Ep 168 Pregnancy: Act 1

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
We want to start with a disclaimer that throughout this series,
we feature explanations and stories that include some heavy material,
including early pregnancy, loss, still birth, and other traumatic experiences
of pregnancy, childbirth, and the postpartum period.

Speaker 2 (00:17):
It was the morning and my son's fourth birthday party,
and I was feeling just not like myself. I was
really tired, which is pretty abnormal for me, especially in
the morning time, and my breasts were pretty tender, and
I was feeling a little nauseous. So I started doing
the math in my head, just thinking about, you know,
when I could have possibly became pregnant if that is

(00:41):
the case. And I started doing the math, and my
husband's a pilots, so I know exactly when he's home
and the days that we've had sex. And that's when
I was like, wow, I could be pregnant right now.
And it was only four weeks so I was due
to get my ministress cycle that so it was very early.

(01:02):
So I asked him to go to the store because
we needed to get ice for the birthday party and
pick up the cake. So I said, hey, while you're there,
can you go get a pregnancy test? And he was like, okay,
you know if that's what you need, then that's what
you need. So remember he came home, he was putting
the drinks in the cooler, and I went into the

(01:25):
spare bathroom and I took the pregnancy test and it
came up right away that I was pregnant. And in
that moment, I had just this realization of wow, like
I'm having another baby. And I went outside and I
told my husband that I was pregnant, and we were

(01:46):
so excited and we're like, wow, we're really doing this.
And it was really neat because this whole party that
we had there, we probably had about thirty people with
kids and parents, and we were the only two people
that knew in that moment that I was pregnant, and
it felt really special. But then after the party was

(02:07):
pretty died down, us and a couple other family friends,
we're all sitting by a fire that we had in
our backyard, a little campfire, and there was a baby there.
And my son had a really good friend and he
had just his mom had just had his baby sister,
who was about two weeks old, and so I'm looking

(02:28):
at this baby that's sitting in front of me, and
I started doing the math in my head again just
counting the months. You know, if I'm pregnant and this
pregnancy is viable and we ended up having this baby,
this baby would be born in August before school starts,
and that means that this baby is going to be
in the same grade as that baby that's sitting right

(02:49):
in front of me. This baby that I just have
found out i'm pregnant with is going to grow up
with that little girl that's sitting in front of me.
And that blew my mind that I was going to
grow a whole human in.

Speaker 1 (03:02):
This school year.

Speaker 2 (03:04):
And so fast forward seven years later, and these two
children are now in the same grade. Sometimes they're in
the same class, and they are growing up together, and
it's just something that's fun to think back on.

Speaker 1 (03:23):
My name is Kenny.

Speaker 3 (03:23):
I'm thirty four from New Zealand and five years ago
I work up with pain in my right lowerbellion vomiting.
I took a pregnancy test and it was positive. Well
followed was the scariest two days of my life, during
which they found an ectopic pregnancy on ultrasound. By the
end of two days, I had pain in my right
shoulder tip, but no abdominal pain as an emergency nurse,

(03:46):
I know that shelder tip pain can be a type
of referred pain indicating diaphragmatic irritation from blood in the
peritoneal cavity. The obg way in on call decided that
my lack of abdominal pain meant that I could go
home and wait for suon. All I could think of
was a case I had treated a few months prior
in my emergency department. She had a ruptured ectopic pregnancy

(04:09):
and we'd poured blood into a rushia to surgery and
she nearly died. That case and my knowledge about the
importance of shoulder tap pain led me to advocate for
myself strongly. I put my foot down and refused to leave.
An hour later, I was in surgery, and an hour
after that they called my partner to say my left
filopian tube was completely blocked and there was blood in

(04:29):
my belly. If I had gone home, there is a
very real chance that would have burst completely and I
could have died. Being an emergency nurse and an advocate
for myself saved my life. Losing a filopian tube was
really hard mentally until I learned the biggest health lesson
I ever have. I can't believe I'd got through so
many anatomy classes without knowing this. But your filopian tubes

(04:51):
aren't fixed, although that's how the textbox show them. They
can reach out and move and grab eggs. Six months
post ectopic and I got pregnant again, and all of
the anxiety came back, but I was very lucky. Nine
months later we welcomed our beautiful son, and another year
and a half later our second son. My other two
pregnancies and births had their own challenges, but I'll never

(05:14):
forget my first, wondering what could have been for that pregnancy,
what could have happened if I wasn't my best advocate,
And I think about my experience every time I go
to work and my own emergency department and treat potentially topics.
It made me a better nurse, a better patient advocate,
and I'm so grateful for my two boys who managed
to find their way to my uterus instead of my

(05:35):
one remaining tube.

Speaker 1 (06:22):
Thank you also so very much for sharing your story
with us, and a huge thank you to everyone who
has written in with their experiences like we read each
and every single one of them, and the hundreds of submissions,
many and We're so grateful and honored that you felt
like you could share those experiences with us, and we

(06:42):
tried to include as many of your stories as possible,
and you'll hear more of these first ten accounts throughout
this episode and the rest of our episodes.

Speaker 4 (06:49):
Yeah, it was honestly such a privilege to be able
to read every one of your stories and hear so
many of your stories, and as many as we included,
there were so many more that we were not able
to So we thank you again from the bottom of
our hearts for sharing your stories with us.

Speaker 1 (07:04):
Yeah, thank you, thank you. Hi. I'm Erin Welsh and
I'm erin Alman Updight and this is this podcast will kill.

Speaker 4 (07:11):
You, and we're coming to you today with the first
of four episodes all about pregnancy.

Speaker 1 (07:18):
Four just four, just four should have been more, I know, really.

Speaker 4 (07:21):
And we're also coming to you from the exactly right
studios for the first time, which is nerve wracking and exciting,
I know.

Speaker 1 (07:28):
But this space is so cool. We get to decorate
our little bookshelves. I feel very fancy right now, very fancy,
too fancy for our real lives. I mean, for sure,
very very different than my tiny little office I know.

Speaker 4 (07:42):
Or my closet literally, So we're super excited to be here,
yes we are.

Speaker 1 (07:48):
We're really really excited about this series, yes for sure.
And before we get into this episode, we want to
share a few words about what these four episodes will cover,
the language that we'll be using, and our goals really
with creating the series. And so we decided early on
to dedicate four episodes to cover pregnancy, just four sure,

(08:08):
one for each trimester. And at the outset, I mean,
we knew that we wouldn't be able to adequately cover
every single aspect of pregnancy and childbirth and the postpartum
period in just four episodes, right and throughout our research,
we did begin jotting down a list of future topics
to cover things like pre acclampsia and breastfeeding and Reese's factor,

(08:29):
and so there will be more episodes on these and
more topics in the future.

Speaker 4 (08:34):
Exactly So, this series might not, and it likely will
not answer all of your questions about pregnancy or cover
every experience that a person might have. Pregnancy is a
very individual experience, as highlighted in so many of our
first hand accounts. But what we aim to do with
the series is take you through the really broad changes

(08:57):
that happen in our human bodies during pregnancy and childbirth
and postpartum, and also explore some of the historical and
evolutionary aspects.

Speaker 1 (09:08):
Really excited about that.

Speaker 4 (09:09):
Aaron of pregnancy and childbirth. So each episode very roughly
corresponds to each trimester. So in this episode, the first one,
we're going to be talking about how you even know
whether or not you're pregnant?

Speaker 1 (09:22):
Yeah, how do you do? How do you know?

Speaker 4 (09:24):
And what's happening in very very early embryonic development.

Speaker 1 (09:28):
And then our second episode centers on the amazing organ
that is the placenta. It's really cool. I think we'll
all leave with a little more appreciation for the placenta,
I hope, So that's my goal, and some of the
physiological changes that a person experiences throughout pregnancy, including some
of the complications that can arise, right.

Speaker 4 (09:46):
And then our third episode is going to focus on
childbirth itself, so labor and different modes of delivery, and
then the history of the cesarean section.

Speaker 5 (09:55):
Yeah yeah, yeah yeah.

Speaker 1 (09:59):
And then finally our fourth episode and our season finale,
our season seven season finale. That's crazy, I know, it's exciting,
It is really exciting. Yeah, But the last episode in
the series will be about this concept of the fourth trimester,
like maybe you've heard of it, maybe you haven't, What
is it. We'll get into all of that and explore
the changes that happen in your body after pregnancy, and

(10:22):
we'll also be talking like big picture history about the
medicalization of pregnancy and childbirth, including the transition from home
to hospital.

Speaker 4 (10:30):
Yeah, we intend for all of these episodes to be
inclusive of all families, and we recognize that not everyone
who experiences pregnancy actually identifies as a woman, so we
try as much as we can wherever we can to
use gender neutral language like pregnant person, and that's what
you'll mostly hear through this episode. However, at the same time,

(10:51):
we know that much of what we discuss when it
comes to medical bias during pregnancy and childbirth, both historically
and today, is in fact the result of gender discrimination
as well as racism, and so in those context we
may also use the term woman or women, and throughout
these episodes we'll be using the term mother or maternal
and paternal as these are terms that are used in
the scientific and medical literature.

Speaker 1 (11:12):
Yeah, and we also want to acknowledge that there is
no such thing as a normal pregnancy. Yeah, like they're
just there isn't one. But we do want to provide
a baseline of the expected physiological and anatomical changes that
occur during pregnancy, as it helps us to understand where
these complications arise from and what is a complication?

Speaker 4 (11:34):
Right right, Yeah, So we will get into all of
that starting with the first trimester.

Speaker 1 (11:39):
But first, but first, it's quarantiny time. It is Aaron,
what are we drinking this? And the next four weeks
we are drinking great Expectations. I love I love this name.
It's a really good name. It's a good name act
we think, and we're also making that this is a
plasyber read for reasons that probably are clear too. I

(12:01):
would thank you for listening, Like it's not an alcoholic,
it's not aholic. That means yep, it is And Aaron,
what is what is in cred.

Speaker 4 (12:09):
Expectations really delicious combination of BlackBerry, gindreal, lemon and mint.
And if you check out the exactly Rights YouTube channel,
you will find a video of us making that drink,
as well as a super secret surprise quarantine coming to us.

Speaker 1 (12:27):
From no one other than Georgia Hartstark herself. That was
the secret. Oh sorry, perfect, Go check it out. It's
gonna be great. It's gonna be great. Gosh, I'm so excited,
beyond trilling, I know it really is very excited about it,
and so yeah. To get the recipes for our quarantini
and plasy berita for this episode and all of our episodes,

(12:50):
actually check out our make sure you're following us on
social media, and you can also find those on our website,
the podcast will kill You dot com. You can over
to you erin to tell me it's on the website.
I don't have to do. Let me tell you what's
on our website. We have so much information there, Aaron.

Speaker 4 (13:06):
We have merch we have oh translusted already, we have transfers,
We've got good Reads list, we've got a link to Bloodmobile.
We've got all of the sources from all of our episodes.

