This Podcast Will Kill You - Ep 168 Pregnancy: Act 1

Episode Date: March 11, 2025

Content Warning: This episode includes mentions of miscarriage, pregnancy loss, pregnancy complications, traumatic birth experiences, and other potentially disturbing topics related to childbirth, pregnancy, and the postpartum period. With this and the next three episodes, we’re delivering a four-part series on pregnancy, trimester by trimester. We start our series with a tour through the history of the pregnancy test: how and when did these sticks with the two blue lines become the everyday at-home medical device they are today? How has their introduction changed the knowledge that women have about their bodies and who has access to that knowledge? Then we explore the biology of what happens at the very beginning of pregnancy with some light embryology, exploring the earliest steps of implantation, placentation, and what could happen if this process doesn’t go as expected. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu Check out Advances In Care, a podcast that showcases the latest medical breakthroughs by physicians at NewYork-Presbyterian hospital. Our very own Erin Welsh just started a hosting role on the pod! Available wherever you get your podcasts: https://go.pddr.app/advances-in-care-hostSee omnystudio.com/listener for privacy information.

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CBS tonight at 87 Central. You're listening to a podcast. So you're doing something else too, like maybe scrolling home listings on Redfin, saving places you like without thinking you'll get them. Because that's what house hunting has become. But Redfin

isn't built for endless browsing. It's built to help you find and own a home. Redfin agents close twice as many deals as other agents, which means when you find a place you love, you've got a real shot at getting it. Redfin helps turn saved listings into real addresses. Get started at Redfin.com. Own the dream. 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 in 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 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? get pregnancy tests. 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, um, I, went outside and I told my husband that I was pregnant and we were so excited and you're like,

wow, we're really doing this. And it was really neat because this whole party that we had there, we probably had about 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 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. So, 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 work out 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 OBG-WA in 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 a.

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 lephalopian tube was completely blocked and there was blood in my belly. If I had have gone home, there is a very real chance

that would have burst completely and I could have died. Being an emergency nurse and an advocate for myself saved my life. Losing a fallopian tube was really hard mentally until I learned the biggest health lesson I ever have. I can't believe I got through so many anatomy classes without knowing this, but your fallopian tubes aren't fixed, although that's how the textbooks show them. They can reach out and move and grab eggs. Six months post-tech topic, and I got pregnant again, and all of the anxiety came back, but I was very lucky. Nine months later, we welcomed our beautiful sun 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 potentially topics. It made me a better nurse, a better patient advocate, and I'm so grateful for my two boys who managed to find their way to my uterus instead of my one remaining tube. Thank you all so very much for sharing your story with us. And a huge thank you to everyone who has written in with their experiences. 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-teen 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 Aaron Olman 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. It 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 the space is so cool. We got to decorate a 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, 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, 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 Reese's 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 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. I'm really excited about that, Erin, of pregnancy and childbirth. So each episode very roughly corresponds to each trim. 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 that? 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 this series will be about this concept of the fourth trimester. Like maybe you've heard of it. Maybe you haven't. What is?

that 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 quarantini time. It is. Aaron, 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 name. Apt, we think.

And we're also making that this is a placebo rita for reasons that probably are clear to people listening. It's not an alcoholic. Is that what that means? Yep, it is. And Aaron, 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 right's 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 Hardstock

herself. That was the secret. Oh, sorry. No, I'm getting it's perfect. Go check it out. It's going to be great. It's going to be great. Gosh, I'm so excited.

Me too. 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 placebo-a-a-a-a 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. This podcast will kill you.com. You can. Over to you, Erin, and 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, Aaron. We have merch.

We have, oh, I've lost it already. We have transcripts. We've got Goodreads list. We've got a link to Blood MoBee. We've got all of the sources from all of our episodes. Contact us form. Contact us form. A first-hand account form.

