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Pregnancy: First Trimester | This Podcast Will Kill You #168

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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.

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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

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,

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.

Yeah. Oof. Probably wasn't good. No. Yeah. Um, yeah. So, that's ectopic

Yeah. Um, yeah. So, that's ectopic pregnancies. Okay. Do you have more

pregnancies. Okay. Do you have more questions? Not right now, but I'm sure I

questions? Not right now, but I'm sure I will. Goodness. In just a few minutes.

will. Goodness. In just a few minutes. There's other um atypical ways that a

There's other um atypical ways that a blastois can implant that might end up

blastois can implant that might end up in a viable pregnancy. If the blastoyst

in a viable pregnancy. If the blastoyst implants too low in the uterus but not

implants too low in the uterus but not in the cervical canal, then it can

in the cervical canal, then it can result in what's called placenta pvia.

result in what's called placenta pvia. Uh-huh. So, the placenta completely

Uh-huh. So, the placenta completely covers the O or the opening to the

covers the O or the opening to the cervix and that is potentially

cervix and that is potentially dangerous. It can cause bleeding during

dangerous. It can cause bleeding during pregnancy, but it also um if that

pregnancy, but it also um if that placenta like if the baby has to deliver

placenta like if the baby has to deliver through the placenta that's that doesn't

through the placenta that's that doesn't safe. Um so, generally that goes to a

safe. Um so, generally that goes to a cescareian section which we'll talk way

cescareian section which we'll talk way more about later. And then of course

more about later. And then of course there is miscarriage or early pregnancy

there is miscarriage or early pregnancy loss. So, I'm going to spend quite a bit

loss. So, I'm going to spend quite a bit of time talking about this. Okay. The

of time talking about this. Okay. The definition of miscarriage actually is

definition of miscarriage actually is different depending on where you live uh

different depending on where you live uh and what country that you live in. Okay?

and what country that you live in. Okay? Because it is defined generally as the

Because it is defined generally as the spontaneous loss of and these words are

spontaneous loss of and these words are important the spontaneous loss of a

important the spontaneous loss of a recognized pregnancy prior either to a

recognized pregnancy prior either to a certain gestational age or a certain

certain gestational age or a certain weight of the fetus depending on what

weight of the fetus depending on what country you live in and things like

country you live in and things like that. So in the US we define a

that. So in the US we define a miscarriage as a pregnancy loss prior to

miscarriage as a pregnancy loss prior to 20 weeks gestation. In the UK it's prior

20 weeks gestation. In the UK it's prior to 24 weeks. In other parts of the EU

to 24 weeks. In other parts of the EU it's like 22 weeks. And per the World

it's like 22 weeks. And per the World Health Organization guidelines it's uh

Health Organization guidelines it's uh the loss of a pregnancy with a fetus

the loss of a pregnancy with a fetus that weighs 500 gram or less which is

that weighs 500 gram or less which is about 22 weeks gestational age. Why is

about 22 weeks gestational age. Why is there such variation? It's it's in part

there such variation? It's it's in part because it depends on like the

because it depends on like the definitions of like viability and things

definitions of like viability and things like that. Um I don't have a great

like that. Um I don't have a great answer as to why there's variation, but

answer as to why there's variation, but the variation exists, which does mean

the variation exists, which does mean that there's differences in terms of

that there's differences in terms of like reporting what is considered a

like reporting what is considered a miscarriage um or an early pregnancy

miscarriage um or an early pregnancy loss and then what is considered a still

loss and then what is considered a still birth, which is if you have a pregnancy

birth, which is if you have a pregnancy loss after that time point. I see. But

loss after that time point. I see. But again, that time point varies a little

again, that time point varies a little bit. And what's the recognized part?

