Ep 168 Pregnancy: Act 1

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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, stillbirth, and other traumatic experiences of pregnancy, childbirth, and the postpartum period.

It was the morning of my son's fourth birthday party, and I was feeling just not like myself.

I was really tired,

which is pretty abnormal for me, especially in the morning time and my breasts were pretty tender and I was feeling a little nauseous.

So I started doing the math in my head just thinking about you know when I could have possibly became pregnant if that is the case.

And I started doing the math and my husband's a 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 it was only four weeks.

So I was due to get my menstrual cycle that week.

So it was very early.

So I asked him to go to the store because we needed to get ice for the birthday party and pick up the cake.

So I said, hey, while you're there, can you go get a pregnancy test?

And he was like, okay, you know, if that's what you need, then that's what you need.

So

remember, he came home, he was putting the drinks in the cooler, and I went into the spare bathroom and I took the pregnancy test and it came up right away that I was pregnant.

And in that moment, I had just this realization of, wow, like I'm having another baby.

And

I went outside and I...

told my husband that I was pregnant and we were so excited and we were like wow we're really doing this

and it was really neat because

this whole party that we had there, we probably had about 30 people with kids and parents.

And we were the only two people that knew in that moment that I was pregnant.

And it felt really special.

But then after the party was pretty died down,

us and a couple other family friends were all sitting by a fire that we had in our backyard, a little campfire.

And there was a baby there.

And my son had a really good friend.

And he had just, his mom had just had his baby sister.

She was about two weeks old.

And so I'm looking at this baby that's sitting in front of me, and I started doing the math in my head again, just counting the months.

You know, if I'm pregnant and this pregnancy is viable and we end up having this baby, this baby will be born in August before school starts.

And that means that this baby is going to be in the same grade as that baby that's sitting right in front of me.

This baby that I just have found out I'm 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.

And so fast forward seven years later, and these two children are now in the same grade.

Sometimes they're in the same class and they are growing up together.

And it's just something that's fun to think back on.

My name is Henny.

I'm 34 from New Zealand, and five 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 two 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 peritoneal cavity.

The OBGYN 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'd 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 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 text box shows them.

They can reach out and move and grab eggs.

Six months post-ectopic, and I got pregnant again, and all of the anxiety came back, but I was very lucky.

Nine months later, we welcomed our beautiful son, and another year and a half later, our second son.

My other two pregnancies and births had their own challenges, but I'll never forget my first.

Wondering what could have been for that pregnancy, what could have happened if I wasn't my best advocate.

And I think about my experience every time I go to work in my own emergency department and treat potential ectopics.

It made me a better nurse, a better patient advocate, and I'm so grateful for my two boys who managed to find their way to my uterus instead of my one remaining tube.

Thank you all so, so very much for sharing your story with us.

And a huge thank you to everyone who has written in with their experiences.

Like we read each and every single one of them and of the hundreds of submissions.

So many.

And we're so grateful and honored that you felt like you could share those experiences with us.

And we tried to include as many of your stories as possible.

And you'll hear more of these first-hand accounts throughout this episode and the rest of our episodes.

Yeah, it was honestly such a privilege to be able to read every one of your stories and hear so many of your stories.

And as many as we included, there were so many more that we were not able to.

So we thank you again from the bottom of our hearts for sharing your stories with us.

Yeah, thank you, thank you.

Hi, I'm Erin Welsh.

And I'm Erin Allman Updike.

And this is this podcast will kill you.

And we're coming to you today with the first of four episodes all about pregnancy.

Four, just four.

Just four.

Should have been more.

I know, really.

And we're also coming to you from the exactly right studios for the first time, which is nerve-wracking and exciting.

I know, but this space is so cool.

We got to decorate our little bookshelves.

I feel very fancy right now.

Very fancy.

Too fancy for our real lives.

I mean, for sure.

Very, very different than my tiny little office.

I know.

Or my closet, literally.

So we're super excited to be here.

Yes, we are.

We're really, really excited about this series.

Yes, for sure.

And before we get into this episode, we want to share a few words about what these four episodes will cover, the language that we'll be using, and our goals really with creating 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 childbirth 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 preeclampsia and breastfeeding and rhesus factor.

And so there will be more episodes on these and more topics in the future.

Exactly.

So this series might not, and it likely will not, answer all of your questions about pregnancy or cover every experience that a person might have.

Pregnancy is a very individual experience, as highlighted in so many of our first-hand accounts.

But what 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 childbirth and postpartum, and also explore some of the historical and evolutionary aspects.

Really excited about that, Erin, of pregnancy and childbirth.

So, each episode very roughly corresponds to each trimester.

So, in this episode, the first one, we're going to be talking about how you even know whether or not you're pregnant.

Yeah.

How do you

know?

And what's happening in very, very early embryonic development.

And then our second episode centers on the amazing organ that is the placenta.

It's really cool.

I think we'll all leave with a little more appreciation for the placenta.

I hope so.

I hope so.

That's my goal.

And some of the physiological changes that a person experiences throughout pregnancy, including some of the complications that can arise.

Right.

And then our third episode is going to focus on childbirth itself.

So labor and different modes of delivery, and then the history of the cesarean section.

Yeah.

Yeah.

Yeah.

Yep.

And then finally, our fourth episode and our season finale, our season seven season finale.

That's crazy.

I know.

It's exciting.

It is really exciting.

Yeah.

But the last episode in the series will be about this concept of the fourth trimester.

Like maybe you've heard of it, maybe you haven't.

What is it?

We'll get into all of that and explore the changes that happen in your body after pregnancy.

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

Yeah.

We intend for all of these episodes to be inclusive of all families.

And we recognize that not everyone who experiences pregnancy actually identifies as a woman.

So we try as much as we can, wherever we can, to use gender-neutral language like pregnant person.

And that's what you'll mostly hear through this episode.

However, at the same time, we know that much of what we discuss when it comes to medical bias during pregnancy and childbirth, both historically and today, is in fact the result of gender discrimination as well as racism.

And so in those 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.

Yeah.

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 occurred 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 quarantining time.

It is.

Erin, what are we drinking this and the next four weeks?

We are drinking Great Expectations.

I love this name.

It's a really good name.

It's a good good name.

Apt, we think.

And we're also making, this is a placebo retreat

for reasons that probably are clear to, I would think, people listening.

It's non-alcoholic.

It's non-alcoholic, that means.

Yep, it is.

And Erin, 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 quarantini

coming to us from no one other than Georgia Hardstark herself.

That was the secret.

Oh, sorry.

No, it's perfect.

Go check it out.

It's going to be great.

It's going to be great.

Gosh, I'm so excited.

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 placebarita for this episode and all of our episodes, actually, check out our, make sure you're following us on social media.

And you can also find those on our website, podcastwillkillyou.com.

You can.

Over to you, Erin, to tell me what's on the website.

