"Pregnancy denial" or "unrecognized pregnancy", which occurs when a woman who has not been diagnosed with any psychiatric illness and continues her normal daily life does not realize that she is pregnant, draws attention as an unrecognized and overlooked medical condition although it is common in society.
In approximately one out of every 2,500 pregnancies, pregnancy denial, which the mother does not realize until birth, can be experienced by women of all ages, educational levels, social classes and professions.
Üsküdar University NP Feneryolu Polyclinic Psychiatry Specialist Assoc. Prof. Dr. Gökben Hızlı Sayar and said that pregnancy denial is a common phenomenon in the world.
PREGNANCY DENIAL IS THE UNDERLYING CAUSE OF DRAMATIC EVENTS
Assoc. Prof. Dr. Gökben Hızlı Sayar evaluated the study they conducted together with Dr. Oğuz Omay from the Department of Perinatal Psychiatry at La Teppe Medical Center in France. Sayar said that although dramatic events such as a mother killing her newborn baby, causing the death of the baby by not taking care of it, or a woman suddenly giving birth in an unfavorable environment such as a toilet attract the attention of the society, the underlying cause of many of these events is pregnancy denial.
Stating that Denial of Pregnancy (Denial of Pregnancy) is one of the negative conditions associated with pregnancy, Assoc. Prof. Dr. Gökben Hızlı Sayar said, "Unnoticed pregnancy is when the woman and her environment are not aware of the pregnancy despite its progress. In addition to partial cases such as realizing the pregnancy after 20 weeks, often when she goes to the doctor for a reason such as abdominal pain, menstruation, there are also cases that realize pregnancy only when she has an unexpected birth. A population screening study in Germany found that in one out of every 450 pregnancies, the expectant mother only becomes aware of the pregnancy after the first 20 weeks. This is called partial denial. In the same study, it was reported that in approximately one in every 2,500 pregnancies, the mother did not realize the pregnancy until the birth began. This is called complete denial. According to these reported rates, denial of pregnancy is three times higher than for triplets and two times higher than for blood incompatibility. Those who do not recognize the pregnancy are not only the women experiencing the condition, but also the families and medical personnel."
NO MENTAL ILLNESS
Stating that in some cases, severe psychiatric illnesses and inadequate mental capacity can prevent women from realizing their pregnancy, Assoc. Prof. Dr. Gökben Hızlı Sayar emphasized that in the case called "pregnancy denial", there is no mental illness that causes this.
IT IS NOT UNDERSTOOD FROM THE OUTSIDE THAT THEY ARE PREGNANT
Stating that research on pregnancy denial draws attention to the fact that there is no special risk group for unrecognized pregnancy, Assoc. Prof. Dr. Gökben Hızlı Sayar said that women of all ages, educational levels, social classes and professions can experience this situation.
Stating that pregnancy denial, which is also seen in women who have experienced pregnancy and given birth before, cannot be explained by not knowing the signs of pregnancy, Assoc. Prof. Dr. Gökben Hızlı Sayar said, "The mentioned picture does not seem to be related to another psychiatric illness. It is not due to a condition that impairs mental functions such as psychosis, mood disorder, mental retardation. Except for their unrecognized advanced pregnancy, these women appear normal and are able to lead their daily lives normally. Equally surprising is the fact that the husbands and close relatives of these women do not recognize this pregnancy. In cases of complete denial of pregnancy examined in forensic medicine, where the pregnancy was realized only during childbirth, there were no obvious changes in the women's bodies suggestive of pregnancy, even in beach photographs taken during the unrecognized pregnancy. The woman may not gain weight and may have bleeding that is perceived as menstrual bleeding. The situation is also different from what we can define as "concealed pregnancy" where the woman knows that she is pregnant but hides it from her environment. In pregnancy denial, when the woman learns that she is pregnant when the birth begins or shortly before the birth, she is as surprised and shocked as her environment, even more than them."
The most important points of unrecognized pregnancies:
1. The woman is not aware that she has a pregnancy over 20 weeks.
2. The woman's circle of family, work and friends, and sometimes the medical personnel to whom she applies, are in the same "unawareness" (shared denial).
3. The physical symptoms of pregnancy are not obvious. The woman's body is also physiologically involved in this state of "not realizing".
4. When the woman is informed that she is pregnant, she is surprised but accepts it and the state of "not noticing" ends.
Undetected pregnancy is a risk for both mother and baby
Assoc. Prof. Dr. Gökben Hızlı Sayar said, "Failure to make the necessary medical follow-up during pregnancy, malnutrition of the woman who does not know that she is pregnant, the possibility of alcohol - drugs, the birth starting unprepared and taking place under inappropriate conditions pose risks for both mother and baby. In addition to all these dangerous medical possibilities, the reactions of the mother or her environment who are surprised by the unexpected birth can also be dangerous."
NOT NOT WANTING THE BABY OR HIDING THE PREGNANCY
Emphasizing that pregnancy denial is a common but poorly known condition, Assoc. Prof. Dr. Gökben Hızlı Sayar said, "The psychological or physiological reasons for this condition are not yet understood. However, not realizing that she is pregnant cannot be explained by the woman's negligence and irresponsibility as society often tries to do. The condition is also not due to any other known psychiatric illness. In most cases, there is no history of psychiatric illness or sexual trauma. The picture is not one of not wanting the baby or hiding the pregnancy, but of not realizing or being unable to realize the pregnancy. In many cases, women have smaller abdominal volumes than normal pregnant women. In some cases, the menstrual cycle may continue throughout the pregnancy. When baby movements are felt, this is often attributed to other causes. In some cases, both the person who applied to the examination with general physical complaints and the doctor missed the pregnancy, as if the woman's close environment and the health professionals she came into contact with were in a similar denial."
MEDICAL AND PSYCHOLOGICAL SUPPORT SHOULD BE PROVIDED
Noting that the pregnancy period is important not only for the baby to grow in the womb, but also for the mother to feel herself in a relationship with her baby and to prepare mentally-emotionally to become a mother, Assoc. Prof. Dr. Gökben Hızlı Sayar said, "When pregnancy denial is detected, medical support should be given to mothers with the joint work of obstetricians and psychiatrists. Supportive psychotherapy, increasing the woman's parenting skills and providing social support are the main approaches. Not all mothers who experience pregnancy denial harm the baby. Many cases have been reported to adapt to motherhood with support and raise their child in a healthy way. However, there is a possibility of experiencing similar denial in subsequent pregnancies. If denial persists until the birth, one of the most important help that can be provided is to provide detailed psychoeducation about the pregnancy denial picture with an empathic and positive approach. In this way, she will be able to evaluate and make sense of the event in a healthier way."
Stating that it is very difficult to detect women who think that they are not pregnant and do not seek any medical help, Assoc. Prof. Dr. Gökben Hızlı Sayar said, "The most important factor that protects from unrecognized pregnancy will be the information of the society and health personnel on the subject. In complaints such as nausea, abdominal pain, weight gain, abdominal bloating, lack of menstruation, the possibility of pregnancy should be kept in mind even if the woman reports the opposite. Probably the most important preventive measure would be for every woman of reproductive age, their spouses, family and friends to keep in mind the fertility potential of women."