bit. And what's the recognized part? Yeah, great question, Erin. So, that

Yeah, great question, Erin. So, that also the definitions kind of differ. So,

also the definitions kind of differ. So, there are like clinically recognized

there are like clinically recognized pregnancies and then there are

pregnancies and then there are pregnancies that maybe weren't

pregnancies that maybe weren't recognized clinically and some of that

recognized clinically and some of that depends on whether or not it was seen on

depends on whether or not it was seen on ultrasound. Okay. Which means not only

ultrasound. Okay. Which means not only like did you have access to ultrasound,

like did you have access to ultrasound, but like how early was it. And then like

but like how early was it. And then like you said Aaron is that the more that we

you said Aaron is that the more that we have access to these very very early

have access to these very very early pregnancy tests that can detect some of

pregnancy tests that can detect some of the home pregnancy tests now can detect

the home pregnancy tests now can detect very low levels of hCG which means you

very low levels of hCG which means you can get it earlier and earlier and

can get it earlier and earlier and earlier and so that does change our like

earlier and so that does change our like rates of miscarriage. Yeah. But in some

rates of miscarriage. Yeah. But in some of the literature, if there's not a

of the literature, if there's not a documented pregnancy with ultrasound,

documented pregnancy with ultrasound, then it's not classified as a

then it's not classified as a miscarriage, but it might be classified

miscarriage, but it might be classified as a early pregnancy loss, quote

as a early pregnancy loss, quote unquote, or a biochemical pregnancy loss

unquote, or a biochemical pregnancy loss is another term that gets thrown around

is another term that gets thrown around a lot, a biochemical pregnancy, or

a lot, a biochemical pregnancy, or sometimes they're called preclinical

sometimes they're called preclinical pregnancy losses. All right. Okay. So,

pregnancy losses. All right. Okay. So, it it all is important. Um, but yeah,

it it all is important. Um, but yeah, the definitions kind of vary. And so

the definitions kind of vary. And so there's a lot of different words that

there's a lot of different words that get thrown around in the literature.

get thrown around in the literature. Yeah. Okay. Um but all that being said,

Yeah. Okay. Um but all that being said, overall the rate of spontaneous lost of

overall the rate of spontaneous lost of early embryos is very very high in

early embryos is very very high in humans. So a lot of those blastoysts

humans. So a lot of those blastoysts that we were talking about never

that we were talking about never actually make it to the point of

actually make it to the point of implantation. So they are lost before

implantation. So they are lost before implantation which means you never knew

implantation which means you never knew that you could have been pregnant even

that you could have been pregnant even though again we're defining pregnancy as

though again we're defining pregnancy as your last menstrual period. So it's very

your last menstrual period. So it's very confusing. Yeah. Yeah. Yeah. We don't

confusing. Yeah. Yeah. Yeah. We don't know exactly how many of these like

know exactly how many of these like pre-mbbryos are lost prior to

pre-mbbryos are lost prior to implantation, but it's estimated to be

implantation, but it's estimated to be somewhere between 20 and 40%. Which is

somewhere between 20 and 40%. Which is very high. That is very high. Very high.

very high. That is very high. Very high. And those are estimates also. Yeah. 20

And those are estimates also. Yeah. 20 to 40 is a huge range. It's a huge

to 40 is a huge range. It's a huge range. Um Yeah. And then after

range. Um Yeah. And then after implantation, so after that start of

implantation, so after that start of implantation, a further 30% are lost.

implantation, a further 30% are lost. But it's thought that about half of

But it's thought that about half of those happened so early that most people

those happened so early that most people and caveats here with early pregnancy

and caveats here with early pregnancy tests, but most people would never know

tests, but most people would never know that they were pregnant or were almost

that they were pregnant or were almost pregnant, could have been pregnant,

pregnant, could have been pregnant, because they don't ever miss a period.

because they don't ever miss a period. Uhhuh. Right. So the implantation

Uhhuh. Right. So the implantation starts, but then it doesn't continue. So

starts, but then it doesn't continue. So then you have shedding of your uterine

then you have shedding of your uterine lining at the time that you typically

lining at the time that you typically would. And those are most often

would. And those are most often classifies as like biochemical or

classifies as like biochemical or preclinical pregnancy losses. Okay. But

preclinical pregnancy losses. Okay. But the more that we have early pregnancy

the more that we have early pregnancy tests, the more that people are going to

tests, the more that people are going to know that that happened to them, right?

know that that happened to them, right? Yeah. Most estimates of the overall risk

Yeah. Most estimates of the overall risk of miscarriage, so the loss of that

of miscarriage, so the loss of that recognized pregnancy prior to 20 to 24

recognized pregnancy prior to 20 to 24 weeks is about 15% globally. Wow. And

weeks is about 15% globally. Wow. And that's a huge number. Yeah, it really

that's a huge number. Yeah, it really is. 15% is 23 million recognized

is. 15% is 23 million recognized miscarriages worldwide every year. Wow.

