Oster makes some things clear:

1. Medical science focused on women is consistently decades out of date, and this not only means that investment in understanding women’s health is low to begin with but also that medical decision-making in pregnancy is as likely to be guided by sexism as it is contemporary medical knowledge (not that these two things are mutually exclusive!)

2. The average woman is going to be fed a great deal of misinformation about pregnancy and is not likely to have the specialization necessary to directly access and evaluate the evidence base

3. Knowing the medical science behind pregnancy is important not so that women can make the one “right” choice, but so that they can make a choice in accordance with their values. Oster points out again and again that many decisions made during pregnancy have no clear answer, and conventional wisdom is often counter to the values of women.

4. Once women have decided what they want to do, they often need the men in their lives to back them up if they are to be taken seriously by doctors. This comes up in Maya Dusenberry’s (phenomenal, five stars) Doing Harm. The medical establishment just doesn’t listen to women, there are no factors (education, etc.) that significantly impact this, and that doesn’t change in pregnancy. Men need to read this book, yeah, and if they take away anything it should be that concept: don’t side with the doctor against the women in your life.

Remember: the “right answer” in Western medicine is often based in a single worldview, which is that of the white man. Additionally, our contemporary medical knowledge is no more static or eternal than it was a hundred years ago. Everything we know now is going to seem pretty silly in a few hundred years and so on forever and that’s just history baby. Oster’s work is extremely empowering because, despite its limitation of not being able to cover everything, it puts the decision-making power in the hands of the mother. Basically, it teaches people how to seek out research and evaluate it, a skill that will remain useful regardless of what time period you live in. Also, it’s a highly readable lit review that teaches a lot in a short period of time. I can’t emphasize enough how rare that is. I’m going to reread it right away.

Read also:

Ten Principles of Values-Based Medicine - K.W.M. Fulford (book chapter)

Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick - Maya Dusenberry (book)

Review for Reread
I'm glad I reread this. the first time around I learned a lot, but it felt like I was establishing the frameworks for decision-making around pregnancy and most of the information was so new to me I had trouble retaining it (don't homeschool your kids). this time, I felt better able to assess what Oster was saying and to ask critical questions of my own. I'm still dumb as bricks but my process for getting less dumb is now more robust!

it's also more obvious to me on a reread that while this is an invaluable overview, it is still only an intro to the questions that come up during pregnancy and childbirth. navigating the medical literature is difficult. each of the topics that Oster covers is approached skilfully and saves me hours or days of doing a worse job and finding the same answers. but that still has to happen with so many questions. I'm grateful to Oster for helping me prepare for this reality, one where I have to feverishly learn things and then make imperfect decisions.