I'm 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, Erin.

We have merch.

We have

lost it already.

We have Transcript.

We've got Goodreads List.

We've got a link to Blood Mobile.

We've got all of the sources from all of our episodes.

Contact us form.

Contact us form.

First-hand account form.

We've got a lot.

We've got a lot.

There's so much.

There's so much.

One last piece of business?

Yes, 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 podcast is called Advances in Care.

And in it, I interview physicians and physician scientists at New York Presbyterian Hospital about their incredible cutting-edge research and groundbreaking medical innovations.

It's really, it's really thrilling.

It's very exciting stuff.

I mean, it actually is.

And it's like really fun to actually get to read about, like, oh, this is someone who's working on this right now.

In real life, in real time, these 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 we shall.

Okay.

Oh, my gosh.

We'll take a break and then get into the history of pregnancy.

Sure.

Something like that.

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I entered my second trimester of my pregnancy.

I started having really intense pain in my abdomen and in my legs and in my hips, and it kind of rendered me almost completely unable to take part in any kind of physical activity or exercise.

And even walking became increasingly uncomfortable.

And I really started to notice as I got bigger that my baby was really crowded to one side of my belly, and I seemed to be protruding far further forward than any other woman that I saw that it was at the same stage as me.

And when I brought those concerns to my OB, it was kind of laughed off.

Isn't that so funny when a baby prefers one side over the other?

And no further exams or tests were ordered to kind of check out what was going on.

So I managed through the rest of that increasingly uncomfortable pregnancy.

And then I went into labor three weeks prior to my due date.

It was a very fast, very intense labor.

I started having contractions at about 9 p.m.

I was at the hospital at 1.30 in the morning.

And then in my first cervical exams, the doctors found that I was only two or three centimeters dilated.

And they really treated me as such, kind of put me on the last of the list for an epidural request because I was a woman who was clearly not close to being ready to push.

And so I was in this very extremely painful and uncomfortable state for an hour and a half while I waited for an epidural.

Once they got that epidural in, they were able to perform a more thorough exam as I was more relaxed and they found that I had a blockage in front of my cervix.

And behind that blockage, I was fully effaced, fully dilated, and actively pushing to get this baby out.

So I was rushed in for an emergency C-section,

and my daughter came out just fine, distressed, but fine.

And And they held up my uterus and found that I had what's called a bicorneate uterus, which is when the membrane that is formed when your uterus is being formed doesn't disintegrate.

basically leads to you having two halves of a uterus.

And so I was growing a baby in a half of a uterus and then trying to give birth in a through a cervix that was blocked by another cervix.

And so while I've healed from that experience, I'm also left wondering why wasn't that found and discovered,

not only during pregnancy, but also prior to pregnancy, and what kind of implications does it mean for a future pregnancy?

Thank you so much for allowing me to tell my story.

Hi, my name is Stevie.

My pronouns are they, them, and I live in Ontario, Canada.

In 2012, my husband and I were extremely excited to be expecting 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 miscarrying, I'd have to stay down in the ER.

I was too early to go up to labor and delivery.

The ultrasound showed a good heartbeat though and bleeding slowed down so I was sent home on bedrest.

Around 1 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 four days, I went into labor.

This time, it didn't stop.

Our daughter was delivered at 1.26 in the afternoon.

She weighed exactly one pound.

Our families were there and we sang her happy birthday.

She lived for three hours.

During that short time, she knew nothing but love.

We all held her and sang to her.

She took her last breath with me.

That night, my husband and I went to sleep in the 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.

If you search for a list of the top medical advancements in history, you might find on that list things like antibiotics, vaccines, gene editing, medical imaging, kidney dialysis, organ transplantation, the manufacture of insulin, and anesthesia.

For a start.

It's a long list.

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 one of those lists.

No, I don't think I wouldn't have guessed that.

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.

That's very true.

Yeah, kidney dialysis, we need to do that.

I know.

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'm already just so invested in this, Erin.

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 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 deigned to prescribe a test.

Oh.

Yeah, prescription only.

Okay.

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, 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 movement.

Which was considered like really one of the most significant signs in terms of like, that is when a pregnancy became real.

Right.

Just quickening.

Yeah.

And I won't speculate on why there was a need or a want to know whether it came from within, someone wanting help understanding what their body was trying to tell them or whether it came from without, like someone wanting to know whether their partner, their friend, their daughter was telling the truth.

And I'm sure there were many reasons for a test

that you would want to 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 tests?

You know, I thought, okay, what, like, what are my usual go-tos are like ancient Egypt, Hippocrates, 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 things.

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.

Okay.

And it turns out that some researchers tested this like a few decades ago.

No way.

And yeah, it's 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, I thought that's so urine.

Yeah.

In your P.

In your P.

It's interesting that even the first test was P.

P has always been a main feature.

Really?

I think it's really, it's, it's fascinating.

Yeah.

And I don't know like where that, like how people made that connection

and so in for instance like in medieval england there was a profession called a piss profit

i mean

really piss profit can you imagine being like on your business card yeah

official assistant piss profit

assistant to the piss profit yeah apprentice piss profit i can't oh my god that's great yeah okay and what did a piss profit do i mean it basically what it sounds like right like you you be able to hold up the, like, the urine in a glass and be like, oh, this person has this disease, that disease.

It was more than just pregnancy at this point.

It was like lots of things.

Okay.

I mean, a horoscope, even probably.

A lot of things you can see in your P, so I get it.

Exactly.

So there is some basis to that.

So some piss profits claimed that I know I keep it.

I keep saying 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.

Casein, yes.

Like a protein, I think.

Which is part of breast milk produced during pregnancy.

Ah, yeah, okay.

Yeah.

Urine did briefly fall out of favor in the 18th and 19th centuries for pregnancy testing.

And instead, physicians performed physical exams to determine whether or not someone was pregnant.

Although, I know.

That doesn't sound great.

It doesn't sound great.

And the doctors were like, as is typical, would be so afraid of modesty.

And so they would just be like, kind of just closing their eyes and like searching.

And it's, yeah, it's not great to think about.

But these signs often included things like changes in the color of the cervix, vagina, labia, softening of the cervix, changes in breasts or nipples, changes in the abdomen, things that typically happened after at least two missed periods.

But these were by no means telltale signs of pregnancy.

And doctors usually advised to just give it time.

Give it time, wait for the quickening, then you'll know.

And in fact, until the 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 patient's word for it.

Huh.

Yeah.

Okay.

Because

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 the books A Woman's Right to Know by Jesse Olzinko-Grin and Pregnancy Test by Karen Weingarten.

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.

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 Zondek,

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 three days.

Whoa.

Kill the mice, and then take a peek at their ovaries.

Sorry.

Okay.

Yeah.

Is this?

Okay, I have so many questions.

I know.

Is it like, are they having to pee multiple days for this twice a day, three times a day?

