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Evidence-Based Pregnancy
August 13, 2013 6:53 AM   Subscribe

Take Back Your Pregnancy When she got pregnant, Emily Oster, associate professor of economics at the Booth School of Business at the University of Chicago, she found herself faced with the laundry list of rules that pregnant women have been handed for years regarding coffee, alcohol, soft cheese, deli meats, and so on. But when she looked at the studies behind the guidelines, she was surprised to see that most of them failed to make the distinction between causation and correlation.

In her article, Oster looked at several different issues that come up during pregnancy. For example, she looked at research regarding listeria, a bacteria that can cause miscarriage and stillbirth in pregnant women. Accordingly, pregnant women have been instructed to avoid deli meat, sushi, soft cheeses and other items. However, when she looked at what causes listeria, she found that since 1998, about 20% of listeria cases have been traced to the Mexican soft cheese queso fresco and 10% to sliced turkey.

"I concluded that avoiding queso fresco and deli turkey was a good idea, but in the end I didn't feel that it made sense even to exclude other deli meats," she wrote. "My best guess was that avoiding sliced ham would lower my risk of listeria from 1 in 8,333 to 1 in 8,255."

Oster's article focuses on two items that pregnant women are specifically discouraged from consuming - alcohol and coffee. Coffee consumption has been linked to miscarriage but coffee consumption generally is higher among older women, who are more likely to miscarry than younger women, independent of their coffee consumption.

Another reason that coffee consumption might be linked to miscarriage is related to nausea. Experiencing nausea frequently indicates that a pregnancy is going well but since coffee can cause upset stomach, women may not drink coffee if they're nauseous. The author herself is a coffee drinker but she skipped it when she felt nauseous in the beginning of her pregnancy.

Moreover, other sources of caffeine including tea and soda are less frequently associated with higher rates of miscarriage and are easier on the stomach, implying 1) that there's something specific about coffee drinkers as a population and 2) the nausea connection is important.
posted by kat518 (173 comments total) 74 users marked this as a favorite

 
Ha, this rang true: Being pregnant was a good deal like being a child again. There was always someone telling me what to do and there I was, doing whatever I wanted anyway, brattily screaming YOU CAN'T TELL ME WHAT TO DO. Great article!
posted by ThePinkSuperhero at 7:06 AM on August 13, 2013 [13 favorites]


I don't think the problem here is the original studies. The problem here is people applying multiple levels of "better safe than sorry" to the original instructions by expanding the the risk category and exaggerating the amount of risk:

deli turkey slightly increases risk -> deli meats increase risk -> deli meats will kill your baby

The only way to fix this problem is to increase the information passed along at every level OR reduce the number of levels.
posted by DU at 7:06 AM on August 13, 2013 [11 favorites]


I met a woman who told me she was so sad about not being able to eat soft-serve ice cream this summer. When I asked why, she said "I plan to get pregnant in the next year." Granted, I'm not the one with the baby, but that seemed to be going a bit far.
posted by showbiz_liz at 7:06 AM on August 13, 2013 [19 favorites]


Pregnant/TTC* complaining about the food they "can't" eat is one of my personal pet peeves. You, A, chose to get or stay pregnant, and B, are choosing not to eat soft-serve/deli meat/ceasar dressing. There is no "can't". There is no Pregnancy Jail. You can do whatever you want, particularly in the privacy of your own kitchen where no one is watching.


*Trying To Conceive, popular acronym on mommy boards
posted by ThePinkSuperhero at 7:19 AM on August 13, 2013 [12 favorites]


The problem I see is that everyone else around pregnant ladies hound them constantly about their choices, even random strangers. Try ordering glass of wine when you are 8 months pregnant at a restaurant and see what happens. I drank moderately throughout my pregnancies, but I refused to do it in public because I just didn't want to deal with the opinions of other people.
posted by tafetta, darling! at 7:27 AM on August 13, 2013 [53 favorites]


I am 100% on board w/ this article. I think that she is doing the smart thing by evaluating the data and making her own decisions rather than just taking all the ridiculous rules that get batted about. And the rules are different for everyone. For instance, her judgement that too much weight gain was not as bad as too little weight gain may have been true for her, but if you are a heavier person this is absolutely not true. The big risk for too much weight gain is gestational diabetes, which if you get it will immediately make your pregnancy a high risk pregnancy, with all the short and long-term risks that entails. A lot of what separates a good OB/Gyn from an okay one in my book is their ability to communicate to you what the real risks of your own pregnancy are.
posted by NathanBoy at 7:27 AM on August 13, 2013 [4 favorites]


If eating blue cheese during pregnancy is actually fine, this may drastically alter my life plan regarding future biological offspring.
posted by greenish at 7:30 AM on August 13, 2013 [7 favorites]


There is no Pregnancy Jail.

No, but Texas is working on it.
posted by maryr at 7:30 AM on August 13, 2013 [162 favorites]


One of the biggest mistakes I made so far in my pregnancy was giving up coffee "just in case." Through most of my first trimester, I felt like I was going to die. I thought this was somehow normal until one morning, groggy and miserable, I poured myself a cup and felt like a human being again.

This, despite the fact that I'd done some research into the studies behind the suggestion not to drink coffee. One oft-cited study links drinking eight or more cups a day to an increased risk of stillbirth. However, the same data shows that those who drank zero cups of coffee a day had a marginally higher stillbirth rate than those who drank one to three cups a day. But I cut it out anyway because all these people were telling me it was a good idea. Just in case. Even though, you know, I wanted to die.

Being pregnant is hard enough without going through caffeine withdrawal, too.

I've recommended it a few times on the green, but this book is pretty good at analyzing the study data in a similar way to the article. The author is perhaps more conservative about possible listeria risks than I am (even as he notes that listeria cases even during pregnancy are "extremely rare" and "extraordinarily unlikely"--unlike, say, dying in a car accident on any given car trip), but then, no one gets between me and my soft serve.
posted by PhoBWanKenobi at 7:36 AM on August 13, 2013 [13 favorites]


Pregnant/TTC* complaining about the food they "can't" eat is one of my personal pet peeves.

OK, but listeriosis, fetal alcohol syndrome and mercury poisoning are real things. Cases may be rare, but there is a valid, scientific basis for avoiding soft cheeses, alcohol, and large fish/shellfish during pregnancy. Some killjoys also frown on smoking during pregnancy.
posted by three blind mice at 7:36 AM on August 13, 2013 [7 favorites]


This is a bit grim but I'm reminded of a part in a book I read about the Middle East where people in Israel were trying to explain/rationalize the occasional bombings. "Oh, your friend was on a bus that exploded at 3 p.m. on Tuesday? Everyone knows that you should never take that bus on Tuesday afternoon."

In some ways, I think that people try to explain/rationalize miscarriage and other things that can go wrong during pregnancy. "You looked at a glass of wine? Watched a movie where people smoked? Walked past a sushi restaurant? That's why your pregnancy didn't work out."

A lot of pregnancies end in miscarriage. Most of the time, no one knows why. These types of rules are helpful in some ways. No one (to my knowledge) encourages binge drinking during pregnancy. But there isn't a lot of evidence behind these rules. They give women who follow them a false sense of security when things are going well and make women feel awful when things don't go well.

A loved one who had a pregnancy end badly blamed herself for eating a turkey sandwich. She had other risk factors related to her pregnancy but in some ways, it's easier to say, next time, I won't eat a turkey sandwich instead of next time, I won't have a high-risk pregnancy.

Getting pregnant, being pregnant, and having a baby all have risks. So does being alive. Everyone should have the information to evaluate what risks they actually needs to worry about. I think that's what this article is about.
posted by kat518 at 7:37 AM on August 13, 2013 [32 favorites]


> I don't think the problem here is the original studies. The problem here is people applying multiple levels of "better safe than sorry" to the original instructions by expanding the the risk category and exaggerating the amount of risk...

This is more or less it. A five year logitudinal study whose five hundred word conclusions section includes something along the lines of "A slightly (<0.001%) elevated correlation between exposure to moderate amounts of alcohol and fetal abnormalities" will never get play on its own. It's usually not the researchers who exaggerate their findings; they're misrepresented by their institutional PR people and latched onto by news media grubbing for viewer ratings, and promulgated by pundits who know they're only onscreen for their credentials, and that they won't get called back if they contradict a sensationalist interpretation.

Pretty much all food, health, and diet fads are built on things like that.
posted by ardgedee at 7:38 AM on August 13, 2013 [6 favorites]


Today I learned that you could rewrite "My Favorite Things" for me and it would basically be a list of what pregnant women are told not to eat.

I met a woman who told me she was so sad about not being able to eat soft-serve ice cream this summer. When I asked why, she said "I plan to get pregnant in the next year." Granted, I'm not the one with the baby, but that seemed to be going a bit far.


You know that thing where you laugh louder than is actually warranted because if you think about something too much it makes you want to cry because of what it says about the world? That just happened.
posted by MCMikeNamara at 7:38 AM on August 13, 2013 [7 favorites]


The only rules my wife followed were the ones set by her doctor and her midwife (who had an MSc in nursing and 40 years of experience). Seems like a no-brainer, but then again we also believe in vaccination.
posted by KokuRyu at 7:41 AM on August 13, 2013 [14 favorites]


@PhoBWanKenobi, my heart goes out to you. Selfishly, that was one reason I was so into this article. And I hate it when people are like, if you can't go nine months without drinking coffee/drinking alcohol/leaving the house/listening to rock music, you aren't going to be a good parent.
posted by kat518 at 7:44 AM on August 13, 2013 [2 favorites]


She's an economist. Does she have any medical experience? Any experience treating significant numbers of pregnant women, medically? Anything other than her own anecdotal evidence to fall back on when it comes to pregnancy?

She's advocating a bit of the "common sense" approach to pregnancy. Which is fine, but the problem is, all pregnancies don't fit a specific mold. Every single one is different because the physical, biological relationship between a mother and her baby includes a huge number of factors which can affect (among other things) an embryo's implantation success rate, the fetus' overall development and whether the pregnancy remains viable -- for many different values of "viable." Including whether the pregnancy ends early, why it might do so and if the baby is far enough along to survive the transition from womb to the outside world.

Here's the problem: an individual pregnancy may be affected by a variety of risk factors that the pregnant woman may not be aware she has. That her OB may not necessarily be aware of. For example, we now know a bit about pre-eclampsia, but not enough to predict with anything close to 100% accuracy when it might be a problem.

So when quantifying risks to mother and child, it's difficult to speak with any accuracy in any but the most general terms. Analysis is more difficult in the case of pregnancy because the causes of certain problems that may arise during pregnancy are not wholly quantified or predictable. Why do some women develop pre-eclampsia while others don't? Or show early cervical dilation? Or develop anemia? The reasons why many conditions develop during pregnancy can be complex and all we can do is analyze and try to reduce risk factors. So the reason obstetricians and perinatologists err on the side of caution is obvious. The "stupid rules" which people complain about help decrease risk in the larger population.
posted by zarq at 7:45 AM on August 13, 2013 [8 favorites]


not being able to eat soft-serve ice cream

No, no, there is no way I'm telling my wife she shouldn't eat Mr. Softee because his soft-serve machine probably hasn't been cleaned since Beanie Babies were a Thing.
posted by uncleozzy at 7:50 AM on August 13, 2013 [1 favorite]


In all our research and discussions with our midwife, coffee/caffeine was the only thing my wife cut out.

FWIW, this article is totally worthless without WEED. Does it affect the fetus? Is vaporizing better than smoking? We need more research!!!

It's the question every pregnant woman is afraid to ask (b/c if you think you get shit for drinking wine, wait till someone sees you smoking a joint at 8 mo. pregnant.)

And yeah, what tpm and zarq said. Every pregnancy is different, and those risks are indeed risks.
posted by mrgrimm at 7:51 AM on August 13, 2013 [4 favorites]


OK, but listeriosis, fetal alcohol syndrome and mercury poisoning are real things. Cases may be rare, but there is a valid, scientific basis for avoiding soft cheeses, alcohol, and large fish/shellfish during pregnancy. Some killjoys also frown on smoking during pregnancy.

Auto accidents are real things--the cause of 2.2% of all deaths worldwide. "Motor vehicle crashes are the leading cause of fetal deaths related to infant trauma." If the purpose of these guidelines is to reduce risk to the fetus, it would be sensible to also recommend that women not be drivers or passengers in motor vehicles.

But they don't, because it's not only about reducing risk to the fetus. A woman, even a pregnant woman, is more than just a vessel for a fetus--she is also an individual. With, you know, a life. And rights.

But it's much easier to police a woman's dietary choices than to restrict her liberty and physical movement, even if telling her to stay home and stay out of cars would likely reduce fetal death more than telling her not to eat some damn brie cheese.
posted by PhoBWanKenobi at 7:51 AM on August 13, 2013 [122 favorites]


(I should also say we are vegetarian, so that nasty lunchmeat is not a concern.)
posted by mrgrimm at 7:52 AM on August 13, 2013


But it's much easier to police a woman's dietary choices than to restrict her liberty and physical movement

(Unlike weed), you won't get arrested for eating deli ham while pregnant, nor have your children taken away from you. Let's not get overdramatic here.
posted by mrgrimm at 7:54 AM on August 13, 2013 [3 favorites]


I think what we can glean from this is that two year olds are assholes.
posted by phunniemee at 7:56 AM on August 13, 2013 [7 favorites]


(Unlike weed), you won't get arrested for eating deli ham while pregnant, nor have your children taken away from you. Let's not get overdramatic here.

No, what I meant was that, even though it's riskier, if you tell women to stay out of cars people will be very mad about their restricted liberty--literally, their ability to physically move around and go to work and go to Lowes because I really need to undertake five thousand home improvement projects now, right now (not that I know anything about that). It's a more obvious encroachment on one's freedom than diet. But also our society has a general attitude that dietary policing, especially of women, is socially acceptable.

It's clearly about more than "risk."
posted by PhoBWanKenobi at 7:58 AM on August 13, 2013 [33 favorites]


She's an economist. Does she have any medical experience? Any experience treating significant numbers of pregnant women, medically? Anything other than her own anecdotal evidence to fall back on when it comes to pregnancy?

The amount of medical experience you need to effectively evaluate the statistical methods and models used in the studies is exactly zero. Instead, crazily enough, the relevant experience would be with evaluating and using statistical methods and models. Wanna guess how working economists spend a lot of their time?
posted by ROU_Xenophobe at 7:59 AM on August 13, 2013 [94 favorites]


She's an economist. Does she have any medical experience? Any experience treating significant numbers of pregnant women, medically? Anything other than her own anecdotal evidence to fall back on when it comes to pregnancy?

