I was catching up with a friend recently and learned that she had, in the years since we’d last spoken, nearly died from an ectopic pregnancy. Hearing that felt sad and spooky.

Ectopic pregnancies, for those of you who don’t know, occur when the fertilized egg implants outside of the main chamber of the uterus. Generally this means the fertilized egg is stuck in the fallopian tube, but they can be in more exciting places. This fertilized egg cannot be brought to term—the fetus can’t develop and survive anywhere but the uterus, because the rest of the abdomen (including the fallopian tube) lacks the blood flow and nutrients and the ability to stretch and encompass a growing fetus. If the fetus grows enough while not in the uterus, it will kill the parent.

My friend didn’t recognize her condition before she was already in trouble. She spent a good while close to death in the hospital as a result. All I could think as she shared this was, “the bad old days are closer than they appear.”

First, here’s a link to the Cleveland Clinic’s page on ectopic pregnancy. Symptoms to look out for include having all the normal pregnancy symptoms (which is a fine phrase but encompasses a dizzying array of options only partially covered here because pregnancy is wild y’all) PLUS: vaginal bleeding; pain in your lower abdomen, pelvis, or lower back; and dizziness or weakness. Bonus points if you recognized that some of those ectopic pregnancy symptoms are the same as other normal pregnancy symptoms.

Honestly, having supported my spouse through pregnancy all I can say is: find good specialized healthcare providers (I suggest experienced midwives) that you feel able to share everything with. Then, ask them lots of questions all the time. As I’ve learned from talking with those midwives and my pregnant friends, the experience of pregnancy varies so much from person to person and from pregnancy to pregnancy. Humans are shockingly good at pregnancy on the whole (we’ve been doing pregnancy for as long as we’ve been around), but there are some really exciting failure modes that our modern American culture may teach you to be embarrassed to talk about.

Get over the embarrassment. Ask questions. Overshare. Take care of yourself and your partner. Read a few good books about this stuff too, like Expecting Better by Emily Oster for practical guidance, and Eve by Cat Bohannon for deeper context.

Also, it wouldn’t hurt for us as a society (including people who will never be pregnant) to be more open to talking about the wild, weird, good, and bad experiences of pregnancy. Everyone you know exists because someone got pregnant. There’s no need to be so awkward about it.

So what was that I was saying about the bad old days?

It’s easy to believe, as someone who grew up privileged in the US in the 1990s and 2000s, that progress is inevitable and inexorable. It was easy to assume that, like Dr MLK Jr’s “long arc of history,” humanity advanced in one direction. There’s some cultural myopia there, assuming that my little corner of the world was the default, and I was blind in the same way children so often are; I didn’t know how many of the things I took for granted were novel inventions from the past few decades, still growing and changing or not yet firmly established.

The truth is more difficult. The progress we make is always interdependent, built on simultaneous technological, social, and cultural changes. When we don’t maintain one piece of that progress, we lose more of the whole.

That loss-upon-lack-of-care is part of what I find horrifying about deferred maintenance. When you decide not to put the effort in, you’re consigning yourself and everyone who comes after you to spending far more effort later just to regain what you have now. This is easy enough to understand and explain when talking about mass transit rail systems: if you stop maintaining the rails and trains and everything around them, eventually everything breaks down and your trains catch on fire.

This is harder to understand when you’re talking about science, or health care. Yes, we continue to make incredible advances in scans and tests and all kinds of other ways to collect hard and measurable data. But medicine remains fundamentally a discipline that requires people to notice something that feels “off” and then to report that, in whatever idiosyncratic way they can, to a medical professional. The professional must then interpret that qualitative description and conjure forth a diagnosis (or at least another few questions to ask the patient).

If patients don’t share information with their provider, the provider can’t help. People might not share information because they’ve been taught to ignore the sensations they’re experiencing—the classic “walk it off, you’ll be fine.” People might not share because they’ve been taught that this subject matter is taboo or embarrassing: a venereal disease, or new sexual partners or habits, or a funny lump in an awkward spot. And people might not share because they don’t know that what they’re experiencing is notable in the first place!

That last one is especially likely with an experience as constantly surprising as pregnancy. It doesn’t help when our society treats pregnancy as a great mystery that you’ll learn about “when you need to,” instead of a regular and important part of life that some people will experience first hand and which everyone should know about.

But each of those cases of not sharing information is an example of our social and cultural changes failing to keep up with our technological changes. We can have the most advanced cancer treatments in the world, but if you don’t get that weird lump on your breast or the hard spot on your testicle looked at because that’s too taboo or you weren’t taught the early signs of cancers, our advanced cancer treatments won’t be able to help you before you’re in deep trouble. If our culture makes it more and more taboo to talk about pregnancy and childbearing—maybe because we’re prosecuting miscarriages, despite miscarriage being a shockingly normal and very sad experience that is outside of a pregnant person’s control—then we should expect worse outcomes in pregnancy and childbirth as people stop sharing everything with their doctor or nurse. If we don’t teach people what to look out for, whether that’s the signs of ectopic pregnancy or how different heart attacks symptoms are in men and women, people might not even know to share the weird symptoms they’re having.

There’s a marvelous quote from William Gibson, “The future is already here—it’s just not very evenly distributed.” I think that’s an excellent summation of how we make and spread (or don’t) our advances. But it’s worth remembering that the bad old days are still here too, and they can return with a little bit of neglect or malice aforethought. What’s more, we obsess over apocalyptic stories but forget that the apocalypse is right here and right now for people all around the world; what else would you call being trapped in war, or famine, or civil strife as the world around you falls apart one lost advance at a time?

It turns out progress is not inevitable. Progress is hard work. It needs constant work, just to keep what we already have. Progress is a labor of love; it is maintaining what was already built, and reassessing and redesigning and rebuilding to better meet our future needs. It’s easy to lose past progress as we forget old lessons—and it’s easy to disagree about what is progress, or what the lessons were, when ideologies clash. That only makes the work of pushing further forward without regressing more difficult and complicated.

That was big and general. I’ll bring it back to the small and specific.

This pattern of progress and loss, and of an unevenly distributed future, is present in the proportional makeup of our medical experts. We develop advanced treatments and interventions for dealing with severe disease, and we train doctors to provide them. But we simultaneously neglect the general practitioners who become primary care physicians and do the necessary education and maintenance work of keeping people healthier in the first place. This just feels like another form of deferred maintenance, one that will inevitably come with its own metaphorical burning trains.

More specific still: we set our children up for failure by not teaching them how their bodies work. We hold them back from the progress we have already made when we don’t teach them what we’ve discovered about their anatomy and health, or when we teach them that talking about their anatomy and health is gross and embarrassing. You can’t teach someone that they should never talk about their sexual health with others and then expect them to communicate effectively about their sexual health with their doctor. When we don’t teach people what warning signs to look for in their own bodies, when we propagate shaming and constrictive beliefs about what information is acceptable to share with others, we lock people out of our society’s progress.

I was talking about sex education there, but it applies far more broadly. I got treatment for Lyme disease because I and my spouse knew what signs to look for. If we hadn’t been alert to the possibility of an infectious tick bite, if I hadn’t known that the classic bullseye rash is more rare than the usual education about Lyme suggests, I might not have put together the clues for my medical provider. I might still be wrestling with a mystery illness, and suffering worse consequences because I didn’t notice it as quickly.

Progress is hard work. Education, and empowering people with useful information and a willingness to share what they learn, is a big part of that work. That’s the best way we have to keep the bad old days at bay.