Denied pregnancy refers to the absence of awareness by a woman that she is pregnant until she delivers her baby. This may occur in 1 of 475 pregnant women.
Women with symptoms of denied or cryptic pregnancy may not have the usual symptoms of pregnancy such as nausea, vomiting, cessation of periods, and enlargement of the abdomen. The babies born to such mothers have a tendency to be small for gestational age. The pregnancy is undetected not only by the mother but by friends and relatives. Even medical personnel may be unaware of the woman’s pregnancy.
The most common explanation for a woman’s failure to realize that she is pregnant until she actually delivers a child is that she is psychologically not ready or willing to accept the pregnancy and its implications. Pregnancy involves many biological changes in the woman, as well as requiring preparation for birth and child care, which is based upon accepting the presence of the fetus and the changes that it brings about in the woman’s body and functioning.
Somatic denial is a popular concept evoked to explain the lack of symptoms, which means that the woman strongly though involuntarily denies the presence of any abnormality in her body or physiological functions. However, this does not explain how the woman continues to have regular monthly periods throughout the pregnancy.
However, there are other more basic explanations.
For example, when there is a conflict between a woman’s perceived best interests for herself and the existence of a pregnancy, deep psychological reactions may lead to cryptic pregnancy. On the one hand, denial of the pregnancy can bring down the level of expenditure by the mother. She will not have to invest energy or adjustment resources on the pregnancy.
These may be in the form of having to limit mobility, depending on others for support, or limiting one’s work habits or substance use. This denial brings about an adaptation which favors the mother’s health and habits over the growth of the fetus.
This correlates with the very low or indiscernible levels of hCG (Human Chorionic Gonadotropin) found in the woman’s blood. Even when the hormone levels are increased, it may not have the normal effects on the body of the woman, leading to a prolonged and slow-growing gestation.
Suggested hypotheses include the following:
- Failure to adapt to this conflict, which results in the woman using resources for her rather than for the baby’s wellbeing.
- Spontaneous abortion of an abnormal fetus that was ‘missed,’ or not clinically evident.
- The environment is one of great stress or danger to the mother and child, as when resources are scant, or support is lacking. In this case, the fetus ‘cooperates’ to the biological signals by growing very slowly and producing minimal symptoms and signs of the pregnancy, thus reducing the energy and health resources the mother is required to invest in the pregnancy. This helps both of them to maximize their chances of the survival by bringing the mother to the point of delivery.
The mother does not usually have any prenatal care. The delivery is usually at home or unassisted.
Any prenatal complications such as blood group incompatibility, hypertension, or diabetes, may go undetected and put the mother and baby at risk.
The mother may practice dangerous behaviors such as alcohol or substance abuse because of the lack of awareness of the fetus.
In most cases of cryptic pregnancy, the baby is born alive and healthy, with the woman realizing that she is pregnant only when she gives birth. Adjustment problems are thus a possibility, though rare.
If a woman in the reproductive age group persistently feels even minor symptoms relating to the abdomen or pelvis, it is advisable to meet a health care professional, who should test for pregnancy among other options, even if the possibility is strongly denied.
Reviewed by Yolanda Smith, BPharm