We've got a lot here. You'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 Physiative. and physician scientists at New York Presbyterian Hospital about their incredible cutting-edge research and groundbreaking medical innovations. 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, things that are actually making a difference in people's lives. Yeah, 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 shaped 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. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake

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I recently got a pair of Quince's Bella stretch wide-leg jeans, and they are now in constant rotation. They are so comfortable. The fit is amazing, and they come in a bunch of different washes, so I'm about to go order some more. Refresh your wardrobe with Quince. Go to quince.com slash this podcast to get free shipping on your order and 365-day returns, now available in Canada, too. That's Q-U-I-N-C-E dot com slash this podcast to get free shipping and 365-day returns. Quince.com slash this podcast. 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 they held up my uterus and found that I had what's called a bichorniate uterus, which is when the membrane that is formed when your uterus is being formed doesn't disintegrate and basically leads to you having two halves of a uterus. And so I was growing a baby in a half of a uterus and then trying to give birth 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 our first child. At 10 weeks, we had started seeing an OB. I'd been spotting off and on, but he kept saying that everything was fine, and while bleeding isn't normal, it is common and don't worry. He said the same thing at every appointment. It's not normal, but it's common. Don't worry, everything's fine. At 18 weeks, he sent me to a specialist. I wasn't expecting it to be a big deal. After all, everything was fine, right? I was wrong. I was blown away by the list of issues and complications being laid in front of me. The only thing I really remember is that I was at a high risk for preterm labor. About a week later at work, I stood up to get something and felt a gush. I reached down and my fingers came up red.

I was hemorrhaging. I had a friend drive me to the ER. My husband met me there and we waited. I was told that if I was 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 bed rest. Around 1 a.m. on November the 11th, I woke up and vomited. I had an intense cramping in my stomach in my back. I told my husband something was wrong. We went back to the ER. The OB said I was in labor, and it can be triggered by dehydration, so I was given an IV, and it stopped. I was moved to a room and told I was staying 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 126 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 stories as often as I can. Pregnancy in infant loss affects one and 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 showing 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 it.

You wouldn't have expected it, yeah. And I know this because I've often skimmed these kinds of lists looking for inspiration for future episodes topics. A lot of those are on our list, actually. It's very true. Yeah, kidney dialysis. We need to do that one. I know.

I know. And so many anesthesia too. 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, Aaron. I mean, are you convinced? Yes. So I can stop. Yeah. Done. Okay, done. They're on the list. No. But the reason I feel so strongly about this is because of the type of knowledge that they grant us. Not guiding principles, not laws of nature, home pregnancy tests give us deeply personal knowledge about our own bodies, empowering us to do with that knowledge what we decide we want or need to do. Share it, keep it to yourself. For the first time, that choice was up to the test taker. They were the first to know. Not the lab technician running the test. test, not the frog being tested. More on that. Can't wait for it. Not the doctor who dained to prescribe

a test. Oh. Yeah, prescription only. Okay. Yeah. The transfer of this knowledge out of the hands of the medical provider and into the hands of the test taker held profound implications for women's reproductive rights. Of course, probably no one needs to be reminded that what you decide to do in terms of continuing with the pregnancy or not is not always up to the pregnant person alone. Yep, especially not in the United States right now. Nope. But the story that I want to tell today is about the quest for this knowledge. Like what ultimately led us to the near universally recognizable stick that shows one or two blue lines and where we might go from here.

I'm so excited, Darren. 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 people. periods, tender breasts, and quickening the fetus's first movements, which was considered really one of the most significant signs in terms of like that is when a pregnancy became real was quickening.

And I won't speculate on why there was a need or a want to know whether it came from within someone wanting help understanding what their body was trying to tell them or whether it came from without, like someone wanting to know whether their partner, their friend, their daughter was telling the truth. And I'm sure there were many reasons for a test, right, that you would want 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 of my usual go-to? So, like, ancient Egypt, Apocrates, germ theory, like things I feel like I have to mention. The humors. I think the humors is the only one I don't mention in any of these episodes. 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 know. 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 like not, it's like not great, but it's not entirely incorrect. Like, is it more than 50%? Yeah. What? 70%.

Really? I know. There's no association with like the sex of the fetus. Just like whether or not you are pregnant. Yeah. So it's like growth hormones. Oh my God. That's so weird.

