We want to start with a disclaimer that throughout this series, we feature explanations and stories that include some heavy material, including early pregnancy, loss, still birth, and other traumatic experiences of pregnancy, childbirth, and the postpartum period.
It was the morning and my son's fourth birthday party, and I was feeling just not like myself. I was really tired, which is pretty abnormal for me, especially in the morning time, and my breasts were pretty tender, and I was feeling a little nauseous. So I started doing the math in my head, just thinking about, you know, when I could have possibly became pregnant if that is the case. And I started doing the math, and my husband's a pilots, so I know exactly when he's home
and the days that we've had sex. And that's when I was like, wow, I could be pregnant right now. And it was only four weeks so I was due to get my ministress cycle that so it was very early. So I asked him to go to the store because we needed to get ice for the birthday party and pick up the cake. So I said, hey, while you're there, can you go get a pregnancy test? And he was like, okay, you know if that's what you need, then that's what
you need. So remember he came home, he was putting the drinks in the cooler, and I went into the spare bathroom and I took the pregnancy test and it came up right away that I was pregnant. And in that moment, I had just this realization of wow, like I'm having another baby. And I went outside and I told my husband that I was pregnant, and we were so excited and we're like, wow, we're really doing this.
And it was really neat because this whole party that we had there, we probably had about thirty people with kids and parents, and we were the only two people that knew in that moment that I was pregnant, and it felt really special. But then after the party was pretty died down, us and a couple other family friends, we're all sitting by a fire that we had in our backyard, a little campfire, and there was a baby there.
And my son had a really good friend and he had just his mom had just had his baby sister, who was about two weeks old, and so I'm looking at this baby that's sitting in front of me, and I started doing the math in my head again just counting the months. You know, if I'm pregnant and this pregnancy is viable and we ended up having this baby, this baby would be born in August before school starts, and that means that this baby is going to be in the same grade as that baby that's sitting right
in front of me. This baby that I just have found out i'm pregnant with is going to grow up with that little girl that's sitting in front of me. And that blew my mind that I was going to grow a whole human in.
This school year.
And so fast forward seven years later, and these two children are now in the same grade. Sometimes they're in the same class, and they are growing up together, and it's just something that's fun to think back on.
My name is Kenny.
I'm thirty four from New Zealand and five years ago I work up with pain in my right lowerbellion vomiting. I took a pregnancy test and it was positive. Well followed was the scariest two days of my life, during which they found an ectopic pregnancy on ultrasound. By the end of two days, I had pain in my right shoulder tip, but no abdominal pain as an emergency nurse, I know that shelder tip pain can be a type of referred pain indicating diaphragmatic irritation from blood in the
peritoneal cavity. The obg way in on call decided that my lack of abdominal pain meant that I could go home and wait for suon. All I could think of was a case I had treated a few months prior in my emergency department. She had a ruptured ectopic pregnancy and we'd poured blood into a rushia to surgery and she nearly died. That case and my knowledge about the importance of shoulder tap pain led me to advocate for myself strongly. I put my foot down and refused to leave.
An hour later, I was in surgery, and an hour after that they called my partner to say my left filopian tube was completely blocked and there was blood in my belly. If I had gone home, there is a very real chance that would have burst completely and I could have died. Being an emergency nurse and an advocate for myself saved my life. Losing a filopian tube was really hard mentally until I learned the biggest health lesson I ever have. I can't believe I'd got through so
many anatomy classes without knowing this. But your filopian tubes aren't fixed, although that's how the textbox show them. They can reach out and move and grab eggs. Six months post ectopic and I got pregnant again, and all of the anxiety came back, but I was very lucky. Nine months later we welcomed our beautiful son, and another year
and a half later our second son. My other two pregnancies and births had their own challenges, but I'll never forget my first, wondering what could have been for that pregnancy, what could have happened if I wasn't my best advocate, And I think about my experience every time I go to work and my own emergency department and treat potentially topics.
It made me a better nurse, a better patient advocate, and I'm so grateful for my two boys who managed to find their way to my uterus instead of my one remaining tube.
Thank you also so very much for sharing your story with us, and a huge thank you to everyone who has written in with their experiences like we read each and every single one of them, and the hundreds of submissions, many and We're so grateful and honored that you felt like you could share those experiences with us, and we tried to include as many of your stories as possible, and you'll hear more of these first ten accounts throughout this episode and the rest of our episodes.
Yeah, it was honestly such a privilege to be able to read every one of your stories and hear so many of your stories, and as many as we included, there were so many more that we were not able to So we thank you again from the bottom of our hearts for sharing your stories with us.
Yeah, thank you, thank you. Hi. I'm Erin Welsh and I'm erin Alman Updight and this is this podcast will kill.
You, and we're coming to you today with the first of four episodes all about pregnancy.
Four just four, just four should have been more, I know, really.
And we're also coming to you from the exactly right studios for the first time, which is nerve wracking and exciting, I know.
But this space is so cool. We get to decorate our little bookshelves. I feel very fancy right now, very fancy, too fancy for our real lives. I mean, for sure, very very different than my tiny little office I know.
Or my closet literally, So we're super excited to be here, yes we are.
We're really really excited about this series, yes for sure. And before we get into this episode, we want to share a few words about what these four episodes will cover, the language that we'll be using, and our goals really with creating the series. And so we decided early on to dedicate four episodes to cover pregnancy, just four sure,
one for each trimester. And at the outset, I mean, we knew that we wouldn't be able to adequately cover every single aspect of pregnancy and childbirth and the postpartum period in just four episodes, right and throughout our research, we did begin jotting down a list of future topics to cover things like pre acclampsia and breastfeeding and Reese's factor, and so there will be more episodes on these and more topics in the future.
Exactly So, this series might not, and it likely will not answer all of your questions about pregnancy or cover every experience that a person might have. Pregnancy is a very individual experience, as highlighted in so many of our first hand accounts. But what we aim to do with the series is take you through the really broad changes that happen in our human bodies during pregnancy and childbirth and postpartum, and also explore some of the historical and evolutionary aspects.
Really excited about that.
Aaron of pregnancy and childbirth. So each episode very roughly corresponds to each trimester. So in this episode, the first one, we're going to be talking about how you even know whether or not you're pregnant?
Yeah, how do you do? How do you know?
And what's happening in very very early embryonic development.
And then our second episode centers on the amazing organ that is the placenta. It's really cool. I think we'll all leave with a little more appreciation for the placenta, I hope, So that's my goal, and some of the physiological changes that a person experiences throughout pregnancy, including some of the complications that can arise, right.
And then our third episode is going to focus on childbirth itself, so labor and different modes of delivery, and then the history of the cesarean section.
Yeah yeah, yeah yeah.
And then finally our fourth episode and our season finale, our season seven season finale. That's crazy, I know, it's exciting, It is really exciting. Yeah, But the last episode in the series will be about this concept of the fourth trimester, like maybe you've heard of it, maybe you haven't, What
is it. We'll get into all of that and explore the changes that happen in your body after pregnancy, and we'll also be talking like big picture history about the medicalization of pregnancy and childbirth, including the transition from home to hospital.
Yeah, we intend for all of these episodes to be inclusive of all families, and we recognize that not everyone who experiences pregnancy actually identifies as a woman, so we try as much as we can wherever we can to use gender neutral language like pregnant person, and that's what
you'll mostly hear through this episode. However, at the same time, we know that much of what we discuss when it comes to medical bias during pregnancy and childbirth, both historically and today, is in fact the result of gender discrimination as well as racism, and so in those context we may also use the term woman or women, and throughout these episodes we'll be using the term mother or maternal and paternal as these are terms that are used in the scientific and medical literature.
Yeah, and we also want to acknowledge that there is no such thing as a normal pregnancy. Yeah, like they're just there isn't one. But we do want to provide a baseline of the expected physiological and anatomical changes that occur during pregnancy, as it helps us to understand where these complications arise from and what is a complication?
Right right, Yeah, So we will get into all of that starting with the first trimester.
But first, but first, it's quarantiny time. It is Aaron, what are we drinking this? And the next four weeks we are drinking great Expectations. I love I love this name. It's a really good name. It's a good name act we think, and we're also making that this is a plasyber read for reasons that probably are clear too. I would thank you for listening, Like it's not an alcoholic, it's not aholic. That means yep, it is And Aaron, what is what is in cred.
Expectations really delicious combination of BlackBerry, gindreal, lemon and mint. And if you check out the exactly Rights YouTube channel, you will find a video of us making that drink, as well as a super secret surprise quarantine coming to us.
From no one other than Georgia Hartstark herself. That was the secret. Oh sorry, perfect, Go check it out. It's gonna be great. It's gonna be great. Gosh, I'm so excited, beyond trilling, I know it really is very excited about it, and so yeah. To get the recipes for our quarantini and plasy berita for this episode and all of our episodes, actually check out our make sure you're following us on social media, and you can also find those on our website,
the podcast will kill You dot com. You can over to you erin to tell me it's on the website. I don't have to do. Let me tell you what's on our website. We have so much information there, Aaron.
We have merch we have oh translusted already, we have transfers, We've got good Reads list, we've got a link to Bloodmobile. We've got all of the sources from all of our episodes.
