There are many questions couples ask themselves when thinking about expanding their family. Having another pregnancy—and another baby—is often fraught with both excitement and anxiety. What would it look like to give our child a sibling? Do we need a larger car, or possibly home? What would life be like for us as a family with one more child?
For women who experienced complications during their previous pregnancy, their consideration of getting pregnant again might include a few scarier questions. Will this pregnancy look like my last? What if my baby or I are in danger again? Is there any way I can better prepare for next time?
Answers to these tough questions are at the core of Emily Oster’s new book, The Unexpected: Navigating Pregnancy During and After Complications. Oster walks readers through the most common adverse pregnancy and postpartum conditions and provides data on the likelihood of recurrence with a future pregnancy. Her co-author, Dr. Nathan Fox, provides valuable medical information and advice throughout. Here’s our recommendation on whether to buy, borrow, or pass on this book.
Emily Oster, a professor of economics at Brown University, is well-known for her data-based approach to pregnancy and parenting. Her 2013 book Ожидание лучшего was a smash-hit, delving into numerous pregnancy topics from drinking alcohol to epidurals during labor. She later wrote Cribsheet и The Family Firm about parenting babies and school-aged children, respectively, and runs the newsletter ParentData. Oster is a frank, honest writer who uses her economics background to discuss parenting matters.
Dr. Nathan Fox, MD, the co-author of The Unexpected, wrote short sections at the end of most chapters. He is a maternal fetal medicine (MFM) doctor, working with pregnant women navigating complex pregnancies. Fox practices at Mount Sinai hospital in New York City, and also runs a podcast on pregnancy called Healthful Woman.
Both Oster and Fox are preeminent in their fields, and the combination of Oster’s data-driven approach and Fox’s real world experience of pregnancy complications in his patients make for a well-rounded pairing.
Кто является целевой аудиторией The Unexpected?
In the introduction of The Unexpected, Oster explains after publication of Ожидание лучшего countless women wrote to ask her about their serious pregnancy complications. They wondered whether and how they could navigate a future pregnancy after dealing with hyperemesis gravidarum (HG), preeclampsia, or even stillbirth. Oster wrote The Unexpected as a roadmap to help these women make crucial decisions in their future pregnancies.
The following conditions during their past pregnancy (or pregnancies) are addressed in The Unexpected:
- Hyperemesis gravidarum (HG)
- Miscarriage
- Gestational diabetes (GD)
- Preeclampsia and gestational hypertension
- Fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR)
- Preterm birth
- Emergency Cesarean section
- Maternal conditions like stroke, hemorrhage, or sepsis
- Stillbirth
- Birth complications like severe vaginal tearing or uterine prolapse
- Postpartum mental health conditions
- Breastfeeding barriers like delayed lactogenesis or supply issues
Каковы основные области содержания The Unexpected?
The Unexpected is divided into two parts: Preparation and Complications.
Preparation
The first part, Preparation, is all about getting ready for a future pregnancy after past complications. Oster dives into how to prepare yourself mentally for getting pregnant again, helping the reader frame the question of whether to have another child, find facts, make a final decision, and follow-up.
One of the key elements of this process is preparing the materials—choosing a healthcare professional, gathering your medical documents, and receiving additional testing when necessary. Oster explains that it is necessary to have a full understanding of what exactly happened during your last pregnancy, including all of the documentation from your hospital and doctor.
Once you’ve decided on your medical clinician and prepared all of the materials necessary, it’s time to start asking questions. The Unexpected includes numerous examples of questions patients should ask their doctors depending on what their condition was, plus details that you should know offhand. For instance, a woman with preeclampsia needs to make sure she knows whether her diagnosis happened before, during, or after labor, as this might be an insight into whether or not she’ll have preeclampsia again.
Complications
The bulk of the book is dedicated to the second part, the complications. In this section, Oster (together with input from Fox) delves into each of the pregnancy and postpartum conditions listed above. Each chapter gives a definition of the condition, quotes from women who experienced the condition during their pregnancy, data on recurrence rates, prevention, and treatment, plus practical recommendations based on Fox’s medical experience.