In your pee. In your pee. It's interesting that even the first test was pee. P has always been a main feature. Really? I think it's really, 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. Really? Can you imagine being like on your business card? Piss profit. Official assistant piss profit. Apprentice. To the Piss Prophet. Yeah.

Apprentice Piss Piff's Farrat. I can't. Oh my God. That's great. Yeah. Okay. And what did a Piss Prophet do? I mean, basically what it sounds like, right?

Like you be able to hold up the, like, the urine in a glass and be like, oh, this person has this disease, that disease. Okay. It was more than just pregnancy at this point. Yeah, yeah. It was like anything. Okay. Your horoscope even probably. A lot of things you can see in your pee, so.

I get it. Exactly. So there is some basis to this. For sure. So some piss profits. claimed that, I know 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. Casin, yeah.

Like a protein, I think. Which is part of breast milk produced during pregnancy. Ah, yeah, okay. Yeah. Yeah. Urine did briefly fall out of favor in the 18th and 19th centuries for pregnancy testing. And instead, physicians, formed 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 it would just be like kind of just like closing their eyes and like searching. And it's, yeah, it's not great to think about. 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. Okay. But these were by no means telltale signs of pregnancy. And doctors usually advised to just give it time. Give it time, wait for the quickening, then you'll know. Right. And in fact, until the 20th century rolled around, because there was no single 100% reliable way

of determining pregnancy from an outside perspective, which is mind-blowing to think about, Yeah. Doctors usually took their patients' word for it. Huh. Okay. Because they believed them. They believed them. Wow.

Then once the lab-based pregnancy test came about, that word slowly held less and less weight in the eyes of medicine. And these tests, these lab-based tests, also made it easier to prosecute someone for abortion because you had proof of early pregnancy, even if you couldn't distinguish between abortion and pregnancy loss. Oh, wow. That's interesting. Yeah. And horrible. horrible. Okay, so how did these tests come about? Science has never followed a straight line of progress and lab pregnancy tests are no exception. But to keep things streamlined for today, I'm sticking to the

major steps along the journey. And if you want that extra nuance, check out the books, A Woman's Right to Know by Jesse Olzenko 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 and 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, Ashheim and Zondek, who gave their names to this test, developed a protocol where they would take urine from a possibly pregnant person, injected into five immature female mice twice a day for three days. Whoa. Kill the mice and then take a peek at their ovaries.

Sorry. Okay, 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 days? Or like one sample? That's a good question. Okay. Too detailed. My guess is it was just one sample.

Okay. And then there, so this is taking many days before you. It's taking many days. Yeah. Okay. And like five mice. Five mice? Yeah.

Yeah. It's a process. Yeah. And then once they cut the mice open to look at their ovaries, if those ovaries were enlarged and congested, it men. 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 corionic gonadotropin. That wasn't even planned. Really, yeah, synced. Initially, researchers thought it was produced in the pituitary gland. Okay. But physician scientist Georgiana Seeger Jones correctly identified its origin as the uterus

and gave it its name in 1945. Wow, okay. 1945 is when HCG was named. HG, yeah. And found to be from the uterus. And eventually, rabbits replaced mice because you could get a result faster and you didn't have to use as many animals.

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 in pregnancy. But that is a euphemeral.

that was commonly used to be like... Did that mean that you were pregnant or weren't pregnant? That you were pregnant? Oh. But it doesn't really make sense because... They killed all the rabbit. Yeah. Okay.

Yeah. Weird. I know. Okay. But I do find it's interesting that there was a euphemism because pregnancy wasn't really something that was discussed out loud very much in like until the middle of the 20th century at the earliest. Really?

Yeah, it was kind of just a, not like taboo, but it was in hush terms, euphemisms. Yeah, exactly. But these tests, the Ashheim Zondek 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. 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, well.

was. Okay. And fortunately, a cheaper animal was available. The African-Claude frog. Oh, they're so cute. They're very cute, aren't they? Also known as the African-Claude Toad. Is it a frog or a toad? I don't know. I'm pretty sure it's a frog. Okay. Yeah. It's a 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 HCG. So then with these, did you just have to like squirt it on? on top because they just diffuse through their skin? Essentially, yeah. Okay.

