Speaker 1: We want to start with a disclaimer that throughout this series,
Speaker 1: we feature explanations and stories that include some heavy material,
Speaker 1: including early pregnancy, loss, still birth, and other traumatic experiences
Speaker 1: of pregnancy, childbirth, and the postpartum period.
Speaker 2: It was the morning and my son's fourth birthday party,
Speaker 2: and I was feeling just not like myself. I was
Speaker 2: really tired, which is pretty abnormal for me, especially in
Speaker 2: the morning time, and my breasts were pretty tender, and
Speaker 2: I was feeling a little nauseous. So I started doing
Speaker 2: the math in my head, just thinking about, you know,
Speaker 2: when I could have possibly became pregnant if that is
Speaker 2: the case. And I started doing the math, and my
Speaker 2: husband's a pilots, so I know exactly when he's home
Speaker 2: and the days that we've had sex. And that's when
Speaker 2: I was like, wow, I could be pregnant right now.
Speaker 2: And it was only four weeks so I was due
Speaker 2: to get my ministress cycle that so it was very early.
Speaker 2: So I asked him to go to the store because
Speaker 2: we needed to get ice for the birthday party and
Speaker 2: pick up the cake. So I said, hey, while you're there,
Speaker 2: can you go get a pregnancy test? And he was like, okay,
Speaker 2: you know if that's what you need, then that's what
Speaker 2: you need. So remember he came home, he was putting
Speaker 2: the drinks in the cooler, and I went into the
Speaker 2: spare bathroom and I took the pregnancy test and it
Speaker 2: came up right away that I was pregnant. And in
Speaker 2: that moment, I had just this realization of wow, like
Speaker 2: I'm having another baby. And I went outside and I
Speaker 2: told my husband that I was pregnant, and we were
Speaker 2: so excited and we're like, wow, we're really doing this.
Speaker 2: And it was really neat because this whole party that
Speaker 2: we had there, we probably had about thirty people with
Speaker 2: kids and parents, and we were the only two people
Speaker 2: that knew in that moment that I was pregnant, and
Speaker 2: it felt really special. But then after the party was
Speaker 2: pretty died down, us and a couple other family friends,
Speaker 2: we're all sitting by a fire that we had in
Speaker 2: our backyard, a little campfire, and there was a baby there.
Speaker 2: And my son had a really good friend and he
Speaker 2: had just his mom had just had his baby sister,
Speaker 2: who was about two weeks old, and so I'm looking
Speaker 2: at this baby that's sitting in front of me, and
Speaker 2: I started doing the math in my head again just
Speaker 2: counting the months. You know, if I'm pregnant and this
Speaker 2: pregnancy is viable and we ended up having this baby,
Speaker 2: this baby would be born in August before school starts,
Speaker 2: and that means that this baby is going to be
Speaker 2: in the same grade as that baby that's sitting right
Speaker 2: in front of me. This baby that I just have
Speaker 2: found out i'm pregnant with is going to grow up
Speaker 2: with that little girl that's sitting in front of me.
Speaker 2: And that blew my mind that I was going to
Speaker 2: grow a whole human in.
Speaker 1: This school year.
Speaker 2: And so fast forward seven years later, and these two
Speaker 2: children are now in the same grade. Sometimes they're in
Speaker 2: the same class, and they are growing up together, and
Speaker 2: it's just something that's fun to think back on.
Speaker 1: My name is Kenny.
Speaker 3: I'm thirty four from New Zealand and five years ago
Speaker 3: I work up with pain in my right lowerbellion vomiting.
Speaker 3: I took a pregnancy test and it was positive. Well
Speaker 3: followed was the scariest two days of my life, during
Speaker 3: which they found an ectopic pregnancy on ultrasound. By the
Speaker 3: end of two days, I had pain in my right
Speaker 3: shoulder tip, but no abdominal pain as an emergency nurse,
Speaker 3: I know that shelder tip pain can be a type
Speaker 3: of referred pain indicating diaphragmatic irritation from blood in the
Speaker 3: peritoneal cavity. The obg way in on call decided that
Speaker 3: my lack of abdominal pain meant that I could go
Speaker 3: home and wait for suon. All I could think of
Speaker 3: was a case I had treated a few months prior
Speaker 3: in my emergency department. She had a ruptured ectopic pregnancy
Speaker 3: and we'd poured blood into a rushia to surgery and
Speaker 3: she nearly died. That case and my knowledge about the
Speaker 3: importance of shoulder tap pain led me to advocate for
Speaker 3: myself strongly. I put my foot down and refused to leave.
Speaker 3: An hour later, I was in surgery, and an hour
Speaker 3: after that they called my partner to say my left
Speaker 3: filopian tube was completely blocked and there was blood in
Speaker 3: my belly. If I had gone home, there is a
Speaker 3: very real chance that would have burst completely and I
Speaker 3: could have died. Being an emergency nurse and an advocate
Speaker 3: for myself saved my life. Losing a filopian tube was
Speaker 3: really hard mentally until I learned the biggest health lesson
Speaker 3: I ever have. I can't believe I'd got through so
Speaker 3: many anatomy classes without knowing this. But your filopian tubes
Speaker 3: aren't fixed, although that's how the textbox show them. They
Speaker 3: can reach out and move and grab eggs. Six months
Speaker 3: post ectopic and I got pregnant again, and all of
Speaker 3: the anxiety came back, but I was very lucky. Nine
Speaker 3: months later we welcomed our beautiful son, and another year
Speaker 3: and a half later our second son. My other two
Speaker 3: pregnancies and births had their own challenges, but I'll never
Speaker 3: forget my first, wondering what could have been for that pregnancy,
Speaker 3: what could have happened if I wasn't my best advocate,
Speaker 3: And I think about my experience every time I go
Speaker 3: to work and my own emergency department and treat potentially topics.
Speaker 3: It made me a better nurse, a better patient advocate,
Speaker 3: and I'm so grateful for my two boys who managed
Speaker 3: to find their way to my uterus instead of my
Speaker 3: one remaining tube.
Speaker 1: Thank you also so very much for sharing your story
Speaker 1: with us, and a huge thank you to everyone who
Speaker 1: has written in with their experiences like we read each
Speaker 1: and every single one of them, and the hundreds of submissions,
Speaker 1: many and We're so grateful and honored that you felt
Speaker 1: like you could share those experiences with us, and we
Speaker 1: tried to include as many of your stories as possible,
Speaker 1: and you'll hear more of these first ten accounts throughout
Speaker 1: this episode and the rest of our episodes.
Speaker 4: Yeah, it was honestly such a privilege to be able
Speaker 4: to read every one of your stories and hear so
Speaker 4: many of your stories, and as many as we included,
Speaker 4: there were so many more that we were not able
Speaker 4: to So we thank you again from the bottom of
Speaker 4: our hearts for sharing your stories with us.
Speaker 1: Yeah, thank you, thank you. Hi. I'm Erin Welsh and
Speaker 1: I'm erin Alman Updight and this is this podcast will kill.
Speaker 4: You, and we're coming to you today with the first
Speaker 4: of four episodes all about pregnancy.
Speaker 1: Four just four, just four should have been more, I know, really.
Speaker 4: And we're also coming to you from the exactly right
Speaker 4: studios for the first time, which is nerve wracking and exciting,
Speaker 4: I know.
Speaker 1: But this space is so cool. We get to decorate
Speaker 1: our little bookshelves. I feel very fancy right now, very fancy,
Speaker 1: too fancy for our real lives. I mean, for sure,
Speaker 1: very very different than my tiny little office I know.
Speaker 4: Or my closet literally, So we're super excited to be here,
Speaker 4: yes we are.
Speaker 1: We're really really excited about this series, yes for sure.
Speaker 1: And before we get into this episode, we want to
Speaker 1: share a few words about what these four episodes will cover,
Speaker 1: the language that we'll be using, and our goals really
Speaker 1: with creating the series. And so we decided early on
Speaker 1: to dedicate four episodes to cover pregnancy, just four sure,
Speaker 1: one for each trimester. And at the outset, I mean,
Speaker 1: we knew that we wouldn't be able to adequately cover
Speaker 1: every single aspect of pregnancy and childbirth and the postpartum
Speaker 1: period in just four episodes, right and throughout our research,
Speaker 1: we did begin jotting down a list of future topics
Speaker 1: to cover things like pre acclampsia and breastfeeding and Reese's factor,
Speaker 1: and so there will be more episodes on these and
Speaker 1: more topics in the future.
Speaker 4: Exactly So, this series might not, and it likely will
Speaker 4: not answer all of your questions about pregnancy or cover
Speaker 4: every experience that a person might have. Pregnancy is a
Speaker 4: very individual experience, as highlighted in so many of our
Speaker 4: first hand accounts. But what we aim to do with
Speaker 4: the series is take you through the really broad changes
Speaker 4: that happen in our human bodies during pregnancy and childbirth
Speaker 4: and postpartum, and also explore some of the historical and
Speaker 4: evolutionary aspects.
Speaker 1: Really excited about that.
Speaker 4: Aaron of pregnancy and childbirth. So each episode very roughly
Speaker 4: corresponds to each trimester. So in this episode, the first one,
Speaker 4: we're going to be talking about how you even know
Speaker 4: whether or not you're pregnant?
Speaker 1: Yeah, how do you do? How do you know?
Speaker 4: And what's happening in very very early embryonic development.
Speaker 1: And then our second episode centers on the amazing organ
Speaker 1: that is the placenta. It's really cool. I think we'll
Speaker 1: all leave with a little more appreciation for the placenta,
Speaker 1: I hope, So that's my goal, and some of the
Speaker 1: physiological changes that a person experiences throughout pregnancy, including some
Speaker 1: of the complications that can arise, right.
Speaker 4: And then our third episode is going to focus on
Speaker 4: childbirth itself, so labor and different modes of delivery, and
Speaker 4: then the history of the cesarean section.
Speaker 5: Yeah yeah, yeah yeah.
Speaker 1: And then finally our fourth episode and our season finale,
Speaker 1: our season seven season finale. That's crazy, I know, it's exciting,
Speaker 1: It is really exciting. Yeah, But the last episode in
Speaker 1: the series will be about this concept of the fourth trimester,
Speaker 1: like maybe you've heard of it, maybe you haven't, What
Speaker 1: is it. We'll get into all of that and explore
Speaker 1: the changes that happen in your body after pregnancy, and
Speaker 1: we'll also be talking like big picture history about the
Speaker 1: medicalization of pregnancy and childbirth, including the transition from home
Speaker 1: to hospital.
Speaker 4: Yeah, we intend for all of these episodes to be
Speaker 4: inclusive of all families, and we recognize that not everyone
Speaker 4: who experiences pregnancy actually identifies as a woman, so we
Speaker 4: try as much as we can wherever we can to
Speaker 4: use gender neutral language like pregnant person, and that's what
Speaker 4: you'll mostly hear through this episode. However, at the same time,
Speaker 4: we know that much of what we discuss when it
Speaker 4: comes to medical bias during pregnancy and childbirth, both historically
Speaker 4: and today, is in fact the result of gender discrimination
Speaker 4: as well as racism, and so in those context we
Speaker 4: may also use the term woman or women, and throughout
Speaker 4: these episodes we'll be using the term mother or maternal
Speaker 4: and paternal as these are terms that are used in
Speaker 4: the scientific and medical literature.
Speaker 1: Yeah, and we also want to acknowledge that there is
Speaker 1: no such thing as a normal pregnancy. Yeah, like they're
Speaker 1: just there isn't one. But we do want to provide
Speaker 1: a baseline of the expected physiological and anatomical changes that
Speaker 1: occur during pregnancy, as it helps us to understand where
Speaker 1: these complications arise from and what is a complication?
Speaker 4: Right right, Yeah, So we will get into all of
Speaker 4: that starting with the first trimester.
Speaker 1: But first, but first, it's quarantiny time. It is Aaron,
Speaker 1: what are we drinking this? And the next four weeks
Speaker 1: we are drinking great Expectations. I love I love this name.
Speaker 1: It's a really good name. It's a good name act
Speaker 1: we think, and we're also making that this is a
Speaker 1: plasyber read for reasons that probably are clear too. I
Speaker 1: would thank you for listening, Like it's not an alcoholic,
Speaker 1: it's not aholic. That means yep, it is And Aaron,
Speaker 1: what is what is in cred.
Speaker 4: Expectations really delicious combination of BlackBerry, gindreal, lemon and mint.
Speaker 4: And if you check out the exactly Rights YouTube channel,
Speaker 4: you will find a video of us making that drink,
Speaker 4: as well as a super secret surprise quarantine coming to us.
Speaker 1: From no one other than Georgia Hartstark herself. That was
Speaker 1: the secret. Oh sorry, perfect, Go check it out. It's
Speaker 1: gonna be great. It's gonna be great. Gosh, I'm so excited,
Speaker 1: beyond trilling, I know it really is very excited about it,
Speaker 1: and so yeah. To get the recipes for our quarantini
Speaker 1: and plasy berita for this episode and all of our episodes,
Speaker 1: actually check out our make sure you're following us on
Speaker 1: social media, and you can also find those on our website,
Speaker 1: the podcast will kill You dot com. You can over
Speaker 1: to you erin to tell me it's on the website.
Speaker 1: I don't have to do. Let me tell you what's
Speaker 1: on our website. We have so much information there, Aaron.
