This episode of "This Podcast Will Kill You" launches a four-part series on pregnancy, focusing on the first trimester, early embryonic development, and the historical and scientific evolution of pregnancy testing. It aims to provide a broad overview of physiological changes, historical context, and potential complications, while acknowledging the deeply personal and varied nature of pregnancy experiences.
Mind Map
انقر للتوسيع
انقر لاستعراض خريطة الذهن التفاعلية الكاملة
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,
childirth, and the postpartum period.
Hi, I'm Aaron Welsh. And I'm Aaron
Almond Updike. And this is This podcast
will kill Kill You. And we're coming to
you today with the first of four
episodes all about pregnancy. Four. Just
four. Just four. Should have been more.
I know. Really? And we're also coming to
you from the Exactly Right studios for
the first time, which is nerve-wracking
and exciting. I know. But this space is
so cool. We got to decorate our little
bookshelves. Um, I feel very fancy right
now. Very fancy. Too fancy for our real
lives. I mean, for sure. Very, very
different than my tiny little office. I
know. Or my closet, literally.
So, we're super excited to be here.
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 this series. And so we decided
early on to dedicate four episodes to
cover pregnancy. Just four. Just four.
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 childirth and
the postpartum period in just four
episodes. And throughout our research,
we did begin jotting down a list of
future topics to cover things like
preeacclampsia and breastfeeding and
reesus factor. And so there will be more
episodes on these and more topics in the
future. Exactly. So this series might
not and it likely will not answer all of
your questions about pregnancy or cover
every experience that a person might
have. Pregnancy is a very individual
experience as highlighted in so many of
our firsthand accounts. But what we aim
to do with this series is take you
through the really broad changes that
happen in our human bodies during
pregnancy and childirth and postpartum
and also explore some of the historical
and evolutionary aspects. Really excited
about that Aaron of pregnancy and
childirth. So each episode very roughly
corresponds to each trimester. So in
this episode the first one we're going
to be talking about how you even know
whether or not you're pregnant. Yeah.
How do you do you? How do you know? And
what's happening in very very early
embryionic development? And then our
second episode centers on the amazing
organ that is the placenta. It's really
cool. I think we'll all leave with a
little more appreciation for the
placenta. I hope so. I hope so. That's
my goal. And some of the physiological
changes that a person experiences
throughout pregnancy, including some of
the complications that can arise, right?
And then our third episode is going to
focus on child birth itself. So, labor
and different modes of delivery and then
the history of the cescareian section.
Yeah. Yeah. Yeah. Yep. And then finally,
our fourth episode and our season
finale, our season 7 season finale.
That's crazy. I know. It's exciting. It
is really exciting. Uh but the the last
episode in the series will be about this
concept of the fourth trimester. Like
maybe you've heard of it, maybe you
haven't. What is it? We'll get into all
of that and explore the changes that
happen in your body after pregnancy and
we'll also be talking like big picture
history about the medicalization of
pregnancy and childirth including the
transition from home to hospital. Yeah,
we intend for all of these episodes to
be inclusive of all families and we
recognize that not everyone who
experiences pregnancy actually
identifies as a woman. So, we try as
much as we can, wherever we can to use
genderneutral language like pregnant
person, and that's what you'll mostly
hear through this episode. However, at
the same time, we also know that much of
what we discuss when it comes to medical
bias during pregnancy and childirth,
both historically and today, is in fact
the result of gender discrimination as
well as racism. And so, in those
contexts, we may also use the term woman
or women. And throughout these episodes,
we'll be using the term mother or
maternal and paternal as these are terms
that are used in the scientific and
medical literature. Yeah. And we also
want to acknowledge that there is no
such thing as a normal pregnancy. Like
there just there isn't. There's not one.
But we do want to provide a baseline of
the expected physiological and
anatomical changes that occur during
pregnancy as it helps us to understand
where these complications arise from and
what is a complication. Right. Right.
Yeah. So, we will get into all of that
starting with the first trimester. But
first, but first, it's quarantiny time. It
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. Apt, we think. And we're also
making this is a place for reasons that
probably are clear to um I would think
people listening. It's like it's not
it's non-alcoholic. alcohol. You know
what that means? Yep, it is. And Aaron,
what is what is in Great Expectations?
It's a really delicious combination of
blackberry, ginger ale, 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 quarantiny
coming to us from no one other than
Georgia Hardstark herself. That was the
secret. Oh, sorry.
No, I'm kidding. It's perfect. Go check
it out. It's going to be great. It's
going to be great. Gosh, I'm so excited
for you. It's like beyond thrilling. I
know. It really is. I'm very excited
about it. And so, yeah, to get the
recipes for our quarantini and [ __ ]
burriita for this episode and all of our
episodes actually, check out our make
sure you're following us on social media
and you can also find those on our
websitewalkkill.com. Over to you, Aaron,
to tell me what's on the website.
So glad I don't have to do this one. Let
me tell you what's on our website. We
have so much information there, Aaron.
We have merch. We have Oh, I lost it
already. We have transcripts. We've got
Goodreads list. We've got a link to
Bloodmobile. We've got um all of the
sources from all of our episodes,
contact us for contact us form, a
firstand account form. We've got a lot
here. We've got a lot. There's so much.
There's so much.
Uh one last piece of business. Yes. It's
one last piece of business. Okay. So, I
am super excited to announce that I have
started a new hosting role at another
podcast. We're really excited for her.
She's not leaving. I'm not leaving. No.
So, this this podcast is called Advances
in Care. And in it, I interview
physicians and physician scientists at
New York Presbyterian Hospital about
their incredible cuttingedge research
and groundbreaking medical innovations.
It's really It's really thrilling. It's
very exciting stuff. It It I mean, it
actually is. And it's like really fun to
actually get to read about like, oh,
this is someone who's working on this
right now, like in real life, in real
time. These are things that are actually
making a difference in people's lives.
Yeah, it's really 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 in Care, and you can get
it wherever you get your podcasts. Yeah,
check it out. Yeah, check it out. I
don't have any business. I think that's
it. Yeah. Shall we? I think I think we
shall. Okay. Oh my gosh. We'll take a
break and then get into the history of
pregnancy. We sure something like that.
It was the morning of my son's fourth
birthday party and I was feeling um just
not like myself. I was really tired um
which is pretty abnormal for me
especially in the morning time and my
breasts were pretty tender and was
feeling a little nauseous. So, I started
doing the math in my head, just thinking
about um you know, when I could have
possibly became pregnant, if that is the
case. And I started doing the math and
um my husband's a pilot, 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 I was, it was only 4 weeks, so
I was due to get my menstrual cycle that
that week. Um so, it was very early. So,
I asked him to go to the store cuz 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, um remember
he came home, he was putting the drinks
in the cooler and I went into the spare
bathroom and I took the pregnancy test
and it came up right away that I was
pregnant. And in that moment, I had just
this realization of, wow, like I'm
having another baby. And I went outside
and I told my husband that I was
pregnant. And we were so excited. And
we're like, "Wow, we're we're really
doing this."
