“Contrary to popular belief, there is no typical profile”: how to identify denial of pregnancy?

Still little known, denial of pregnancy is considered a disorder of psychological gestation. It affects one in 500 pregnancies, according to several sources. “To date, it does not appear as a specific diagnosis in the international classifications, the ICD-11 and the DSM-5 and there is no consensus on its definition yet,” says Claire Petin, clinical psychologist.

It is a mysterious and complex process which escapes purely scientific rationalization, continues the specialist. But how can we identify it even though it is a denial? Is there a typical profile of women at risk?

Psychologies: What is pregnancy denial?

Claire Pettine : We speak of a denial of pregnancy when the woman is pregnant without being aware of being pregnant. There are no clearly identified specific risk factors that would explain pregnancy denial, and its underlying mechanisms remain poorly understood.

Denial is an unconscious defense mechanism that consists of a refusal to recognize reality. I would like to point out that when we speak of a denial of pregnancy it is a non-psychotic denial and that the denial of pregnancy is to be distinguished from the concealment of pregnancy, that is to say when the pregnancy is deliberately hidden. Nervous pregnancy, when a woman shows signs of pregnancy even though she is not pregnant, is also a different phenomenon.

How can we explain it?

C. P. : Each denial of pregnancy is part of an eminently singular and complex story. We must therefore not give in to a simplification and generalization of the causes and determinants of this.

Some women may be in denial of pregnancy due to various underlying traumas such as childhood abuse, sexual violence, assault, or experiences of failing early relational attachment. Other factors include false diaper, the belief of being sterile, a lack of knowledge of how their body works, an overestimation of the effectiveness of their contraception or an underestimate of its necessity, as well as ambivalence about their desire to have a child. What whatever the possibility, the result is that, for these women, being pregnant is not within the realm of awareness.

As for the positioning of the baby, it is lodged behind the ribs, along the spine, the uterus lengthens and is positioned vertically, this is why the belly does not round out. or little during gestation. You should also know that in the event of denial of pregnancy it is not justified to consider that there is necessarily an underlying mental disorder. Women are not “crazy”, are not guilty of anything and are above all the first to not understand what is happening to them. Even in the event of denial of pregnancy, since it is very real, a blood test or a pregnancy test can confirm it.

Do women always come out of pregnancy denial at the same time?

C. P. : In general, we can speak of denial of pregnancy when there is no awareness beyond the first trimester of pregnancy. There are partial denials which correspond to awareness during pregnancy and total denials, which means that the woman realizes that she is expecting a child only at the time of childbirth.

This phenomenon is called lifting denial. On this occasion, the woman’s stomach, which until then was flat, revealing no clue about the pregnancy, can become rounder in a few minutes or a few hours. It is a psychological release: as soon as the pregnancy is made known, the body transforms, which can be very impressive!

These are often young women whose testimonies we hear. Can denial of pregnancy occur in all women?

C. P. : Contrary to popular belief, there is no typical profile of the woman who experiences denial of pregnancy. This can concern all socio-professional categories and all women of childbearing age, so we must not stereotype the profile of those who do. are experiencing. It may concern women who are already mothers of one or more children, in a relationship, socially integrated, fulfilled, in a stable couple relationship and who are not in a precarious situation. We don’t necessarily know it, but there is a risk of recurrence: a woman can therefore experience several denials of pregnancy.

But you should know that it is not because she is experiencing pregnancy denial that the woman does not want a child. The arrival of a baby happens anachronistically: for some, a baby yes, but not now. This is therefore not possible at the moment, the pregnancy then occurs without their knowledge.

Is there anything in common between them?

C. P. : Yes, there is one. At some point in their lives, being pregnant is unthinkable for these women. Denial of pregnancy could result from an inner conflict, something that could not be worked out or expressed, which protects the woman from what is unthinkable for her: becoming pregnant. It would then be a conflict between the inconceivable and the conceived.

Women who experience pregnancy denial do not recognize the signals warning them of the baby’s existence. Some people think they are having their period because they have regular bleeding, but this cannot be the case because they are pregnant. Fetal movements, weight gain, nausea, breast pain will also be rationalized and interpreted without connection to the possibility of pregnancy. As for these women pregnancy is not a possibility, it is logical not to make the connection: the somatic signs of pregnancy are therefore repressed.