Yeah. So in 1933, researchers Shapiro and Swarrenstein discovered that, yeah, if you just sort of sprinkle urine, well, I don't know if it was actually sprinkling, like if you exposed. Okay. 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...

Like have to give it like a washout period or something? Okay. Yeah. Okay. And so soon labs around the world began importing these frogs for pregnancy testing. Wow. And guess what may have hitched a ride? Kittred?

Kittred. Stop it. Yeah. How did we not talk about this in our Kittred episode? We may have, Aaron. That was like seven years ago. Oh, wait. Yeah.

Yeah. So, and for those of you who haven't heard of Kittred or haven't listened to our Kittred episode, Kittred is a type of fungus that is absolutely deadly, like devastating to some species of amphibians. It has wiped out populations of frogs. Like extinction in the wild type of the 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 Kittred. I kind of hope that we actually did cover this and I have completely forgotten it. I know.

It's embarrassing. I feel like we did. We might. I don't know, though. It sounded vaguely familiar, 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. A memory? Yeah, I don't know. A manufactured memory or whatever? Exactly.

Okay. 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 Kittred infection is from one of these frogs in 1938.

Wow. 1938, yeah. Okay. Not wild. Yeah, that is wild. But so anyway, the frogs were in 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?

Exactly. Or keep the animals because it's so expensive. But the first of these dreamed of tests was developed in the late 1950s, and it was an immuno-assay 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 a test, at least in the U.S. Even after they moved away from these animal assays,

like just to the amino assay ones. Yeah, everything. It was prescription, yeah. Okay. And then you had to wait weeks to hear the results from the doctor. And you're like, oh, I already have missed like three periods by now, so I know. Yeah, I think I know. Yeah.

These things cost time and money, right? And second of all, stigma. Some doctors refuse 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 how I was going to get livid this early in the series. Oh, I'm so sorry. It's just get ready. Strap in. Strapped. There was stigma attached to wanting to find out if you were pregnant before you started showing these quote-unquote natural signs. Interesting. Because it suggested you had anxiety about the pregnancy or about the father. If you were married, forget about it. Your reputation would never recover.

What? Often, yeah. Just for, like, wanting to know this information, then people assumed that you were up to something. Often, yeah. Wow. The 1966 Better Homes and Gardens Baby Book said that pregnancy tests, quote, there is no need for one. Yeah. Wow.

And it's hard not to see this is just another way to control women and the choices that made. 100%. Right? This is knowledge that does not belong to them. 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 know. Pleasantly surprised.

It was a woman by them name of Margaret or Meg Crane. Okay. So one day in 1967, the 26-year-old crane was walking through the offices of Organon, which sounds made up, a pharmaceutical company. where she worked as a freelance graphic designer. 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 they were pregnancy tests. Crain 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 Crain 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 love it. This is not that hard. We should be able to do this. What, like it's hard? Yeah. That is 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 cranes. But cranes was the only one to include a urine collection cup.

Oh my God. Are you serious? Yeah. We've got the rhinestones, but not the collection cup. Right. Right. Exactly. So someone's like what? And one of the other designers was like, yeah, I just, I just figured. And then they're like, what do you do with that afterwards? I love this story, Aaron. I know, I know. And so cranes, because of this and because of, 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, and that had a mirror. 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? No pregnant. No donut, no pregnant. Okay, wow, that is really complicated. It's really complicated. But it's also something that is, like,

you could do it at home. Yeah. Right. It was very similar to. Not that much harder than like COVID tests, Or you're like, okay, I swab this and I move this and I drop her this and I, right? Yeah, I'm something of a epidemiologist myself. Yeah. Yeah. 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 a 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 Oregonon's home pregnancy test, was on. 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 stocking them because he, quote, didn't think women could be trusted to accurately obtain results. Okay, Bob.