Speaker 1 (13:20):
Contact us, contact us form a first hand account form.
We've got a lot, You've got a lot. There's so much,
but there's so much. One last piece of business, yes,
one last piece of business is okay, So I am
super excited to announce that I have started a new
hosting role at another podcast. We're really excited for her.
She's not leaving. I'm not leaving. No. So this this

(13:42):
podcast is called Advances and Care and in it, I
interview physicians and physicians scientists at New York Presbyterian Hospital
about their incredible cutting edge research and groundbreaking medical innovations.
It's really it's really thrilling, very exciting stuff. I mean,
it actually is, and it's like really fun to actually
get to read about, like, oh, this is someone who's

(14:02):
working on this right right now.

Speaker 4 (14:04):
In real life, in real time, these things that is
actually making a difference in people's lives.

Speaker 1 (14:10):
Yeah, it's reahly cool. It's been such a fun project
to work on. And if you want to learn more
about the research that's truly shaping the future of medicine,
this podcast is for you. Again, it's called Advances and
Care and you can get it wherever you get your podcasts. Yeah,
check it out. Yeah, check it out. I don't have
any business. I think that's it. Yeah, shall we? I

(14:30):
think we shall.

Speaker 4 (14:31):
Okay, we'll take a break and then get into the
history of pregnancy.

Speaker 1 (14:38):
Sure, something like that.

Speaker 6 (14:56):
Entered my second trimester of my pregnancy. I started having
really intense pain in my abdomen and in my legs
and in my hips, and it kind of rendered me
almost completely unable to take part in any kind of
physical activity or exercise, and even walking became increasingly uncomfortable.
And I really started to notice as I got bigger

(15:17):
that my baby was really crowded to one side of
my belly, and I seemed to be protruding far further
forward than any other woman that I saw that it
was at the same stage as me. And when I
brought those concerns to my ob it was kind of
laughed off. Isn't that so funny when a baby prefers
one side over the other and no further exams or

(15:38):
tests were ordered to kind of check out what was
going on. So I managed through the rest of that
increasingly uncomfortable pregnancy, and then I went into labor three
weeks prior to my due date. It was very fast,
very intense labor. I started having contractions at about nine PM.
I was at the hospital at one thirty in the morning.

(15:59):
And then and in my first cervical exams, the doctors
found that I was only two or three centimeters dilated,
and they really treated me as such, kind of put
me on the last of the lists for an epidural
request because I was a woman who was clearly not
close to being ready to push, and so I was

(16:20):
in this very extremely painful and uncomfortable state for an
hour and a half while I waited for an epidural.
Once they got that epidural in, they were able to
perform a more thorough exam as I was more relaxed,
and they found that I had a blockage in front
of my cervix, and behind that blockage, I was fully effaced,

(16:40):
fully dilated, and actively pushing to get this baby out.
So I was rushed in for an emergency C section,
and my daughter came out just find distressed but fine,
And they held up my uterus and found that I
had what's called a bicorneate uterus, which is when the
memo brain that is formed when your uterus is being

(17:03):
formed doesn't disintegrate and basically leads to you having two
halves of a uterus. And so I was growing a
baby in a half of a uterus and then trying
to give birth in a through a cervix that was
blocked by another cervix, and so while I've healed from

(17:25):
that experience, I'm also left wondering why wasn't that found
and discovered not only during pregnancy, but also prior to pregnancy,
and what kind of implications does it mean for a
future pregnancy. Thank you so much for allowing me to
tell my story.

Speaker 2 (17:45):
Hi.

Speaker 7 (17:45):
My name is Stevie, my pronouns are they them, and
I live in Ontario, Canada. In twenty twelve, my husband
and I were extremely excited to be expecting our first child.
At ten weeks, we had started seeing an ob. I'd
been spotting off and on, but he kept saying that
everything was fine, and what bleeding isn't normal? It is common,
and don't worry. He said the same thing at every appointment.
It's not normal, but it's common. Don't worry, Everything's fine.

(18:06):
At eighteen weeks he sent me to a specialist. I
wasn't expecting it to be a big deal. After all,
everything was fine, right.

Speaker 1 (18:12):
I was wrong.

Speaker 7 (18:13):
I was blown away by the list of issues and
complications being laid in front of me. The only thing
I really remember is that I was at a high
risk for pre term labor. About a week later, at work,
I set up to get something and felt a gush.
I reached down and my fingers came up red. I
was hemorrhaging. Had a friend drive me to the er.
My husband met me there and we waited. I was
told that if I was miscarrying, I'd have to stay
down in the er. I was too early to go

(18:34):
up to labor and delivery. The ultrasound showed a good heartbeat, though,
and bleeding slowed down, so I was sent home on
bed rest. Around one am on November eleventh, I woke
up and vomited. I had an intense cramping in my stomach,
in my back. I told my husband something was wrong.
We went back to the er. The ob said I
was in labor and it can be triggered by dehydration.
So I was given an IV and it stopped. I
was moved to a room and told I was staying

(18:56):
there until I delivered, whenever that was. But at under
twenty four weeks, there was really no hope for the baby.
On November fourteenth, at twenty one weeks and four days,
I went into labor. This time it didn't stop. Our
daughter was delivered at one twenty six in the afternoon.
She weighed exactly one pound. Our families were there and
we sang her Happy birthday. She lived for three hours.
During that short time, she knew nothing but love. We

(19:18):
all held her and sang to her. She took her
last breath with me. That night, my husband and I
went to sleep in the postpartu ward to the sound
of other people's babies crying. The specialist never found a
reason for our loss. She said it was probably a
placental abruption, but she really wasn't sure. We went on
to have two more pregnancies, and we have another daughter
and a son. We have pictures of our firstborn, and

(19:39):
she's very much part of our lives. Our other kids
say they see her when they see the first stars
come out at night. As I always say, she's our
perfect girl, made of stars. I share our stories often
as I can. Pregnancy and infant loss affects one in
four pregnancies and is not discussed enough. I felt so
alone after our loss. Every year on her birthday, I
share our story and new people will share their own

(19:59):
stories with me. I hope that sharing my story here
will help people to feel less alone. Our loss should
not be hidden. We shouldn't have to grieve in silence.

Speaker 1 (20:32):
If you search for a list of the top medical
advancements in history, you might find on that list things
like antibiotics, vaccines, gene editing, medical imaging, kidney dialysis, organ transplantation,
the manufacture of insulin, and anesthesia for a start. It's
a long list, a long list. I couldn't stop once
I started. Yeah, but I would be shocked if you

(20:55):
found home pregnancy tests on one of those lists. No,
I don't think I wouldn't. You wouldn't have expected it. Yeah,
And I know this because I've often skimmed these kinds
of lists looking for inspiration for future episode topics. A
lot of those are on our list, I'm really true. Yeah,
kidney dialysis, we need to do that, I know, and
so many I know. But I've never seen home pregnancy

(21:17):
tests mentioned. I don't think so, And to a degree,
I get it right, Like, these tests didn't provide new
avenues for treatment, nor did they represent a paradigm shift
in how we understood the workings of the human body.
But I would argue that these sticks and the plastic
rectangular boxes that preceded them absolutely deserve a place on

(21:38):
any list of significant medical breakthroughs.

Speaker 4 (21:40):
I'm already just so invested in this Errand I mean.

Speaker 1 (21:43):
Are you convinced yes, so I can stop? Yeah? Done, Okay, done,
They're on the list. But the reason I feel so
strongly about this is because of the type of knowledge
that they grant us. Not guiding principles, not laws of nature.
Home pregnancy tests give us deeply personal knowledge about our
own bodies, empowering us to do with that knowledge what

(22:07):
we decide we want or need to do, share it,
keep it to yourself. For the first time, that choice
was up to the test taker. They were the first
to know, not the lab technician running the test, not
the frog being tested. More on that way, Not the
doctor who deigned to prescribe a test, oh yeah, prescription

(22:27):
only okay, yeah. The transfer of this knowledge out of
the hands of the medical provider and into the hands
of the test taker held profound implications for women's reproductive rights.
Of course, probably no one needs to be reminded that
what you decide to do in terms of continuing with
the pregnancy or not is not always up to the
pregnant person alone. Yep, especially not in the United States. Nope.

(22:50):
But the story that I want to tell today is
about the quest for this knowledge, like what ultimately led
us to the near universally recognizable stick that shows one
or two blue lines, and where we might go from here.
I'm sorry, Okay, For thousands of years, people have searched

(23:10):
for a way of knowing whether someone was pregnant or
not outside of like the bodily signs like morning sickness,
missed periods, tender breasts, and quickening the fetus' first movement,
which was considered like really one of the most significant
signs in terms of like that is when a pregnancy
became real just quickening. Yeah, And I won't speculate on

(23:31):
why there was a need or a want to know,
whether it came from within someone wanting help understanding what
their body was trying to tell them, or whether it
came from without, like someone wanting to know whether their partner,
of their friend, their daughter was telling the truth. And
I'm sure there were many reasons for a test right right,
that you would want to test. The first pregnancy test

(23:52):
comes to us all the way from an ancient Egyptian papyrus.
Stop it, I know.

Speaker 4 (23:57):
How can you pull ancient egypt out when we're talking
about pregnancy.

Speaker 1 (24:00):
T you know, I thought, okay, what, like, what of
my usual go tos are ancient Egypt Apocrates germ theory
like things. I feel like I have to mention the humors.
I think the humors is the only one. I don't
mention any of these shoggings I know, But yeah, ancient
Egypt pregnancy tests. Stop it. Thirteen fifty BCE there was
a like a papyrus or something that instructed women to

(24:22):
pee in two bags. One bag contained wheat, one bag
contained barley. Okay, if the wheat grew, it meant a
female child. If the barley grew, it meant a male child.
Why does this feel vaguely familiar? I think we might
have talked about it in our IVF episode part one. Okay, yeah, okay,
yeah weird, But I don't remember if I like dug

(24:43):
any deeper because I did this time. And it turns
out that some researchers tested this like a two decades ago,
and yeah, it's like not it's like not great, but
it's not entirely incorrect, Like is it more than fifty percent? Yeah?
Seventy percent? Really, I know, there's no association with like
the sex of the fetus, just like whether or not

(25:05):
you are pregnant. Yeah, so it's like growth hormones in urine, yeah,
P in your p.

Speaker 4 (25:11):
It's interesting that even the first test was p.