miscarriages worldwide every year. Wow. I know. We don't talk about it like at

I know. We don't talk about it like at all. It's like not something that we

all. It's like not something that we talk about. It's not something that's

talk about. It's not something that's polite to talk about. Um, but something

polite to talk about. Um, but something there's a few things I feel like I have

there's a few things I feel like I have a lot of feelings about this, but one in

a lot of feelings about this, but one in three women are also estimated to

three women are also estimated to experience a miscarriage at some point

experience a miscarriage at some point during their reproductive years. So,

during their reproductive years. So, it's not just that it's common globally.

it's not just that it's common globally. It's also common that you might have

It's also common that you might have throughout your reproductive lifespan a

throughout your reproductive lifespan a miscarriage at some point in time.

miscarriage at some point in time. And something being common does not make

And something being common does not make it unimportant. Yeah. Right. Of course.

it unimportant. Yeah. Right. Of course. It happens all the time. It's really

It happens all the time. It's really important. Right. There was a study in a

important. Right. There was a study in a paper that I read that looked at only

paper that I read that looked at only 500 women, but so it's a small study,

500 women, but so it's a small study, but I think this is still really

but I think this is still really important data. 537 women with a

important data. 537 women with a pregnancy loss, a recognized pregnancy

pregnancy loss, a recognized pregnancy loss, found that after 9 months, 18% of

loss, found that after 9 months, 18% of them met criteria for post-traumatic

them met criteria for post-traumatic stress, 17% for moderate or severe

stress, 17% for moderate or severe anxiety, and 6% for moderate or severe

anxiety, and 6% for moderate or severe depression.

depression. So like losing a pregnancy, whether it

So like losing a pregnancy, whether it was a planned pregnancy, an unplanned

was a planned pregnancy, an unplanned pregnancy, an early pregnancy loss, or a

pregnancy, an early pregnancy loss, or a later pregnancy loss, like that is very

later pregnancy loss, like that is very hard potentially and it's really lonely

hard potentially and it's really lonely if it's something that you're not able

if it's something that you're not able to talk about in quote unquote polite

to talk about in quote unquote polite company. Well, and I feel like you make

company. Well, and I feel like you make a really good point that like this even

a really good point that like this even though this does happen a lot and it's

though this does happen a lot and it's not it's not talked about a lot and it

not it's not talked about a lot and it doesn't take away the the pain and the

doesn't take away the the pain and the trauma that that can result. Right.

trauma that that can result. Right. Yeah.

Yeah. Most pregnancy losses, most miscarriages

Most pregnancy losses, most miscarriages happen in the first trimester. So

happen in the first trimester. So sometime in the first 10 to 12 weeks,

sometime in the first 10 to 12 weeks, okay? But 1 to 2% of pregnancy losses

okay? But 1 to 2% of pregnancy losses will happen in the second or third

will happen in the second or third trimester. And like we said, if it's

trimester. And like we said, if it's after that 20 to 24 weeks, then we

after that 20 to 24 weeks, then we classify it as a still birth rather than

classify it as a still birth rather than a miscarriage. And no matter how early

a miscarriage. And no matter how early any pregnancy loss has the potential to

any pregnancy loss has the potential to be met with shame or stigma, loneliness,

be met with shame or stigma, loneliness, guilt, fear, frustration, like so many

guilt, fear, frustration, like so many different things. And a lot of people

different things. And a lot of people understandably want to know like what

understandably want to know like what causes this. Why is this happening? And

causes this. Why is this happening? And we don't know. Yeah. Right. Except that

we don't know. Yeah. Right. Except that it happens like very commonly across the

it happens like very commonly across the board to these early embryos

board to these early embryos especially. Most estimates are that

especially. Most estimates are that about 50 to 80% of the time miscarriages

about 50 to 80% of the time miscarriages are due to chromosomeal abnormalities in

are due to chromosomeal abnormalities in the fetus. All right. Okay. Um, and that

