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Chechko N, Losse E, Nehls S. Pregnancy Denial: Toward a New Understanding of the Underlying Mechanisms. Curr Psychiatry Rep 2023; 25:493-500. [PMID: 37597131 PMCID: PMC10627956 DOI: 10.1007/s11920-023-01448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE OF REVIEW Pregnancy denial is the lack of awareness of being pregnant. The aim of the review is to understand why the affected women do not recognize the signs of pregnancy. RECENT FINDINGS Twelve case reports of pregnancy denial were published in the last ten years. While in five cases the women had an underlying mental disorder, the rest of the cases involved women who either exhibited no physical symptoms or perceived themselves to be not pregnant despite the symptoms (i.e., repression mechanisms). Pregnancy denial is considered to be a pathological issue, a likely consequence of trauma, the wish to not have a child, or a psychiatric problem. However, it appears that the majority of cases cannot be linked to any of the above reasons. We argue, therefore, that, in most cases, pregnancy denial is not associated with mental or physiological problems. Under certain circumstances, it can affect any woman.
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Affiliation(s)
- Natalia Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428, Jülich, Germany.
| | - Elena Losse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428, Jülich, Germany
| | - Susanne Nehls
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428, Jülich, Germany
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Parrish S, Vasan SK, Karpe F, Hardy-Johnson P, Jarjou O, Bittaye M, Prentice AM, Ulijaszek S, Jobe M. Concealed pregnancy as an act of care? A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia. BMC Pregnancy Childbirth 2023; 23:374. [PMID: 37226126 PMCID: PMC10207755 DOI: 10.1186/s12884-023-05710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND A barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost. METHODS Five focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC. RESULTS Two reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy's obvious visibility to others were given by focus group participants. These were 'pregnancy outside of marriage' and 'evil spirits and miscarriage.' Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection. CONCLUSION Women's lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women's access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies.
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Affiliation(s)
- Sabine Parrish
- School of Anthropology and Museum Ethnography, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK.
| | - Senthil K Vasan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, OUH Trust, Oxford, UK
| | | | | | - Mustapha Bittaye
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- University of The Gambia, Banjul, The Gambia
| | | | - Stanley Ulijaszek
- School of Anthropology and Museum Ethnography, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK
| | - Modou Jobe
- MRC Unit The Gambia at LSHTM, Banjul, The Gambia
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Testa A, Lee J, Semenza DC, Jackson DB, Ganson KT, Nagata JM. Intimate partner violence and barriers to prenatal care. Soc Sci Med 2023; 320:115700. [PMID: 36708607 DOI: 10.1016/j.socscimed.2023.115700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
RATIONALE Past research has shown that intimate partner violence (IPV) is associated with less adequate access to prenatal care. However, less is known about why IPV creates challenges for accessing prenatal care, including how IPV is related to unique barriers to prenatal care. OBJECTIVE The aim of this study is to examine the association between physical IPV around the time of pregnancy (preconception IPV, prenatal IPV, or both preconception and prenatal IPV) and (1) adequacy of prenatal care, and (2) barriers to prenatal care. METHODS Data are from 35 sites (34 states and New York City) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for years 2009-2016 (n = 166,840). Adequacy of prenatal care is examined using multinomial logistic regression and measures of barriers to prenatal care are assessed using negative binomial regression and logistic regression. RESULTS The findings reveal that women with IPV exposure-especially those who experience IPV both before and during pregnancy-are more likely to experience inadequate prenatal care. In addition, women with IPV exposure incur a higher rate of barriers to prenatal care, as well as several specific barriers to prenatal care including not having transportation, not being able to get time off work, being too busy, being unable to find child care, and keeping a pregnancy a secret. CONCLUSIONS Considering the adverse consequences of both IPV and inadequate access to prenatal care for maternal and child health, the findings of this study highlight the need for public health interventions that both reduce the prevalence of IPV and remove barriers to prenatal care for IPV-exposed women.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, United States.
| | - Jacqueline Lee
- Department of Criminal Justice, Boise State University, United States
| | - Daniel C Semenza
- Department of Sociology, Anthropology, & Criminal Justice, Rutgers University, Camden, United States
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, United States
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Chechko N, Losse E, Stickel S. A case report involving the experience of pervasive pregnancy denial: detailed observation of the first 12 postpartum weeks. BMC Psychiatry 2022; 22:774. [PMID: 36494788 PMCID: PMC9732985 DOI: 10.1186/s12888-022-04377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pervasive pregnancy denial is a rare condition associated with distress and unassisted delivery. CASE PRESENTATION The case involves a 38-year-old woman (NN), with two older children (ages 8 and 11), who was unaware, until delivery, that she had been pregnant. The case is discussed in the context of a 12-week observation of postpartum mood, stress, and mother-child attachment. NN and other 558 non-depressed women (mean age 32.41 years) were selected from the pool of participants in the RIPOD (risk of postpartum depression) study. All participants were recruited within 1-6 days of delivery. In addition to surveying depressed mood at childbirth, remote assessments of mood, mother-child attachment, and perceived stress were conducted at 3, 6, 9, and 12 weeks postpartum. Every other day, the participants also reported their current perceived stress levels based on a scale from 1 (low) to 10 (high). During the entire period of postpartum observation, NN reported no symptoms on the Edinburgh Postpartum Depression Scale, similar to only 1.6% of the sample, no stress as 0.7% of the sample, and above-average mother-infant bonding akin to only 4.6% of the sample. Her daily stress levels showed no disturbance, which was the case for only 3.32% of the total sample. On the day of delivery, NN reported a stress level of 1 (the minimum possible level), which was reported by only 4.2% of the total sample. However, NN reported the experience of delivery to be traumatic given that the child had fallen to the floor. CONCLUSION The experience of a denied pregnancy did not appear to disturb NN at any time point, not even on the day of delivery. Compared to NN, the other non-depressed participants reported wide fluctuations in stress levels during the observation period. NN did not report any risk factors for denied pregnancy. Thus, she belonged neither to any group of typical pregnancy deniers, as reported in the literature, nor to a typical postpartum group. We postulate, therefore, that the extent to which pregnancy denial can be deemed a normal variation, unrelated to a psychological or physiological condition, depends largely on personal traits.