Speaker 1 (25:14):
P has always been a main feature. Really, I think
it's really it's it's fascinating. Yeah, And I don't know
like where that like how people made that connection. And
so in for instance, like in medieval England, there was
a profession called a piss profit. This profit can you

(25:36):
imagine being like on your business cardfit official assistant, piss
profit assistance too that this profit yeah, Prentice far Up,
I can't. Oh my god, that's great. Yeah, okay, And
what did a piss profit do? I mean it basically
what it sounds, okay, right, like you be able to
hold up the like the urine and the glass and

(25:57):
be like, oh, this person has this disease. That it
was more than just pregnancy. It was like lots of things, okay,
I mean horoscope even probably a lot of things you
can see in your peace. So I gets exactly. So
there is some basis to them. So some piss profits
claimed that I know I keep saying, claimed that deposits
of white, flaky material in urine that had been left

(26:19):
standing for a couple of days could indicate pregnancy, so
the deposit may have been casin. Okay is how you
say it. I mean casin is a thing. Casine like
a protein, yeah think, which is as part of breast
milk produced during pregnancy. Ah yeah, okay. Yeah. Urine did
briefly fall out of favor in the eighteenth and nineteenth
centuries for pregnancy testing, and instead physicians performed physical exams

(26:44):
to determine whether or not someone was pregnant. Although I
know that doesn't sound great. It doesn't sound great, and
the doctors were like, as is typical, would be so
afraid of modesty and so it would just be like
kind of just closing their eyes and like searching, and
it's yeah, it's not great to think about, okay. But
these signs often included things like changes in the color

(27:06):
of the cervix, vagina labia, softening of the cervix, changes
in breasts or nipples, changes in the abdomen, things that
typically happened after at least two missed periods. Okay, but
these were by no means telltale signs of pregnancy, and
doctors usually advised to just give it time, give it time,
wait for the quickening, then you'll know. And in fact,

(27:27):
until the twentieth century rolled around, because there was no single,
one hundred percent reliable way of determining pregnancy from an
outside perspective, which is mind blowing to think about. Yeah,
doctors usually took their patients for it. Huh yeah, okay,
because they believed them. I believed that. Wow. Then once
the lab based pregnancy test came about, that word slowly

(27:50):
held less and less weight in the eyes of medicine.
And these tests, these lab based tests also made it
easier to prosecute someone for abortion because you had proof
of early pregnancy, even if you couldn't distinguish between abortion
and pregnancy loss. Oh wow, that's interesting and horrible and horrible. Okay,
so how did these tests come about? Science has never

(28:12):
followed a straight line of progress, and lad pregnancy tests
are no exception. But to keep things streamlined for today,
I'm sticking to the major steps along the journey. And
if you want that extra nuanced, check out the books
A Woman's Right to Know by Jesse Olzinco Grinn and
A Pregnancy Test by Karen Wengarten. In the first couple
of decades of the twentieth century, the field of endochronology,

(28:33):
which is a study of hormones, took off in full force.
Researchers investigated how adrenaline worked, what insulin did, which hormones
fluctuated during pregnancy, and other endochronology related questions. There were
a million of them. Finding the answers to some of
these questions like which hormone is excreted in urine and
people who are pregnant before they even realize they are pregnant,

(28:54):
led them to even more questions like what would happen
if we injected some of this urine into immature female mice.
That's a normal question. It's a normal question, And that
pretty much sums up how the first lab pregnancy test
came to be Oh really really In nineteen twenty seven,

(29:15):
two researchers Asheim and Zondek, who gave their names to
this test, developed a protocol where they would take urine
from a possibly pregnant person injected into five immature female
mice twice a day for three days. Whoa kill the
mice and then take a peek at their ovaries? Sorry, okay, yeah?
Is this okay? Have so many questions.

Speaker 4 (29:37):
I know, is it like, are they having to pee
multiple days for this twice a day, three times a
day or like once a sam question? Okay, too detailed.

Speaker 1 (29:46):
My guess is it was just one sample, okay. And
then there so this is taking many days. It's taking
many days. Yeah, and like five five mices, Simon and
I said, yeah, yeah, it's a process. Yeah. And then
once they once they cut the mice open to look
at their ovaries, if those ovaries were enlarged and congested,
it meant that the.

Speaker 4 (30:05):
Pro was pregnant then, I mean makes sense physiologically, but okay,
very interesting.

Speaker 1 (30:11):
Yeah, yeah. So, and what these animals were responding to
was a hormone in the urine called hCG hCG human
choonic ganada tropin that was vening really yeah. Initially researchers
thought it was produced in the pituitary gland, but physician
scientists Georgiana Seagar Jones correctly identified its origin as the

(30:33):
uterus and gave it its name in nineteen forty five.

Speaker 4 (30:36):
Wow, Okay, nineteen forty five is when hCG was named
HG Yeah, and found to be from the uterus, and
eventually rabbits replaced mice because you could get a result
faster and you didn't have to use as many animals.

Speaker 1 (30:50):
Gosh, the phrase the rabbit died. Have you ever heard
of this? No, it's used. I feel like I've been
rewatching mad men and there's another part of mad I've
thinking a lot about mad men and pregnancy. But that
is a euphemism that was commonly used to be like,
did that mean that you were pregnant or weren't that
you were pregnant? But it doesn't really make sense because

(31:11):
they killed all around it. Yeah, okay, yeah, weird, I know, Okay,
but I do find it it's interesting that there was
a euphemism because pregnancy wasn't really something that was discussed
out loud very much in like until the middle of
the twentieth century at the earliest. Really, yeah, it was
kind of just not like taboo, but it was in
hush terms euphemisms. Yeah, exactly. But these tests, the Asheims

(31:35):
on Deck test and the Freedman test, which is what
the rabbit one was called, delivered pretty accurate results, but
they did come with limitations. So, for one, the urine
was often about seven percent of the time toxic. Oh
so then it would kill the it would kill Yeah.
Maybe that's where it comes from and it had to
be treated otherwise it would kill the rabbit just outright. Yeah.

(31:56):
And the second was that the animals were expensive to keep.
Animal welfare didn't seem like a pressing concern at the time,
but cost was. Unfortunately, a cheaper animal was available, the
African claud frog. Oh, they're so cute. They're very cute,
aren't they also known as the African claud toad. Is

(32:17):
it a frog or toad? I don't know. I'm pretty
sure it's a frog. Yeah, it's a scientific name Zinopus
leave us. Okay, but I don't know. But it only
happens to ovulate in the presence of a male frog
or or in the presence of a HGG.

Speaker 4 (32:30):
So then with these, did you just have to like
squirt it on top because they just diffuse through their
skin essentially?

Speaker 1 (32:36):
Okay, Yeah, So in nineteen thirty three, researchers Shapiro and
Swarnstein discovered that yeah, if you just sort of sprinkle urine,
well I don't.

Speaker 5 (32:43):
Know if it was actually sprinkling, like if you exposed,
we'll say that, Yeah, you're in from a pregnant person
to these frogs, and you could induce ovulation in the
frog eight to twelve hours later.

Speaker 4 (32:54):
And then so that's much quicker, much quicker. And do
you have to kill the frog or no? Nope, can
you we use that frog?

Speaker 1 (33:01):
I think you can. I think you just would not
like like have to give it like a wash up
period exactly. Okay, yeah, okay. And so soon labs around
the world began importing these frogs for pregnancy testing. Wow,
and guess what may have hitched a ride Kittrid Kittrid
stop it? Yeah this, How did we not talk about
this in our kitchriend that we may have aaron that

(33:23):
was like seven years ago? Wait? Uh yeah, So and
if for those of you who haven't heard of kittrid
or haven't listened to our Kittrid episode, Kittrid is a
type of fungus that is absolutely deadly, like devastating in
some species of ad populations of frogs, like extinction in
the wild the thing. Yeah, but researcher. Some researchers think

(33:44):
that the widespread distribution of these African Claude frogs for
pregnancy testing may have led to the global spread of Kittrid.

Speaker 4 (33:51):
I kind of hope that we actually did cover this
and I have completely forgotten.

Speaker 1 (33:55):
No, it's I feel I feel like we did. We might.
I don't know those it sounded vaguely familiar. But or
is it like one of those where it's a memory
and then it becomes or it's a new thing, it
becomes a memory.

Speaker 4 (34:08):
Yeah, on manufactured memory exactly. Wow, Okay, that's really interesting. Yeah,
they're dated to back it up, or it's just like
a guess.

Speaker 1 (34:16):
Oh funny you should ask. One of the earliest identified
specimens of captured infection is from one of these frogs
in nineteen thirty eight. Wow, nineteen thirty eight. Yeah, okay, okay,
that wild? Yeah was wild. But so anyway, the frogs
were an improvement from like the rabbits and the mice.
But do you know what would be even better if
you didn't need to kill an animal or exact yeah,

(34:38):
or or keep the animal is so expensive? Yeah. But
the first of these dreamed of tests was developed in
the late nineteen fifties, and it was an immuno assay
that detected hCG. With these tests, especially as specificity increased
and false positive decrease with later improvements, researchers could decrease
turnaround time as well as cost, and that ultimately resulted

(35:00):
in more people utilizing these tests, but probably not as
many as you think. Getting a pregnancy test was by
no means a typical part of any pregnancy throughout the
nineteen fifties and the nineteen sixties, and in fact most
people didn't get tested.

Speaker 5 (35:15):
Why.

Speaker 1 (35:16):
First of all, access, If you wanted a pregnancy test,
you had to make a doctor's appointment and get a
prescription for a test, at least in the US.

Speaker 4 (35:24):
Even after they moved away from these animal assays, like
just to the IMO assay ones.

Speaker 1 (35:28):
Yeah, everything was prescription, yeah okay, And then you had
to wait weeks to hear the results from the doctor
and you're like, oh, I already have missed like three
periods by now, so I know, yeah, okay, I think,
I think, I know. Yeah. These things cost time and money, right,
And Second of all, stigma. Some doctors refused to test
certain people to prevent them from getting an abortion, and

(35:49):
so they would withhold that information until it was too late.
They would say, well, if you want a test, I'm
worried about what you're going to do with those results.

Speaker 4 (35:55):
Oh, my god, I hate that so much, and I
wish that it surprised me more.

Speaker 1 (35:59):
I know, I know, or they would tell husband first
so that he could make a decision. I didn't know
I was going to get livid this early in the series. Sorry,
it's just get ready, strap in strapped. There was stigma
attached to wanting to find out if you were pregnant
before you started showing these quote unquote natural signs, interesting

(36:20):
because it suggested you had anxiety about the pregnancy or
about the father. If you were married, forget about it.
Your reputation would never recover what often yeah.

Speaker 4 (36:29):
Just for like wanting to know this information. Then people
assumed that you were up to something often yeah wow.

Speaker 1 (36:36):
The nineteen sixty six Better Homes and Gardens Baby book
said that pregnancy tests quote there is no need for one.
Yeah wow. And it's hard not to see this is
just another way to control women and the choices, right.
This is this is knowledge that should not that does
not belong to It doesn't belong to you. Yeah no.
And the introduction of the home pregnancy test in the

(36:57):
nineteen seventies it didn't immediately erase stigma, but it did
make testing an option or at least more of an
option for the people who where previously it wasn't who
saw this need and did something about it, someone who
could make money off it. Actually no, oh, okay, I
know pleasantly sy There was a woman by the name

(37:18):
of Margaret or Meg Crane. Okay, So, one day in
nineteen sixty seven, the twenty six year old Crane was
walking through the offices of organ On which sounds made up,
a pharmaceutical company where she worked as a freelance graphic designer,
and something caught her eye. One of the rooms as
she walked past, was filled with a bunch of test
tubes hanging in some sort of bizarre contraption, and she

(37:40):
asked her colleague, like, well, what's going on in there?
It turns out they were pregnancy tests. Crane listened as
her colleague explained how they work, and she thought to herself,
this sounds pretty simple, Like why can't we do this
ourselves at home? And this thought followed Crane around and
she found herself in her spare time des a home
pregnancy test prototype. As a graphic designer. She's like, I

(38:04):
can do this.