the fetus. All right. Okay. Um, and that is one of the big reasons that age,

is one of the big reasons that age, female age specifically, is a big

female age specifically, is a big contributor where younger people are

contributor where younger people are much less likely to have a miscarriage

much less likely to have a miscarriage compared to as we get older. The rates

compared to as we get older. The rates are like vastly different. It's so

are like vastly different. It's so interesting because I know that we talk

interesting because I know that we talk about the impact of female age,

about the impact of female age, but it I feel like it does add it can

but it I feel like it does add it can add blame sometimes. Absolutely. and to

add blame sometimes. Absolutely. and to not to like also the sperm age or like

not to like also the sperm age or like age of the person who's making the sperm

age of the person who's making the sperm also plays a role. I think I saw at

also plays a role. I think I saw at least one study that looked at that and

least one study that looked at that and it there is actually an increased risk

it there is actually an increased risk of miscarriage I believe. Wish I had

of miscarriage I believe. Wish I had written more detail on this but but it's

written more detail on this but but it's at an older age whereas with females it

at an older age whereas with females it starts at like 35 or so that the rates

starts at like 35 or so that the rates of increased chance of miscarriage go

of increased chance of miscarriage go up. It starts later like after 40 or

up. It starts later like after 40 or maybe it was 45. Okay. Don't quote me on

maybe it was 45. Okay. Don't quote me on that cuz I'd have to go back to the

that cuz I'd have to go back to the paper. Yeah. Yeah. But yeah. So you're

paper. Yeah. Yeah. But yeah. So you're right. It's not like a it's not a nil

right. It's not like a it's not a nil factor is a contributor, but we don't

factor is a contributor, but we don't talk about it. Well, it just it always

talk about it. Well, it just it always it's like age of the age of the mother,

it's like age of the age of the mother, age of the woman, advanced maternal

age of the woman, advanced maternal advanced maternal age, geriatric womb.

advanced maternal age, geriatric womb. We don't call that that anymore. Okay. I

We don't call that that anymore. Okay. I don't I'm sure people do. Yeah. I think

don't I'm sure people do. Yeah. I think there are probably a handful out there.

there are probably a handful out there. Um so yeah, so miscarriage is a really

Um so yeah, so miscarriage is a really important topic I think to talk about.

important topic I think to talk about. Yeah. The other thing important to know

Yeah. The other thing important to know about miscarriage is how we manage it.

about miscarriage is how we manage it. Mhm. Because there's three main ways

Mhm. Because there's three main ways like medically that we can manage it.

like medically that we can manage it. One is called expectant management which

One is called expectant management which basically means you don't do anything

basically means you don't do anything like there's no medical intervention and

like there's no medical intervention and you wait for that tissue to pass on its

you wait for that tissue to pass on its own spontaneously. There's another

own spontaneously. There's another option which is a medication option and

option which is a medication option and most of the time there's a combination

most of the time there's a combination of medicines that are used misoprosttol

of medicines that are used misoprosttol and mephipristone aka abortion

and mephipristone aka abortion medicines. Mhm. or with a vacuum

medicines. Mhm. or with a vacuum aspiration or a DNC which is a dilation

aspiration or a DNC which is a dilation and curage which is the exact same

and curage which is the exact same surgical procedures as are used in quote

surgical procedures as are used in quote unquote elective abortions. Abortion is

unquote elective abortions. Abortion is healthcare. Abortion is healthcare.

healthcare. Abortion is healthcare. Every one of these options expectant

Every one of these options expectant management, medical management and

management, medical management and surgical management are all associated

surgical management are all associated with risks and benefits for the

with risks and benefits for the individual. M and in fact in the data

individual. M and in fact in the data there's no difference in like one is

there's no difference in like one is more risky, one is less risky. They all

more risky, one is less risky. They all have risks of bleeding, they have risks

have risks of bleeding, they have risks of infection and the choice to do one or

of infection and the choice to do one or the other should lie only with the

the other should lie only with the person who is pregnant and their medical

person who is pregnant and their medical doctor. However, however, because we

doctor. However, however, because we live currently in the United States,

live currently in the United States, especially with all of these abortion

especially with all of these abortion restrictions that are going into place,

restrictions that are going into place, this is no longer the case. It is now

this is no longer the case. It is now very often the decision between a legal

very often the decision between a legal team and the hospital administration on

team and the hospital administration on when to do something about it, on when

when to do something about it, on when not to do something about it, on when

not to do something about it, on when you have to just wait, etc., etc. Just a

you have to just wait, etc., etc. Just a a a round a conference table, someone's

a a round a conference table, someone's making decisions about what should what

making decisions about what should what is happening inside your body. Yep. And

is happening inside your body. Yep. And you're not involved in that decision.

