancy and I know we talked about the first trimester miscarriage, you always hear like the second trimester that's supposed to be the golden age of pregnancy, a lot of the, you know, annoying first trimester symptoms that many people have subsided. You actually start to look pregnant. You you believe that this might turn into a viable baby. What sort of complications are more towards the second and the third trimester that you studied and covered in your book?

Emily Oster (24m 38s):

There are a lot of complications that arise later. There are some which are sort of more like things you would just manage. So like gestational diabetes is a good example of something where like everyone gets screened for that sort of, typically towards the end of the second trimester. It's actually quite common, it's very manageable. So it's not like many, it's never fun to be diagnosed with something and the test for gestational diabetes is incredibly unpleasant. But it's an example of something where like medicine really has a way to kind of dial this in and generally outcomes for pregnancies are sort of no worse than, than they would be otherwise. And then there are things, so like preeclampsia is reasonably common complication than arises towards the second and and third trimester and can be really, can be really devastating because it, it almost pits the health of the mom against the health of the baby.

Emily Oster (25m 29s):

And so the, the solution to preeclampsia is delivery and so sometimes you're just kind of waiting till like to try to get the baby as viable as possible while monitoring the health of of mom. So that's one where, where there's a little bit of good news, which is that we have that actually the risk of preeclampsia can be reduced with regular taking of, of baby aspirin, which is now a very common common prescription. But if it does occur it is, it is complicated to manage, requires a lot of management.

Katie Ferraro (25m 57s):

Can we talk about the role of race in pregnancy complications? How do maternal mortality rates differ among black Hispanic and non-Hispanic white women? And is this due to healthcare access or prenatal care or are there other factors at play?

Emily Oster (26m 12s):

So the most striking fact in this space is that that maternal mortality rates for black women are two to three times as high as they are for the average for white women. And you know, Hispanic women have a elevated rate also but not nearly as much. And so that is sometimes called the black maternal mortality crisis. Why that is occurring I I think is there are many factors which seem like they contribute and no single answer. So the risk of black women seem to not be fully explained. Maybe a bit explained by demographic differences but certainly not fully explained. So mortality complications or maternal complications for black women at the top of the income distribution are actually are worse than basically white women at the bottom of the income distribution.

Emily Oster (26m 58s):

So it's not, not income or not completely income is not completely education with a lot of talk about structural racism in hospitals. I think that that almost certainly plays some role. How much of it, it's not something that's very easy to, to evaluate when we talk about this I think it's almost always most, most valuable. Not so much to talk about like why is this occurring but to talk about what could we do? Like what are some solutions? And so one that I think is always really valuable to highlight is doulas. So a doula during birth, which is just to be clear not a midwife, it's a person who's not gonna deliver the baby but is a birth will will help. They are there doing various things. It turns out that that really improves birth outcomes across the board and is a very good idea.

Katie Ferraro (27m 44s):

Okay not to downplay the importance of race in maternal mortality rates, but across the board in the United States don't we generally have higher maternal mortality rates than in other developed countries.

Emily Oster (27m 54s):

We have a higher maternal mortality rate. This is a source of a lot of like fairly esoteric discussion. It's actually quite a hard number to measure and but by most of the measures we would have, our maternal mortality rate is is worse than our peer countries.

Katie Ferraro (28m 10s):

If you had a complicated previous pregnancy and then you're considering getting pregnant again, you in your book Emily, advise parents to fact find, whether that's finding support in your area or making professional accommodations at your job. What are some good resources or where should people look when they're seeking out these facts?

Emily Oster (28m 28s):

I'm gonna give one answer which is that the book I think is good for a lot of those questions but I do think these complications are so specific to individuals, like the sort of details of your complication are so relevant that the best source for this is going to be your doctor and your medical records. So before even like you should have access to your medical records, that should be part of how you prepare for thinking about another pregnancy. And you should be able to talk with your doctor about the details of what happened to you because things like we were talking about preeclampsia. So whether preeclampsia is likely to happen again and how significant it is depends tremendously on the circumstances of your preeclampsia last time.