Or like one sample question.

Okay.

Too detailed.

My guess is it was just one sample.

Okay.

And then they're, so this is taking many days.

It's a very long time.

It's taking many days.

Yeah.

Okay.

And like five, five mice.

Is that how many mice had?

Yeah.

Yeah.

It's a it's a process.

Yeah.

And then once they once they cut the mice open to look at their ovaries, if those ovaries were enlarged and congested, it meant that the person was pregnant.

That, I mean, makes sense physiologically, but okay, very interesting.

Yeah.

Yeah.

So, and what these animals were responding to was a hormone in the urine called HCG.

HCG, human chorionic gonadiness.

That was

really, yeah.

Initially, researchers thought it was produced in the pituitary gland,

but physician scientist Georgiana Seeger-Jones correctly identified its origin as the uterus and gave it its name in 1945.

Wow, okay.

1945 is a human being.

It's when HCG was named HCG

and found to be from the uterus.

And eventually, rabbits replaced mice because you could get a result faster and you didn't have to use as many animals.

Gosh.

The phrase the rabbit died.

Have you ever heard of this?

No.

It's used.

I feel like I've been re-watching Mad Men.

And there's another part of Mad Men.

I've been thinking a lot about Mad Men and Pregnancy.

But that is a euphemism that was commonly used to be like.

Did that mean that you were pregnant or weren't pregnant?

That you were pregnant.

But it doesn't really make sense because they killed all the rabbits.

Yeah.

Okay.

Yeah.

Weird.

I know.

Okay.

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 not like taboo, but it was

in hush terms euphemisms.

Yeah, exactly.

But these tests, the Asheim-Zondeck test and the Friedman 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.

And it had to be treated, otherwise it would kill the rabbit just outright.

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.

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 clawed toad.

Is it a frog or a toad?

I don't know.

I'm pretty sure it's a frog.

Yeah.

It's the scientific name Xenopus levis.

Okay.

I don't know.

But it only happens to ovulate in the presence of a male frog or in the presence of an HCG.

So then with these, did you just have to like squirt it on top because they just diffuse through their skin?

Essentially, yeah.

Okay.

Yeah.

So in 1933, researchers Shapiro and Zwarnstein discovered that, yeah, if you just sort of sprinkle urine, well, I don't know if it was actually sprinkling, like if you expose, we'll say that.

Yeah.

Urine from a pregnant person to these frogs, and you could induce ovulation in the frog eight 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.

Okay.

I think you just would not like have to give it like a washout period.

Exactly.

Okay.

Yeah.

Yeah.

Okay.

And so soon, labs around the world began importing these frogs for pregnancy testing.

Wow.

And guess what may have hitched a ride?

Kytrid?

Kytrid.

Stop it.

Yeah.

This.

How did we not talk about this in our Kytrid episode?

We may have, Erin.

That was like seven years ago.

Yeah.

So, and for those of you who haven't heard of Kytrid or haven't listened to our Kytrid episode, Kytrid is a type of fungus that is absolutely deadly, like devastating to some species of amphibians.

Populations of frogs.

Like extinction in the wild kind of thing.

Yeah.

But

some researchers think that the widespread distribution of these African-clawed frogs for pregnancy testing may have led to the global spread of chytrid.

I kind of hope that we actually did cover this and I have completely forgotten it.

I know.

It's, I feel like,

I feel like we did.

We might, I don't know, though.

It sounded vaguely familiar, but, or is it like one of those where it's a memory and then it becomes, or it's a new thing and it becomes a memory.

Yeah.

A manufactured memory.

Exactly.

And 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 chytrid infection is from one of these frogs in 1938.

Wow.

1938.

Yeah.

Okay.

Okay.

Is that wild?

Yeah, it 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 keep the animals

so expensive.

Yeah.

But the first of these dreamed of tests was developed in the late 1950s, and it was an immunoassay that detected HCG.

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 for a test, at least in the U.S.

Even after they moved away from these animal assays, like just to the immunoassay ones.

Yeah, everything was prescription.

Yeah.

Okay.

And then you had to wait weeks to hear the results from the doctor.

And you're like, I already have missed like three periods by now, so I know.

Okay.

I think I know.

Yeah.

These things cost time and money.

Right.

And second of all, stigma.

Some doctors refused to test certain people to prevent them from getting an abortion.

And so they would withhold that information until it was too late.

They would say, well, if you want to test, I'm worried about what you're going to do with those results.

Oh my God, I hate that so much.

And I wish that it surprised me more.

I know, I know.

Or they would tell husband first so that he could make a decision.

I didn't know I was going to get livid this early in the series.

Sorry.

It's just get ready.

Yeah, yeah, yeah.

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 as just another way to control women and the choices they make.

100%.

Right.

This is, this is knowledge that should not, that does not belong to you.

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?

Someone who could make money off it?

Actually, no.

Oh, okay.

I knew.

Pleasantly surprised.

It 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 Oreganon, which sounds made up, a pharmaceutical company where she worked as a freelance graphic designer.

Oh.

And something caught her eye.

One of the rooms, as she walked past, was filled with a bunch of test tubes hanging in some sort of bizarre contraption.

And she asked her colleague, like, well, what's going on in there?

It turns out there were pregnancy tests.

Crane listened as her colleague explained how they work.

And she thought to herself, this sounds pretty simple.

Like, why can't we do this ourselves at home?

And this thought followed Crane around and she found herself in her spare time designing a home pregnancy test prototype.

As a graphic designer, she's like, I can do this.

Yeah, I just love it.

This is not that hard.

We should be able to do it.

Like, it's hard.

Yeah.

That's perfect.

Thank you.

But yeah, she didn't do it because her boss asked her to do it.

She just knew how revolutionary it could be.

She saw the potential and what a change it would make.

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.

So a few weeks later, Crane walked into work to find a big meeting taking place.

And she was like, what's going on in there?

Turns out it was a meeting to discuss different home pregnancy test designs.

So she crashed the meeting,

put her design on the table with all the others, which all of which were designed by men.

One had rhinestone edging, one had a cute little tassel, all were pink except Crane's.

But Crane's was the only one to include a urine collection cup.

Oh my God, are you serious?

Yeah.

Well, you got the rhinestones, but not the collection cup?

Would you use a mug?

Exactly.

So someone's like, what?

And

one of the other designers was like, yeah, 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, Crane's, 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 and sheep blood.

So, you collect some urine into the top half of the box, add a few drops to the test tube along with some tap water.

Okay.

And then you waited for two hours, which is much better than two weeks with the test tube sitting in the bottom half of the box.

Okay.

And that had a mirror.

It's like, it's complicated.

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

very much.

Yeah.

Right.

It was very similar to.

Not that much harder than like COVID tests where you're like, oh, yeah, I swab this and I buy this and I drop her this and I, right?

