A Tale of Two Books for Moms To Be

It seems for those of us in the world of FASD it’s one step forward and five steps back. Just when we are making progress, and word is getting it out that consuming alcohol while pregnant is not advised, someone questions the evidence and gains an audience to keep the debate raging on.

The first published literature that linked prenatal alcohol use with birth defects was in France, in 1968, by Dr. Paul Lemoine. In 1973, researchers at the University of Washington published their findings regarding a group of children who shared uncommon physical features and developmental delay. These children all had mothers who had consumed alcohol in pregnancy. The term Fetal Alcohol Syndrome (FAS) was created to describe the patterns observed in these children.

FAS has evolved into different diagnostic terms for different countries, but one thing remains common: they are all caused by alcohol consumption during pregnancy.

First, I want to say, if you are a birth mom, to a child with Fetal Alcohol Spectrum Disorder, this is not about shaming and blaming you. We are working hard to prevent stigma. This post is for the women, who should know better, who choose to ignore the advice and drink while pregnant. This post is directed at the “why should I stop drinking alcohol just because I’m pregnant, no one is going to tell me what to do” crowd. The ones who feel entitled to do whatever they want because they think people providing suggestions is an invasion of their personal rights and thinking lack of evidence means evidence.

So what has prompted this resurgence of the debate? An updated book suggesting it is safe to drink alcohol during pregnancy. Below is a review a fellow advocate asked if I’d share. I have not read the book. Many on the FASD Groups I belong to have. What I did find interesting in reading the reviews on the Amazon Canada site is that despite many noting the author does not cite enough about the scientific studies or provide much evidence they still rate the book highly and feel safe drinking alcohol!

It appears the author came to her conclusions using statistical interpretation.

According to the Centers for Disease Control, the odds of being struck by a car in the United States is about one in 4,292. Does that mean I will never be around cars? No. But does that mean I take precautions around cars? Absolutely! Same with alcohol. Does every child whose mother consumed alcohol during pregnancy have FASD? No. But in the United States 1 in 20 children born will have FASD.

So why drink a substance that is known to cause FASD. Why not pass on the alcohol for nine months?

Here, with some minor edits, is her review on the book, Expecting Better.

The fact that 792 people have given this book a rating of near 5 stars on Amazon.Com is petrifying, when you consider that this non-medical-professional, economist author is advising women to drink while pregnant, even though the Centers for Disease Control clearly states that no amount of drinking during pregnancy is safe or acceptable. The idea that (this woman) could be ruining so many lives with her reckless advice is both outrageous and heartbreaking.

The author is very UNpopular on the closed Facebook page, Parenting Teens and Adults with FASD (membership 3,192) and that is because the (caregivers) on that page live with … FASD every day, and as bad as it is for them, it’s so much worse for their children (with FASD).

Most people probably don’t even understand what FASD is. It is not just a little brain damage, not just a little ADD. (Many) people with FASD can’t hold jobs as adults. Fewer than 20% will ever live independently.  Many are prone to anger outbursts, rages, addiction, jail-time and homelessness. Many have ethical problems, sometimes sexual problems. They tend to have poor working memory and low processing speed.

If you parent a child with FASD, you very likely may never even get any financial support in the form of SSI or SSDI because they tend to have strong verbal skills and present as more capable than they are (The Centers for Disease Control calls this an “invisible disability”). Knowing this, why would anyone ever risk it?

I don’t understand how someone with a background in business and economics feels that she can override advice given by the Centers for Disease Control regarding pregnancy and drinking….but (the author) clearly feels this is not an issue. If you want to play Russian Roulette with your unborn child, go ahead and drink through your pregnancy. You might think your baby is fine for the first couple years…as most kids with FASD don’t receive their diagnoses until around age 11-12.

Don’t use Emily’s flawed logic as an excuse to drink during pregnancy. If you need help quitting, seek help.

A better book to read about this entire topic is one by Susan D. Rich, MD, an actual – YES, ACTUAL DOCTOR – who has researched FASD tirelessly and written an actual QUALITY book called “The Silent Epidemic: A Child Psychiatrist’s Journey Beyond Death Row”.

(Dr. Rich) will explain how consuming even a very small amount of ill-timed alcohol during pregnancy can cause FASD. But she also proposes many solutions.

One last suggestion – if you have been harmed by the advice in Emily’s book, perhaps consult a lawyer to see if you have any legal recourse.

I wrote about this debate two years ago FASD: It’s time to Stop the Debate.


There should be no more debate. It truly is time to stop.

I understand women do not want to be told what to do. No one wants to be told what to do. I don’t like to be told what to do.

Using the car analogy again, do I cross the street in front of an oncoming car because I feel being told not to cross the street in front of an oncoming car is an invasion of my personal rights?


I would not walk in front of a car because I would not want to harm myself.

But drinking alcohol while pregnant is one of those warnings.

Not everyone who walks in front of a car might be hit, injured or killed. The driver might be able to stop, avoid you, or you may only walk away with a bump or bruise. But I still wouldn’t do it just in case I was seriously injured or killed.

And drinking alcohol is like that. Why take the risk?

For those that want to drink alcohol throughout their pregnancy, please help me understand why you think drinking a pyschotropic teratogen while pregnant is a good idea? Would you smoke cigarettes or take other drugs?


There is no evidence that says light drinking is safe.

But if those mothers that want to take that lack of evidence as a nod to drink alcohol, will you agree to be of part of a study to see how your children grow up? To see if your light drinking really didn’t have an effect?