Emily Oster (29m 10s):

So preeclampsia at 28 weeks is really different than preeclampsia at 38 weeks in terms of the recurrence risk, the likelihood of a, of a serious recurrence again et cetera. And so your doctor and your own history is way more important than any average data that you might be able to. And

Katie Ferraro (29m 28s):

That sounds so basic like yeah get copies of your records but like I don't think I did that.

Emily Oster (29m 34s):

Very few people do that.

Katie Ferraro (29m 35s):

You're right.

Emily Oster (29m 36s):

And you're entitled to them but almost nobody does.

Katie Ferraro (29m 39s):

Exactly. I was a diabetes educator for many years so I was happy to see you included a whole chapter on gestational diabetes. Could you just cover the known risk factors for gestational diabetes? I mean it sounds so scary and parents are like, does this mean I'm gonna have diabetes for the rest of my life and my baby's gonna have it? How is gestational different from what I think a lot of people just understand to be, you know, just your basic run of not run of the mill but type two diabetes that had does not have to do with pregnancy.

Emily Oster (30m 1s):

Yeah, so, so gestational diabetes is actually a kind of a poor name because it ends up being two basically two different things. So there are some people who have diabetes before pregnancy or are and it's not diagnosed and then the first time it gets diagnosed is during pregnancy because that's when they're seeing their doctor. And it turns out that is both likely to persist post-pregnancy because it was kind of there before pregnancy and it's also associated with slightly higher rates of complication because it suggests just more uncontrolled blood sugar to begin with. So for this reason, doctors will sometimes try to screen people who they think are at risk very early in pregnancy before the traditional screening to try to see if they have like undiagnosed diabetes.

Emily Oster (30m 44s):

The typical thing we think about and that actually the majority of what, what ends up as gestational diabetes is called gestational diabetes is diagnosed in the second trimester and is a result of pregnancy. So the experience of pregnancy, the like hormones, placenta, insulin resistance changes and then people can get diabetes during pregnancy. There are some risk factors like BMI and other demographic features but a lot of people are diagnosed with this like a lot of these risk factors are just gonna be genetic and plenty of people who exercise all the time and are at a healthy weight and end up with gestational diabetes and then they, it resolves post birth and you're managing during pregnancy with either changes in diet or insulin and then it, it resolves after birth.

Emily Oster (31m 33s):

One thing I will say is, is if you have gestational diabetes during pregnancy, you are at higher risk for type two diabetes later and that probably reflects some sort of common genetic sort of component. And so one of the things we say in the book is, you know when you see, when you have a conversation with a new primary care or somebody after when you get older you should always mention any of these complications you had during pregnancy. That's like an important part of your medical history for them to know about.

Katie Ferraro (31m 59s):

I was interested to learn that cerclage. So putting a suture or stitch around the cervix to prevent it from dilating too soon is an old well-known treatment but has no large scale randomized trial evidence for its efficiency. Are there other standard practices and obstetrics that you came across that just like get done because we've always done them that way.

Emily Oster (32m 17s):

I mean there are some that we know don't work but still get done. Like bedrest, bedrest is like a thing which is very commonly prescribed and there's very few if any complications for which it's actually shown to prevent preterm birth. I'm trying to think if there's anything else in this category of like we just do it

Katie Ferraro (32m 34s):

But bedrest is massive. Like anytime you have multiple pregnancy people like well did they put you on bedrest? And I was like, I wish, like no.

Emily Oster (32m 40s):

I would love to lie down. You shouldn't lie down too much, you get bed sores. And so yeah, I mean I think circlage is a, is a good example that, I mean there are other places where I think we're, we are like our evidence is more complicated than is sort of able to really be summarized like the, like Nate talks a bunch in the book about epi episiotomy. So we sort of know that like routine epi episiotomy sort of cut cutting to make it easier for the baby to come through. We know that routine epi episiotomy is not a good idea and Nate sort of makes the case in the book that like there are circumstances in which it is a good idea and we don't actually have all of the data we'd like to sort of understand if what if any of those are real.