And it was really neat because this
whole party that we had there, we
probably had about 30 people um with
kids and parents and we were the only
two people that knew in that moment that
I was pregnant and it felt really
special. But then after the party was
pretty died down, us and a couple other
family friends um were all sitting by a
fire that we had in our backyard, a
little campfire. And um there was a baby
there and my son had a really good
friend and he had just uh his mom had
just had his baby sister. She was about
2 weeks old. And so I'm looking at this
baby that's sitting in front of me and I
started doing the math in my head again,
just counting the months. You know, if
I'm pregnant and this pregnancy is
viable and we end up having this baby,
this baby will be born in August um
before school starts. And that means
that this baby is going to be in the
same grade as that baby that's sitting
right in front of me. This baby that I
just have found out I'm pregnant with is
going to grow up with that little girl
that's sitting in front of me. And that
blew my mind that I was going to grow a
whole human in a school year. Um, and so
fast forward 7 years later and these two
children are now in the same grade.
Sometimes they're in the same class and
they are um growing up together and it's
just something that's fun to think back on.
on.
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 manufacturer of
insulin, and anesthesia for a start.
It's a long list. It's a long list. I
couldn't stop once I started. Yeah, but
I would be shocked if you found home
pregnancy tests on the one of those
lists. No, I don't think I wouldn't have
guessed it. 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 actually. True. Yeah. Kidney
diialysis. We need to do that one. I
know. And so many anesthesia. I know. I
know. But I've never seen home pregnancy
tests mentioned. I don't think so. And
to a degree, I get it. Right. like these
tests didn't provide new avenues for
treatment, nor did they represent a
paradigm shift in how we understood the
workings of the human body. Okay? But I
would argue that these sticks and the
plastic rectangular boxes that preceded
them absolutely deserve a place on any
list of significant medical
breakthroughs. I I I'm already just so
invested in this, Aaron. I mean, are you
convinced? Yes. So, I can stop. Yeah.
Done. Okay. Done. They're on the list.
But the reason I feel so strongly about
this is because of the type of knowledge
that they grant us. Not guiding
principles, not laws of nature. Home
pregnancy tests give us deeply personal
knowledge about our own bodies,
empowering us to do with that knowledge
what we decide we want or need to do.
Share it. Keep it to yourself. For the
first time, that choice was up to the
test taker. They were the first to know.
Not the lab technician running the test.
Not the frog being tested. More on that.
Can't wait for it. Not the doctor who
dained to prescribe a test. Oh yeah.
Prescription only. Okay. Yeah. The
transfer of this knowledge out of the
hands of the medical provider and into
the hands of the test taker held
profound implications for women's
reproductive rights. Of course, probably
no one needs to be reminded that what
you decide to do in terms of continuing
with the pregnancy or not is not always
up to the pregnant person alone. Yep.
Especially not in the United States
right now. Nope. But the story that I
want to tell today is about the quest
for this knowledge. Like what ultimately
led us to the near universally
recognizable stick that shows one or two
blue lines and where we might go from
here. I'm so excited, Aaron. Me, too.
Okay. Okay, for thousands of years,
people have searched for a way of
knowing whether someone was pregnant or
not. Okay, outside of like the bodily
signs like morning sickness, missed
periods, tender breasts, and quickening,
the fetus's first movements,
which was considered like really one of
the most significant signs in terms of
like that is when a pregnancy became
real was quickening. And I won't
speculate on why there was a need or a
want to know whether it came from
within. Someone wanting help
understanding what their body was trying
to tell them or whether it came from
without like someone wanting to know
whether their partner, their friend,
their daughter was telling the truth.
And I'm sure there were many reasons for
a test, right, that you would want a
test. Yeah. The first pregnancy test
comes to us all the way from an ancient
Egyptian papyrus. Stop it. I know. How
can you pull ancient Egypt out when
we're talking about pregnancy test? You
know, I thought, okay, what like what
are my my usual go-tos are ancient
Egypt, Hypocrates, 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 in any of
these. I know, but yeah, ancient Egypt
pregnancy test. Stop it. 1350 BCE, there
was a like a papyrus or something that
instructed women to pee in two bags. One
bag contained wheat. One bag contained
barley. Okay. If the wheat grew, it
meant a female child. If the barley
grew, it meant a male child. Why does
this feel vaguely familiar? I think we
might have talked about it in our IVF
episode part one. Okay. Yeah. Okay.
Yeah. Weird. But I don't remember if I
like dug any deeper because I did this
time and it turns out that some
researchers tested this like a few
decades ago. No way. And yeah, it's like
not it's like not great, but it's not
entirely incorrect. Like is it more than
50%. Yeah. 70%. Really? I know. There's
no association with like the sex of the
fetus. Just like whether or not you are
pregnant. Yeah. So it's like growth
hormones. Oh my god, that's so urine. In
your pee. In your pee. It's interesting
that even the first test was pee. P has
always been a main feature. Really? It's
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
Really piss profit. Can you imagine
being like on your business card? Yeah.
Piss profit. Official assistant piss profit.
profit.
Assistant to the piss profit. Yeah.
Apprentice piss profit. I can't Oh my
god. That's great. Okay. And what did a
piss prophet do? I mean, basically what
it sounds like, right? Like you be able
to hold up the urine in a glass and be
like, "Oh, this person has this disease,
that disease, this person." It was more
than just pregnancy at this point. It was
was
like a horoscope even probably. A lot of
things you can see in your piece. So I
get it. Exactly. So there is some basis
to this. So some piss prophets claimed
that I know I get it. claimed that
deposits of white flaky material in
urine that had been left standing for a
couple of days could indicate pregnancy.
So the deposit may have been casein.
Okay. Is that how you say it? I mean
casein is a thing like a protein I
think. Which is it's part of breast milk
produced during pregnancy. Ah yeah.
Okay. Yeah. Mhm. Urine did briefly fall
out of favor in the 18th and 19th
centuries uh for pregnancy testing and
instead physicians performed physical
exams to determine whether or not
someone was pregnant. Although I know
that doesn't sound great. It doesn't
sound great. And the doctors were like,
as is typical would so afraid of modesty
and so it would just be like kind of
just like closing their eyes and like
searching and it's yeah, it's not great
to think about. Okay. Uh but these signs
often included things like changes in
the color of the cervix, vagina, labia,
softening of the cervix, changes in
breasts or nipples, changes in the
abdomen, u 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. Like give it time, wait for the
quickening, then you'll know, right? And
in fact, until the 20th century rolled
around, because there was no single 100%
reliable way of determining pregnancy
from an outside perspective, which is
mind-blowing to think about, doctors
usually took their patients word for it.
Huh. Yeah. Okay. Because they believed
them. They believed them. Wow. Then once
the lab-based pregnancy test came about,
that word slowly held less and less
weight in the eyes of medicine. And
these tests, these lab-based tests, also
made it easier to prosecute someone for
abortion because you had proof of early
pregnancy, even if you couldn't
distinguish between abortion and
pregnancy loss. Oh, wow. That's
interesting. Yeah. And horrible. And
horrible. Okay. So, how did these tests
come about? Science has never followed a
straight line of progress, and lab
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
nuance, check out the books A Woman's
Right to Know by Jesse Olinko Grin and A
Pregnancy Test by Karen
Wearten. My name is Henny. I'm 34 from
New Zealand and 5 years ago, I woke up
with pain in my right lower belly and
vomiting. I took a pregnancy test and it
was positive. What followed was the
scariest two days of my life during
which they found an ectopic pregnancy on
ultrasound. By the end of 2 days, I had
pain in my right shoulder tip, but no
abdominal pain. As an emergency nurse, I
know that shoulder tip pain can be a
type of referred pain, indicating
diaphragmatic irritation from blood in
the peritineal cavity. The OB/GYN on
call decided that my lack of abdominal
pain meant that I could go home and wait
for surgery. All I could think of was a
case I had treated a few months prior in
my emergency department. She had a
ruptured ectopic pregnancy and we had
poured blood into her rushed her to
surgery and she nearly died. That case
and my knowledge about the importance of
shoulder tip 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
fallopian tube was completely blocked
and there was blood in my belly. If I
had have gone home there is a very real
chance it would have burst completely
and I could have died. Being an
emergency nurse and an advocate for
myself saved my life. Losing a fallopian
tube was really hard mentally until I
learned the biggest health lesson I ever
have. I can't believe I got through so
many anatomy classes without knowing
this. But your fallopian tubes aren't
fixed. Although that's how the textbooks
show them. They can reach out and move
and grab eggs. 6 months postectopic and
I got pregnant again and all of the
anxiety came back. But I was very lucky.