Speaker 4: We have merch we have oh translusted already, we have transfers,
Speaker 4: We've got good Reads list, we've got a link to Bloodmobile.
Speaker 4: We've got all of the sources from all of our episodes.
Speaker 1: Contact us, contact us form a first hand account form.
Speaker 1: We've got a lot, You've got a lot. There's so much,
Speaker 1: but there's so much. One last piece of business, yes,
Speaker 1: one last piece of business is okay, So I am
Speaker 1: super excited to announce that I have started a new
Speaker 1: hosting role at another podcast. We're really excited for her.
Speaker 1: She's not leaving. I'm not leaving. No. So this this
Speaker 1: podcast is called Advances and Care and in it, I
Speaker 1: interview physicians and physicians scientists at New York Presbyterian Hospital
Speaker 1: about their incredible cutting edge research and groundbreaking medical innovations.
Speaker 1: It's really it's really thrilling, very exciting stuff. I mean,
Speaker 1: it actually is, and it's like really fun to actually
Speaker 1: get to read about, like, oh, this is someone who's
Speaker 1: working on this right right now.
Speaker 4: In real life, in real time, these things that is
Speaker 4: actually making a difference in people's lives.
Speaker 1: Yeah, it's reahly cool. It's been such a fun project
Speaker 1: to work on. And if you want to learn more
Speaker 1: about the research that's truly shaping the future of medicine,
Speaker 1: this podcast is for you. Again, it's called Advances and
Speaker 1: Care and you can get it wherever you get your podcasts. Yeah,
Speaker 1: check it out. Yeah, check it out. I don't have
Speaker 1: any business. I think that's it. Yeah, shall we? I
Speaker 1: think we shall.
Speaker 4: Okay, we'll take a break and then get into the
Speaker 4: history of pregnancy.
Speaker 1: Sure, something like that.
Speaker 6: Entered my second trimester of my pregnancy. I started having
Speaker 6: really intense pain in my abdomen and in my legs
Speaker 6: and in my hips, and it kind of rendered me
Speaker 6: almost completely unable to take part in any kind of
Speaker 6: physical activity or exercise, and even walking became increasingly uncomfortable.
Speaker 6: And I really started to notice as I got bigger
Speaker 6: that my baby was really crowded to one side of
Speaker 6: my belly, and I seemed to be protruding far further
Speaker 6: forward than any other woman that I saw that it
Speaker 6: was at the same stage as me. And when I
Speaker 6: brought those concerns to my ob it was kind of
Speaker 6: laughed off. Isn't that so funny when a baby prefers
Speaker 6: one side over the other and no further exams or
Speaker 6: tests were ordered to kind of check out what was
Speaker 6: going on. So I managed through the rest of that
Speaker 6: increasingly uncomfortable pregnancy, and then I went into labor three
Speaker 6: weeks prior to my due date. It was very fast,
Speaker 6: very intense labor. I started having contractions at about nine PM.
Speaker 6: I was at the hospital at one thirty in the morning.
Speaker 6: And then and in my first cervical exams, the doctors
Speaker 6: found that I was only two or three centimeters dilated,
Speaker 6: and they really treated me as such, kind of put
Speaker 6: me on the last of the lists for an epidural
Speaker 6: request because I was a woman who was clearly not
Speaker 6: close to being ready to push, and so I was
Speaker 6: in this very extremely painful and uncomfortable state for an
Speaker 6: hour and a half while I waited for an epidural.
Speaker 6: Once they got that epidural in, they were able to
Speaker 6: perform a more thorough exam as I was more relaxed,
Speaker 6: and they found that I had a blockage in front
Speaker 6: of my cervix, and behind that blockage, I was fully effaced,
Speaker 6: fully dilated, and actively pushing to get this baby out.
Speaker 6: So I was rushed in for an emergency C section,
Speaker 6: and my daughter came out just find distressed but fine,
Speaker 6: And they held up my uterus and found that I
Speaker 6: had what's called a bicorneate uterus, which is when the
Speaker 6: memo brain that is formed when your uterus is being
Speaker 6: formed doesn't disintegrate and basically leads to you having two
Speaker 6: halves of a uterus. And so I was growing a
Speaker 6: baby in a half of a uterus and then trying
Speaker 6: to give birth in a through a cervix that was
Speaker 6: blocked by another cervix, and so while I've healed from
Speaker 6: that experience, I'm also left wondering why wasn't that found
Speaker 6: and discovered not only during pregnancy, but also prior to pregnancy,
Speaker 6: and what kind of implications does it mean for a
Speaker 6: future pregnancy. Thank you so much for allowing me to
Speaker 6: tell my story.
Speaker 2: Hi.
Speaker 7: My name is Stevie, my pronouns are they them, and
Speaker 7: I live in Ontario, Canada. In twenty twelve, my husband
Speaker 7: and I were extremely excited to be expecting our first child.
Speaker 7: At ten weeks, we had started seeing an ob. I'd
Speaker 7: been spotting off and on, but he kept saying that
Speaker 7: everything was fine, and what bleeding isn't normal? It is common,
Speaker 7: and don't worry. He said the same thing at every appointment.
Speaker 7: It's not normal, but it's common. Don't worry, Everything's fine.
Speaker 7: At eighteen weeks he sent me to a specialist. I
Speaker 7: wasn't expecting it to be a big deal. After all,
Speaker 7: everything was fine, right.
Speaker 1: I was wrong.
Speaker 7: I was blown away by the list of issues and
Speaker 7: complications being laid in front of me. The only thing
Speaker 7: I really remember is that I was at a high
Speaker 7: risk for pre term labor. About a week later, at work,
Speaker 7: I set up to get something and felt a gush.
Speaker 7: I reached down and my fingers came up red. I
Speaker 7: was hemorrhaging. Had a friend drive me to the er.
Speaker 7: My husband met me there and we waited. I was
Speaker 7: told that if I was miscarrying, I'd have to stay
Speaker 7: down in the er. I was too early to go
Speaker 7: up to labor and delivery. The ultrasound showed a good heartbeat, though,
Speaker 7: and bleeding slowed down, so I was sent home on
Speaker 7: bed rest. Around one am on November eleventh, I woke
Speaker 7: up and vomited. I had an intense cramping in my stomach,
Speaker 7: in my back. I told my husband something was wrong.
Speaker 7: We went back to the er. The ob said I
Speaker 7: was in labor and it can be triggered by dehydration.
Speaker 7: So I was given an IV and it stopped. I
Speaker 7: was moved to a room and told I was staying
Speaker 7: there until I delivered, whenever that was. But at under
Speaker 7: twenty four weeks, there was really no hope for the baby.
Speaker 7: On November fourteenth, at twenty one weeks and four days,
Speaker 7: I went into labor. This time it didn't stop. Our
Speaker 7: daughter was delivered at one twenty six in the afternoon.
Speaker 7: She weighed exactly one pound. Our families were there and
Speaker 7: we sang her Happy birthday. She lived for three hours.
Speaker 7: During that short time, she knew nothing but love. We
Speaker 7: all held her and sang to her. She took her
Speaker 7: last breath with me. That night, my husband and I
Speaker 7: went to sleep in the postpartu ward to the sound
Speaker 7: of other people's babies crying. The specialist never found a
Speaker 7: reason for our loss. She said it was probably a
Speaker 7: placental abruption, but she really wasn't sure. We went on
Speaker 7: to have two more pregnancies, and we have another daughter
Speaker 7: and a son. We have pictures of our firstborn, and
Speaker 7: she's very much part of our lives. Our other kids
Speaker 7: say they see her when they see the first stars
Speaker 7: come out at night. As I always say, she's our
Speaker 7: perfect girl, made of stars. I share our stories often
Speaker 7: as I can. Pregnancy and infant loss affects one in
Speaker 7: four pregnancies and is not discussed enough. I felt so
Speaker 7: alone after our loss. Every year on her birthday, I
Speaker 7: share our story and new people will share their own
Speaker 7: stories with me. I hope that sharing my story here
Speaker 7: will help people to feel less alone. Our loss should
Speaker 7: not be hidden. We shouldn't have to grieve in silence.
Speaker 1: If you search for a list of the top medical
Speaker 1: advancements in history, you might find on that list things
Speaker 1: like antibiotics, vaccines, gene editing, medical imaging, kidney dialysis, organ transplantation,
Speaker 1: the manufacture of insulin, and anesthesia for a start. It's
Speaker 1: a long list, a long list. I couldn't stop once
Speaker 1: I started. Yeah, but I would be shocked if you
Speaker 1: found home pregnancy tests on one of those lists. No,
Speaker 1: I don't think I wouldn't. You wouldn't have expected it. Yeah,
Speaker 1: And I know this because I've often skimmed these kinds
Speaker 1: of lists looking for inspiration for future episode topics. A
Speaker 1: lot of those are on our list, I'm really true. Yeah,
Speaker 1: kidney dialysis, we need to do that, I know, and
Speaker 1: so many I know. But I've never seen home pregnancy
Speaker 1: tests mentioned. I don't think so, And to a degree,
Speaker 1: I get it right, Like, these tests didn't provide new
Speaker 1: avenues for treatment, nor did they represent a paradigm shift
Speaker 1: in how we understood the workings of the human body.
Speaker 1: But I would argue that these sticks and the plastic
Speaker 1: rectangular boxes that preceded them absolutely deserve a place on
Speaker 1: any list of significant medical breakthroughs.
Speaker 4: I'm already just so invested in this Errand I mean.
Speaker 1: Are you convinced yes, so I can stop? Yeah? Done, Okay, done,
Speaker 1: They're on the list. But the reason I feel so
Speaker 1: strongly about this is because of the type of knowledge
Speaker 1: that they grant us. Not guiding principles, not laws of nature.
Speaker 1: Home pregnancy tests give us deeply personal knowledge about our
Speaker 1: own bodies, empowering us to do with that knowledge what
Speaker 1: we decide we want or need to do, share it,
Speaker 1: keep it to yourself. For the first time, that choice
Speaker 1: was up to the test taker. They were the first
Speaker 1: to know, not the lab technician running the test, not
Speaker 1: the frog being tested. More on that way, Not the
Speaker 1: doctor who deigned to prescribe a test, oh yeah, prescription
Speaker 1: only okay, yeah. The transfer of this knowledge out of
Speaker 1: the hands of the medical provider and into the hands
Speaker 1: of the test taker held profound implications for women's reproductive rights.
Speaker 1: Of course, probably no one needs to be reminded that
Speaker 1: what you decide to do in terms of continuing with
Speaker 1: the pregnancy or not is not always up to the
Speaker 1: pregnant person alone. Yep, especially not in the United States. Nope.
Speaker 1: But the story that I want to tell today is
Speaker 1: about the quest for this knowledge, like what ultimately led
Speaker 1: us to the near universally recognizable stick that shows one
Speaker 1: or two blue lines, and where we might go from here.
Speaker 1: I'm sorry, Okay, For thousands of years, people have searched
Speaker 1: for a way of knowing whether someone was pregnant or
Speaker 1: not outside of like the bodily signs like morning sickness,
Speaker 1: missed periods, tender breasts, and quickening the fetus' first movement,
Speaker 1: which was considered like really one of the most significant
Speaker 1: signs in terms of like that is when a pregnancy
Speaker 1: became real just quickening. Yeah, And I won't speculate on
Speaker 1: why there was a need or a want to know,
Speaker 1: whether it came from within someone wanting help understanding what
Speaker 1: their body was trying to tell them, or whether it
Speaker 1: came from without, like someone wanting to know whether their partner,
Speaker 1: of their friend, their daughter was telling the truth. And
Speaker 1: I'm sure there were many reasons for a test right right,
Speaker 1: that you would want to test. The first pregnancy test
Speaker 1: comes to us all the way from an ancient Egyptian papyrus.
Speaker 1: Stop it, I know.
Speaker 4: How can you pull ancient egypt out when we're talking
Speaker 4: about pregnancy.
Speaker 1: T you know, I thought, okay, what, like, what of
Speaker 1: my usual go tos are ancient Egypt Apocrates germ theory
Speaker 1: like things. I feel like I have to mention the humors.
Speaker 1: I think the humors is the only one. I don't
Speaker 1: mention any of these shoggings I know, But yeah, ancient
Speaker 1: Egypt pregnancy tests. Stop it. Thirteen fifty BCE there was
Speaker 1: a like a papyrus or something that instructed women to
Speaker 1: pee in two bags. One bag contained wheat, one bag
Speaker 1: contained barley. Okay, if the wheat grew, it meant a
Speaker 1: female child. If the barley grew, it meant a male child.
Speaker 1: Why does this feel vaguely familiar? I think we might
Speaker 1: have talked about it in our IVF episode part one. Okay, yeah, okay,
Speaker 1: yeah weird, But I don't remember if I like dug
Speaker 1: any deeper because I did this time. And it turns
Speaker 1: out that some researchers tested this like a two decades ago,
Speaker 1: and yeah, it's like not it's like not great, but
Speaker 1: it's not entirely incorrect, Like is it more than fifty percent? Yeah?
Speaker 1: Seventy percent? Really, I know, there's no association with like
Speaker 1: the sex of the fetus, just like whether or not
Speaker 1: you are pregnant. Yeah, so it's like growth hormones in urine, yeah,
Speaker 1: P in your p.
Speaker 4: It's interesting that even the first test was p.