Speaker 8 (38:04):
I was like, love, but this is not that hard.
We should be able to do it, like it's hard,
that's perfect, thank you. But yeah, she didn't do it
because her boss asked her to do it. She just
knew how revolutionary it could be.

Speaker 1 (38:18):
She saw the potential and what a change it would make,
and in fact, when she showed her boss her design,
he scoffed. But when a male employee later suggested a
home pregnancy test, the option seemed more appealing. So a
few weeks later, Crane walked into work to find a
big meeting taking place, and she was like, what's going
on in there? Turns out it was a meeting to

(38:40):
discuss different home pregnancy test designs, so she crashed the
meeting put her design on the table with all the others,
which all of which were designed by men. One had
rhinestone edging, one had a cute little tassel, all were
pink except Cranes, but Cranes was the only one to

(39:02):
include a urine collection cup. Oh my god, are you serious.

Speaker 4 (39:05):
Yeah, we've got the rhinestones, but not the collection cup.

Speaker 1 (39:10):
Would we use a mug exactly? So someone's like what
And one of the other designers was like, yeah, I
just I just figured And then they're like, and what
do you do with that? Afterwards? I love this story erin,
I know, I know, and so Cranes. Because of this,
and because of the other practical aspects of its design,
was considered the winning model. And so let me paint

(39:31):
you a picture please. A hard, clear, rectangular box made
of two pieces that joined in the center. Inside the
box was a dropper and a test tube that contained
dried rabbit antibodies and sheep blood. So you collect some
urine into the top half of the box, add a
few drops to the test tube along with some tap water,
and then you waited for two hours much better than

(39:53):
two weeks, with the test tube sitting in the bottom
half of the box. And that had a mirror. It's like,
it's complicated. Yeah. Yeah. If you were pregnant, a red
brown ring like a doughnut would form in the bottom
of the tube, reflected by the mirror. No donut meant
no pregnant. Oh no pregnant, Yeah, no donut, no pregnant. Okay,

(40:13):
well that is really complicated. It's really complicated, but it's
also something that is like it was you can do
very much. Yeah right, it was very similar.

Speaker 4 (40:21):
To not that much harder than like COVID tests or
you're like, oh yeah, I swap this, and I mid this,
and I drop her this, and I.

Speaker 1 (40:27):
Yeah, I'm something of a myself. Yeah uh yeah. Also,
I just want on a cute little side notes. So
Crane met her future husband at that meeting. He I
think was the one who was like, this design is
clearly the best good, not like I produced the rhinestone one.
No no, no uh. And eventually they opened their own

(40:48):
ad agency where she was the head designer and he
was a copy cheese. Oh so cute. But with Crane's
design in hand, Organons sought to get this test to market,
Facing heavy opposition in the US. Was it reliable enough?
What would women do with this information? Organon instead turned
to Canada, where, unlike the US, you did not have
to have a prescription to get a pregnancy test, and

(41:10):
you could just take one at the pharmacy without a
doctor's appointment. Okay, unbelievable, I mean totally believable. By summer
of nineteen seventy one, Predictor, which is Organon's home pregnancy test,
was on the shelves in Canadian drug stores for five
dollars and fifty cents. Which is about the same price
as a BRA and a little less expensive than a

(41:30):
lab test. Okay, just to get it, yeah, protexted.

Speaker 9 (41:34):
Yep.

Speaker 1 (41:35):
Not everyone was a fan of the lab test. So
one pharmacist in British Columbia named Bob no last name
that I could detect, said that he wouldn't be stalking
them because he quote didn't think women could be trusted
to accurately obtain results. Okay, Bob, thanks Bob, we can't
or piano cup come on, yep geez. Others described it

(41:58):
as a passing fad. Oh questions. Yeah, but the market
didn't lie. The test flew off the shelves and it
quickly sold out, and with such a successful launch in Canada,
other countries' approval wasn't too far behind. Home pregnancy tests
became available in many places around the world by the
end of the nineteen seventies. In the US, the FDA

(42:18):
approved the test in nineteen seventy six, and they hit
the shelves in nineteen seventy seven. Wow. One of the
earliest ads for these tests, the EPT in Home Early
Pregnancy Test, described it as quote a private, little revolution
any woman can easily buy at her drug store, I
love it. Yeah. Early TV ads ended with time is

(42:39):
on your side at last. The tone from these ads
reflect the push for and the milestones in reproductive rights
in the US and the nineteen seventies, like Roe v.
Wade was nineteen seventy three, for instance, but the private
little revolution wasn't immediate. These tests cost ten US do

(42:59):
all about fifty one in twenty twenty four dollars holy cow. Yeah,
took two hours for a result again, and had a
decently high rate of false negatives not false positives, though,
which is good. This was not a cheap test, and
the recommendation to buy two tests in case you took
the first test too too early. It made home testing

(43:20):
prohibitedly expensive for some people, and according to some who
used it, the test wasn't the most intuitive and in
fact was kind of complicated. It just had to sit
for two hours in a completely still dark environment. Any jostling, yeah,
because otherwise the ring would probably dissolve. Oh interesting, the
doughnut okay, yeah, and stigma lingered right. There was one

(43:41):
state official telling consumer reports in nineteen seventy eight that quote,
there is no reason for a woman in Maryland to
buy such a kit as the ept unless she doesn't
want to be seen at the health department. Yeah, leading
the magazine to conclude that it was a quote unquote
useless purchase. Wow. Yeah, just like our avocado test. If

(44:06):
you didn't buy so much avocado test, would you can
buy out? But the sentiment revealed a disconnect between what
most physicians, some politicians, and a puritanical, patriarchal society thought
women needed and what women felt they needed, especially in
the US, where there initially was pushback against allowing the
test to be sold in drug stores over the counter. Yeah,

(44:28):
regardless of how accessible you made pregnancy tests at the clinic,
like getting rid of prescription requirements reducing the cost. Whatever
the tests revealed at those clinics was first learned by
someone else, right, not ever the patient. Putting pregnancy tests
in the hands of women reasserted their rightful control over
their own bodies and the knowledge about their bodies. Yeah.

(44:51):
There's a quote I want to read you from the
book Pregnancy Test by Karen Weingarten. Quote. With a home
pregnancy test, women could take control of their decision from
They wouldn't need to find a doctor willing to test
them for pregnancy. Who might question their motives or next steps.
They wouldn't even need to share their news with anyone
until they were ready end quote. Even early marketing materials

(45:13):
focused on what this meant for women, not families, not
a couple, but for a woman who thinks she might
be pregnant, focusing on the privacy aspect of these tests.
The pharmaceutical companies that produce them also had to convince
physicians that this was a good thing, that early pregnancy
detection meant people could get prenatal care earlier, and most

(45:34):
physicians agreed with that potential positive impact, but many remained
skeptical that the tests were accurate, and they would insist
on a clinical test to confirm home results. And this
is not without merit, of course, Even the most accurate
tests today are not one hundred percent accurate or may
not be able to give you all the information that
you need to decide what to do next. The pregnancy

(45:55):
test does not reduce the need for or replace medical
care at all. It is simply often the first step
along the journey, whatever that journey. Maybe. By the nineteen
eighties and Reagan's presidency, these ads shifted in tone to
be more about family values. Of course they did, of course,
featuring straight couples sharing the joy that a test could bring.

(46:17):
The nineteen nineties saw reality advertising for pregnancy tests, with
couples finding out on camera the results of the test.
In the nineties, yeah, I mean, come on, you like
Jerry Springer morey stuff like that. Yeah, yeah, okay, America's
Funniest Home video.

Speaker 10 (46:33):
Sure.

Speaker 1 (46:34):
Sorry, I don't know if I'm sure pregnancy test featured
on I'm sure they didn't. But these these nineties tests,
that's when the first time people of color were featured
in many of these ads. And while most couples in
these realities, so it would be like a couple being like, oh,
let's find out the results on air or whatever, and
then most of them like clearly wanted a positive result,

(46:58):
like they were happy with the positive result. One couple
was relieved about their negative test, which interesting. Yeah. What
was missing from these ads were depictions of women who
did not want to be pregnant but were. David Lynch, So,
the guy who did twin Peaks in the movie Blue
Velvet He Passed Away, recently directed a nineteen ninety seven
pregnancy test ad where the woman in the ad finds

(47:21):
out the results, but the audience doesn't get to see them.
I love it.

Speaker 9 (47:27):
Waiting to find out if you're pregnant or not. Nothing
else in the world matters until you know. Introducing clear
Blue Easy one minute pregnancy test, because only clear Blue
Easy gives you a clear yes or no in one minute.

Speaker 4 (47:42):
So that's the first time that it's just waiting and
you have to kind of infer yourself.

Speaker 1 (47:47):
I think so interesting. Yeah, isn't that? Isn't that so
fascinating because a lot of the other ones were like,
it's positive, I'm happy, or it's negative, I'm relieved. But
this one, she's smiling. You don't know is she happy
that it's positive or negative? Right? I really like it. Yeah,
the mystery of it, that ad is especially important too,

(48:08):
for showing that it's about the knowledge, not about the result.
And I think that's a big shift in that perception
of what these tests have given us. So within twenty
five years of their release, home pregnancy tests had become
a widely used, recognizable, commonplace diagnostic tool as well as
you useful plot device. TV shows, movies, novels all began

(48:30):
to feature pregnancy tests as a useful way to increase
dramatic tension or force character growth. I mean, how many
sitcoms have an episode where someone finds a positive pregnancy
test in the trash? Whose is it? Everyone?

Speaker 11 (48:43):
My god?

Speaker 1 (48:43):
I can think of so many. Yeah, They've been used
in TV and movies as an opportunity for safe sex
talks between parents and a teenager, a moment of self
reflection for whether or not a character wants the test
to be positive or negative, whether they want children at
all or feel ready to have kids. It's on reality
TV in really twisted scenarios, like there's a Maury one

(49:06):
where someone has to tell like it's like someone's teenage
daughter takes one on air to be like is she
lying or not? I know that's horrific, I know, yeah,
but there are yeah, a million examples.

Speaker 10 (49:18):
Right.

