Emily Oster’s Expecting Better: Voldemort’s Shadow

ExpectingBetterVoldemortIn Expecting Better, Economics Professor Emily Oster bucks the conventional wisdom of standard prenatal care. Her book’s title, and her support for early prenatal genetic testing, however, casts an ominous, unspoken shadow.

Oster considers chorionic villus sampling (“CVS”) “clearly the better option” for prenatal genetic testing. She arrives at this conclusion after considering a study of a center in California and another in St. Louis that found that, at those specific hospitals, they had a lower miscarriage rate with CVS than is traditionally reported (usually between 0.5 and 2%). The relevance of those studies are questionable for an expecting mom giving birth anywhere else, as Oster did in Chicago. And, Oster’s endorsement of CVS is particularly curious given that in a preceding chapter she wrote of being “even more nervous about miscarriage” after hearing and seeing her daughter’s heartbeat at her seven-week ultrasound, which made her realize that there was “something to lose.”

But then just a few weeks later, when CVS is performed, Oster exults over how “cool” it would be to have a complete mapping of her daughter’s genome prenatally. Never mind that receiving that cool genetic sequencing involves inserting a needle into the womb and choosing to risk miscarriage by having that test. Further, the newest technology with CVS (or an amnio in the second trimester) is micro-array testing, which can detect micro-deletions and other genetic conditions, the impact of which are largely unknown prenatally. And, never mind (since Oster doesn’t inform the reader of this) that a significant number of women have described receiving these results not as “cool,” but as “toxic.”

Throughout her discussion of prenatal genetic testing, Oster’s focus is on emphasizing being reassured that her daughter is healthy. Oster acknowledges, though, that current prenatal screening tests can only detect a handful of the multitude of conditions that 3% of all births will be born with. And, she acknowledges that with regards to health, the conditions that could actually impact a child’s viability at birth–heart, intestinal, or other structural abnormalities–are not even detected by prenatal genetic tests, but rather a second trimester ultrasound.

Ultimately, Oster receives a measure of reassurance from a screening result showing she’s at a low likelihood for having a child with Down syndrome or other aneuploidy. Though this testing was to reassure her about her child’s health, Oster still experiences “panic” after the results knowing only a diagnostic test can tell for certain whether her child has a genetic condition. As a result, she decides that if she becomes pregnant again, she will go directly with a CVS, skipping the screening tests.

This quest for information prenatally and reassurance as to her daughter’s health–this quest to Expect Better–causes the reader to wonder: what would happen if Oster received a test result indicating Down syndrome? What would Expecting Better mean, then?

Oster alludes to this possibility only once:

Most women who do this screening do it in the first trimester. There are two reasons for this. First, this is when the tests provide the most information. Second, at this point in the pregnancy, most women are not showing, and may not have told many people they are expecting. This may lessen the burden of making a difficult choice about continuing the pregnancy.

(emphasis added). Again, in a chapter devoted to prenatal testing, there remains “that-which-must-not-be-named.” The Voldemort of abortion casts its shadow over Oster’s discussion about prenatal testing, her pregnancy, and Expecting Better. This despite professional guidelines instructing practitioners that they should counsel their patients about termination following a prenatal diagnosis for Down syndrome. And, despite women saying they wish they had known they would be confronted with that decision prior to accepting prenatal testing–not doubling the surprise of receiving a diagnosis for Down syndrome with also the question of whether they planned to continue their pregnancy.

For Oster, perhaps she sought prenatal testing for solely the information it provides–as many women do. But her aversion to addressing what Expecting Better means should the prenatal test return a result for Down syndrome makes the reader wonder: Would her daughter be here–would Oster have even written her book–if her prenatal test result had been different?


  1. Oster reinforces false perceptions. A prenatal diagnosis of Down syndrome is no indicator of the health of the child. Diagnostic tests are almost exclusively used for selective abortion, not preparation. There is no therapeutic benefit to the child that relies on a diagnosis of Down syndrome before birth, this is a myth perpetuated by the medical elites.

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