Speaker 1: P has always been a main feature. Really, I think
Speaker 1: it's really it's it's fascinating. Yeah, And I don't know
Speaker 1: like where that like how people made that connection. And
Speaker 1: so in for instance, like in medieval England, there was
Speaker 1: a profession called a piss profit. This profit can you
Speaker 1: imagine being like on your business cardfit official assistant, piss
Speaker 1: profit assistance too that this profit yeah, Prentice far Up,
Speaker 1: I can't. Oh my god, that's great. Yeah, okay, And
Speaker 1: what did a piss profit do? I mean it basically
Speaker 1: what it sounds, okay, right, like you be able to
Speaker 1: hold up the like the urine and the glass and
Speaker 1: be like, oh, this person has this disease. That it
Speaker 1: was more than just pregnancy. It was like lots of things, okay,
Speaker 1: I mean horoscope even probably a lot of things you
Speaker 1: can see in your peace. So I gets exactly. So
Speaker 1: there is some basis to them. So some piss profits
Speaker 1: claimed that I know I keep saying, claimed that deposits
Speaker 1: of white, flaky material in urine that had been left
Speaker 1: standing for a couple of days could indicate pregnancy, so
Speaker 1: the deposit may have been casin. Okay is how you
Speaker 1: say it. I mean casin is a thing. Casine like
Speaker 1: a protein, yeah think, which is as part of breast
Speaker 1: milk produced during pregnancy. Ah yeah, okay. Yeah. Urine did
Speaker 1: briefly fall out of favor in the eighteenth and nineteenth
Speaker 1: centuries for pregnancy testing, and instead physicians performed physical exams
Speaker 1: to determine whether or not someone was pregnant. Although I
Speaker 1: know that doesn't sound great. It doesn't sound great, and
Speaker 1: the doctors were like, as is typical, would be so
Speaker 1: afraid of modesty and so it would just be like
Speaker 1: kind of just closing their eyes and like searching, and
Speaker 1: it's yeah, it's not great to think about, okay. But
Speaker 1: these signs often included things like changes in the color
Speaker 1: of the cervix, vagina labia, softening of the cervix, changes
Speaker 1: in breasts or nipples, changes in the abdomen, things that
Speaker 1: typically happened after at least two missed periods. Okay, but
Speaker 1: these were by no means telltale signs of pregnancy, and
Speaker 1: doctors usually advised to just give it time, give it time,
Speaker 1: wait for the quickening, then you'll know. And in fact,
Speaker 1: until the twentieth century rolled around, because there was no single,
Speaker 1: one hundred percent reliable way of determining pregnancy from an
Speaker 1: outside perspective, which is mind blowing to think about. Yeah,
Speaker 1: doctors usually took their patients for it. Huh yeah, okay,
Speaker 1: because they believed them. I believed that. Wow. Then once
Speaker 1: the lab based pregnancy test came about, that word slowly
Speaker 1: held less and less weight in the eyes of medicine.
Speaker 1: And these tests, these lab based tests also made it
Speaker 1: easier to prosecute someone for abortion because you had proof
Speaker 1: of early pregnancy, even if you couldn't distinguish between abortion
Speaker 1: and pregnancy loss. Oh wow, that's interesting and horrible and horrible. Okay,
Speaker 1: so how did these tests come about? Science has never
Speaker 1: followed a straight line of progress, and lad pregnancy tests
Speaker 1: are no exception. But to keep things streamlined for today,
Speaker 1: I'm sticking to the major steps along the journey. And
Speaker 1: if you want that extra nuanced, check out the books
Speaker 1: A Woman's Right to Know by Jesse Olzinco Grinn and
Speaker 1: A Pregnancy Test by Karen Wengarten. In the first couple
Speaker 1: of decades of the twentieth century, the field of endochronology,
Speaker 1: which is a study of hormones, took off in full force.
Speaker 1: Researchers investigated how adrenaline worked, what insulin did, which hormones
Speaker 1: fluctuated during pregnancy, and other endochronology related questions. There were
Speaker 1: a million of them. Finding the answers to some of
Speaker 1: these questions like which hormone is excreted in urine and
Speaker 1: people who are pregnant before they even realize they are pregnant,
Speaker 1: led them to even more questions like what would happen
Speaker 1: if we injected some of this urine into immature female mice.
Speaker 1: That's a normal question. It's a normal question, And that
Speaker 1: pretty much sums up how the first lab pregnancy test
Speaker 1: came to be Oh really really In nineteen twenty seven,
Speaker 1: two researchers Asheim and Zondek, who gave their names to
Speaker 1: this test, developed a protocol where they would take urine
Speaker 1: from a possibly pregnant person injected into five immature female
Speaker 1: mice twice a day for three days. Whoa kill the
Speaker 1: mice and then take a peek at their ovaries? Sorry, okay, yeah?
Speaker 1: Is this okay? Have so many questions.
Speaker 4: I know, is it like, are they having to pee
Speaker 4: multiple days for this twice a day, three times a
Speaker 4: day or like once a sam question? Okay, too detailed.
Speaker 1: My guess is it was just one sample, okay. And
Speaker 1: then there so this is taking many days. It's taking
Speaker 1: many days. Yeah, and like five five mices, Simon and
Speaker 1: I said, yeah, yeah, it's a process. Yeah. And then
Speaker 1: once they once they cut the mice open to look
Speaker 1: at their ovaries, if those ovaries were enlarged and congested,
Speaker 1: it meant that the.
Speaker 4: Pro was pregnant then, I mean makes sense physiologically, but okay,
Speaker 4: very interesting.
Speaker 1: Yeah, yeah. So, and what these animals were responding to
Speaker 1: was a hormone in the urine called hCG hCG human
Speaker 1: choonic ganada tropin that was vening really yeah. Initially researchers
Speaker 1: thought it was produced in the pituitary gland, but physician
Speaker 1: scientists Georgiana Seagar Jones correctly identified its origin as the
Speaker 1: uterus and gave it its name in nineteen forty five.
Speaker 4: Wow, Okay, nineteen forty five is when hCG was named
Speaker 4: HG Yeah, and found to be from the uterus, and
Speaker 4: eventually rabbits replaced mice because you could get a result
Speaker 4: faster and you didn't have to use as many animals.
Speaker 1: Gosh, the phrase the rabbit died. Have you ever heard
Speaker 1: of this? No, it's used. I feel like I've been
Speaker 1: rewatching mad men and there's another part of mad I've
Speaker 1: thinking a lot about mad men and pregnancy. But that
Speaker 1: is a euphemism that was commonly used to be like,
Speaker 1: did that mean that you were pregnant or weren't that
Speaker 1: you were pregnant? But it doesn't really make sense because
Speaker 1: they killed all around it. Yeah, okay, yeah, weird, I know, Okay,
Speaker 1: but I do find it it's interesting that there was
Speaker 1: a euphemism because pregnancy wasn't really something that was discussed
Speaker 1: out loud very much in like until the middle of
Speaker 1: the twentieth century at the earliest. Really, yeah, it was
Speaker 1: kind of just not like taboo, but it was in
Speaker 1: hush terms euphemisms. Yeah, exactly. But these tests, the Asheims
Speaker 1: on Deck test and the Freedman test, which is what
Speaker 1: the rabbit one was called, delivered pretty accurate results, but
Speaker 1: they did come with limitations. So, for one, the urine
Speaker 1: was often about seven percent of the time toxic. Oh
Speaker 1: so then it would kill the it would kill Yeah.
Speaker 1: Maybe that's where it comes from and it had to
Speaker 1: be treated otherwise it would kill the rabbit just outright. Yeah.
Speaker 1: And the second was that the animals were expensive to keep.
Speaker 1: Animal welfare didn't seem like a pressing concern at the time,
Speaker 1: but cost was. Unfortunately, a cheaper animal was available, the
Speaker 1: African claud frog. Oh, they're so cute. They're very cute,
Speaker 1: aren't they also known as the African claud toad. Is
Speaker 1: it a frog or toad? I don't know. I'm pretty
Speaker 1: sure it's a frog. Yeah, it's a scientific name Zinopus
Speaker 1: leave us. Okay, but I don't know. But it only
Speaker 1: happens to ovulate in the presence of a male frog
Speaker 1: or or in the presence of a HGG.
Speaker 4: So then with these, did you just have to like
Speaker 4: squirt it on top because they just diffuse through their
Speaker 4: skin essentially?
Speaker 1: Okay, Yeah, So in nineteen thirty three, researchers Shapiro and
Speaker 1: Swarnstein discovered that yeah, if you just sort of sprinkle urine,
Speaker 1: well I don't.
Speaker 5: Know if it was actually sprinkling, like if you exposed,
Speaker 5: we'll say that, Yeah, you're in from a pregnant person
Speaker 5: to these frogs, and you could induce ovulation in the
Speaker 5: frog eight to twelve hours later.
Speaker 4: And then so that's much quicker, much quicker. And do
Speaker 4: you have to kill the frog or no? Nope, can
Speaker 4: you we use that frog?
Speaker 1: I think you can. I think you just would not
Speaker 1: like like have to give it like a wash up
Speaker 1: period exactly. Okay, yeah, okay. And so soon labs around
Speaker 1: the world began importing these frogs for pregnancy testing. Wow,
Speaker 1: and guess what may have hitched a ride Kittrid Kittrid
Speaker 1: stop it? Yeah this, How did we not talk about
Speaker 1: this in our kitchriend that we may have aaron that
Speaker 1: was like seven years ago? Wait? Uh yeah, So and
Speaker 1: if for those of you who haven't heard of kittrid
Speaker 1: or haven't listened to our Kittrid episode, Kittrid is a
Speaker 1: type of fungus that is absolutely deadly, like devastating in
Speaker 1: some species of ad populations of frogs, like extinction in
Speaker 1: the wild the thing. Yeah, but researcher. Some researchers think
Speaker 1: that the widespread distribution of these African Claude frogs for
Speaker 1: pregnancy testing may have led to the global spread of Kittrid.
Speaker 4: I kind of hope that we actually did cover this
Speaker 4: and I have completely forgotten.
Speaker 1: No, it's I feel I feel like we did. We might.
Speaker 1: I don't know those it sounded vaguely familiar. But or
Speaker 1: is it like one of those where it's a memory
Speaker 1: and then it becomes or it's a new thing, it
Speaker 1: becomes a memory.
Speaker 4: Yeah, on manufactured memory exactly. Wow, Okay, that's really interesting. Yeah,
Speaker 4: they're dated to back it up, or it's just like
Speaker 4: a guess.
Speaker 1: Oh funny you should ask. One of the earliest identified
Speaker 1: specimens of captured infection is from one of these frogs
Speaker 1: in nineteen thirty eight. Wow, nineteen thirty eight. Yeah, okay, okay,
Speaker 1: that wild? Yeah was wild. But so anyway, the frogs
Speaker 1: were an improvement from like the rabbits and the mice.
Speaker 1: But do you know what would be even better if
Speaker 1: you didn't need to kill an animal or exact yeah,
Speaker 1: or or keep the animal is so expensive? Yeah. But
Speaker 1: the first of these dreamed of tests was developed in
Speaker 1: the late nineteen fifties, and it was an immuno assay
Speaker 1: that detected hCG. With these tests, especially as specificity increased
Speaker 1: and false positive decrease with later improvements, researchers could decrease
Speaker 1: turnaround time as well as cost, and that ultimately resulted
Speaker 1: in more people utilizing these tests, but probably not as
Speaker 1: many as you think. Getting a pregnancy test was by
Speaker 1: no means a typical part of any pregnancy throughout the
Speaker 1: nineteen fifties and the nineteen sixties, and in fact most
Speaker 1: people didn't get tested.
Speaker 5: Why.
Speaker 1: First of all, access, If you wanted a pregnancy test,
Speaker 1: you had to make a doctor's appointment and get a
Speaker 1: prescription for a test, at least in the US.
Speaker 4: Even after they moved away from these animal assays, like
Speaker 4: just to the IMO assay ones.
Speaker 1: Yeah, everything was prescription, yeah okay, And then you had
Speaker 1: to wait weeks to hear the results from the doctor
Speaker 1: and you're like, oh, I already have missed like three
Speaker 1: periods by now, so I know, yeah, okay, I think,
Speaker 1: I think, I know. Yeah. These things cost time and money, right,
Speaker 1: And Second of all, stigma. Some doctors refused to test
Speaker 1: certain people to prevent them from getting an abortion, and
Speaker 1: so they would withhold that information until it was too late.
Speaker 1: They would say, well, if you want a test, I'm
Speaker 1: worried about what you're going to do with those results.
Speaker 4: Oh, my god, I hate that so much, and I
Speaker 4: wish that it surprised me more.
Speaker 1: I know, I know, or they would tell husband first
Speaker 1: so that he could make a decision. I didn't know
Speaker 1: I was going to get livid this early in the series. Sorry,
Speaker 1: it's just get ready, strap in strapped. There was stigma
Speaker 1: attached to wanting to find out if you were pregnant
Speaker 1: before you started showing these quote unquote natural signs, interesting
Speaker 1: because it suggested you had anxiety about the pregnancy or
Speaker 1: about the father. If you were married, forget about it.
Speaker 1: Your reputation would never recover what often yeah.
Speaker 4: Just for like wanting to know this information. Then people
Speaker 4: assumed that you were up to something often yeah wow.
Speaker 1: The nineteen sixty six Better Homes and Gardens Baby book
Speaker 1: said that pregnancy tests quote there is no need for one.