Erm, I thought at least part of the point of the article was that she wasn't relying on anecdotal evidence but on scientific evidence taken from published research.
posted by logicpunk at 7:59 AM on August 13, 2013 [19 favorites]


Cases may be rare, but there is a valid, scientific basis for avoiding soft cheeses, alcohol, and large fish/shellfish during pregnancy. Some killjoys also frown on smoking during pregnancy.

Sure, and feel free to avoid anything you feel you should. But don't complain to me about it. It's the complaining that makes me batty.
posted by ThePinkSuperhero at 8:00 AM on August 13, 2013 [4 favorites]


I thought at least part of the point of the article was that she wasn't relying on anecdotal evidence but on scientific evidence taken from published research.

But... but... she's a woman! Can she do that?
posted by scody at 8:01 AM on August 13, 2013 [39 favorites]


There are some dumb pregnancy books out there. I was given a few as gifts, and one of the worst of them recommended I avoid standing near the microwave because it could cause birth defects.

"Congratulations! You're pregnant! Go live in a cave until you give birth, because everything will kill you and your baby."
posted by schnee at 8:02 AM on August 13, 2013 [2 favorites]


Actually cave habitation is associated with a 20% risk of spontaneous rupture of membranes and premature labour. Sorry.
posted by chiquitita at 8:03 AM on August 13, 2013 [24 favorites]


kat518: " A lot of pregnancies end in miscarriage. Most of the time, no one knows why."

We know many causes of miscarriage, but determining why a specific pregnancy ends may require additional testing. Which most women (and men) are likely unwilling to undergo unless they experience several miscarriages and seek out the help of a fertility specialist. The most common causes of miscarriage are chromosomal abnormalities, immunological or hormonal disorders including PCOS/PCOD, uterine abnormalities, or outside influences, such as an infection or smoking.

logicpunk: " Erm, I thought at least part of the point of the article was that she wasn't relying on anecdotal evidence but on scientific evidence taken from published research."

And my point (sorry, I thought I was being clear, but I guess not, apologies) was that I believe she's relying on false assumptions gleaned from her personal experiences -- i.e. taking it for granted that analysis of pregnancy as a condition can be so simplistically reduced.

scody: " But... but... she's a woman! Can she do that?"

You know scody, I like and respect you a great deal. But this is a supremely shitty fucking thing to say. You and I both know damn well that's not what I'm saying. And yet you're accusing me of sexism?
posted by zarq at 8:05 AM on August 13, 2013 [2 favorites]


But it's much easier to police a woman's dietary choices than to restrict her liberty and physical movement, even if telling her to stay home and stay out of cars would likely reduce fetal death more than telling her not to eat some damn brie cheese.

Certainly your statistics are correct PhoBWanKenobi, but deaths due to automobile accidents apply to all people and not just pregnant ones.

It may be a remote chance that eating brie will result in a miscarriage, but the harshness of the result introduces significant skewness into one's perception of the likelihood of risk. Surely an economist knows about that?
posted by three blind mice at 8:06 AM on August 13, 2013 [3 favorites]


She's an economist. Does she have any medical experience?

Is medical experience, particularly experience in family practice or obstetrics, training enough to adequately evaluate statistical methodologies and to understand false positive and negative errors in factor matrices? I've helped educate pre-meds (chemistry), have had several friends and family members go through the process. Most doctors are about as statistically literate as any generic science bachelorate, which is to say, not very much.

I agree, professional qualifications in a quantitative statistics, like a lot of economists have, is quite relevant to this question.
posted by bonehead at 8:08 AM on August 13, 2013 [26 favorites]


My OB/GYN practice was surprisingly hands-off with any recommendations, given what I'd been expecting based on hearing about others' experiences. I was given a list of meds that were fine to take, and told to pretty much just live my life. They did throw in a free copy of "What to Expect", so I guess they assume everyone reads that. I'm pretty well versed in stats, so I've been doing something like the author here has done, and looked for the reasons behind the recommendations. I have eaten deli meat, I do drink caffeine (keeping it below the 200-300mg level), and I found that the cheese issue is mostly for unpasteurized cheeses anyway.
posted by bizzyb at 8:09 AM on August 13, 2013 [2 favorites]


bonehead: " Is medical experience, particularly experience in family practice or obstetrics training enough to adequately evaluate statistical methodologies and to understand false positive and negative errors in factor matricies?

Extensive experience can help a medical professional identify whether a particular person is likely to have a specific risk factor, yes. It can also help them establish a "risk baseline" so to speak. But the point I'm making is that this sort of thing isn't so easily quantifiable or generalized.
posted by zarq at 8:10 AM on August 13, 2013


One of the biggest mistakes I made so far in my pregnancy was giving up coffee "just in case." Through most of my first trimester, I felt like I was going to die. I thought this was somehow normal until one morning, groggy and miserable, I poured myself a cup and felt like a human being again.

I did this too for about 6 weeks, then when I mentioned it to my OB she was like, "Why would you do that? You're totally fine to have two cups a day; the evidence linking less than 200 mg / day of caffeine to adverse outcomes is conflicting and not particularly solid." (There's a great write-up on Junkfood Science that really pushed me over to the side of not being at all concerned about my lovely, lovely cup of coffee every morning.)

I have to say though, I've found it surprising how sensitive I am to other people's comments about how I "should" be eating. I'm usually the sort of person who doesn't take other people's different choices personally or as an affront to my own, but there's something oddly embarrassing about correcting a coworker who jokes about how much tougher mornings must be for me with no coffee. And I can recognize that by and large it's not been people who are trying to police my food intake or make me feel bad, they're just incorrectly assuming something that makes me feel really defensive. It's made me reflect a bit more on the "mommy wars" between SAHMs and WOHMs and how there's something about parenting that seems to make people feel judged and defensive when confronted with people making different choices.
posted by iminurmefi at 8:11 AM on August 13, 2013 [12 favorites]


Zarq, I didn't take scody's comment that way. I took it as that's what other people would say.
posted by IndigoRain at 8:12 AM on August 13, 2013 [7 favorites]


And yet you're accusing me of sexism?

Pretty sure she was making a joke. If scody thinks you are a sexist, scody will just say that.
posted by jessamyn at 8:13 AM on August 13, 2013 [24 favorites]


Diagnostics are not the same skill set as understanding how to interpret a statistical study, not even slightly.
posted by bonehead at 8:13 AM on August 13, 2013 [3 favorites]


What is the required dose, what is the risk per dose, and are you willing to deal with the consequences if you are that one in several tens or hundreds of thousands that ends up suffering?

(For the author, the answers are massive, in the tens of thousands, and yes).
posted by Slackermagee at 8:13 AM on August 13, 2013 [1 favorite]


Certainly your statistics are correct PhoBWanKenobi, but deaths due to automobile accidents apply to all people and not just pregnant ones.

Listeriosis impacts something like three people out of a million per year. Of those three people, they are 30% more likely to be pregnant women than not. But it is still very very very rare.

It may be a remote chance that eating brie will result in a miscarriage, but the harshness of the result introduces significant skewness into one's perception of the likelihood of risk. Surely an economist knows about that?

This is true for other risky behavior during pregnancy--including getting into your car. Many injuries and illnesses have a "harsher" outcome during pregnancy.
posted by PhoBWanKenobi at 8:15 AM on August 13, 2013 [9 favorites]


It may be a remote chance that eating brie will result in a miscarriage, but the harshness of the result introduces significant skewness into one's perception of the likelihood of risk. Surely an economist knows about that?

She determined what cheese (queso fresco) was actually linked to listeria and cut that out of her diet. She's advocating a more scientific and less paranoid approach to pregnancy, not arguing against taking any precautions.
posted by mmmbacon at 8:16 AM on August 13, 2013 [26 favorites]


I was just looking at statistics for SSRIs during pregnancy as well. What a shitty tradeoff:

"Infants born to mothers who took selective serotonin reuptake inhibitors (SSRIs) after the 20th week of pregnancy were 6 times more likely to have persistent pulmonary hypertension (PPHN) than infants born to mothers who did not take antidepressants during pregnancy (see SSRI drug names at the bottom of this sheet). The background risk of a woman giving birth to an infant affected by PPHN in the general population is estimated to be about 1 to 2 infants per 1000 live births."

Ok thats bad, so stop taking anti-depression/anxiety meds right?
YET

women who discontinued antidepressant medication during pregnancy had a higher risk of relapse of major depression during pregnancy (68%) than women who maintained antidepressant medication throughout pregnancy (26%)

70 fucking % of women who stopped taking meds during pregnancy developed MAJOR depression. Like the life-ending, don't take care of yourself, ruin-shit kind of depression.

1/6 chance of increasing death of baby in childbirth by .002% OR 70% chance of going off the deep-end. That must really suck to contemplate.
posted by Potomac Avenue at 8:16 AM on August 13, 2013 [20 favorites]


Also, I'm wondering how much of the 'I shouldn't do that it might disrupt activity x' is heightened for pregnant women as they will occasionally be sent to jail for making a mistake they weren't educated to enough to know that they were making. Particularly in those states where the anti-abortion/medical choice constriction laws are in full force.
posted by Slackermagee at 8:17 AM on August 13, 2013 [3 favorites]


Extensive experience can help a medical professional identify whether a particular person is likely to have a specific risk factor, yes.

No. No no no no no. Being the guy that supervises the bumper cars at the amusement park doesn't make you better qualified to decide whether there's a statistically significant risk to riding in the cars. The fact doctors wear white coats and go to school doesn't make them any different. If economics/ statistics can teach us anything, it's that human brains are not wired to draw good conclusions from data.

Specific to your suggestion about "a specific risk factor", which ones is she ignoring? The whole takeaway from the article for me (full disclosure: I majored in Economics and never used it + our first child is on the way in November and I've been feeling guilty about what my wife has to give up) is that there are no specific risk factors identified. The issues she mentions seem to me to specifically resist being tied to specific factors about the mother.
posted by yerfatma at 8:17 AM on August 13, 2013 [19 favorites]


Sorry, zarq, first-thing-in-the-morning-without-my-coffee joke. Not accusing you of anything.
posted by scody at 8:23 AM on August 13, 2013 [5 favorites]


IndigoRain: "Zarq, I didn't take scody's comment that way. I took it as that's what other people would say."

jessamyn: " Pretty sure she was making a joke. If scody thinks you are a sexist, scody will just say that."

Ugh. Okay. Sorry, scody. Obviously I misread your tone.
posted by zarq at 8:23 AM on August 13, 2013 [7 favorites]


scody: "Sorry, zarq, first-thing-in-the-morning joke. Not accusing you of anything."

No worries. I need to calibrate my joke meter.
posted by zarq at 8:24 AM on August 13, 2013 [3 favorites]


No worries on my side either. I may need to calibrate my joke meter as well.
posted by scody at 8:25 AM on August 13, 2013 [1 favorite]


/pours coffee for everyone, yes even the the pregnant people
posted by rtha at 8:27 AM on August 13, 2013 [36 favorites]


threeblindmice: OK, but listeriosis, fetal alcohol syndrome and mercury poisoning are real things.

And being real things, they are caused by real things, not fears and supersititions. Fetal alchohol syndrome, for example, is not caused by light to moderate drinking late in the pregnancy. We could present reality to mothers, but instead we take the "hot lava!" approach to everything.
posted by spaltavian at 8:28 AM on August 13, 2013 [26 favorites]


A wine writer friend of mine, Evan Dawson, went through the literature on consumption of alcohol during pregnancy, and wrote about his (non-scientist) understanding of the conclusions, the media's role in all of this, and I feel like it hasn't gotten enough attention, so here it is.
posted by knile at 8:28 AM on August 13, 2013 [6 favorites]


To be fair, everybody, especially men in positions of authority, like telling women, especially pregnant women, what to do. Well, they also like telling new mothers what to do. If we, as a society, stopped doing this, our self-satisfaction scores would drop by an estimated 37.35%. So there is that.
posted by GenjiandProust at 8:30 AM on August 13, 2013 [3 favorites]


I think it's important to note that guidelines about foods to avoid are different in different cultures. In Australia, for example, it's recommended that women avoid bagged salads due to listeria risk. Bagged salad has been linked to listeria in the US, too, so I'm not entirely sure why it doesn't make the list here while hot dogs and soft serve do.
posted by PhoBWanKenobi at 8:33 AM on August 13, 2013 [2 favorites]


Being the guy that supervises the bumper cars at the amusement park doesn't make you better qualified to decide whether there's a statistically significant risk to riding in the cars.

This is exactly why we dismissed one of the potential offices/doctors for mseld's pregnancy.

The doctor in question kinda talked the talk regarding statistics and risk factors with respect to our questions about do's/dont's/the birth process/etc, of which we have quite a few as well as what is likely an above average understanding of some of the research and implications thereof since mseld is in the final months of an intensive clinical research geared PhD program, and then blew it all to hell at the end by saying something magnanimous like

'... But really all those statistics don't really matter so much as our opinion and we just know what has to be done.'

MsEld and I looked at each other and knew we could probably start wrapping this up about now.

It's sad to say that we constantly got the impression that her (perfectly normal so far) pregnancy defaulted to a disease that needed to be treated with kid gloves and, potentially extreme, medical interventions. We've since found a great midwife we like who, as could be expected I suppose, believes in treating the process as something natural that will usually tend to go ok with current monitoring/medical supervision and if it doesn't then we'll use the wonderful tools modern science has provided us. It's exciting and a hell of a load off our minds. I hope all women can find someone they feel comfortable with to guide them through their pregnancy.
posted by RolandOfEld at 8:35 AM on August 13, 2013 [7 favorites]


We could present reality to mothers, but instead we take the "hot lava!" approach to everything.

Well put.
posted by RolandOfEld at 8:38 AM on August 13, 2013


It's clearly about more than "risk."
Being familiar with the anthropological work of Mary Douglas, who sort of put risk on the map is handy here. Two questions: Who decides what risk is, and what do we do about people who take "unecessary" risks. (Purity and danger...if you're impure, you're in danger! Funny thing, some foods have been viewed as "polluting" at various times and in various cultures. It's no accident that we continue to view food as a "risk!") In a nutshell, Societies have to agree on what is "risky" in order to function as cohesive units. This is why folks with crippling fear of flying are not generally considered unhinged, but if someone told you they were too terrified of automobiles to get in one, most people would at least look askance. Yet, the statistics indicate that getting into an airplane is much less likely to cause you death or even grave bodily injury (as compared to driving or being an automobile passenger.) A common example given for this is the cause of malaria. Engage people with the fact that a parasite carried by mosquitoes is involved (don't just Tell them, Engage them!) and they will shift their behavior. Look further...volcanoes and plate tectonics! Lecture at them that they're stupid or backward for believing in witchcraft or a god that requires a virgin sacrifice, and you will make no progress.

