When to Give Your Newborn Baby Formula
This is goodbye! I hope you enjoyed the blog, and if you have more questions, check out the whole book, which covers many more topics: epidurals, home births, weight gain and hot yoga, among others.
My book stops at the delivery room but, as many people have pointed out to me in emails, the decisions definitely do not. As we part, I just wanted to share with you the first big one I faced not as a pregnant woman but as a new mom. My daughter was born at 7 pounds 12 ounces, and since she arrived first thing in the morning, we got two nights in the hospital. On the second night they took her away for some kind of test, and came back to inform me that she had lost 11 percent of her body weight. Since the hospital’s limit was 10 percent, I would have to start giving her formula or—and this is a direct quote—“She might not be able to go home with you.”
The data-driven part of me thought, “wait a minute, aren’t 11 percent and 10 percent basically the same?” The hormone-crazed post-partum mom part thought, “I will do anything under the sun to take my baby home.” And so I found myself taping together some kind of elaborate tubing system so Penelope would think she was nursing but really be getting formula.
I remember thinking to myself, “I really should research this weight-loss issue.” But then they did let me take her home, and I completely forgot about the issue until months later a friend told me that she experienced the same thing. It seems to be a pretty common situation—another friend was told to save all the diapers her kid produced to weigh them. So what’s the deal?
I Wrote That It's OK to Drink While Pregnant. Everyone Freaked Out. Here's Why I'm Right.
When I was pregnant, I wondered, as many women do: Can I have a drink? It is well-known that drinking to excess during pregnancy is dangerous, and perhaps less well known but still true, that even one or two episodes of binge drinking can be harmful. But what about an occasional glass of wine with dinner?
Expert opinions on this differ. What to Expect When You’re Expecting says no alcohol. Panic-Free Pregnancy says an occasional drink is fine. A 2010 survey asked obstetricians, “How much alcohol can a pregnant woman consume without risk of adverse pregnancy outcomes?” Sixty percent of the OBs said none, but the other 40 percent said some alcohol was fine. The American Congress of Obstetricians and Gynecologists (ACOG) says no amount of alcohol has been shown to be safe, but the U.K. equivalent (the Royal College of Obstetricians and Gynecologists) says that while not drinking is the safest option, “Small amounts of alcohol during pregnancy have not been shown to be harmful.”
My obstetrician said a few drinks a week was fine. But as with everything else, amid this disagreement, I needed to go to the data myself.
Please Can I Have a Turkey Sandwich and Sleep on My Back While Pregnant?
More great reader questions this week. Here are some answers.
From Deli Meat Lover:
Are all deli meats a no-go? Or can I continue to eat fancy soppressata sandwiches?
The place to start on this is to figure out why deli meats are off limits. The answer is listeria, a very dangerous food-borne illness. Listeria grows well at room temperature, so things like deli meats that sit around in display cases for a long time can be susceptible. It’s very clear that you want to avoid listeria; it can cause miscarriage and stillbirth, and pregnant women are especially susceptible.
What is less clear is how to avoid it. Listeria is rare, which is reassuring, but it’s also hard to avoid. Outbreaks crop up at random—in the last couple of years there were large outbreaks in cantaloupe and celery, for example. If you took what would seem like an obvious approach—avoid everything that has caused known outbreaks in the last ten years, say—you would put deli turkey on your list, but also bean sprouts, chicken, celery, and cantaloupe.
The Best Method for Getting Pregnant
We all know people who decide to stop using birth control, just let things happen naturally, and are pregnant two weeks later. I wish I could say I approached getting pregnant with this relaxed attitude. In reality, I came to it with the grim determination of someone training for a marathon. Yeah, there might be some endorphins along the way, but basically we’re just going for the finish line.
Consistent with how I’d approach any goal-oriented activity, I wanted to make sure I was doing everything I could to accomplish the task. So I started taking my temperature every morning. This is an old technique for charting fertility; it relies on the fact that morning body temperature is slightly higher in the second half of the menstrual cycle, after ovulation, than the first half. By recording temperatures, you can in principle learn which days of the month are most fertile for you.
In the books I read, the temperature charts looked beautiful: low temperatures at the start of the month, a huge increase one day, and then high temperatures the rest of the month. My charts, in contrast, looked like a kindergarten art project. I eventually did get pregnant, but no thanks to the thermometer. When I then sat down a few months later to write Expecting Better, I wondered whether I was the only one who couldn’t get this right.
How to Know Which Pregnancy Studies Are Legit
Most weeks, CNN Health or the New York Times Science section (or Slate!) reports on another study about health. Within the last couple of weeks there was one about how four cups of coffee a day kills you and one on which brands of beer are most likely to result in a trip to the ER (answer: malt liquor).
