A woman goes to the hospital complaining of stomach pains and ends up delivering a healthy—albeit totally unexpected—bouncing bundle of joy. She didn’t even know she was pregnant. Many of us have heard this story before and the phenomenon is called denial of pregnancy. After reading magazine articles about it and watching shows like Discovery Health’s I Didn’t Know I Was Pregnant, it seems like any woman could potentially fall prey to this devastating perversion of fate. According to an article in Psychology Today published in February 2009, it’s “a mysterious and rare disorder.” Mysterious and rare? Definitely. A disorder? Not exactly, at least not a physical one.
Ignoring the Truth
It’s normal to wonder exactly how any woman can be oblivious to pregnancy. With all the hormonal and physical changes that happen, you’d think that these women would have at least some indication that there was a bun in the oven. Most women discover their pregnancies within a few months, so is there something strange or terrible that causes some to remain unaware? In a nutshell, everyone can breathe a collective sigh of relief, because there’s no disease that causes a symptomless pregnancy, and it’s extremely rare for a normal, well-adjusted woman to be unknowingly pregnant for months on end.
That’s where the denial part comes in. Denial of pregnancy isn’t a medical issue; it’s a psychological problem. Denial is a primitive defense mechanism wherein the mind literally rejects an idea that is uncomfortable or scary, and pregnancy can certainly be both of those things. It’s normal for any woman to be surprised when she finds herself pregnant. If she wasn’t trying for a baby, it might be the last thing on her mind. However, the majority of women will quickly draw the right conclusions when faced with the symptoms—breast swelling, morning sickness, and missed periods. For women who experience denial of pregnancy, the symptoms are there, but they just don’t recognize them for what they are.
Denial, In All Its Forms
Denial of pregnancy can manifest in a few different ways, depending on the specific circumstances. Affective denial is the term for a mother who does not bond with her fetus or make any pregnancy-related lifestyle changes, occurring most often in women with substance-abuse issues or those who plan to give the baby up for adoption. There’s also psychotic denial, suffered by women with underlying psychiatric conditions. Some doctors also consider it denial when women conceal or hide their pregnancy. About one out of every 500 or so births fits into one of the categories of pregnancy denial, but the cases that get the most headlines are the unusual cases of pervasive denial, where the woman has no idea she’s expecting until late in the pregnancy. When a woman in pervasive denial finally does go to the hospital, it’s usually for treatment of what she perceives as a digestive ailment like stomach cramps or food poisoning. Some go to the ER for vaginal bleeding, or other complications such as eclampsia, without knowing that they’re actually in labor.
Women who are at risk for denial of pregnancy tend to be young, have limited education or intellectual ability, and have experienced irregular periods. Many have been diagnosed with psychiatric problems such as anxiety or depression. Some women also have religious conflicts at home, fear they’ll be abandoned by the baby’s father, have a contentious relationship with their own parents, or anticipate losing custody of the baby.
Flu or Fetus?
The most severe cases of denial seem to coincide with cases where pregnancy symptoms are relatively mild. Women who experience denial of pregnancy commonly report that they attribute their minor bouts of nausea to flu symptoms or food poisoning. They rationalize their modest weight gain as poor diet or lack of exercise. Many insist that they couldn’t be pregnant, since they continued to get their periods, but they don’t know that spotting throughout pregnancy is very common. Many women who experience denial of pregnancy have also experienced previous menstrual irregularities. Because they’ve never had regular periods, they don’t notice anything wrong when it fails to show up. If denial continues far enough into a pregnancy, they tell themselves they have gas, when they’re actually feeling the baby kick. A few even take home-pregnancy tests. They trust the negative results, even though home tests are not as reliable as those in a doctor’s office.
Sometimes, women have convincing reasons for not considering pregnancy as the source of their expanding waistline. Many women who are diagnosed with fertility problems are caught off-guard when they discover that they’re unexpectedly pregnant. Women taking contraceptives are often surprised by an unexpected pregnancy, too. Most surprised are women who have had surgical sterilizations, yet find themselves pregnant anyway. Whatever the reason, it’s highly unusual for a pregnancy to remain unknown right up until the delivery. Most denials of pregnancy last only a few months, until the signs become so unmistakable that women see their doctors. It’s very rare for a pregnancy to remain undetected until the woman goes into labor.
For every woman who experiences denial of pregnancy, there were many signs she ignored. The odds are overwhelming that any woman who gets pregnant will know it pretty quickly, but any woman who finds herself with unexplained nausea, breast swelling, weight gain, or missed periods—no matter how moderate—should check in with a doctor immediately. Blood pregnancy tests are the only way to definitively confirm or rule out pregnancy. As every woman who’s walked into the hospital with a stomachache and out with a baby will tell you, it’s better to know sooner rather than later.