Wave a bunch of scientific "evidence" at women without actually giving them access or tools to really Engage with the material, and you can certainly scare them into a lot of behavior. Without a broader view of the implications of choices, women can be scared into or out of all kinds of things. But I, for one, believe that much is lost.

zarq, I think that scody was making a jab at generalized pearl clutching combined with a long history of anti-woman tactics, and not at you specifically. I do think many people here are trying to point out that you may be caught up in some structural sexism that isn't easily recognized because your life as a pregnant person has not been and never will be proscribed to the extent that actual pregnant people have and/or will experience. The fact of deli turkey being potentially dangerous is not something in dispute here. What is upsetting your interlocuters is extending that risk category to ham and other meats, without any evidence that this is warranted. Ditto on the cheese front. The queso fresco listeria outbreaks mentioned above? Those were limited to very specific manufacturing locations that were not cleaning properly, and/or not pasteurizing the milk/product, and not to all queso fresco everywhere. The vegetable sources of listeria are NOT DISCUSSED in scaring (ahem, "informing") mothers. But a major recent outbreak was caused by fresh cantaloupe. How do you think you kill listeria? You cook it. How do you cook canteloupe? You don't. Remember the green onion Hepatitis outbreak a few years ago? How are green onions eaten? Raw. Risk is real, but it is not as easy to pin down as "medical professionals" would have us believe. Women are not yet being told to grow all their own produce at home, to protect from listeria, hepatitis and (I wish I were kidding) salmonella. (I'll save the explanation of the most common ways for salmonella to get into/onto produce for another day.)

Extensive experience can help a medical professional identify whether a particular person is likely to have a specific risk factor, yes. It can also help them establish a "risk baseline" so to speak. But the point I'm making is that this sort of thing isn't so easily quantifiable or generalized.

What I find especially problematic with your statements here is that medical professionals here do not actually seem to take into account real risk factors of the pregnant woman they are treating. If that were the case, the United States would not be in the appalling position it is with regard to maternal and infant mortality and morbidity. Our caesarean section rate would be...drastically lower than it is. Yet, women in the US are having c-sections at astonishing rates, while other nations are doing much better with fewer resources.

I'm a big fan or body autonomy. I'm just as big a fan of actual, real, informed consent. Scare tactics are not information. Pregnancy is hard and is in fact dangerous to women, with lifelong consequences that range from not even noticeable to severe. It seems a shame to me that real dangers are not discussed, or are glossed over, while we argue here about ham and brie.
posted by bilabial at 8:39 AM on August 13, 2013 [29 favorites]


Bagged salad has been linked to listeria in the US, too, so I'm not entirely sure why it doesn't make the list here while hot dogs and soft serve do.

+1 for melons, one of the more recent listeria outbreak sources.

This is why the food recommendations drive me batty. They are very strict - I got a list of foods I should avoid with zero caveats. The problem is the list doesn't seem to correlate to the actual listeria risk in our modern food system. Why should I skip feta but not melons?
posted by paddingtonb at 8:41 AM on August 13, 2013 [3 favorites]


bonehead: "Diagnostics are not the same skill set as understanding how to interpret a statistical study, not even slightly."

To form a full picture of the various factors that can impact a pregnancy, both need to be considered. However, because there are so many variables to consider, pregnancy is not so easily reduced to simple statistical risk/benefit analysis in individual cases. This is especially true in the cases of prospective parents who have previously had difficulty conceiving. The suggested rules regarding alcohol and coffee are an attempt to minimize risk for the largest possible segment of the population, but as Ms. Oster mentions in the linked article, deeper, better studies really are needed.
posted by zarq at 8:46 AM on August 13, 2013


PhoB, I think some (though certainly not all, or maybe even most) of that can be explained by actual differences in the vectors for food poisoning in different countries. For example, pregnant women in England are told it's a-okay to eat raw or undercooked eggs, but the requirements for egg production and handling are such that salmonella is not really an issue for eggs there, whereas it is a (very small) issue in the United States. (WHY YES I HAVE BEEN MISSING THE YOLKY GOODNESS OF FRIED EGGS, WHY DO YOU ASK??)

Of course a lot of the advice is also shaped by: (1) how the risk was first understood to be transmitted, even if that's no longer the most prevalent avenue; and (2) the general public-health mindset that nuanced messages that talk about levels of risk are counterproductive lest they "encourage" people to make bad choices. (This isn't just limited to pregnancy, it also runs through a whole lot of other public-health pushes, and it generally drives me batshit.)

One of the things I found really interesting in delving into CDC statistics about the vectors for various types of food poisoning is that everybody has heard that pregnant women shouldn't change the litterbox because cat poop can give you toxoplasmosis, but the few studies that have tried to actually quantify the size of different risk vectors in the U.S. have suggested that most people who are infected with this parasite get it from eating rare / not-well-done beef, lamb, or pork. My Mayo Guide to a Healthy Pregnancy says that pregnant women should avoid eating "rare or undercooked meat or eggs" but totally fails to differentiate between the risks of toxo versus salmonella, and definitely gives the impression that the risk of a rare steak is salmonella (which is miserable but doesn't particularly affect the fetus).
posted by iminurmefi at 8:46 AM on August 13, 2013 [2 favorites]


Ok, I know that she's the economist and probably understands statistics better than I do, but how how does this sentence make sense?

"My best guess was that avoiding sliced ham would lower my risk of listeria from 1 in 8,333 to 1 in 8,255."
posted by sparklemotion at 8:59 AM on August 13, 2013 [3 favorites]


bilabial: " zarq, I think that scody was making a jab at generalized pearl clutching combined with a long history of anti-woman tactics, and not at you specifically.

Yes. I realize that now.

I do think many people here are trying to point out that you may be caught up in some structural sexism that isn't easily recognized because your life as a pregnant person has not been and never will be proscribed to the extent that actual pregnant people have and/or will experience.

That is not a valid dismissal of anything I've said. It's an ad hominem argument.

I worked for a chain of fertility clinics for seven years as a publicist. Interviewed teams of reproductive endocrinologists, ob/gyns (FACOGs) and other medical professionals and learned the ins and outs of pregnancy, infertility and various related risk factors, then promoted what they were doing to the media. Sat in on procedures, physician consultations and media interviews with patient consent. Interviewed literally hundreds of men and women who were dealing with infertility issues and trying to conceive. Then, my wife had a miscarriage. She has PCOS. She eventually had an IUI procedure and her resulting pregnancy was filled with complications, including a selective reduction, another fetus that died in the womb during the pregnancy, various tests and procedures and a whole host of other complications that were countered -- not always successfully -- with both oral and injectable drugs. Oh, and incidentally my kids were preemies. All of this is why I tend to speak up in threads that talk about pregnancy, ART and infertility, twins, early delivery, etc.,

I'm not "caught up in structural sexism," bilabial. I merely feel that those experiences and whatever knowledge I gained from them may give me a unique perspective and (hopefully, I'd like to think) the ability to contribute something helpful.

If you disagree with something I've said, that's fine. But can we skip the ad hominem stuff, please? No one here should have to pass a litmus test for weighing in, and in my case, I'd appreciate it if you would address the argument, not the poster. Please.

What I find especially problematic with your statements here is that medical professionals here do not actually seem to take into account real risk factors of the pregnant woman they are treating.

Personally, I think the state of obstetrics in the US is appalling. And I do agree with you. However, the article discusses the risk factors of coffee and alcohol. Which is what I've been trying to address.
posted by zarq at 9:05 AM on August 13, 2013 [6 favorites]


To form a full picture of the various factors that can impact a pregnancy, both [diagnostics and statistical literacy] need to be considered

No they don't, at least not if you believe in the utility of statistics. The whole idea is to be able to define causation vs correlation, etc independent of what the variables are. If you're saying that it's important to distinguish whether the negative outcome is slight heart burn or miscarriage, of course. Economics has a toolset for that as well, Expected Values.

pregnancy is not so easily reduced to simple statistical risk/benefit analysis in individual cases

Then I have to ask what we're doing here. You're conflating two opposed things in order to undercut the value of statistics. Statistics isn't about What Will Happen to You. It's about What Will Likely Happen to You. Someone wins the lottery most days, but most people never win the lottery on any day.

My takeaway is that it's better to be informed by smart people. They don't have to be doctors or statisticians, they should be some of both. But it would be nice to have hard evidence rather than dusty opinions masquerading as medical fact. The downside to the nice people in white coats is they get used to having everything they say accepted as gospel and that leads some people to stop thinking critically before opening their gobs.

On preview: zarq, I'm sorry for your loss.
posted by yerfatma at 9:10 AM on August 13, 2013 [3 favorites]


"I believe she's relying on false assumptions gleaned from her personal experiences -- i.e. taking it for granted that analysis of pregnancy as a condition can be so simplistically reduced."

No, she's relying on statistics. We can talk about whether they're good or bad statistics or whether her perspective as a non-medical professional is relevant but she barely mentions her personal experience except as an afterthought. I don't think it's fair to suggest otherwise. Her article is not based on anecdotes.
posted by kat518 at 9:12 AM on August 13, 2013 [12 favorites]


To form a full picture of the various factors that can impact a pregnancy, both need to be considered. However, because there are so many variables to consider, pregnancy is not so easily reduced to simple statistical risk/benefit analysis in individual case.


You'll get no argument from me in saying that going from statistical results to individual risk is tricky, but the important thing to understand is that you're talking about two different things.

The big studies try to quantify the probability of harm happening given a specific influence, drinking, smoking, taking vitamins, to a broad population. More detailed studies will try to identify co-factors which influence that probability: age, obesity, previous conditions, what have you.

The skills to evaluate these studies are statistical, mathematical. There are lots of potential gotchas in study design and interpretation which are not obvious.

Doctors, particularly front-line doctors, are trained to diagnose, to identify specific conditions associated with their patients. This is also tricky and difficult.

Your problem, the problem facing most doctors in discussing this with their patients, is how to mesh a particular patient's risk factors with the probabilities of harm found in these studies.

It would be expecting superhuman capabilities of someone who has spent 10 or 12 years learning one of these skills sets to also have the other (there are people who do, but not many). Doctors get their information on risks from studies of studies, metastudies, and standards of practice established based on those metastudies. Front-line doctors generally rely on a community of statistical and medical experts to filter for them.

To make the risk analysis robust, because this information has to go through a long chain to get to patients, these standards of practice employ a "precautionary" approach. This leads to logic like: if something has the possibility to be bad, ban it entirely. Precautionary risk management is minimally risk-tolerant, ideally as close to zero-risk as possible.

A precautionary approaches deal with the question of understanding risk for a particular mother by simple prohibition. It simple to communicate and it's as safe as possible. This approach also avoids doctors having to understand and communicate risk-based decisions as well as providing simple answers to patients.

More nuanced approaches to risk are possible, as the author has done for herself. However, given the precautionary risk management strategies used by most of the medical profession, it's a conversation not many doctors are well-equipped to have.
posted by bonehead at 9:15 AM on August 13, 2013 [5 favorites]


zarq, rather than this very generalized "doctors know more about risks!!" argument that you're making here it would be useful if you could point out some actual error in the article or some specific individualized risk-factor which pregnant women should get individually measured or what have you.

The article is criticizing a widespread, non-individualized set of 'guidelines' that are reinforced through multiple channels based purely on general claims about increased statistical risks. If the science does not support those claims, then there is absolutely no good basis for the guidelines. If there are individual risk profiles that doctors are able to assess which mean that some individuals should totally avoid alcohol during pregnancy or totally avoid all soft cheeses during pregnancy or what have then people should get those individual tests to determine if those are risks they, as individuals, need to manage. But a blanket "thou shalt not" to all pregnant women is as ridiculous as a blanket rule that no one should eat shellfish because some individual are highly allergic to shellfish.
posted by yoink at 9:24 AM on August 13, 2013 [6 favorites]


KJ Dell'Antonia's response to this was interesting - she did in fact lose a baby to listeria (the actual source of the bacteria wasn't found). She agrees with the numbers but "when the risk is one of miscarriage or stillbirth, there are reasons for avoiding certain foods that go beyond the numbers."

I kind of talked a big game before I first got pregnant about being skeptical with respect to actual risks related to food. And I work with statistics all the time. But then actually standing beside that deli tray or open bar or sushi or whatever... thoughts always intruded like "would this bite of turkey really be worth going through a miscarriage, or possible harm to the baby's brain development?" And the answer was almost always no (except for a couple of slices of prosciutto!).

But, it's relatively easy to avoid certain foods for those 9 months - which maybe is why it's such a focus of policing pregnancies? Most of the other risks about pregnancy are so far beyond the mother's or doctor's or society's control that we seek to over-control this little element of risk.
posted by raxast at 9:29 AM on August 13, 2013 [5 favorites]


Yeah, when Mrs. Furnace was pregnant, out doctors were awesome compared to the stories we have heard. Wine was ingested (in small quantities), as was some beer. So were soft cheeses of reliable provenance. Coffee was consumed a regular quantities.

But this is all because my wife was an is really healthy, and she had her doctors permission to imbibe with restraint. Which made her feel much better and relaxed throughout the pregnancy.

Anyways, Little dude is, at two years old, goddamn huge, and in the 90th percentile for height, weight, head size and he's developmentally right on track for his age.

Yeah, everything's different for everyone, but people ought really calm down in general about 'risk' when it comes to kids. This remark extends to 2 yer olds playing outside too. And to 12 year olds riding the bus alone.
posted by furnace.heart at 9:34 AM on August 13, 2013 [2 favorites]


MetaFilter: It seems a shame to me that real dangers are not discussed, or are glossed over, while we argue here about ham and brie.

(Some of you have convinced me to look into a midwife, and this article is full of awesome.)
posted by polly_dactyl at 9:42 AM on August 13, 2013 [2 favorites]


She's an economist. Does she have any medical experience?

Epidemiologists are not doctors; one epidemiologist I know was trained as a chemist. The statistician who works for her unit has a PhD in sociology (specializing in demography).

I would trust an epidemiologist over a doctor on health risks any day.
posted by jb at 9:42 AM on August 13, 2013 [6 favorites]


as for bagged salads: I avoid those like the plague. Not only could they have more bacteria, but they are so much more likely to go wilty and gross than a nice solid head of greens.
posted by jb at 9:44 AM on August 13, 2013 [1 favorite]


I kind of talked a big game before I first got pregnant about being skeptical with respect to actual risks related to food. And I work with statistics all the time. But then actually standing beside that deli tray or open bar or sushi or whatever... thoughts always intruded like "would this bite of turkey really be worth going through a miscarriage, or possible harm to the baby's brain development?"