Yeah, I'm something of a

demeologist myself.

Yeah.

Yeah.

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.

And eventually they opened their own ad agency where she was the head designer and he was the copy chief.

Oh, so cute.

But with Crane's design in hand, Organon sought to get this test to market.

Facing heavy opposition in the U.S., was it reliable enough?

What would women do with this information?

Organon instead turned to Canada, where unlike the U.S., you did not have to have a prescription to get a pregnancy test and you could just take one at the pharmacy without a doctor's appointment.

Okay.

Unbelievable.

I mean, totally believable.

By summer of 1971, Predictor, which is Oregon'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.

Just to put it in context.

Yep.

Not everyone was a fan of the lab test.

So one pharmacist in British Columbia named Bob, no last name that I could detect, said that he wouldn't be stalking them because he, quote, didn't think women could be trusted to accurately obtain results.

Okay, Bob.

Thanks, Bob.

We can't read derivative shelves.

Or pee in a cup.

Come on.

Yep.

Jeez.

Others described it as a passing fad.

Oh, of course.

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 U.S., the FDA approved the test in 1976 and they hit the shelves in 1977.

Wow.

One of the earliest ads for these tests, the EPT in-home early pregnancy test, described it as, quote, a private little revolution any woman can easily buy at her 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 U.S.

in the 1970s.

Like Roe v.

Wade was 1973, for instance.

But the private little revolution wasn't immediate.

These tests cost 10 US dollars,

51 in 2024 dollars.

Holy cow.

Yeah.

Took two hours for a result again and had a decently high rate of false negatives, not false positives, though, which is good.

This was not a cheap test.

And the recommendation to buy two tests in case you took the first test too early,

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, because otherwise the ring would probably dissolve.

Oh, interesting.

With 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 EPT unless she doesn't want to be seen at the health department.

Yeah.

Leading the magazine to conclude that it was a quote-unquote useless purchase.

Wow.

Yeah.

Just like our avocado toast.

If you didn't buy so much avocado toast, maybe you could buy a house.

Maybe you could buy a house.

But the sentiment revealed a disconnect between what most physicians, some politicians, and a puritanical patriarchal society thought women needed and what women felt they needed, especially in the U.S., where there initially was pushback 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'm going to read you from from the book Pregnancy Test by Karen Weingarten.

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, Maury, 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 them.

I'm sure they didn't.

But these 90s tests, that's when the first time 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 most of them

clearly wanted a positive result, right?

They were happy with the positive result.

One couple was relieved about their negative test.

Which interesting.

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.

Waiting to find out if you're pregnant or not.

Nothing else in the world matters until you know.

Introducing Clear Blue Easy one minute pregnancy test because only Clear Blue Easy gives you a clear yes or no in one minute.

So that's the first time that it's just waiting and you have to kind of infer yourself.

I think so.

Interesting.

Yeah.

Isn't that so fascinating?

Because a lot of the other ones were like, it's positive.

I'm happy.

Or it's negative.

I'm relieved.

Okay.

But this one, she's smiling.

You don't know.

Is she happy that it's positive or negative?

Right.

I really, I really like it.

Yeah.

The mystery of it.

That ad is especially important too for showing that it's about the knowledge, not about the result.

And I think that's, that's a big shift in.

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?

Whose 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 there's a Mori one where someone has to, like, it's like someone's teenage daughter takes one on air to be like, is she lying or not?

I know.

That's horrific.

I know.

Yeah.

But there are, yeah, a million examples, right?

In 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.

Yeah.

Yep.

And this plotline was criticized by Vice President Dan Quayle as quote unquote eroding family values.

Of course it was.

Right.

Yeah.

It's, yeah.

I think that.

That test though, or that sitcom, Murphy Brown, when she took the pregnancy test, that also helped to kind of popularize popularize it and be like this is a thing that people can do this is yeah right I think it just kind of had just 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 covet 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 monoclonal antibodies, which eliminated the need for lab animals, more precise testing.

The now familiar, easy-to-read stick pregnancy test with the two lines was introduced in 1987.

Now some of them say pregnant or not pregnant.

Pregnant.

Digital ones.

In 2021, a flushable pregnancy test was introduced, which is an incredible development to protect privacy.

Wow.

Yeah.

I was just thinking about sewage lines.

Like, are they actually flushable?

I mean, I think, I think they are.

Fascinating.

Yeah.

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, my cell is 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 sequential test afterward to be like, is it dropping?

Right.

I've seen different estimates, but around 8 million people in the U.S.

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 Levitt.

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 timeframe 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 grandma.

My mom took a home pregnancy test.

I assume that my mom did, but I never asked her.

I asked her so many other things about her pregnancy for this episode, but I didn't ask her that.

Yeah.

It's incredible.

Yeah.

But that knowledge can come at a cost.

Also, from Levitt, 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.

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 U.S.

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 U.S., early detection of pregnancy can be critical, especially for those living in states that restrict abortion to a narrow window, like six weeks.

Right.

Or like outlaw it at all.

So you have to figure out where you're going to travel to.

Where 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 too long.

Yeah.

And so with that, Erin, I'd love for you to tell me about how HCG works and what's going on in early pregnancy.

I I don't know if I'm going to answer that first question.

Okay, what's going on in early pregnancy?

We'll get to it.

Okay.

Great.

Right after this break.

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I didn't have a glowing pregnancy.

Sciatica made every step painful.

Braxton Hicks robbed me of my sleep.

And even the smell of my beloved garlic turned my stomach.

Hormones didn't help, especially when my husband jokingly called me Shamu after the infamous killer whale because of my black and white maternity wardrobe.

I snapped at him one night when he made what I thought was a mean comment about how puffy my ankles were looking and then I forgot about it.

Until January 17th, 2018.

At 2am, my waters broke.

We grabbed a cab to Lewisham Hospital in southeast London, expecting to be sent home as labour had not started yet.

Instead, after a long wait and a quick reflex test where my legs shot up in the air, we realised that those puffy ankles had been an indicator of preeclampsia.

The only cure, birth, within 24 hours.

Suddenly, I was on a hormone drip to induce labour and magnesium dripped to prevent seizures.

Hooked up to monitors, I was told that I could not eat anything.

For hours, I waited, feeling contractions build.

But just when I needed the epidural most, we realized that it had become detached, and I had to push without pain relief, which resulted in my blood pressure increasing in a way that the midwives were not very happy about.

Suddenly, the room blurred in a wave of blue medical sheets.

and rushing staff.

My baby was facing the wrong way up.

Another complication.

The doctor used a vacuum to rotate her and finally, to Queen's I Wanted to Break Free, my daughter entered the world.

The traditional National Health Service tea and toast afterwards is still to this day the best meal of my life.

Two days later we went home.

That baby is now a feisty seven-year-old testing every boundary.

Life since hasn't been simple.

