Pregnancy Myth-Busting with Emily Oster: Sushi, Caffeine, Epidurals & More

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0:30Two Parents & A Podcast Hosts:so good so good so good new markdowns up to 70 off are at nordstrom rack stores now stock up and stay big on shoes tops dresses accessories and more must-haves for summer join the nordic club to unlock exclusive discounts shop new arrivals first and more plus buy online and pick up at your favorite rack store for free great brands great prices that's why you rack Welcome back to another episode of Two Parents in a Podcast. I posted that we were interviewing Emily Oster on my DMs and they lit on fire. My best friend specifically. Are you kidding me in all caps? And I said, no. That would be a weird joke.

1:15Two Parents & A Podcast Hosts:I'm here. I DMed you. Did you? I think I went back and deleted it when we booked you. But I did. when we first started the second episode. And I was like, hi, we'd love to interview you. You ghosted me, it's okay. I'm sorry. It's fine, you're busy. I'm sorry. Now we've got you. And I'm here, I'm so excited. We're so excited to talk to you. I don't think you need an introduction, but you are a best-selling, I'm not gonna try to do it for heart, that would have been great, I was gonna try. Emily Oster is a best-selling author and economist, which I didn't know. known for bringing data-driven clarity to some of the most confusing parts of pregnancy and parenting now this first part we're going to do we're going to focus specifically on pregnancy great expecting better we read it together um if you haven't read the book don't you even worry because we're going to break it apart we're going to ask her all about it um but when we found that i was pregnant we were scared we had all these questions my friend katie beach sent me your book She said, read it.

2:19Two Parents & A Podcast Hosts:You'll be good. Thanks, Katie. Yeah. Thanks, Katie. Appreciate it. And thank you, Katie. And now now here we are with you. So we're excited to talk to you. I think you are a lot of people's true north when they're pregnant. I think there's a lot of don't eat sushi. Don't do this. Don't do that. And you're like, OK. And then our generation's really good at going. Well, why? Yeah. Wait. But why would we not do that? And you really explained why you wouldn't or why you would do that. I think so I was expecting better when I got pregnant because I wanted the why I remember coming to that first prenatal visit and getting this list of things not to do like almost on my way out the door they were like oh here's this list of what not to do and I was like but wait but like which of these are important and why and that and that was kind of my entry into like oh I'm not I'm not having the experience that I thought that I would in terms of getting answers that work with the questions I have.

3:15And that's kind of where Expecting Better came from. And I have been surprised. I was surprised at the time. I continue to be surprised at the fact that that wasn't out in the market because it seems clear that women would like to be treated like adults.

3:30Two Parents & A Podcast Hosts:Yeah, I think people just blindly follow things. But now I think you've really made a name for yourself. Like when the By Heart thing happened, we immediately went to your page and then watched what you said. And we were like, okay, I think I think you are like I said the true north for questions that people have which I think is awesome I find it really unique because I feel like a lot of people us included we take such a data-driven approach to so many facets of our lives and so where your book really landed was all right if we take this approach in so many other places then why wouldn't it be brought to pregnancy and and and parenting totally I think people come into this and you're like I'm used to interacting with the rest of my life in this way that's based on evidence and data and facts.

4:17And I also want to take that to my pregnancy. And so and so how did an economist become one of the most trusted voices in in pregnancy and parenting? Was it that moment leaving the doctor where they gave you that to do list or was there was there a little more to it? So there was a little more to it by, you know, the kind of so we tell people you're an economist, they will sometimes ask you like, what should I invest in? And I'm not that kind of economist. My work is really about data. My expertise is in data and data analysis. And so when I got that list and then in a few other moments of my pregnancy, I found myself looking into the data like the way that I would with my job.

5:02And Expecting Better really came out of that experience feeling like, okay, this is how I want to be treated when I'm pregnant. This is the information that I want. Maybe now having gotten this in the service of my own pregnancy, maybe I should write about it and maybe other people would like this. But I really, people say, well, why did you think that was a good idea? Like, I don't know. I just remember thinking, I want to write about this. I want to, I just like, I need to vomit out this information and maybe people will be interested and maybe they won't. But it was very, Expecting Better was really a passion project.