Contact us, contact us form a first hand account form. We've got a lot, You've got a lot. There's so much, but there's so much. One last piece of business, yes, one last piece of business is okay, So I am super excited to announce that I have started a new hosting role at another podcast. We're really excited for her.
She's not leaving. I'm not leaving. No. So this this podcast is called Advances and Care and in it, I interview physicians and physicians scientists at New York Presbyterian Hospital about their incredible cutting edge research and groundbreaking medical innovations. It's really it's really thrilling, very exciting stuff. I mean, it actually is, and it's like really fun to actually get to read about, like, oh, this is someone who's working on this right right now.
In real life, in real time, these things that is actually making a difference in people's lives.
Yeah, it's reahly cool. It's been such a fun project to work on. And if you want to learn more about the research that's truly shaping the future of medicine, this podcast is for you. Again, it's called Advances and Care and you can get it wherever you get your podcasts. Yeah, check it out. Yeah, check it out. I don't have any business. I think that's it. Yeah, shall we? I think we shall.
Okay, we'll take a break and then get into the history of pregnancy.
Sure, something like that.
Entered my second trimester of my pregnancy. I started having really intense pain in my abdomen and in my legs and in my hips, and it kind of rendered me almost completely unable to take part in any kind of physical activity or exercise, and even walking became increasingly uncomfortable. And I really started to notice as I got bigger that my baby was really crowded to one side of my belly, and I seemed to be protruding far further forward than any other woman that I saw that it
was at the same stage as me. And when I brought those concerns to my ob it was kind of laughed off. Isn't that so funny when a baby prefers one side over the other and no further exams or tests were ordered to kind of check out what was going on. So I managed through the rest of that increasingly uncomfortable pregnancy, and then I went into labor three weeks prior to my due date. It was very fast, very intense labor. I started having contractions at about nine PM.
I was at the hospital at one thirty in the morning. And then and in my first cervical exams, the doctors found that I was only two or three centimeters dilated, and they really treated me as such, kind of put me on the last of the lists for an epidural request because I was a woman who was clearly not close to being ready to push, and so I was in this very extremely painful and uncomfortable state for an hour and a half while I waited for an epidural.
Once they got that epidural in, they were able to perform a more thorough exam as I was more relaxed, and they found that I had a blockage in front of my cervix, and behind that blockage, I was fully effaced, fully dilated, and actively pushing to get this baby out.
So I was rushed in for an emergency C section, and my daughter came out just find distressed but fine, And they held up my uterus and found that I had what's called a bicorneate uterus, which is when the memo brain that is formed when your uterus is being formed doesn't disintegrate and basically leads to you having two
halves of a uterus. And so I was growing a baby in a half of a uterus and then trying to give birth in a through a cervix that was blocked by another cervix, and so while I've healed from that experience, I'm also left wondering why wasn't that found and discovered not only during pregnancy, but also prior to pregnancy, and what kind of implications does it mean for a future pregnancy. Thank you so much for allowing me to tell my story.
Hi.
My name is Stevie, my pronouns are they them, and I live in Ontario, Canada. In twenty twelve, my husband and I were extremely excited to be expecting our first child. At ten weeks, we had started seeing an ob. I'd been spotting off and on, but he kept saying that everything was fine, and what bleeding isn't normal? It is common, and don't worry. He said the same thing at every appointment. It's not normal, but it's common. Don't worry, Everything's fine.
At eighteen weeks he sent me to a specialist. I wasn't expecting it to be a big deal. After all, everything was fine, right.
I was wrong.
I was blown away by the list of issues and complications being laid in front of me. The only thing I really remember is that I was at a high risk for pre term labor. About a week later, at work, I set up to get something and felt a gush. I reached down and my fingers came up red. I was hemorrhaging. Had a friend drive me to the er. My husband met me there and we waited. I was told that if I was miscarrying, I'd have to stay down in the er. I was too early to go
up to labor and delivery. The ultrasound showed a good heartbeat, though, and bleeding slowed down, so I was sent home on bed rest. Around one am on November eleventh, I woke up and vomited. I had an intense cramping in my stomach, in my back. I told my husband something was wrong. We went back to the er. The ob said I was in labor and it can be triggered by dehydration. So I was given an IV and it stopped. I was moved to a room and told I was staying
there until I delivered, whenever that was. But at under twenty four weeks, there was really no hope for the baby. On November fourteenth, at twenty one weeks and four days, I went into labor. This time it didn't stop. Our daughter was delivered at one twenty six in the afternoon. She weighed exactly one pound. Our families were there and we sang her Happy birthday. She lived for three hours. During that short time, she knew nothing but love. We all held her and sang to her. She took her
last breath with me. That night, my husband and I went to sleep in the postpartu ward to the sound of other people's babies crying. The specialist never found a reason for our loss. She said it was probably a placental abruption, but she really wasn't sure. We went on to have two more pregnancies, and we have another daughter and a son. We have pictures of our firstborn, and she's very much part of our lives. Our other kids say they see her when they see the first stars
come out at night. As I always say, she's our perfect girl, made of stars. I share our stories often as I can. Pregnancy and infant loss affects one in four pregnancies and is not discussed enough. I felt so alone after our loss. Every year on her birthday, I share our story and new people will share their own stories with me. I hope that sharing my story here will help people to feel less alone. Our loss should not be hidden. We shouldn't have to grieve in silence.
If you search for a list of the top medical advancements in history, you might find on that list things like antibiotics, vaccines, gene editing, medical imaging, kidney dialysis, organ transplantation, the manufacture of insulin, and anesthesia for a start. It's a long list, a long list. I couldn't stop once I started. Yeah, but I would be shocked if you found home pregnancy tests on one of those lists. No,
I don't think I wouldn't. You wouldn't have expected it. Yeah, And I know this because I've often skimmed these kinds of lists looking for inspiration for future episode topics. A lot of those are on our list, I'm really true. Yeah, kidney dialysis, we need to do that, I know, and so many I know. But I've never seen home pregnancy
tests mentioned. I don't think so, And to a degree, I get it right, Like, these tests didn't provide new avenues for treatment, nor did they represent a paradigm shift in how we understood the workings of the human body. But I would argue that these sticks and the plastic rectangular boxes that preceded them absolutely deserve a place on any list of significant medical breakthroughs.
I'm already just so invested in this Errand I mean.
Are you convinced yes, so I can stop? Yeah? Done, Okay, done, They're on the list. But the reason I feel so strongly about this is because of the type of knowledge that they grant us. Not guiding principles, not laws of nature. Home pregnancy tests give us deeply personal knowledge about our own bodies, empowering us to do with that knowledge what we decide we want or need to do, share it, keep it to yourself. For the first time, that choice
was up to the test taker. They were the first to know, not the lab technician running the test, not the frog being tested. More on that way, Not the doctor who deigned to prescribe a test, oh yeah, prescription only okay, yeah. The transfer of this knowledge out of the hands of the medical provider and into the hands of the test taker held profound implications for women's reproductive rights.
Of course, probably no one needs to be reminded that what you decide to do in terms of continuing with the pregnancy or not is not always up to the pregnant person alone. Yep, especially not in the United States. Nope. But the story that I want to tell today is about the quest for this knowledge, like what ultimately led us to the near universally recognizable stick that shows one or two blue lines, and where we might go from here.
I'm sorry, Okay, For thousands of years, people have searched for a way of knowing whether someone was pregnant or not outside of like the bodily signs like morning sickness, missed periods, tender breasts, and quickening the fetus' first movement, which was considered like really one of the most significant signs in terms of like that is when a pregnancy
became real just quickening. Yeah, And I won't speculate on why there was a need or a want to know, whether it came from within someone wanting help understanding what their body was trying to tell them, or whether it came from without, like someone wanting to know whether their partner, of their friend, their daughter was telling the truth. And I'm sure there were many reasons for a test right right,
that you would want to test. The first pregnancy test comes to us all the way from an ancient Egyptian papyrus. Stop it, I know.
How can you pull ancient egypt out when we're talking about pregnancy.
T you know, I thought, okay, what, like, what of my usual go tos are ancient Egypt Apocrates germ theory like things. I feel like I have to mention the humors. I think the humors is the only one. I don't mention any of these shoggings I know, But yeah, ancient Egypt pregnancy tests. Stop it. Thirteen fifty BCE there was a like a papyrus or something that instructed women to pee in two bags. One bag contained wheat, one bag contained barley. Okay, if the wheat grew, it meant a
female child. If the barley grew, it meant a male child. Why does this feel vaguely familiar? I think we might have talked about it in our IVF episode part one. Okay, yeah, okay, yeah weird, But I don't remember if I like dug any deeper because I did this time. And it turns out that some researchers tested this like a two decades ago, and yeah, it's like not it's like not great, but it's not entirely incorrect, Like is it more than fifty percent? Yeah?
Seventy percent? Really, I know, there's no association with like the sex of the fetus, just like whether or not you are pregnant. Yeah, so it's like growth hormones in urine, yeah, P in your p.
It's interesting that even the first test was p.