We've moved countries.

She's learned new languages.

And her dad and I have separated.

But she's the center of our universe.

And through it all, even though I've never fully understood why I got preeclampsia and why we hadn't noticed it earlier, I'll forever be grateful to the NHS for bringing us through safely.

For the most part, my pregnancy was pretty typical, pretty textbook,

no complications or anything.

The two things that really kind of stood out to me as

different in my experience that I was not prepared for.

The first

was when the whole time that I was pregnant, people always were saying, Oh, when you go into labor, you may not even know it.

It may be hard to tell when labor starts.

It's not going to be like it is in the movies where you have this big dramatic gush of your water breaking, and that's what starts things.

But that was exactly what happened.

I had woken up at about four o'clock in the morning, needed to use the bathroom, and I got up off, I was sleeping on my basement couch, got up off the couch as best I could, and the second my feet hit the floor, it was a gush that was unmistakable.

I

knew at that point that it was time to go to the hospital.

Then the other unexpected for me was as my labor progressed, it seemed like things were going relatively quickly And you know, just a few short hours into being at the hospital, I was told, oh, it's time to push.

And at that point, I was thinking, oh, okay, I'm going to have the baby in just a few minutes.

Everybody I've ever talked to says they pushed for 15 minutes or two pushes and the baby was out.

That was definitely not my experience.

I pushed for two hours.

That was pretty grueling.

And I overall everything turned out fine, but I did not realize before that point that

you could be ready to push and have it still take that long.

She hadn't descended through my pelvis yet, so even though I was already fully effaced and dilated, it took a little bit of work.

All in all, it was worth it, and I would do it again, but you just really never know what you're signing up for when you get pregnant.

So

this might sound silly now after everything that you went through, but I felt like to make all of these episodes make sense, I wanted to start by just defining pregnancy.

No, that's a great way to start.

Cool.

I'm 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 through, how we've been able to determine whether or not someone is pregnant has really changed over time.

So, I want to start with how we date a pregnancy today.

Great.

Okay.

This is how we decide when a pregnancy quote unquote begins.

Okay.

And in medicine, that is pretty universally based on your last menstrual period.

The first day of your last menstrual period is the start of a cycle, your menstrual cycle.

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 two weeks between 38 and 40, that's the time it takes from the start of that last menstrual period to ovulation slash fertilization.

Does that make sense?

I think so.

So that's why your pregnancies are always longer than you would think it is.

By the time that you have missed a period, you're already four weeks pregnant.

Oh my gosh.

Even though fertilization just happened two weeks ago,

got it, okay, yeah, and it is confusing, yeah, because then it really makes that timetable.

And if we're talking about like access to abortion and things like that, it's really important, right?

So, we'll go through all of what is happening there, and but I just want to set the stage that that is how we define pregnancy, that's the time frame of pregnancy.

Okay, I have a question real quick.

All right,

give it to me.

So, there then is a potential uh like error bars around absolutely and so then like let's say that you know that conception happens okay on this date uh-huh but then your doctor's like oh well when was the last day of your last period you want to talk about me because 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?

Yeah.

And it all depends on like how early that ultrasound is, how it's growing and all of that.

And there's like very specific regulations on how that's all decided.

Okay.

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

everything.

Yeah.

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.

Yeah.

And now that we have the better ultrasounds that we have, the more accurate we can be in dating.

Okay.

If you have access to an early ultrasound, because ultrasound gets less accurate the farther you get in pregnancy.

I am going so far off.

No, this is great.

I'm, I'm, 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 two weeks after your last menstrual cycle.

Okay.

On average.

You have ovulation.

That's when you ovulate.

And if a sperm is present, then you have fertilization.

These two single cells will come together and join their nuclear contents and make a brand new cell.

I'm taking everything that happens prior to that point for granted because it's cool, but it's way too detailed.

Okay.

So that's where we begin.

Within the first 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 two to four to eight 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-filled ball.

And we talked about this in our IVF episode.

It's called a blastocyst.

Yep.

And I imagine the blastocyst like a tennis ball.

Yes.

I brought one.

Did you bring one?

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.

She was like, we're playing, right?

She was like, is that my ball?

Is that my ball?

I did not take her ball.

Okay, so imagine this is a hollow ball, right?

But it's filled with fluid instead of just being filled with air like an actual tennis ball.

But instead of being like perfectly symmetric inside and outside, in the blastocyst, 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 blastocyst stage, six or seven 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 with is this blastocyst 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 blastocyst and eventually fetus does not grow in that cavity.

It grows within the wall of the uterus.

Okay.

Now the outer wall of that blastocyst, like the fuzzy green layer of the tennis ball, it's called the syncytiotrophoblast.

And that is the layer that will continue to invade into the walls of our endometrium, into our uterus, and all the way into the first third of the muscle layer, the myometrium of our uterine wall.

Yeah.

And I know you're going to talk more about that.

I think so.

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

by completely remodeling.

So the structure of 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

recap it briefly.

So the cell 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.

Yep.

The outside part is what invades and then becomes the placenta.

Yep.

And there's like layers, obviously.

It's so interesting, the differentiation.

What are the signals that say you be placenta?

You be

embryo.

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'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 syncyster trophoblast, the cells that are burrowing their way into our endometrium, will start to secrete HCG.

And that is not only important for detecting a pregnancy, but also one of the major keys for a pregnancy to be able to continue.

Okay.

Because

don't worry, I'll get there.

Because up until this point, all of the tissues of our endometrium, the lining of our endometrium, and everything that has changed thus far, it has been supported primarily by the hormone progesterone.

And that hormone, up until this point of implantation and HCG secretion, has has been secreted by this thing called the corpus luteum, 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 two weeks supporting the lighting of your endometrium, hoping that a blastocyst will implant.

Right.

But the corpus luteum only lives about two 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 your system, then this corpus luteum will disintegrate, your progesterone levels will drop, and you will have a menstrual period.

You will shed the lining of your uterus.

The decidua.

The decidua.

Yes.

Well, I just, I'm trying to track that with all the senses stuff.

I don't even know if I talk about the decidua, but that is what it is called.

It is the what the lining of your uterus becomes.

Yeah.

It's called the decidua.

Okay.

But if this blastocyst was able to successfully start implantation, it starts secreting HCG, and that HCG sends a signal to our corpus luteum, don't disintegrate, keep it going, keep secreting progesterone, and it does.

Our corpus luteum will continue to produce progesterone for several more weeks, all the way until the point that the placenta has formed and can take over the majority of the necessary hormone production to support the growing pregnancy.

Okay.

Right?

Amazing.

Amazing.

So we've already learned a lot.

Yeah.

First, it means that the absolute earliest that you could conceivably test for a pregnancy via HCG is a couple days after implantation, which is usually a few days prior to your missed period because it's like 48 hours after implantation, which is day five, six, seven, somewhere in there.

