Rational analysis doesn’t hold sway with the pregnancy police, says Steven Shaw in a great Op-Ed in the New York Times about sushi consumption and pregnancy. His point? The prohibition against raw fish during pregnancy is unnecessary. I ate sushi while I was pregnant, and lots of other things I wasn't supposed to eat, and I'm happy to see someone ask some reasonable questions about what women consume while pregnant since the current thinking seems excessive to me. Shaw writes:
"Why take any risk?" they ask. The medical establishment and the culture at large have twisted logic around to the point where any risk, no matter how infinitesimal, is too much. So powerful is this Puritanical impulse that, once a health objection is raised, however irrational the recommended behavior, it’s considered irresponsible to behave any other way.
And let me tell you, the guilt that seeps in from the "Puritanical impulse" is powerful. Then there's the "It's only nine months" argument, like it's not that long to sacrifice. Actually, it's like nine and a half, (or nearly ten if your baby is late like mine!) and that's a very long time to be in a worked-up state about what you can and cannot ingest. Believe me when I tell you the pressure to ensure everything you eat isn't going to kill or permanently damage your unborn child is intense. I quietly struggled with that as I wrote about things for this site, especially when I wrote about changing recommendations for fish consumption (tuna good, tuna bad, tuna OK) and chemicals in food and salmonella in lettuce and peanut butter.
After a couple months, I came up with an approach that worked really well for me for the duration of my pregnancy. (Usual disclaimer applies: I am not a doctor, and if you're pregnant you should speak with yours before following any of my advice, etc.) First, I did a lot of research about every prohibition. What was the reason for it? And what was the risk and the consequence? I found that you could divvy up the guidelines into two groups: illnesses that crossed the placental barrier and affected the fetus, and those that didn't. To put it another way, would eating something make me any sicker because I was pregnant than if I weren't? Or would the outcome be the same?
Recommendations say to avoid deli meat or raw milk products because they can become contaminated with Listeria monocytogenes, a bacterium that causes listeriosis. Listeriosis is serious, though very rare — 2,500 cases a year in the US, but something like 80% occur in pregnant women. It can cause miscarriage, stillbirth, or premature delivery in pregnant women. So by my reckoning, any food that could cause listeriosis was on my avoidance list because the consequences were severe. So I skipped deli meat and raw cheese and most soft cheese and NYC street hot dogs during the course of my pregnancy.
But sushi and shellfish and many other prohibited items only make you sick the same way they make you sick if you're not pregnant. Yes, you might have a lowered immunity, so you might be more likely to get ill, but the result won't directly impact the fetus. If you get a parasite from sushi, the baby won't get a parasite. And so that was my guiding rule. I ate raw oysters several times (much to many people's horror) and suffered no ill effects. Of course, I ate them in season, from reputable restaurants, and I didn't push my luck by doing it weekly.
I stopped eating soft-boiled eggs every day simply because the odds of getting salmonella increased with every day I had an undercooked egg. But I did occasionally have undercooked eggs. And I ate medium-rare meat. But I ate it, again, at reputable restaurants where I could be confident of its quality, or I prepared it myself. Getting salmonella would suck, but it runs its course in a few days. Worst case, you take antibiotics and you get better.
With all my "reckless" pregnancy eating, I did get sick once. The culprit? Chicken enchiladas from the local Mexican place. That was in my sixth month, and I didn't eat chicken enchiladas again. But I never once heard warnings to keep away from chicken enchiladas. Every pregnant woman needs to find her own balance, and it's not going to be the same for each. For me the anxiety of worrying about what I ate was worse than actually eating it. Early on, I was so worked up I wasn't gaining enough weight. And that's a much worse consequence for a developing fetus.
Why take any risk? Because life is risky. Are you going to stop driving because you're pregnant? Are you going to stop leaving the house? I found my balance between enjoying food and tolerating risk, and it included the occasional Wellfleet on the half-shell. It's easy to get overwhelmed by all the recommendations, and to live in fear of every bite of food you put into your mouth. But that makes for a very stressful, anxious, long nine (plus) months. And that certainly isn't good for the fetus.