Speaker 1 (49:19):
In nineteen ninety one, the show Murphy Brown showed Murphy
taking a home pregnancy test and ultimately deciding to become
a single mother after considering abortion. This is nineteen ninety one. Wow,
I feel like that's it's like not allowed today. Yeah, yep.
This plotline was criticized by Vice President Dan Quail as

(49:39):
quote unquote eroding family value. Of course it was, right, Yeah,
it's yeah. I think that that test though, or that
Sitcom Murphy Brown when she when she took the pregnancy test,
that also helped to kind of popularize it and be
like this is a thing that people can do. This
is Yeah. I think it just kind of had increased
momentum even more like normal. Yeah, exactly. But it's incredible

(50:04):
how over the almost five decades since its release, the
home pregnancy test has become almost universally recognizable, even for
people who have never used one. I loved how like, yeah,
the early COVID tests and people would take pictures and
like everyone thought it was a pregnancy test immediately. Yeah.
But improvements to the test over these decades include things

(50:25):
like the invention of monoclonal antibodies, which eliminated the need
for lab animals. More precise testing than now familiar, easy
to read stick pregnancy test with the two lines was
introduced in nineteen eighty seven. Now some of them say
pregnant or not pregnant digit. In twenty twenty one, a
flushable pregnancy test was introduced, which is an incredible development

(50:46):
to protect privacy.

Speaker 4 (50:49):
Wow, yeah, I was just thinking about sewage lines, like,
is are they actually flushable.

Speaker 1 (50:54):
I mean I think, I think they are fascinating. Yeah,
tests have been developed that can be read by blonde
or low vision people without the help of someone else. Wow,
I know that's amazing. I never would have thought of that,
I know, I know. It's so incredible, the different innovations
that have been thought of. Yeah, one organization has introduced

(51:14):
a test that measures hCG as a way of verifying
that an abortion worked. And so you take like a
you know, sequential test afterward to be like, is it
dropping right? I've seen different estimates, but around eight million
people in the US alone used a home pregnancy test
in twenty twenty. Wow. Think about that compared to fifty
years ago. I'm going to read you a quote from

(51:35):
an article by historian Sarah Abigail Levitt. Quote. Though women
have found ways throughout history to find out about impending pregnancy,
that has only been within the last quarter century that
this information was available to so many women with such
reliable accuracy. Women in this generation who take home pregnancy
tests are able to know something about themselves and their

(51:57):
futures in a time frame that was simply not possible
for their grandmothers or even their mothers. Isn't that mind blowing?
Like my grandma wouldn't have taken a pregnancy test. I
wish that I could ask, Yeah, my grandma, my mom
took a home pregnancy test. I assume that my mom did,
but I never asked her.

Speaker 4 (52:18):
I asked her so many other things about her pregnantities
for this episode, but I didn't ask her that.

Speaker 1 (52:23):
Yeah. It's incredible. Yeah, but that knowledge can come at
a cost. Also from Levett, the pregnancy test has liberated
women by giving them information earlier and allowing them to
digest the information in the privacy of their own homes. However,
it oppresses women when it forces them to make decisions
earlier and earlier, when it forces them to confront a

(52:46):
miscarriage they might otherwise never have known about, or when
it falls into the hands of those with whom they
did not wish to share the information, and when it
proves an untrustworthy narrator and gets the answer wrong. Yeah,
have been and continue to be tested for pregnancy without
their consent or by those who have ulterior motives, such

(53:06):
as testing unhoused women. In the nineteen eighties in New
York City who had to be tested if they wanted
city housing. Wow, or women on certain police forces being
secretly tested employers pretending to test potential employees for drugs
but actually testing for pregnancy. That has happened. Oh my god. Yeah,

(53:26):
the US Immigration and Customs Enforcement ICE test those arriving
at a detention center who are over ten years old,
ads for free pregnancy testing at clinics that are actually
anti abortion clinics. That's major. It's a major one. And
then the early detection and sensitivity of these tests could
be seen as a double edged sword. Some suggest that

(53:47):
pregnancy test is not really an accurate term, that these
tests aren't detecting viable pregnancies, but just the presence of hCG,
and so non viable pregnancies that may not have been
noticed in the past are now recognized, potentially increasing the
trauma of that experience. For some, however, that experience may
be incredibly meaningful. These days in the US, early detection

(54:10):
of pregnancy can be critical, especially for those living in
states that restrict abortion to a narrow window like.

Speaker 4 (54:17):
Six weeks or like outlaw it at all. So you
have to figure out where you're going to travel.

Speaker 1 (54:21):
So you're going to travel, Yeah, waiting until you've missed
a period to take a test might already be too late.
Knowledge is power, and that can be dangerous if that
knowledge falls into the wrong hands or is used against us.
But it can also be incredibly liberating and empowering, giving
us access to and control over information about our bodies

(54:42):
that should have been ours to be long. Yeah, and
so with that, Aaron, I'd love for you to tell
me about how hCG works and what's going on in
early pregnancy. I don't know if I'm going to answer
that first question. Okay, what's going on early pregnancy? Okay, great.
Right after this break, I.

Speaker 11 (55:14):
Didn't have a glowing pregnancy. Sciatica made every step painful,
Braxton Hicks robbed me of my sleep, and even the
smell of my beloved garlic turned my stomach. Hormones didn't help,
especially when my husband jokingly called me Shamou after the
infamous killer Whale because of my black and white maternity wardrobe.

(55:35):
I snapped at him one night when he made what
I thought was a mean comment about how puffy my
ankles were looking, and then I forgot about it until
January seventeenth, twenty eighteen, at two am my waters broke.
We grabbed a cab to Lewisham Hospital in southeast London,
expecting to be sent home as labor had not started yet. Instead,

(55:58):
after a long wait and a quick reflexed test where
my legs shot up in the air, we realized that
those puffy ankles had been an indicator of preacclansia, the
only cure birth within twenty four hours. Suddenly I was
on a hormone drip to induce labor and magnesium dripped
to prevent seizures. Hooked up to monitors, I was told

(56:21):
that I could not eat anything for hours. I waited,
feeling contractions build, but just when I needed the aperture
a most we realized that it had become detached and
I had to push without pain relief, which resulted in
my blood pressure increasing in a way that the midwives
were not very happy about. Suddenly the room blurred in

(56:44):
a wave of blue medical sheets and rushing staff. My
baby was facing the wrong way up, another complication. The
doctor used a vacuum to rotate her and finally, to
Queen's I wanted to break read. My daughter entered the world.
Their traditional national health service tea and toast afterwards is

(57:08):
still to this day the best feal of my life.
Two days later we went home. That baby is now
a feisty seven year old testing every boundary. Life since
hasn't been simple. We've made countries, she's learned new languages,
and her dad and I have separated, but she's the
center of our universe and through it all, even though

(57:31):
I've never fully understood why I got prea clamsia and
why we hadn't noticed it earlier, I'll forever be grateful
to the NHS for bringing us through safely.

Speaker 10 (57:44):
For the most part, my pregnancy was pretty typical, pretty textbook,
no complications or anything. The two things that really kind
of stood out to me as different in my experience
that I was not prepared for. The first was when

(58:06):
the whole time that I was pregnant, people always were saying, oh,
when you go into labor, you may not even know it.
It may be hard to tell when labor starts. It's
not going to be like it is in the movies
where you have this big dramatic gush of your water
breaking and that's what starts things. That was exactly what happened.
I had woken up at about four o'clock in the morning,

(58:26):
needed to use the bathroom and I got up off
I was sleeping on my basement couch, got up off
the couch as best I could, and the second my
feet hit the floor, it was a gush that was unmistakable.
I knew at that point that it was time to
go to the hospital. Then the other unexpected for me

(58:47):
was as my labor progressed, it seemed like things were
going relatively quickly, and you know, just a few short
hours into being at the hospital, I was told, oh,
it's time to push, and at that point I was thinking, Okay,
I'm gonna have the baby in just a few minutes.
Everybody I've ever talked to says they pushed for fifteen
minutes or two pushes and the baby was out. That

(59:08):
was definitely not my experience. I pushed for two hours.
That was pretty grueling, and I overall everything turned out fine.
But I did not realize before that point that you
could be ready to push and have it still take
that long. She hadn't descended through my pelvis yet, so
even though I was already fully effaced and dilated, it

(59:30):
took a little bit of work. All in all, it
was worth it, and I would do it again. But
you just really never know what you're signing up for
when you get pregnant.

Speaker 4 (01:00:05):
So this might sound silly now after everything that you
went through, but I felt like to make all of
these episodes make sense, I wanted to start by just
defining pregnancy.

Speaker 1 (01:00:18):
No, that's a great, okay way to start.

Speaker 4 (01:00:19):
Cool, Like, it might sound very obvious, right, Like, I
think we all know what we think pregnancy is, right,
It is the period of time when there is a
fetus growing in your uterus.

Speaker 1 (01:00:29):
That's what we think of as a pregnancy.

Speaker 4 (01:00:31):
Yeah, But like you just walked us through, how we've
been able to determine whether or not someone is pregnant
has really changed over time. So I want to start
with how we date a pregnancy today. Great, okay, this
is how we decide when a pregnancy quote unquote begins. Okay,
And in medicine that is pretty universally based on your

(01:00:55):
last menstrual period. The first day of your last menstrual
period is the start of a cycle, your menstrual cycle. Yeah,
we assume in medicine that all menstrual cycles are twenty
eight days long.

Speaker 1 (01:01:07):
Exactly. We know that they're not, but that's an average.

Speaker 4 (01:01:11):
And so based on that assumption, pregnancy is forty weeks long.
It's about two hundred and eighty days, all right. The
time that it takes from fertilization will get there to
a mature fetus or baby is about thirty eight weeks
two hundred and sixty six days. So that extra two
weeks between thirty eight and forty that's the time it

(01:01:32):
takes from the start of that last menstrual period to
ovulation slash fertilization.

Speaker 1 (01:01:39):
Does that make sense? I think so.

Speaker 4 (01:01:40):
So that's why your pregnancies are always longer than you
would think it is. By the time that you have
missed a period, you're already four weeks pregnant. Oh my god,
even though fertilization just happened two weeks.

Speaker 1 (01:01:53):
Ago, got it? Okay? Yeah?

Speaker 4 (01:01:56):
And it is confusing, yeah, because then it really makes
that timetable. And if we're talking about like access to
abortion and things like that, it's really important. Right, So
we'll go through all of what is happening there. But
I just want to set the state, so that is
how we define pregnancy. That's the time frame of pregnancy. Okay,
I have a question real quick, right to me.

Speaker 1 (01:02:19):
So there then is a potential like error bars around absolutely,
and so then like let's say that you know that
conception happened on this date, but then your doctor's like, oh, well,
when what was the last day of your last period?
You want to talk about me? Because that was my

(01:02:39):
life I was angling too. Yeah.

Speaker 4 (01:02:42):
So if you have like, for example, very long menstrual
cycles like thirty six days or something like that that's
pretty different than twenty eight days, then your conception date
might be more accurate if you know it. That's like
your ovulation date. But generally what happens is that we
use ultrasound early ultrasound to make sure what the embryo
and fetus is growing as and if it's off by

(01:03:05):
a certain number of days, then you change the date
of the pregnancy.

Speaker 1 (01:03:09):
Okay, does that makes sense?

Speaker 4 (01:03:10):
Yeah, And it all depends on how early that ultrasound is,
how it's growing and all of that, and there's like
very specific regulations on how that's all decided. But yes,
for some people that date ends up changing and it's
not exactly consistent. But at the start, it's always assumed
that the start of your pregnancy is the first day
of your last menstr period.

