Saturday, June 24, 2006

Denial

I took care of a full term baby last week, for a relatively minor problem, whose mother said she didn't know she was pregnant until she delivered or shortly before. Perhaps as a male I have no right to comment on this, but it seems to me to be pretty implausible. Didn't you feel the baby move? He didn't move the whole time. What about your lack of periods? I had bleeding throughout the pregnancy. And the weight gain? Well, I guess in our society it's not so unusual that someone gains 40 pounds over nine months.

Like most health care professionals who come in contact with obstetrics, I have seen this phenomenon many times before, and I always wonder where the level of denial is. I suspect that some who claim they didn't know they were pregnant really do know it but find it convenient or easier to deny it. The frightened single teen who just doesn't know how to handle telling her parents comes to mind. Others perhaps know that something is afoot but deny it to themselves. Then, maybe, there are those who have mental illness that makes them not recognize the pregnancy. Finally, there are probably some who really just don't figure it out that they are pregnant, although I suspect that's a minority of pregnancy deniers.

I guess I should be glad that this woman didn't continue to deny it after the baby was born. Now and then you hear about parents trying to flush a newborn down the toilet or throwing them in the garbage, although most of the time that's probably not a denial but just an act of desperation.

This mother had a diagnosis of schiziphrenia, although you sure wouldn't know it from talking to her. She seemed very lucid and rational. This was her fourth pregnancy, and it turns out it was the second time she didn't realize she was pregnant, which I guess makes her a serial pregnancy denier.

P.S. Shinga has asked me to remind people about the next Pediatric Grand Rounds. Submit your post to him by July 1, 1500 London time, at breath dot spa at googlemail dot com.

14 Comments:

Anonymous Dawn said...

I have, in my nursing career, encountered women who "didn't know" they were pregnant. Many times, yes, there is a HUGE amount of denial there. But, one woman was my coworker, a very intelligent woman, who had regular periods and gained weight but didn't know she was pregnant. She was quite overweight. She, having been told many times by her OB/Gyn that "only a miracle" would get her pregnant (this was prior to IVF), didn't know she was pregnant until she went into labor and delivered at 30 weeks. She never felt the baby move ...or she interpreted the movements as abdominal pain and gas. Again, her weight and belief in her infertility may have had a lot to do with it. But, it does happen.

7:18 PM  
Blogger Flea said...

Easy one ND,

This woman's reality testing is obviously poor. I'm sure you've spoken to enough patients with schizophrenia to know that their social interactions can appear normal at times, depending on how much med they have on board.

best,

Flea

7:32 AM  
Anonymous Anonymous said...

I heard about an 18 year old once, who was pregnant and didn't find out until she was due in a few weeks. Since she was overweight her whole life, she never had regular periods so the fact that she didn't have any then, was not out of the ordinary. She was very overweight and went on Weight Watchers to lose weight, never knowing she was pregnant, and lost quite a bit over that time, everything except her stomach. Since she looked that way ever since she was a child, it did not seem unusual. She was very young and inexperienced, so to speak. So while it does seem quite odd that she wouldn't feel the movement, I can understand it since she was so young. This happened over forty plus years ago when 18 was considered young to have a child.

10:17 PM  
Blogger NeoNurseChic said...

Someone at work recently told me about someone they knew that didn't know they were pregnant. In this case, the woman was older and at an age where menopause could have begun. She was also heavier, and she didn't notice the weight gain. I can see that happening, but it would still be very strange!

As far as the patient having schizophrenia but not being able to tell from talking to her, I second Flea on this one. Plenty of people who suffer from schizophrenia appear completely normal at times during certain social interactions. It has a very broad spectrum, like most psychiatric disorders.

I have actually not yet run into a patient that claimed she didn't know she was pregnant. Everyone had come to terms with it on some level, whether they wanted it or not. Everyone meaning everyone I've met in the last year and a half. However, I have met one woman who said she forgot she had the baby - she was a drug addict - it was actually very very sad... :(

Take care1
Carrie :)

2:25 AM  
Blogger Surgeon in my dreams said...

If it had not been for the fact that I became very close to the nearest restroom and considered it my dearest friend, I may not have noticed my pregnancies either. My babies are 29 and 24 but I can still vividly remember the inside of that toilet. We were close, close friends.

9:18 AM  
Anonymous Ariella said...

Not quite the same thing, but my aunt (an ER nurse for 30 years) assumed she was going into early menopause when she got pregnant (she was 42) and didn't get any testing done until she started gaining weight. This was around the fifth month.

She had terrible fibroids that had prevented her from getting pregnant in the past, so I suppose they just assumed they were infertile and didn't use contraception. After 15 years of marriage, she and my uncle were sure shocked when my cousin came along!

11:12 AM  
Blogger Fat Doctor said...