A question that comes up again and again in reading these, and came up all the time when I was writing my book on pregnancy, is how to know which studies warrant our attention.
The gold standard in medicine, and in other fields, is the randomized controlled trial. In a study like this, participants are divided into two (or more) groups randomly and each is told to do something different. In a drug study, one group takes a drug and the other does not. Because the groups are randomly selected, on average they are similar before the study. So if the researchers see differences after the study, they can be confident the differences are due to the treatment.
Even in a randomized study, there are limitations. No research study is run on the entire population of the world. What we learn from these studies is the impact of the treatment on average, not on every individual.
So, if you are approaching a health decision based on data from a randomized study, that’s great. But: the majority of the time, especially in public health where I looked for data on pregnancy, the studies aren’t randomized. In 2012, the American Journal of Public Health published 128 papers—only 14 of them were randomized.
Exercise During Pregnancy: How Much Is Too Much?
I got a lot of great reader questions last week, and about every third one was on exercise. Obviously, Slate has many very fit readers, since most questions focused on whether high intensity exercise is a problem. A couple of examples:
I am a pretty fit person (i run, I do Pilates etc.) but in all of my pregnancies I have toned down my workouts while pregnant, in large part because running just isn't comfortable.
But, I've noticed a lot of pregnant women continuing very rigorous exercise (boot camp style classes) throughout most of their pregnancy, what is the general thinking on this? Is it safe to continue with a high intensity workout or should women be toning it down? Is the risk to the unborn child, or to the body of the woman carrying the child?
Your Doctor Offers to Induce Labor. Should You Say Yes?
A new study came out last week linking autism to labor induction. I will not get into the weeds right now on that particular study (although here is one very critical take), but it got me thinking again about labor induction, a topic that I cover at some length in Expecting Better.
When I was 39 weeks pregnant, my doctor offered to schedule an induction at my due date. This is common now, although that wasn’t always the case. In 1990, fewer than 10 percent of births followed medical induction of labor; by 2009, this number had risen to 25 percent. This increase has occurred across the board, not just for babies who are overdue. In 1990, only 7 percent of births at 39 weeks of pregnancy were induced, but 23 percent were induced by 2009.
Against Bed Rest
As many as 20 percent of women are prescribed bed rest for a period of time during their pregnancies, ranging from a few days to multiple months. Usually the concern is threatened premature labor, which could result from a specific condition or occur without warning.
So why bed rest? Well, it seems logical—surely laying down and not jostling so much is a good idea! And if you know someone who has been on bed rest and went on to have a healthy, full-term delivery, it may look like it worked. Many women who are put on bed rest go on to have their babies at a normal time.
But, and I cannot stress this enough, that is not evidence that it works. We don’t know what would have happened if those women engaged in normal activities. In fact, there is no compelling evidence to suggest that bed rest is effective at preventing preterm labor.
Introducing Expecting Better
You’re pregnant. You’re at Starbucks, minding your own business, waiting for your iced skinny vanilla latte. “I hope that’s decaf!” says the lady behind you. Resisting the urge to pour the drink all over her head, you stare at her, stone-faced, and leave the store.
Now imagine another scenario. Same store, same latte, same lady. But this time you’re ready. Rather than just staring and leaving, you calmly explain to her the many, many studies that show that caffeine, in moderation, is fine for your baby. She apologizes profusely, and you leave triumphant.
If that sounds good, this is the blog for you.
My new book—Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong, and What You Really Need to Know—is out tomorrow. It’s about pregnancy, but doesn’t include any sections on how big your baby is each week (or what fruit size it compares to) or what emotions you’ll be feeling. Instead, you’ll find information you can use to make better decisions.
Can I have a glass of wine? Coffee? How much weight can I gain? Should I get an epidural? When is the baby coming out, anyway?
The book is decidedly not about recommendations. It’s about information. You can find plenty of books that tell you, “Go ahead, have a glass of wine.” I do say that, but I also explain why I came to that conclusion, with citations to the medical literature, providing you with ammunition for the nosy Starbucks ladies.
I’m an economist; my business is decision-making and data. When I got pregnant, I used the tools from my job to think about my pregnancy. It didn’t occur to me to do it any other way.
So what’s going to be on this blog? For the next month or so, I’ll give you a few tidbits from the book, and a few things that didn’t make it in. I’d also like to hear from you. Got a burning question about pregnancy? Send it along to email@example.com. (I’ll use your name unless you specify otherwise, and please check out Slate's submission guidelines before you write in.) I’ll pick some favorites, do the research for you, and post the answer. Think of me as your own personal pregnancy concierge.
So, sit back, enjoy that caffeinated latte, and get ready to expect better.
First up: The persistent myth of bed rest.