5:34Two Parents & A Podcast Hosts:perfect well it caught fire it did well it did i bet it did well okay so do you ever get any like i think the i think the most obvious off the top question is going to be do you ever get you're not a doctor no so you're an economist yes right and do people ever comment or say that to you of like why would we take medical advice from you yes many people have said that okay um and you know i think the answer is there are many things where like i i am not a doctor and i'm not going to deliver your baby. And I would not trust an economist to deliver your baby. But there's a thing I have an expertise in, which is data and what does the data say, what's causal, what's not causal.

6:13That's actually something where the training that I have as an economist is far better suited than most of the training you get in medical school, which talks relatively little about data. So on these questions, like what does the data say on sushi, on coffee, on epidurals, on all of these things that's really a data question for which the expertise I have is very well suited and I think that that was kind of a that was in that was my entry and I that's the that's what I bring to the table and yeah I will usually tell people like you I ideally you would read this book so you were better prepared for conversations with your doctor so you can go and you can be having the most productive conversations that are possible there okay I'm good with that

6:58Two Parents & A Podcast Hosts:yeah i like it i feel like i will say i think over over time when i first came out with this book and it was like here's this economist writing this book there was a lot of like what is happening over time you know i've spent a lot more time with doctors there are many more doctors who i think like this approach and i i think increasingly there are doctors who'll be like look you should read this person's book because like i don't have time to deal with all the weird questions that you know not not because they're not a good doctor but just doctor's time is limited Like, here is a book that has a bunch of answers for the questions that you have.

7:31And then we can talk about them after you've read it.

7:33Two Parents & A Podcast Hosts:Yeah. And I think it's complex. Like, you're supposed to trust your OB. Okay. Of course we do. But your OB is not going to sit there with you and explain every single thing to you. So I do think that there's a lot of merit to that. And I've never had more questions in my life than when I was pregnant, especially the first time. Totally. And there's no, you know, in medical care, there often isn't time to deal with all those questions. You know, your doctor is trying to do the doctoring things, measure, make sure everything is looking good. medically you know listen to the heartbeat all this stuff they don't have time to deal with your like there are many more questions that can be answered in those in those visits totally okay so let's go big picture yeah first and then we're going to zoom in so big picture what's the number one pregnancy rule like no sushi no deli meat that doesn't make sense once you look at the research bed rest a good share of women are still put on bed rest for some substantial period of pregnancy And there is basically no complication for which bed rest is a good idea.

8:25And a lot of reasons why you would not want to have it because it causes muscle atrophy and other things.

8:32Two Parents & A Podcast Hosts:Oh. I didn't know people were still placed on bed rest. A lot of people are. No, I had a friend that was actually. Yeah. So a lot of people are still placed on bed rest. It's gotten much less common over time because slowly this evidence has percolated into the world. but I think partly it like it feels like it makes sense sort of like well if you just lay down like just you know lay down and then it like won't nothing will happen but that turns out that's not how it works okay so you're supposed to be up and moving so can you explain the mismatch between how a doctor goes and gives this suggestion when you know on the other side of it there's what sounds like an overwhelming amount of data that goes against what they're telling their patients to be doing?

9:24Yeah. So I think there's a couple of pieces here. So one is that for something like bed rest, the sort of most common thing this could be prescribed for was just like threatened preterm labor. We're worried you're going to go into labor preterm, so we're going to put people on bed rest. That used to be very, very common. And if you are a doctor who has been doing that for decades, most of the time, the people you put on bed rest don't have their babies prematurely. And that's not because you put them on bed rest. It's because they weren't going to have them prematurely anyway. And if you look in randomized trials, you can see that that didn't make any difference.