Nine months later, we welcomed our
beautiful son and another year and a
half later, our second son. My other two
pregnancies and births had their own
challenges, but I'll never forget my
first, wondering what could have been
for that pregnancy. What could have
happened if I wasn't my best advocate?
And I think about my experience every
time I go to work in my own emergency
department and treat potential ectopics.
It made me a better nurse, a better
patient advocate. I'm so grateful for my
two boys who managed to find their way
to my uterus instead of my one remaining tube.
tube.
In the first couple of decades of the
20th century, the field of
endocrinology, which is the study of
hormones, took off in full force.
Researchers investigated how adrenaline
worked, what insulin did, which hormones
fluctuated during pregnancy, and other
endocrinology related questions. There
were a million of them. Yeah. Finding
the answers to some of these questions
like which hormone is excreted in urine
in people who are pregnant before they
even realize they are pregnant led them
to even more questions like what would
happen if we injected some of this urine
into immature female mice. That's a
normal question. It's a normal question.
And that pretty much sums up how the
first lab pregnancy test came to be. Oh,
really? Really. In 1927, two
researchers, Ashim and Zandek, uh, who
gave their names to this test, developed
a protocol where they would take urine
from a possibly pregnant person, inject
it into five immature female mice twice
a day for 3 days. Whoa. Kill the mice,
and then take a peek at their ovaries.
Sorry. Okay. Is this Okay, I have so
many questions. I know. Um, is it like
are they having to pee multiple days for
this? Twice a day, three times a day or
like one sample. Question. Okay. Too
detailed. My guess is it was just one
sample. Okay. And then there So this is
taking many days before. It's taking
many days. Yeah. And and like five five
mice. Is that how many I said? Yeah. Uh
yeah. It's a it's a process. Uh 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 person was pregnant. That I
mean makes sense physiologically, but
Okay. Very interesting. So, and what
these animals were responding to was a
hormone in the urine called HCG. HCG,
human corionic gadotropen.
Nice. Really? Yeah. S. Uh, initially
researchers thought it was produced in
the pituitary gland, but physician
scientist Georgiana Seager Jones
correctly identified its origin as the
uterus and gave it its name in 1945.
Wow. Okay.
1945 when hCG was named HCG. Yeah. And
found to be from the uterus. And
eventually rabbits replaced mice because
you could get a result faster and you
didn't have to use as many animals.
Gosh. The phrase the rabbit died. Have
you ever heard of this? No. I've been
rewatching madmen and there's another
part of mad I've been thinking a lot
about mad men in pregnancy. And um but
that is a euphemism that was commonly
used to be like did that mean that you
were pregnant or weren't pregnant? you
were pregnant, but it doesn't really
make sense because they killed all the
rabbits. Yeah. Okay. Yeah. Weird. I
know. I know. But I do find it's 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 20th century at the earliest.
Really? Yeah. It was kind of just a not
like taboo, but it was in hush terms,
euphemisms. Yeah. Exactly.
Uh but these tests, the Ashims on deck
test and the Freriedman 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 7% of the
time toxic. Oh, so then it would kill
the It would kill Yeah, maybe that's
where it comes from. I mean, okay. Uh
and it had to be treated otherwise it
would kill the rabbit just outright.
Yeah. And the second was that the
animals were expensive to keep. Yeah.
Animal welfare didn't seem like a
pressing concern at the time, but cost
was. Okay.
And fortunately, a cheaper animal was
available. The African clawed frog. Oh,
they're so cute. They're very cute,
aren't they? Also known as the African
claw toad. Is it a frog or a toad? I
don't know. I'm pretty sure it's a frog.
And yeah, it's the scientific name
zenopus leas. Okay. I don't know. But it
only happens to ovulate in the presence
of a male frog or in the presence of HCG.
HCG.
So then did with these did you just have
to like squirt it on top because they
just diffuse through their skin or
essentially. Yeah. Yeah. Yeah. So, in
1933, researchers Shapiro and Zorenstein
discovered that yeah, if you just sort
of sprinkle urine, well, I don't know if
it was actually sprinkling, but like if
you expose, we'll say that, uh, urine
from a pregnant person to these frogs,
then you could induce ovulation in the
frog 8 to 12 hours later. And then, so
that's much quicker. Much quicker. And
do you have to kill the frog or No.
Nope. Can you reuse that frog? I think
you can. I think you just would not like
like have to give it like a wash out period.
period.
Yeah. Yeah. And so soon labs around the
world began importing these frogs for
pregnancy testing. Wow. And guess what?
May have hitched a ride. Kitrid. Kitrid.
Stop it. Yeah. This How did we not talk
about this in our Kitchen episode? We
may have, Erin, that was like seven
years ago. Wait.
Uh, yeah. So, and for those of you who
haven't heard of Kitrid or haven't
listened to our Kitrid episode, Kitrid
is a type of fungus that is absolutely
deadly. like devastating to some species
of amphibian populations of frogs like
extinction in the wild type of a thing.
Yeah. But researcher some researchers
think that the widespread distribution
of these African clawed frogs for
pregnancy testing may have led to the
global spread of kitrid. I kind of hope
that we actually did cover this and I
have completely forgotten it. I know
it's I I feel like I feel like we did. I
don't know though. It sounded vaguely
familiar, but it or is it like one of
those where it's a memory and then it
becomes or it's a new thing and it
becomes a memory manufactured memory or
whatever. Exactly. That's it. Yeah. Wow.
Okay. That's really interesting. Yeah.
Is there data to back it up or it's just
like a guess? Oh, funny you should ask.
One of the earliest identified specimens
of kit infection is from one one of
these frogs in 1938. Wow. 1938. Yeah.
Okay. Okay. Isn't that wild? Yeah, that
is 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 Exactly. or or keep the
animal so expensive. Yeah. But the first
of these dreamed of tests was developed
in the late 1950s and it was an
imuninoay that detected hcg. Okay. With
these tests, especially as specificity
increased and false positive decreased
with later improvements, researchers
could decrease turnaround time as well
as cost. And that ultimately resulted in
more people utilizing these tests, but
probably not as many as you think.
Getting a pregnancy test was by no means
a typical part of any pregnancy
throughout the 1950s and the 1960s. And
in fact, most people didn't get tested.
Why? First of all, access. If you wanted
a pregnancy test, you had to make a
doctor's appointment and get a
prescription for a test, at least in the
US, even even after they moved away from
these animal assays, like just to the
iminoassay ones. Yeah. Everything was
prescription. Yeah. And then you had to
wait weeks to hear the results from the
doctor and you're like, I already have
missed like three periods by now, so I
know. Okay. I think I think I know.