P has always been a main feature. Really, I think it's really it's it's fascinating. Yeah, And I don't know like where that like how people made that connection. And so in for instance, like in medieval England, there was a profession called a piss profit. This profit can you imagine being like on your business cardfit official assistant, piss profit assistance too that this profit yeah, Prentice far Up, I can't. Oh my god, that's great. Yeah, okay, And
what did a piss profit do? I mean it basically what it sounds, okay, right, like you be able to hold up the like the urine and the glass and be like, oh, this person has this disease. That it was more than just pregnancy. It was like lots of things, okay, I mean horoscope even probably a lot of things you can see in your peace. So I gets exactly. So
there is some basis to them. So some piss profits claimed that I know I keep saying, claimed that deposits of white, flaky material in urine that had been left standing for a couple of days could indicate pregnancy, so the deposit may have been casin. Okay is how you say it. I mean casin is a thing. Casine like a protein, yeah think, which is as part of breast
milk produced during pregnancy. Ah yeah, okay. Yeah. Urine did briefly fall out of favor in the eighteenth and nineteenth centuries for pregnancy testing, and instead physicians performed physical exams to determine whether or not someone was pregnant. Although I know that doesn't sound great. It doesn't sound great, and the doctors were like, as is typical, would be so afraid of modesty and so it would just be like kind of just closing their eyes and like searching, and
it's yeah, it's not great to think about, okay. But these signs often included things like changes in the color of the cervix, vagina labia, softening of the cervix, changes in breasts or nipples, changes in the abdomen, things that typically happened after at least two missed periods. Okay, but these were by no means telltale signs of pregnancy, and doctors usually advised to just give it time, give it time,
wait for the quickening, then you'll know. And in fact, until the twentieth century rolled around, because there was no single, one hundred percent reliable way of determining pregnancy from an outside perspective, which is mind blowing to think about. Yeah, doctors usually took their patients for it. Huh yeah, okay, because they believed them. I believed that. Wow. Then once the lab based pregnancy test came about, that word slowly held less and less weight in the eyes of medicine.
And these tests, these lab based tests also made it easier to prosecute someone for abortion because you had proof of early pregnancy, even if you couldn't distinguish between abortion and pregnancy loss. Oh wow, that's interesting and horrible and horrible. Okay, so how did these tests come about? Science has never followed a straight line of progress, and lad pregnancy tests are no exception. But to keep things streamlined for today,
I'm sticking to the major steps along the journey. And if you want that extra nuanced, check out the books A Woman's Right to Know by Jesse Olzinco Grinn and A Pregnancy Test by Karen Wengarten. In the first couple of decades of the twentieth century, the field of endochronology, which is a study of hormones, took off in full force. Researchers investigated how adrenaline worked, what insulin did, which hormones fluctuated during pregnancy, and other endochronology related questions. There were
a million of them. Finding the answers to some of these questions like which hormone is excreted in urine and people who are pregnant before they even realize they are pregnant, led them to even more questions like what would happen if we injected some of this urine into immature female mice.
That's a normal question. It's a normal question, And that pretty much sums up how the first lab pregnancy test came to be Oh really really In nineteen twenty seven, two researchers Asheim and Zondek, who gave their names to this test, developed a protocol where they would take urine from a possibly pregnant person injected into five immature female mice twice a day for three days. Whoa kill the mice and then take a peek at their ovaries? Sorry, okay, yeah? Is this okay? Have so many questions.
I know, is it like, are they having to pee multiple days for this twice a day, three times a day or like once a sam question? Okay, too detailed.
My guess is it was just one sample, okay. And then there so this is taking many days. It's taking many days. Yeah, and like five five mices, Simon and I said, yeah, yeah, it's a process. Yeah. And then once they once they cut the mice open to look at their ovaries, if those ovaries were enlarged and congested, it meant that the.
Pro was pregnant then, I mean makes sense physiologically, but okay, very interesting.
Yeah, yeah. So, and what these animals were responding to was a hormone in the urine called hCG hCG human choonic ganada tropin that was vening really yeah. Initially researchers thought it was produced in the pituitary gland, but physician scientists Georgiana Seagar Jones correctly identified its origin as the uterus and gave it its name in nineteen forty five.
Wow, Okay, nineteen forty five is when hCG was named HG Yeah, and found to be from the uterus, and eventually rabbits replaced mice because you could get a result faster and you didn't have to use as many animals.
Gosh, the phrase the rabbit died. Have you ever heard of this? No, it's used. I feel like I've been rewatching mad men and there's another part of mad I've thinking a lot about mad men and pregnancy. But that is a euphemism that was commonly used to be like, did that mean that you were pregnant or weren't that you were pregnant? But it doesn't really make sense because
they killed all around it. Yeah, okay, yeah, weird, I know, Okay, but I do find it it's interesting that there was a euphemism because pregnancy wasn't really something that was discussed out loud very much in like until the middle of the twentieth century at the earliest. Really, yeah, it was kind of just not like taboo, but it was in
hush terms euphemisms. Yeah, exactly. But these tests, the Asheims on Deck test and the Freedman test, which is what the rabbit one was called, delivered pretty accurate results, but they did come with limitations. So, for one, the urine was often about seven percent of the time toxic. Oh so then it would kill the it would kill Yeah. Maybe that's where it comes from and it had to be treated otherwise it would kill the rabbit just outright. Yeah.
And the second was that the animals were expensive to keep. Animal welfare didn't seem like a pressing concern at the time, but cost was. Unfortunately, a cheaper animal was available, the African claud frog. Oh, they're so cute. They're very cute, aren't they also known as the African claud toad. Is it a frog or toad? I don't know. I'm pretty sure it's a frog. Yeah, it's a scientific name Zinopus
leave us. Okay, but I don't know. But it only happens to ovulate in the presence of a male frog or or in the presence of a HGG.
So then with these, did you just have to like squirt it on top because they just diffuse through their skin essentially?
Okay, Yeah, So in nineteen thirty three, researchers Shapiro and Swarnstein discovered that yeah, if you just sort of sprinkle urine, well I don't.
Know if it was actually sprinkling, like if you exposed, we'll say that, Yeah, you're in from a pregnant person to these frogs, and you could induce ovulation in the frog eight to twelve hours later.
And then so that's much quicker, much quicker. And do you have to kill the frog or no? Nope, can you we use that frog?
I think you can. I think you just would not like like have to give it like a wash up period exactly. Okay, yeah, okay. And so soon labs around the world began importing these frogs for pregnancy testing. Wow, and guess what may have hitched a ride Kittrid Kittrid stop it? Yeah this, How did we not talk about this in our kitchriend that we may have aaron that
was like seven years ago? Wait? Uh yeah, So and if for those of you who haven't heard of kittrid or haven't listened to our Kittrid episode, Kittrid is a type of fungus that is absolutely deadly, like devastating in some species of ad populations of frogs, like extinction in the wild the thing. Yeah, but researcher. Some researchers think that the widespread distribution of these African Claude frogs for pregnancy testing may have led to the global spread of Kittrid.
I kind of hope that we actually did cover this and I have completely forgotten.
No, it's I feel I feel like we did. We might. I don't know those it sounded vaguely familiar. But or is it like one of those where it's a memory and then it becomes or it's a new thing, it becomes a memory.
Yeah, on manufactured memory exactly. Wow, Okay, that's really interesting. Yeah, they're dated to back it up, or it's just like a guess.
Oh funny you should ask. One of the earliest identified specimens of captured infection is from one of these frogs in nineteen thirty eight. Wow, nineteen thirty eight. Yeah, okay, okay, that wild? Yeah was wild. But so anyway, the frogs were an improvement from like the rabbits and the mice. But do you know what would be even better if you didn't need to kill an animal or exact yeah,
or or keep the animal is so expensive? Yeah. But the first of these dreamed of tests was developed in the late nineteen fifties, and it was an immuno assay that detected hCG. With these tests, especially as specificity increased and false positive decrease with later improvements, researchers could decrease turnaround time as well as cost, and that ultimately resulted in more people utilizing these tests, but probably not as
many as you think. Getting a pregnancy test was by no means a typical part of any pregnancy throughout the nineteen fifties and the nineteen sixties, and in fact most people didn't get tested.
Why.
First of all, access, If you wanted a pregnancy test, you had to make a doctor's appointment and get a prescription for a test, at least in the US.
Even after they moved away from these animal assays, like just to the IMO assay ones.
Yeah, everything was prescription, yeah okay, And then you had to wait weeks to hear the results from the doctor and you're like, oh, I already have missed like three periods by now, so I know, yeah, okay, I think, I think, I know. Yeah. These things cost time and money, right, And Second of all, stigma. Some doctors refused to test certain people to prevent them from getting an abortion, and so they would withhold that information until it was too late.
They would say, well, if you want a test, I'm worried about what you're going to do with those results.
Oh, my god, I hate that so much, and I wish that it surprised me more.
I know, I know, or they would tell husband first so that he could make a decision. I didn't know I was going to get livid this early in the series. Sorry, it's just get ready, strap in strapped. There was stigma attached to wanting to find out if you were pregnant before you started showing these quote unquote natural signs, interesting because it suggested you had anxiety about the pregnancy or about the father. If you were married, forget about it.
Your reputation would never recover what often yeah.
Just for like wanting to know this information. Then people assumed that you were up to something often yeah wow.