Okay, so most people are going to be considered four weeks pregnant at this point, plus or minus.

Is

I have strong feelings about that.

Yeah, I

tell me your feelings.

Enrage, I guess.

Like, that is so

inaccurate.

I mean, it's not, it's because it's, okay, it's consistently inaccurate.

So that's one aspect of it.

Except it also, great.

That's, that's the one pro of this.

The rest is that everything else is then shifted.

Right.

And I mean, yeah.

I know.

It's interesting.

It's, and I mean, it's, it's really a relic of

when we didn't have ultrasound.

It's like, it's like that laws are now based on.

Oh, yeah.

100%.

Preaching, choir.

Yeah.

And this process of implantation, it's also a very delicate sort of dance.

A lot of things can go not as I just explained within this process and prior leading up to this process.

So I'm going to pause here and actually take a few steps backward to talk about some of the potential either complications that can arise even as early as this,

or just things that don't go this way.

Like Like what are the alternative routes that can happen here?

And then we'll come back and I'll talk more about the inner cell mass, how it becomes an embryo.

There's a few things that can happen with implantation, the process of implantation.

One is that it could happen in an atypical location, and that is called an ectopic pregnancy.

And because most fertilization events happen in the fallopian tubes, which are the little tubes leading from our ovaries to our uterus, then most of the time, like 95, 96% of the time, if a ectopic pregnancy happens, it happens in the fallopian tube.

Okay.

So this blastocyst implants in the wrong place in your fallopian tube.

Got it.

Or right at the junction there where the fallopian tube meets the uterus.

And because fallopian tubes cannot expand the way that the uterus can, as that blastocyst continues to grow into an embryo, it can cause rupture of the fallopian tubes, which can cause catastrophic blood loss.

So ectopic pregnancies are very dangerous.

The fallopian tube is not the only place that it can implant.

Ectopic pregnancies can also happen in the cervix, so like a little too far down.

Interesting.

Okay.

They can happen in the scar from a cesarean section, which might end up being a viable pregnancy, depending on how it continues to grow.

They can sometimes happen in the ovary or even in the abdominal cavity because the ovaries and your fallopian tubes are not like connected.

They're like floating.

And your fallopian tubes can also like move around back and forth and things like that.

Okay, that's amazing.

I know.

But it's not great if one implants in like the abdominal cavity.

And so all of these are considered ectopic because it's all typical just outside of the

ectopic, just outside of the uterus.

Outside of the uterus.

Overall, most estimates are that about 1 to 2% of pregnancies are ectopic, depending on the source.

1 to 2%.

Okay.

Okay.

Question.

I expected questions.

I have answers.

Okay, wonderful.

So

one to two percent of the time, how does, how do you figure out whether something's an ectopic pregnancy?

Number one.

Number two, like what, what next?

Great questions.

How do you determine it?

A lot of different ways is the answer to that question.

Okay.

Ultrasound is really important in this,

but it also can depend on how early that pregnancy is, because sometimes if it's super early, then you don't see anything in the uterus or elsewhere, then it might be classified as a pregnancy of unknown location.

And so then what you do with that might change kind of depending.

But in general, it's ultrasound to try and determine that.

A lot of times ectopic pregnancies might present as atypical early on.

So you might have bleeding that we don't expect.

You might have abdominal pain, especially like one-sided abdominal pain, but not always.

Sometimes you might not have symptoms.

What you do about it is really important.

So ectopic pregnancies are very important to be treated.

And they're generally treated one of two ways.

So one is with a medicine called methotrexate, which is also used in some places for abortions.

But methotrexate is one medication that you can use, especially if it's small and it's at low risk of rupture.

It requires continued medical monitoring to make sure that you've completely lost the rest of that.

uh pregnancy tissue

or it requires surgery and surgery usually requires the loss of that fallopian tube if it um if it if that's where it it planted

okay um and how like how often is it surgery versus it's a good question i don't have it i don't have data on that okay that's a solid question i think it probably depends like location geography all that kind of stuff gosh we really we should do an entire episode on the history because i i really am just curious what how we learned about ectopic pregnancies right and how we figured it out early on and before ultrasound what happened yeah oof probably wasn't good no yeah

um yeah so that's ectopic pregnancies okay do you have more questions Not right now, but I'm sure I will in just a few minutes.

There's other atypical ways that a blastocyst can implant that might end up in a viable pregnancy.

If the blastocyst implants too low in the uterus, but not in the cervical canal, then it can result in what's called placenta previa.

So the placenta completely covers the OS or the opening to the cervix, and that is potentially dangerous.

It can cause bleeding during pregnancy, but it also,

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

So generally, that goes to a cesarean section, which we'll talk way more about later.

And then, of course, there is miscarriage or early pregnancy loss.

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

Okay.

The definition of miscarriage actually is different depending on where you live.

and what country that you live in.

Okay.

Because it is defined generally as the spontaneous loss of, and these words are important, the spontaneous loss of a recognized pregnancy

prior either to a certain gestational age or a certain weight of the fetus, depending on what country you live in and things like that.

So in the US, we define a miscarriage as a pregnancy loss prior to 20 weeks gestation.

In the UK, it's prior to 24 weeks.

In other parts of the EU, it's like 22 weeks.

And per the World Health Organization guidelines, it's the loss of a pregnancy with with a fetus that weighs 500 grams or less, which is about 22 weeks gestational age.

Why is there such variation?

It's in part because it depends on like the definitions of like viability and things like that.

I don't have a great answer as to why there's variation, but the variation exists, which does mean that there's differences in terms of like reporting what is considered a miscarriage or an early pregnancy loss and then what is considered a stillbirth, which is if you have a pregnancy loss after that time point.

I see.

But again, that time point varies a little bit.

And what's the recognized part?

Yeah, great question, Erin.

So that also, the definitions kind of differ.

So there are like clinically recognized pregnancies, and then there are pregnancies that maybe weren't recognized clinically.

And some of that depends on whether or not it was seen on ultrasound.

Okay.

Which means not only like, did you have access to ultrasound, but like how early was it?

And then like you said, Erin, is that the more that we have access to these very very early pregnancy tests that can detect some of the home pregnancy tests now can detect very low levels of hcg which means you can get it earlier and earlier and earlier and so that does change our

like rates of miscarriage yeah but in some of the literature if there's not a documented pregnancy with ultrasound, then it's not classified as a miscarriage, miscarriage, but it might be classified as a early pregnancy loss, quote unquote, or a biochemical pregnancy loss is another term that gets thrown around a lot, biochemical pregnancy.

Or sometimes they're called preclinical pregnancy losses.

All right.

Okay.

So it all is important,

but yeah, the definitions kind of vary.

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

Yeah.

Okay.

But all that being said,

overall, the rate of spontaneous spontaneous loss of early embryos is very, very high in humans.