These things cost time and money, right?
And second of all, stigma. M some
doctors refused to test certain people
to prevent them from getting an abortion
and so they would withhold that
information until it was too late. They
would say, "Well, if you want a test,
I'm worried about what you're going to
do with those results." Oh my god, I
hate that so much. And I wish that it
surprised me more. I know. I know. Or
they would tell husband first so that he
could make a decision. I didn't know I
was going to get livid this early in the
series. I'm so sorry. It's just get
ready. Strap in. Strapped.
There was stigma attached to wanting to
find out if you were pregnant before you
started showing these quote unquote
natural signs. Interesting. Because it
suggested you had anxiety about the
pregnancy or about the father. If you
were married, forget about it. Your
reputation would never recover. What?
Often. Yeah. Just for like wanting to
know this information, then people
assumed that you were up to something.
Often. Yeah. Wow. The 1966 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 they made. 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 1970s, it
didn't immediately erase the stigma, but
it did make testing an option or at
least more of an option for the people
where previously it wasn't. Who saw this
need and did something about it? Uh,
someone who could make money off it. Um,
actually no. Oh, okay. I know.
Pleasantly surprised. Yeah. Coming up.
There was a woman by the name of
Margaret or Meg Crane. Okay. So, one day
in 1967, the 26-year-old Crane was
walking through the offices of Organon,
which sounds made up, a pharmaceutical
company where she worked as a freelance
graphic designer. And something caught
her eye. One of the rooms as she walked
past was filled with a bunch of test
tubes hanging in some sort of bizarre
contraption, and she asked her colleague
like, "Well, what's what's going on in
there?" It turns out they were pregnancy
tests. M 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 designing a home pregnancy
test prototype as a graphic designer
she's like I can do this yeah she's like
this is not that hard we we should be
that was perfect thank you but yeah she
didn't do it because her boss asked her
to do it. She just knew how
revolutionary it could be. She saw the
potential and what a change it would
make. I love this. 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. And so a few weeks
later, Crane walked into work to find a
big meeting taking place and she was
like, "What's going on in there?" Turns
out it was a meeting to discuss
different home pregnancy test designs.
So she crashed the meeting, put her
design on the table with all the others
which all of which were designed by uh
men. One had rhinestone edging, one had
a cute little tassel. All were pink
except cranes.
But Cranes was the only one to include a
urine collection cup. Oh my god. Are you
serious? Yeah.
We've got the rhinestones, but not the
collection cup. What if we use a mug?
Exactly. So someone's like, "What?" And
the one of the 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, Aaron. I know. I
know. And so cranes because of this and
because of the other practical aspects
of its design was considered the winning
model. And so, let me paint you a
picture, please. A hard clear
rectangular box made of two pieces that
joined in the center. Okay. Inside the
box was a dropper and a test tube that
contained dried rabbit antibodies in
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. Okay. And then you waited for
2 hours, which is much better than 2
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. Wow. Yeah. If you were pregnant, a
red brown ring like a donut 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. Wow, that is really
complicated. It's really complicated,
but it's also something that is like it
was pretty much Yeah, it was very
similar to Not that much harder than
like COVID tests where you're like,
"Okay, I swab this and I move this and I
drop her this and I Right." Yeah. I'm
something of a epidemiologist myself. Yeah.
Yeah.
Uh yeah. Uh, also I just want to add a
cute little side note. So Crane met her
future husband at that meeting. He, I
think, was the one who was like, "This
design is clearly the best." Oh, good.
Not like I produced the rhinestone one.
No, no, no. Uh, and eventually they
opened their own ad agency where she was
the head designer and he was the copy
chief. A so cute. But with Crane's
design in hand, Organon sought to get
this test to market. Facing heavy
opposition in the US, was it reliable
enough? What would women do with this
information? Organon instead turned to
Canada where unlike the US, you did not
have to have a prescription to get a
pregnancy test and you could just take
one at the pharmacy without a doctor's
appointment. Okay.
Unbelievable. I mean, totally believable.
believable.
By summer of 1971, Predictor, which is
Organon's home pregnancy test, was on
the shelves in Canadian drugstores for
$5.50. Wow. Which is about the same
price as a bra and a little less
expensive than a lab test. Okay. Okay,
just to put it in context. Yep. Not
everyone was a fan of the lab tests. 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 read directions or pee in a cup.
Come on. Yep. Jeez. Others described it
as a passing fad. Oh, of course. just
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 1970s. Wow. In the US, the FDA
approved the test in 1976 and they hit
the shelves in 1977. Wow. One of the
earliest ads for these tests, the EP
inhome early pregnancy test, described
it as quote, "A private little
revolution any woman can easily buy at
her drugstore." I love it. Yeah. Early
TV ads ended with, "Time is on your side
at last." The tone from these ads
reflect the push for and the milestones
in reproductive rights in the US in the
1970s. Okay? Like Roie Wade was 1973,
for instance.
But the private little revolution wasn't
immediate. These tests cost $10, which
is about 51 in 2024. Holy cow. Yeah.
Took 2 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 early Mhm.
it made home testing prohibitively
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. Cuz
otherwise the ring would probably
dissolve. Oh, interesting. The donut.
Yeah. Yeah. And stigma lingered. Right.
There was one state official telling
Consumer Reports in 1978 that quote,
"There is no reason for a woman in
Maryland to buy such a kit as the EP
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
If you didn't buy so much avocado toast
to test, maybe you could buy a house.
But the sentiment revealed a disconnect
between what most physicians, some
politicians, and a puritanical
patriarchical society thought women
needed and what women felt they needed,
especially in the US where there
initially was push back against allowing
the test to be sold in drugstores over
the counter. Yeah. Regardless of how
accessible you made pregnancy tests at
the clinic, like getting rid of
prescription requirements, reducing the
cost, whatever the tests revealed at
those clinics was first learned by
someone else, 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. There's a quote I
want to read you from the book Pregnancy
Test by Karen Weinearten. Quote, "With a
home pregnancy test, women could take
control of their decision from day one.
They wouldn't need to find a doctor
willing to test them for pregnancy who
might question their motives or next
steps. They wouldn't even need to share
their news with anyone until they were
ready." End quote. Even early marketing
materials focused on what this meant for
women, not families, not a couple, but
for a woman who thinks she might be
pregnant, focusing on the privacy aspect
of these tests. The pharmaceutical
companies that produced them also had to
convince physicians that this was a good
thing. That early pregnancy detection
meant people could get prenatal care
earlier. And most physicians agreed with
that potential positive impact. But many
remained skeptical that the tests were
accurate and they would insist on a
clinical test to confirm home results.
And this is not without merit. Of
course, even the most accurate tests
today are not 100% accurate or may not
be able to give you all the information
that you need to decide what to do next.
The pregnancy test does not reduce the
need for or replace medical care at all.
It is simply often the first step along
the journey, whatever that journey may
be. By the 1980s and Reagan's
presidency, these ads shifted in tone to
be more about family values. Of course
they did. of course, featuring straight
couples sharing the joy that a test
could bring. The 1990s saw reality
advertising for pregnancy tests with
couples finding out on camera the
results of those tests. All the way in
the '90s. In the '90s. Yeah. I mean,
come on. You like Jerry Springer, Mory,
stuff like that. Yeah. Yeah. Okay.
America's Funniest Home Video. Sure.