So, yes, you have every right to do as you choose. But please don’t take the word of someone who has no medical background.


Developing babies have the same blood alcohol concentration as their mother, but they lack the ability to process or metabolize alcohol. So when a pregnant woman drinks, so does her baby.

You may not see any effects at first, but as your child grows, and accommodations are not put in place, you may  see your child affected. Your Health Care Practitioner if not aware you drank alcohol, or not educated about Fetal Alcohol Spectrum Disorder, might diagnose your child with ADHD, ODD, Autism or another condition or disorder that is similar. But the ways to help children with those conditions rarely work for children with FASD.

If you do choose to drink alcohol during pregnancy, please disclose your alcohol use to your health care professional so that your child’s development can be properly assessed and monitored.

How much alcohol is safe during pregnancy?

But don’t take my word for it.

Check out Proof Alliance’s Pregnancy and Alcohol Calculator.

From the article Drug Use in Pregnancy:

In general, drugs unless absolutely necessary should not be used during pregnancy because drugs taken by a pregnant woman can reach the fetus and harm it by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the growth and development of fetus.

From University of California San Francisco:

Drinking alcohol can increase the risk of miscarriage, stillbirth, newborn death and fetal alcohol syndrome (FAS). Since it is not known if there is a safe level of alcohol during pregnancy, the best advice is not to drink at all. Even one drink a day has been shown to have effects on the growing fetus. The best time to stop drinking alcohol is before you conceive. If your pregnancy is unplanned, you should stop drinking as soon as you suspect you are pregnant.

Your child may may not be affected. There are other factors at play. And yes, the timing and the amount of alcohol have an impact. But why can you not give up alcohol for nine months? Do you not want the child growing inside of you to have the best chance at a healthy start to life? 

From the National Institute of Health:

Have you ever heard the term ”psychoactive drugs?”

Drugs in this category act on the central nervous system and and alter its normal, everyday activity, causing changes in mood, awareness, and behavior. Psychoactive drugs disrupt the communication between neurons (brain cells), so abusing them can have serious short- and long-term effects on the brain.

Psychoactive drugs include four groups of drugs: depressants like alcohol and sleeping pills; stimulants like nicotine and ecstasy; opioids like heroin and pain medications; and hallucinogens like LSD.

What about the warnings?

According to the CDC and the U.S. Surgeon General, “There is no known safe amount of alcohol to drink while pregnant. There is also no known safe time during pregnancy or safe type of alcohol.”

The American Academy of Pediatrics also takes a stance against drinking during pregnancy, “There is no safe amount of alcohol when a woman is pregnant. Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity, or sudden infant death syndrome.

For more reports, check out: these studies.

From the Canadian Pediatrics Society:

If you drink (beer, wine, coolers, liquor) while you are pregnant, the alcohol will pass through your bloodstream to your baby.

Drinking while pregnant can cause fetal alcohol spectrum disorder (FASD), a serious condition that affects a child for life.

From Australia:

Associate Professor Carmela Pestell of the University of Western Australia, a researcher at the Telethon Kids Institute, said as many as 60 per cent of expectant mothers in Australia report drinking, despite expert advice that there is no known safe limit for alcohol consumption in pregnancy.

Professor Pestell said: “We know that women do not intend to harm their babies, but many unhelpful myths persist that it is okay to drink during pregnancy. We do not know how much is actually safe to drink and so medical guidelines recommend that the safest option is not drinking. Many women are unaware of this, or lack support to give up drinking even when they are trying for a baby or breastfeeding.”

Yes, we all have a right to make our own choices and decisions. But what about your unborn child? Did they ask for a drink of alcohol while in the womb? Because that is exactly what is happening. The placenta does not protect the child from alcohol. You drink, your baby drinks. You have a choice to abstain. Your baby doesn’t.


So please for the health of your baby, go 049. No alcohol for nine months during pregnancy to prevent FASD.

More than forty years of published research has shown alcohol to be a teratogen, a toxic substance to a developing baby, and can interfere with healthy development causing brain damage and other birth defects.

So who are you going to listen to? A woman with a background in economics and business or medical professionals?

As a side note: In researching for this post, I came across this presentation Is it Safe? During Pregnancy and For Mom and Baby developed and produced in partnership by Healthy Child Manitoba Office and Healthy Start for Mom & Me which lists facts and myths. Their advice:

  • No amount of alcohol is safe.
  • There is no safe time to drink during pregnancy.
  • Wine, beer, coolers, hard liquor and home-made alcohol can all cause harm.
  • Stopping or cutting back on drinking alcohol during pregnancy reduces the risk of harm to your baby’s development.

Even the World Health Organization recommends abstinence during pregnancy.


This is more than a tale of two books. It’s a comparison of the experience and knowledge of a subject.

One written Emily Oster, an American Professor of Economics who studied data to arrive at conclusions about what women should or shouldn’t do during pregnancy. 

Another written by Dr. Susan D. Rich, psychiatrist and international speaker with a background in public health who for the last twenty five years has been developing programs and services for individuals with FASD. A woman who has seen first hand what happens when alcohol is consumed during pregnancy and a child is affected.

And Dr. Rich’s book is backed up by the medical experts noted above.

The choice is yours.

All I ask is, who are you going to base your decision about alcohol and pregnancy on?

For myself, I might seek out Emily’s advice on a business decision, but I’d rather go to a medical professional about pregnancy.

I think I would also speak to people with FASD and their caregivers.

In the words of my daughter, who has Fetal Alcohol Spectrum Disorder, “just saying.”

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