Thanks, Bob. We can't read direction. Or pee in a cup? Come on. Yeah. Jeez. Others described it as a passing fad. Oh, of course it is. 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 E.P.T. 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. Okay. Like Roe v. Wade was 1973, for instance. But the private little revolution wasn't immediate. These tests cost $10 U.S. dollars, which is that $51 in $24. 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. Oh, dark. Yeah, because otherwise the ring would probably dissolve.

Oh, interesting. It's the donut. Okay. 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 E.P.T. 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 in home breakfast, maybe you could buy 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. Yeah. There's a quote I'm going to read you from the book Pregnancy Test by Karen Weingarten. Quote, with a home pregnancy test, women could take control of their decision from 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, like Jerry Springer, Mori, stuff like that. Yeah, yeah, yeah. Okay. America's funniest home video.

Sure. Sorry. I don't know if I'm sure pregnancy tests featured on some of those. 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 like clearly wanted a positive result. They were happy with a positive result.

One couple was relieved about their negative test. 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, 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. Yeah. You don't know. No idea. Is she happy that it's positive or negative? Right. Interesting. I really, I really like it. The mystery. The mystery of it. That ad is especially important, too, for showing that it's about the knowledge, not about the result. And I think that's a big shift in that perception of what these tests have given us. Okay. So within 25 years of their release, home pregnancy tests had become a widely used, recognizable, commonplace diagnostic tool, as well as a useful plot device.

TV shows, movies, novels all began to feature pregnancy tests as a useful way to increase dramatic tension or force character growth. I mean, how many sitcoms have an episode where someone finds a positive pregnancy test in the trash. Who's 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 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. This plot line was criticized by Vice President Dan Quare. as quote-unquote eroding family values. Of course it was. Right. Yeah.

It's, yeah, I think that test, though, or that sitcom Murphy Brown when she took the pregnancy test, that also helped to kind of popularize it and be like, this is a thing that people can do. This is, yeah. Right. I think it just kind of had to increase momentum. Right. Made it even more like normal.

Yeah, exactly. But it's incredible how over the almost five decades since its release, the home pregnancy test has become almost universally recognizable, even for people who have never used one. Right. I loved how, like, yeah, the early COVID tests and people would take pictures and, 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. Yeah, the 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 they are. Fascinating. 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 ableism showing. I know. 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 his story. 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 time frame that was simply not possible for their grandmothers or even their mothers. Isn't that mind-blowing? 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 assumed that my mom did, but I never asked her.

I asked her so many other things about her pregnancies for this episode, but I didn't ask her that. Yeah. It's incredible. 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. 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. Mm-hmm.

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 test those arriving at a detention center who are over 10 years old. Adds 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 test is not really an accurate term that these tests aren't detecting viable pregnancies but just the presence of HCG. And so non-viable pregnancies

that may not have been noticed in the past are now recognized, potentially increasing the trauma of that excessive. 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 all along. Yeah. And so with that, Aaron, I'd love for you to tell me about how HCG works and what's going on in early pregnancy. I don't know if I'm going to answer that first question. Okay, what's going on in early pregnancy? We'll do that. Okay. Great. Right after this break. Anyone who works long hours knows the routine.

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Need to hire? This is a job for Indeed Sponsored Jobs. I didn't have a glowing pregnancy. Seastica 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 it in 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 17, 2018. At 2 a.m., 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 drip to prevent seizures. Hooked up to monitors, I was told that I could not eat anything. For hours, I waited, feeling contractions built. But just when I needed the epidural most, we realised 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 Queens I want to break free, my daughter entered the world. Their traditional National Health Service tea and toast afterwards is still to this day the best 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 preaclampsia 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. 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 4 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 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. I'm like, it might sound very obvious, right? Like, I think we all know what we think pregnancy is, right? It is the period of time when there is a fetus growing in your uterus. 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 start of a second. cycle, your menstrual cycle. Yeah. 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 access to abortion and things like that, it's really important. Right. So we'll go through all of what is happening there. But I just want to set the stage. 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. Give it to me. So there then is a potential, like, error bars around. Absolutely. And so then, like, let's say that you know that conception happened on this date. But then your doctor's like, oh, well, when was the last day of your last period?