9:59But the experience that you've had is I've put all these people on bed rest and they didn't have their babies prematurely. So my lived experience is kind of consistent with the idea that this works. And moving your brain to like, okay, but the randomized data says this, that's actually very hard for everybody. It's just like, that's not, our brains are really, really wired to learn from the experiences we've had. And so I think that's some of what's going on. And often people ask me, you know, well, my doctor recommended something and I don't think the data shows it. And the way I will always tell people to respond to that is don't be like, you don't know what the data says just ask why are you recommending that to me what is it about my case that would suggest this is a good recommendation even though the average it's not the average recommendation because that's a like a much lower conflict way to ask that question right but the root of the initial suggestion is coming from what they learned in medical school which may or may not be out I think that's correct okay okay so so what that is a general theme that applying that as a general theme to I think everything we're going to talk about.

11:11Two Parents & A Podcast Hosts:Yeah I think that's right. Correct. What that was what I was going to ask next is how much of the advice we hear is truly backed by research versus just old school caution and so it's some of it is backed by old data some of it is backed by data where it seemed like that was true but then when you got better data it wasn't true and some of it is just backed by logic and some Some of that might be right, some of it might not be right, but again, I think for each of these recommendations, it's why, for me, the right approach should be to say, you know, what does the data say? Why do we think that?

11:45And that lets people, lets us get to like which of these things really are things you should not do and which of them maybe this just is a little bit made up, not based on very good data, logic based rather than fact based.

11:58Two Parents & A Podcast Hosts:Okay. So now let's start with early pregnancy. Is there any truth to more nausea equals a healthier pregnancy, better hormones? So it is true that on average, pregnancy nausea is associated with lower miscarriage rates. And that likely does relate to the hormonal aspects of a pregnancy that is sort of developing normally versus not. So I will say this is not definitive. so many people who are not nauseous that the vast majority will go on to have to not miscarry go on to have healthy pregnancies and it is possible to be nauseous and also miscarry but on average nausea is associated with a lower risk of miscarriage i did look at a chart on that because i would go into my ob and i would say i'm so nauseous and she'd say that's so that's so awesome and then you know you'd leave and you'd be like actually you know like is it actually a good thing and so you just you do want to know but I do think it's a bit fear-mongering because I have so many friends I looked at one in the face who was also pregnant and I was like apparently it's a good thing that I don't feel good and then I was like oh my god you feel great and there and she's had two beautiful babies and there was no yeah so sometimes there is no correlation but you are saying yes it is there's a correlation but I think there's an important place for to say like Like, yes, there's a correlation, but it's not like everyone who is nauseous goes on to a healthy pregnancy and everyone who is not doesn't.

13:28Like the correlation is not that strong. Okay.

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15:35Two Parents & A Podcast Hosts:Trust me, you need magnetic me to make changing time easier. for you and your baby. If you're a parent or shopping for a parent, this holiday season, go to magneticme.com. Plus, they have the cutest gift box to wrap the gifts and have anything from baby up to toddler age. Plus, new customers will get 15 % off. Don't wait. That's magneticme.com. Now we're going to go to food and drink. Yeah. Which I bet when you were writing the book was just... because okay because what I think you've done there's this trend on social media of women giving you know just having birth their baby and they'll have a sushi tray in front of them or they'll have a ham sandwich and they'll be like waited nine months for this and then I'll always go to the comments and it's just like now people are saying like you could have you could have had the sushi could have just eaten the sandwich like you know and so I think that but I think you started that way because I don't think anybody ever challenged it beforehand I'm so happy that I was pregnant after this book was written um because I found a lot of it fascinating like you know don't eat gas station sushi well like never eat it also don't ever do that that's not a good idea that's so not a good idea there so what's the real risk with deli meat and listeria today so deli turkey in particular is one place people have gotten listeria and so So relative to other foods, it has a slightly elevated risk, but listeria is very rare.

17:07And most of the large outbreaks of listeria are in places you can totally not predict. So sort of there are sometimes outbreaks in ice cream or frozen vegetables or bean sprouts. It's a food issue that can come up in almost any food. And so the thing I'm sort of trying to help people understand in the book is, you know, how much would my risk go down if I avoided deli meats? And the answer is the reduction in risk is really, really tiny because the baseline risk is really small. And the share of listeria cases that are about deli meat are also really small.