So a lot of those blastocysts that we were talking about never actually make it to the point of implantation.

So they are lost before implantation, which means you never knew that you could have been pregnant.

Even though, again, we're defining pregnancy as your last menstrual period.

So it's very confusing.

Yeah, yeah, yeah.

We don't know exactly how many of these like pre-embryos are lost prior to implantation, but it's estimated to be somewhere between 20 and 40 percent, which is very high.

That is very high.

It's very high.

Yeah.

And those are estimates.

Also, yeah, 20 to 40 is a huge range.

It's a huge range.

Yeah.

And then after implantation, so after that start of implantation, a further 30% are lost, but it's thought that about half of those happen so early that most people, and caveats here with early pregnancy tests, but most people would never know that they were pregnant or were almost pregnant, could have been pregnant, because they don't ever miss a period.

Uh-huh.

Right?

Yeah.

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

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

And those are most often classified as like biochemical or preclinical pregnancy losses.

Okay.

But the more that we have early pregnancy tests, the more that people are going to know that that happened to them.

Yeah.

Right.

Yeah.

Most estimates of the overall risk of miscarriage, so the loss of that recognized pregnancy prior to 20 to 24 weeks is about 15% globally.

Wow.

And that's a huge number.

Yeah, it really is.

15% is 23 million recognized miscarriages worldwide every year.

Wow.

I know.

We don't talk about it.

Like at all.

Yeah.

It's like not something that we talk about.

It's not something that's polite to talk about.

But something.

There's a few things I feel like.

I have a lot of feelings about this, but

one in three women are also estimated to experience a miscarriage at some point during their reproductive years.

So it's not just that it's common globally.

It's also common that you might have throughout your reproductive lifespan a miscarriage at some point in time.

And something being common does not make it unimportant.

Yeah.

Right.

Of course.

It happens all the time.

It's really important.

Right.

There was a study in a paper that I read that looked at only 500 women, but so it's a small study, but I think this is still really important data.

537 women with a pregnancy loss, a recognized pregnancy loss, found that after nine months, 18% of them met criteria for post-traumatic stress, 17% for moderate or severe anxiety, and 6% for moderate or severe depression.

So like losing a pregnancy, whether it was a planned pregnancy, an unplanned pregnancy, an early pregnancy loss, or a later pregnancy loss, like that is very hard potentially.

And it's really lonely if it's something that you're not able to talk about in quote unquote polite company.

Well, and I feel like you make a really good point that like this, even though this does happen a lot and it's not, it's not talked about a lot and it doesn't take away the pain and the trauma that can result.

Yeah.

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

So sometime in the first 10 to 12 weeks.

Okay.

But one to 2% of pregnancy losses will happen in the second or third trimester.

And like we said, if it's after that 20 to 24 weeks, then we classify classify it as a stillbirth rather than a miscarriage.

And no matter how early any pregnancy loss has the potential to be met with shame or stigma, loneliness, guilt, fear, frustration, like so many different things.

And a lot of people understandably want to know, like, what causes this?

Right.

Why is this happening?

And we don't know.

Yeah.

Right.

Except that it happens like very commonly across the board to these early embryos, especially.

Most estimates are that about 50 to 80% of the time, miscarriages are due to chromosomal abnormalities in the fetus.

All right.

Okay.

And that is one of the big reasons that age, female age specifically, is a big contributor, where younger people are much less likely to have a miscarriage compared to as we get older.

The rates are like vastly different.

It's so interesting because I know that we talk about the impact of female age, but

I feel like it does add, it can add blame sometimes.

Absolutely.

And to not, like, also the sperm age or like age of the person who's making the sperm also plays a role.

I think I saw at least one study that looked at that.

And there is actually an increased risk of miscarriage, I believe.

Yeah.

I wish I had written more detail on this, but it's at an older age, whereas with females, it starts at like 35 or so that the rates of increased chance of miscarriage go up.

It starts later, like after 40, or maybe it was 45.

Okay.

Don't quote me on that because I'd have to go back to the paper.

Yeah, yeah.

But yeah, so you're right.

It's not like an, it's not a nil factor.

Right.

It's a contributor, but we don't talk about it.

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

Advanced maternal age.

Advanced maternal age.

Geriatric.

Womb.

We don't call that that anymore.

Okay, I don't.

I'm sure people do.

Yeah, I think there are probably a handful out there.

So yeah, so miscarriage is a really important topic, I think.

Yeah.

Yeah.

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

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

One is called expectant management, which basically means you don't do anything, like there's no medical intervention, and you wait for that tissue to pass on its own spontaneously.

There's another option, which is a medication option.

And most of the time, there's a combination of medicines that are used, mesoprostyl and mifipristone, aka

abortion medicines,

or with a vacuum aspiration or a DNC, which is a dilation and curatage, which is the exact same surgical procedures as are used in quote-unquote elective abortions.

Abortion is healthcare.

Abortion is healthcare.

Every one of these options, expectant management, medical management, and surgical management, are all associated with risks and benefits for the individual.

And in fact, in the data, there's no difference in like one is more risky, one is less risky.

They all have risks of bleeding, they have risk of infection.

And the choice to do one or the other

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

However,

because we live currently in the United States, especially with all of these abortion restrictions that are going into place, this is no longer the case.

It is now very often the decision between a legal team and the hospital administration on when to do something about it, on when not to do something about it, on when you have to just wait, et cetera, et cetera.

Just

around a conference table, someone's making decisions about what is happening inside your body.

Yep.

I mean, you're not involved in that decision.

Yep.

You don't have a seat at the table.

Oh, gosh.

That was a lot.

Yeah.

That's a lot.

Do you have any questions about that?

I have feelings about that.

I do too.

Trying to think if I have any specific questions.

Yeah.

Okay.

One question I have is like, you said that it's the risks associated with each of these are more or less the same.

So then why would one, why would someone opt for one versus another?

I mean, it's in part personal preference.

It's in part to like how far along you might be, or if you have sort of started to pass that or not.

And then a lot of it really is personal preference because it's like, are you going to feel more comfortable doing this at home where you have maybe support around you, or maybe you don't have any support at home?

Maybe the thought of having to wait a long time because you don't know how long it will take to pass it on your own is really more traumatic.

And so having something done where it's over and you know that it's done is maybe more appealing to you.

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

Got it.

Yeah.

Okay.

So let's stop there for now and bring it all the way back to the developing embryo.

Got it.

Oh, just this.

Here we go.

Okay.

Another prop where we left off.

It's the same prop.

My tennis ball.

Yeah.

This inner cell mass.

Okay, we're here.

So during all of this time and before implantation and after implantation starts, what's happening with this inner cell mass, I'm going to walk you through really quickly embryonic development.

And when I say really quickly, I mean this is like the most Cliff Notes version, right?

Okay.

So we are back now at about two weeks post-fertilization, week four of pregnancy.