The nineteen sixty six Better Homes and Gardens Baby book said that pregnancy tests quote there is no need for one. Yeah wow. And it's hard not to see this is just another way to control women and the choices, right. This is this is knowledge that should not that does
not belong to It doesn't belong to you. Yeah no. And the introduction of the home pregnancy test in the nineteen seventies it didn't immediately erase stigma, but it did make testing an option or at least more of an option for the people who where previously it wasn't who saw this need and did something about it, someone who could make money off it. Actually no, oh, okay, I know pleasantly sy There was a woman by the name
of Margaret or Meg Crane. Okay, So, one day in nineteen sixty seven, the twenty six year old Crane was walking through the offices of organ On which sounds made up, a pharmaceutical company where she worked as a freelance graphic designer, and something caught her eye. One of the rooms as she walked past, was filled with a bunch of test tubes hanging in some sort of bizarre contraption, and she asked her colleague, like, well, what's going on in there?
It turns out they were pregnancy tests. Crane listened as her colleague explained how they work, and she thought to herself, this sounds pretty simple, Like why can't we do this ourselves at home? And this thought followed Crane around and she found herself in her spare time des a home pregnancy test prototype. As a graphic designer. She's like, I can do this.
I was like, love, but this is not that hard. We should be able to do it, like it's hard, that's perfect, thank you. But yeah, she didn't do it because her boss asked her to do it. She just knew how revolutionary it could be.
She saw the potential and what a change it would make, and in fact, when she showed her boss her design, he scoffed. But when a male employee later suggested a home pregnancy test, the option seemed more appealing. So a few weeks later, Crane walked into work to find a big meeting taking place, and she was like, what's going on in there? Turns out it was a meeting to discuss different home pregnancy test designs, so she crashed the meeting put her design on the table with all the others,
which all of which were designed by men. One had rhinestone edging, one had a cute little tassel, all were pink except Cranes, but Cranes was the only one to include a urine collection cup. Oh my god, are you serious.
Yeah, we've got the rhinestones, but not the collection cup.
Would we use a mug exactly? So someone's like what And one of the other designers was like, yeah, I just I just figured And then they're like, and what do you do with that? Afterwards? I love this story erin, I know, I know, and so Cranes. Because of this, and because of the other practical aspects of its design, was considered the winning model. And so let me paint you a picture please. A hard, clear, rectangular box made
of two pieces that joined in the center. Inside the box was a dropper and a test tube that contained dried rabbit antibodies and sheep blood. So you collect some urine into the top half of the box, add a few drops to the test tube along with some tap water, and then you waited for two hours much better than two weeks, with the test tube sitting in the bottom half of the box. And that had a mirror. It's like,
it's complicated. Yeah. Yeah. If you were pregnant, a red brown ring like a doughnut would form in the bottom of the tube, reflected by the mirror. No donut meant no pregnant. Oh no pregnant, Yeah, no donut, no pregnant. Okay, well that is really complicated. It's really complicated, but it's also something that is like it was you can do very much. Yeah right, it was very similar.
To not that much harder than like COVID tests or you're like, oh yeah, I swap this, and I mid this, and I drop her this, and I.
Yeah, I'm something of a myself. Yeah uh yeah. Also, I just want on a cute little side notes. So Crane met her future husband at that meeting. He I think was the one who was like, this design is clearly the best good, not like I produced the rhinestone one. No no, no uh. And eventually they opened their own ad agency where she was the head designer and he was a copy cheese. Oh so cute. But with Crane's design in hand, Organons sought to get this test to market,
Facing heavy opposition in the US. Was it reliable enough? What would women do with this information? Organon instead turned to Canada, where, unlike the US, you did not have to have a prescription to get a pregnancy test, and you could just take one at the pharmacy without a doctor's appointment. Okay, unbelievable, I mean totally believable. By summer of nineteen seventy one, Predictor, which is Organon's home pregnancy test, was on the shelves in Canadian drug stores for five
dollars and fifty cents. Which is about the same price as a BRA and a little less expensive than a lab test. Okay, just to get it, yeah, protexted.
Yep.
Not everyone was a fan of the lab test. So one pharmacist in British Columbia named Bob no last name that I could detect, said that he wouldn't be stalking them because he quote didn't think women could be trusted to accurately obtain results. Okay, Bob, thanks Bob, we can't or piano cup come on, yep geez. Others described it as a passing fad. Oh questions. Yeah, but the market didn't lie. The test flew off the shelves and it quickly sold out, and with such a successful launch in Canada,
other countries' approval wasn't too far behind. Home pregnancy tests became available in many places around the world by the end of the nineteen seventies. In the US, the FDA approved the test in nineteen seventy six, and they hit the shelves in nineteen seventy seven. Wow. One of the earliest ads for these tests, the EPT in Home Early Pregnancy Test, described it as quote a private, little revolution any woman can easily buy at her drug store, I love it. Yeah. Early TV ads ended with time is
on your side at last. The tone from these ads reflect the push for and the milestones in reproductive rights in the US and the nineteen seventies, like Roe v. Wade was nineteen seventy three, for instance, but the private little revolution wasn't immediate. These tests cost ten US do all about fifty one in twenty twenty four dollars holy cow. Yeah, took two hours for a result again, and had a decently high rate of false negatives not false positives, though,
which is good. This was not a cheap test, and the recommendation to buy two tests in case you took the first test too too early. It made home testing prohibitedly expensive for some people, and according to some who used it, the test wasn't the most intuitive and in fact was kind of complicated. It just had to sit for two hours in a completely still dark environment. Any jostling, yeah, because otherwise the ring would probably dissolve. Oh interesting, the
doughnut okay, yeah, and stigma lingered right. There was one state official telling consumer reports in nineteen seventy eight that quote, there is no reason for a woman in Maryland to buy such a kit as the ept unless she doesn't want to be seen at the health department. Yeah, leading the magazine to conclude that it was a quote unquote useless purchase. Wow. Yeah, just like our avocado test. If you didn't buy so much avocado test, would you can
buy out? But the sentiment revealed a disconnect between what most physicians, some politicians, and a puritanical, patriarchal society thought women needed and what women felt they needed, especially in the US, where there initially was pushback against allowing the test to be sold in drug stores over the counter. Yeah, regardless of how accessible you made pregnancy tests at the clinic,
like getting rid of prescription requirements reducing the cost. Whatever the tests revealed at those clinics was first learned by someone else, right, not ever the patient. Putting pregnancy tests in the hands of women reasserted their rightful control over their own bodies and the knowledge about their bodies. Yeah. There's a quote I want to read you from the
book Pregnancy Test by Karen Weingarten. Quote. With a home pregnancy test, women could take control of their decision from They wouldn't need to find a doctor willing to test them for pregnancy. Who might question their motives or next steps. They wouldn't even need to share their news with anyone
until they were ready end quote. Even early marketing materials focused on what this meant for women, not families, not a couple, but for a woman who thinks she might be pregnant, focusing on the privacy aspect of these tests.
The pharmaceutical companies that produce them also had to convince physicians that this was a good thing, that early pregnancy detection meant people could get prenatal care earlier, and most physicians agreed with that potential positive impact, but many remained skeptical that the tests were accurate, and they would insist
on a clinical test to confirm home results. And this is not without merit, of course, Even the most accurate tests today are not one hundred percent accurate or may not be able to give you all the information that you need to decide what to do next. The pregnancy test does not reduce the need for or replace medical care at all. It is simply often the first step along the journey, whatever that journey. Maybe. By the nineteen eighties and Reagan's presidency, these ads shifted in tone to
be more about family values. Of course they did, of course, featuring straight couples sharing the joy that a test could bring. The nineteen nineties saw reality advertising for pregnancy tests, with couples finding out on camera the results of the test. In the nineties, yeah, I mean, come on, you like Jerry Springer morey stuff like that. Yeah, yeah, okay, America's Funniest Home video.
Sure.
Sorry, I don't know if I'm sure pregnancy test featured on I'm sure they didn't. But these these nineties tests, that's when the first time people of color were featured in many of these ads. And while most couples in these realities, so it would be like a couple being like, oh, let's find out the results on air or whatever, and then most of them like clearly wanted a positive result, like they were happy with the positive result. One couple
was relieved about their negative test, which interesting. Yeah. What was missing from these ads were depictions of women who did not want to be pregnant but were. David Lynch, So, the guy who did twin Peaks in the movie Blue Velvet He Passed Away, recently directed a nineteen ninety seven pregnancy test ad where the woman in the ad finds out the results, but the audience doesn't get to see them. I love it.
Waiting to find out if you're pregnant or not. Nothing else in the world matters until you know. Introducing clear Blue Easy one minute pregnancy test, because only clear Blue Easy gives you a clear yes or no in one minute.
So that's the first time that it's just waiting and you have to kind of infer yourself.
I think so interesting. Yeah, isn't that? Isn't that so fascinating because a lot of the other ones were like, it's positive, I'm happy, or it's negative, I'm relieved. But this one, she's smiling. You don't know is she happy that it's positive or negative? Right? I really like it. Yeah, the mystery of it, that ad is especially important too, for showing that it's about the knowledge, not about the result. And I think that's a big shift in that perception
of what these tests have given us. So within twenty five years of their release, home pregnancy tests had become a widely used, recognizable, commonplace diagnostic tool as well as you useful plot device. TV shows, movies, novels all began to feature pregnancy tests as a useful way to increase dramatic tension or force character growth. I mean, how many sitcoms have an episode where someone finds a positive pregnancy test in the trash? Whose is it? Everyone?