Speaker 1: Yeah wow. And it's hard not to see this is
Speaker 1: just another way to control women and the choices, right.
Speaker 1: This is this is knowledge that should not that does
Speaker 1: not belong to It doesn't belong to you. Yeah no.
Speaker 1: And the introduction of the home pregnancy test in the
Speaker 1: nineteen seventies it didn't immediately erase stigma, but it did
Speaker 1: make testing an option or at least more of an
Speaker 1: option for the people who where previously it wasn't who
Speaker 1: saw this need and did something about it, someone who
Speaker 1: could make money off it. Actually no, oh, okay, I
Speaker 1: know pleasantly sy There was a woman by the name
Speaker 1: of Margaret or Meg Crane. Okay, So, one day in
Speaker 1: nineteen sixty seven, the twenty six year old Crane was
Speaker 1: walking through the offices of organ On which sounds made up,
Speaker 1: a pharmaceutical company where she worked as a freelance graphic designer,
Speaker 1: and something caught her eye. One of the rooms as
Speaker 1: she walked past, was filled with a bunch of test
Speaker 1: tubes hanging in some sort of bizarre contraption, and she
Speaker 1: asked her colleague, like, well, what's going on in there?
Speaker 1: It turns out they were pregnancy tests. Crane listened as
Speaker 1: her colleague explained how they work, and she thought to herself,
Speaker 1: this sounds pretty simple, Like why can't we do this
Speaker 1: ourselves at home? And this thought followed Crane around and
Speaker 1: she found herself in her spare time des a home
Speaker 1: pregnancy test prototype. As a graphic designer. She's like, I
Speaker 1: can do this.
Speaker 8: I was like, love, but this is not that hard.
Speaker 8: We should be able to do it, like it's hard,
Speaker 8: that's perfect, thank you. But yeah, she didn't do it
Speaker 8: because her boss asked her to do it. She just
Speaker 8: knew how revolutionary it could be.
Speaker 1: She saw the potential and what a change it would make,
Speaker 1: and in fact, when she showed her boss her design,
Speaker 1: he scoffed. But when a male employee later suggested a
Speaker 1: home pregnancy test, the option seemed more appealing. So a
Speaker 1: few weeks later, Crane walked into work to find a
Speaker 1: big meeting taking place, and she was like, what's going
Speaker 1: on in there? Turns out it was a meeting to
Speaker 1: discuss different home pregnancy test designs, so she crashed the
Speaker 1: meeting put her design on the table with all the others,
Speaker 1: which all of which were designed by men. One had
Speaker 1: rhinestone edging, one had a cute little tassel, all were
Speaker 1: pink except Cranes, but Cranes was the only one to
Speaker 1: include a urine collection cup. Oh my god, are you serious.
Speaker 4: Yeah, we've got the rhinestones, but not the collection cup.
Speaker 1: Would we use a mug exactly? So someone's like what
Speaker 1: And one of the other designers was like, yeah, I
Speaker 1: just I just figured And then they're like, and what
Speaker 1: do you do with that? Afterwards? I love this story erin,
Speaker 1: I know, I know, and so Cranes. Because of this,
Speaker 1: and because of the other practical aspects of its design,
Speaker 1: was considered the winning model. And so let me paint
Speaker 1: you a picture please. A hard, clear, rectangular box made
Speaker 1: of two pieces that joined in the center. Inside the
Speaker 1: box was a dropper and a test tube that contained
Speaker 1: dried rabbit antibodies and sheep blood. So you collect some
Speaker 1: urine into the top half of the box, add a
Speaker 1: few drops to the test tube along with some tap water,
Speaker 1: and then you waited for two hours much better than
Speaker 1: two weeks, with the test tube sitting in the bottom
Speaker 1: half of the box. And that had a mirror. It's like,
Speaker 1: it's complicated. Yeah. Yeah. If you were pregnant, a red
Speaker 1: brown ring like a doughnut would form in the bottom
Speaker 1: of the tube, reflected by the mirror. No donut meant
Speaker 1: no pregnant. Oh no pregnant, Yeah, no donut, no pregnant. Okay,
Speaker 1: well that is really complicated. It's really complicated, but it's
Speaker 1: also something that is like it was you can do
Speaker 1: very much. Yeah right, it was very similar.
Speaker 4: To not that much harder than like COVID tests or
Speaker 4: you're like, oh yeah, I swap this, and I mid this,
Speaker 4: and I drop her this, and I.
Speaker 1: Yeah, I'm something of a myself. Yeah uh yeah. Also,
Speaker 1: I just want on a cute little side notes. So
Speaker 1: Crane met her future husband at that meeting. He I
Speaker 1: think was the one who was like, this design is
Speaker 1: clearly the best good, not like I produced the rhinestone one.
Speaker 1: No no, no uh. And eventually they opened their own
Speaker 1: ad agency where she was the head designer and he
Speaker 1: was a copy cheese. Oh so cute. But with Crane's
Speaker 1: design in hand, Organons sought to get this test to market,
Speaker 1: Facing heavy opposition in the US. Was it reliable enough?
Speaker 1: What would women do with this information? Organon instead turned
Speaker 1: to Canada, where, unlike the US, you did not have
Speaker 1: to have a prescription to get a pregnancy test, and
Speaker 1: you could just take one at the pharmacy without a
Speaker 1: doctor's appointment. Okay, unbelievable, I mean totally believable. By summer
Speaker 1: of nineteen seventy one, Predictor, which is Organon's home pregnancy test,
Speaker 1: was on the shelves in Canadian drug stores for five
Speaker 1: dollars and fifty cents. Which is about the same price
Speaker 1: as a BRA and a little less expensive than a
Speaker 1: lab test. Okay, just to get it, yeah, protexted.
Speaker 9: Yep.
Speaker 1: Not everyone was a fan of the lab test. So
Speaker 1: one pharmacist in British Columbia named Bob no last name
Speaker 1: that I could detect, said that he wouldn't be stalking
Speaker 1: them because he quote didn't think women could be trusted
Speaker 1: to accurately obtain results. Okay, Bob, thanks Bob, we can't
Speaker 1: or piano cup come on, yep geez. Others described it
Speaker 1: as a passing fad. Oh questions. Yeah, but the market
Speaker 1: didn't lie. The test flew off the shelves and it
Speaker 1: quickly sold out, and with such a successful launch in Canada,
Speaker 1: other countries' approval wasn't too far behind. Home pregnancy tests
Speaker 1: became available in many places around the world by the
Speaker 1: end of the nineteen seventies. In the US, the FDA
Speaker 1: approved the test in nineteen seventy six, and they hit
Speaker 1: the shelves in nineteen seventy seven. Wow. One of the
Speaker 1: earliest ads for these tests, the EPT in Home Early
Speaker 1: Pregnancy Test, described it as quote a private, little revolution
Speaker 1: any woman can easily buy at her drug store, I
Speaker 1: love it. Yeah. Early TV ads ended with time is
Speaker 1: on your side at last. The tone from these ads
Speaker 1: reflect the push for and the milestones in reproductive rights
Speaker 1: in the US and the nineteen seventies, like Roe v.
Speaker 1: Wade was nineteen seventy three, for instance, but the private
Speaker 1: little revolution wasn't immediate. These tests cost ten US do
Speaker 1: all about fifty one in twenty twenty four dollars holy cow. Yeah,
Speaker 1: took two hours for a result again, and had a
Speaker 1: decently high rate of false negatives not false positives, though,
Speaker 1: which is good. This was not a cheap test, and
Speaker 1: the recommendation to buy two tests in case you took
Speaker 1: the first test too too early. It made home testing
Speaker 1: prohibitedly expensive for some people, and according to some who
Speaker 1: used it, the test wasn't the most intuitive and in
Speaker 1: fact was kind of complicated. It just had to sit
Speaker 1: for two hours in a completely still dark environment. Any jostling, yeah,
Speaker 1: because otherwise the ring would probably dissolve. Oh interesting, the
Speaker 1: doughnut okay, yeah, and stigma lingered right. There was one
Speaker 1: state official telling consumer reports in nineteen seventy eight that quote,
Speaker 1: there is no reason for a woman in Maryland to
Speaker 1: buy such a kit as the ept unless she doesn't
Speaker 1: want to be seen at the health department. Yeah, leading
Speaker 1: the magazine to conclude that it was a quote unquote
Speaker 1: useless purchase. Wow. Yeah, just like our avocado test. If
Speaker 1: you didn't buy so much avocado test, would you can
Speaker 1: buy out? But the sentiment revealed a disconnect between what
Speaker 1: most physicians, some politicians, and a puritanical, patriarchal society thought
Speaker 1: women needed and what women felt they needed, especially in
Speaker 1: the US, where there initially was pushback against allowing the
Speaker 1: test to be sold in drug stores over the counter. Yeah,
Speaker 1: regardless of how accessible you made pregnancy tests at the clinic,
Speaker 1: like getting rid of prescription requirements reducing the cost. Whatever
Speaker 1: the tests revealed at those clinics was first learned by
Speaker 1: someone else, right, not ever the patient. Putting pregnancy tests
Speaker 1: in the hands of women reasserted their rightful control over
Speaker 1: their own bodies and the knowledge about their bodies. Yeah.
Speaker 1: There's a quote I want to read you from the
Speaker 1: book Pregnancy Test by Karen Weingarten. Quote. With a home
Speaker 1: pregnancy test, women could take control of their decision from
Speaker 1: They wouldn't need to find a doctor willing to test
Speaker 1: them for pregnancy. Who might question their motives or next steps.
Speaker 1: They wouldn't even need to share their news with anyone
Speaker 1: until they were ready end quote. Even early marketing materials
Speaker 1: focused on what this meant for women, not families, not
Speaker 1: a couple, but for a woman who thinks she might
Speaker 1: be pregnant, focusing on the privacy aspect of these tests.
Speaker 1: The pharmaceutical companies that produce them also had to convince
Speaker 1: physicians that this was a good thing, that early pregnancy
Speaker 1: detection meant people could get prenatal care earlier, and most
Speaker 1: physicians agreed with that potential positive impact, but many remained
Speaker 1: skeptical that the tests were accurate, and they would insist
Speaker 1: on a clinical test to confirm home results. And this
Speaker 1: is not without merit, of course, Even the most accurate
Speaker 1: tests today are not one hundred percent accurate or may
Speaker 1: not be able to give you all the information that
Speaker 1: you need to decide what to do next. The pregnancy
Speaker 1: test does not reduce the need for or replace medical
Speaker 1: care at all. It is simply often the first step
Speaker 1: along the journey, whatever that journey. Maybe. By the nineteen
Speaker 1: eighties and Reagan's presidency, these ads shifted in tone to
Speaker 1: be more about family values. Of course they did, of course,
Speaker 1: featuring straight couples sharing the joy that a test could bring.
Speaker 1: The nineteen nineties saw reality advertising for pregnancy tests, with
Speaker 1: couples finding out on camera the results of the test.
Speaker 1: In the nineties, yeah, I mean, come on, you like
Speaker 1: Jerry Springer morey stuff like that. Yeah, yeah, okay, America's
Speaker 1: Funniest Home video.
Speaker 10: Sure.
Speaker 1: Sorry, I don't know if I'm sure pregnancy test featured
Speaker 1: on I'm sure they didn't. But these these nineties tests,
Speaker 1: that's when the first time people of color were featured
Speaker 1: in many of these ads. And while most couples in
Speaker 1: these realities, so it would be like a couple being like, oh,
Speaker 1: let's find out the results on air or whatever, and
Speaker 1: then most of them like clearly wanted a positive result,
Speaker 1: like they were happy with the positive result. One couple
Speaker 1: was relieved about their negative test, which interesting. Yeah. What
Speaker 1: was missing from these ads were depictions of women who
Speaker 1: did not want to be pregnant but were. David Lynch, So,
Speaker 1: the guy who did twin Peaks in the movie Blue
Speaker 1: Velvet He Passed Away, recently directed a nineteen ninety seven
Speaker 1: pregnancy test ad where the woman in the ad finds
Speaker 1: out the results, but the audience doesn't get to see them.
Speaker 1: I love it.
Speaker 9: Waiting to find out if you're pregnant or not. Nothing
Speaker 9: else in the world matters until you know. Introducing clear
Speaker 9: Blue Easy one minute pregnancy test, because only clear Blue
Speaker 9: Easy gives you a clear yes or no in one minute.
Speaker 4: So that's the first time that it's just waiting and
Speaker 4: you have to kind of infer yourself.
Speaker 1: I think so interesting. Yeah, isn't that? Isn't that so
Speaker 1: fascinating because a lot of the other ones were like,
Speaker 1: it's positive, I'm happy, or it's negative, I'm relieved. But
Speaker 1: this one, she's smiling. You don't know is she happy
Speaker 1: that it's positive or negative? Right? I really like it. Yeah,
Speaker 1: the mystery of it, that ad is especially important too,
Speaker 1: for showing that it's about the knowledge, not about the result.
Speaker 1: And I think that's a big shift in that perception
Speaker 1: of what these tests have given us. So within twenty
Speaker 1: five years of their release, home pregnancy tests had become
Speaker 1: a widely used, recognizable, commonplace diagnostic tool as well as
Speaker 1: you useful plot device. TV shows, movies, novels all began
Speaker 1: to feature pregnancy tests as a useful way to increase
Speaker 1: dramatic tension or force character growth. I mean, how many
Speaker 1: sitcoms have an episode where someone finds a positive pregnancy
Speaker 1: test in the trash? Whose is it? Everyone?