you're not involved in that decision. Mhm. Yep. You don't have a seat at the

Mhm. Yep. You don't have a seat at the table. Oh gosh, that was a lot. Yeah,

table. Oh gosh, that was a lot. Yeah, that was a lot. Do you have any

that was a lot. Do you have any questions about that? I have feelings

questions about that? I have feelings about that. I do too.

about that. I do too. trying to think if I have any specific

trying to think if I have any specific questions. Um, okay. One one question I

questions. Um, okay. One one question I have is like you said that it's they the

have is like you said that it's they the risks associated with each of these are

risks associated with each of these are are more or less the same. So then why

are more or less the same. So then why would one why would someone opt for one

would one why would someone opt for one versus another? I mean it's in part

versus another? I mean it's in part personal preference, it's in part to

personal preference, it's in part to like how far along you might be or if

like how far along you might be or if you have sort of started to pass that or

you have sort of started to pass that or not. And then a lot of it really is

not. And then a lot of it really is personal preference because it's like

personal preference because it's like are you going to feel more comfortable

are you going to feel more comfortable doing this at home where you have maybe

doing this at home where you have maybe support around you or maybe you don't

support around you or maybe you don't have any support at home. Maybe the

have any support at home. Maybe the thought of having to wait a long time

thought of having to wait a long time because you don't know how long it will

because you don't know how long it will take to pass it on your own is really

take to pass it on your own is really more traumatic and so having something

more traumatic and so having something done where it's over and you know that

done where it's over and you know that it's done um is maybe more appealing to

it's done um is maybe more appealing to you. So there's not like a a hard line

you. So there's not like a a hard line that like this has to be one way or the

that like this has to be one way or the other. Got it. Yeah. Okay. So, let's

other. Got it. Yeah. Okay. So, let's stop there for now. Okay. And bring it

stop there for now. Okay. And bring it all the way back to the developing

all the way back to the developing embryo. Got it. Oh, just

embryo. Got it. Oh, just this another prop where we left off.

this another prop where we left off. It's the same prop. My tennis ball. Um,

It's the same prop. My tennis ball. Um, this inner cell mass. Okay, we're here.

this inner cell mass. Okay, we're here. So, during all of this time and before

So, during all of this time and before implantation and after implantation

implantation and after implantation starts, what's happening with this inner

starts, what's happening with this inner cell mass? I'm gonna walk you through

cell mass? I'm gonna walk you through really quickly embryionic development.

really quickly embryionic development. All right. And when I say really

All right. And when I say really quickly, I mean this is like the most

quickly, I mean this is like the most cliffnotes version. Ready? Okay. So, we

cliffnotes version. Ready? Okay. So, we are back now at about 2 weeks post

are back now at about 2 weeks post fertilization, week four of pregnancy.

fertilization, week four of pregnancy. Okay. And this little pre- embryo at

Okay. And this little pre- embryo at this point, this inner cell mass, it's a

this point, this inner cell mass, it's a little disc of cells that has formed the

little disc of cells that has formed the three essential germ layers that will

three essential germ layers that will eventually become all of the different

eventually become all of the different tissues and organs in our body. Okay?

tissues and organs in our body. Okay? And then these little discs of tissue

And then these little discs of tissue will form tubes. Tubes. One tube will

will form tubes. Tubes. One tube will become our brain and spinal cord. Yeah.

become our brain and spinal cord. Yeah. The other tube will become our guts.

