Wednesday, 18 May 2016

How women can get to the ninth month without knowing they’re pregnant

In societies around the world, it is a “notorious fact”, one so commonly accepted and obvious it requires no evidence to support it in a court of law, that every woman knows when she is pregnant. 

Many women experience the usual signs like missing their monthly menstral period, morning sickness, testing positive to pregnancy kits and so on. 

Yet cases of “cryptic pregnancy” – also known as “pregnancy denial”(which sounds judgmental by the way)  – are not particularly rare. In fact, they are estimated to occur in around one in 2,500 cases, suggesting around 320 cases in the UK, (for example) annually, or a potential headline story almost every day.

How does it happen?

Various physiological or psychological theories have been suggested to explain cryptic pregnancy. While it may occur more commonly in women who have a co-existing mental health condition, many cases occur in women who have no evidence of underlying mental health problems and its cause remains unknown.

Headline cases generally depict happy outcomes, but while pregnancy is a normal physiological life event, a woman who doesn’t recognise that she is pregnant (and her baby) are at considerable risk both physiologically and psychologically.

For all women, pregnancy is a time of change and preparation for motherhood. While the reality of motherhood may still surprise any woman, those who are unaware of their pregnancy are likely to be profoundly shocked by their unexpected motherhood. This can be extremely difficult to overcome.

In addition, these women will not access antenatal care, complications will not be detected and women may continue to smoke or drink alcohol unaware of the potential for harm. A characteristic of cases of women completely unaware of their pregnancy appears to be that they seek medical help for severe abdominal pains. Many, however, give birth alone or without skilled assistance and this places both mother and baby at considerable and life-threatening risk.

Darker consequences

There is a darker side to the way in which cryptic birth is interpreted and understood, too. Studies of historical case reports have described the legal consequences for women who gave birth alone and where the baby was stillborn or died shortly after birth. Women’s claims of cryptic pregnancy were often treated as lies – although the condition was recognised in the medical literature of the time – and women could be charged with infanticide.

Mona Rautelin in her account of such cases in pre-modern Finland also cites modern cases from Europe and China where the “notorious fact” that women will have knowledge of their pregnancy has resulted in charges of infanticide. In a recent headline case from America, a woman who claimed that she had a stillbirth after a concealed pregnancy was jailed for infanticide.

The physiology and psychology of concealed and cryptic pregnancy are different and both are complex. However, they may be difficult to distinguish in these rare and tragic cases. There are many uncertainties surrounding childbirth and even today many, superficially straightforward, aspects of pregnancy and birth remain poorly understood. While we may continue to read these news reports with some disbelief, we must ensure that we respect and protect the women behind these tales of the unexpected.

This story originally appeared on The Conversation and was written by Helen Cheyne: 
Royal College of Midwives Professor of Midwifery Research, University of Stirling.