Speaker 11: My god?
Speaker 1: I can think of so many. Yeah, They've been used
Speaker 1: in TV and movies as an opportunity for safe sex
Speaker 1: talks between parents and a teenager, a moment of self
Speaker 1: reflection for whether or not a character wants the test
Speaker 1: to be positive or negative, whether they want children at
Speaker 1: all or feel ready to have kids. It's on reality
Speaker 1: TV in really twisted scenarios, like there's a Maury one
Speaker 1: where someone has to tell like it's like someone's teenage
Speaker 1: daughter takes one on air to be like is she
Speaker 1: lying or not? I know that's horrific, I know, yeah,
Speaker 1: but there are yeah, a million examples.
Speaker 10: Right.
Speaker 1: In nineteen ninety one, the show Murphy Brown showed Murphy
Speaker 1: taking a home pregnancy test and ultimately deciding to become
Speaker 1: a single mother after considering abortion. This is nineteen ninety one. Wow,
Speaker 1: I feel like that's it's like not allowed today. Yeah, yep.
Speaker 1: This plotline was criticized by Vice President Dan Quail as
Speaker 1: quote unquote eroding family value. Of course it was, right, Yeah,
Speaker 1: it's yeah. I think that that test though, or that
Speaker 1: Sitcom Murphy Brown when she when she took the pregnancy test,
Speaker 1: that also helped to kind of popularize it and be
Speaker 1: like this is a thing that people can do. This
Speaker 1: is Yeah. I think it just kind of had increased
Speaker 1: momentum even more like normal. Yeah, exactly. But it's incredible
Speaker 1: how over the almost five decades since its release, the
Speaker 1: home pregnancy test has become almost universally recognizable, even for
Speaker 1: people who have never used one. I loved how like, yeah,
Speaker 1: the early COVID tests and people would take pictures and
Speaker 1: like everyone thought it was a pregnancy test immediately. Yeah.
Speaker 1: But improvements to the test over these decades include things
Speaker 1: like the invention of monoclonal antibodies, which eliminated the need
Speaker 1: for lab animals. More precise testing than now familiar, easy
Speaker 1: to read stick pregnancy test with the two lines was
Speaker 1: introduced in nineteen eighty seven. Now some of them say
Speaker 1: pregnant or not pregnant digit. In twenty twenty one, a
Speaker 1: flushable pregnancy test was introduced, which is an incredible development
Speaker 1: to protect privacy.
Speaker 4: Wow, yeah, I was just thinking about sewage lines, like,
Speaker 4: is are they actually flushable.
Speaker 1: I mean I think, I think they are fascinating. Yeah,
Speaker 1: tests have been developed that can be read by blonde
Speaker 1: or low vision people without the help of someone else. Wow,
Speaker 1: I know that's amazing. I never would have thought of that,
Speaker 1: I know, I know. It's so incredible, the different innovations
Speaker 1: that have been thought of. Yeah, one organization has introduced
Speaker 1: a test that measures hCG as a way of verifying
Speaker 1: that an abortion worked. And so you take like a
Speaker 1: you know, sequential test afterward to be like, is it
Speaker 1: dropping right? I've seen different estimates, but around eight million
Speaker 1: people in the US alone used a home pregnancy test
Speaker 1: in twenty twenty. Wow. Think about that compared to fifty
Speaker 1: years ago. I'm going to read you a quote from
Speaker 1: an article by historian Sarah Abigail Levitt. Quote. Though women
Speaker 1: have found ways throughout history to find out about impending pregnancy,
Speaker 1: that has only been within the last quarter century that
Speaker 1: this information was available to so many women with such
Speaker 1: reliable accuracy. Women in this generation who take home pregnancy
Speaker 1: tests are able to know something about themselves and their
Speaker 1: futures in a time frame that was simply not possible
Speaker 1: for their grandmothers or even their mothers. Isn't that mind blowing?
Speaker 1: Like my grandma wouldn't have taken a pregnancy test. I
Speaker 1: wish that I could ask, Yeah, my grandma, my mom
Speaker 1: took a home pregnancy test. I assume that my mom did,
Speaker 1: but I never asked her.
Speaker 4: I asked her so many other things about her pregnantities
Speaker 4: for this episode, but I didn't ask her that.
Speaker 1: Yeah. It's incredible. Yeah, but that knowledge can come at
Speaker 1: a cost. Also from Levett, the pregnancy test has liberated
Speaker 1: women by giving them information earlier and allowing them to
Speaker 1: digest the information in the privacy of their own homes. However,
Speaker 1: it oppresses women when it forces them to make decisions
Speaker 1: earlier and earlier, when it forces them to confront a
Speaker 1: miscarriage they might otherwise never have known about, or when
Speaker 1: it falls into the hands of those with whom they
Speaker 1: did not wish to share the information, and when it
Speaker 1: proves an untrustworthy narrator and gets the answer wrong. Yeah,
Speaker 1: have been and continue to be tested for pregnancy without
Speaker 1: their consent or by those who have ulterior motives, such
Speaker 1: as testing unhoused women. In the nineteen eighties in New
Speaker 1: York City who had to be tested if they wanted
Speaker 1: city housing. Wow, or women on certain police forces being
Speaker 1: secretly tested employers pretending to test potential employees for drugs
Speaker 1: but actually testing for pregnancy. That has happened. Oh my god. Yeah,
Speaker 1: the US Immigration and Customs Enforcement ICE test those arriving
Speaker 1: at a detention center who are over ten years old,
Speaker 1: ads for free pregnancy testing at clinics that are actually
Speaker 1: anti abortion clinics. That's major. It's a major one. And
Speaker 1: then the early detection and sensitivity of these tests could
Speaker 1: be seen as a double edged sword. Some suggest that
Speaker 1: pregnancy test is not really an accurate term, that these
Speaker 1: tests aren't detecting viable pregnancies, but just the presence of hCG,
Speaker 1: and so non viable pregnancies that may not have been
Speaker 1: noticed in the past are now recognized, potentially increasing the
Speaker 1: trauma of that experience. For some, however, that experience may
Speaker 1: be incredibly meaningful. These days in the US, early detection
Speaker 1: of pregnancy can be critical, especially for those living in
Speaker 1: states that restrict abortion to a narrow window like.
Speaker 4: Six weeks or like outlaw it at all. So you
Speaker 4: have to figure out where you're going to travel.
Speaker 1: So you're going to travel, Yeah, waiting until you've missed
Speaker 1: a period to take a test might already be too late.
Speaker 1: Knowledge is power, and that can be dangerous if that
Speaker 1: knowledge falls into the wrong hands or is used against us.
Speaker 1: But it can also be incredibly liberating and empowering, giving
Speaker 1: us access to and control over information about our bodies
Speaker 1: that should have been ours to be long. Yeah, and
Speaker 1: so with that, Aaron, I'd love for you to tell
Speaker 1: me about how hCG works and what's going on in
Speaker 1: early pregnancy. I don't know if I'm going to answer
Speaker 1: that first question. Okay, what's going on early pregnancy? Okay, great.
Speaker 1: Right after this break, I.
Speaker 11: Didn't have a glowing pregnancy. Sciatica made every step painful,
Speaker 11: Braxton Hicks robbed me of my sleep, and even the
Speaker 11: smell of my beloved garlic turned my stomach. Hormones didn't help,
Speaker 11: especially when my husband jokingly called me Shamou after the
Speaker 11: infamous killer Whale because of my black and white maternity wardrobe.
Speaker 11: I snapped at him one night when he made what
Speaker 11: I thought was a mean comment about how puffy my
Speaker 11: ankles were looking, and then I forgot about it until
Speaker 11: January seventeenth, twenty eighteen, at two am my waters broke.
Speaker 11: We grabbed a cab to Lewisham Hospital in southeast London,
Speaker 11: expecting to be sent home as labor had not started yet. Instead,
Speaker 11: after a long wait and a quick reflexed test where
Speaker 11: my legs shot up in the air, we realized that
Speaker 11: those puffy ankles had been an indicator of preacclansia, the
Speaker 11: only cure birth within twenty four hours. Suddenly I was
Speaker 11: on a hormone drip to induce labor and magnesium dripped
Speaker 11: to prevent seizures. Hooked up to monitors, I was told
Speaker 11: that I could not eat anything for hours. I waited,
Speaker 11: feeling contractions build, but just when I needed the aperture
Speaker 11: a most we realized that it had become detached and
Speaker 11: I had to push without pain relief, which resulted in
Speaker 11: my blood pressure increasing in a way that the midwives
Speaker 11: were not very happy about. Suddenly the room blurred in
Speaker 11: a wave of blue medical sheets and rushing staff. My
Speaker 11: baby was facing the wrong way up, another complication. The
Speaker 11: doctor used a vacuum to rotate her and finally, to
Speaker 11: Queen's I wanted to break read. My daughter entered the world.
Speaker 11: Their traditional national health service tea and toast afterwards is
Speaker 11: still to this day the best feal of my life.
Speaker 11: Two days later we went home. That baby is now
Speaker 11: a feisty seven year old testing every boundary. Life since
Speaker 11: hasn't been simple. We've made countries, she's learned new languages,
Speaker 11: and her dad and I have separated, but she's the
Speaker 11: center of our universe and through it all, even though
Speaker 11: I've never fully understood why I got prea clamsia and
Speaker 11: why we hadn't noticed it earlier, I'll forever be grateful
Speaker 11: to the NHS for bringing us through safely.
Speaker 10: For the most part, my pregnancy was pretty typical, pretty textbook,
Speaker 10: no complications or anything. The two things that really kind
Speaker 10: of stood out to me as different in my experience
Speaker 10: that I was not prepared for. The first was when
Speaker 10: the whole time that I was pregnant, people always were saying, oh,
Speaker 10: when you go into labor, you may not even know it.
Speaker 10: It may be hard to tell when labor starts. It's
Speaker 10: not going to be like it is in the movies
Speaker 10: where you have this big dramatic gush of your water
Speaker 10: breaking and that's what starts things. That was exactly what happened.
Speaker 10: I had woken up at about four o'clock in the morning,
Speaker 10: needed to use the bathroom and I got up off
Speaker 10: I was sleeping on my basement couch, got up off
Speaker 10: the couch as best I could, and the second my
Speaker 10: feet hit the floor, it was a gush that was unmistakable.
Speaker 10: I knew at that point that it was time to
Speaker 10: go to the hospital. Then the other unexpected for me
Speaker 10: was as my labor progressed, it seemed like things were
Speaker 10: going relatively quickly, and you know, just a few short
Speaker 10: hours into being at the hospital, I was told, oh,
Speaker 10: it's time to push, and at that point I was thinking, Okay,
Speaker 10: I'm gonna have the baby in just a few minutes.
Speaker 10: Everybody I've ever talked to says they pushed for fifteen
Speaker 10: minutes or two pushes and the baby was out. That
Speaker 10: was definitely not my experience. I pushed for two hours.
Speaker 10: That was pretty grueling, and I overall everything turned out fine.
Speaker 10: But I did not realize before that point that you
Speaker 10: could be ready to push and have it still take
Speaker 10: that long. She hadn't descended through my pelvis yet, so
Speaker 10: even though I was already fully effaced and dilated, it
Speaker 10: took a little bit of work. All in all, it
Speaker 10: was worth it, and I would do it again. But
Speaker 10: you just really never know what you're signing up for
Speaker 10: when you get pregnant.
Speaker 4: So this might sound silly now after everything that you
Speaker 4: went through, but I felt like to make all of
Speaker 4: these episodes make sense, I wanted to start by just
Speaker 4: defining pregnancy.
Speaker 1: No, that's a great, okay way to start.
Speaker 4: Cool, Like, it might sound very obvious, right, Like, I
Speaker 4: think we all know what we think pregnancy is, right,
Speaker 4: It is the period of time when there is a
Speaker 4: fetus growing in your uterus.
Speaker 1: That's what we think of as a pregnancy.
Speaker 4: Yeah, But like you just walked us through, how we've
Speaker 4: been able to determine whether or not someone is pregnant
Speaker 4: has really changed over time. So I want to start
Speaker 4: with how we date a pregnancy today. Great, okay, this
Speaker 4: is how we decide when a pregnancy quote unquote begins. Okay,
Speaker 4: And in medicine that is pretty universally based on your
Speaker 4: last menstrual period. The first day of your last menstrual
Speaker 4: period is the start of a cycle, your menstrual cycle. Yeah,
Speaker 4: we assume in medicine that all menstrual cycles are twenty
Speaker 4: eight days long.
Speaker 1: Exactly. We know that they're not, but that's an average.
Speaker 4: And so based on that assumption, pregnancy is forty weeks long.
Speaker 4: It's about two hundred and eighty days, all right. The
Speaker 4: time that it takes from fertilization will get there to
Speaker 4: a mature fetus or baby is about thirty eight weeks
Speaker 4: two hundred and sixty six days. So that extra two
Speaker 4: weeks between thirty eight and forty that's the time it
Speaker 4: takes from the start of that last menstrual period to
Speaker 4: ovulation slash fertilization.
Speaker 1: Does that make sense? I think so.
Speaker 4: So that's why your pregnancies are always longer than you
Speaker 4: would think it is. By the time that you have
Speaker 4: missed a period, you're already four weeks pregnant. Oh my god,
Speaker 4: even though fertilization just happened two weeks.