You want to talk about me? Because that was my life. 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 I feel like that has such huge implications for... Huge. 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. Yeah. So 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 sorry. I started this down this rabbit hole. I love it. Okay.

But so let me find where I'm at. Yeah. Okay. But yes. So 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 does that mean? Just stop me.

Okay. 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 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 blastocysts, like a tennis ball. Yes. I brought one here. Okay, perfect. It's a tennis ball. Okay. Your dog is going to be really sad.

She was when I was like making what I made with this. She was like, we're playing, right? He 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, a 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 blastocysts is 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 blastocysts, like the fuzzy green layer of the tennis ball, it's called the syncytricyrofoblast. And that is the layer that will continue.

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 next episode. Yeah. 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. by the way, become the placenta, by completely remodeling. So the structure of our uterine lining completely changes. We have huge changes in the inflammatory signals that are being sent within our body. I'm excited for you to talk more about it. And then also big changes in the hormones that are dancing around in our bloodstream. Okay. So just to recap it briefly. So the implantation, multiplication, some of those multiplied cells become the placenta eventually and some become the embryo later fetus.

Exactly. Yeah. The inside part is what's going to become eventually the baby. The outside part is what invades and then becomes the placenta. Yep. And there's like layers, obviously. It's so interesting, the differentiation. What are the signals that say you be placenta, you be embryo?

I love it. It's so, so, so fascinating, Erin. And you could go in so much more detail on like every single step within this. I mean, there are entire textbooks on like this exact thing. That's 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 since this showed trophoblast, the cells that are burrowing their way into our endometrium, will start to secrete HCG. Uh-huh. 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. Yep. Don't worry. I'll get there. Because up until this point, all of the tissues of our endometrium, the lining of our endometrium, and everything that has changed thus far, far. It has been supported primarily by the hormone progesterone. And that hormone, up until this point of implantation and HCG secretion, 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 system, then this corpus luteum will disintegrate, your progesterone levels will drop and you will have a menstrual period. Right. 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 placenta stuff, which I don't even know if I talk about the decidua, but that is what it is

called what the lining of your uterus becomes, is called the decidua. 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. That 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. It is. So that's one aspect of it, except it also, great. 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. And I mean, it's really a relic of when we didn't have ultrasound and things like that. A relic that laws are now based on. Oh, yeah. 100% error. 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.

Okay. Or just things that don't go this way. 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 for 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 percent of the time, if an ectopic pregnancy happens, it happens in the fallopian tube.

Okay. So this plasticist 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 actopic 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 Philippine tubes are not, like, connected.

They're like floating. And your Philippine 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. actopic because it's a typical just outside of the uterus. Exactly. Yeah. Ectopic just outside of the uterus. Overall, most estimates are that about one to two

percent of pregnancies are ectopic, depending on the source. One to two percent. Okay. Okay. Question. I expected questions. I have answers. Okay, wonderful. So, um, 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. Uh, how do you do you do? 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 pregnancy tissue.

Or it requires surgery. And surgery usually requires the loss of that fallopian tube. Okay. If that's where it is. Okay. And how often is it surgery versus medication? It's a good question. 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 really am just curious 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. Yeah, so that's ectopic pregnancies. Okay. Do you have more question?

Not right now, but I'm sure I will in just a few minutes. There's other atypical ways that ablasticus 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. Uh-huh. So the placenta completely covers the oz 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 doesn't. Right.

It's not safe. It's not. Yeah. 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 U.S., we define a miscarriage as a pregnancy loss prior to 20 weeks, gestation. In the U.K., 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 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 wasn't? Yep. 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, 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, a 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 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 pre-embryos are lost prior to implantation. but it's estimated to be somewhere between 20 and 40%, 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 happened 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. Aha. Right?

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 happened to them. Yeah. Right?

