- The Washington Times - Sunday, April 27, 2008

Some pregnancy advice will always remain constant: Eat reasonably well, see your doctor, don’t smoke and take your prenatal vitamins. Much of the rest goes in and out of fashion. Expectant mothers’ views on everything from epidurals to how long maternity leave should be has cycled around nearly as often as a fully cranked-up crib mobile.

That is why “What to Expect When You’re Expecting,” the top-selling pregnancy book of all time with more than 14 million copies sold, has gotten a makeover. The fourth edition was released this month, completely rewritten because not only have pregnant women changed, so has the world in which they live, says author Heidi Murkoff.

“This edition is practical and realistic, realistic and practical,” says Ms. Murkoff, who penned the proposal for the book’s first edition when she was pregnant 25 years ago. “ ’What to Expect’ has always been the right book for the right time. This one is pretty much rewritten cover to cover.”

The makeover, in fact, begins on the cover. For a quarter-century, the “What to Expect” cover mom-to-be wore a tent dress and sat in a rocking chair like a bloated Whistler’s Mother.

In the fourth edition, she is standing in boots and stylish maternity jeans, showing off her “baby bump” and actually smiling. She looks like a pregnant woman who has things to do — a brunch in Penn Quarter, maybe, or casual Friday at a Dulles tech company.

“She’s finally off her rocker,” Ms. Murkoff says. “No one sits around in a chair. You are living your life in the meantime while you are expecting.”

Other important changes inside: advice to reflect the rise in multiple births (the birth rate for twins is up 50 percent) and working mothers (67 percent of expectant mothers work during pregnancy — 80 percent of them through their ninth month, according to the book). More obscure advice: how to breast-feed if one has, ahem, a piercing that may interfere; and whether antidepressants or alternative treatments such as aromatherapy are safe during pregnancy.

The book also addresses the move back toward using pain medication during labor. Illinois obstetrician-gynecologist Sarah Kilpatrick, chairwoman of the American College of Obstetricians and Gynecologists’ best practices committee, says rates of epidural use and Caesarean sections — even elective C-sections — are rising nationwide.

“There is always going to be a group that very much advocates natural childbirth,” says Dr. Kilpatrick. “But C-sections are at about 30 percent, and at some hospitals epidurals are 80 percent, so more women are going for pain relief.”

Also gone from the book is the Best-Odds Diet, which many expectant mothers found nearly impossible to follow. In its place is a chapter, “Nine Months of Eating Well,” which adds flexibility and lightens up on inducing guilt over eating a cookie that isn’t sweetened with fruit juice.

“We figured the Best-Odds Diet was well-intentioned,” says Ms. Murkoff. “We thought we would ask moms to aim high, but then they ran screaming to the nearest McDonald’s. I think this approach works a lot better. We’re saying, ‘Diet or don’t diet; just eat a balanced diet.’ You are the sole caterer of your uterine cafe.”

The new edition also tones down the worst-case scenarios found in many of the book’s Q&A; sections. Women on the snarky parenting site Urbanbaby.com call Ms. Murkoff’s book “What to Freak Out About When You’re Expecting.”

Amy Corbett Storch is a popular Washington-area blogger (amalah.com) who is expecting her second child. She says she bought the previous edition of “What to Expect” before she even conceived her son Noah, who is now 2.

“When I looked up innocuous symptoms, it would say ‘in most cases, this is normal, but in rare cases … ,’ ” Ms. Storch says. “That is all it takes for a nervous, first-trimester mom to say, ‘Oh my God!’ Honestly, I can work myself into a state all by myself. I don’t need to read to worry that the skin rash might be deadly.”

As a second-time mom, Ms. Storch is reading fewer books because, well, she knows what to expect. She also is writing a pregnancy blog, “Zero to Forty,” at alphamom.com, so this time around, she is dispensing the advice.

Bloggers and message boards are another big change in pregnancy. One of the reasons “What to Expect” was so popular when it came out in the mid-1980s is because it was written by a mother, not a doctor. These days — for better or worse — women can talk to other women with the click of a mouse. If an expectant mom is worried at 2 a.m. because she can’t feel the baby move, there are thousands out there in cyberspace to support, scare or diagnose her.

“The Internet is so much more useful to me these days,” Ms. Storch says. “Other moms will tell you when to shut up.”

Ms. Murkoff is not blind to the Internet’s role among new parents. She says she often “hangs out” on the message boards at her site, whattoexpect.com, to see what people are talking about. Many new entries in the book were inspired by concerns and topics on the message boards, she says.

“When I was pregnant, I was 23 years old and the first one by far in my peer group [to have a baby],” she says. “I had no pregnancy friends to relate to. If you find yourself with no pregnant friends, you can now make tens of thousands of them online. Now you can compare yourself to them, not just to your sister-in-law.”


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