The Unexpected

Book Review: 4/5 Impact On Me (Book By Emily Oster)

Read more about the book here

I rate the impact of this book on me a 4 out of 5. It gave me a lot of new information, but some I already knew or was not relevant, neither of which are issues with the book. Some parts helped me stay prepared.

The author opens by saying this is a book many may need but she hopes most do not have to read it. That fits. The book is about unexpected negative complications in pregnancy.

I found it helpful that she says most causes of challenges in this or a previous pregnancy are external or genetic. So you did not do something wrong. You do not need to feel guilty.

Five reasons a baby can be born prematurely

1. By accident your labor clock is set to the wrong date.

2. Preeclampsia.

3. Bacterial infection.

   
   

Gestational Diabetes

If you had gestational diabetes in a previous pregnancy, the probability of having it again is 50%. High.

8% of births have complications from gestational diabetes. That is why screening is so common. If you know you have it, the way to keep symptoms and the problem under control is well defined.

Against Preeclampsia

Calcium supplements can reduce the likelihood of preeclampsia. But the ideal daily dose is very high: 1000 mg. Prenatal vitamins are already large. You need multiple tablets. Adding enough calcium would make the pill so big you would need a fork and knife to eat it.

Baby aspirin can reduce the chance of preeclampsia.

Preterm birth

Only one third of babies survive when born at 24 weeks. At 36 or 40 weeks, 99% or more survive.

You can try to reduce the likelihood of preterm birth with omega-3 fatty acids (from fish oil), progesterone, or baby aspirin. The data on all three is mixed and not strong.

C-section and VBAC

About 35% of births in the US are by c-section. If you had a c-section before, your later pregnancy is more than 50% likely to be a c-section too. A few years ago the default was: if you had a c-section, you would have a c-section again. From 1970, VBAC attempts started.

18% of women try. 14% succeed.

Success rates are higher at academic centers where it is easier.

Women who had an elective c-section and women who had a natural birth both rate their experience well. Women who went through labor and then had an emergency c-section rate their experience low.

If your earlier c-section was because of stalled labor, those same conditions might happen again in your next pregnancy and delivery.

Trial of labor after cesarean (TOLAC)

A more accurate term is TOLAC: trial of labor after cesarean.

One rare risk when you attempt labor after a previous c-section is that the scar is close to the uterine wall and labor forces might break open the uterus.

There are multiple types of plans. One example: I want to try for labor, but if I need to be induced I would rather have an elective c-section.

39 weeks

In 20 to 50% of third-trimester stillbirths, the cause is chromosomal abnormalities or medical issues (maternal infections, physical injury from something like a crash). If you had a stillborn previously, in your next pregnancy it is better to be offered induction at 39 weeks.

Episiotomy

Episiotomy in the research went from routinely doing it for everybody to routinely not doing it for anybody. Now the latest numbers say about 10% might need it. Most women delivering their first child will have some vaginal tearing. The doctor decides whether to do an episiotomy: for example when a fourth-degree delivery is required, or when the doctor needs to move the tear away from the urethra (where the tear is painful) toward the anus.

Postpartum depression and psychosis

If you had postpartum depression the first time, it is very likely again because the underlying causes are the same. Postpartum psychosis is a different problem. You might feel like harming the baby. Depression is when negative emotions make it hard to function day to day and may lead to self-harm. Some women are so traumatized by postpartum feelings that it is one of the factors they consider when thinking about another baby.

Breastfeeding the second time

Research shows that breast milk supply is usually enough for more than one child at a time. The rest depends on demand from the baby or a pump.

Research shows that the second time you breastfeed it is much easier than the first. That fits the popular notion that we have evolved to give birth and know intuitively how to do it.

Severe nausea

Some women have severe nausea that requires hospitalization and an IV. Those women may face stigma and judgment from friends, family, and colleagues because it is common for women to have some manageable nausea.

Miscarriage

90% of first-trimester miscarriages are chromosomal. So there is nothing the parents could have done. Older maternal age means older eggs and more likelihood.

There is no problem trying for another pregnancy right after one miscarriage. If you wait for one period, it is easier to date the next pregnancy. In some cases you may need to wait so any infection clears.

Blood loss and delivery

Blood loss from the uterus after delivery can be 1 liter per minute. Sounds scary.

C-section involves more blood loss than vaginal delivery.

Many other complications are clearly complications. C-section is somewhere in between: a reasonable way to deliver, not a complication in itself.

Known unknowns

The cause is unknown for 50% of stillbirths.