17:39Two Parents & A Podcast Hosts:So like if you really wanted to avoid listeria, you need to stop eating lettuce. Like you just would need to. I think it's more than that. It's like it would be impossible to predict. Because it isn't like, you know, it isn't that there's a really long list of foods that, you know, are, and if you avoided all of those, it would be like every food. Okay. I mean, you could say basically I've exclusively eaten Doritos. You know, like Doritos cannot really get listeria. Okay. So if your whole, that was the only food you ate like Doritos and saltines for your entire pregnancy, like you wouldn't get listeria, but also it's not good for you.

18:13There's not enough fiber in that and other vitamins.

18:16Two Parents & A Podcast Hosts:Fact. And so, you know, I think it's not really possible to avoid eating all of the possible foods that listeria could be in because it is all foods. And so how many cases of listeria from deli meats have surfaced over, you know, the last five years or last 10 years or whatever relevant time frame? It's very hard to tell what most listeria cases come from. But if we look at like things that are identified, it's maybe one or two a year. Okay. that can be like definitively traced to. There are some things that... And that's across all people. Not one or two tied to pregnant women, but one or two listeria cases in the country a year tied to delineate.

18:58Two Parents & A Podcast Hosts:Okay, if you get listeria while you're pregnant, what's the problem? That's bad. So listeria is very bad while you're pregnant because it's not sort of fully understood, but it is associated with a risk of miscarriage and stillbirth. It affects the placenta and is very dangerous. So you definitely don't want to get listeria It's just that this particular avoidance Is really not changing that impact very much Okay, if you take the deli meat and cook it more Is that good? Yeah, that would avoid listeria But it would also make it taste bad No, I do that though You microwave your deli meats? I'll microwave it or I'll put it on the stove Because I'll warm it up Okay, so you really would have to If it in fact did have listeria Which again, very unlikely Warming it up in like in a panini is not going to do it for you You could like microwave it on a plate like it's bacon Until it's like kind of charred But then it wouldn't be as good Okay, that's what I thought I was No, you're not I thought I was doing something there No, you were not doing something I wasn't doing anything Okay, can pregnant women eat sushi safely?

20:03Two Parents & A Podcast Hosts:And if so, like what are three ways they could do that? So the risks with sushi are that you could get foodborne illness you know any raw food has a slightly higher risk than a cooked food but and this is the piece that is really important it is not higher risk in pregnancy so it's not if you know if you get a stomach flu during pregnancy that is uncomfortable just like it is uncomfortable to be sick at any time but there is no specific pregnancy risk and so if you are if there is sushi that you are comfortable eating in your normal life you should be comfortable eating it when you're pregnant And what that means is, you know, you should eat reputable sushi from like a place that is handling it well and is, you know, not leaving it out for many days because that's a bad thing to do.

20:50The one thing that is worth avoiding are very high mercury fish. So swordfish, tuna, shark. Most people don't eat shark sushi. I think it's very chewy. But the sort of very high mercury fish you want to avoid when you're pregnant. And so you're saying. You can have sushi. You can have sushi. That's what I'm saying. You can have sushi. How do you think we got here on sushi? Because that is. Where did we go wrong? I feel like, you know, as the guy I'm sitting here from the sidelines. But it feels like that's the number one thing I hear and see from pregnant people is no sushi. So I think it is partly out of so many of these recommendations are what are in this abundance of caution space.

21:35like you know well we want people to be more careful in general when they're pregnant and you know you're more likely to get a stomach flu from sushi than from something else just because of the way food works and so let's you know tell pregnant women not to have that because we just want to be extra cautious and i think many of these recommendations come sort of like that you know let's be extra cautious because just pregnancy is a vulnerable time and once you start telling people those things then it kind of then it reinforces and reinforces and and I and it also becomes difficult to push back on because when you are pregnant someone says you don't do this and then if you say like why but I want to do it it's sort of like well don't you care about your baby.

22:25You just care about yourself. You just love your sushi so much. You can't sacrifice for your baby. And I think that attitude then is very hard to push back on. And so what does the data specifically say on this, though? Like, what is the data that is saying it's safe? Or what is the data that someone would push back at you against and say, like, hey, it's not safe. There's XYZ cases of no no there's no xyz cases i think what you would say is in general in in general people are more likely to get sick from raw sushi than they are from cooked fish that's just a true statement that's the statement about people because it's not cooked but aren't they more likely to get sick from chicken than sushi undercooked chicken or just chicken in general if you look at foodborne illness is it more cases is it is there more foodborne illness cases from chicken or raw sushi?