Katie Ferraro (33m 19s):

I had to skip the part on app episiotomy 'cause I remember like I was pregnant with my first baby and you do like the hospital tour and stuff and when they started talking about it, my husband looked at me, he is like, I'm out and he just like left the tour and I was like, oh this bodes well. Like you can't even handle them talking, but it's not even actually happening. Like this is gonna be great. So since then it's something that, but again it's like they still do that like yeah sometimes.

Emily Oster (33m 41s):

Yeah, when we had, when we had our first hosp, our first baby we went to like the birthing class at the hospital and they showed this, like, they had this like, like illustration, don don't know like of, of like what happens with the baby comes through and it was like there was a turtleneck and there was like a doll and they were like pushing the turtleneck through doll. My husband was like totally freaked out and then they were like, do you have any questions? And this other couple was like, what? Like we heard that we've heard conflicting reports about whether you can get the baby's footprint put on like stamped onto that day's newspaper and I thought my husband was just gonna get up and be like, did you see where it comes out of just like you just like couldn't believe it.

Katie Ferraro (34m 21s):

And that's like we focus so much on, you know, getting to the point where you have the birth and then getting through the birth and that. I know a lot of new moms who are actually surprised like, oh I got so much bad after like, after the birth. There's so much stuff that couldn't go wrong. Not to scare people who haven't had their baby yet, but what are some common recovery complications just to be aware of and maybe educate yourself about so if they happen to you, you know how to handle 'em. Yeah,

Emily Oster (34m 42s):

So I think the, the first thing people should understand is like that like you will keep bleeding after birth for some period of time, even if you've had a c-section. I think it's often very surprising. Like people sort of think of people, some people think of the bleeding as like a result of the, like the the vaginal birth issues, but no, actually it's, it's the inside of the, the lotion, the uterus is sloughing off. So that will, that will happen for like potentially up to six, six weeks after birth. But the one thing I think is really important for people to have their eye on is postpartum mental health. So, you know, 10 to 15% of people will experience postpartum depression that's diagnosed, that's gonna be more than that for for many people and it gets, you know, often dismissed or undertreated.

Emily Oster (35m 32s):

We don't, I think screen enough for this. We kind of assume people are gonna get screened like when they show up at their doctor at their six week visit. Not everybody has that visit. That's actually not a great time to screen in the sense that like, people are up and out of the house and maybe that's, you know, they're, they're in front of their doctor. It's like it's not a time that maybe really is fully capturing how they're feeling. So one of, one of the things I will almost always recommend people do is like, have a plan to fill out this depression screen like every other week for all the adults in the household because that is a way to figure out like how are things going?

Katie Ferraro (36m 13s):

Hey, we're gonna take a quick break, but I'll be right back. In closing, I wanted to ask that the chapter on stillbirth was, I mean I was crying the whole time, it never happened to me. But as someone who talks to moms who've had lots of complications as part of your work and your students and what do you say or not say if you haven't gone through that yourself, but you want to express empathy but sometimes it's it, what are the words that you say to a mom that just had a stillbirth? Who's your friend?

Emily Oster (36m 45s):

So I've asked this a lot of times to people and what I get a lot is what not to say, which is things like, you know, well like everything happens for a reason or you know, it's lucky you already have a child. No one's particularly grim, but just things like, I think our instinct when we're talking to someone is to try to say something positive and in fact the best thing to say, maybe I am so sorry this happened, I am here with you. And that like, there may be nothing more that one really can say, there may be nothing more than one can say. And then people say, what should I do?