Sorry. Don't know if I'm sure pregnancy
tests featured on some of those. I'm
sure they didn't, but but these these
'9s tests, that's when the first time uh
people of color were featured in many of
these ads. And while most couples in
these reality, so it would be like a
couple being like, "Oh, let's find out
the results on air or whatever." And
then um most of them like clearly wanted
a positive result or 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 1997
pregnancy test ad where the woman in the
ad finds out the results, but the
audience doesn't get to see them. I love
it. When you're waiting to find out if
you're pregnant or not, nothing else in
the world matters until you know.
Introducing Clear Blue Easy 1 minute
pregnancy test because only Clear Blue
Easy gives you a clear yes or no in 1
minute. So that's the first time that
it's just waiting and you have to kind
of infer yourself. I think so.
Interesting. Yeah. Isn't that Isn't that
other relieved but she's smiling and you
don't know is she happy that it's
positive or negative. I really I really
like it. The mystery the mystery of it.
That ad is especially important too for
showing that it's about the knowledge
not about the result. And I think that's
that's a big shift in that perception of
like what these tests have given us.
Okay. So within 25 years of their
release, home pregnancy tests had become
a widely used, recognizable, commonplace
diagnostic tool, as well as a useful
plot device. TV shows, movies, novels,
all began to feature pregnancy tests as
a useful way to increase dramatic
tension or force character growth. I
mean, how many sitcoms have an episode
where someone finds a positive pregnancy
test in the trash? Who is it? Everyone.
Oh my god, I can think of so many. Yeah,
they've been used in TV and movies as an
opportunity for safe sex talks between
parents and a teenager. A moment of
self-reflection for whether or not a
character wants the test to be positive
or negative, whether they want children
at all or feel ready to have kids on
reality TV in really twisted scenarios.
Like I there's a a my one where someone
has to take 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, but there are, yeah, a
million examples, right? In 1991, the
show Murphy Brown showed Murphy taking a
home pregnancy test and ultimately
deciding to become a single mother after
considering abortion. This is 1991. Wow.
I feel like that's it's like not allowed
today. It Yeah. Yep. And this plotline
was criticized by Vice President Dan
Quayle as quote unquote eroding family
values. Of course, it was. Right. Yeah.
Um 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,
right? Made it even more like normal.
Yeah. Exactly. But it's incredible how
over the almost five decades since its
release, the home pregnancy test has
become almost universally recognizable
even for people who have never used one.
Right. I loved how like yeah the early
COVID tests and people would take
pictures and it like everyone thought it
was a pregnancy test immediately. Yeah.
But improvements to the test over these
decades include things like the
invention of monoconal antibodies which
eliminated the need for lab animals.
More precise testing. The now familiar
easyto read stick test with the two
lines was introduced in 1987. Now some
of them say pregnant or not pregnant
digital ones. In 2021, a flushable
pregnancy test was introduced, which is
an incredible uh development to protect privacy.
privacy.
Wow. Yeah. I was just thinking about
sewage lines. Like, is are they actually
flushable? I mean, I think I think they
are fascinating. Yeah. Uh tests have
been developed that can be read by blind
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. Oh, myism showing. I know.
It's so it's so incredible the different
innovations that have been thought of.
Yeah. One organization has introduced a
test that measures hCG as a way of
verifying that an abortion worked. And
so you take like a, you know, sequential
test afterward to be like, is it
dropping? Right? I've seen different
estimates, but around 8 million people
in the US alone used a home pregnancy
test in 2020. Wow. Think about that
compared to 50 years ago. I'm going to
read you a quote from an article by
historian Sarah Abigail Levit.
Quote, "Though women have found ways
throughout history to find out about
impending pregnancy, it has only been
within the last quarter century that
this information was available to so
many women with such reliable accuracy.
Women in this generation who take home
pregnancy tests are able to know
something about themselves and their
futures in a time frame that was simply
not possible for their grandmothers or
even their mothers." Isn't that
mind-blowing? Like my grandma wouldn't
have taken a pregnancy test. I wish that
I could ask my my grandma. My mom took a
home pregnancy test. I assumed that my
mom did, but I never asked her. I asked
her so many other things about her
pregnancy for this episode, but I didn't
ask her that. Yeah, it's incredible.
But that knowledge can come at a cost.
Also from Levit, the pregnancy test has
liberated women by giving them
information earlier and allowing them to
digest the information in the privacy of
their own homes. However, it oppresses
women when it forces them to make
decisions earlier and earlier, when it
forces them to confront a miscarriage
they might otherwise never have known
about, or when it falls into the hands
of those with whom they did not wish to
share the information, and when it
proves an untrustworthy narrator and
gets the answer wrong. Yeah, people have
been and continue to be tested for
pregnancy without their consent or by
those who have ulterior motives, such as
testing unhoused women in the 1980s in
New York City who had to be tested if
they wanted city housing. Wow. Mhm. Or
women on certain police forces being
secretly tested. Employers pretending to
test potential employees for drugs but
actually testing for pregnancy. That has
happened. Oh my god. Yeah. The US
Immigration and Customs Enforcement,
ICE, tests those arriving at a detention
center who are over 10 years
old ads for free pregnancy testing at
clinics that are actually anti-abortion
clinics. That's major. That's a major
one. And then the early detection and
sensitivity of these tests could be seen
as a double-edged sword. Some suggest
that pregnancy tests is not really an
accurate term, that these tests aren't
detecting viable pregnancies, but just
the presence of hcg. And so non-viable
pregnancies that may not have been
noticed in the past are now recognized,
potentially increasing the trauma of
that experience. For some, however, that
experience may be incredibly meaningful.
These days in the US, early detection of
pregnancy can be critical, especially
for those living in states that restrict
abortion to a narrow window like 6
weeks, right? Or like outlaw it at all.
So you have to figure out where you're
going to travel to. When you're going to
travel Yeah.
Waiting until you've missed a period to
take a test might already be too late.
Knowledge is power and that can be
dangerous if that knowledge falls into
the wrong hands or is used against us.
But it can also be incredibly liberating
and empowering, giving us access to and
control over information about our
bodies that should have been ours all.
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 at
Early Burger? We'll get to it. Okay.
Great. Right after this break.
Hi, my name is Stevie. My pronouns are
they them, and I live in Ontario,
Canada. In 2012, my husband and I were
extremely excited to be expecting our
first child. At 10 weeks, we had started
seeing an OB. I'd been spotting off and
on, but he kept saying that everything
was fine. And while bleeding isn't
normal, it is common, and don't worry.
He said the same thing at every
appointment. It's not normal, but it's
common. Don't worry, everything's fine.
At 18 weeks, he sent me to a specialist.
I wasn't expecting it to be a big deal.
After all, everything was fine, right? I
was wrong. I was blown away by the list
of issues and complications being laid
in front of me. The only thing I really
remember is that I was at a high risk
for preterm labor. About a week later at
work, I stood up to get something and
felt a gush. I reached down and my
fingers came up red. I was hemorrhaging.
I had a friend drive me to the ER. My
husband met me there and we waited. I
was told that if I was misarrying, I'd
have to stay down in the ER. I was too
early to go up to labor and delivery.
The ultrasound showed a good heartbeat,
though, and bleeding slowed down, so I
was sent home on bed rest. Around 1:00
a.m. on November the 11th, I woke up and
vomited. I had an intense cramping in my
stomach and my back. I told my husband
something was wrong. We went back to the
ER. The OB said I was in labor and it
can be triggered by dehydration. So, I
was given an IV and it stopped. I was
moved to a room and told I was staying
there until I delivered, whenever that
was. But at under 24 weeks, there was
really no hope for the baby. On November
the 14th, at 21 weeks and 4 days, I went
into labor. This time, it didn't stop.