23:20Almost certainly numerically, yes. Although I don't know about as a share of the consumption of those two foods. Okay. Because yes.

23:32Two Parents & A Podcast Hosts:I've gotten food poisoning many times from chicken. Never, never. I've never gotten sick from sushi, but I have, I did get some, I did get sick from some fish tacos recently. It's not good. Yeah. At this stage in my life, I'm really focusing on the quality of my sleep. And for me, that includes what I wear to bed. When you are pregnant, sleep time is sacred, you guys, and you want to be as comfy as possible. Skims has the best pajamas. I literally feel like I sleep better when I feel good in the fabrics that I'm wearing. And Skims is cute and it is great to sleep in, you guys. And the best part about Skims is they have something for everybody in the family, even pets, mom dad kids pets you name it they've got it their holiday shop is so cute and so go and get that matching set of holiday pajamas because that is the best photo on the planet you guys so shop my favorite pajamas at skims.com after you place your order be sure to let them know we sent you select podcast and the survey and be sure to select our show in the drop down menu that follows and if you're looking for the perfect gifts for everyone on your list the skims holiday shop is now open at skims.com I mean I think okay okay so what you're saying is like if you do eat sushi let's say and you do get sick from it in general what's the harm to not sorry not in general if you're pregnant what's the harm to the baby just it's uncomfortable it's just uncomfortable for you okay and I think that I mean that's the important distinction in some of these things that I sort of try to make in the book is a question of like is this a recommendation that is about the health of the baby or is this a recommendation about the fact that you are you know slightly more immune compromised as an adult, right?

25:13So you're bigger, there's more stuff going on, it might be more uncomfortable to vomit. So you might want to be a little more cautious about your food choices during pregnancy, just because it would be uncomfortable. But in terms of the, like, I want to be cautious because this might be damaging to the baby, that is not a consideration that you should have about sushi. Okay, wow.

25:34Two Parents & A Podcast Hosts:And I do think sushi is just the big one. Okay, soft cheeses while pregnant and runny eggs while pregnant are also on the no list and is that the same school of thought the same so the soft cheeses is about listeria and the runny eggs is about the same thing as sushi so the runny eggs have the kind of same sushi vibe unpasteurized soft cheese is actually more so than deli turkey associated with some listeria cases okay so again with listeria it's highly unlikely but it is possible it is possible but it's also possible with lots of foods unless they're doritos or something like that yeah okay so just knowing that um okay i know your answer to this but when you're pregnant how much caffeine is actually safe more than zero uh so we have you quite strong evidence about no risk when we're talking about up to you know two cups of coffee a day uh when you start talking about you know five to eight cups of coffee a day there are some associations with miscarriage early on in pregnancy it's actually a little hard to know if that's the caffeine or if it's about nausea so women who are more nauseous we talked about this before are slightly less likely to miscarry they also drink less coffee because when you are nauseous coffee makes you feel bad and so like someone who's drinking eight cups of coffee a day is almost certainly not nauseous at all right so it may Maybe that like we're picking up that a little bit in the miscarriage data.

27:05But certainly if you said, you know, I want to be like on the cautious end of this, still it would be fine to have a couple of cups of coffee every day. What are the caffeine consumptions that we see in other countries amongst pregnant women? It is much more common to have caffeine in Europe.

27:26Two Parents & A Podcast Hosts:Like coffee through every meal? People have more coffee in Europe. In fact, many of the good studies of coffee come from Sweden where they really like coffee. If you want a study that looks at people having up to eight cups of coffee, you've got to go to Scandinavia. They're doing it over there. And what's going on with their data? I mean, the data in these European countries, the data is very good. And generally, birth outcomes are better in Europe. That's for a lot of reasons. Okay. What about alcohol during pregnancy? Safe, not safe? How much is safe? What are your thoughts there? So binge drinking, heavy drinking during pregnancy is very dangerous and should be avoided.