Speaker 1 (01:03:29):
Interesting. Yeah, okay, so that I feel like that has
such huge implications for everaching. Yeah, and it really does.

Speaker 4 (01:03:36):
Like for my both of my pregnancies were not dated
accurately based on that. One of them I found out
early on and it was fine. The next one it
was the day I went in for an induction.

Speaker 1 (01:03:44):
Oh my gosh, It's all fine, because then there's that
it's like, well, you need an induction, right or you
don't you? Or yeah, so it does. It does matter.

Speaker 4 (01:03:52):
And now that we have the better ultrasounds that we have,
the more accurate we can be in dating if you
have access to an early ultrasound, because ultrasound gets less
accurate the farther you get in pregnancy.

Speaker 1 (01:04:02):
I am going so far off. No, this is great.
I'm sorry I started to stun as a rabbit hole. I
love it, okay, but so let me find where I'm at.

Speaker 4 (01:04:11):
Yeah okay, but yes, so that that is how we
define it in medicine. I'm going to walk through like
the steps after fertilization and the very early parts of
a pregnancy. So if any of my dating gets confusing,
where you're like, what, what does that mean, just stop
me so I can clarify, Okay, And that is what
I'm going to walk us through today is early development

(01:04:32):
and then some of the things that can go wrong
within that early, very early time period. And we'll talk
a lot about miscarriage and early pregnancy loss. And my
goal for this part of the episode is to help
us understand the question of what has to happen biologically
for a pregnancy to be possible. Yeah, okay, So we

(01:04:54):
will begin two weeks after your last menstrual cycle.

Speaker 1 (01:04:58):
Okay.

Speaker 4 (01:04:58):
On average, you have ovulation. That's when you ovulate, and
if a sperm is present, then you have fertilization. These
two single cells will come together and join their nuclear
contents and make a brand new cell. I'm taking everything
that happens prior to that point for granted because.

Speaker 1 (01:05:15):
It's cool, but it's way too detailed. Okay.

Speaker 4 (01:05:17):
So that's where we begin. Within the first twelve to
twenty four hours after this fertilization event is when you'll
have the first cell division. So pretty quickly you go
from one cell to two, and then every twelve to
twenty four hours or so after that you continue dividing,
so you go from two to four to eight to
sixteen to thirty two cells in this tight little ball

(01:05:38):
by about day three after ovulation, which is like seventeen
days or so after your last menstrual period.

Speaker 1 (01:05:45):
Got it.

Speaker 4 (01:05:46):
And as this ball of cells continues to divide, it
starts to take a shape. It forms itself by about
day five or six, so nineteen or twenty of your
menstrual period after your last mental period, into a hollow,
fluid filled ball. And we talked about this in our
IVF episode. It's called a blasticist, yep. And I imagine

(01:06:06):
the blasticist like a tennis ball.

Speaker 1 (01:06:09):
Yes, I brought one? Did you bring Okay? Perfect, it's
a tennis ball. Okay, your dog is going to be
really said she was. When I was like making what
I made was she was like, is that my ball?
Is that my ball? I did not take her ball? Okay.

Speaker 4 (01:06:22):
So imagine this is a hollow ball, right, but it's
filled with fluid instead of just being filled with air
like an actual tennis ball, but instead of being like
perfectly symmetric inside and outside, in the blasticist, there is
on the inside an extra few layers of cells called
the inner cell mass. And this inner cell mass that

(01:06:44):
we have here is what will eventually become the embryo
opecially the fetus.

Speaker 1 (01:06:49):
Okay, just a little few little cells.

Speaker 4 (01:06:52):
And at this blasticist stage, six or seven days or
so after fertilization, about day twenty one of your menstrual cycle,
this is when implantation will begin. Okay, So implantation itself,
implanting into the uterine wall. It's not a discrete event.
It's not one time point. It takes at least a
well over a week or so. And what it results

(01:07:15):
with is this blasticist completely embedding itself into the wall
of the uterus. So our uterus has a cavity, right,
it has this empty space in the middle, yep. But
this blasticist and eventually fetus does not grow in that cavity.
It grows within the wall of the uterus.

Speaker 1 (01:07:35):
Okay.

Speaker 4 (01:07:36):
Now, the outer wall of that blasticist like the fuzzy
green layer of the tennis ball. It's called the sensisio trophoblast,
and that is the layer that will continue to invade
into the walls of our endometrium, into our uterus and
all the way into the first third of the muscle layer,

(01:07:57):
the myometrium of our uterine wall and I know you're
going to talk more about that, yeah kind of yeah, yes,
So the maternal endometrium, like our own cells, are not
passive in this process by any means way. Our body
is responding to the invasion of these fetal cells that
will eventually, by the way, become the placenta by completely remodeling.

(01:08:21):
So the structure of our uterine lining completely changes. We
have huge changes in the inflammatory signals that are being
sent within our body. I'm excited for you to talk
more about it, and then also big changes in the
hormones that are dancing around in our bloodstream.

Speaker 1 (01:08:37):
Okay, So just to re recap it briefly, So the
cell implantation multiplication, some of those multiplied cells become the
placenta eventually, and some become the embryo ex lator feed
us exactly.

Speaker 10 (01:08:52):
Yeah.

Speaker 4 (01:08:52):
The inside part is what they're going to become eventually
the baby yep. The outside part is what invades and
then becomes the placenta.

Speaker 1 (01:08:59):
Yep. And there's like layers obviously, it's so interesting the differentiation.
What are the signals that say you be placenta, you
be I love embryos.

Speaker 4 (01:09:09):
It's so so, so fascinating aaron, and you could go
in so much more detail on like every single step
within this.

Speaker 1 (01:09:16):
There are entire textbooks on like this exactly best Slayer.

Speaker 4 (01:09:19):
I know I'm not going to go there, but I'm
going to focus on this for a second. Because the
start of implantation, so the start of that implantation process,
which again takes time, it's a really really important milestone
in a pregnancy for a few reasons.

Speaker 10 (01:09:34):
Uh.

Speaker 4 (01:09:34):
The first is that about forty eight hours or so
after implantation starts, is when the cells of that since
sisho trophoblast, the cells that are burrowing their way into
our endometrium, will start to secrete hCG. And that is
not only important for detecting a pregnancy, but also one

(01:09:54):
of the major keys for a pregnancy to be able
to continue. Okay, because don't worry, I'll get there. Because
up until this point, all of the tissues of our endometrium,
the lining of our endometrium, and everything that has changed
thus far, it has been supported primarily by the hormone progesterone,

(01:10:16):
and that hormone up until this point of implantation, and hcg'
secretion has been secreted by this thing called the corpus lutium,
which is what's left over in your ovary after you ovulate.
So everyone makes one of these every time they ovulate,
and it hangs out there for like two weeks, supporting
the lining of your endometrium, hoping that a blastocyst will

(01:10:37):
implant But the corpus lutium only lives about two weeks
or so. So by day fourteen after ovulation, twenty eight
days or so after your last menstrual period, if you
don't have the presence of hCG in your system, then
this corpus lutium will disintegrate, your progesterone levels will drop,
and you will have a menstrual period. You will shed

(01:11:00):
the lining of your uterus.

Speaker 1 (01:11:01):
The decidua. The decidua. Yes, well, I just I'm trying
to track that with all that stuff which I don't
even know if I talk about the decidua, But.

Speaker 4 (01:11:09):
That is what it is called, is what the lining
of your uterus becomes, is called the decidua. But if
this blasticist was able to successfully start implantation, it starts
secreting hCG, and that hCG sends a signal to our
corpus lutium, don't disintegrate, keep it going, keep secreting progesterone,
and it does. Our corpus lutium will continue to produce

(01:11:32):
progesterone for several more weeks, all the way until the
point that the placenta has formed and can take over
the majority of the necessary hormone production to support the
growing pregnancy. Okay, right, amazing, amazing, So we've already learned
a lot. First, it means that the absolute earliest that
you could conceivably test for a pregnancy via hCG is

(01:11:53):
a couple days after implantation, which is usually a few
days prior to your missed period, because it's like forty
eight hours after implantation, which is day five, six seven.

Speaker 1 (01:12:03):
Somewhere in there.

Speaker 4 (01:12:04):
Okay, so most people are going to be considered four
weeks pregnant at this point.

Speaker 1 (01:12:10):
Plus and minus is I have strong feelings about that. Yeah,
I tell me your feelings. Rage, I guess, like that
is so inaccurate. I mean it's yeah, it's because it's Okay,
it's consistently inaccurate. So that's one contestant, except it also great.

(01:12:34):
That's that's the one pro of this. The rest is
that everything else is then shifted, right, And I mean, yeah.

Speaker 4 (01:12:42):
I know, it's interesting, it's and I mean it's it's
really a relic of when we didn't have ultrasound, like
laws are now based on oh yeah, preaching, chire yeah,
and this process of implantation. It's also a very delicate
sort of dance. A lot of things can go not

(01:13:04):
as I just explained, within this process and prior leading
up to this process. So I'm going to pause here
and actually take a few steps backward to talk about
some of the potential either complications that can arise even
as early as this, or just things that don't go
this way, like what are what are the alternative roots
that can happen here? And then we'll come back and

(01:13:27):
I'll talk more about the inner cell mass how it
becomes an embryo. There's a few things that can happen
with implantation the process of implantation. One is that it
could happen in an atypical location, and that is called
an ectopic pregnancy. And because most fertilization events happen in
the philopian tubes, which are the little tubes leading from

(01:13:50):
our ovaries to our uterus, then most of the time,
like ninety five ninety six percent of the time, if
a ectopic pregnancy happens, it happens in the filopian tubeube.
So this blasticism implants in the wrong place in your
Filippian tube or right at the junction there where the
Filippian tube meets the uterus. And because Filippian tubes cannot

(01:14:11):
expand the way that the uterus can, as that blasticist
continues to grow into an embryo, it can cause rupture
of the Filippian tubes, which can cause catastrophic blood loss.
So ectopic pregnancies are very dangerous. Flipping tube is not
the only place that it can implant. Ectopic pregnancies can
also happen in the cervix so like a little too

(01:14:33):
far down interesting. They can happen in the scar from
a cesarean section, which might end up being a viable
pregnancy depending on how it continues to grow. They can
sometimes happen in the ovary or even in the abdominal
cavity because the ovaries and your philippine tubes are not
like connected, they're like floating, and your Filippian tubes can

(01:14:54):
also like move around back and forth.

Speaker 1 (01:14:56):
And things like that.

Speaker 4 (01:14:57):
Okay, that's amazing, I know, but it's not great if
one implants in like the abnomenal cavity.

Speaker 1 (01:15:03):
And so all of these are considered ec topic because it's.

Speaker 4 (01:15:05):
All just outside of exactly EC topic, just outside of
the uter Overall, most estimates are that about one to
two percent of pregnancies are ectopic, depending on the source.

Speaker 1 (01:15:17):
Okay, okay, question I expected questions I have answers. Okay, wonderful,
So one to two percent of the time. How does
how do you figure out whether something's an ectopic pregnancy?
Number one? Number two? Like, what what next?