My god?
I can think of so many. Yeah, They've been used in TV and movies as an opportunity for safe sex talks between parents and a teenager, a moment of self reflection for whether or not a character wants the test to be positive or negative, whether they want children at all or feel ready to have kids. It's on reality TV in really twisted scenarios, like there's a Maury one where someone has to tell like it's like someone's teenage daughter takes one on air to be like is she
lying or not? I know that's horrific, I know, yeah, but there are yeah, a million examples.
Right.
In nineteen ninety one, the show Murphy Brown showed Murphy taking a home pregnancy test and ultimately deciding to become a single mother after considering abortion. This is nineteen ninety one. Wow, I feel like that's it's like not allowed today. Yeah, yep. This plotline was criticized by Vice President Dan Quail as quote unquote eroding family value. Of course it was, right, Yeah,
it's yeah. I think that that test though, or that Sitcom Murphy Brown when she when she took the pregnancy test, that also helped to kind of popularize it and be like this is a thing that people can do. This is Yeah. I think it just kind of had increased momentum even more like normal. Yeah, exactly. But it's incredible how over the almost five decades since its release, the home pregnancy test has become almost universally recognizable, even for
people who have never used one. I loved how like, yeah, the early COVID tests and people would take pictures and like everyone thought it was a pregnancy test immediately. Yeah. But improvements to the test over these decades include things like the invention of monoclonal antibodies, which eliminated the need for lab animals. More precise testing than now familiar, easy to read stick pregnancy test with the two lines was introduced in nineteen eighty seven. Now some of them say
pregnant or not pregnant digit. In twenty twenty one, a flushable pregnancy test was introduced, which is an incredible development to protect privacy.
Wow, yeah, I was just thinking about sewage lines, like, is are they actually flushable.
I mean I think, I think they are fascinating. Yeah, tests have been developed that can be read by blonde or low vision people without the help of someone else. Wow, I know that's amazing. I never would have thought of that, I know, I know. It's so incredible, the different innovations that have been thought of. Yeah, one organization has introduced a test that measures hCG as a way of verifying that an abortion worked. And so you take like a you know, sequential test afterward to be like, is it
dropping right? I've seen different estimates, but around eight million people in the US alone used a home pregnancy test in twenty twenty. Wow. Think about that compared to fifty years ago. I'm going to read you a quote from an article by historian Sarah Abigail Levitt. Quote. Though women have found ways throughout history to find out about impending pregnancy, that has only been within the last quarter century that this information was available to so many women with such
reliable accuracy. Women in this generation who take home pregnancy tests are able to know something about themselves and their futures in a time frame that was simply not possible for their grandmothers or even their mothers. Isn't that mind blowing? Like my grandma wouldn't have taken a pregnancy test. I wish that I could ask, Yeah, my grandma, my mom took a home pregnancy test. I assume that my mom did, but I never asked her.
I asked her so many other things about her pregnantities for this episode, but I didn't ask her that.
Yeah. It's incredible. Yeah, but that knowledge can come at a cost. Also from Levett, the pregnancy test has liberated women by giving them information earlier and allowing them to
digest the information in the privacy of their own homes. However, it oppresses women when it forces them to make decisions earlier and earlier, when it forces them to confront a miscarriage they might otherwise never have known about, or when it falls into the hands of those with whom they did not wish to share the information, and when it
proves an untrustworthy narrator and gets the answer wrong. Yeah, have been and continue to be tested for pregnancy without their consent or by those who have ulterior motives, such as testing unhoused women. In the nineteen eighties in New York City who had to be tested if they wanted city housing. Wow, or women on certain police forces being secretly tested employers pretending to test potential employees for drugs
but actually testing for pregnancy. That has happened. Oh my god. Yeah, the US Immigration and Customs Enforcement ICE test those arriving at a detention center who are over ten years old, ads for free pregnancy testing at clinics that are actually anti abortion clinics. That's major. It's a major one. And then the early detection and sensitivity of these tests could
be seen as a double edged sword. Some suggest that pregnancy test is not really an accurate term, that these tests aren't detecting viable pregnancies, but just the presence of hCG, and so non viable pregnancies that may not have been noticed in the past are now recognized, potentially increasing the trauma of that experience. For some, however, that experience may
be incredibly meaningful. These days in the US, early detection of pregnancy can be critical, especially for those living in states that restrict abortion to a narrow window like.
Six weeks or like outlaw it at all. So you have to figure out where you're going to travel.
So you're going to travel, Yeah, waiting until you've missed a period to take a test might already be too late. Knowledge is power, and that can be dangerous if that knowledge falls into the wrong hands or is used against us. But it can also be incredibly liberating and empowering, giving us access to and control over information about our bodies that should have been ours to be long. Yeah, and so with that, Aaron, I'd love for you to tell me about how hCG works and what's going on in
early pregnancy. I don't know if I'm going to answer that first question. Okay, what's going on early pregnancy? Okay, great. Right after this break, I.
Didn't have a glowing pregnancy. Sciatica made every step painful, Braxton Hicks robbed me of my sleep, and even the smell of my beloved garlic turned my stomach. Hormones didn't help, especially when my husband jokingly called me Shamou after the infamous killer Whale because of my black and white maternity wardrobe.
I snapped at him one night when he made what I thought was a mean comment about how puffy my ankles were looking, and then I forgot about it until January seventeenth, twenty eighteen, at two am my waters broke. We grabbed a cab to Lewisham Hospital in southeast London, expecting to be sent home as labor had not started yet. Instead, after a long wait and a quick reflexed test where my legs shot up in the air, we realized that those puffy ankles had been an indicator of preacclansia, the
only cure birth within twenty four hours. Suddenly I was on a hormone drip to induce labor and magnesium dripped to prevent seizures. Hooked up to monitors, I was told that I could not eat anything for hours. I waited, feeling contractions build, but just when I needed the aperture a most we realized that it had become detached and I had to push without pain relief, which resulted in my blood pressure increasing in a way that the midwives were not very happy about. Suddenly the room blurred in
a wave of blue medical sheets and rushing staff. My baby was facing the wrong way up, another complication. The doctor used a vacuum to rotate her and finally, to Queen's I wanted to break read. My daughter entered the world. Their traditional national health service tea and toast afterwards is still to this day the best feal of my life. Two days later we went home. That baby is now a feisty seven year old testing every boundary. Life since
hasn't been simple. We've made countries, she's learned new languages, and her dad and I have separated, but she's the center of our universe and through it all, even though I've never fully understood why I got prea clamsia and why we hadn't noticed it earlier, I'll forever be grateful to the NHS for bringing us through safely.
For the most part, my pregnancy was pretty typical, pretty textbook, no complications or anything. The two things that really kind of stood out to me as different in my experience that I was not prepared for. The first was when the whole time that I was pregnant, people always were saying, oh, when you go into labor, you may not even know it. It may be hard to tell when labor starts. It's not going to be like it is in the movies where you have this big dramatic gush of your water
breaking and that's what starts things. That was exactly what happened. I had woken up at about four o'clock in the morning, needed to use the bathroom and I got up off I was sleeping on my basement couch, got up off the couch as best I could, and the second my feet hit the floor, it was a gush that was unmistakable. I knew at that point that it was time to
go to the hospital. Then the other unexpected for me was as my labor progressed, it seemed like things were going relatively quickly, and you know, just a few short hours into being at the hospital, I was told, oh, it's time to push, and at that point I was thinking, Okay, I'm gonna have the baby in just a few minutes. Everybody I've ever talked to says they pushed for fifteen minutes or two pushes and the baby was out. That was definitely not my experience. I pushed for two hours.
That was pretty grueling, and I overall everything turned out fine. But I did not realize before that point that you could be ready to push and have it still take that long. She hadn't descended through my pelvis yet, so even though I was already fully effaced and dilated, it took a little bit of work. All in all, it was worth it, and I would do it again. But you just really never know what you're signing up for when you get pregnant.
So this might sound silly now after everything that you went through, but I felt like to make all of these episodes make sense, I wanted to start by just defining pregnancy.
No, that's a great, okay way to start.
Cool, Like, it might sound very obvious, right, Like, I think we all know what we think pregnancy is, right, It is the period of time when there is a fetus growing in your uterus.
That's what we think of as a pregnancy.
Yeah, But like you just walked us through, how we've been able to determine whether or not someone is pregnant has really changed over time. So I want to start with how we date a pregnancy today. Great, okay, this is how we decide when a pregnancy quote unquote begins. Okay, And in medicine that is pretty universally based on your last menstrual period. The first day of your last menstrual
period is the start of a cycle, your menstrual cycle. Yeah, we assume in medicine that all menstrual cycles are twenty eight days long.
Exactly. We know that they're not, but that's an average.
And so based on that assumption, pregnancy is forty weeks long. It's about two hundred and eighty days, all right. The time that it takes from fertilization will get there to a mature fetus or baby is about thirty eight weeks two hundred and sixty six days. So that extra two weeks between thirty eight and forty that's the time it takes from the start of that last menstrual period to ovulation slash fertilization.
