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What to Expect When You’re Expecting

A correspondent asked me to review the book What to Expect When You’re Expecting by Heidi Murkoff and Sharon Mazel. She wrote “I’m very worried about this book.”

She had just seen an NPR article about the book and was alarmed because it provided an excerpt from the book recommending that patients with morning sickness “Try Sea-Bands” and “Go CAM Crazy.” She knew from reading SBM and other science blogs that “going CAM crazy” is not a good idea. She was savvy enough to search Google Books with the title and “CAM” and found more alarming advice

The book is billed as the #1 bestselling pregnancy book and is now in its 4th edition. It has been widely praised by the media and by doctors. In Amazon’s sales rankings it’s number 1 in its category and number 57 overall. It even has its own article on Wikipedia that tells us

Originally published in 1984, the book consistently tops the New York Times bestseller list in the paperback advice category, is one of USA Today’s “25 Most Influential Books” of the past 25 years and has been described as “the bible of American pregnancy.” As of 2008, over 14.5 million copies were in print. According to USA Today, 93 percent of all expectant mothers who read a pregnancy guide read What to Expect When You’re Expecting.

So it’s certainly worthwhile to look at this book to get an idea of what American women are learning about pregnancy.

It’s an impressive tome (616 pages) that does a good job of explaining everything an expectant mother might want to know as well as some things she mightn’t (critics have called it too alarmist because it covers scary complications).  It covers fetal development, diet and lifestyle recommendations for a healthy pregnancy, common symptoms, labor and delivery, the postpartum period, and much more. It is well-organized and easy to read. It has question and answer sections to cover pretty much every question a pregnant woman has ever asked, even rather silly ones (“All my pregnant friends seem to have problems with constipation. I don’t — in fact, I’ve remained very regular. Is my system working right?”) and it has separate chapters on every month of pregnancy.

Most of the book is so good I wish I could recommend it. But it has a disturbing flaw: misinformation about CAM. Here are some examples from its section on CAM:

The Place of CAM

CAM is more and more likely to find a place in your life…[Its practitioners examine and integrate] the nutritional, emotional, and spiritual influences, as well as the physical ones. CAM also emphasizes the body’s ability to heal itself, with a little help from some natural friends, including herbs, physical manipulation, the spirit, and the mind.

Acupuncture

The Chinese have known for thousands of years that acupuncture can be used to relieve a number of pregnancy symptoms… Scientific studies now back up the ancient wisdom. [No they don’t, and it’s not ancient wisdom.]

It recommends acupuncture for pain, nausea, speeding progress in labor, and treating infertility. It warns against stimulating certain acupressure points in the ankle before term because it can cause uterine contractions. If only! Wouldn’t overdue women and frustrated obstetricians love it if they could bring on labor that easily!

Chiropractic

This therapy uses physical manipulation of the spine and other joints to enable nerve impulses to move freely through an aligned body, encouraging the body’s natural ability to heal. Chiropractic medicine can help pregnant women battle nausea; back, neck, or joint pain; and sciatica (plus other types of pain), as well as help relieve postpartum pain.

Reflexology

Similar to acupressure, reflexology is a therapy in which pressure is applied to specific areas of the feet, hands, and ears to relieve a variety of aches and pains, as well as to stimulate labor and reduce the pain of contractions.

As with acupressure, the book warns against stimulating contractions before term.

Moxibustion

…combines acupuncture with heat (in the form of smoldering mugwort, an herb) to gradually help turn a breech baby.

Aromatherapy

Scented oils are used to heal body, mind, and spirit and are utilized by some practitioners during pregnancy; however, most experts advise caution, since certain aromas …may pose a risk to pregnant women.

Herbal Remedies

At last, a voice of reason: it points out that “natural” is not synonymous with “safe.”

Most experts do not recommend herbal remedies for pregnant women because adequate studies on safety have not yet been done.

But even here it quickly degenerates as it continues,

Even the most traditional ob-gyns are realizing that [CAM] is a force to be reckoned with, and one to begin incorporating into ob-business as usual.

Homeopathy

Homeopathy is inappropriately included under herbal remedies and there is no explanation of what it is or whether it is effective. They only say the safety of the remedies has not been established by any regulatory system so they recommend that it be avoided unless it has been specifically prescribed by a traditional practitioner who is knowledgeable in CAM and who knows you’re pregnant.

The section concludes

CAM can still be strong medicine. Depending on how it’s used, this potency can be therapeutic or it can be hazardous.

Advice for Specific Problems

CAM misinformation pops up in several other sections of the book.

  • For labor pain: acupuncture, hypnosis, hydrotherapy, and reflexology.
  • For symphysis pubis pain: acupuncture or chiropractic.
  • For carpal tunnel syndrome: acupuncture.
  • For indigestion: meditation, visualization, biofeedback, or hypnosis.
  • And for morning sickness:
    • Try Sea-Bands to put pressure on acupressure points or use a battery-operated ReliefBand that uses electrical stimulation.
    • “Go CAM crazy. There are a wide variety of complementary medical approaches, such as acupuncture, acupressure, biofeedback, or hypnosis, that can help minimize the symptoms of morning sickness — and they’re all worth a try.”

Conclusion

There is no credible scientific evidence to support any of these recommendations. It could be argued that this is all feel-good, “keep-the-patient entertained” advice with little chance of direct harm. But it is deceptive and dishonest to represent these modalities as effective treatments based on science, especially in a book that is otherwise scientifically reliable. It would be interesting to find out whether the coverage of CAM has changed from earlier editions. It could be much worse: at least there is no hint of anti-vaccine propaganda.

It’s an “almost very good” book that I can’t recommend. There is no way for the average reader to separate the accurate science-based information from the misinformation about CAM.  It’s unfortunate that so many women are reading and presumably trusting everything it says.

 

 

 

 

Posted in: Book & movie reviews, Obstetrics & gynecology

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