Our daughter was delivered at 1:26 in
the afternoon. She weighed exactly 1 lb.
Our families were there and we sang her
happy birthday. She lived for 3 hours.
During that short time, she knew nothing
but love. We all held her and sang to
her. She took her last breath with me.
That night, my husband and I went to
sleep in the postpartum ward to the
sound of other people's babies crying.
The specialist never found a reason for
our loss. She said it was probably a
placental abruption, but she really
wasn't sure. We went on to have two more
pregnancies, and we have another
daughter and a son. We have pictures of
our firstborn, and she's very much part
of our lives. Our other kids say they
see her when they see the first stars
come out at night. As I always say,
she's our perfect girl made of stars. I
share our story as often as I can.
Pregnancy and infant loss affects one in
four pregnancies and is not discussed
enough. I felt so alone after our loss.
Every year on her birthday, I share our
story and new people will share their
own stories with me. I hope that sharing
my story here will help people to feel
less alone. Our loss should not be
hidden. We shouldn't have to grieve in silence.
So, this might sound silly now after
everything that you went through, but I
felt like to make all of these episodes
make sense, I wanted to start by just
defining pregnancy. No, that's a great
way to start. Cool. Like, it might sound
very obvious, right? Like, I think we
all know what we think pregnancy is,
right? It's it is the period of time
when there is a fetus growing in your
uterus. That's what we think of as a
pregnancy. Yeah, but like you just
walked us
I want to start with how we date a
pregnancy today. Great. Okay. This is
how we decide when a pregnancy quote
unquote begins. Okay. And in medicine
that is pretty universally based on your
last menstrual period. The first day of
your last menstrual period is the start
of a cycle, your menstrual cycle. We
assume in medicine that all menstrual
cycles are 28 days long. Exactly. We
know that they're not, but that's an
average. And so based on that
assumption, pregnancy is 40 weeks long.
It's about 280 days. All right. The time
that it takes from fertilization, and
we'll get there, to a mature fetus or
baby is about 38 weeks, 266 days. So
that extra 2 weeks between 38 and 40,
that's the time it takes from the start
of that last menstrual period to ovulation/fertilization.
ovulation/fertilization.
Does that make sense? I think so. So
that's why your pregnancies are always
longer than you would think it is. By
the time that you have missed a period,
you're already four weeks pregnant. Oh
my gosh. Even though fertilization just
happened two weeks ago.
Got it. Okay. Yeah. And it is confusing
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 and but I just want to
set the stage that is how we define
pregnancy. That's the time frame of
pregnancy. Okay. I have a question real
quick. I know. Give it to me. Give it to
me. So there then is a potential
uh like error bars around Absolutely.
And so then how 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
cuz that was my life. I was I was
angling too. Yeah. So if you have like
for example very long menstrual cycles
like 36 days or something like that
that's pretty different than 28 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 measure what the embryo
and fetus is growing as. And if it's off
by a certain number of days then you
change the date of the pregnancy. Okay?
Does that make sense? And it all depends
on like how early that ultrasound is,
how it's growing and 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 menstrual
period. Interesting. Yeah. Okay. So that
I feel like that has such huge
implications for Yeah. everything. Yeah.
And and it really does like for my both
of my pregnancies were not dated
accurately based on that. Right. One of
them I found out early on and it was
fine. The next one it was the day I went
in for an induction. Oh my gosh. It's
all fine because then there's that it's
like well you need an induction, right?
Or you don't. Yeah. So it does it does
matter. And now that we have the better
ultrasounds that we have, the more
accurate we can be in dating if you have
access to an early ultrasound cuz
ultrasound gets less accurate the
farther you get in pregnancy. I am going
so far off. No, this is great. I'm I
sorry I started this down this rabbit
hole. I love it. Okay. But so let me
find where I'm at. Yeah. Uh okay. But
yes, so that that is how we define it in
medicine. I'm going to walk through like
the steps after fertilization and the
very early parts of a pregnancy. So if
any of my dating gets confusing where
you're like, what what does that mean?
Just stop me so I can clarify. Okay? And
that is what I'm going to walk us
through today is early development and
then some of the things that can go
wrong within that early very early time
period. And we'll talk a lot about
miscarriage and early pregnancy loss.
And my goal for this part of the episode
is to help us understand the question of
what has to happen biologically for a
pregnancy to be possible. Yeah. Okay.
So, we will begin 2 weeks after your
last menstrual cycle. Okay. Okay, on
average you have ovulation. That's when
you ovulate. And if a sperm is present,
then you have fertilization. These two
single cells will come together and join
their nuclear contents and make a brand
new cell. I'm taking everything that
happens prior to that point for granted
cuz it's cool, but it's way too
detailed. Okay, so that's where we
begin. Within the first 12 to 24 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 12 to 24 hours or so
after that you continue dividing. So you
go from 2 to 4 to 8 to 16 to 32 cells in
this tight little ball by about day
three after ovulation which is like 17
days or so after your last menstrual
period. Got it? And as this ball of
cells continues to divide it starts to
take a shape. It forms itself by about
day five or six. So 19 or 20 of your
menstrual period after your last
menstrual period into a hollow fluid fil
ball. And we talked about this in our
IVF episode. It's called a blastoyst.
Yep. And I imagine the blast assist like
a tennis ball. Yes. I brought one here.
Did you bring Okay, perfect. It's a
tennis ball. Okay. Your dog is going to
be really sad. She was when I was like
making what I made with playing, right?
She was like, "Is that my ball? Is that
my ball?" I did not take her ball. Um,
okay. So imagine this is a hollow ball,
right? But it's filled with fluid
instead of just being filled with air
like an actual tennis ball. But instead
of being like perfectly symmetric inside
and outside in the blastoyst, there is
on the inside
an extra few layers of cells called the
inner cell mass. And this inner cell
mass that we have here is what will
eventually become the embryo and
eventually the fetus. Okay? Just this
little few little cells. And at this
blastois stage 6 or 7 days or so after
fertilization about day 21 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 is this blastoyst 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 blastoyst and
eventually fetus does not grow in that
cavity. It grows within the wall of the
uterus. Mhm. Okay. Now the outer wall of
that blasty like the fuzzy green layer
of the tennis ball it's called the
sensitio trophoblast and that is the
layer that will continue to invade into
the walls of our endometrium in into our
uterus and all the way into the first
third of the muscle layer the myometrium
of our uterine wall. Yeah. And I know
you're going to talk more about that
next episode kind of. Yeah. Yes. So the
maternal endometrium like our own cells
are not passive in this process by any
means. No way. Our body is responding to
the invasion of these fetal cells that
will eventually by the way become the placenta
placenta
by completely remodeling. So the
structure of our uterine lining
completely changes. We have huge changes
in the inflammatory signals that are
being sent within our body. I'm excited
for you to talk more about it. and then
also big changes in the hormones that
are dancing around in our bloodstream.
Okay, so just to just to recap recap it
briefly. So the cell implantation
implantation
multiplication some of those multiplied
cells become the placenta eventually and
some become the embryo later fetus.