Does that make sense? I think so.
So that's why your pregnancies are always longer than you would think it is. By the time that you have missed a period, you're already four weeks pregnant. Oh my god, even though fertilization just happened two weeks.
Ago, got it? Okay? Yeah?
And it is confusing, yeah, because then it really makes that timetable. And if we're talking about like access to abortion and things like that, it's really important. Right, So we'll go through all of what is happening there. But I just want to set the state, so that is how we define pregnancy. That's the time frame of pregnancy. Okay, I have a question real quick, right to me.
So there then is a potential like error bars around absolutely, and so then like let's say that you know that conception happened on this date, but then your doctor's like, oh, well, when what was the last day of your last period? You want to talk about me? Because that was my life I was angling too. Yeah.
So if you have like, for example, very long menstrual cycles like thirty six days or something like that that's pretty different than twenty eight days, then your conception date might be more accurate if you know it. That's like your ovulation date. But generally what happens is that we use ultrasound early ultrasound to make sure what the embryo and fetus is growing as and if it's off by a certain number of days, then you change the date of the pregnancy.
Okay, does that makes sense?
Yeah, And it all depends on how early that ultrasound is, how it's growing and all of that, and there's like very specific regulations on how that's all decided. But yes, for some people that date ends up changing and it's not exactly consistent. But at the start, it's always assumed that the start of your pregnancy is the first day of your last menstr period.
Interesting. Yeah, okay, so that I feel like that has such huge implications for everaching. Yeah, and it really does.
Like for my both of my pregnancies were not dated accurately based on that. One of them I found out early on and it was fine. The next one it was the day I went in for an induction.
Oh my gosh, It's all fine, because then there's that it's like, well, you need an induction, right or you don't you? Or yeah, so it does. It does matter.
And now that we have the better ultrasounds that we have, the more accurate we can be in dating if you have access to an early ultrasound, because ultrasound gets less accurate the farther you get in pregnancy.
I am going so far off. No, this is great. I'm sorry I started to stun as a rabbit hole. I love it, okay, but so let me find where I'm at.
Yeah okay, but yes, so that that is how we define it in medicine. I'm going to walk through like the steps after fertilization and the very early parts of a pregnancy. So if any of my dating gets confusing, where you're like, what, what does that mean, just stop me so I can clarify, Okay, And that is what I'm going to walk us through today is early development and then some of the things that can go wrong within that early, very early time period. And we'll talk
a lot about miscarriage and early pregnancy loss. And my goal for this part of the episode is to help us understand the question of what has to happen biologically for a pregnancy to be possible. Yeah, okay, So we will begin two weeks after your last menstrual cycle.
Okay.
On average, you have ovulation. That's when you ovulate, and if a sperm is present, then you have fertilization. These two single cells will come together and join their nuclear contents and make a brand new cell. I'm taking everything that happens prior to that point for granted because.
It's cool, but it's way too detailed. Okay.
So that's where we begin. Within the first twelve to twenty four hours after this fertilization event is when you'll have the first cell division. So pretty quickly you go from one cell to two, and then every twelve to twenty four hours or so after that you continue dividing, so you go from two to four to eight to sixteen to thirty two cells in this tight little ball by about day three after ovulation, which is like seventeen days or so after your last menstrual period.
Got it.
And as this ball of cells continues to divide, it starts to take a shape. It forms itself by about day five or six, so nineteen or twenty of your menstrual period after your last mental period, into a hollow, fluid filled ball. And we talked about this in our IVF episode. It's called a blasticist, yep. And I imagine the blasticist like a tennis ball.
Yes, I brought one? Did you bring Okay? Perfect, it's a tennis ball. Okay, your dog is going to be really said she was. When I was like making what I made was she was like, is that my ball? Is that my ball? I did not take her ball? Okay.
So imagine this is a hollow ball, right, but it's filled with fluid instead of just being filled with air like an actual tennis ball, but instead of being like perfectly symmetric inside and outside, in the blasticist, there is on the inside an extra few layers of cells called the inner cell mass. And this inner cell mass that we have here is what will eventually become the embryo opecially the fetus.
Okay, just a little few little cells.
And at this blasticist stage, six or seven days or so after fertilization, about day twenty one of your menstrual cycle, this is when implantation will begin. Okay, So implantation itself, implanting into the uterine wall. It's not a discrete event. It's not one time point. It takes at least a well over a week or so. And what it results with is this blasticist completely embedding itself into the wall of the uterus. So our uterus has a cavity, right,
it has this empty space in the middle, yep. But this blasticist and eventually fetus does not grow in that cavity. It grows within the wall of the uterus.
Okay.
Now, the outer wall of that blasticist like the fuzzy green layer of the tennis ball. It's called the sensisio trophoblast, and that is the layer that will continue to invade into the walls of our endometrium, into our uterus and all the way into the first third of the muscle layer, the myometrium of our uterine wall and I know you're going to talk more about that, yeah kind of yeah, yes, So the maternal endometrium, like our own cells, are not
passive in this process by any means way. Our body is responding to the invasion of these fetal cells that will eventually, by the way, become the placenta by completely remodeling. So the structure of our uterine lining completely changes. We have huge changes in the inflammatory signals that are being sent within our body. I'm excited for you to talk more about it, and then also big changes in the hormones that are dancing around in our bloodstream.
Okay, So just to re recap it briefly, So the cell implantation multiplication, some of those multiplied cells become the placenta eventually, and some become the embryo ex lator feed us exactly.
Yeah.
The inside part is what they're going to become eventually the baby yep. The outside part is what invades and then becomes the placenta.
Yep. And there's like layers obviously, it's so interesting the differentiation. What are the signals that say you be placenta, you be I love embryos.
It's so so, so fascinating aaron, and you could go in so much more detail on like every single step within this.
There are entire textbooks on like this exactly best Slayer.
I know I'm not going to go there, but I'm going to focus on this for a second. Because the start of implantation, so the start of that implantation process, which again takes time, it's a really really important milestone in a pregnancy for a few reasons.
Uh.
The first is that about forty eight hours or so after implantation starts, is when the cells of that since sisho trophoblast, the cells that are burrowing their way into our endometrium, will start to secrete hCG. And that is not only important for detecting a pregnancy, but also one of the major keys for a pregnancy to be able
to continue. Okay, because don't worry, I'll get there. Because up until this point, all of the tissues of our endometrium, the lining of our endometrium, and everything that has changed thus far, it has been supported primarily by the hormone progesterone, and that hormone up until this point of implantation, and hcg' secretion has been secreted by this thing called the corpus lutium, which is what's left over in your ovary after you ovulate.
So everyone makes one of these every time they ovulate, and it hangs out there for like two weeks, supporting the lining of your endometrium, hoping that a blastocyst will implant But the corpus lutium only lives about two weeks or so. So by day fourteen after ovulation, twenty eight days or so after your last menstrual period, if you don't have the presence of hCG in your system, then this corpus lutium will disintegrate, your progesterone levels will drop,
and you will have a menstrual period. You will shed the lining of your uterus.
The decidua. The decidua. Yes, well, I just I'm trying to track that with all that stuff which I don't even know if I talk about the decidua, But.
That is what it is called, is what the lining of your uterus becomes, is called the decidua. But if this blasticist was able to successfully start implantation, it starts secreting hCG, and that hCG sends a signal to our corpus lutium, don't disintegrate, keep it going, keep secreting progesterone,
and it does. Our corpus lutium will continue to produce progesterone for several more weeks, all the way until the point that the placenta has formed and can take over the majority of the necessary hormone production to support the growing pregnancy. Okay, right, amazing, amazing, So we've already learned
a lot. First, it means that the absolute earliest that you could conceivably test for a pregnancy via hCG is a couple days after implantation, which is usually a few days prior to your missed period, because it's like forty eight hours after implantation, which is day five, six seven.
Somewhere in there.
Okay, so most people are going to be considered four weeks pregnant at this point.
Plus and minus is I have strong feelings about that. Yeah, I tell me your feelings. Rage, I guess, like that is so inaccurate. I mean it's yeah, it's because it's Okay, it's consistently inaccurate. So that's one contestant, except it also great. That's that's the one pro of this. The rest is that everything else is then shifted, right, And I mean, yeah.
I know, it's interesting, it's and I mean it's it's really a relic of when we didn't have ultrasound, like laws are now based on oh yeah, preaching, chire yeah, and this process of implantation. It's also a very delicate sort of dance. A lot of things can go not as I just explained, within this process and prior leading
up to this process. So I'm going to pause here and actually take a few steps backward to talk about some of the potential either complications that can arise even as early as this, or just things that don't go this way, like what are what are the alternative roots that can happen here? And then we'll come back and I'll talk more about the inner cell mass how it becomes an embryo. There's a few things that can happen
with implantation the process of implantation. One is that it could happen in an atypical location, and that is called an ectopic pregnancy. And because most fertilization events happen in the philopian tubes, which are the little tubes leading from our ovaries to our uterus, then most of the time, like ninety five ninety six percent of the time, if a ectopic pregnancy happens, it happens in the filopian tubeube.