I once had a patient, age 24, who was in such denial that she actually delivered at home, then thought she should probably bring the baby to the hospital to be examined. Also she was having some fairly remarkable bleeding, so that may have figured into the equation.

When I asked her if she knew, she completely denied it. Her family was at that time in the room. Later, I returned to her room and she finally admitted, "I thought maybe it was a baby." I asked her why she didn't come see me. She said, "I thought you'd be mad because I'm not married."

Oh man, did I ever do some soul searching that day.

11:57 AM  
Blogger Ex Utero said...

Hey NeoDoc,

Unrelated - thanks for the comment on my sidebar, I was wondering if anybody actually looked at that stuff.

You got linked in the dedication section of The Plague Town Anthology today.

2:46 PM  
Anonymous J said...

One of my family members, living in the same home as me, hid her pregnancy and labor and birth from all of us. Yeah, I noticed she was even fatter than before and having trouble getting around. She says she didn't know. It's plausible as she still had periods during some of her gestation, but I still don't know if she really knew or not, sometimes I wonder, even though it's been years past. There is mental illness involved as well.
Afterwards, her appearance didn't really change, either. Surprizing for a term birth.

4:45 PM  
Blogger neonataldoc said...

Thanks for all the comments. I see that I'm not the only one who's seen this.

As for the schizophrenia, actually I haven't seen many cases, so thanks for the info. I guess it's one of those things that just hasn't crossed my career path much.

10:02 PM  
Anonymous Anonymous said...

Quite a bit late to the party - but I thought I'd add my own observations here.

We had a 24-year-old patient who first discovered that she was pregnant at 32 weeks. She had a large subchorionic hematoma which bled irregularly throughout the first and second trimesters. Only when it stopped bleeding did she come in for a pregnancy test - thought it was for her first missed period.

2:19 PM  
Anonymous Anonymous said...

Actually, this happened to my mother's aunt. She had no clue she was pregnant, and went to the ER with severe abdominal pain. Turned out, she was in labor!

In the case you describe, however, I find it unlikely she didn't know TWICE.

11:34 PM  
Anonymous legalmama said...

I know this is a very old post, but I just happened on your blog, through a rather circuitous route, and found it very interesting. I have twin girls who were born at 31 weeks, and spent 5 and 6 weeks in the NICU. Interesting to hear things from the doc's perspective.

Anyway, on the pregnancy deniers, I have a funny story. My great Aunt Kate married in her 20's, and tried very hard to get pregnant. Never did, and she and my uncle Jimmy just gave up, assumed it wasn't in the cards for them. They were always sad about it. This was a long long time ago, so there wasn't much doctors could do for infertility. Then when my Aunt Kate was in her mid to late-40's, her period stopped. She assumed, reasonably so, that it was menopause. She and her doctor attributed her other physical symptoms to menopause also. But then when her stomach began to swell, they feared cancer. It never occurred to them that she was pregnant. Not after all those years, and not at her age.

It was only when she felt the baby, my cousin Denise, kicking that she figured it out. And I don't think she realized what she was feeling until she was quite far along. It you weren't looking for it, you would not necessarily be aware of a baby kicking for quite a while, I think.

That was well over 50 years ago. My Aunt Kate died when I was a little girl, so I never even knew any of this until after she was gone. But I would love to know what she thought when she felt that baby kick, when it really dawned on her. How absolutely astonished she must have been.

It is hard to imagine, under any other circumstances, not realizing you are pregnant until the end. I was so miserable at the end, with both my singleton and my twins. How could that go unnoticed?

9:02 PM  
Blogger Kelsey said...

It's entirely possible.

In November, I will be 21. In the past two years, I have had 2 periods. I went to my doctor several times to figure it out, and it never regulated it, so my family and I just chocked it up to that being how my body wanted to be. This year, in May, we went again and I was given medication to take for a week that would, hopefully, regulate it.

Back in April of this year, I got my period and went on about my business. Thinking the medication should have worked, when my period didn't return, I decided to take a couple of tests. Over 20 to be exact, and that's no exaggeration. All of them were negative, so again, I went on about my business. Waited a week or so, called my doctor, and he said there wasn't anything else he could offer. I figured I'd have to accept my irregularities, or maybe he was a jerk. I don't know, honestly.

This week, however, I've noticed a significant swell in my abdomen. It's a little hard to push on, and I'm feeling movement on and off every day - mainly when I'm resting. And yes, admittedly, I did attribute the movement to gas. I didn't consider the possibilty of a baby, given the circumstances.

I am already slightly overweight. Not obsese or anything to the point where I don't notice weight gain. Believe me, I notice.

So while yes, it's entirely possible that it's major denial. And yes, it's probably true for most people - especially those scared to tell their parents, or of having a child period. But there are a couple of us who genuinely didn't know. I am 28 weeks pregnant, and lucky I didn't have to wait until "it was time" to find out I am, in fact, having a baby.

8:05 PM  

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