Speaker 4 (01:15:32):
Great questions? How do you determine it? A lot of
different ways, is the answer to that question. Ultrasound is
really important in this, but it also can depend on
how early that pregnancy is, because sometimes if it's super early,
then you don't see anything in the uterus or elsewhere,
then it might be classified as a pregnancy of unknown location,

(01:15:54):
and so then what you do with that might change
kind of depending but in general it's ultrasound to try
and determine that a lot of times ectopic pregnancies might
present as a typical early on, so you might have
bleeding that we don't expect. You might have abdominal pain,
especially like one sided abdominal pain, but not always. Sometimes
you might not have symptoms. What you do about it

(01:16:17):
is really important. So ectopic pregnancies are very important to
be treated, and they're generally treated one of two ways.
So one is with a medicine called methotrex eate, which
is also used in some places for abortions. But methotrexate
is one medication that you can use, especially if it's
small and it's at low risk of rupture. It requires

(01:16:38):
continued medical monitoring to make sure that you've completely lost
the rest of that pregnancy tissue, or it requires surgery,
and surgery usually requires the loss of that filopian tube.

Speaker 1 (01:16:50):
If that's where I plan did okay? And how often
is it surgery versus it's a good question. I don't
have it.

Speaker 4 (01:16:59):
I don't have data on that, Okay, that's a solid question.
I think it probably depends like location, geography, all that
kind of stuff.

Speaker 1 (01:17:05):
Gosh, we really we should do an entire episode on
the history, because I really am just curious how we
learned about a.

Speaker 4 (01:17:12):
Topic pregnancy right, and how we figured it out early
on and before ultrasound.

Speaker 1 (01:17:15):
What happened? Yeah, ooh, probably wasn't good.

Speaker 4 (01:17:17):
No, yeah, yeah, So that's ectopic pregnancies.

Speaker 1 (01:17:20):
Okay, do you have more question? Not right now, but
I'm sure I will in just a few minutes.

Speaker 4 (01:17:26):
There's other atypical ways that a blasticis can implant that
might end up in a viable pregnancy. If the blasticism
implants too low in the uterus but not in the
cervical canal, then it can result in what's called placenta previa.

Speaker 1 (01:17:41):
Ah, So the.

Speaker 4 (01:17:42):
Placenta completely covers the oss or the opening to the cervix,
and that is potentially dangerous. It can cause bleeding during pregnancy.
But it also if that placenta, like if the baby
has to deliver through the placenta, that's that.

Speaker 1 (01:17:56):
Doesn't right, It's not safe, it's not. Yeah.

Speaker 4 (01:17:58):
So generally that goes to a cesareans, which we'll talk
way more about later. And then of course there is
miscarriage or early pregnancy loss. So I'm going to spend
quite a bit of time talking about this.

Speaker 2 (01:18:08):
Okay.

Speaker 4 (01:18:09):
The definition of miscarriage actually is different depending on where
you live and what country that you live in, Okay,
because it is defined generally as the spontaneous loss of
and these words are important, the spontaneous loss of a
recognized pregnancy prior either to a certain gestational age or

(01:18:29):
a certain weight of the fetus, depending on what country
you live in and things like that. So in the
US we define a miscarriage as a pregnancy loss prior
to twenty weeks gestation. In the UK it's prior to
twenty four weeks. In other parts of the EU it's
like twenty two weeks, And per the World Health Organization guidelines,

(01:18:50):
it's the loss of a pregnancy with a fetus that
weighs five hundred grams or less, which is about twenty
two weeks gestational age.

Speaker 1 (01:18:58):
Why is there such variations.

Speaker 4 (01:19:00):
It's in part because it depends on like the definitions
of like viability and things like that. I don't have
a great answer as to why there's variation, but the
variation exists, which does mean that there's differences in terms
of like reporting what is considered a miscarriage or an
early pregnancy loss, and then what is considered a still birth,

(01:19:23):
which is if you have a pregnancy loss after that
time point.

Speaker 1 (01:19:26):
I see, but again that time point varies a little
bit and what's the recognized part?

Speaker 4 (01:19:30):
Yeah, great question Erin so that also the definitions kind
of differ.

Speaker 1 (01:19:35):
So there are like.

Speaker 4 (01:19:36):
Clinically recognized pregnancies and then there are pregnancies that maybe
weren't recognized clinically, and some of that depends on whether
or not it was seen on ultrasound, okay, which means
not only like did you have access to ultrasound, but
like how early was it yea And then like you said, aarin,
is that the more that we have access to these
very very early pregnancy tests that can detect some of

(01:19:59):
the home pregnancy test now can detect very low levels
of hCG, which means you can get it earlier and
earlier and earlier, and so that.

Speaker 1 (01:20:08):
Does change our rates of miscarriage.

Speaker 4 (01:20:14):
But in some of the literature, if there's not a
documented pregnancy with ultrasound, then it's not classified as a miscarriage,
but it might be classified as a early pregnancy loss
quote unquote, or a biochemical pregnancy loss is another term
that gets thrown around a lot of biochemical pregnancy or
sometimes they're called pre clinical pregnancy losses. Right, Okay, So

(01:20:38):
it all is important, But yeah, the definitions kind of vary,
and so there's a lot of different words that get
thrown around in the literature. Yeah, okay, but all that
being said, overall, the rate of spontaneous loss of early
embryos is very very high in humans. So a lot

(01:20:58):
of those blastocysts that we were talking about never actually
make it to the point of implantation, so they are
lost before implantation, which means you never knew that you
could have been pregnant, even though again we're defining pregnancy
as your last menstrual period, so it's very confusing. Yeah, yeah, Yeah,
we don't know exactly how many of these, like pre
embryos are lost prior to implantation, but it's estimated to

(01:21:20):
be somewhere between twenty and forty percent, which is very high.
It is high, very high, and those are estimates also, Yeah,
twenty to forty is a huge it's a huge range.

Speaker 1 (01:21:29):
Yeah.

Speaker 4 (01:21:30):
And then after implantation, so after that start of implantation,
a further thirty percent are lost. But it's thought that
about half of those happens so early that most people
and caveats here with early pregnancy tests, but most people
would never know that they were pregnant or were almost pregnant,
could have been pregnant because they don't ever miss a period. Ah, right,

(01:21:54):
So the implantation starts, but then it doesn't continue, So
then you have shedding of your unine life at the
time that you typically would and those are most often
classifies as like biochemical or pre clinical pregnancy losses. But
the more that we have early pregnancy tests, the more
that people are going to know that that happened to them.

Speaker 11 (01:22:12):
Right.

Speaker 4 (01:22:13):
Yeah, most estimates of the overall risk of miscarriage, so
the loss of that recognized pregnancy prior to twenty to
twenty four weeks is about fifteen percent globally. Wow, and
that's a huge number.

Speaker 1 (01:22:26):
Yeah, it really is.

Speaker 4 (01:22:27):
Fifteen percent is twenty three million recognized miscarriages worldwide every year.

Speaker 1 (01:22:35):
Wow.

Speaker 4 (01:22:35):
I know we don't talk about it at all. It's
like not something that we talk about. It's not something
that's polite to talk about, but something there's a few
things I feel like, I have a lot of feelings
about this, but one in three women are also estimated
to experience a miscarriage at some point during their reproductive years.
So it's not just that it's common globally, it's also

(01:22:57):
common that you might have throughout your reproductive lifespan a
miscarriage at some point in time, and something being common
does not make it unimportant. Yeah, right, of course, Well
what happens all the time, it's really important. There was
a study in a paper that I read that looked
at only five hundred women, but so it's a small study,

(01:23:18):
but I think this is still really important. Data five
hundred and thirty seven women with a pregnancy loss, a
recognized pregnancy loss, found that after nine months, eighteen percent
of them met criteria for post traumatic stress, seventeen percent
for moderate or severe anxiety, and six percent for moderate
or severe depression. So, like losing a pregnancy, whether it

(01:23:40):
was a planned pregnancy, an unplanned pregnancy, an early pregnancy loss,
or a later pregnancy loss, like that is very hard potentially,
and it's really lonely if it's something that you're not
able to talk about in quote unquote polite company.

Speaker 1 (01:23:55):
Well, and I feel like you make a really good
point that like this, even though this does happen a
lot and it's not talked about a lot, and it
doesn't take away the pain exactly, the trauma that can result.

Speaker 4 (01:24:06):
Yeah, Yeah, most pregnancy losses. Most miscarriages happen in the
first trimester, so sometime in the first ten to twelve weeks,
but one to two percent of pregnancy losses will happen
in the second or third trimester, And like we said,
if it's after that twenty to twenty four weeks, then
we classify it as a still birth rather than a miscarriage.
And no matter how early, any pregnancy loss has the

(01:24:28):
potential to be met with shame or stigma, loneliness, guilt, fear, frustration,
like so many different things, and a lot of people
understandably want to know what causes this, why is this happening?
And we don't knowh right, except that it happens like
very commonly across the board to these early embryos, especially.

(01:24:53):
Most estimates are that about fifty to eighty percent of
the time miscarriages are due to chromosomal abnormalities in the fetus.
All right, okay, And that is one of the big
reasons that age. Female age specifically is a big contributor
where younger people are much less likely to have a
miscarriage compared to as we get older, the rates are

(01:25:14):
like vastly different.

Speaker 1 (01:25:15):
It's so interesting because I know that we talk about
the impact of female age, but I feel like it
does add it can add blame sometimes absolutely, and to
not like Also, the sperm age or like age of
the person who's making the sperm also plays a role.

Speaker 4 (01:25:32):
I think I saw at least one study that looked
at that, and there is actually an increased risk of miscarriage,
I believe. Yeah, I wish I had written more detail
on this, but but it's at an older age. Whereas
with females it starts at like thirty five or so
that the rates of increased chance of miscarriage go up,
it starts later, like after forty or maybe it was
forty five. Okay, don't quote me on that because I'd

(01:25:53):
have to go back to the paper.

Speaker 1 (01:25:54):
Yeah, yeah, but.

Speaker 4 (01:25:55):
Yeah, so you're right, it's not like an it's not
a male factor, right, it's a contributor.

Speaker 1 (01:25:59):
But we don't talk about it well just always it's
like age of the age of the edge of the mother,
age of the woman, advanced age, geriatric womb. We don't
call that that anymore, Okay, I don't. I'm sure people do. Yeah,
I think they're probably a handful out there.

Speaker 4 (01:26:14):
So yeah, So miscarriage is a really important topic I
think you talk about.

Speaker 10 (01:26:18):
Yeah.