The other tube will become our guts. Isn't that cute? Two tubes. And then

Isn't that cute? Two tubes. And then after that a little lump will start to

after that a little lump will start to form at the top of the this tube of

form at the top of the this tube of cells and that lump will become our

cells and that lump will become our head. And then little bumps come up

head. And then little bumps come up along the back and those will eventually

along the back and those will eventually become our

become our vertebra by about the sixth week of

vertebra by about the sixth week of pregnancy. So this about 2 weeks after a

pregnancy. So this about 2 weeks after a year missed period potentially. This

year missed period potentially. This embryo, it's called an embryo now. It

embryo, it's called an embryo now. It still does not look like a human like at

still does not look like a human like at all. No. Um, it looks to me very much

all. No. Um, it looks to me very much like the alien in Alien. I mean like

like the alien in Alien. I mean like embryionic development. Oh, there's some

embryionic development. Oh, there's some quote and I don't remember who it's by,

quote and I don't remember who it's by, whether it's like Dubansky or I don't

whether it's like Dubansky or I don't know one of those old evolutionary

know one of those old evolutionary biologists that's like everything our

biologists that's like everything our entire evolutionary history can be

entire evolutionary history can be traced to on anttogyny and like the

traced to on anttogyny and like the development of an an embryo. I'm

development of an an embryo. I'm probably butchering that quote horrific.

probably butchering that quote horrific. I mean, I like it. Yeah. I I wish I knew

I mean, I like it. Yeah. I I wish I knew who it was by. Well, listen, it wasn't

who it was by. Well, listen, it wasn't Djansky. At this point, we look like an

Djansky. At this point, we look like an alien, okay? Like the the head thing is

alien, okay? Like the the head thing is like and curved over. There's this big

like and curved over. There's this big long thing that comes off the back,

long thing that comes off the back, these bumps along the back. Very

these bumps along the back. Very reptilian. I mean, our origins, our

reptilian. I mean, our origins, our evolutionary origins. Yeah. Right. And

evolutionary origins. Yeah. Right. And when you look at like embryo development

when you look at like embryo development side by side of like all the different

side by side of like all the different species, we look all the same the same

species, we look all the same the same the same the same all the way through

the same the same all the way through this point. But we're not as scary as an

this point. But we're not as scary as an alien cuz it's like 2 mm long.

alien cuz it's like 2 mm long. Not as scary as an alien as the Oh, as

Not as scary as an alien as the Oh, as aliens. Capital A. Capital A alien.

aliens. Capital A. Capital A alien. Yeah. Proper noun. Alien. Proper noun.

Yeah. Proper noun. Alien. Proper noun. But at this point too, when we look like

But at this point too, when we look like alien is when things like the eyes, what

alien is when things like the eyes, what will become the eyes start to develop.

will become the eyes start to develop. So you get these two little dots that

So you get these two little dots that will eventually become our eye cells.

will eventually become our eye cells. The parts that will become our jaws and

The parts that will become our jaws and our ears. And all of this is very

our ears. And all of this is very important patterning that has to happen

important patterning that has to happen in exactly the right way for all of our

in exactly the right way for all of our body parts to actually develop. And at

body parts to actually develop. And at this point too, about week six is when

this point too, about week six is when you could first detect what will become

you could first detect what will become a heartbeat. So this little bulge that

a heartbeat. So this little bulge that will become our heart starts to beat.

will become our heart starts to beat. And you can see that on ultrasound. It's

And you can see that on ultrasound. It's also when we start to see arm and leg

also when we start to see arm and leg buds, the buds, yeah, that was loud.

buds, the buds, yeah, that was loud. start to kind of pop out just a little

start to kind of pop out just a little bit and then eventually those limb buds

bit and then eventually those limb buds will make paddles first and then little

will make paddles first and then little fingers and toe buds. So by the 10th

fingers and toe buds. So by the 10th week of pregnancy, so 10 weeks after

week of pregnancy, so 10 weeks after your last menstrual period, okay, 8

your last menstrual period, okay, 8 weeks that since fertilization. Got it?

weeks that since fertilization. Got it? Okay, is when you start to have

Okay, is when you start to have something that looks more like a human

something that looks more like a human than all of our vertebrate cousins.

than all of our vertebrate cousins. Uh-huh. And that is when we are almost

Uh-huh. And that is when we are almost to the second trimester and then we

to the second trimester and then we enter the fetal period. The fetal

enter the fetal period. The fetal period. The fetal period. At the same

period. The fetal period. At the same time as this is also when that

time as this is also when that sensitur time been invading its way into

sensitur time been invading its way into the myometrium all the way through. It

the myometrium all the way through. It has finally at the same time point

has finally at the same time point finished the formation of the placenta

finished the formation of the placenta which isn't all the way formed until

which isn't all the way formed until week 13 of our pregnancy. Wild. I know.