Exactly. Yeah. The inside part is what's
going to become eventually the baby. The
outside part is what invades and then
becomes the placenta. Yep. And there's
like layers obviously. So interesting
the differentiation. How what are the
signals that say you be placenta you be
I love it. It's it's so so so
fascinating Erin and I you could go in
so much more detail on like every single
step within this. There are entire
textbooks on like this exact layer. I
know I'm not going to go there but I 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. The first is that about 48
hours or so after implantation starts is
when the cells of that sensitial
trophoblast, the cells that are burring
their way into our endometrium will
start to secrete hCG. Uhhuh. And that is
not only important for detecting a
pregnancy, but also one of the major
keys for a pregnancy to be able to continue.
continue.
Okay. Because Yep. 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. Mhm. And that
hormone up until this point of
implantation and hCG secretion has been
secreted by this thing called the corpus
ludium, which is what's left over in
your ovary after you ovulate. Okay? So,
everyone makes one of these every time
they ovulate and it hangs out there for
like 2 weeks supporting the lining of
your endometrium hoping that a blastoyst
will implant. Right? But the corpus
ludium only lives about 2 weeks or so.
So by day 14 after
ovulation 28 days or so after your last
menstrual period if you don't have the presence of hcg in your system then this
presence of hcg in your system then this corpus ludium will disintegrate your
corpus ludium will disintegrate your progesterone levels will drop and you
progesterone levels will drop and you will have a menstrual period you will
will have a menstrual period you will shed the lining of your uterus the
shed the lining of your uterus the decidua. The decidua okay well I just
decidua. The decidua okay well I just I'm trying to track that with all the
I'm trying to track that with all the stuff which I don't even know if I talk
stuff which I don't even know if I talk about the decidua but that is what it is
about the decidua but that is what it is called. It is the what the lining of
called. It is the what the lining of your uterus becomes is called the
your uterus becomes is called the decidua. But if this blastoyst was able
decidua. But if this blastoyst was able to successfully start implantation, it
to successfully start implantation, it starts secretreting hCG and that hCG
starts secretreting hCG and that hCG sends a signal to our corpus ludium.
sends a signal to our corpus ludium. Don't disintegrate, keep it going, keep
Don't disintegrate, keep it going, keep secretreting progesterone. And it does.
secretreting progesterone. And it does. Our corpus ludium will continue to
Our corpus ludium will continue to produce progesterone for several more
produce progesterone for several more weeks all the way until the point that
weeks all the way until the point that the placenta has formed and can take
the placenta has formed and can take over the majority of the necessary
over the majority of the necessary hormone production to support the
hormone production to support the growing pregnancy. Okay? Right? Amazing.
growing pregnancy. Okay? Right? Amazing. Amazing. So, we've already learned a
Amazing. So, we've already learned a lot. Um, first it means that the
lot. Um, first it means that the absolute earliest that you could
absolute earliest that you could conceivably test for a pregnancy via hCG
conceivably test for a pregnancy via hCG is a couple days after implantation,
is a couple days after implantation, which is usually a few days prior to
which is usually a few days prior to your missed period cuz it's like 48
your missed period cuz it's like 48 hours after implantation, which is day
hours after implantation, which is day 5, 6, 7, somewhere in there. Okay. So,
5, 6, 7, somewhere in there. Okay. So, most people are going to be considered
most people are going to be considered four weeks pregnant at this point. Plus
four weeks pregnant at this point. Plus or minus
or minus is I have strong feelings about that.
is I have strong feelings about that. Yeah. I
Yeah. I tell me your feelings
tell me your feelings and rage I guess like that is so um
and rage I guess like that is so um inaccurate. I mean it's not it's because
inaccurate. I mean it's not it's because it's okay. It's consistently inaccurate.
it's okay. It's consistently inaccurate. So that's one aspect of it except it
So that's one aspect of it except it also great. That's that's the one pro of
also great. That's that's the one pro of this. The rest is that everything else
this. The rest is that everything else is then shifted. Right. And I mean yeah
is then shifted. Right. And I mean yeah I know it's interesting. It's and I mean
I know it's interesting. It's and I mean it's it's really a relic of when we
it's it's really a relic of when we didn't have ultrasound relic that laws
didn't have ultrasound relic that laws are now based on. Oh yeah 100%
are now based on. Oh yeah 100% preaching choir. Mhm. Yeah. And this
preaching choir. Mhm. Yeah. And this process of implantation it's also a very
process of implantation it's also a very delicate sort of dance. A lot of things
delicate sort of dance. A lot of things can go not as I just explained within
can go not as I just explained within this process and prior leading up to
this process and prior leading up to this process. So, I'm going to pause
this process. So, I'm going to pause here and actually take a few steps
here and actually take a few steps backward to talk about some of the
backward to talk about some of the potential either complications that can
potential either complications that can arise even as early as this, okay? Or
arise even as early as this, okay? Or just things that don't go this way, like
just things that don't go this way, like what are what are the alternative routes
what are what are the alternative routes that can happen here. Um, and then we'll
that can happen here. Um, and then we'll come back and I'll talk more about the
come back and I'll talk more about the inner cell mass.
inner cell mass. I didn't have a glowing pregnancy.
I didn't have a glowing pregnancy. Sciatica made every step painful.
Sciatica made every step painful. Braxton Hicks robbed me of my sleep and
Braxton Hicks robbed me of my sleep and even the smell of my beloved garlic
even the smell of my beloved garlic turned my stomach. Hormones didn't help,
turned my stomach. Hormones didn't help, especially when my husband jokingly
especially when my husband jokingly called me Shimu after the infamous
called me Shimu after the infamous killer whale because of my black and
killer whale because of my black and white maternity wardrobe. I snapped at
white maternity wardrobe. I snapped at him one night when he made what I
him one night when he made what I thought was a mean comment about how
thought was a mean comment about how puffy my ankles were looking. And then I
puffy my ankles were looking. And then I forgot about it until January 17th,
forgot about it until January 17th, 2018. At 2:00 a.m., my waters broke. We
2018. At 2:00 a.m., my waters broke. We grabbed a cab to Lewisham Hospital in
grabbed a cab to Lewisham Hospital in Southeast London, expecting to be sent
Southeast London, expecting to be sent home as labor had not started yet.
home as labor had not started yet. Instead, after a long wait and a quick
Instead, after a long wait and a quick reflex test where my legs shot up in the
reflex test where my legs shot up in the air, we realized that those puffy ankles
air, we realized that those puffy ankles had been an indicator of preeacclampsia.
had been an indicator of preeacclampsia. The only cure, birth within 24 hours.