So this blasticism implants in the wrong place in your Filippian tube or right at the junction there where the Filippian tube meets the uterus. And because Filippian tubes cannot expand the way that the uterus can, as that blasticist continues to grow into an embryo, it can cause rupture of the Filippian tubes, which can cause catastrophic blood loss. So ectopic pregnancies are very dangerous. Flipping tube is not
the only place that it can implant. Ectopic pregnancies can also happen in the cervix so like a little too far down interesting. They can happen in the scar from a cesarean section, which might end up being a viable pregnancy depending on how it continues to grow. They can sometimes happen in the ovary or even in the abdominal cavity because the ovaries and your philippine tubes are not like connected, they're like floating, and your Filippian tubes can also like move around back and forth.
And things like that.
Okay, that's amazing, I know, but it's not great if one implants in like the abnomenal cavity.
And so all of these are considered ec topic because it's.
All just outside of exactly EC topic, just outside of the uter Overall, most estimates are that about one to two percent of pregnancies are ectopic, depending on the source.
Okay, okay, question I expected questions I have answers. Okay, wonderful, So one to two percent of the time. How does how do you figure out whether something's an ectopic pregnancy? Number one? Number two? Like, what what next?
Great questions? How do you determine it? A lot of
different ways, is the answer to that question. Ultrasound is really important in this, but it also can depend on how early that pregnancy is, because sometimes if it's super early, then you don't see anything in the uterus or elsewhere, then it might be classified as a pregnancy of unknown location, and so then what you do with that might change kind of depending but in general it's ultrasound to try and determine that a lot of times ectopic pregnancies might
present as a typical early on, so you might have bleeding that we don't expect. You might have abdominal pain, especially like one sided abdominal pain, but not always. Sometimes you might not have symptoms. What you do about it is really important. So ectopic pregnancies are very important to be treated, and they're generally treated one of two ways. So one is with a medicine called methotrex eate, which
is also used in some places for abortions. But methotrexate is one medication that you can use, especially if it's small and it's at low risk of rupture. It requires continued medical monitoring to make sure that you've completely lost the rest of that pregnancy tissue, or it requires surgery, and surgery usually requires the loss of that filopian tube.
If that's where I plan did okay? And how often is it surgery versus it's a good question. I don't have it.
I don't have data on that, Okay, that's a solid question. I think it probably depends like location, geography, all that kind of stuff.
Gosh, we really we should do an entire episode on the history, because I really am just curious how we learned about a.
Topic pregnancy right, and how we figured it out early on and before ultrasound.
What happened? Yeah, ooh, probably wasn't good.
No, yeah, yeah, So that's ectopic pregnancies.
Okay, do you have more question? Not right now, but I'm sure I will in just a few minutes.
There's other atypical ways that a blasticis can implant that might end up in a viable pregnancy. If the blasticism implants too low in the uterus but not in the cervical canal, then it can result in what's called placenta previa.
Ah, So the.
Placenta completely covers the oss or the opening to the cervix, and that is potentially dangerous. It can cause bleeding during pregnancy. But it also if that placenta, like if the baby has to deliver through the placenta, that's that.
Doesn't right, It's not safe, it's not. Yeah.
So generally that goes to a cesareans, which we'll talk way more about later. And then of course there is miscarriage or early pregnancy loss. So I'm going to spend quite a bit of time talking about this.
Okay.
The definition of miscarriage actually is different depending on where you live and what country that you live in, Okay, because it is defined generally as the spontaneous loss of and these words are important, the spontaneous loss of a recognized pregnancy prior either to a certain gestational age or a certain weight of the fetus, depending on what country you live in and things like that. So in the US we define a miscarriage as a pregnancy loss prior
to twenty weeks gestation. In the UK it's prior to twenty four weeks. In other parts of the EU it's like twenty two weeks, And per the World Health Organization guidelines, it's the loss of a pregnancy with a fetus that weighs five hundred grams or less, which is about twenty two weeks gestational age.
Why is there such variations.
It's in part because it depends on like the definitions of like viability and things like that. I don't have a great answer as to why there's variation, but the variation exists, which does mean that there's differences in terms of like reporting what is considered a miscarriage or an early pregnancy loss, and then what is considered a still birth, which is if you have a pregnancy loss after that time point.
I see, but again that time point varies a little bit and what's the recognized part?
Yeah, great question Erin so that also the definitions kind of differ.
So there are like.
Clinically recognized pregnancies and then there are pregnancies that maybe weren't recognized clinically, and some of that depends on whether or not it was seen on ultrasound, okay, which means not only like did you have access to ultrasound, but like how early was it yea And then like you said, aarin, is that the more that we have access to these very very early pregnancy tests that can detect some of the home pregnancy test now can detect very low levels
of hCG, which means you can get it earlier and earlier and earlier, and so that.
Does change our rates of miscarriage.
But in some of the literature, if there's not a documented pregnancy with ultrasound, then it's not classified as a miscarriage, but it might be classified as a early pregnancy loss quote unquote, or a biochemical pregnancy loss is another term that gets thrown around a lot of biochemical pregnancy or sometimes they're called pre clinical pregnancy losses. Right, Okay, So it all is important, But yeah, the definitions kind of vary, and so there's a lot of different words that get
thrown around in the literature. Yeah, okay, but all that being said, overall, the rate of spontaneous loss of early embryos is very very high in humans. So a lot of those blastocysts that we were talking about never actually make it to the point of implantation, so they are lost before implantation, which means you never knew that you could have been pregnant, even though again we're defining pregnancy
as your last menstrual period, so it's very confusing. Yeah, yeah, Yeah, we don't know exactly how many of these, like pre embryos are lost prior to implantation, but it's estimated to be somewhere between twenty and forty percent, which is very high. It is high, very high, and those are estimates also, Yeah, twenty to forty is a huge it's a huge range.
Yeah.
And then after implantation, so after that start of implantation, a further thirty percent are lost. But it's thought that about half of those happens so early that most people and caveats here with early pregnancy tests, but most people would never know that they were pregnant or were almost pregnant,
could have been pregnant because they don't ever miss a period. Ah, right, So the implantation starts, but then it doesn't continue, So then you have shedding of your unine life at the time that you typically would and those are most often classifies as like biochemical or pre clinical pregnancy losses. But the more that we have early pregnancy tests, the more that people are going to know that that happened to them.
Right.
Yeah, most estimates of the overall risk of miscarriage, so the loss of that recognized pregnancy prior to twenty to twenty four weeks is about fifteen percent globally. Wow, and that's a huge number.
Yeah, it really is.
Fifteen percent is twenty three million recognized miscarriages worldwide every year.
Wow.
I know we don't talk about it at all. It's like not something that we talk about. It's not something that's polite to talk about, but something there's a few things I feel like, I have a lot of feelings about this, but one in three women are also estimated to experience a miscarriage at some point during their reproductive years.
So it's not just that it's common globally, it's also common that you might have throughout your reproductive lifespan a miscarriage at some point in time, and something being common does not make it unimportant. Yeah, right, of course, Well what happens all the time, it's really important. There was a study in a paper that I read that looked at only five hundred women, but so it's a small study,
but I think this is still really important. Data five hundred and thirty seven women with a pregnancy loss, a recognized pregnancy loss, found that after nine months, eighteen percent of them met criteria for post traumatic stress, seventeen percent for moderate or severe anxiety, and six percent for moderate
or severe depression. So, like losing a pregnancy, whether it was a planned pregnancy, an unplanned pregnancy, an early pregnancy loss, or a later pregnancy loss, like that is very hard potentially, and it's really lonely if it's something that you're not able to talk about in quote unquote polite company.
Well, and I feel like you make a really good point that like this, even though this does happen a lot and it's not talked about a lot, and it doesn't take away the pain exactly, the trauma that can result.
Yeah, Yeah, most pregnancy losses. Most miscarriages happen in the first trimester, so sometime in the first ten to twelve weeks, but one to two percent of pregnancy losses will happen in the second or third trimester, And like we said, if it's after that twenty to twenty four weeks, then we classify it as a still birth rather than a miscarriage.
And no matter how early, any pregnancy loss has the potential to be met with shame or stigma, loneliness, guilt, fear, frustration, like so many different things, and a lot of people understandably want to know what causes this, why is this happening? And we don't knowh right, except that it happens like very commonly across the board to these early embryos, especially.
Most estimates are that about fifty to eighty percent of the time miscarriages are due to chromosomal abnormalities in the fetus. All right, okay, And that is one of the big reasons that age. Female age specifically is a big contributor where younger people are much less likely to have a miscarriage compared to as we get older, the rates are like vastly different.
It's so interesting because I know that we talk about the impact of female age, but I feel like it does add it can add blame sometimes absolutely, and to not like Also, the sperm age or like age of the person who's making the sperm also plays a role.
I think I saw at least one study that looked at that, and there is actually an increased risk of miscarriage, I believe. Yeah, I wish I had written more detail on this, but but it's at an older age. Whereas with females it starts at like thirty five or so that the rates of increased chance of miscarriage go up, it starts later, like after forty or maybe it was forty five. Okay, don't quote me on that because I'd have to go back to the paper.
Yeah, yeah, but.