Except this is a kind of magical thinking--or, rather, it is a thinking about "risk" that is almost entirely divorced from any actual risk calculus. PhoBWanKenobi made the central point about this very well above. Sure, you looked at the slice of turkey and thought "do I feel lucky, punk"--but did you make the same calculus about hopping in the car to drive to the deli? And if you didn't, then you just happily accepted a relatively enormous risk so you could congratulate yourself about avoiding a relatively miniscule risk.

If you measure every. single. decision. you make during the course of every day against the metric "would this really be worth going through a miscarriage?" then you'll end up living in a padded room eating nothing but irradiated pablum for the entire duration of your pregnancy. It simply is not possible to go through a pregnancy saying "I will avoid all non-zero risks to the baby's health." The value of your baby's life is incommensurable with pretty much anything else; is it worth continuing to go to work when there is a non-zero risk associated with the commute, the chemicals in the copier toner in the office, the offgassing from the office carpets etc. etc. etc.? There's a non-zero risk that your husband/partner will become violent and cause harm to the fetus--no matter how much of a sweetheart he seems to be--so you'd better go through a divorce. Oops, but wait, there's a non-zero risk that the divorce lawyer will go mad and attack you, so you'd better play it safe and just poison your husband/partner (make sure the poison is baby-safe, though! Maybe you'd better use a knife).

At some point you have to accept that you're going to do things that present some measure of risk to yourself and your infant. The question that is worth asking is not "is doing A worth my baby's life?" but "does doing A present an unreasonable risk to my baby's well-being?" And when you put the question that way, eating that slice of turkey loaf stops looking like gambling with your baby's life and starts looking like every single other thing you do during the course of a normal day that presents a very, very, very minor risk to the infant but not one sufficient to be worthy of notice.
posted by yoink at 9:47 AM on August 13, 2013 [21 favorites]


Forgive me if this is naïve, but...

Rather than expecting doctors to become expert statisticians, shouldn't it be possible to create a computer program that accepts the patient's medical profile as input, and produces a list of the riskiness of various foods/behaviors for that patient as output?

If a given piece of information about the patient is unavailable, just assume the worst case scenario, and issue a blanket prohibition, as we currently do.
posted by escape from the potato planet at 9:49 AM on August 13, 2013 [1 favorite]


Ok, I know that she's the economist and probably understands statistics better than I do, but how how does this sentence make sense?

"My best guess was that avoiding sliced ham would lower my risk of listeria from 1 in 8,333 to 1 in 8,255."


It makes sense if you realize it's indicating that she doesn't know much about probabilities and how they are noted.
posted by FatherDagon at 9:50 AM on August 13, 2013 [2 favorites]


I would trust an epidemiologist over a doctor on health risks any day.

In my experience doctors are typically very poor at risk analysis. They are drawn (understandably) to being able to say both "here is a thing you can do to avoid illness" and "here is a thing you can take/procedure you can undergo to make you all better!" without thinking in any meaningful way about the relative risk/benefit tradeoffs in either case. That's why so many doctors are both taken completely by surprise by and deeply resistant to large epidemiological studies that show that some standard element of their practice actually does more harm than good (HRT, mammograms etc.). Doctors are not magically immune to the psychological predispositions that make all humans suck horribly at assessing risk.
posted by yoink at 9:53 AM on August 13, 2013 [7 favorites]


"My best guess was that avoiding sliced ham would lower my risk of listeria from 1 in 8,333 to 1 in 8,255."

It makes sense if you realize it's indicating that she doesn't know much about probabilities and how they are noted.


Yes, I'm sure the professor of economics knows nothing at all about probabilities, not even that "1 in N" is a lower probability than "1 in less-than-N." That, after all, is infinitely more likely than this being a meaningless typo or some sub-editor screwing up her article copy.
posted by yoink at 9:56 AM on August 13, 2013 [33 favorites]


I kind of talked a big game before I first got pregnant about being skeptical with respect to actual risks related to food. And I work with statistics all the time. But then actually standing beside that deli tray or open bar or sushi or whatever... thoughts always intruded like "would this bite of turkey really be worth going through a miscarriage, or possible harm to the baby's brain development?" And the answer was almost always no (except for a couple of slices of prosciutto!).

So, raxast and anybody else doesn't need my approval for this, especially since I've never been pregnant, but this kind of thing makes total sense to me. What's critical though is getting to make this choice, having access to information and guidance on how to interpret it in the first place. The problem, I think, is that many pregnant women aren't being given the information, or social support, to make these calculations for themselves and with their doctors. We all take calculated risks, often with tremendous potential downsides, every day. And sure, with those choices we're victims to our own psychology - miscarriages and terrorist attacks are all much more present to us than traffic accidents, damn the statistics. And pregnancy has the added factor over terrorist attacks of being intensely and intimately personal, and I imagine it's hard to feel much other than total responsibility for something that's actually living off of you.

As for policymakers though, the decisions we make and the advice we give about what's *horribly dangerous and will kill your baby*, I think there's a responsibility to listen to the epidemiologists over the fearmongers. I think the TSA/general attitudes about terrorist attacks is a fairly good parallel here - making policy from worst case scenarios results in untenable situations which can put a huge burden on individual people. What you do with the evidence on risk is up to you - avoid flying to countries that you're not comfortable in, avoid soft cheese when pregnant if thinking about listeria is keeping you up nights - but you have to have the right kind of evidence to do it. And I do think there's an added element of paternalism when it comes to women and the choices they make while pregnant (or anytime, really), and that doesn't help.
posted by heyforfour at 10:02 AM on August 13, 2013 [8 favorites]


I would be willing to live with discussing my pregnancy with my doctors and epidemiologists to determine what the things I should avoid are. It's the random folks on the street who feel they have not just the right, but the obligation, to explain to pregnant and might-be-pregnant women that they shouldn't drink/eat sushi/have cheese/etc. that drive me batty. I'm really glad I'm past the age where I take a lot of flak about that; just the hassle as a woman of breeding age was significant in my decision to never get pregnant.

Some Victorians believed using your womanly brain too much weakened your womanly reproductive powers. That was wrong, and it's not any righter the other way around.
posted by immlass at 10:02 AM on August 13, 2013 [7 favorites]


Sure, you looked at the slice of turkey and thought "do I feel lucky, punk"--but did you make the same calculus about hopping in the car to drive to the deli?

I absolutely did, for what it's worth. In the last few months of my pregnancy I basically stopped going anywhere except work and the doctor's, precisely because I knew being in the car in Los Angeles was by far the riskiest thing I did on any sort of regular basis. I also stopped driving myself because I was too short to reach the pedals without sitting unacceptably close to the airbag. My husband and I carpool to work, so thankfully this wasn't a big deal for me. I stopped working at 37 weeks and basically never left the house except to go to the doctor for the last three weeks of my pregnancy.

I hated being pregnant enough that I wasn't taking any fucking chances. It's all well and good to go on about how you can't avoid every risky behavior, and before I got pregnant I thought I'd be a chill and relaxed pregnant lady who enjoyed brie and an occasional beer, but as my pregnancy went on I became more and more invested in having it end as well as possible for me and for the baby, and being rational about risk levels grew very difficult. I suspect this is pretty common.

With all this going on inside the average pregnant woman's head I think it's easy for "you might want to minimize this" to become "you'll hurt your baby if you don't avoid this" - especially when the larger culture takes so much glee in shaming women who consider themselves to be full human beings with agency and rights while they're pregnant, and in the event that anything does go wrong, delighting in pointing out that the woman in question had it coming.
posted by town of cats at 10:03 AM on August 13, 2013 [16 favorites]


With all this going on inside the average pregnant woman's head I think it's easy for "you might want to minimize this" to become "you'll hurt your baby if you don't avoid this" - especially when the larger culture takes so much glee in shaming women who consider themselves to be full human beings with agency and rights while they're pregnant, and in the event that anything does go wrong, delighting in pointing out that the woman in question had it coming.

Indeed: which is why I think articles like the one linked in the FPP are important. The more the word can get out that these behaviors are not "OMG gambling with your baby's LIFE!!!!" the less random asshole strangers will feel empowered to scold pregnant women when they see them eating brie or drinking a glass of wine or what have you.
posted by yoink at 10:10 AM on August 13, 2013 [1 favorite]


I'm so thankful to have had caregivers during both my pregnancies who had a good handle on statistics and whose model of care centered around Informed Choice. Thus, statistics were always available to me every step of the way. As an anxious first time mother, these reassurances were important.

I'm sure it wouldn't surprise anyone to know that I was seen by midwives. So much of their job is based in risk assessment. The way I hear many women recount their experiences with an OB suggests they haven't been provided enough opportunity to talk things over with their care provider and are left to get faulty/anecdotal information from friends, family, the internet, books. If only these doctors had more time to sit down with their patients, to do the statistical analysis themselves, they wouldn't have to take the "better safe than sorry" approach that we see all too often. Forget the social pressures. People are looking for an authority that they aren't finding.
posted by sunshinesky at 10:10 AM on August 13, 2013 [2 favorites]


Extensive experience can help a medical professional identify whether a particular person is likely to have a specific risk factor, yes. It can also help them establish a "risk baseline" so to speak.

I'd bet you a dollar that there's no meaningful evidence to support this claim.
posted by ROU_Xenophobe at 10:15 AM on August 13, 2013 [5 favorites]


What's amazing to me is that women gave birth for centuries eating unpasteurized cheeses and suspicious meats as well as unwashed vegetables, drinking primarily alcoholic drinks (to avoid contaminated water), and generally living a less sterile lifestyle. The infant mortality rate might have been higher, because of lack of medical care, but as a species, we managed to be fairly fecund. How we baby boomers made it is a miracle--plenty of booze, Mother's Helpers, ciggies, and coffee for our mums.

I'm not advocating triple shot espressos, multiple martini lunches, and a pack a day for prospective mums, but everything (except the cigarettes*) in moderation.

I'm not a big fan of prepackaged salads, but even more than the listeria I worry about pesticide and herbicide residues, hormones in meats, mercury and other poisons in fish, residual drugs in the water supply, chemical contamination from dry cleaning, chemicals left in soils from manufacturing, pollutants from auto exhaust, radiation from atomic testing (especially here in the west, what with Hanford and Nevada nuclear testing.)

No matter how much corporate scientists protest that their particular pollutants aren't the cause of cancer, neurological problems, cancers, and other nastiness from autism to skin disease, I won't be persuaded that there aren't some teratogenic effects from the continual exposure to multiple agents. Sure, one type of exposure might not have a statistical significance, but organisms exposed to many types of environmental difficulties are going to have quantifiable health problems.


A woman, even a pregnant woman, is more than just a vessel for a fetus--she is also an individual. With, you know, a life. And rights.

Might I suggest that the political right has taken Handmaid's Tale quite literally.


*Tobacco is just evil for everybody.
posted by BlueHorse at 10:19 AM on August 13, 2013 [1 favorite]


The more the word can get out that these behaviors are not "OMG gambling with your baby's LIFE!!!!" the less random asshole strangers will feel empowered to scold pregnant women when they see them eating brie or drinking a glass of wine or what have you.

I wish I could believe this...but ultimately I think most people stop paying attention to what's okay during pregnancy right around when they and their friends stop being pregnant. So my peers will probably be slapping wineglasses out of pregnant ladies' hands in colonies on the moon sixty years hence, even if it's been irrefutably shown that babies whose mothers drink a glass a day while pregnant get a +1 fortitude bonus and thicker, more lustrous hair.
posted by town of cats at 10:22 AM on August 13, 2013 [6 favorites]


Rather than expecting doctors to become expert statisticians, shouldn't it be possible to create a computer program that accepts the patient's medical profile as input, and produces a list of the riskiness of various foods/behaviors for that patient as output?

I don't see how this would be possible, in the case of food-borne illnesses. It seems like they strike more or less at random, more in some foods than others but it's not like you can say "oh, you have genetic marker flurb so you DEFINITELY need to not eat fresh cheese." That's not how it works.

I mean, if someone has a compromised immune system, that's another story, but they'd presumably already know that.
posted by showbiz_liz at 10:23 AM on August 13, 2013 [1 favorite]


Sure, you looked at the slice of turkey and thought "do I feel lucky, punk"--but did you make the same calculus about hopping in the car to drive to the deli? And if you didn't, then you just happily accepted a relatively enormous risk so you could congratulate yourself about avoiding a relatively miniscule risk.

Yes, in fact every time I get in the car it does cross my mind, and trust me, I don't "congratulate" myself about avoiding "miniscule" risks. I've had a miscarriage, (incredibly common) and I've had more than one incredibly uncommon ailments. The 1 in however many thousand means little when it is you that gets it. And as heyfourfour says, "it's hard to feel much other than total responsibility for something that's actually living off of you." Being pregnant, you have to somehow coming to terms with what you can and can't control as you are growing something that's so much you and so much separate.

I am not in any way an anxious person, about as low-strung as they come, but yes, I did spend a non insignificant amount of time evaluating practically any potential risk I could think of while I was pregnant and thinking about whether it's worth it to do something to avoid it. For example, we live on a farm - I spent some time worried about pesticide residue. Action? I read articles wherein the conclusion was that the greatest risk was to those who manufacture rather than people like me, but yes, I avoided being outside for the few days they're being sprayed. And it's not like these are decisions that are constantly being weighed all day every day - you think about them once and move on. Other things you just have to shrug your shoulders about - I can't really do anything about office carpet offgassing but I can consider and dismiss that as just a condition of being alive in the world.

I'm under no illusion that I can control the vast majority of bad things that could happen to me or my baby. Controlling food intake offers a small little bit of reassurance. What I can control and did a lot during my pregnancy is think about how I would react to bad news about my baby or threats to my own health and reminding myself that everyone alive had a pregnant mother at one point, and hey, most of us are okay.
posted by raxast at 10:33 AM on August 13, 2013 [6 favorites]


As a person who hopes to become pregnant in the near future, this article is really interesting. I hope I will be able to find a doctor/midwife who will be reasonable and level with me about what I really should avoid and what is okay in moderation. Then again, speaking of dealing with strangers who want to police pregnant women's behaviors - A Sudden Valley man must serve 20 days of jail time for threatening a pregnant woman because she was smoking a cigarette.
posted by coupdefoudre at 10:42 AM on August 13, 2013 [2 favorites]


The way I hear many women recount their experiences with an OB suggests they haven't been provided enough opportunity to talk things over with their care provider and are left to get faulty/anecdotal information from friends, family, the internet, books. If only these doctors had more time to sit down with their patients, to do the statistical analysis themselves, they wouldn't have to take the "better safe than sorry" approach that we see all too often.

I commented above about our search through multiple doctors offices before settling on a midwife for our current, first pregnancy. This is exactly how we felt.

Here's our experience, you be the judge of which one you'd like to be the person to guide you through a pregnancy and who actually does the whole 'sit down/spend time with' thing better. It was/is a big deal for us.