Speaker 1: Ago, got it? Okay? Yeah?
Speaker 4: And it is confusing, yeah, because then it really makes
Speaker 4: that timetable. And if we're talking about like access to
Speaker 4: abortion and things like that, it's really important. Right, So
Speaker 4: we'll go through all of what is happening there. But
Speaker 4: I just want to set the state, so that is
Speaker 4: how we define pregnancy. That's the time frame of pregnancy. Okay,
Speaker 4: I have a question real quick, right to me.
Speaker 1: So there then is a potential like error bars around absolutely,
Speaker 1: and so then like let's say that you know that
Speaker 1: conception happened on this date, but then your doctor's like, oh, well,
Speaker 1: when what was the last day of your last period?
Speaker 1: You want to talk about me? Because that was my
Speaker 1: life I was angling too. Yeah.
Speaker 4: So if you have like, for example, very long menstrual
Speaker 4: cycles like thirty six days or something like that that's
Speaker 4: pretty different than twenty eight days, then your conception date
Speaker 4: might be more accurate if you know it. That's like
Speaker 4: your ovulation date. But generally what happens is that we
Speaker 4: use ultrasound early ultrasound to make sure what the embryo
Speaker 4: and fetus is growing as and if it's off by
Speaker 4: a certain number of days, then you change the date
Speaker 4: of the pregnancy.
Speaker 1: Okay, does that makes sense?
Speaker 4: Yeah, And it all depends on how early that ultrasound is,
Speaker 4: how it's growing and all of that, and there's like
Speaker 4: very specific regulations on how that's all decided. But yes,
Speaker 4: for some people that date ends up changing and it's
Speaker 4: not exactly consistent. But at the start, it's always assumed
Speaker 4: that the start of your pregnancy is the first day
Speaker 4: of your last menstr period.
Speaker 1: Interesting. Yeah, okay, so that I feel like that has
Speaker 1: such huge implications for everaching. Yeah, and it really does.
Speaker 4: Like for my both of my pregnancies were not dated
Speaker 4: accurately based on that. One of them I found out
Speaker 4: early on and it was fine. The next one it
Speaker 4: was the day I went in for an induction.
Speaker 1: Oh my gosh, It's all fine, because then there's that
Speaker 1: it's like, well, you need an induction, right or you
Speaker 1: don't you? Or yeah, so it does. It does matter.
Speaker 4: And now that we have the better ultrasounds that we have,
Speaker 4: the more accurate we can be in dating if you
Speaker 4: have access to an early ultrasound, because ultrasound gets less
Speaker 4: accurate the farther you get in pregnancy.
Speaker 1: I am going so far off. No, this is great.
Speaker 1: I'm sorry I started to stun as a rabbit hole. I
Speaker 1: love it, okay, but so let me find where I'm at.
Speaker 4: Yeah okay, but yes, so that that is how we
Speaker 4: define it in medicine. I'm going to walk through like
Speaker 4: the steps after fertilization and the very early parts of
Speaker 4: a pregnancy. So if any of my dating gets confusing,
Speaker 4: where you're like, what, what does that mean, just stop
Speaker 4: me so I can clarify, Okay, And that is what
Speaker 4: I'm going to walk us through today is early development
Speaker 4: and then some of the things that can go wrong
Speaker 4: within that early, very early time period. And we'll talk
Speaker 4: a lot about miscarriage and early pregnancy loss. And my
Speaker 4: goal for this part of the episode is to help
Speaker 4: us understand the question of what has to happen biologically
Speaker 4: for a pregnancy to be possible. Yeah, okay, So we
Speaker 4: will begin two weeks after your last menstrual cycle.
Speaker 1: Okay.
Speaker 4: On average, you have ovulation. That's when you ovulate, and
Speaker 4: if a sperm is present, then you have fertilization. These
Speaker 4: two single cells will come together and join their nuclear
Speaker 4: contents and make a brand new cell. I'm taking everything
Speaker 4: that happens prior to that point for granted because.
Speaker 1: It's cool, but it's way too detailed. Okay.
Speaker 4: So that's where we begin. Within the first twelve to
Speaker 4: twenty four hours after this fertilization event is when you'll
Speaker 4: have the first cell division. So pretty quickly you go
Speaker 4: from one cell to two, and then every twelve to
Speaker 4: twenty four hours or so after that you continue dividing,
Speaker 4: so you go from two to four to eight to
Speaker 4: sixteen to thirty two cells in this tight little ball
Speaker 4: by about day three after ovulation, which is like seventeen
Speaker 4: days or so after your last menstrual period.
Speaker 1: Got it.
Speaker 4: And as this ball of cells continues to divide, it
Speaker 4: starts to take a shape. It forms itself by about
Speaker 4: day five or six, so nineteen or twenty of your
Speaker 4: menstrual period after your last mental period, into a hollow,
Speaker 4: fluid filled ball. And we talked about this in our
Speaker 4: IVF episode. It's called a blasticist, yep. And I imagine
Speaker 4: the blasticist like a tennis ball.
Speaker 1: Yes, I brought one? Did you bring Okay? Perfect, it's
Speaker 1: a tennis ball. Okay, your dog is going to be
Speaker 1: really said she was. When I was like making what
Speaker 1: I made was she was like, is that my ball?
Speaker 1: Is that my ball? I did not take her ball? Okay.
Speaker 4: So imagine this is a hollow ball, right, but it's
Speaker 4: filled with fluid instead of just being filled with air
Speaker 4: like an actual tennis ball, but instead of being like
Speaker 4: perfectly symmetric inside and outside, in the blasticist, there is
Speaker 4: on the inside an extra few layers of cells called
Speaker 4: the inner cell mass. And this inner cell mass that
Speaker 4: we have here is what will eventually become the embryo
Speaker 4: opecially the fetus.
Speaker 1: Okay, just a little few little cells.
Speaker 4: And at this blasticist stage, six or seven days or
Speaker 4: so after fertilization, about day twenty one of your menstrual cycle,
Speaker 4: this is when implantation will begin. Okay, So implantation itself,
Speaker 4: implanting into the uterine wall. It's not a discrete event.
Speaker 4: It's not one time point. It takes at least a
Speaker 4: well over a week or so. And what it results
Speaker 4: with is this blasticist completely embedding itself into the wall
Speaker 4: of the uterus. So our uterus has a cavity, right,
Speaker 4: it has this empty space in the middle, yep. But
Speaker 4: this blasticist and eventually fetus does not grow in that cavity.
Speaker 4: It grows within the wall of the uterus.
Speaker 1: Okay.
Speaker 4: Now, the outer wall of that blasticist like the fuzzy
Speaker 4: green layer of the tennis ball. It's called the sensisio trophoblast,
Speaker 4: and that is the layer that will continue to invade
Speaker 4: into the walls of our endometrium, into our uterus and
Speaker 4: all the way into the first third of the muscle layer,
Speaker 4: the myometrium of our uterine wall and I know you're
Speaker 4: going to talk more about that, yeah kind of yeah, yes,
Speaker 4: So the maternal endometrium, like our own cells, are not
Speaker 4: passive in this process by any means way. Our body
Speaker 4: is responding to the invasion of these fetal cells that
Speaker 4: will eventually, by the way, become the placenta by completely remodeling.
Speaker 4: So the structure of our uterine lining completely changes. We
Speaker 4: have huge changes in the inflammatory signals that are being
Speaker 4: sent within our body. I'm excited for you to talk
Speaker 4: more about it, and then also big changes in the
Speaker 4: hormones that are dancing around in our bloodstream.
Speaker 1: Okay, So just to re recap it briefly, So the
Speaker 1: cell implantation multiplication, some of those multiplied cells become the
Speaker 1: placenta eventually, and some become the embryo ex lator feed
Speaker 1: us exactly.
Speaker 10: Yeah.
Speaker 4: The inside part is what they're going to become eventually
Speaker 4: the baby yep. The outside part is what invades and
Speaker 4: then becomes the placenta.
Speaker 1: Yep. And there's like layers obviously, it's so interesting the differentiation.
Speaker 1: What are the signals that say you be placenta, you
Speaker 1: be I love embryos.
Speaker 4: It's so so, so fascinating aaron, and you could go
Speaker 4: in so much more detail on like every single step
Speaker 4: within this.
Speaker 1: There are entire textbooks on like this exactly best Slayer.
Speaker 4: I know I'm not going to go there, but I'm
Speaker 4: going to focus on this for a second. Because the
Speaker 4: start of implantation, so the start of that implantation process,
Speaker 4: which again takes time, it's a really really important milestone
Speaker 4: in a pregnancy for a few reasons.
Speaker 10: Uh.
Speaker 4: The first is that about forty eight hours or so
Speaker 4: after implantation starts, is when the cells of that since
Speaker 4: sisho trophoblast, the cells that are burrowing their way into
Speaker 4: our endometrium, will start to secrete hCG. And that is
Speaker 4: not only important for detecting a pregnancy, but also one
Speaker 4: of the major keys for a pregnancy to be able
Speaker 4: to continue. Okay, because don't worry, I'll get there. Because
Speaker 4: up until this point, all of the tissues of our endometrium,
Speaker 4: the lining of our endometrium, and everything that has changed
Speaker 4: thus far, it has been supported primarily by the hormone progesterone,
Speaker 4: and that hormone up until this point of implantation, and hcg'
Speaker 4: secretion has been secreted by this thing called the corpus lutium,
Speaker 4: which is what's left over in your ovary after you ovulate.
Speaker 4: So everyone makes one of these every time they ovulate,
Speaker 4: and it hangs out there for like two weeks, supporting
Speaker 4: the lining of your endometrium, hoping that a blastocyst will
Speaker 4: implant But the corpus lutium only lives about two weeks
Speaker 4: or so. So by day fourteen after ovulation, twenty eight
Speaker 4: days or so after your last menstrual period, if you
Speaker 4: don't have the presence of hCG in your system, then
Speaker 4: this corpus lutium will disintegrate, your progesterone levels will drop,
Speaker 4: and you will have a menstrual period. You will shed
Speaker 4: the lining of your uterus.
Speaker 1: The decidua. The decidua. Yes, well, I just I'm trying
Speaker 1: to track that with all that stuff which I don't
Speaker 1: even know if I talk about the decidua, But.
Speaker 4: That is what it is called, is what the lining
Speaker 4: of your uterus becomes, is called the decidua. But if
Speaker 4: this blasticist was able to successfully start implantation, it starts
Speaker 4: secreting hCG, and that hCG sends a signal to our
Speaker 4: corpus lutium, don't disintegrate, keep it going, keep secreting progesterone,
Speaker 4: and it does. Our corpus lutium will continue to produce
Speaker 4: progesterone for several more weeks, all the way until the
Speaker 4: point that the placenta has formed and can take over
Speaker 4: the majority of the necessary hormone production to support the
Speaker 4: growing pregnancy. Okay, right, amazing, amazing, So we've already learned
Speaker 4: a lot. First, it means that the absolute earliest that
Speaker 4: you could conceivably test for a pregnancy via hCG is
Speaker 4: a couple days after implantation, which is usually a few
Speaker 4: days prior to your missed period, because it's like forty
Speaker 4: eight hours after implantation, which is day five, six seven.
Speaker 1: Somewhere in there.
Speaker 4: Okay, so most people are going to be considered four
Speaker 4: weeks pregnant at this point.
Speaker 1: Plus and minus is I have strong feelings about that. Yeah,
Speaker 1: I tell me your feelings. Rage, I guess, like that
Speaker 1: is so inaccurate. I mean it's yeah, it's because it's Okay,
Speaker 1: it's consistently inaccurate. So that's one contestant, except it also great.
Speaker 1: That's that's the one pro of this. The rest is
Speaker 1: that everything else is then shifted, right, And I mean, yeah.
Speaker 4: I know, it's interesting, it's and I mean it's it's
Speaker 4: really a relic of when we didn't have ultrasound, like
Speaker 4: laws are now based on oh yeah, preaching, chire yeah,
Speaker 4: and this process of implantation. It's also a very delicate
Speaker 4: sort of dance. A lot of things can go not
Speaker 4: as I just explained, within this process and prior leading
Speaker 4: up to this process. So I'm going to pause here
Speaker 4: and actually take a few steps backward to talk about
Speaker 4: some of the potential either complications that can arise even
Speaker 4: as early as this, or just things that don't go
Speaker 4: this way, like what are what are the alternative roots
Speaker 4: that can happen here? And then we'll come back and
Speaker 4: I'll talk more about the inner cell mass how it
Speaker 4: becomes an embryo. There's a few things that can happen
Speaker 4: with implantation the process of implantation. One is that it
Speaker 4: could happen in an atypical location, and that is called
Speaker 4: an ectopic pregnancy. And because most fertilization events happen in
Speaker 4: the philopian tubes, which are the little tubes leading from
Speaker 4: our ovaries to our uterus, then most of the time,
Speaker 4: like ninety five ninety six percent of the time, if
Speaker 4: a ectopic pregnancy happens, it happens in the filopian tubeube.
Speaker 4: So this blasticism implants in the wrong place in your
Speaker 4: Filippian tube or right at the junction there where the
Speaker 4: Filippian tube meets the uterus. And because Filippian tubes cannot
Speaker 4: expand the way that the uterus can, as that blasticist
Speaker 4: continues to grow into an embryo, it can cause rupture
Speaker 4: of the Filippian tubes, which can cause catastrophic blood loss.