Yeah, so you're right, it's not like an it's not a male factor, right, it's a contributor.
But we don't talk about it well just always it's like age of the age of the edge of the mother, age of the woman, advanced age, geriatric womb. We don't call that that anymore, Okay, I don't. I'm sure people do. Yeah, I think they're probably a handful out there.
So yeah, So miscarriage is a really important topic I think you talk about.
Yeah.
The other thing important to know about miscarriage is how we manage it, because there's three main ways, like medically, that we can manage it. One is called expectant management, which basically means you don't do anything, like there's no medical intervention and you wait for that tissue to pass
on its own spontaneously. There's another option, which is a medication option, and most of the time there's a combination of medicines that are used mesa prostal and mifipristone aka abortion medicines, or with a vacuum aspiration or a d n C which is a dilation in curetage, which is the exact same surgical procedures as are used in quote
unquote elective abortions. Abortion is health abortion is healthcare. Every one of these options, expectant management, medical management, and surgical management are all associated with risks and benefits for the individual, and in fact, in the data there's no difference in like one is more risky, one is less risky. They all have risks of bleeding, they have risk of infection, and the choice to do one or the other should lie only with the person who is pregnant and their
medical doctor. However, however, because we live currently in the United States, especially with all of these abortion restrictions that are going into place, this is no longer the case. It is now very often the decision between a legal team and the hospital administration. You have on when to do something about it, on when not to do something about it, on when you have to just wait, et cetera, et cetera.
Just around a conference table, someone's making decisions about what is happening inside your body.
Yep.
I mean you're not involved in that decision. Yep, you don't have a seat at the table. Oh gosh, that's a lot. Yeah, I thought, do you have any questions about that? I have feelings about that. I do too, try to think if I have any specific questions. Yeah, okay. One question I have is, like you said that, it's the risks associated with each of these are more or less the same. So then why would why would someone opt for one versus another?
I mean, it's in part personal preference, it's in part two, like how far along you might be or if you have sort of started to pass that or not. And then a lot of it really is personal preference, because it's like, are you going to feel more comfortable doing this at home where you have maybe support around you,
or maybe you don't have any support at home. Maybe the thought of having to wait a long time because you don't know how long it will take to pass it on your own is really more traumatic, and so having something done where it's over and you know that it's done is maybe more appealing to you. So there's not like a hard line that like this has to be one way or the other.
Got it.
Yeah, So let's stop there for now and bring it all the way back to the developing embryo.
Got it? Oh? Just this another prop where we left.
It's the same prop my tennis ball, This inner cell mass. Okay, we're here. So during all of this time and before implantation and after implantation starts, what's happening with this inner cell mass? I'm going to walk you through really quickly embryonic development. And when I say really quickly, I mean this is like the most cliff Notes version.
Right.
Okay, So we are back now at about two weeks post fertilization, week four of pregnancy, Okay, and this little pre embryo at this point, this inner cell mass, it's a little disk of cells that has formed the three essential germ layers that will eventually become all of the different tissues and organs in our body. Okay, And then these little disks of tissue will form tubes tubes. One tube will become our brain and spinal cord. Yeah, the other tube will become our.
Guts, like you. That's two tubes.
And then after that, a little lump will start to form at the top of this tube of cells, and that lump will become our head. And then little bumps come up along the back and those will eventually become our vertebra. By about the sixth week of pregnancy, so there's about two weeks after a year missed period potentially this embryo it's called an embryo. Now it still does not look like a human like at all.
No, it looks to me very much like the alien in alien, I mean like embryonic development. Oh, there's some quote and I don't remember who it's by, whether it's like Dubjanski or I don't know. So one of those old evolutionary biologists that's like everything our entire evolutionary history can be traced to ontogeny and like the development of and embryo. I'm probably butchering that quote. I mean I like it. Yeah, God wish I knew who it was by well listen, it wasn't.
At this point, we look like an alien, Okay, Like the head thing is like I'm curved over. There's this big long thing that comes off the back, these bumps along the back.
Very reptilian, I'm very artil engines and our evolutionary origins.
Yeah right, And when you look at like embryo development side by side of like all the different species, we look all the same, the same, the same, the same all the way through this point. But we're not as scary as an alien because it's like two millimeters long.
I'm not as scary as an alien as oh as alien as capital a cattal am proper not alien proper noun.
But at this point too, when we look like alien is when things like the eyes what will become the eyes start to develop. So you get these two little dots that will eventually become our eye cells, the parts that will become our jaws and our ears and all of this. This is very important patterning that has to happen in exactly the right way for all of our body parts to actually develop. And at this point too, about week six is when you could first detect what
will become a heartbeat. So this little bulge that will become our heart starts to beat, and you can see that on ultrasound. It's also when we start to see arm and leg buds. The buds, yeah that was loud, start to kind of pop out just a little bit. And then eventually those limb buds will make paddles first,
and then little fingers and toe buds. And then by the end of the tenth week of pregnancy, so ten weeks after your last menstrual period, okay, eight weeks since fertilization, got it, okay, is when you start to have something that looks more like a human than all of our vertebrate cousins. And that is when we are almost to the second trimester, and then we enter the.
Fetal period, the fetal period, fetal period.
At the same time as this is also when that since this your trophoblast that has during this whole time been invading its way into the myometrium all the way through, it has finally at the same time point finished the formation of the placenta, which isn't all the way formed until week thirteen, which.
Is our pregnancy.
Wild I know, and that is the organ that you erin will pick up with next.
Week, I certainly will. I have a question though, and you might be getting into them next week. I probably won't, so give them to me. Now. What's going on in the pargnive person's body is all next week.
But I'm so glad you asked because I cannot wait to tell you about it. Oh my gosh, it's really good because it's already started.
Yes from Oh, I'm so excited about it. Oh, I can't wait. I know.
I'm also done talking about the fetus. I'm not going to mention them again pretty much.
Okay, well we will and we will do more feetus stuff in the future.
So much feelings about it, and I want to talk all about it. But we were talking about pregnancy for this.
Pregnancy, so there we are there.
We made it to the end of the first trimester.
Oh my gosh, Oh my gosh, that went by faster. And also we covered so much I know, but we didn't cover. We have so much more to cover. I have thoughts okay.
Too, but everyone is going to have more that they want to learn, so we're going to tell you where to learn it and all of our sources.
Yes, okay, So for this I actually didn't have as many sources as I do for my later episodes. I have a few more, but I'm going to shout out three in particular. One is the book Pregnancy Test by Karen Winegarden, which I referred to in my notes. Also A Woman's Right to Know by Jesse Olzinco Grin, and then by Sarah Abigail Levitt A Private Little Revolution. It's an article about the home pregnancy test. And I really liked those three together. I sort of like this big
picture view of everything that I talked about. Well, I loved your whole part, so maybe you want to read this. Thank you.
I realized very heavily on a textbook that's very old at this point. It was by Jones and Lopez and it was called Human Reproductive Biology.
So it's like a primer on it all. Is it very old? Mean the late twentieth century, as like the youth, So it's like, wait, it was the twenty first century. It was from twenty thirteen. Ok, It's like ten years.
Old, but I mean, like that's for textbook is our knowledge of this part hasn't changed. But I will also say that like it's good for data, but it has a lot of weird I don't know editorialization in parts of it, so I don't interesting Anyways, I cited it, it's what I used primarily. And then a few other papers that I think were really important, especially in learning about the placental development. If you want more detail on that,
which you'll get to you next week. But there was one from Proceedings of the Royal Society b from twenty twenty three called the Human Placenta New Perspectives on its Formation and function during early pregnancy. And then there was a whole series in The Lancet from twenty twenty one all about miscarriage, and my favorite one from that was called Miscarriage Matters the Epidimeologie, Physical, Psychological and Economic Costs of early pregnancy loss. But there was a few other
papers in that series as well. But as always, you can find all of our sources, because there are so many more on our website This podcast will Kill You dot Com under the episodes tab. You certainly can this and all of our episodes, all of our opos.
We have literally so many sources it's kind of unbelievable. Yeah, proud of us, me too. Thank you again, so so much to everyone who provided their first hand account, everyone who wrote in with their first hand account. We really we don't have the words to express how grateful we are. No, it's like so so.
Meaningful to us, and we could not do especially this series without you. So thank you, Thank you.
Thank you also to Exactly Right Studios and everyone who is here.
You're like looking at the window. It's so exciting, very exciting. You to Tom and Leanna who's not here today but will be. And I'm saying too much. Thank you, to Jessica and to Brent and to Craig and everyone else.
Yeah, all that. We're so excited about this. It's really been so much fun. I feel so cool and feel cool, but I'm having a lot of fun. Me too, Yeah, me too. So thank you all for all of your work. We're excited. Yes, thank you. Thank you to Bloodmobile, who provides the music for this episode and all of our episodes, and thank you to you listeners yeah, and viewers, to viewers. Yeah, amazing.
We hope you had fun with this one and you're prepared for three more episodes on pregnancy.
Yeah, I hope you like more where this is coming from, because we've got it. I don't know, make that sentence didn't make sense. It's fine, you know what. And thank you to our patrons. We really do appreciate your support. It means the world to us, it really does. Thank you. Well, until next time, wash your hands, filthy animals
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