Emily Oster (37m 25s):

And the answer is like, drop off food. Like things that don't require anything of them. Don't ask if they need food, put food outside their house, text them and say there's food outside your house. If they don't want the food, they'll throw the food in the trash. It's fine. Like ra you know, sort of be the, try not to ask things of people and also try not to make things feel better

Katie Ferraro (37m 46s):

Because it's not, it's not okay.

Emily Oster (37m 47s):

It's just not okay. Its a terrible thing.

Katie Ferraro (37m 48s):

It's a terrible thing. It's a hard thing to write about. It's a hard thing to teach about. Thank you so much for putting this book in the world because I think if we don't go into pregnancy thinking, I mean there's a tendency to think like what's the worst thing that's gonna happen? But it's like, well instead of just wondering about it, like you should educate yourself about it and here's some things that might happen and how to deal with it. And if it's happened to you before, I know for a lot of parents they're, they're scared to expand their families and so I love the data about listen, there is a risk, it's this much and you also need to put your own personal touch on all of these decisions yourself. And, and as much, it's funny 'cause as as much as you are like the parent data person, a lot of it is like at the end of the day the data's not gonna answer it for you. I mean, here's a path to look at, but it's ultimately up to you. So where can our audience go? Where do you prefer them to get the book from?

Katie Ferraro (38m 30s):

I always like to ask authors.

Emily Oster (38m 32s):

I am delighted for people to buy the book anywhere they, that they can find it.

Katie Ferraro (38m 36s):

And where can our audience go to learn more and listen to you teach about a variety of topics related to pregnancy and parenting.

Emily Oster (38m 43s):

Parentdata.org is where we have all of our resources on pregnancy parenting, there's like 1500 articles. It is all your parenting, pregnancy and reproductive health questions.

Katie Ferraro (38m 52s):

Your new site is beautiful by the way too. So not only is it informative, but it's also pleasant to look at my.

Emily Oster (38m 57s):

Beautiful pictures.

Katie Ferraro (38m 57s):

Okay. I have to ask you one final question. Last time I interviewed you I was blown away because I think you're talking about summer camp preparation and that you would like make an Asana task for your husband and then he would actually do them. Is that, are you guys still like doing Asana with each other? 'Cause that's awesome.

Emily Oster (39m 14s):

We haven't used as much test management. We've really, 'cause the kids are a bit bigger and we're not in the middle of any large projects, but we, we do have a very elaborate email, ongoing email and Google doc system. Although I realize recently now my oldest kid is 13 and we recently realized she's only using the Google Auto replies. And so she isn't, she like, sometimes you'll think she's read an email because you'll get something back that's like, thanks for letting me know about this. But that's actually what Google suggests.

Katie Ferraro (39m 41s):

There will be a quiz on this email. We're about to start a yard project like with for our kids. And I was thinking about like putting together an Asana board. Like don't, you know, you were, he has a corporate job and like respond to like, how can you always be on time for that conference call yet? Like, I asked you to come in at this time and help me with dinner and you can, but like maybe just using the tools from corporate world in your personal life would help.

Emily Oster (40m 0s):

I'll try. Yes. You need the, you need the calendar invites. I mean my, my husband really likes a calendar invite and you know, that's, that works.

Katie Ferraro (40m 8s):

We moved to a shared calendar for kids sports 'cause like, it's insane. And I said I would never do it and it changed my life. So you, you can teach an old dog new tricks, it turns out. Well thank you so much for the conversation. I really appreciate it.

Emily Oster (40m 18s):

Thank you so much for having me.

Katie Ferraro (40m 20s):

Well I hope you enjoyed that interview with Emily Oster. I love how succinct and down to earth she is. Like she's got the economist vibe where like she's all business, but then she also is like a real life mom and has those experiences to share as well. I'm gonna share all of the resources that Emily covered in this episode in the shownotes, which those will be online at blwpodcast.com/454. A special thank you to our partners at AirWave Media. If you guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave or online at blwpodcast.com. Thanks for listening and I'll see you next time.