The only cure, birth within 24 hours. Suddenly, I was on a hormone drip to
Suddenly, I was on a hormone drip to induce labor and magnesium dripped to
induce labor and magnesium dripped to prevent seizures. Hooked up to monitors,
prevent seizures. Hooked up to monitors, I was told that I could not eat
I was told that I could not eat anything. For hours, I waited, feeling
anything. For hours, I waited, feeling contractions build. But just when I
contractions build. But just when I needed the epidural most, we realized
needed the epidural most, we realized that it had become a detached, and I had
that it had become a detached, and I had to push without pain relief, which
to push without pain relief, which resulted in my blood pressure increasing
resulted in my blood pressure increasing in a way that the midwives were not very
in a way that the midwives were not very happy about. Suddenly, the room blurred
happy about. Suddenly, the room blurred in a wave of blue medical sheets and
in a wave of blue medical sheets and rushing staff. My baby was facing the
rushing staff. My baby was facing the wrong way up. Another complication. The
wrong way up. Another complication. The doctor used a vacuum to rotate her and
doctor used a vacuum to rotate her and finally to Queens. I wanted to break
finally to Queens. I wanted to break free. My daughter entered the world.
free. My daughter entered the world. Their traditional National Health
Their traditional National Health Service tea and toast afterwards is
Service tea and toast afterwards is still to this day the best meal of my
still to this day the best meal of my life. 2 days later, we went home. That
life. 2 days later, we went home. That baby is now a feisty 7-year-old testing
baby is now a feisty 7-year-old testing every boundary. Life since hasn't been
every boundary. Life since hasn't been simple. We've moved countries. She's
simple. We've moved countries. She's learned new languages. And her dad and I
learned new languages. And her dad and I have separated, but she's the center of
have separated, but she's the center of our universe. And through it all, even
our universe. And through it all, even though I've never fully understood why I
though I've never fully understood why I got preeacclampsia and why we hadn't
got preeacclampsia and why we hadn't noticed it earlier, I'll forever be
noticed it earlier, I'll forever be grateful to the NHS for bringing us
grateful to the NHS for bringing us through
through safely. There's a few things that can
safely. There's a few things that can happen with implantation, the process of
happen with implantation, the process of implantation. One is that it could
implantation. One is that it could happen in an atypical location, and that
happen in an atypical location, and that is called an ectopic pregnancy. And
is called an ectopic pregnancy. And because most fertilization events happen
because most fertilization events happen in the fallopian tubes which are the
in the fallopian tubes which are the little tubes leading from our ovaries to
little tubes leading from our ovaries to our uterus then most of the time like 95
our uterus then most of the time like 95 96% of the time if a ectopic pregnancy
96% of the time if a ectopic pregnancy happens it happens in the fallopian
happens it happens in the fallopian tube. Okay. So this blastois implants in
tube. Okay. So this blastois implants in the wrong place in your fallopian tube.
the wrong place in your fallopian tube. Got it. Or right at the junction there
Got it. Or right at the junction there where the fallopian tube meets the
where the fallopian tube meets the uterus. Yeah. And because fallopian
uterus. Yeah. And because fallopian tubes cannot expand the way that the
tubes cannot expand the way that the uterus can, as that blastoyst continues
uterus can, as that blastoyst continues to grow into an embryo, it can cause
to grow into an embryo, it can cause rupture of the fallopian tubes, which
rupture of the fallopian tubes, which can cause catastrophic blood loss. So,
can cause catastrophic blood loss. So, ectopic pregnancies are very dangerous.
ectopic pregnancies are very dangerous. The fallopian tube is not the only place
The fallopian tube is not the only place that it can implant. Ectopic pregnancies
that it can implant. Ectopic pregnancies can also happen in the cervix. So, like
can also happen in the cervix. So, like a little too far down. Interesting.
a little too far down. Interesting. Okay. They can happen in the scar from a
Okay. They can happen in the scar from a cescareian section which might end up
cescareian section which might end up being a viable pregnancy depending on
being a viable pregnancy depending on how it continues to grow. Um they can
how it continues to grow. Um they can sometimes happen in the ovary or even in
sometimes happen in the ovary or even in the abdominal cavity because the the
the abdominal cavity because the the ovaries and your fallopian tubes are not
ovaries and your fallopian tubes are not like connected. They're like floating
like connected. They're like floating and your fallopian tubes can also like
and your fallopian tubes can also like move around back and forth and things
move around back and forth and things like that. Okay, that's amazing. I know.
like that. Okay, that's amazing. I know. Um, but it's not great if one implants
Um, but it's not great if one implants in like the abdominal cavity. And so all
in like the abdominal cavity. And so all of these are considered ectopic because
of these are considered ectopic because it's just outside of the ectopic just
it's just outside of the ectopic just outside of the uterus. Outside of the
outside of the uterus. Outside of the uterus, overall most estimates are that
uterus, overall most estimates are that about 1 to 2% of pregnancies are ectopic
about 1 to 2% of pregnancies are ectopic depending on the source. 1 to 2%. Okay.
depending on the source. 1 to 2%. Okay. Okay. Question. I expected questions. I
Okay. Question. I expected questions. I have answers. Okay. Wonderful. So, um,
have answers. Okay. Wonderful. So, um, one to two% of the time, how does how do
one to two% of the time, how does how do you figure out whether something's an
you figure out whether something's an ectopic pregnancy? Number one. Number
ectopic pregnancy? Number one. Number two, like what next? Great questions.
two, like what next? Great questions. Uh, how do you determine it? Um, a lot
Uh, how do you determine it? Um, a lot of different ways is the answer to that
of different ways is the answer to that question. Ultrasound is really important
question. Ultrasound is really important in this. Um, but it also can depend on
in this. Um, but it also can depend on how early that pregnancy is. Cuz
how early that pregnancy is. Cuz sometimes if it's super early, then you
sometimes if it's super early, then you don't see anything in the uterus or
don't see anything in the uterus or elsewhere, then it might be classified
elsewhere, then it might be classified as a pregnancy of unknown location.
as a pregnancy of unknown location. Um, and so then what you do with that
Um, and so then what you do with that might change kind of depending, but in
might change kind of depending, but in general it's ultrasound to try and
general it's ultrasound to try and determine that. A lot of times ectopic
determine that. A lot of times ectopic pregnancies might present as atypical
pregnancies might present as atypical early on. So you might have bleeding
early on. So you might have bleeding that we don't expect. You might have
that we don't expect. You might have abdominal pain, especially like
abdominal pain, especially like one-sided abdominal pain, but not
one-sided abdominal pain, but not always. Sometimes you might not have
always. Sometimes you might not have symptoms. Um, what you do about it is
symptoms. Um, what you do about it is really important. So ectopic pregnancies
really important. So ectopic pregnancies are very important to be treated. Um and
are very important to be treated. Um and they're generally treated one of two
they're generally treated one of two ways. So one is with a medicine called
ways. So one is with a medicine called methtoresate which is also used in some
methtoresate which is also used in some places for abortions. Um but
places for abortions. Um but methtoresate is one medication that you
methtoresate is one medication that you can use especially if it's small and
can use especially if it's small and it's at low risk of rupture. It requires
it's at low risk of rupture. It requires continued medical monitoring to make
continued medical monitoring to make sure that you've completely lost the
sure that you've completely lost the rest of that uh pregnancy tissue. Or it
rest of that uh pregnancy tissue. Or it requires surgery. And surgery usually
requires surgery. And surgery usually requires the loss of that fallopian tube
requires the loss of that fallopian tube if it um if it if that's where
if it um if it if that's where implanted. Okay. Um and how like how
implanted. Okay. Um and how like how often is it surgery versus It's a good
often is it surgery versus It's a good question. I don't have a I don't have
question. I don't have a I don't have data on that. Okay. That's a solid
data on that. Okay. That's a solid question. I think it probably depends
question. I think it probably depends like location, geography, all that kind
like location, geography, all that kind of stuff. Gosh, we really we should do
of stuff. Gosh, we really we should do an entire episode on the history because
an entire episode on the history because I I really am just curious what how we
I I really am just curious what how we learned about ectopic pregnancies,
learned about ectopic pregnancies, right? And how we figured it out early
right? And how we figured it out early on and before ultrasound, what happened.
on and before ultrasound, what happened. Yeah. Oof. Probably wasn't good. No.