week 13 of our pregnancy. Wild. I know. And that is the organ that you Aaron

And that is the organ that you Aaron will pick up with next week. I certainly

will pick up with next week. I certainly will. Uh I have uh questions and you

will. Uh I have uh questions and you might be getting into them next week. So

might be getting into them next week. So I probably won't. So give them to me

I probably won't. So give them to me now. What's going on in the pregnant

now. What's going on in the pregnant person's body? Is that all next week?

person's body? Is that all next week? That's all next week.

That's all next week. But I'm so glad you asked because I

But I'm so glad you asked because I cannot wait to tell you about it. Oh my

cannot wait to tell you about it. Oh my gosh, it's really good because it's

gosh, it's really good because it's already started like from Oh, I'm so

already started like from Oh, I'm so excited about it. Oh, I can't wait. I

excited about it. Oh, I can't wait. I know. I'm also done talking about the

know. I'm also done talking about the fetus. I'm not going to mention them

fetus. I'm not going to mention them again pretty much. Okay. Well, we will

again pretty much. Okay. Well, we will and we will do more fetus stuff in the

and we will do more fetus stuff in the future. I have so much feelings about it

future. I have so much feelings about it and I want to talk all about it, but we

and I want to talk all about it, but we were talking about pregnancy for this.

were talking about pregnancy for this. We're talking about pregnancy. So, there

We're talking about pregnancy. So, there we are. We've made it to the end of the

we are. We've made it to the end of the first trimester. Oh my gosh. Oh my gosh.