As an example: the chapter on preeclampsia opens with a definition and the risk of recurrence (20-50%, which is considered intermediate). Oster breaks down the various levels of preeclampsia, and gives the perspectives of multiple women who experienced the condition during their pregnancies. She then cites a 2016 study on the approximate risk of having preeclampsia in a subsequent pregnancy, with a chart displaying how some women (especially those with severe preeclampsia or HELLP before 37 weeks) have a much higher risk of recurrence than those with only mild preeclampsia at full term. She also weighs the pros and cons of various treatments, using multiple studies to back up her claims.
In his section, Fox discusses four of the most common recommendations for preeclampsia (such as low-dose aspirin and home blood pressure monitoring), describing which types of patients typically do best with each. His advice is kind and reassuring yet practical.
Каковы сильные стороны The Unexpected?
If you experienced a complicated and difficult pregnancy, The Unexpected has a lot to offer. It gives a framework of questioning that is valuable for couples in their discernment, plus lists of questions to consider or ask your doctor. Oster’s advice on gathering your medical documentation and understanding what happened previously is crucial.
The individual chapters on each condition are definitely where Oster’s data-driven background shines. She cites a host of studies that can help predict how likely it is for the conditions to recur, plus valuable information on preventing or treating them. Readers will also appreciate the recommendations from Fox, which give a look into what a maternal fetal medicine specialist might suggest in their case.
Another key strength of Oster’s work is that while she provides the reader with a framework of thinking which is bolstered by her research, she doesn’t explicitly give recommendations on what to do. She gives advice on the questions to ask your doctor and things to keep in mind when considering a future pregnancy, but she respects individual readers’ ability to make their own decisions regarding interventions and treatments. This approach can be empowering, as Oster gives you the resources necessary to make your собственный decisions, but does not dictate what those decisions should be.
The Unexpected’s ограничения или "слепые пятна
The most obvious limitation of The Unexpected is that it does not discuss каждый pregnancy complication. For example, it leaves out issues such as внематочная беременность, group B strep (GBS) during labor, and rare but serious medical conditions like cholestasis. If you experienced any pregnancy complications, it’s a good idea to check the list of included conditions above (or peruse the table of contents in the book) before reading.
Data-driven rather than story-based approach
While many readers will love Oster’s data-driven approach, some readers might find it a bit impersonal and desire information from someone who’s “been there” herself. Successful birth stories (especially redemptive second births!) are popular for a reason, as many pregnant moms wish to hear other women describe how they’ve walked challenging roads and grew stronger and more hopeful along the way. The Unexpected does contain anecdotes from women, but they’re not as in-depth as some might be looking for.
The section on C-sections
Another blindspot of The Unexpected is Oster’s treatment of C-sections. While Oster does a good job discussing the decision-making process that needs to happen when considering a vaginal birth after Cesarean (VBAC), her main points against a repeat C-section have only to do with the risks of the surgery itself. She discusses how having repeat C-sections might pose risks for future pregnancies, giving a table which displays the risk for placenta accreta (where the placenta is too deeply embedded in the uterine wall and does not detach on its own, potentially necessitating a hysterectomy). This is all extremely valuable information for women weighing another C-section or a VBAC.
However, Oster does не delve into the fact that many of the C-sections in the United States are largely unnecessary. She also does not mention how a vaginal birth carries a number of преимущества to both the mother and the baby, such as easier breastfeeding, natural pain relief from endorphins, and a more robust immune system in the newborn from the beneficial bacteria of the mother’s vaginal canal.
Women who are looking for information on C-sections and VBAC should supplement The Unexpected с further research on birth, especially if they question the necessity of their past C-section.
Вердикт: купить, одолжить или пропустить The Unexpected?
The Unexpected is a great one to borrow from the library or a friend if you’ve experienced any of the complications that Oster and Fox discuss. Due to the nature of the book, the average reader will only need some of the chapters included, so it’s not really necessary to have it as a purchased reference for the future. Readers would do well to take note of Oster’s framework of decision-making and take the information included in their specific complication chapter to their medical team as a starting place for conversations. Overall, The Unexpected includes valuable information for women seeking to have another baby after experiencing a challenging pregnancy, giving data-based reassurance with the hope of making the next time go a little smoother.