And forgive me for getting lengthy but someone commented above that they might be looking into a midwife and I couldn't think of a better place to relate our experiences. Feel free to pick them apart or whatever as desired, if I can use the info here to make mseld one iota happier because she can eat some sushi (she's vegetarian so... really...) or soft cheese then I've come out way ahead.

Initial Questioning period: "Hi, we'd like to come in and ask some questions regarding placing ourselves under your care for the duration of our pregnancy. Kind of like a meet and greet because we're still very much undecided as to who we want to go with. What can you do for us?"

Doctor's Office - You'll have to schedule an appointment AND do all the paperwork as if you were comitting to our practice for the pregnancy AND you must sign the waiver saying you agree to pay for any/all teh things AND we won't have our billing person available for you to talk to now or for the following 5 times you try to contact us AND we'll go ahead and code things like you're our patient because that's the way it is..

Midwife - Sure, come in sometime this week, we'll setup a meet and greet with the midwife and you can ask any/all questions you have. If you decide you like us then we'll continue on with making you our patient. No paperwork needed for meet and greet.

Wait times:

Doctor's Office - From 1 to 2 hours. One office had computer problems and lost our appointment and we didn't even get to meet their midwife/nurse that we specifically requested. The other just made us wait past out appointment time because, well because....

Midwife - We were warned that if the midwife was with another woman (singular, one woman) we may have to wait a few minutes as those appointments go until they're done and aren't rushed. We were seen within 20 mins of arrival.

Initial appointment/meet and greet:

Doctor's Office: We were herded around like cattle, asked questions by a nurse who then 2 times out of three obviously didn't pass them on to the doctor, met with a doctor who was clearly working with multiple women at the same time and was too busy to focus on us or my wife's situation/questions and warned of the things that could go wrong and cause us to need surgical interventions. Several interruptions while the doctor(s) leave the room. We are treated like sick people that could go critical at any moment.

Midwife - We meet in the comfy sofa room and have an extended chat with the midwife. We are not rushed. We are talked to like intelligent adults going through a fun, but potentially scary, phase in their lives.

Billing:

Doctor's Office - We are now fighting to prove that we are not, in truth, having a baby while under the care of 3+ doctor's offices that coded us for their payment for a full term's worth of care. Resolution TBD. Actually more expensive but insurance would have paid for most/all of it.

Midwife - Her office will help us get the crazy waiver from our insurance we need even though she's cheaper overall. Insurance will pay less. We eat the difference.

Again, none of this is bashing doctors and what they do, nor am I saying that women should feel guilty for feeling guilty about eating/drinking anything. What I am saying is that I think a lot more people would be happier if they could treat their pregnancy as a natural, wonderful thing instead of a risky, failure prone thing that will lead to the world at large judging them unworthy for parenthood if things don't go 100% fine and dandy.
posted by RolandOfEld at 10:44 AM on August 13, 2013 [6 favorites]


What's amazing to me is that women gave birth for centuries eating unpasteurized cheeses and suspicious meats as well as unwashed vegetables, drinking primarily alcoholic drinks (to avoid contaminated water), and generally living a less sterile lifestyle.

Oh man, this is not the way to make this point. The bad old days really were awful for mothers.
posted by Jpfed at 10:53 AM on August 13, 2013 [20 favorites]


Oi, the brie thing. My wife was told to avoid brie because it's raw or unpasteurized or something. This was tough because a brie, pear, and apricot sandwich on baguette is one of our favorite things. In celebration and to avoid the bland hospital food, I made her one the day after our daughter was born. I noticed on the label that day that it's pasteurized. And after looking around, most cheeses in the grocery store are. For non-pasteurized raw milk cheese you have to actually do a bit of searching.
posted by Hoopo at 10:54 AM on August 13, 2013 [1 favorite]


Again, none of this is bashing doctors and what they do,

I simply see that the perspective of doctors is so different than that of midwives. Both in business and the profession itself. There are plenty of great doctors who take time and care in answering their patients' questions, but the deck is stacked against them from a business point of view. They tend to be the exception rather than the rule, particularly when there are so many layers of care in the system. The communication breakdown between nurses and doctors is no small thing. It's simpler to offer a basic set of rules than to treat each patient as an individual when there's no harm in restriction.
posted by sunshinesky at 10:57 AM on August 13, 2013


three blind mice: Pregnant/TTC* complaining about the food they "can't" eat is one of my personal pet peeves.

OK, but listeriosis, fetal alcohol syndrome and mercury poisoning are real things. Cases may be rare, but there is a valid, scientific basis for avoiding soft cheeses, alcohol, and large fish/shellfish during pregnancy. Some killjoys also frown on smoking during pregnancy.
I'm pretty sure the article was written about a subset of the population you're speaking for, 3bm. Nowhere does she say, "Ignore all restrictions, guzzle vodka, eat old thermometer bulbs, and develop a 2-pack-a-day habit; it won't hurt anything!"

She acknowledges the risks you are pointing out... again... which no pregnant woman ever has heard before... this hour... from you, at least. Pregnant women are just tired of being harped on.
posted by IAmBroom at 11:01 AM on August 13, 2013 [1 favorite]


Oh man, this is not the way to make this point. The bad old days really were awful for mothers.

I read BlueHorse's comment quite differently than you did apparently.

I don't see it as an argument saying "The analysis put forth by this article makes sense because things were so great back when children were born in filth and raised based upon ignorant myths surrounding the cycles of the moon", because that would be a dumb argument indeed.

But instead of saying that, again that the 'bad old days' (as you name them) are to be idealized, it points out that the 'great new days' still have some important questions to be answered as to what is necessary, prudent, and valid with respect to pregnant mothers and getting everyone positive results for families/society as a whole.
posted by RolandOfEld at 11:04 AM on August 13, 2013 [2 favorites]


When I was pregnant with my son, I asked my OB what the story was on hair dye - I kept hearing it was unsafe during pregnancy, because reasons (it would enter your bloodstream through your scalp? the fumes could be dangerous?) My OB - a professor at Columbia Medical School - told me to wait till after the first trimester. She said that it was probably completely fine, that pregnant women have been coloring their hair for decades at this point, that pregnant women work as hair colorists and at Clairol factories. But I should still hold off just to be on the safe side -- a complete superstitious guess, basically -- because there were no studies. And none of the hair-color companies wanted to do a test and risk finding out they were responsible for something. And finding pregnant women willing to participate in such a research study would just not be possible.

So I listened, even though like the writer of the piece, I felt it wasn't science, it was just guessing. And I didn't avoid maintaining my hair color when I was trying to conceive again. I've since had 2 miscarriages (both after heartbeat, both with no conclusive evidence what caused them), and I still remember everything I ate or did that was probably fine but maybe I should have avoided (beef jerky? touching up my roots before I knew I was pregnant? Not losing all my baby weight?).

You want to be smart. You want to only make good choices, and there really is very little in the way of hard numbers when it comes to what or how much of 'risky' things is okay. But when things go wrong, even if you know it's almost certainly genetic abnormality, it is almost impossible not to blame yourself for doing something you should have known not to do.

I'm not sure that it correlates that if nothing goes wrong, therefore all your choices were right. Especially if that leads to more pressure on every other pregnant woman facing the same unknowns with their own different environment and biology.
posted by Mchelly at 11:12 AM on August 13, 2013 [3 favorites]


yerfatma: " No they don't, at least not if you believe in the utility of statistics. The whole idea is to be able to define causation vs correlation, etc independent of what the variables are.

Okay, but what I don't understand is how multiple, complex variables and influences can be completely divorced from the conclusions. In individual cases, they may matter very much and the risk assessment guidelines are in place to account for them. They also are likely in place to help account for patient behavior.

Bonehead's excellent and informative comment clarified a lot of what I've been trying to say. I'm concerned that drawing anything but general conclusions from study results could be problematic when applied to individuals.

Look, this article only gives us a partial picture. And that's because the studies she's referencing also only give us a partial picture. Ms. Oster talks about at least two Australian studies. OK, great.

She mentions an Australian study that collected IQ results and draws a statistical conclusion that higher IQ directly correlates to light drinking during early pregnancy. But it is not the only possible influence on fetal brain development. Could drinking be a factor? Sure. Can we draw a meaningful conclusion about slightly higher IQ levels from a single study? Unknown. We know some of the factors that influence the intelligence quotient, including the ratio of brain weight to body weight, the thickness of the cortex and the amount of gray matter in the brain, the size of one's frontal lobes, etc. FAS affects brain development, yes. You can see the physical changes to the brain in kids with FAS, note physical characteristics common to them and see marked developmental disabilities. But that's not what second study was about. It was about women who drank lightly during early pregnancy compared to those who didn't. Has anyone been able to show a direct correlation between the physical factors that affect IQ and drinking lightly during early pregnancy? Did the study in question? Unknown.

I want to emphasize that a partial picture is usually better than none at all as long as the conclusions being drawn make sense. But at the same time she's advocating evidence-based guidelines (which is a really, truly laudable goal) and drawing conclusions from studies that might not be taking some influences into consideration.

I think the variables have to matter.

Then I have to ask what we're doing here. You're conflating two opposed things in order to undercut the value of statistics. Statistics isn't about What Will Happen to You. It's about What Will Likely Happen to You. Someone wins the lottery most days, but most people never win the lottery on any day.

I'm not trying to undercut statistics. I'm trying to determine whether it can be useful to draw specific and non-general conclusions that apply to the majority of the population in this particular instance. And whether those conclusions can help us determine reasonable guidelines.

My takeaway is that it's better to be informed by smart people.

I think that when it comes to analyzing pregnancy and its possible risk factors I'm more inclined to trust people who actually have to assess them for risks/benefits on a daily basis. Maybe I'm wrong about that. I don't know.

They don't have to be doctors or statisticians, they should be some of both. But it would be nice to have hard evidence rather than dusty opinions masquerading as medical fact."

Sure. Yet biology is squishy and can be hard to quantify.
posted by zarq at 11:15 AM on August 13, 2013 [1 favorite]


The bad old days really were awful for mothers.


Jpfed, in no way did I mean to imply that mothers had it easy then! Lack of prenatal and postpartum care, inadequate nutrition, overwork, yearly pregnancies with no recovery period, delivery without hand-washing, no antibiotics for infections, dealing with (now) easily avoided infant problems such as German measles, RH factors, whooping cough, cholera, smallpox.... And on, and on.

What I was trying to emphasize is that many women gave birth to healthy infants despite these factors, and eating cheese and meats as well as drinking wine and coffee are minimal risks compared to the environmental factors that were/are at play.

Thank you Roland of Eld, for stating it clearer than I did.
posted by BlueHorse at 11:22 AM on August 13, 2013 [2 favorites]


Hoopo, that's definitely true--it's illegal to sell unpasteurized cheeses in the U.S. that are aged for less than 60 days, which I understand includes most soft cheeses. (Hard cheeses aged over 60 days are much lower-risk for listeria, though not zero-risk.) I've been eating a ton of feta all summer because nothing tastes as good as greek salad, and I don't know that I've even run across an unpasteurized feta cheese brick in any of my local grocery stores. The conflation of "unpasteurized cheese" with "soft cheese" is one of the public-health things where I suspect the people crafting the message think it's better to be broader with the restriction so that people don't get confused, even though it's not supported by the evidence.

Reading through some of the materials that CDC has posted on listeria, it's interesting that over the past 20 years their surveillance system has improved quite a bit and as a result they're catching a lot of individual cases or small outbreaks of listeria that would not have been caught before. So, 20 years ago, when only REALLY BIG outbreaks floated up to the level of CDC investigation, nearly all of the cases they saw were associated with deli meats and unpasteurized soft cheeses, and hence the warnings for pregnant women to avoid those foods. More recently the smaller outbreaks or individual cases they are seeing are coming from a much larger variety of places (sprouts, bagged salads, melons, hummus, etc etc etc), but those risks probably haven't changed so much as they are just being tracked better today.

That KJ Dell'Antonia response that raxast linked to was interesting. I've come around to thinking (as does she, in her final paragraph) that listeria risk is pretty much present to some degree in nearly all fresh foods, so I am working to not stress too much about it--I'm not convinced there's realistically much you can do to totally eliminate the risk, even if you scrupulously avoid soft cheeses and deli meats. I do wonder if the drum-beat of messages about risk-reduction / risk-elimination by choosing the "right" foods leads to more guilt for women who have a (very very rare) stillbirth related to listeria from unknown causes, like Dell'Antonia did, compared to women who lose a pregnancy due to other rare complications like placental abruption that might be triggered by something (car accident, falling down the stairs) but aren't really seen as caused by a pregnant woman making a "bad choice" or not being careful enough.
posted by iminurmefi at 11:23 AM on August 13, 2013


While I agree with most of Oster's conclusions, I just wanted to point out that she didn't shrug off the burdensome cloak of correlation / causation - she just defined narrower correlations to equate with causations. This is not to say that she is ipso facto wrong on any point. In fact, that's pretty much what you're stuck doing in most of medicine since rigorously controlled experiments to determine what causes adverse events (in pregnancy or most anywhere else) kind of puts you deep into evil Nazi doctor territory.
posted by Kid Charlemagne at 11:26 AM on August 13, 2013 [1 favorite]


I don't know that I've even run across an unpasteurized feta cheese brick in any of my local grocery stores

Yeah, if you want raw-milk, unaged cheeses these days in the U.S., you have to Know a Guy. Or be one, I suppose.
posted by rtha at 11:29 AM on August 13, 2013 [2 favorites]


what I don't understand is how multiple, complex variables and influences can be completely divorced from the conclusions

I don't think they can. Unless I'm misunderstanding you, isn't what these studies attempt the opposite of that? Given a large enough pool of candidates you're going to get a fairly broad selection from the multiple, complex variables you mention. If, given the wide distribution of possibilities, you see a consistent, statistically-significant outcome from a common input, make a hypothesis that the input matters and test that. Test it by being completely suspicious of the conclusion, looking for other common factors or something the study didn't consider, etc. If Input X seems to cause Negative Outcome Y after all the hypotheses have been tested, tell potential moms to avoid Input X, especially if they fall into any categories that seem to also correlate.

To clarify my position, I'm not totally opposed to knee-jerk denial of things that are potentially dangerous. I think the debate in this thread is a great one to have, but the participants are part of a pretty similar cohort. Not everyone belongs to it. My wife and I are finishing up our childbirth classes this week (thankfully); I spent a fair bit of time being completely annoyed by the judgmental tone of the videos and presentation: you'd better breast feed, you'd better not even consider an epidural and if you need a C-section, you're a complete failure of a parent.

But in the past week or so I've realized there are 6 couples in the class including us and of the other 5, I'd trust maybe 2 to successfully raise a child. So the issue's a bit more complex than just whether or not a cup of coffee or a glass of wine here and there is ok. The problem is doctors need to provide a consistent message. Say that drinking in moderation is ok and the people in this thread will do just fine. But another segment of the population has a very different concept of moderation and the end result is disaster.