first trimester. Oh my gosh. Oh my gosh. That went by faster. And also, we

That went by faster. And also, we covered so much. I know. But we didn't

covered so much. I know. But we didn't cover a lot. We have so much more to

cover a lot. We have so much more to cover. Five thoughts. Me, too. But

cover. Five thoughts. Me, too. But everyone is going to have more that they

everyone is going to have more that they want to learn. So, we're going to tell

want to learn. So, we're going to tell you where to learn it and all of our

you where to learn it and all of our sources. Yes. Okay. So, for this, I

sources. Yes. Okay. So, for this, I actually didn't have as many sources as

actually didn't have as many sources as I do for my later episodes. I have a few

I do for my later episodes. I have a few more, but I'm going to shout out three

more, but I'm going to shout out three in particular. One is the book Pregnancy

in particular. One is the book Pregnancy Test by Karen Weingarten, which I

Test by Karen Weingarten, which I referred to in my notes. Also, A Woman's

referred to in my notes. Also, A Woman's Right to Know by Jesse Olinko Grin, and

Right to Know by Jesse Olinko Grin, and then by Sarah Abigail Levit, a private

then by Sarah Abigail Levit, a private little revolution. It's an article uh

little revolution. It's an article uh about the home pregnancy test. And I

about the home pregnancy test. And I really liked those three together as

really liked those three together as sort of like this big picture view of

sort of like this big picture view of everything that I talked about. Well, I

everything that I talked about. Well, I loved your whole part, so it made me

loved your whole part, so it made me want to read those. Thank you. Um I

want to read those. Thank you. Um I relied very heavily on a textbook that's

relied very heavily on a textbook that's very old at this point. Uh it was by

very old at this point. Uh it was by Jones and Lopez and it was called human

Jones and Lopez and it was called human reproductive biology. So it's like a

reproductive biology. So it's like a primer on it all. Is it very old? Mean

primer on it all. Is it very old? Mean the late 20th century as like the youth

the late 20th century as like the youth say it's like wait it was the 21st

say it's like wait it was the 21st century. It was from 2013. Okay. But

century. It was from 2013. Okay. But it's like 10 years old. But I mean like

it's like 10 years old. But I mean like for a textbook is our knowledge of this

for a textbook is our knowledge of this part hasn't changed. But I will also say

part hasn't changed. But I will also say that like it's good for data but it has

that like it's good for data but it has a lot of weird I don't know

a lot of weird I don't know editorialization in parts of it. So I

editorialization in parts of it. So I don't know. Anyways, I I cited it. It's

don't know. Anyways, I I cited it. It's what I used primarily. And then a few

what I used primarily. And then a few other papers that I think were really

other papers that I think were really important, especially in learning about

important, especially in learning about the placental development, if you want

the placental development, if you want more detail on that, which you'll get to

more detail on that, which you'll get to next week, but there was one from

next week, but there was one from Proceedings of the Royal Society B from

Proceedings of the Royal Society B from 2023 called the human placenta, new

2023 called the human placenta, new perspectives on its formation and

perspectives on its formation and function during early pregnancy. Oo. And

function during early pregnancy. Oo. And then there was a whole series in the

then there was a whole series in the Lancet from 2021, all about miscarriage.

Lancet from 2021, all about miscarriage. And my favorite one from that was called

And my favorite one from that was called Miscarriage Matters: The

Miscarriage Matters: The Epidemiological, Physical,

Epidemiological, Physical, Psychological, and Economic Costs of

Psychological, and Economic Costs of Early Pregnancy Loss. But there was a

Early Pregnancy Loss. But there was a few other papers in that series as well.

few other papers in that series as well. But as always, you can find all of our

But as always, you can find all of our sources because there are so many more

sources because there are so many more on our website, this podcast will kill

on our website, this podcast will kill you.com under the episodes tab. You

you.com under the episodes tab. You certainly can. This and all of our

certainly can. This and all of our episodes. All of our episodes. There's

episodes. All of our episodes. There's We have literally so many sources. It's

We have literally so many sources. It's kind of unbelievable. Yeah. I'm proud of

kind of unbelievable. Yeah. I'm proud of us. Me, too.

us. Me, too. Thank you again so so much to everyone

Thank you again so so much to everyone who provided their firsthand account,

who provided their firsthand account, everyone who wrote in with their

everyone who wrote in with their firstand account. We really we don't

firstand account. We really we don't have the words to express how grateful

have the words to express how grateful we are. No, it's like so so so

we are. No, it's like so so so meaningful to us and we we could not do

meaningful to us and we we could not do especially this series without you. So

especially this series without you. So thank you. Thank you. Thank you also to

thank you. Thank you. Thank you also to Exactly right studios and everyone who's

Exactly right studios and everyone who's here like looking at the window. It's so

here like looking at the window. It's so exciting. very excited. Thank you to Tom

exciting. very excited. Thank you to Tom and Lyanna who's not here today but will

and Lyanna who's not here today but will be and I'm saying too much. Um, thank

be and I'm saying too much. Um, thank you to Jessica and to Brent and to Craig

you to Jessica and to Brent and to Craig and everyone else. All All we're so

and everyone else. All All we're so excited about this. It's really been so

excited about this. It's really been so much fun. I feel so cool. I still feel

much fun. I feel so cool. I still feel too nerdy. I feel cool.

too nerdy. I feel cool. But I'm having a lot of fun. Me too. Me

But I'm having a lot of fun. Me too. Me too. So, thank you all for all of your

too. So, thank you all for all of your work. We're excited. Yes. Thank you.

work. We're excited. Yes. Thank you. Thank you to Blood Mobile, who provides

Thank you to Blood Mobile, who provides the music for this episode and all of

the music for this episode and all of our episodes. And thank you to you

our episodes. And thank you to you listeners and viewers too. And viewers.

listeners and viewers too. And viewers. Yeah. Amazing. We hope you had fun with

Yeah. Amazing. We hope you had fun with this one and you're prepared for three

this one and you're prepared for three more episodes on pregnancy. Yeah. I hope

more episodes on pregnancy. Yeah. I hope you like more where this is coming from

you like more where this is coming from cuz we've got it. I don't know. That

cuz we've got it. I don't know. That sentence didn't make sense, but you know

sentence didn't make sense, but you know what? And thank you to our patrons. We

what? And thank you to our patrons. We really do appreciate your support. It

really do appreciate your support. It means the world to us. It really does.

means the world to us. It really does. Thank you. Well, until next time, wash

Thank you. Well, until next time, wash your hands, you filthy animals.

your hands, you filthy animals. [Music]

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YouTube Transcript:Pregnancy: First Trimester | This Podcast Will Kill You #168