Being pregnant without knowing it: all about denial of pregnancy

Still taboo, the denial of pregnancy concerns between 600 and 1,800 pregnancies per year in France. How can you be pregnant without knowing it? What are the psychic mechanisms involved? Answers from Karine Denza, psychoanalyst and author of the book Le double denial of pregnancy.

What is pregnancy denial?

Denial of pregnancy refers to being pregnant without being aware of it. In the introduction to her book, Le double denial of pregnancy, the psychoanalyst Karine Denza recalls a significant episode of her youth: the denial of pregnancy by one of her comrades. “Her name was Corinne. We were in first class and we were 17 each. She looked like a tomboy, her hair still tied up, in jeans, sneakers and a T-shirt. One day, I no longer saw her in class. I inquired with my teacher who told me: Corinne was pregnant without knowing it and she has just given birth, we will not see her again. And indeed, I never saw her again.

The denial of pregnancy is still a taboo subject. It's hard to believe that a woman can be pregnant without realizing it.

Partial denial of pregnancy or total denial of pregnancy?

We speak of denial of pregnancy when the woman learns that she is pregnant from the fourteenth week of amenorrhea. There are two different types of denial: partial denial and total denial.

“The denial is said to be partial when it is lifted before the end of the pregnancy and total when the woman learns at the time of her delivery that she is pregnant”, explains Karine Denza. According to studies conducted in France on the subject, denial of pregnancy (total or partial) concerns 1 case out of 450 or 500 births.

An invisible pregnancy

During denial, the signs of pregnancy – nausea, weight gain, amenorrhea, swollen belly – are absent or misinterpreted. "Unlike the" nervous pregnancy ", where the woman appears pregnant but is not, here, she does not appear pregnant when she is," explains the psychiatrist Benoît Bayle in his book The denial of pregnancy, a disorder of psychic gestation. It's a "free rider" pregnancy. False "rules" are sometimes present, all the more easily if the woman takes oral contraception or has bleeding at the start of pregnancy. She is not gaining weight, or even losing it. She doesn't feel any nausea, doesn't notice them, or barely. She does not perceive the swelling of her breasts. She does not feel her child move. So this is confusing."

No late period

Indeed, in the denial of pregnancy, the delay in menstruation which frequently leads a woman to consult her gynecologist may be non-existent. According to a study by Dr. Christoph Brezinka (source 1), who studied these characteristics in women who had presented partial or total denial of pregnancy: only 26% reported amenorrhea, 15% had regular bleeding evoking their usual periods, 7 % reported continuous blood loss and 44% had irregular bleeding.

No signs of pregnancy

The other sympathetic signs of pregnancy - nausea, breast tenderness, drowsiness, fatigue and frequent urination - are not present and there is little or no weight gain. Thus, according to the study by Dr. Christoph Brezinka, only 22% of women admit to having had nausea. Even fetal movements, usually felt around the 20th week of pregnancy, go unnoticed or are interpreted as digestive disorders.

“In the case of a denial of pregnancy, the body does not metamorphose, confirms Karine Denza. The baby is placed behind the ribs, the belly does not grow, the periods are often present, nothing suggests that the woman is pregnant or at least the signs that the body manifests are not interpreted as such by the woman, because for her, it is unthinkable that she is pregnant, it is not representable”.

What causes pregnancy denial?

Denial is a very powerful psychic defense mechanism.

This fear may be related to childhood trauma, adjustment disorder, or unresolved intrapsychic conflicts. In her book, the psychoanalyst evokes the example of Lise: “Lise has always thought that motherhood was distressing, she didn't want to be a mother, she saw it as “a huge thing”. She did not want this anguish, she writes. Denial was the best way for her to be a mother, because she could never have overcome her anguish, her trauma. Without this denial, Lise would undoubtedly have aborted or experienced her pregnancy very badly if she had known that she was pregnant”.

How to detect a denial of pregnancy?

Women with neither symptoms nor outward signs of pregnancy (bulging belly, weight gain, etc.), it is very difficult to detect a denial of pregnancy. Generally, the closest entourage does not notice anything and it even happens that doctors miss a very advanced pregnancy!

The lifting of denial

In partial denial of pregnancy, the woman often discovers that she is pregnant by chance, during a routine examination with her doctor or a visit to her gynecologist. “As soon as the woman learns that she is pregnant – by visualizing, for example, the ultrasound images – and that the denial is lifted, that frees the body. The belly sometimes rounds out in a few hours, underlines the psychoanalyst.

On the other hand, in total denial where the woman only learns that she is pregnant at the time of childbirth, the lifting of the denial of pregnancy coinciding with the birth of the child is much more difficult. Very often, moreover, the mother recognizes the child only when a member of the family comes to see them and when the latter recognizes the child himself. As a result, he takes a place in the family line, the lifting of the denial is therefore deferred”.

What are the risk factors?

Are some women more prone than others to deny pregnancy? Karine Denza is categorical: “Denial affects all social classes, all women of childbearing age, no common criteria seem to exist”.

Several factors increase the risk of denial. For example :

What are the implications for the child?

Normally, the relationship between mother and child is built very early in utero. The future mother imagines her baby, talks to him, buys clothes. A link is created. "Over the months, the expected child finds a place in the family history," confides the psychoanalyst. In partial denial of pregnancy, the woman has time to get to know her baby. But, in the total denial of pregnancy, it is more complicated. In the absence of this time of necessary psychological maturation of the pregnancy, the link can be difficult to put in place. An accompaniment of the mother and the child is then necessary to help the mother to weave this emotional bond with her baby”.

To read to go further:

Source 1: "Denial of pregnancy: obstetrical aspects", Brezinka, C.; Huter, O.; Biebl, W.; Kinzl, J.; J. Psychosom. Obstet. Gynecol. No. 15, 1994.