Pregnancy ‘Bible’ Has a New Look and Updated Advice

One thing you can surely expect if you’re expecting: Somewhere along the line, you will buy, borrow or be given a copy of “What to Expect When You’re Expecting.” The pregnancy bible’s rebirth in an expanded, updated third edition, which recently hit the shelves, makes that outcome even likelier.

The most popular of all pregnancy guidebooks, “What to Expect” has sold more than 10 million copies in the United States since its publication in 1984 and has spent more than 80 weeks on the New York Times bestseller list; according to a poll conducted by USA Today, it’s used by 93% of women who consult a guidebook during pregnancy.

The babies who were mere blips on the ultrasound when the book first came out are now old enough to think about using the book themselves. A glance at the new cover, though, signals that this isn’t your mother’s “What to Expect.” The now-iconic image of a frumpy mom-to-be, a sourpuss in flour-sack dress and permed hair, has been replaced by, well, another mousy gal.

But this one’s wearing a sweater set and slacks, career-girl hair and the faintest hint of a smile. On the back cover, another sign of change: A Q&A; sampler has dumped the once-topical query “Will the X-ray I had before I knew I was pregnant hurt my baby?” in favor of “Could talking on a cell phone have any effect on my baby?”

While the first “What to Expect” was a concise affair, with plenty of room for notes in the margins, the 2002 edition can barely shut up after 479 densely packed pages. Which prompts the question: How much can things have changed in 18 years?

The short answer is--plenty. For example, the role of folic acid in preventing birth defects such as spina bifida wasn’t well known in 1984, so the vitamin was barely mentioned; now its importance is hammered home in several places in the book.

And while the first edition pays little or no attention to pregnant working women, expectant dads, HMOs and alternative medical treatments such as acupuncture, hypnosis and biofeedback, the new book acknowledges their expanded places in the new health-care universe.

But before we take a closer look at how pregnancy care has changed, a little history:

The book was the brainchild of California resident Heidi Murkoff, who discovered, while pregnant in 1983 with her first child, that existing guidebooks lacked the fear-allaying information she craved. Working with her mother, the late Arlene Eisenberg (a medical writer), and her sister, Sandee Eisenberg Hathaway (a registered nurse), Murkoff set out to create an easy-to-read, reassuring resource for the modern mom-to-be.

The first edition established the twin trademarks of the “Expect” franchise: a question-and-answer format and month-by-month coverage of the events of pregnancy. A new edition in 1991 incorporated many piecemeal changes. For the newest version, Murkoff has revised the old material wholesale and added the space to flesh out things she only could briefly mention before.

Some examples of what has changed in the way of medical practice between the first “What to Expect” and the new edition:

* Weight gain. Pregnant women in the ‘80s were told to gain between 20 and 30 pounds; for the 21st-century woman, the recommended spread is 25 to 35 pounds. (The slight shift recognizes that too little weight can produce undersize babies, with greater health risks.)

* Episiotomies. According to the 1984 “Expect,” episiotomies were performed in as many as 90% of first births, and pre-delivery enemas and pubic-hair shearing were common. Episiotomies are no longer recommended, and the other procedures are nearly unheard of because they don’t prevent complications, as once thought, and could even create complications of their own.

* Doulas and birthing plans. Readers seeking information about a doula (a woman trained as a childbirth companion) were out of luck in 1984; now that more women use doulas, they get a page-long box.

* Multiples. The updated edition has greatly expanded its coverage of multiples (including enlightening diagrams showing different strategies for breast-feeding twins). “Multiple births are multiplying,” says the book, partly because more women are having babies later in life, when erratic ovulation and doctor-assisted fertilization means a greater chance of twins, triplets and more.

* Postpartum depression. One of the biggest, and most reflective, changes is in this section. In 1984, “What to Expect” noted that about 50% of new mothers suffered from some form of baby blues or depression, covering the issue in 2 1/2 pages. In 2002--the same year Texas mother Andrea Yates was convicted of having killed her children while suffering from postpartum depression--the book cites the number of new mothers suffering from the condition as between 60% and 80%, and the section has doubled in size.

* Diet. Here, the discussion gets juicy.

Straddling the line between medical advice and cultural awareness, the infamous Best-Odds Diet of the first “What to Expect” counseled mothers--some say heavy-handedly--to Make Every Bite Count: “Before you close your mouth on a forkful of food, consider, ‘Is this the best I can give my baby?’ If it will benefit your baby, chew away. If it’ll benefit only your sweet tooth or appease your appetite, put your fork down.”

The authors outlined a diet in which every mouthful was to be chock-full of nutrients, in which white flour and sugar were contraband, and whole-wheat pretzels or toasted sunflower seeds were offered as alternatives to potato chips. Need a pick-me-up? How about some farina-banana pudding (with apple juice concentrate and wheat germ)? Or some carob brownies?

The Best-Odds Diet became a flash point for many women who resented what they took to be a patronizing tone. Murkoff professed initial bafflement at the negative response. After all, she says, that’s the way she eats. Now, though, she says she’s made an effort to sound less “whole wheatier than thou.”

“As you raise fork to mouth,” the new advice reads, “consider: ‘Is this a bite that will benefit my baby?’ If it is, chew away. If it isn’t, see if you can’t find a bite more worthy. Though most bites should count for good nutrition, some can--and should--count for pure pleasure.”

How does the book play in today’s medical community? Unevenly.

Asking the American College of Obstetrics and Gynecology, or ACOG, to comment on it is like asking a newborn’s mother to crow over someone else’s baby. ACOG, after all, has published a doctor-written pregnancy guide (“Planning Your Pregnancy and Birth,” 2000). Charles Lockwood, chair of ACOG’s committee on obstetric practice, allows that “a lot of my patients read (‘What to Expect’), and ... for the most part they get good, reasonable information.”