The denial of pregnancy defies modern medicine. Invisible until childbirth, some pregnancies escape all clinical radars. A gynecologist tells what the body was silent, what the spirit is pushing and what doctors do not see.
The denial of pregnancy is a clinical enigma. How can a pregnancy remain completely invisible, sometimes until childbirth? A gynecologist tells what medicine sees, what she does not see and how far the body can go to be silent.
“That day, she came for back pain …” Dr Alain B., gynecologist-obstetrician for over twenty years, remembers this patient perfectly. “She was 38, three children already. She arrived in the emergency room for low back pain. A discreet woman, not worried, tired. ” A few hours later, she gave birth to a term, which she did not know.
The denial of pregnancy is not a myth or an isolated news item. It concerns approximately 1 to 3 pregnancies out of 1,000 according to French estimates. In 20% of cases, it is said to be total: pregnancy is only discovered at the time of childbirth. For Dr. B., this clinical situation “puts doctors in the face of a gray area of their knowledge. It is a dead angle of modern medicine which supposes that everything is seen, everything is measured, everything is controlled. ”
A body that does not speak
What strikes in the denial of pregnancy is the silence of the body. No prominent belly, or very little. No nausea, no abnormal fatigue, no clearly perceived fetal movements. Or, trivialized symptoms, reinterpreted. “Some patients tell you that they believed they had gained some weight, or that they thought they were premenopause. They are not women detached from their bodies, they are women whose body has found a way to hide. ”
Physiologically, several hypotheses exist. In overweight women or with a retroversed uterus, the fetus can remain in depth, making pregnancy difficult to perceptible. But that is not enough to explain the extent of the phenomenon. “The real mystery is the way in which the hormonal axis adapts,” continues the doctor. The rules sometimes continue in the form of light or irregular bleeding. The absence of major weight gain, the absence of perceptible contractions, the low activity of the baby … everything contributes to the illusion. “
The psychic factor seems to play a decisive role. The organization, in the absence of mental representation of pregnancy, does not manifest it. “It is a denial in the strong sense. It is not a lie, it is not a voluntary concealment. It is an unconscious mechanism. The brain does not integrate the idea that there is a pregnancy, so it does not send the associated signals. ” For the doctor, it is a disturbing demonstration of the power of the psyche on the body.
A medical puzzle
Most women in pregnancy are not interrupted their medical follow -up. They go to the general practitioner, sometimes even in the gynecologist, for other reasons: infections, digestive pain, migraines. “And we miss it. Because the interrogation does not mention a risky sexual intercourse, because the urinary test is not done, because the belly does not “say”. “
This can cause discomfort in practitioners. Dr. B. admits: “We are trained to locate the signs, and we do not see them. It is frustrating, sometimes guilty. But it is not a fault. It must be accepted that medicine has its limits. “
Emergency is often childbirth. And it can occur in extremely precarious conditions: at home, in toilets, in a car. The shock is immense, for the mother as for the caregivers. “It’s brutal. For some, it is a psychic collapse. They do not understand what is happening to them. Others immediately put themselves in survival mode, take care of the child. But the impact is immense, even if they do not express it. ”
What medicine can – or cannot – do
Following a denial of pregnancy, the role of doctors is first to protect. The child, if born premature or without prenatal follow -up, may have complications: respiratory distress, hypoglycemia, infections. For the mother, the main risk is psychic. Psychiatric or psychological follow -up is systematically proposed, but often refused. “You have to understand that for many, the collapse comes after. When reality is essential. And there, you need solid, discreet support, which does not judge. ”
Medicine, despite all its progress, remains disarmed in the face of a phenomenon which is as much of the clinic as of the symbolic. “We would like to be able to warn, but it’s difficult. There is no typical profile. The women concerned come from all circles, all ages, all stories. There is no universal symptom. “
What medicine can do, says Dr. B. is more attentive. Do not reduce everything to figures. Refit the basic questions. Do not rule out the hypothesis of a pregnancy too quickly. And above all, get out of the judgment. “The denial of pregnancy is still perceived as a strangeness, even a fault. While it is a survival mechanism. A radical solution, of course. But a solution. “
Key figures
- About 1 to 3 births out of 1,000 come from a denial of pregnancy in France.
- In 1 in 5 cases, denial is total: pregnancy is only discovered at the time of childbirth.
- The majority of women concerned have already had children.
- Obstetric risks are increased (unprepared delivery, absence of prenatal follow -up).
