One of the most consistent pieces of advice I’ve gotten while pregnant (I’m writing this now three weeks from my due date, hello) was to read Emily Oster’s 2013 book, Expecting Better. In it, Oster applies her training as a health economist to the science of pregnancy and childbirth, juxtaposing conventional medical advice with interpretation. Not all of Oster’s conclusions align with standard medical advice — her conclusion that light drinking is safe is notably controversial — but all come from analysis of the available data.
In her new book, Cribsheet, Oster brings her hybrid methodology to bear on early parenthood, from the first moments after delivery to preschool, helping readers think through decisions including breastfeeding, sleep, screentime, and potty-training. There are fewer firm answers in Cribsheet than in Expecting Better, but what’s consistent is Oster’s style, built on the idea of a cost-benefit assessment of choices in which there’s no right answer for everyone. I spoke to her about how parenting has changed for millennials, how her personal life influences her writing, and how to make good decisions without copious data. Our conversation has been condensed and lightly edited for clarity.
Do you think that, for this generation of parents, it’s harder or easier to factor our own wellbeing into decision-making? I can’t quite tell if millennials are breaking free of old patterns of misery and choicelessness, or if there’s more pressure now to overachieve in pregnancy.
It’s hard to answer those questions sometimes because it’s hard for us to ask, “What was it like to be pregnant [back then]?” I’m not sure that our parents even remember. But I do think that there has been an increased focus on doing this right, and people feeling like they have to accomplish this in a way. Maybe as people are having fewer kids there’s more of what economists would call a quantity/quality trade-off. I think it also probably intersects to some extent with the desire to better yourself, to optimize everything — wear your Fitbit and track your sleep. So then parenthood is another part of your life where there’s a way to do it right or not.
Where were you in your parenting life when you started work on Cribsheet?
I wrote this book between when my second kid was 2 and 3. With my first kid I’d had the experience a lot of parents have, which is that there are so many decisions coming at you in your face all the time, and it was hard to make them in the ways that I was accustomed to making decisions. I don’t think after that experience I was particularly well equipped to reflect on that process, because the experience is just like [she makes a low sound somewhere between a moan and a roar:] wrhaaaaaagh wrhaaaaagh. I don’t know how you’re gonna use that on tape.
But when we had our second it was much easier. Of course there were many surprises, but I had a chance to be like, “Okay, I remember. I’m going to need to make this choice. Let me think about how we want to do that systematically.” I would not have been equipped to write this before the second kid.
The differences between the two books aren’t just the urgency of decision-making, though. There’s also a difference in how much data there is about the decisions.
Cribsheet is much more of a book about the process of decision making, even in the face of limited data. In Expecting Better, there were a lot of things like “Can I eat sushi? Yes,” where the value is in what the evidence says. In Cribsheet, there are a few questions like that, but there are many more where it’s, “Here is the data we have, limited as it is,” and then, “Here are the considerations that should weigh in your decision, and by the way, in almost all cases one of those considerations is what works for your family — not just your baby, but all the other people in your family, also.”
Is there a certain decision you’d say is the most important decision a parent has to make in their kid’s first few years?
I think the main thing is there are no decisions like that. And I think that we treat almost every decision like that, like the most important decision that you’re going to make. Some of them are more important than others, but there isn’t one thing that is going to be the thing, the choice that you make that makes your kid more or less successful, more or less happy.
I love how every time you say “The studies confirm that this does affect IQ,” it’s always by, like, three points.
By a tiny amount.
Do you get a lot of emails from readers with questions? When we were scheduling this interview, I even snuck in that pseudoephedrine question. [I had a cold and there is absolutely ZERO consensus about whether this decongestant is safe in pregnancy, which is very frustrating.]
I get some questions. I don’t get enough questions that I don’t write back. They’re often similar questions, and so I will often already have an answer. It’s fine. That’s my job.
I really appreciate you saying that because I also know it’s sort of not.
It is not my job, that’s true.
But some doctors, whose job it is, don’t have the answers patients feel like we need.
There are definitely some OBs who tell their patients to read Expecting Better. I think Cribsheet will have more penetration in pediatrics. In the first book, the central tension is sort of the medical system versus you. I think in the second book, the central tension is not with your pediatrician. It’s much more with society, and with yourself.