So I got nothing.
posted by yerfatma at 11:33 AM on August 13, 2013


One of the drivers of research for chemical and physical danger risk assessments in my lifetime has been to get datasets that don't literally rely on evil Nazi doctors.
posted by bonehead at 11:33 AM on August 13, 2013 [1 favorite]


don't literally rely on evil Nazi doctors.

I mean, I knew of this sort of thing, and it is just a wikipedia link, but that link may just qualify for the NSFL warning. Be warned I guess.

posted by RolandOfEld at 11:40 AM on August 13, 2013


But it's much easier to police a woman's dietary choices than to restrict her liberty and physical movement, even if telling her to stay home and stay out of cars would likely reduce fetal death more than telling her not to eat some damn brie cheese.

Yeah, but for most people, the cost of staying home or staying out of cars is enormously higher than the cost of not eating brie.

These questions really are different from a health care provider's perspective vs. a patient's perspective.

If you can save one life every three years by adding brie to the list of things you tell your patients to avoid when they're pregnant, doesn't it kind of make sense to do that?

On the other hand, if you realize that giving up brie has only a 0.00003% chance (or whatever it is) of having any effect on your particular pregnancy, doesn't it make sense to ignore your doctor and eat brie if you want to?
posted by straight at 11:43 AM on August 13, 2013 [2 favorites]


women gave birth for centuries eating unpasteurized cheeses and suspicious meats as well as unwashed vegetables, drinking primarily alcoholic drinks (to avoid contaminated water), and generally living a less sterile lifestyle. BlueHorse
Not only was infant mortality higher, maternal mortality was, as well, largely due to sepsis.

Having experienced a hospital-induced post-partum/ post-surgical infection, I'm greatly in favor of anything that reduces infection. Having a family member with Fetal Alcohol Syndrome, I urge any woman who is pregnant, especially early in her pregnancy, not to drink. It's possible that an occasional drink may not cause significant problems. Until there's a really valid study, it's a bad idea. I'd probably be taller and maybe healthier if my Mom didn't smoke & drink during pregnancy, but she didn't know how bad it was, and, with her addictions, might not have been able to control them anyway. FAS is genuinely tragic for the person who has it.

Low birth weight is a major problem, and I encourage any woman to be as healthy as possible, and especially to not smoke.

Eating cheese, salad, ham, coffee, etc., - try to eat healthy. Take folate if pregnancy is at all possible for you (I have another family who had a mild neural-tube disorder). If you think you should shame a woman for her choices, pregnant or otherwise, go fuck yourself. You have no idea what's going on. That green bottle might be O'Douls, maybe it's the 1 cigarette a week she allows herself, maybe it's none of your fucking business.

The writer of the article didn't do fantastic research. Gain a lot of weight? (I gained 50+ pregnancy lbs.) You are at higher risk of pregnancy-induced diabetes, which makes you at greater risk of diabetes now or later in life. Plus, the fasting blood sugar tests made me so sick they're still a benchmark for disgustivity. Plus, having a 10 lb. baby makes a c-section more likely.
posted by theora55 at 11:43 AM on August 13, 2013 [1 favorite]


I think a big part of what is left out of the "avoid X because $tinyRisk" messaging (well often the messaging is that X -- small amounts of alcohol, caffeine, certain foods, etc -- has much larger risks than supportable) is that we are ignoring other stresses. Pregnancy can be really quite stressful in itself. This morning I rolled over and ugh, that was uncomfortable, because I guess the baby moved a bit and it pulled on some ligaments (or knocked my lower intestine around which is really weirdly and intensely uncomfortable). Or, wow, I only walked 5 miles but I sure am a lot more tired than expected. Or, work was really stressful today and I know I'm over-reacting probably due to hormones but I feel like breaking something because X, Y and Z happened today and it was SO FRUSTRATING. And so on. The relentless messaging that every little thing a pregnant woman does (or doesn't) is this risk she should be good enough to avoid is draining. When it's about something like a couple lattes a week or a glass of wine occasionally at dinner - where it's pretty clear small amounts are not linked to harm -- it galls. I've already turned my life upside down to create another human being, a pursuit most humans see as worthwhile and important. I'm damn well going to have a glass of wine occassionally at dinner like a civilized person. Or have sips of that tasty beer my partner is drinking because it makes me happier and less stressed out. And I'm going to have the occasional latte because that's how we socialize at work and I like them.
posted by R343L at 11:45 AM on August 13, 2013 [6 favorites]


...get rid of...

Sorry if that wasn't clear.
posted by bonehead at 11:45 AM on August 13, 2013


> There is no Pregnancy Jail.

No, but Texas is working on it.

Note that Utah, Delaware, and New York have statutes that criminalize "intentional" miscarriages though, and according to that second article in Iowa a few years ago there was the case of a woman who fell down the stairs at her house and was arrested because she mentioned to the EMTs that she hadn't always been sure that she wanted to have a child.
posted by XMLicious at 11:49 AM on August 13, 2013 [1 favorite]


Those are the kinds of laws I was thinking of. I think some of them mean well but that slippery slope sure is awfully slick.
posted by maryr at 11:56 AM on August 13, 2013


(I guess the ones that mean well but seem very slipperly slope to me are more the ones meant to carry stricter punishments for shooting pregnant women, for example. The slope on the "intentional" miscarriage laws is even steeper and lower frictioned.)

In other news, I only know maybe two synonyms for "slippery" that work in metafor.)

posted by maryr at 12:00 PM on August 13, 2013 [1 favorite]


women gave birth for centuries eating unpasteurized cheeses and suspicious meats as well as unwashed vegetables...

Any time you see the phrase "X did Y for centuries and it was fine", the unspoken ellipse you should always add on is "...for some people".
posted by dry white toast at 12:00 PM on August 13, 2013 [3 favorites]


If I ever get pregnant, I'm going to make a shirt that says MIND YOUR OWN DAMN BUSINESS, or something similar.
posted by inertia at 12:01 PM on August 13, 2013


Here's the correct link to the excellent Evan Dawson piece.

Conclusion: the main study that people are using to support the "no alcohol ever, your kids'll have FAS" position (the Feldman study) doesn't say any such thing, and there are loads of large-sample-size studies that suggest that "light drinking" (2-6 per week, or just 2, depending) actually IMPROVES your child's health and development. FAS is a risk for heavy drinkers (and has a very specific physiological meaning, visible in facial features).

There is a special level of hell for people who go out of their way to tell pregnant strangers what they should and should not be doing, and there's a level one deeper for the ones who are retailing the opposite of truth.

As an aside, they are so much more likely to go wilty and gross than a nice solid head of greens isn't true. Put a fresh head of red leaf or iceberg lettuce in your crisper next to bagged (or better yet, clam-shelled) salad greens, and it will turn to goo before the bagged greens show any signs of wilt. Those bags are specially engineered for perfect aeration and so forth, and actually work really well. This has nothing to do with the listeria content, of course. I use whole heads most of the time, but only if I know I'm going to be using it all right away.
posted by Fnarf at 12:04 PM on August 13, 2013 [3 favorites]


To make a much better "women did X and were fine" comparison, let's compare the US to other parts of the world. Women in France generally drink moderately and France is not known for worse outcomes. Women in most of Europe and Japan aren't told not to eat raw fish (still told to avoid raw shellfish due to Shigella) and also don't have worse outcomes. As noted up thread, women in some other countries are told to avoid bagged salads. Recommendations vary but outcomes are not worse in these other countries. Comparing to the bad old days is certainly a bit silly, but I would love if the US treated pregnancy and child birth more like Europe.
posted by R343L at 12:07 PM on August 13, 2013 [1 favorite]


Also, the French regard pasteurized cheese as an abomination, and their infant mortality rate and every other imaginable health indicators are dramatically better than those in the US, which suggests that there may be other factors at work.
posted by Fnarf at 12:08 PM on August 13, 2013 [2 favorites]


Yeah, I feel like all the stress that pregnant women are under to avoid this and that has to be far worse for the fetus than coffee and alcohol in moderation. Thank goodness I had a doctor who was pretty chill about everything, including my total inability to gain more than 15 pounds total for my entire pregnancy (baby ended up being 7 lb 7 oz incidentally). One of the other things that a pregnant woman ABSOLUTELY SHOULDN'T DO is sleep on her back (something about increased risk of blood clots). I always fall asleep on my side, and roll onto my back at some point in the night. I was all concerned, and my doctor said "meh, women have slept on their back for centuries", so I figured I wouldn't worry too much. Conversely, I have a good friend who is very pregnant right now, and she is so worried about sleeping on her back that she wakes up in a panic every time she rolls over. She isn't getting a whole lot of sleep. Which is worse for the baby--an infinitesimally greater risk of a blood clot, or a stressed out mom who isn't sleeping? Overall, I think the focus should be on keeping the mom-to-be happy and relaxed, as well as being as healthy as possible given those circumstances.
posted by Go Banana at 12:20 PM on August 13, 2013 [1 favorite]


If I ever get pregnant I'm going to ask "What baby?!" whenever people ask me nosy questions or make assertions/demands about what I ought to do.

That'll stop 'em. Right? right?
posted by bilabial at 12:32 PM on August 13, 2013 [4 favorites]


Also, the French regard pasteurized cheese as an abomination, and their infant mortality rate and every other imaginable health indicators are dramatically better than those in the US, which suggests that there may be other factors at work.

1. Which, of course, could easily be true even if raw cheese significantly raised miscarriage rates in both countries.

2. If raw cheese is the norm in France, it seems very likely they have better traditions and infrastructure for keeping it free from contamination than countries where raw cheese is the exception.
posted by straight at 12:33 PM on August 13, 2013 [2 favorites]


Fnarf: "Also, the French regard pasteurized cheese as an abomination, and their infant mortality rate and every other imaginable health indicators are dramatically better than those in the US, which suggests that there may be other factors at work."

Well for one thing France is smaller than the state of Texas, so they're not as economically and demographically all over the map as we are. They probably also have less diversity than we do. They have universal health care and a government national health insurance. We don't, and IMR's in the US are highest in states with high poverty and high numbers of people without insurance.

Also, France only records live births if a baby is born later than 22 weeks which may skew their numbers slightly. The US records every live birth.

The high US infant mortality rate is in part the result of three factors: congenital defects (somewhere around 20%), short gestational times (less than 37 weeks) and low birth weight (under 5.5lbs) (combined those two latter factors make up about 16%). And shorter gestational times and low birth weight are linked since shorter time in the womb generally doesn't give babies enough time to gain a healthy birth weight. More here.
posted by zarq at 12:47 PM on August 13, 2013 [2 favorites]


Any time you see the phrase "X did Y for centuries and it was fine", the unspoken ellipse you should always add on is "...for some people".

Yeah. I wandered around an 18th century cemetery a little this weekend. You know what else people did for centuries? Bury (sometimes multiple) children with their ages measured in months and/or days.
posted by maryr at 12:50 PM on August 13, 2013 [5 favorites]


My OB encouraged me to have an occasional alcoholic drink (which doesn't just include wine, by the way) if I was stressed out because, as she said, there is NO EVIDENCE that occasional alcohol consumption has any negative impact.

Interestingly, a friend from high school who now lives outside Paris told me that her OB told her never to drink during her pregnancy.

Again, the statistical analysis of the issues addressed in this article is helpful, so pregnant women can make reasonable determinations about their plans, rather than be simply frightened into compliance with unsupported and/or outdated restrictions.

Of course some individuals need additional restrictions for weight gain, or alcohol consumption, or caffeine consumption, etc., depending on the individual's medical circumstances. But that to be applied by that person's doctor, after considering the actual scientific evidence for women overall.
posted by miss tea at 1:08 PM on August 13, 2013


"most of them failed to make the distinction between causation and correlation"

As Kid Charlemagne notes, it's difficult to do RCTs with pregnant women. Near the end of her pregnancy, my wife actually asked me to please stop telling how how much stuff about pregnancy and labour was actually unknown or based on nothing more than vague hunches. She said it made her too anxious. One of the more fundamental things about labour, for instance, is that the precise "signal" that begins definitive cervical ripening leading to necrosis of the cervical plug and subsequent expulsion of the fetus in humans remains unknown. We know what this is definitively in many mammals, but it's eluded us in humans for centuries. Not knowing exactly what starts the process means we our techniques for delaying or arresting it when it's premature are based on empirical findings, and we're unsure of how many drugs will interact with this putative signal. We know many drugs and medical conditions lead to an increase in pre-term labour but we don't precisely know why for most of them.

A thing I tell my female patients is there are very, very few things, drugs or foods, etc, that are absolutely known to have no deleterious outcomes for a developing fetus. And a lot of these get reported in studies in terms of their relative risk increase. So it sounds alarming when you hear that "X caused a 300% increase in Y". But if the absolute rate was 1/1,000 and this therapy moves that to 3/10,000, that's still way less than the overall risk of abnormalities in the population at birth. And the risk of an untreated disease may be greater. And except for some very specific abnormalities, it's usually impossible to point to an abnormality and say "Oh, this Y was caused by X" when many of them are much more likely to have happened spontaneously. Many people can function okay dealing with this uncertainty, but others become so anxious about their potential for causing harm or guilt over believing they caused this specific harm that it becomes a real problem.
posted by meehawl at 1:32 PM on August 13, 2013 [10 favorites]


Well for one thing France is smaller than the state of Texas, so they're not as economically and demographically all over the map as we are. They probably also have less diversity than we do

Umm... there are almost three times as many people in France as in Texas. And I find it hard to believe you've been to France if you think there's less demographic / economic / cultural diversity there than Texas.
posted by bumpkin at 2:22 PM on August 13, 2013 [6 favorites]


Women in France generally drink moderately and France is not known for worse outcomes.

Do you have a cite for this? I've read that OBs in France recommend abstaining from alcohol during pregnancy about as much as OBs in the States, and my friends who've been pregnant in France have corroborated this. They definitely do eat raw-milk cheeses...and one friend said they told her not to eat salad (!)...but it's my impression that the "pregnant women in France drink wine all the time" meme is based on American beliefs about French culture, not facts on the ground.
posted by town of cats at 2:31 PM on August 13, 2013


Well for one thing France is smaller than the state of Texas, so they're not as economically and demographically all over the map as we are. They probably also have less diversity than we do.

No offense, but you just lost a lot of credibility points.

Auto accidents are real things--the cause of 2.2% of all deaths worldwide. "Motor vehicle crashes are the leading cause of fetal deaths related to infant trauma." If the purpose of these guidelines is to reduce risk to the fetus, it would be sensible to also recommend that women not be drivers or passengers in motor vehicles.