Speaker 4: So ectopic pregnancies are very dangerous. Flipping tube is not
Speaker 4: the only place that it can implant. Ectopic pregnancies can
Speaker 4: also happen in the cervix so like a little too
Speaker 4: far down interesting. They can happen in the scar from
Speaker 4: a cesarean section, which might end up being a viable
Speaker 4: pregnancy depending on how it continues to grow. They can
Speaker 4: sometimes happen in the ovary or even in the abdominal
Speaker 4: cavity because the ovaries and your philippine tubes are not
Speaker 4: like connected, they're like floating, and your Filippian tubes can
Speaker 4: also like move around back and forth.
Speaker 1: And things like that.
Speaker 4: Okay, that's amazing, I know, but it's not great if
Speaker 4: one implants in like the abnomenal cavity.
Speaker 1: And so all of these are considered ec topic because it's.
Speaker 4: All just outside of exactly EC topic, just outside of
Speaker 4: the uter Overall, most estimates are that about one to
Speaker 4: two percent of pregnancies are ectopic, depending on the source.
Speaker 1: Okay, okay, question I expected questions I have answers. Okay, wonderful,
Speaker 1: So one to two percent of the time. How does
Speaker 1: how do you figure out whether something's an ectopic pregnancy?
Speaker 1: Number one? Number two? Like, what what next?
Speaker 4: Great questions? How do you determine it? A lot of
Speaker 4: different ways, is the answer to that question. Ultrasound is
Speaker 4: really important in this, but it also can depend on
Speaker 4: how early that pregnancy is, because sometimes if it's super early,
Speaker 4: then you don't see anything in the uterus or elsewhere,
Speaker 4: then it might be classified as a pregnancy of unknown location,
Speaker 4: and so then what you do with that might change
Speaker 4: kind of depending but in general it's ultrasound to try
Speaker 4: and determine that a lot of times ectopic pregnancies might
Speaker 4: present as a typical early on, so you might have
Speaker 4: bleeding that we don't expect. You might have abdominal pain,
Speaker 4: especially like one sided abdominal pain, but not always. Sometimes
Speaker 4: you might not have symptoms. What you do about it
Speaker 4: is really important. So ectopic pregnancies are very important to
Speaker 4: be treated, and they're generally treated one of two ways.
Speaker 4: So one is with a medicine called methotrex eate, which
Speaker 4: is also used in some places for abortions. But methotrexate
Speaker 4: is one medication that you can use, especially if it's
Speaker 4: small and it's at low risk of rupture. It requires
Speaker 4: continued medical monitoring to make sure that you've completely lost
Speaker 4: the rest of that pregnancy tissue, or it requires surgery,
Speaker 4: and surgery usually requires the loss of that filopian tube.
Speaker 1: If that's where I plan did okay? And how often
Speaker 1: is it surgery versus it's a good question. I don't
Speaker 1: have it.
Speaker 4: I don't have data on that, Okay, that's a solid question.
Speaker 4: I think it probably depends like location, geography, all that
Speaker 4: kind of stuff.
Speaker 1: Gosh, we really we should do an entire episode on
Speaker 1: the history, because I really am just curious how we
Speaker 1: learned about a.
Speaker 4: Topic pregnancy right, and how we figured it out early
Speaker 4: on and before ultrasound.
Speaker 1: What happened? Yeah, ooh, probably wasn't good.
Speaker 4: No, yeah, yeah, So that's ectopic pregnancies.
Speaker 1: Okay, do you have more question? Not right now, but
Speaker 1: I'm sure I will in just a few minutes.
Speaker 4: There's other atypical ways that a blasticis can implant that
Speaker 4: might end up in a viable pregnancy. If the blasticism
Speaker 4: implants too low in the uterus but not in the
Speaker 4: cervical canal, then it can result in what's called placenta previa.
Speaker 1: Ah, So the.
Speaker 4: Placenta completely covers the oss or the opening to the cervix,
Speaker 4: and that is potentially dangerous. It can cause bleeding during pregnancy.
Speaker 4: But it also if that placenta, like if the baby
Speaker 4: has to deliver through the placenta, that's that.
Speaker 1: Doesn't right, It's not safe, it's not. Yeah.
Speaker 4: So generally that goes to a cesareans, which we'll talk
Speaker 4: way more about later. And then of course there is
Speaker 4: miscarriage or early pregnancy loss. So I'm going to spend
Speaker 4: quite a bit of time talking about this.
Speaker 2: Okay.
Speaker 4: The definition of miscarriage actually is different depending on where
Speaker 4: you live and what country that you live in, Okay,
Speaker 4: because it is defined generally as the spontaneous loss of
Speaker 4: and these words are important, the spontaneous loss of a
Speaker 4: recognized pregnancy prior either to a certain gestational age or
Speaker 4: a certain weight of the fetus, depending on what country
Speaker 4: you live in and things like that. So in the
Speaker 4: US we define a miscarriage as a pregnancy loss prior
Speaker 4: to twenty weeks gestation. In the UK it's prior to
Speaker 4: twenty four weeks. In other parts of the EU it's
Speaker 4: like twenty two weeks, And per the World Health Organization guidelines,
Speaker 4: it's the loss of a pregnancy with a fetus that
Speaker 4: weighs five hundred grams or less, which is about twenty
Speaker 4: two weeks gestational age.
Speaker 1: Why is there such variations.
Speaker 4: It's in part because it depends on like the definitions
Speaker 4: of like viability and things like that. I don't have
Speaker 4: a great answer as to why there's variation, but the
Speaker 4: variation exists, which does mean that there's differences in terms
Speaker 4: of like reporting what is considered a miscarriage or an
Speaker 4: early pregnancy loss, and then what is considered a still birth,
Speaker 4: which is if you have a pregnancy loss after that
Speaker 4: time point.
Speaker 1: I see, but again that time point varies a little
Speaker 1: bit and what's the recognized part?
Speaker 4: Yeah, great question Erin so that also the definitions kind
Speaker 4: of differ.
Speaker 1: So there are like.
Speaker 4: Clinically recognized pregnancies and then there are pregnancies that maybe
Speaker 4: weren't recognized clinically, and some of that depends on whether
Speaker 4: or not it was seen on ultrasound, okay, which means
Speaker 4: not only like did you have access to ultrasound, but
Speaker 4: like how early was it yea And then like you said, aarin,
Speaker 4: is that the more that we have access to these
Speaker 4: very very early pregnancy tests that can detect some of
Speaker 4: the home pregnancy test now can detect very low levels
Speaker 4: of hCG, which means you can get it earlier and
Speaker 4: earlier and earlier, and so that.
Speaker 1: Does change our rates of miscarriage.
Speaker 4: But in some of the literature, if there's not a
Speaker 4: documented pregnancy with ultrasound, then it's not classified as a miscarriage,
Speaker 4: but it might be classified as a early pregnancy loss
Speaker 4: quote unquote, or a biochemical pregnancy loss is another term
Speaker 4: that gets thrown around a lot of biochemical pregnancy or
Speaker 4: sometimes they're called pre clinical pregnancy losses. Right, Okay, So
Speaker 4: it all is important, But yeah, the definitions kind of vary,
Speaker 4: and so there's a lot of different words that get
Speaker 4: thrown around in the literature. Yeah, okay, but all that
Speaker 4: being said, overall, the rate of spontaneous loss of early
Speaker 4: embryos is very very high in humans. So a lot
Speaker 4: of those blastocysts that we were talking about never actually
Speaker 4: make it to the point of implantation, so they are
Speaker 4: lost before implantation, which means you never knew that you
Speaker 4: could have been pregnant, even though again we're defining pregnancy
Speaker 4: as your last menstrual period, so it's very confusing. Yeah, yeah, Yeah,
Speaker 4: we don't know exactly how many of these, like pre
Speaker 4: embryos are lost prior to implantation, but it's estimated to
Speaker 4: be somewhere between twenty and forty percent, which is very high.
Speaker 4: It is high, very high, and those are estimates also, Yeah,
Speaker 4: twenty to forty is a huge it's a huge range.
Speaker 1: Yeah.
Speaker 4: And then after implantation, so after that start of implantation,
Speaker 4: a further thirty percent are lost. But it's thought that
Speaker 4: about half of those happens so early that most people
Speaker 4: and caveats here with early pregnancy tests, but most people
Speaker 4: would never know that they were pregnant or were almost pregnant,
Speaker 4: could have been pregnant because they don't ever miss a period. Ah, right,
Speaker 4: So the implantation starts, but then it doesn't continue, So
Speaker 4: then you have shedding of your unine life at the
Speaker 4: time that you typically would and those are most often
Speaker 4: classifies as like biochemical or pre clinical pregnancy losses. But
Speaker 4: the more that we have early pregnancy tests, the more
Speaker 4: that people are going to know that that happened to them.
Speaker 11: Right.
Speaker 4: Yeah, most estimates of the overall risk of miscarriage, so
Speaker 4: the loss of that recognized pregnancy prior to twenty to
Speaker 4: twenty four weeks is about fifteen percent globally. Wow, and
Speaker 4: that's a huge number.
Speaker 1: Yeah, it really is.
Speaker 4: Fifteen percent is twenty three million recognized miscarriages worldwide every year.
Speaker 1: Wow.
Speaker 4: I know we don't talk about it at all. It's
Speaker 4: like not something that we talk about. It's not something
Speaker 4: that's polite to talk about, but something there's a few
Speaker 4: things I feel like, I have a lot of feelings
Speaker 4: about this, but one in three women are also estimated
Speaker 4: to experience a miscarriage at some point during their reproductive years.
Speaker 4: So it's not just that it's common globally, it's also
Speaker 4: common that you might have throughout your reproductive lifespan a
Speaker 4: miscarriage at some point in time, and something being common
Speaker 4: does not make it unimportant. Yeah, right, of course, Well
Speaker 4: what happens all the time, it's really important. There was
Speaker 4: a study in a paper that I read that looked
Speaker 4: at only five hundred women, but so it's a small study,
Speaker 4: but I think this is still really important. Data five
Speaker 4: hundred and thirty seven women with a pregnancy loss, a
Speaker 4: recognized pregnancy loss, found that after nine months, eighteen percent
Speaker 4: of them met criteria for post traumatic stress, seventeen percent
Speaker 4: for moderate or severe anxiety, and six percent for moderate
Speaker 4: or severe depression. So, like losing a pregnancy, whether it
Speaker 4: was a planned pregnancy, an unplanned pregnancy, an early pregnancy loss,
Speaker 4: or a later pregnancy loss, like that is very hard potentially,
Speaker 4: and it's really lonely if it's something that you're not
Speaker 4: able to talk about in quote unquote polite company.
Speaker 1: Well, and I feel like you make a really good
Speaker 1: point that like this, even though this does happen a
Speaker 1: lot and it's not talked about a lot, and it
Speaker 1: doesn't take away the pain exactly, the trauma that can result.
Speaker 4: Yeah, Yeah, most pregnancy losses. Most miscarriages happen in the
Speaker 4: first trimester, so sometime in the first ten to twelve weeks,
Speaker 4: but one to two percent of pregnancy losses will happen
Speaker 4: in the second or third trimester, And like we said,
Speaker 4: if it's after that twenty to twenty four weeks, then
Speaker 4: we classify it as a still birth rather than a miscarriage.
Speaker 4: And no matter how early, any pregnancy loss has the
Speaker 4: potential to be met with shame or stigma, loneliness, guilt, fear, frustration,
Speaker 4: like so many different things, and a lot of people
Speaker 4: understandably want to know what causes this, why is this happening?
Speaker 4: And we don't knowh right, except that it happens like
Speaker 4: very commonly across the board to these early embryos, especially.
Speaker 4: Most estimates are that about fifty to eighty percent of
Speaker 4: the time miscarriages are due to chromosomal abnormalities in the fetus.
Speaker 4: All right, okay, And that is one of the big
Speaker 4: reasons that age. Female age specifically is a big contributor
Speaker 4: where younger people are much less likely to have a
Speaker 4: miscarriage compared to as we get older, the rates are
Speaker 4: like vastly different.
Speaker 1: It's so interesting because I know that we talk about
Speaker 1: the impact of female age, but I feel like it
Speaker 1: does add it can add blame sometimes absolutely, and to
Speaker 1: not like Also, the sperm age or like age of
Speaker 1: the person who's making the sperm also plays a role.
Speaker 4: I think I saw at least one study that looked
Speaker 4: at that, and there is actually an increased risk of miscarriage,
Speaker 4: I believe. Yeah, I wish I had written more detail
Speaker 4: on this, but but it's at an older age. Whereas
Speaker 4: with females it starts at like thirty five or so
Speaker 4: that the rates of increased chance of miscarriage go up,
Speaker 4: it starts later, like after forty or maybe it was
Speaker 4: forty five. Okay, don't quote me on that because I'd
Speaker 4: have to go back to the paper.
Speaker 1: Yeah, yeah, but.
Speaker 4: Yeah, so you're right, it's not like an it's not
Speaker 4: a male factor, right, it's a contributor.
Speaker 1: But we don't talk about it well just always it's
Speaker 1: like age of the age of the edge of the mother,
Speaker 1: age of the woman, advanced age, geriatric womb. We don't
Speaker 1: call that that anymore, Okay, I don't. I'm sure people do. Yeah,
Speaker 1: I think they're probably a handful out there.