Okay.

And this little pre-embryo at this point, this inner cell mass, it's a little disc of cells that has formed the three essential germ layers that will eventually become all of the different tissues and organs in our body.

Okay.

And then these little discs of tissue will form tubes.

Tubes.

One tube will become our brain and spinal cord.

Yeah.

The other tube will become our guts.

Isn't that cute?

That's very cute.

Two tubes.

And then after that, a little lump will start to form at the top of this tube of cells, and that lump will become our head.

and then little bumps come up along the back and those will eventually become our vertebra

by about the sixth week of pregnancy so this is about two weeks after a year missed period potentially this embryo it's called an embryo now it still does not look like a human like at all no um it looks to me very much like the alien in alien I mean like embryonic development oh there's some quote and I don't remember who it's by whether it's like Dobjansky or, I don't know, one of those old evolutionary biologists that's like everything,

our entire evolutionary history can be traced to ontogeny and like the development of an embryo.

I'm probably butchering that quote for risk.

I mean, I like it.

Yeah.

I wish I knew who it was by.

Well, listen.

It wasn't Dobzhansky.

At this point, we look like an alien.

Okay.

Like the head thing is like and curved over.

There's this big long thing that comes off the back, these bumps along the back.

Very reptilian.

I mean, very reptilian.

Our evolution, our evolutionary origins, yeah.

Right.

And when you look at like embryo development side by side of like all the different species, we look all the same, the same, the same, the same.

Yeah.

All the way through this point.

Yeah.

But we're not as scary as an alien because it's like two millimeters long.

Not as scary as an alien.

Oh, as alien.

As capital A.

Capital A alien.

Yeah.

Proper noun alien.

Proper noun.

But at this point, too, when we look like alien is when things like the eyes, what will become the eyes, start to develop.

so you get these two little dots that will eventually become our eye cells the parts that will become our jaws and our ears and all of this is very important patterning that has to happen in exactly the right way for all of our body parts to actually develop and at this point too about week six is when you could first detect what will become a heartbeat so this little bulge that will become our heart starts to beat and you can see that on ultrasound

it's also when we start to see arm and leg buds,

the buds,

start to kind of pop out just a little bit.

And then eventually, those limb buds will make paddles first, and then little fingers and toe buds.

And then, by the end of the 10th week of pregnancy, so 10 weeks after your last menstrual period,

eight weeks since fertilization.

Got it.

Okay.

Is when you start to have something that looks more like a human than all of our vertebrate cousins.

And And that is when we are almost to the second trimester and then we enter the fetal period.

The fetal period.

The fetal period.

At the same time as this is also when that syncytial trophoblast that has during this whole time been invading its way into the myometrium all the way through.

It has finally at the same time point finished the formation of the placenta, which isn't all the way formed until week 13 is our pregnancy.

Wild.

I know.

And that is the organ that you, Erin, will pick up with next week.

I certainly will.

I have questions.

And you might be getting into them next week.

I probably won't.

So give them to me now.

What's going on in the pregnant person's body?

Is that all next week?

All next week.

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

Oh my gosh.

It's really good because it's already started.

Yes.

From, oh, I'm so excited about it.

Oh, I can't wait.

I know.

I'm also done talking about the fetus.

I'm not going to mention them again pretty much.

Okay.

Well, we will, and we will do more fetus stuff in the future.

There are so much feelings about it, and I want to talk all about it, but we were talking about pregnancy for this.

We're talking about pregnancy.

So there we are.

We've made it to the end of the first trimester.

Oh, my gosh.

Oh, my gosh.

That went by faster.

And also, we covered so much.

I know.

But we didn't cover more.

We have so much more to cover.

I have thoughts.

Okay.

But everyone is going to have more that they want to learn.

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

Yes.

Okay.

So.

For this, I actually didn't have as many sources as I do for my later episodes.

I have a few more, but I'm going to shout out three in particular.

One is the book Pregnancy Test by Karen Weingarten, which I referred to in my notes.

Also, A Woman's Right to Know by Jesse Olzinko-Grin.

And then by Sarah Abigail Levitt, A Private Little Revolution.

It's an article about the home pregnancy test.

And I really liked those those three together as sort of like this big picture view of everything that I talked about.

Well, I loved your whole part.

So it made me want to read this.

Thank you.

I relied very heavily on a textbook that's very old at this point.

It was by Jones and Lopez, and it was called Human Reproductive Biology.

So it's like a primer on it all.

Is it very old mean the late 20th century as like the youth said?

And it's like, wait.

It was the 21st century.

It was from 2013.

Okay.

It's like 10 years old.

But I mean, like,

our knowledge of this part hasn't changed.

But I will also say that, like, it's good for data, but it has a lot of weird, I don't know, editorialization in parts of it.

So

interesting.

Anyways, I cited it.

It's what I used primarily.

And then a few other papers that I think were really important, especially in learning about the placental development, if you want more detail on that, which you'll get to next week.

But there was one from Proceedings of the Royal Society B from 2023 called The Human Placenta, New Perspectives on Its Formation and Function During Early Pregnancy.

Ooh.

And then there was a a whole series in The Lancet from 2021 all about miscarriage.

And my favorite one from that was called Miscarriage Matters: The Epidemiological, Physical, Psychological, and Economic Costs of Early Pregnancy Loss.

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

But as always,

you can find all of our sources because there's so many more on our website, thispodcastwillkillYou.com under the episodes tab.

You certainly can.

This in all of our episodes.

All of our episodes.

We have literally so many sources.

It's kind of unbelievable.

Yeah.

I'm proud of us.

Me too.

Thank you again, so, so much to everyone who provided their first-hand account, everyone who wrote in with their first-hand account.

We really, we don't have the words to express how grateful we are.

No, it's like so, so, so meaningful to us.

And we, we could not do, especially this series without you.

So thank you.

Thank you.

Thank you also to Exactly Wright Studios and everyone who's here, like looking at the window.

It's so exciting.

Very exciting.

Thank you to Tom and Liana, who's not here today, but will be.

And I'm saying too much.

Thank you to Jessica and to Brent and to Craig and everyone else.

We're so excited about this.

It's really been so much fun.

I feel so cool.

I still feel too cool.

I don't feel cool.

But I'm having a lot of fun.

Me too.

Me too.

So thank you all for all of your work.

We're excited.

Yes.

Thank you.

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

And thank you to you, listeners.

Yeah.

And

viewers, too.

Viewers.

Yeah.

Amazing.

We hope you had fun with this one and you're prepared for three more episodes on pregnancy.

Yeah.

I hope you like more where this is coming from because we've got it.

I don't know.

That sentence didn't make sense.

It's fine.

You know what?

And thank you to our patrons.

We really do appreciate your support.

It means the world to us.

It really does.

Thank you.

Well, until next time, wash your hands.

You filthy animals.

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