You say it like that's inconceivable. I preferred my wife not to ride in automobiles when she was pregnant. I prefer my kids not to ride in automobiles at all. (I can make the decision for my kids, but not my wife ...) Anyway ...

She determined what cheese (queso fresco) was actually linked to listeria and cut that out of her diet. She's advocating a more scientific and less paranoid approach to pregnancy, not arguing against taking any precautions.

bears repeating. (and yeah, you're more likely to get hit by lightning than get listeria.)

To be fair, everybody, especially men in positions of authority, like telling women, especially pregnant women, what to do. Well, they also like telling new mothers what to do.

In my opinion, the women are worse, or maybe they have the leeway to say more things. No man would ever question my wife's drinking during pregnancy; all the comments she got were from other women. /anecdata
posted by mrgrimm at 2:38 PM on August 13, 2013 [3 favorites]


I preferred my wife not to ride in automobiles when she was pregnant. I prefer my kids not to ride in automobiles at all. (I can make the decision for my kids, but not my wife ...) Anyway ...

But there's no generalized "avoid riding in automobiles when possible!" advice out there for pregnant women. You don't see TV shows where someone notices a character saying "no, I'll walk" when offered a ride home and people looking at each other and saying "hey...could she be pregnant?" (whereas almost the only time anyone who isn't a recovering alcoholic turns down a drink in a TV show or film it is either because they are pregnant or for HILARIOUS WACKY PLOT REASONS we're supposed to think they are). NOT TAKING UNNECESSARY CAR TRIPS is not listed as one of the "THINGS YOU MUST NOT DO" in books like "What to Expect When You're Expecting" and so forth. People don't make frowny "what on earth could she be THINKING" faces when they see a pregnant woman step out of a car. And yet by any actuarial calculus most of the risks pregnant women are so stressed out about avoiding are essentially rounding errors compared to their increased risk from non-essential car trips.
posted by yoink at 2:55 PM on August 13, 2013 [2 favorites]


bumpkin: " Umm... there are almost three times as many people in France as in Texas. And I find it hard to believe you've been to France if you think there's less demographic / economic / cultural diversity there than Texas."

Not Texas, the US. Less cultural diversity than the entire United States.

I was trying to say that France is quite a bit smaller than we are.
posted by zarq at 3:02 PM on August 13, 2013 [1 favorite]


Pregnant gf, upon hearing that deli meat is pretty much fine except for turkey: "Well all I fucking want is a turkey sandwich so that's not very helpful, is it?"
posted by thsmchnekllsfascists at 3:04 PM on August 13, 2013 [2 favorites]


mrgrimm: " No offense, but you just lost a lot of credibility points."

For the life of me, I have no idea why.

I said France is smaller than the US, and possibly less diverse. I'm really not sure why that should be a revelation to anyone. France has 65 million people in an area slightly smaller than Texas. We have 300+ million people in a much larger area. Which is why I said that they are less 'economically and demographically all over the map than we are."
posted by zarq at 3:06 PM on August 13, 2013


Not Texas, the US. Less cultural diversity than the entire United States.

Well that right there is spoken like somebody who has clearly never been to Texas.
posted by hobo gitano de queretaro at 3:19 PM on August 13, 2013 [1 favorite]


even as he notes that listeria cases even during pregnancy are "extremely rare" and "extraordinarily unlikely"

My sister's GP told her to eat as much brie as she wanted; he'd never seen a single case of listeria in 27 years of practice (Australia typically only has single-digit cases per year; some years none at all). What a dude.

PS PhoB, you're for a treat, because people telling you what to do and how to do it in regards to your foetus doesn't stop once the little fella pops out of your uterus, on the contrary; it only intensifies. Everyone's an expert on babies, and there are Reasons they do everything.
posted by smoke at 5:33 PM on August 13, 2013 [1 favorite]


I'm 24 weeks along, and I'm a PhD student in the sciences, which means that if nothing else, I'm really good at looking up articles and interpreting data. I know all about the risks. Way too much, really. My midwife seems to consider it her job to play down pretty much all of my concerns. She knows I am very well informed and cautious in temperament (and, thankfully, the baby and I are also extremely healthy). The only concern she seems to have is that I am not hydrated enough, or, more specifically, that I should be more conscientious about my hydration while hiking and running to avoid excessive Braxton Hicks contractions. Every time I see her she clucks about what terrible misinformation and bad advice pregnant women get from the world at large, and tells me I'm doing fine.

She is a midwife at a busy city hospital serving a mostly high-risk population, and she has a degree in public health. She is all about evidence-based care. Being a scientist, I double-check most of her advice and she knows what she's talking about.
posted by Cygnet at 6:05 PM on August 13, 2013 [2 favorites]


Cygnet: "The only concern she seems to have is that I am not hydrated enough"

People can follow good advice to bad places. I once saw a woman less than two hours post-partum who was endangering her newborn. At first people were worried than she had experienced a psychotic break. She'd been brought in to the ED from a local natural birthing center. Turns out she'd had a water birth with no anaesthesia and been encouraged to drink tiny sips right through the rather prolonged labour to "reduce the pain". She had become completely delirious because of hyponatremia - she had literally diluted her blood's sodium from drinking too much water.

There's a real jungle of people out there giving advice to people. It's very difficult to separate the good from the bad, and to evaluate optimally. And for something like colic, or autism, it can become positively dangerous.
posted by meehawl at 6:40 PM on August 13, 2013 [4 favorites]


Just once I would like to read a story about someone getting thrown out of a restaurant for harassing a pregnant woman about her choices.
posted by George_Spiggott at 6:48 PM on August 13, 2013 [4 favorites]


meehawl - Sure, I've heard of plenty of athletes who took hydration way too seriously and ended up with hyponatremia. I'm well aware that it's a concern. My midwife's advice to me was quite personal, though - I was actually dehydrated (according to urine tests), actually not drinking enough (according to her judgment and mine), and the dehydration was setting off Braxton Hicks contractions that disappeared when I rested and drank water. It wasn't a case of overzealous generic health advice.
posted by Cygnet at 6:49 PM on August 13, 2013


I'm a PhD student in the sciences, which means that if nothing else, I'm really good at looking up articles and interpreting data.

No it doesn't, it just means you think you are. Now test that hypothesis.
posted by yerfatma at 7:22 PM on August 13, 2013


I said France is smaller than the US

People are confused and arguing because you mistakely wrote Texas, not the US.
Well for one thing France is smaller than the state of Texas, so they're not as economically and demographically all over the map as we are.
posted by muddgirl at 7:48 PM on August 13, 2013 [1 favorite]


When I was pregnant with my first I was planning a trip to Santa Fe and read in What to Expect that it was very unsafe to travel to high elevations. (High was defined as something ridiculous like 3,000 feet or something.) And that if the trip was absolutely necessary, I should spend a week acclimating at increasingly high elevations.

I still remember the quizzical look on my doctor's face when I asked her about it and she told me that no, I could go to Santa Fe, that would be okay.
posted by gerstle at 7:55 PM on August 13, 2013


The thing people are ignoring is the trade-off between benefit and potential loss. As noted above, ""would this bite of turkey really be worth going through a miscarriage, or possible harm to the baby's brain development?" And the answer was almost always no (except for a couple of slices of prosciutto!)." The risks from, say, eating brie are very low. But so's the benefit. And miscarriage really sucks.
posted by ThatFuzzyBastard at 8:09 PM on August 13, 2013 [1 favorite]


Anecdata: my second pregnancy was after a C-section. The father and I actually went through a divorce toward the end because of his violent behavior.
I experienced premature labor.
Alcohol SAVED my lovely daughter. I was medically ordered to drink in the last six weeks of that pregnancy.
Normally, early in a pregnancy alcohol is a Bad Thing in the amounts I was specifically ordered to take. In a premature labor situation though, it is a life-saver.
And nothing wrong with her abilities mental or physical.
posted by Katjusa Roquette at 10:59 PM on August 13, 2013 [1 favorite]


Oh and salad, in Europe they tell pregnant women to stay away from salad because of toxoplasmosis.
Bagged salads are especially a bad idea.
Which is really too bad since salad is nice.
I don't eat salad like I used to because it is hard on my stomach. Mt. Roquette can't chew it. So we just don't have it anymore.
posted by Katjusa Roquette at 11:43 PM on August 13, 2013


Geez, muddgirl, would people stop picking at zarq. He clearly meant, "France is so much smaller than the USA it's not even as big as the state of Texas, so France is not as economically and demographically diverse as the USA" which is one of a dozen reasons you can't just point to France's lower infant mortality rate and claim it proves anything about the risks of eating raw cheese.
posted by straight at 12:13 AM on August 14, 2013 [3 favorites]


For all these car based accidents, where and when do they occur? How do they compare to the death rate of pedestrians in similar circumstances? Also for heavily pregnant women it can be basically impossible to walk anywhere very fast without a lot of discomfort? There are lots of obvious reasons why car driving is not treated the same as particular dietary choices.

I'm all for accurate depiction of the risks. In the UK if you chat to midwifes they will tell you that, while a little alcohol is actually fine, they recommend none because there will be a portion of the population who simply do not understand what a little is. Recommendations to pregnant women are usually on a mass level. That is, most things increase risk factors by a marginal amount, but mean that there are 200 less miscarriages a year maybe.

There is an emotional cost to it. I know its ludicrous, but speaking as the husband of an 8 month pregnant wife, I can't imagine the emotional guilt if a miscarriage occured or occurs and we had done something "bad". I'm not sure its possible to remove that emotional burden whatever we do.
posted by Cannon Fodder at 12:21 AM on August 14, 2013 [3 favorites]


Its worth mentioning too that observational studies as a whole do present a problem for society, because establishing causation is just really hard. There isn't a magic bullet for doing this, although there are some methods out there. Ideally what we'd like is a good medical explanation for why something might increase a risk factor before accepting it as bad. This link is often missing or weak in much dietary science in general, which is why advice can be very contradictory. If we claim a couple of glasses of wine a week can actually improve outcomes, we might want to wonder why that is.
posted by Cannon Fodder at 12:24 AM on August 14, 2013


Thanks, straight. That's what I meant to say.
posted by zarq at 5:03 AM on August 14, 2013


I'm a PhD student in the sciences, which means that if nothing else, I'm really good at looking up articles and interpreting data.

No it doesn't, it just means you think you are. Now test that hypothesis.
posted by yerfatma at 10:22 PM on August 13


Yeah, take that, silly scientists, always thinking they can test hypotheses and interpret data when they should leave that to the REAL experts, who are . . . um . . . wait . . . ???
posted by Salvor Hardin at 5:11 AM on August 14, 2013 [2 favorites]


The risks from, say, eating brie are very low. But so's the benefit. And miscarriage really sucks.

You seem to have never experienced pregnancy cravings. The other day I burst into tears because my husband brought me home mint chocolate chip instead of pistachio ice cream ("It's not the same!!!!") Lately I seem to be incapable of rational thought if the body decides it really wants something, much less capable of a risk-reward assessment.

I keep wanting to write a horror story about a cannibal fetus that makes the mother dine on the flesh of her loved ones, but I figure it's probably been done.
posted by PhoBWanKenobi at 6:42 AM on August 14, 2013 [1 favorite]


Oh and salad, in Europe they tell pregnant women to stay away from salad because of toxoplasmosis.

Wouldn't it be easier to stop having cats make your salads?
posted by yoink at 6:54 AM on August 14, 2013 [11 favorites]


Plus their little claws always tear up the lettuce.
posted by PhoBWanKenobi at 6:58 AM on August 14, 2013 [5 favorites]


Just because this discussion made be curious:

France
Pop: 65.35 million, 85% White

USA
Pop: 316.45 million, 63.7% non-Hispanic White

Texas
Pop: 26.06 million, 44% non-Hispanic White
posted by spaltavian at 7:37 AM on August 14, 2013


The other day I burst into tears because my husband brought me home mint chocolate chip instead of pistachio ice cream.

I once had a breakdown because my husband forgot to refrigerate the apples overnight and they weren't as crispy. (Mushy food made me nauseous). Those hormones are no joke.

I had the benefit of a really great OB with my first pregnancy, so when my current one gave me her list of "thou shalt nots," I smiled politely and made my husband take me out for sushi. But only fancy sushi, because, you know, safety. And noms.
posted by snickerdoodle at 8:11 AM on August 14, 2013 [4 favorites]


The risks from, say, eating brie are very low. But so's the benefit. And miscarriage really sucks.

There's nothing inherently incorrect about that statement, and obviously nobody here is suggesting that any individual person is "wrong" to make whatever assessment of risks/benefits they want to make. But that's not what this discussion is about. It's about a whole cultural machinery of admonishing and reprimanding and monitoring pregnant women over a series of actions that are held up as real and credible threats to the wellbeing of their babies-to-be on the basis of almost no plausible evidence whatsoever.

Again, as a personal decision your choice not to eat brie while pregant is unimpeachable, but as a Public Health proclamation, "Pregnant Women Must Avoid Brie!!!" is completely nuts. And part of the reason it is nuts has to do with the fact that we none of us, in fact, live our lives according to the calculus you sketch above ("let me weigh the risks against the benefit and abandon the benefit if it doesn't outweigh the maximum potential loss"). And I can demonstrate to you that you don't actually live your life that way (unless you're some kind of paranoid basket-case). I mean, sure, "miscarriage really sucks." That's entirely true. But you know what else sucks? Losing a 2-year old. Losing an 8-year-old. Losing a 13-year-old. Losing a 16-year-old. Also dying yourself really sucks. These are all catastrophic losses (most of them by most measures worse in terms of their effect on people's lives and well-being than a miscarriage, in fact) against which any imaginable "benefit" pales into insignificance. But does anyone regard "total avoidance of all imaginable risk" as a healthy yardstick to use in deciding how they'll conduct their lives or the lives of their 2, 8, 13 or 16-year-old child? Is the "benefit" of riding a bike worth the death of your child? Of course not. But is the non-zero risk to the child's life of riding a bike a reason to insist that they don't? Is the "benefit" of eating salads worth your or your child's life? Of course not. But does that mean the non-zero risk of a whole range of food-poisonings from fresh produce is a good reason to insist that you and your children never eat any unprocessed foods? Is driving the family to Yosemite for a vacation worth you and your children's lives? Of course not. But does that mean the far from non-zero risk of a car accident on the way and back as well as the smaller but non-zero risk of catching the Hansa virus or of being attacked by a bear or of falling from a cliff or some other unlikely-but-not-impossible accident make such a vacation an unthinkable risk? And one could proliferate examples ad infinitum. Every day you are choosing to do things with a non-zero risk of death or severe injury attached to them and you do them for benefits that are utterly incommensurable with the maximum potential risk associated with that activity. This is simply the nature of living, and to attempt to get around it would, as I say, be indistinguishable from a profound mental disorder. And yet somehow we've carved out this one portion of our lives--the period while we're in utero--and declared that it's not only acceptable for parents to act like crazy people during that time, but that it is morally suspect if they do not. This is not, I believe, a healthy situation for pregnant women, and it exacerbates the guilt and self-blame that inevitably wells up in those tragic but unavoidable instances when miscarriages do occur.
posted by yoink at 9:20 AM on August 14, 2013 [15 favorites]


It's about a whole cultural machinery of admonishing and reprimanding and monitoring pregnant women over a series of actions that are held up as real and credible threats to the wellbeing of their babies-to-be on the basis of almost no plausible evidence whatsoever.