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Affiliation(s)
- Natalia Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany. .,Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428, Jülich, Germany.
| | - Elena Losse
- grid.1957.a0000 0001 0728 696XDepartment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Susanne Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
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Milia G, Noonan M. Experiences and perspectives of women who have committed neonaticide, infanticide and filicide: A systematic review and qualitative evidence synthesis. J Psychiatr Ment Health Nurs 2022; 29:813-828. [PMID: 35255182 PMCID: PMC9790608 DOI: 10.1111/jpm.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 12/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The phenomenon of child killing (neonaticide, infanticide or filicide) is a rare event that cannot be fully explained by a single construct as each case involves the unique life circumstances of each woman who committed the act(s). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of women who committed neonaticide, infanticide or filicide regretted the act and regretted not seeking help from family and healthcare professionals. Women who committed neonaticide, infanticide or filicide in the main had complex circumstances characterised by poverty, abusive relationships, poor family and social support or over reliance on family supports and mental health issues. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women may be pathological and require further assessment. Women need to be made aware of the support service pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences to reduce child homicide mortality and support women and their families. ABSTRACT INTRODUCTION: Meaning and personal experiences of the acts of neonaticide, infanticide and filicide have rarely been investigated from the perspectives of the women who committed those acts. AIMS To identify and synthesise evidence on the perspectives of women directly involved in the complex phenomena of neonaticide, infanticide or filicide from the evidence available on their unique point of view and how these experiences have affected women's lives. To understand how the experiences and perceptions of women who engaged in child killing present similarities or differences according to the child's age at time of death. METHODS Qualitative primary studies published in English were included if they explored the experiences of women who engaged in neonaticide, infanticide or filicide. Methodological quality was assessed using the qualitative Critical Appraisal Skills Programme (CASP) checklist. A thematic analysis framework guided the synthesis. RESULTS Seven papers reporting on five studies met the inclusion criteria for the review. Three analytical themes were identified: Not ready to be a mother; Intentionality and premeditation in the context of trauma and mental health issues; Sorrow of regret. DISCUSSION The majority of women who committed neonaticide, infanticide or filicide had complex psychological, social and personal circumstances and in the main regretted the act and regretted not seeking help from family and healthcare professionals. Healthcare professionals in contact with women during the perinatal period and beyond need to be aware of the profiles of vulnerable women and undertake holistic integrated assessments to identify the woman's personal context, changes in interpersonal relationships, social isolation or over reliance on family supports and changes in mental health status or new onset of mental health conditions. IMPLICATIONS FOR PRACTICE Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women might be pathological and require further assessment. Women need to be made aware of the support services pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences of each of the phenomena separately to reduce child homicide mortality and support women and their families.
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Affiliation(s)
- Giulia Milia
- Faculty of Education and Health Science, University of Limerick, Limerick, Ireland
| | - Maria Noonan
- Faculty of Education and Health Science, University of Limerick, Limerick, Ireland
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Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder. Arch Womens Ment Health 2022; 25:51-59. [PMID: 34392438 DOI: 10.1007/s00737-021-01176-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.
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Nanjundaswamy MH, Gaddapati S, Thippeswamy H, Thampy M, Vaiphei K, Kashyap H, Kishore T, Ganjekar S, Chandra PS. Denial of Pregnancy: Psychopathology and Clinical Management. Psychopathology 2019; 52:271-274. [PMID: 31593965 DOI: 10.1159/000503151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Abstract
Denial of pregnancy (DOP) is a challenging condition with poorly understood psychopathology. DOP is reported to be associated with problems such as severe psychological conflicts, obstetric complications, risks to the newborn, and difficulties in bonding with the infant. In this paper, we present and discuss the clinical manifestations of a severe form of DOP that lasted until the time of delivery with resultant multifaceted complications. Our paper highlights the severity of psychopathology and the need for coordinated management. Descriptions from different cultural backgrounds would improve the conceptual understanding of DOP.
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Affiliation(s)
- Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sravani Gaddapati
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India,
| | - Mareena Thampy
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Murphy-Tighe S, Lalor JG. Regaining agency and autonomy: A grounded typology of concealed pregnancy. J Adv Nurs 2018; 75:603-615. [PMID: 30307061 DOI: 10.1111/jan.13875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/23/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore and understand the experience of concealed pregnancy and develop a framework for practitioners. BACKGROUND Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence. DESIGN A Glaserian grounded theory study was undertaken. DATA SOURCES Thirty women were interviewed, between 2014 - 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data. METHODS The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology. RESULTS Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many women's relationships were characterized by emotional, mental, sexual, or physical violence. Fear for one's survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone. CONCLUSIONS This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.
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Affiliation(s)
- Sylvia Murphy-Tighe
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Joan G Lalor
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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