Photo: Emily Oster
"This is the book I want to be able to hand someone when they say 'I had preeclampsia. I had a preterm birth. I had a miscarriage.' I want to say 'Read this and figure out how to navigate the next steps for yourself'."
Although half of pregnancies involve complications, there's a "complete black hole" in our understanding of how this experience affects people's mental health and parenting, says economist and parenting writer Emily Oster.
Over the years the 44-year-old mother of two has received thousands of questions about how to navigate common pregnancy complications she was lucky not to experience herself.
Her new book The Unexpected (with foetal medicine specialist Nathan Fox MD) fills a "data vacuum" facing the many women whose first pregnancies do not go to plan.
Feature interview
In pregnancy and early parenting, decision-making can feel very high-stakes, Oster says.
The Unexpected has tips for parents on structuring constructive conversations with medical professionals about their fears and concerns.
"When something happens that's sad or scary it can be really hard to think about the right questions to ask. People get very nervous, and they get very, very anxious about how to how to talk to their doctor."
The amount of information that is useful to receive depends on the individual person, Oster says, but some people find it "relaxing" and "grounding" to have data on hand for their decision-making.
"The data doesn't exactly boss you into something but it can provide a place to start from which people can feel confident in their own choices.
"Some people really, really benefit and really value having all of the information. And some people say 'I don't really need all of that. I need you to help me with enough information to make good decisions but I don't want to know everything'."
Photo: Supplied
In the case of miscarriage - which ends about a quarter of pregnancies - women naturally seek an answer to the why, Oster says - "Let me figure out what is the thing that I screwed up, the thing that I did that caused this?"
The statistical reality is around 90 percent of miscarriages are a result of chromosomal abnormalities, she says, so usually there is nothing that could have been done.
"It was a chromosomal abnormality. It happened by chance. It happened by accident. And it's extremely sad but it isn't something that you did, and it's not usually something where anything could have been done by a doctor."
For these women, moving forward requires something like a "radical acceptance of miscarriage", Oster says.
"We somehow need to be able to live with the idea that something very bad happened and it just happened. It happened not for a reason that we understand, not because we did something wrong, not because we're being punished by the universe - it just happened."
When people who've experienced miscarriage go on to a second pregnancy, they're challenged with holding grief alongside hope and joy, she says.
"That's another piece of this acceptance - being able to accept we can be both sad and happy at the same time about very similar things."
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