In essence I agree. The only thing I might question is the level of admonishment (and monitoring? - are doctors examining stool samples for brie?) seems a bit exaggerated. The biggest problem I see is that the US government publishes some of the most alarmist and restrictive messaging.

But here's an article from the very conservative US News and World Report from 6 years ago that says "For Pregnant Women, Some 'Hazards' Are Part Myth - Expecting moms don't need to panic about coffee, X-rays, or other overblown no-no's"

I'd say the important message of the article is to own your pregnancy. Do your own research. Learn how to be a strong advocate for yourself as a patient. Change doctors (if you can). Fathers and partners, learn how you can support and empower mom. Again, everyone is different.

I think that advice goes for all medical patients, but particularly for pregnant women because, as others have said, everybody has a bad tendency to go all but-think-of-the-baby batshit crazy with pregnant women.

The other message is to STFU about other people's choices around pregnancy and childbirth. If your sister wants to Webcast her birth in a tub in her third-floor walkup in the Mission, shush with the criticism and say "I'm with you."
posted by mrgrimm at 10:16 AM on August 14, 2013 [1 favorite]


The only thing I might question is the level of admonishment (and monitoring? - are doctors examining stool samples for brie?)

The admonishment and monitoring I'm referring to is social. Pregnant women are subject to constant "Oh, you really shouldn't do that, you know, think of the baby" advice from all kinds of random people about all of this nonsense. A pregnant woman drinking a glass of wine in public might as well be shooting up for the level of "OMG what are you thinking!" that will instantly pervade the atmosphere. And this is heavily reinforced in the broader culture; if you want to show that someone is a Bad Mother and an Irresponsible Person in TV or the movies, all you do is show them with a beer bottle or a wine glass while they're visibly pregnant. They are instantly branded as Beyond the Pale. And this is just nutso.
posted by yoink at 10:29 AM on August 14, 2013 [5 favorites]


And noms.
posted by snickerdoodle


epony-delicious
posted by RolandOfEld at 10:36 AM on August 14, 2013


Again, as a personal decision your choice not to eat brie while pregant is unimpeachable, but as a Public Health proclamation, "Pregnant Women Must Avoid Brie!!!" is completely nuts.

I'd say this is completely backwards.

As an individual, the odds that eating brie will affect your pregnancy are so small it's a very questionable thing to worry about.

As a Public Health proclamation, "Pregnant Women Must Avoid Brie!" will probably prevent some miscarriages (if there's indeed any danger to eating brie). The question is whether it prevents enough miscarriages to be worth the costs and harms of making such a proclamation.
posted by straight at 11:00 AM on August 14, 2013


The question is whether it prevents enough miscarriages to be worth the costs and harms of making such a proclamation.

Er, as you may have gleaned from the rest of my comment, my argument is that it does not "prevent enough miscarriages to be worth the costs and harms of making such a proclamation." "If people do this, some non-zero number of lives will be saved" is not a good enough reason for making Public Health proclamations about a given activity by exactly the same logic I outlined in the post.

And, if it were, there are thousands of far riskier activities we engage in on a daily basis that should be higher on the Public Health Announcement priority list than brie. It is staggeringly more risky to have a bath (OMG, talk about tempting fate!) or a shower (ayeeeee!!!) than to wash yourself with a washcloth and a sink full of water, for example. It would also save an enormous amount of water, so it's win win all round. Are people in TV shows and movies who have baths or showers shown as reckless madmen and wastrels? No. Again, we have highlighted a few very remote risks out of all proportion simply because of a set of particular cultural anxieties about pregnancy and not at all because of any sane and sober risk analysis.
posted by yoink at 11:15 AM on August 14, 2013 [1 favorite]


You're talking about the specific cost/benefit analysis for eating brie, and I agree with what you're saying.

My point is that, in general, if it's not worth making a public health proclamation about (where statistically you're almost certain someone will benefit), it's almost certainly not worth an individual worrying about it (where statistically an individual is almost certain not to benefit unless they're in some sort of specific high-risk group). I was taking issue with what you said about the personal choice not to eat brie being unimpeachable.
posted by straight at 12:00 PM on August 14, 2013


We could present reality to mothers, but instead we take the "hot lava!" approach to everything.

It seems to get worse every year, too.

When I was pregnant with Elder Monster, there was one thing I was explicitly told to avoid, and that was caffeine. My blood pressure was a hot mess during that pregnancy, and caffeine just made it worse. When I asked my doc about other things to avoid, he told me to throw out the damned What to Expect book and just continue as I always had, the only thing I really needed to pay attention to was my RA, if in the course of my visits he finds something amiss, he will address it. Four years later, with Younger Monster, it was much the same. I ate whatever I pleased, even had the occasional glass of wine with my dinner after the morning sickness finally let go of me. They seem to have grown up just fine.

Flash forward to friends now having children, and the list of DON'Ts they get sent home with is absolutely absurd, and while I certainly had my share of nosy-nelly strangers questioning my choices while pregnant, it seems like my pregnant friends are suffering from it 20-fold. Gods help them if they tell these assholes to mind their own business, they've got it under control - the "think of the BABY!" nonsense just gets turned up to 11. Ugh.
posted by MissySedai at 12:50 PM on August 14, 2013 [1 favorite]


I was taking issue with what you said about the personal choice not to eat brie being unimpeachable

Oh, I see what you meant. My point was that its entirely any individual's right to make such choices as they see fit--not that it is a rational choice, which I clearly do not believe.
posted by yoink at 1:16 PM on August 14, 2013


And yet somehow we've carved out this one portion of our lives--the period while we're in utero--and declared that it's not only acceptable for parents to act like crazy people during that time, but that it is morally suspect if they do not. This is not, I believe, a healthy situation for pregnant women, and it exacerbates the guilt and self-blame that inevitably wells up in those tragic but unavoidable instances when miscarriages do occur.

Yes, I agree that it's shitty when people think that parents-to-be are morally suspect if they don't get all risk averse during pregnancy. I think you're overstating it though - or you move in circles that are a lot judgier than my own. Throughout my pregnancy, I can't say I experienced that kind of moral judgement - and I think public health officals and doctors generally have their hands full with dealing with things that are actually risky.

But I do think the self-policing is interesting. As I said above, I thought I would remain relaxed about food restrictions, and have a beer or glass of wine occasionally, and not restrict my diet. I'm often the person trying to talk people out of their irrational fears about personal safety, nutrition, health, etc. Yet when the opportunities would arise that "they" advise against, I would invariably not partake, either because I didn't really care that much about eating it anyway, or I realized that there's no point in being "rebellious", or the benefit/pleasure really wasn't worth the risk. And I'm definitely not saying pregnancy made me crazy and irrational and unable to effectively evaluate risks, but I think there's a lot of cultural baggage that women tend to carry (body image and food especially) combined with starting to think of yourself as a mother that can emerge all at once when you become pregnant. And I find it interesting that it all focuses on these few things that we can avoid consuming.
posted by raxast at 2:20 PM on August 14, 2013 [1 favorite]


if you want to show that someone is a Bad Mother and an Irresponsible Person in TV or the movies, all you do is show them with a beer bottle or a wine glass while they're visibly pregnant.

Is this really a thing? I don't think so. Why not use a cigarette?

you move in circles that are a lot judgier than my own

I must concur. I get what you're saying, but I think things have gotten a lot better in the last decade, as far as giving pregnant women more agency in their care.
posted by mrgrimm at 4:41 PM on August 14, 2013


yoink: "The admonishment and monitoring I'm referring to is social. Pregnant women are subject to constant "Oh, you really shouldn't do that, you know, think of the baby""

If you want to see this taken to a particular conclusion, read Intrusion by Ken McLeod. It's a "soft" dystopia, set a few years in the future, where within a risk-averse technocratic society, pregnant women are effectively cloistered in their homes and unable to work because of the health risks to the fetus of their coming in contact with so many of the pollutants from the 20th century casually deposited within buildings after generations of cigarette smoking and flame retardant use (and which would be allegedly too expensive to remediate). One of the protagonists is a pregnant women who declines to take a (so far) non-compulsory but socially expected genetic "fix" for many inborn errors of metabolism found during routine screenings. Pregnant women have to wear ankle monitoring bracelets, for example, so if they are detected in or around alcohol, they get a visit from a finger-waving social worker to talk to them about their potential inability to receive social benefits. It's really a very cleverly done novel.
posted by meehawl at 6:56 PM on August 14, 2013


I do wonder where all these judgy people are. When my partner and I were pregnant, everyone we saw would smilingly lean in and say "You know, a glass of beer is fine!" What was really odd was that *everyone* would do that, and *everyone* seemed to think they were being terribly naughty by doing so.
posted by ThatFuzzyBastard at 7:32 PM on August 14, 2013 [2 favorites]


I move in pretty liberal, educated circles and I've faced lectures and looks for fairly minor things (once, eating lox!) My longtime bestfriend is also pregnant, and works and lives in a more conservative area. She's gotten it much worse than I have. Plus a big heap of, "What do you mean, you're not going to be a stay at home mom?!"

If you disbelieve the judgment happens, just google "can I eat x pregnant" where x is anything that may or may not be verboten. Mainstream rhetoric seems conservative, and increasingly so.
posted by PhoBWanKenobi at 7:46 PM on August 14, 2013 [1 favorite]


It's not that I disbelieve it's happened to people, I just find it weird that our experience was so different, even as everyone we spoke to seemed convinced that everyone but them was being super judgey. We're in a liberal big city, but travel in some fairly socially conservative circles within it.
posted by ThatFuzzyBastard at 8:23 PM on August 14, 2013


And I don't think "Can I eat x while pregnant" searches equals a conservative society. We searched for that question plenty of times, because while making a sensible decision about risks makes sense, eating something that could be risky without at least some knowledge seems, well, really stupid and irresponsible.
posted by ThatFuzzyBastard at 8:25 PM on August 14, 2013


I mean that the lay answers you'll find on any random sample of momboards/pregnancy sites are more indicative of the public feelings at large about this than, say, anecdata from a small sample size of people on a liberal-leaning and fairly educated site like metafilter. Here's an example (from a search of "can I eat lox pregnant"):
NO SHE IS NOT

It is not a question of mercury - Smoked salmon can contain parasites in it and be contaminated with listeriosis that can be harmful to the baby.

NO.

She can't have ANY cold meat or fish (expect canned tuna). She must heat all cold cuts to steaming before eating and no raw hot dogs (and unless you are 5 - this isn't really a concern).
Source(s):
Thumbs down - well, it is up to you - listen to these ill informed Yahoos and risk serious birth defect or just tell her you'll buy her all the lox she could ever eat in 5 months time. Whichever.
Also people who are all "you are going to hurt the baby!!!!" tend to be way more loudmouthed/passionate/judgmental than people who are like "you have to assess the risks for yourself" or whatever.
posted by PhoBWanKenobi at 9:00 PM on August 14, 2013 [3 favorites]


If I'm going to have to treat anonymous message board comments as more significant than my direct lived experience, life is going to get very odd indeed.
posted by ThatFuzzyBastard at 8:34 AM on August 15, 2013


They're not more significant (to you) than your own experience, but they show that your experience is not everyone's. No one's asking you to agree that oh yes, you did experience judgey behavior! Because you didn't experience it doesn't make it all that weird that other people do.
posted by rtha at 9:23 AM on August 15, 2013 [3 favorites]


PhoBie, you'd get the same results whether 60% of the population is poised to denounce any pregnant woman eating lox or 0.006% of the population feels that way.

No one's going to post an answer to that question if their response is, "I don't know. I never heard it was dangerous." And there's very few things about which anyone could say, "Science PROVES lox is totally safe for pregnant women!" You might get a few, "Well studies haven't shown any risk.." types, but you're mostly gonna get the passionate, "DON'T TOUCH IT I READ IT KILLS BABIES" whether there's 5 of them or 5000.
posted by straight at 9:25 AM on August 15, 2013 [1 favorite]


Sure, and feel free to avoid anything you feel you should. But don't complain to me about it. It's the complaining that makes me batty.

First, if this makes you batty, you should really see someone about that. Second, it's funny to publicly complain about other people complaining. Pregnant people have choices, so they are not allowed to complain? So what's your justification for complaining? Don't you have a choice not to talk to pregnant people? Oh, it might mean losing your job, for instance? Well, that's clearly more important than losing your baby! Justified or not in your opinion, that's the choice they *think* they are making. God, women are boxed in. Drink wine, and people will judge you. Dare to speak out that it annoys you that you don't feel you can drink wine, and other people will judge you.
posted by pizzazz at 9:52 AM on August 15, 2013 [2 favorites]


Auto accidents are real things

Absolutely.

But people tend to think most of their driving is a necessity and is something that they, unlike all the other assholes on the road, can do very well, so warning pregnant women about the real risk of car travel would be asking them to make a real sacrifice (in terms of general daily pleasure and convenience) to avoid a risk they think they already mitigate by being wonderful drivers. Mothers would likely ignore warnings about cars, and the usual publishers of such warnings ("10 Things Expectant Mothers Should Avoid!") wouldn't publish this warning because it isn't what their readers want to hear.

Whereas most people know they can easily do without soft cheeses and they probably don't think they know a special safe way to eat soft cheeses, so warning pregnant women about the extremely remote risk of getting listeria from soft cheeses is more likely to change behavior. It gives expectant mothers something simple they can do to make themselves feel irrationally good about themselves at little or no personal cost, and it gives the usual publishers some more fluff to sell.
posted by pracowity at 5:32 AM on August 19, 2013


Is this really a thing? I don't think so. Why not use a cigarette?

TV Tropes on the subject. Yeah, it's really a thing.
posted by yoink at 1:21 PM on August 20, 2013


If you disbelieve the judgment happens, just google "can I eat x pregnant"

judge for yourself:

can i eat cheese pregnant
can i eat shellfish pregnant
can i drink coffee pregnant
can i drink wine pregnant
can i drink beer pregnant
can i eat deli meat pregnant
can i drink alcohol pregnant
can i smoke marijuana pregnant
posted by mrgrimm at 8:06 AM on August 22, 2013


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