Yeah. Most estimates of the overall risk of miscarriage, so the loss of that recognized pregnancy, prior 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 at all. Yeah, we don't. 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. Well, 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 and 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 talked about a lot and it doesn't take away the pain and the trauma that can result. Right. Yeah. Most pregnancy losses, most miscarriages happen in the first trimester. So sometime in the first 10 to 12 weeks. Okay. But one to two percent of pregnancy losses will happen in.

the second or third trimester. And like we said, if it's after that 20 to 24 weeks, then we 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 percent of the time miscarriages are due to chromosomal abnormalities in the fetus. All right. Okay. And that is one of the big reasons that age, female age specifically,

is a big contributor where younger people are much less likely to have a miscarriage compared to as we get older. The rates are 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 a nil factor. Right. It's a contributor, but we don't talk about it. Well, it's always it's like age of the mother, age of the woman. Advanced maternal age. Geriatric womb. We don't call 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, to talk about. Yeah. The other thing important to know about miscarriage is how we manage it. Mm-hmm.

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, mesoprostal and mifipristone, a.k.A. 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 health care. Abortion is health care. 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's a lot. Yeah. I thought. Do you have any questions about that? I have feelings about that. I do too. I try to think if I have any specific questions. Yeah. Okay, one question I have is like you said that it's the risks associated with each of these are more or 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 two, like how far along you might be or if you have sort of started to pass that or not. And then a lot of it really is personal preference because it's like, are you going to feel more comfortable? doing this at home where you have maybe support around you or maybe you don't have any support at home. Maybe the thought of having to wait a long time because 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. Okay. And bring it all the way back to the developing embryo. Got it. Oh. Just this. Here we go. Okay. It's like, 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, the, Most Cliff Notes version, ready? Okay. So we are back now at about two weeks post-fertilization, week four of pregnancy. Okay. And this little pre-embrio 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 disks 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 there's 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. It looks, to me, very much like the alien in alien. I mean, like embryonic development, 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. I mean, I like it. Yeah. I wish I knew who it was by. Well, listen. It wasn't Zabjansky. 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, our origins, 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, 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, capital A, got it. Yeah. Proper not 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. 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, yeah, it was loud, 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. Okay. 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. Uh-huh. 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 syncytrophoblast 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 of our pregnancy.

Which is wild. I know. And that is the organ that you, Aaron, 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? That's 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. I have so much feelings about it, and I want to talk all about it, but we were talking about pregnancy for this series. We're talking about pregnancy. So there we are.

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 a lot.

We have so much more to cover. Oh, I have thoughts. Okay. Me too. But everyone is going to have more that they want to learn. So we're going to tell you where to learn it and all of our sources. Yes. Okay.

So for this, I actually. 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 Olzingo 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 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 wonder. 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 youths say? It's like, wait. It was the 21st century. It was from 2013. Okay. That's like 10 years old. But I mean like... Yeah, that's for a textbook. Our knowledge of this part hasn't changed. But I will also say that like it's good for data, but it has a lot of weird, I don't know, editorialization in parts of it.

So I don't know. 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 you next week. But there was one from Proceedings of the Roas Society B from 2023 called the Human Placenta,

New Perspectives on its formation and function during early pregnancy. Ooh. And then there was a whole series in The Lancet from 2021, all about miscarriage. And my favorite one from that, 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 are so many more on our website, this podcast will kill you.com under the episodes tab. You certainly can. This and 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-time 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 could not do, especially this series without you. So thank you. Thank you. Thank you also to exactly right studios. And everyone is here, like looking at the window. It's so exciting. It's very exciting. Thank you to Tom and Leanna, who's not here today, but will be. And I'm saying too much. Thank you to Jessica and to Brent and to Craig and everyone else.

Yeah. All that we're so excited about this. It's really been so much fun. I feel so cool. I still feel too nerdy. But I'm having a lot of fun. Me too. Yes.

So thank you all for all of your work. We're excited. Yes, thank you. Thank you to Bloodmobile, who provides the music for this episode and all of our episodes. And thank you to you, listeners. Yeah. And viewers too.

And viewers. Yeah. Amazing. We hope you had fun with this one. And you're prepared. fired 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, but you know what. And thank you to our patrons. We really do appreciate your support. It means the world to us. It really does.

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