Speaker 4: So yeah, So miscarriage is a really important topic I
Speaker 4: think you talk about.
Speaker 10: Yeah.
Speaker 4: The other thing important to know about miscarriage is how
Speaker 4: we manage it, because there's three main ways, like medically,
Speaker 4: that we can manage it. One is called expectant management,
Speaker 4: which basically means you don't do anything, like there's no
Speaker 4: medical intervention and you wait for that tissue to pass
Speaker 4: on its own spontaneously. There's another option, which is a
Speaker 4: medication option, and most of the time there's a combination
Speaker 4: of medicines that are used mesa prostal and mifipristone aka
Speaker 4: abortion medicines, or with a vacuum aspiration or a d
Speaker 4: n C which is a dilation in curetage, which is
Speaker 4: the exact same surgical procedures as are used in quote
Speaker 4: unquote elective abortions. Abortion is health abortion is healthcare. Every
Speaker 4: one of these options, expectant management, medical management, and surgical
Speaker 4: management are all associated with risks and benefits for the individual,
Speaker 4: and in fact, in the data there's no difference in
Speaker 4: like one is more risky, one is less risky. They
Speaker 4: all have risks of bleeding, they have risk of infection,
Speaker 4: and the choice to do one or the other should
Speaker 4: lie only with the person who is pregnant and their
Speaker 4: medical doctor. However, however, because we live currently in the
Speaker 4: United States, especially with all of these abortion restrictions that
Speaker 4: are going into place, this is no longer the case.
Speaker 4: It is now very often the decision between a legal
Speaker 4: team and the hospital administration. You have on when to
Speaker 4: do something about it, on when not to do something
Speaker 4: about it, on when you have to just wait, et cetera,
Speaker 4: et cetera.
Speaker 1: Just around a conference table, someone's making decisions about what
Speaker 1: is happening inside your body.
Speaker 9: Yep.
Speaker 1: I mean you're not involved in that decision. Yep, you
Speaker 1: don't have a seat at the table. Oh gosh, that's
Speaker 1: a lot. Yeah, I thought, do you have any questions
Speaker 1: about that? I have feelings about that. I do too,
Speaker 1: try to think if I have any specific questions. Yeah, okay.
Speaker 1: One question I have is, like you said that, it's
Speaker 1: the risks associated with each of these are more or
Speaker 1: less the same. So then why would why would someone
Speaker 1: opt for one versus another?
Speaker 4: I mean, it's in part personal preference, it's in part two,
Speaker 4: like how far along you might be or if you
Speaker 4: have sort of started to pass that or not. And
Speaker 4: then a lot of it really is personal preference, because
Speaker 4: it's like, are you going to feel more comfortable doing
Speaker 4: this at home where you have maybe support around you,
Speaker 4: or maybe you don't have any support at home. Maybe
Speaker 4: the thought of having to wait a long time because
Speaker 4: you don't know how long it will take to pass
Speaker 4: it on your own is really more traumatic, and so
Speaker 4: having something done where it's over and you know that
Speaker 4: it's done is maybe more appealing to you. So there's
Speaker 4: not like a hard line that like this has to
Speaker 4: be one way or the other.
Speaker 1: Got it.
Speaker 4: Yeah, So let's stop there for now and bring it
Speaker 4: all the way back to the developing embryo.
Speaker 1: Got it? Oh? Just this another prop where we left.
Speaker 4: It's the same prop my tennis ball, This inner cell mass. Okay,
Speaker 4: we're here. So during all of this time and before
Speaker 4: implantation and after implantation starts, what's happening with this inner
Speaker 4: cell mass? I'm going to walk you through really quickly
Speaker 4: embryonic development. And when I say really quickly, I mean
Speaker 4: this is like the most cliff Notes version.
Speaker 2: Right.
Speaker 4: Okay, So we are back now at about two weeks
Speaker 4: post fertilization, week four of pregnancy, Okay, and this little
Speaker 4: pre embryo at this point, this inner cell mass, it's
Speaker 4: a little disk of cells that has formed the three
Speaker 4: essential germ layers that will eventually become all of the
Speaker 4: different tissues and organs in our body. Okay, And then
Speaker 4: these little disks of tissue will form tubes tubes. One
Speaker 4: tube will become our brain and spinal cord. Yeah, the
Speaker 4: other tube will become our.
Speaker 1: Guts, like you. That's two tubes.
Speaker 4: And then after that, a little lump will start to
Speaker 4: form at the top of this tube of cells, and
Speaker 4: that lump will become our head. And then little bumps
Speaker 4: come up along the back and those will eventually become
Speaker 4: our vertebra. By about the sixth week of pregnancy, so
Speaker 4: there's about two weeks after a year missed period potentially
Speaker 4: this embryo it's called an embryo. Now it still does
Speaker 4: not look like a human like at all.
Speaker 1: No, it looks to me very much like the alien
Speaker 1: in alien, I mean like embryonic development. Oh, there's some
Speaker 1: quote and I don't remember who it's by, whether it's
Speaker 1: like Dubjanski or I don't know. So one of those
Speaker 1: old evolutionary biologists that's like everything our entire evolutionary history
Speaker 1: can be traced to ontogeny and like the development of
Speaker 1: and embryo. I'm probably butchering that quote. I mean I
Speaker 1: like it. Yeah, God wish I knew who it was
Speaker 1: by well listen, it wasn't.
Speaker 4: At this point, we look like an alien, Okay, Like
Speaker 4: the head thing is like I'm curved over. There's this
Speaker 4: big long thing that comes off the back, these bumps
Speaker 4: along the back.
Speaker 1: Very reptilian, I'm very artil engines and our evolutionary origins.
Speaker 4: Yeah right, And when you look at like embryo development
Speaker 4: side by side of like all the different species, we
Speaker 4: look all the same, the same, the same, the same
Speaker 4: all the way through this point. But we're not as
Speaker 4: scary as an alien because it's like two millimeters long.
Speaker 1: I'm not as scary as an alien as oh as
Speaker 1: alien as capital a cattal am proper not alien proper noun.
Speaker 4: But at this point too, when we look like alien
Speaker 4: is when things like the eyes what will become the
Speaker 4: eyes start to develop. So you get these two little
Speaker 4: dots that will eventually become our eye cells, the parts
Speaker 4: that will become our jaws and our ears and all
Speaker 4: of this. This is very important patterning that has to
Speaker 4: happen in exactly the right way for all of our
Speaker 4: body parts to actually develop. And at this point too,
Speaker 4: about week six is when you could first detect what
Speaker 4: will become a heartbeat. So this little bulge that will
Speaker 4: become our heart starts to beat, and you can see
Speaker 4: that on ultrasound. It's also when we start to see
Speaker 4: arm and leg buds. The buds, yeah that was loud,
Speaker 4: start to kind of pop out just a little bit.
Speaker 4: And then eventually those limb buds will make paddles first,
Speaker 4: and then little fingers and toe buds. And then by
Speaker 4: the end of the tenth week of pregnancy, so ten
Speaker 4: weeks after your last menstrual period, okay, eight weeks since fertilization,
Speaker 4: got it, okay, is when you start to have something
Speaker 4: that looks more like a human than all of our
Speaker 4: vertebrate cousins. And that is when we are almost to
Speaker 4: the second trimester, and then we enter the.
Speaker 1: Fetal period, the fetal period, fetal period.
Speaker 4: At the same time as this is also when that
Speaker 4: since this your trophoblast that has during this whole time
Speaker 4: been invading its way into the myometrium all the way through,
Speaker 4: it has finally at the same time point finished the
Speaker 4: formation of the placenta, which isn't all the way formed
Speaker 4: until week thirteen, which.
Speaker 1: Is our pregnancy.
Speaker 4: Wild I know, and that is the organ that you
Speaker 4: erin will pick up with next.
Speaker 1: Week, I certainly will. I have a question though, and
Speaker 1: you might be getting into them next week. I probably won't,
Speaker 1: so give them to me. Now. What's going on in
Speaker 1: the pargnive person's body is all next week.
Speaker 4: But I'm so glad you asked because I cannot wait
Speaker 4: to tell you about it. Oh my gosh, it's really
Speaker 4: good because it's already started.
Speaker 1: Yes from Oh, I'm so excited about it. Oh, I
Speaker 1: can't wait. I know.
Speaker 4: I'm also done talking about the fetus. I'm not going
Speaker 4: to mention them again pretty much.
Speaker 1: Okay, well we will and we will do more feetus
Speaker 1: stuff in the future.
Speaker 4: So much feelings about it, and I want to talk
Speaker 4: all about it. But we were talking about pregnancy for this.
Speaker 1: Pregnancy, so there we are there.
Speaker 4: We made it to the end of the first trimester.
Speaker 1: Oh my gosh, Oh my gosh, that went by faster.
Speaker 1: And also we covered so much I know, but we
Speaker 1: didn't cover. We have so much more to cover. I
Speaker 1: have thoughts okay.
Speaker 4: Too, but everyone is going to have more that they
Speaker 4: want to learn, so we're going to tell you where
Speaker 4: to learn it and all of our sources.
Speaker 1: Yes, okay, So for this I actually didn't have as
Speaker 1: many sources as I do for my later episodes. I
Speaker 1: have a few more, but I'm going to shout out
Speaker 1: three in particular. One is the book Pregnancy Test by
Speaker 1: Karen Winegarden, which I referred to in my notes. Also
Speaker 1: A Woman's Right to Know by Jesse Olzinco Grin, and
Speaker 1: then by Sarah Abigail Levitt A Private Little Revolution. It's
Speaker 1: an article about the home pregnancy test. And I really
Speaker 1: liked those three together. I sort of like this big
Speaker 1: picture view of everything that I talked about. Well, I
Speaker 1: loved your whole part, so maybe you want to read this.
Speaker 1: Thank you.
Speaker 4: I realized very heavily on a textbook that's very old
Speaker 4: at this point. It was by Jones and Lopez and
Speaker 4: it was called Human Reproductive Biology.
Speaker 1: So it's like a primer on it all. Is it
Speaker 1: very old? Mean the late twentieth century, as like the youth,
Speaker 1: So it's like, wait, it was the twenty first century.
Speaker 1: It was from twenty thirteen. Ok, It's like ten years.
Speaker 4: Old, but I mean, like that's for textbook is our
Speaker 4: knowledge of this part hasn't changed. But I will also
Speaker 4: say that like it's good for data, but it has
Speaker 4: a lot of weird I don't know editorialization in parts
Speaker 4: of it, so I don't interesting Anyways, I cited it,
Speaker 4: it's what I used primarily. And then a few other
Speaker 4: papers that I think were really important, especially in learning
Speaker 4: about the placental development. If you want more detail on that,
Speaker 4: which you'll get to you next week. But there was
Speaker 4: one from Proceedings of the Royal Society b from twenty
Speaker 4: twenty three called the Human Placenta New Perspectives on its
Speaker 4: Formation and function during early pregnancy. And then there was
Speaker 4: a whole series in The Lancet from twenty twenty one
Speaker 4: all about miscarriage, and my favorite one from that was
Speaker 4: called Miscarriage Matters the Epidimeologie, Physical, Psychological and Economic Costs
Speaker 4: of early pregnancy loss. But there was a few other
Speaker 4: papers in that series as well. But as always, you
Speaker 4: can find all of our sources, because there are so
Speaker 4: many more on our website This podcast will Kill You
Speaker 4: dot Com under the episodes tab. You certainly can this
Speaker 4: and all of our episodes, all of our opos.
Speaker 1: We have literally so many sources it's kind of unbelievable. Yeah,
Speaker 1: proud of us, me too. Thank you again, so so
Speaker 1: much to everyone who provided their first hand account, everyone
Speaker 1: who wrote in with their first hand account. We really
Speaker 1: we don't have the words to express how grateful we are. No,
Speaker 1: it's like so so.
Speaker 4: Meaningful to us, and we could not do especially this
Speaker 4: series without you. So thank you, Thank you.
Speaker 1: Thank you also to Exactly Right Studios and everyone who
Speaker 1: is here.
Speaker 4: You're like looking at the window. It's so exciting, very exciting.
Speaker 4: You to Tom and Leanna who's not here today but
Speaker 4: will be. And I'm saying too much. Thank you, to
Speaker 4: Jessica and to Brent and to Craig and everyone else.
Speaker 1: Yeah, all that. We're so excited about this. It's really
Speaker 1: been so much fun. I feel so cool and feel cool,
Speaker 1: but I'm having a lot of fun. Me too, Yeah,
Speaker 1: me too. So thank you all for all of your work.
Speaker 1: We're excited. Yes, thank you. Thank you to Bloodmobile, who
Speaker 1: provides the music for this episode and all of our episodes,
Speaker 1: and thank you to you listeners yeah, and viewers, to viewers. Yeah, amazing.
Speaker 4: We hope you had fun with this one and you're
Speaker 4: prepared for three more episodes on pregnancy.
Speaker 1: Yeah, I hope you like more where this is coming from,
Speaker 1: because we've got it. I don't know, make that sentence
Speaker 1: didn't make sense. It's fine, you know what. And thank
Speaker 1: you to our patrons. We really do appreciate your support.
Speaker 1: It means the world to us, it really does. Thank you. Well,
Speaker 1: until next time, wash your hands, filthy animals
Speaker 7: MU