Speaker 4 (01:26:18):
The other thing important to know about miscarriage is how
we manage it, because there's three main ways, like medically,
that we can manage it. One is called expectant management,
which basically means you don't do anything, like there's no
medical intervention and you wait for that tissue to pass
on its own spontaneously. There's another option, which is a

(01:26:39):
medication option, and most of the time there's a combination
of medicines that are used mesa prostal and mifipristone aka
abortion medicines, or with a vacuum aspiration or a d
n C which is a dilation in curetage, which is
the exact same surgical procedures as are used in quote
unquote elective abortions. Abortion is health abortion is healthcare. Every

(01:27:02):
one of these options, expectant management, medical management, and surgical
management are all associated with risks and benefits for the individual,
and in fact, in the data there's no difference in
like one is more risky, one is less risky. They
all have risks of bleeding, they have risk of infection,
and the choice to do one or the other should

(01:27:25):
lie only with the person who is pregnant and their
medical doctor. However, however, because we live currently in the
United States, especially with all of these abortion restrictions that
are going into place, this is no longer the case.
It is now very often the decision between a legal
team and the hospital administration. You have on when to

(01:27:45):
do something about it, on when not to do something
about it, on when you have to just wait, et cetera,
et cetera.

Speaker 1 (01:27:52):
Just around a conference table, someone's making decisions about what
is happening inside your body.

Speaker 9 (01:27:58):
Yep.

Speaker 1 (01:27:59):
I mean you're not involved in that decision. Yep, you
don't have a seat at the table. Oh gosh, that's
a lot. Yeah, I thought, do you have any questions
about that? I have feelings about that. I do too,
try to think if I have any specific questions. Yeah, okay.
One question I have is, like you said that, it's
the risks associated with each of these are more or

(01:28:19):
less the same. So then why would why would someone
opt for one versus another?

Speaker 4 (01:28:23):
I mean, it's in part personal preference, it's in part two,
like how far along you might be or if you
have sort of started to pass that or not. And
then a lot of it really is personal preference, because
it's like, are you going to feel more comfortable doing
this at home where you have maybe support around you,
or maybe you don't have any support at home. Maybe
the thought of having to wait a long time because

(01:28:45):
you don't know how long it will take to pass
it on your own is really more traumatic, and so
having something done where it's over and you know that
it's done is maybe more appealing to you. So there's
not like a hard line that like this has to
be one way or the other.

Speaker 1 (01:28:59):
Got it.

Speaker 4 (01:28:59):
Yeah, So let's stop there for now and bring it
all the way back to the developing embryo.

Speaker 1 (01:29:07):
Got it? Oh? Just this another prop where we left.

Speaker 4 (01:29:12):
It's the same prop my tennis ball, This inner cell mass. Okay,
we're here. So during all of this time and before
implantation and after implantation starts, what's happening with this inner
cell mass? I'm going to walk you through really quickly
embryonic development. And when I say really quickly, I mean

(01:29:34):
this is like the most cliff Notes version.

Speaker 2 (01:29:36):
Right.

Speaker 4 (01:29:36):
Okay, So we are back now at about two weeks
post fertilization, week four of pregnancy, Okay, and this little
pre embryo at this point, this inner cell mass, it's
a little disk of cells that has formed the three
essential germ layers that will eventually become all of the
different tissues and organs in our body. Okay, And then

(01:30:00):
these little disks of tissue will form tubes tubes. One
tube will become our brain and spinal cord. Yeah, the
other tube will become our.

Speaker 1 (01:30:10):
Guts, like you. That's two tubes.

Speaker 4 (01:30:13):
And then after that, a little lump will start to
form at the top of this tube of cells, and
that lump will become our head. And then little bumps
come up along the back and those will eventually become
our vertebra. By about the sixth week of pregnancy, so
there's about two weeks after a year missed period potentially

(01:30:35):
this embryo it's called an embryo. Now it still does
not look like a human like at all.

Speaker 1 (01:30:40):
No, it looks to me very much like the alien
in alien, I mean like embryonic development. Oh, there's some
quote and I don't remember who it's by, whether it's
like Dubjanski or I don't know. So one of those
old evolutionary biologists that's like everything our entire evolutionary history
can be traced to ontogeny and like the development of

(01:31:04):
and embryo. I'm probably butchering that quote. I mean I
like it. Yeah, God wish I knew who it was
by well listen, it wasn't.

Speaker 4 (01:31:13):
At this point, we look like an alien, Okay, Like
the head thing is like I'm curved over. There's this
big long thing that comes off the back, these bumps
along the back.

Speaker 1 (01:31:22):
Very reptilian, I'm very artil engines and our evolutionary origins.

Speaker 4 (01:31:26):
Yeah right, And when you look at like embryo development
side by side of like all the different species, we
look all the same, the same, the same, the same
all the way through this point. But we're not as
scary as an alien because it's like two millimeters long.

Speaker 1 (01:31:38):
I'm not as scary as an alien as oh as
alien as capital a cattal am proper not alien proper noun.

Speaker 4 (01:31:45):
But at this point too, when we look like alien
is when things like the eyes what will become the
eyes start to develop. So you get these two little
dots that will eventually become our eye cells, the parts
that will become our jaws and our ears and all
of this. This is very important patterning that has to
happen in exactly the right way for all of our

(01:32:06):
body parts to actually develop. And at this point too,
about week six is when you could first detect what
will become a heartbeat. So this little bulge that will
become our heart starts to beat, and you can see
that on ultrasound. It's also when we start to see
arm and leg buds. The buds, yeah that was loud,

(01:32:27):
start to kind of pop out just a little bit.
And then eventually those limb buds will make paddles first,
and then little fingers and toe buds. And then by
the end of the tenth week of pregnancy, so ten
weeks after your last menstrual period, okay, eight weeks since fertilization,
got it, okay, is when you start to have something

(01:32:47):
that looks more like a human than all of our
vertebrate cousins. And that is when we are almost to
the second trimester, and then we enter the.

Speaker 1 (01:32:57):
Fetal period, the fetal period, fetal period.

Speaker 4 (01:33:01):
At the same time as this is also when that
since this your trophoblast that has during this whole time
been invading its way into the myometrium all the way through,
it has finally at the same time point finished the
formation of the placenta, which isn't all the way formed
until week thirteen, which.

Speaker 1 (01:33:21):
Is our pregnancy.

Speaker 4 (01:33:22):
Wild I know, and that is the organ that you
erin will pick up with next.

Speaker 1 (01:33:27):
Week, I certainly will. I have a question though, and
you might be getting into them next week. I probably won't,
so give them to me. Now. What's going on in
the pargnive person's body is all next week.

Speaker 4 (01:33:42):
But I'm so glad you asked because I cannot wait
to tell you about it. Oh my gosh, it's really
good because it's already started.

Speaker 1 (01:33:50):
Yes from Oh, I'm so excited about it. Oh, I
can't wait. I know.

Speaker 4 (01:33:54):
I'm also done talking about the fetus. I'm not going
to mention them again pretty much.

Speaker 1 (01:33:58):
Okay, well we will and we will do more feetus
stuff in the future.

Speaker 4 (01:34:02):
So much feelings about it, and I want to talk
all about it. But we were talking about pregnancy for this.

Speaker 1 (01:34:06):
Pregnancy, so there we are there.

Speaker 4 (01:34:09):
We made it to the end of the first trimester.

Speaker 1 (01:34:11):
Oh my gosh, Oh my gosh, that went by faster.
And also we covered so much I know, but we
didn't cover. We have so much more to cover. I
have thoughts okay.

Speaker 4 (01:34:19):
Too, but everyone is going to have more that they
want to learn, so we're going to tell you where
to learn it and all of our sources.

Speaker 1 (01:34:25):
Yes, okay, So for this I actually didn't have as
many sources as I do for my later episodes. I
have a few more, but I'm going to shout out
three in particular. One is the book Pregnancy Test by
Karen Winegarden, which I referred to in my notes. Also
A Woman's Right to Know by Jesse Olzinco Grin, and
then by Sarah Abigail Levitt A Private Little Revolution. It's

(01:34:47):
an article about the home pregnancy test. And I really
liked those three together. I sort of like this big
picture view of everything that I talked about. Well, I
loved your whole part, so maybe you want to read this.
Thank you.

Speaker 4 (01:34:59):
I realized very heavily on a textbook that's very old
at this point. It was by Jones and Lopez and
it was called Human Reproductive Biology.

Speaker 1 (01:35:08):
So it's like a primer on it all. Is it
very old? Mean the late twentieth century, as like the youth,
So it's like, wait, it was the twenty first century.
It was from twenty thirteen. Ok, It's like ten years.

Speaker 4 (01:35:20):
Old, but I mean, like that's for textbook is our
knowledge of this part hasn't changed. But I will also
say that like it's good for data, but it has
a lot of weird I don't know editorialization in parts
of it, so I don't interesting Anyways, I cited it,
it's what I used primarily. And then a few other
papers that I think were really important, especially in learning
about the placental development. If you want more detail on that,

(01:35:41):
which you'll get to you next week. But there was
one from Proceedings of the Royal Society b from twenty
twenty three called the Human Placenta New Perspectives on its
Formation and function during early pregnancy. And then there was
a whole series in The Lancet from twenty twenty one
all about miscarriage, and my favorite one from that was
called Miscarriage Matters the Epidimeologie, Physical, Psychological and Economic Costs

(01:36:02):
of early pregnancy loss. But there was a few other
papers in that series as well. But as always, you
can find all of our sources, because there are so
many more on our website This podcast will Kill You
dot Com under the episodes tab. You certainly can this
and all of our episodes, all of our opos.

Speaker 1 (01:36:18):
We have literally so many sources it's kind of unbelievable. Yeah,
proud of us, me too. Thank you again, so so
much to everyone who provided their first hand account, everyone
who wrote in with their first hand account. We really
we don't have the words to express how grateful we are. No,
it's like so so.

Speaker 4 (01:36:35):
Meaningful to us, and we could not do especially this
series without you. So thank you, Thank you.

Speaker 1 (01:36:41):
Thank you also to Exactly Right Studios and everyone who
is here.

Speaker 4 (01:36:46):
You're like looking at the window. It's so exciting, very exciting.
You to Tom and Leanna who's not here today but
will be. And I'm saying too much. Thank you, to
Jessica and to Brent and to Craig and everyone else.

Speaker 1 (01:36:57):
Yeah, all that. We're so excited about this. It's really
been so much fun. I feel so cool and feel cool,
but I'm having a lot of fun. Me too, Yeah,
me too. So thank you all for all of your work.
We're excited. Yes, thank you. Thank you to Bloodmobile, who
provides the music for this episode and all of our episodes,
and thank you to you listeners yeah, and viewers, to viewers. Yeah, amazing.

Speaker 4 (01:37:23):
We hope you had fun with this one and you're
prepared for three more episodes on pregnancy.

Speaker 1 (01:37:27):
Yeah, I hope you like more where this is coming from,
because we've got it. I don't know, make that sentence
didn't make sense. It's fine, you know what. And thank
you to our patrons. We really do appreciate your support.
It means the world to us, it really does. Thank you. Well,
until next time, wash your hands, filthy animals

Speaker 7 (01:38:00):
MU

All Episodes

Episode Transcript

Hosts And Creators

Erin Welsh

Erin Allmann Updyke

Popular Podcasts

Stuff You Should Know

Dateline NBC

On Purpose with Jay Shetty

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Ep 168 Pregnancy: Act 1