Women Who Deny or Hide Pregnancies Get Little Psychiatric Care

Women who go to great lengths to hide their pregnancies or even convince themselves they are not pregnant until giving birth may not be getting the psychiatric care they need, according to a new survey.

In their study of more than 30,000 birth records at a Midwestern urban hospital, Susan Hatters Friedman, M.D., of Case Western Reserve University, and colleagues found that pregnancy denial and concealment is relatively rare, occurring in only 0.26 percent of all deliveries.

However, fewer than 5 percent " four of 81 of these reluctant new mothers " received psychiatric referrals, "although infants were frequently discharged to the care of mothers who had denied or concealed their existence until birth," the researchers write in the March-April issue of the journal Psychosomatics.

Friedman said health-care workers seem to be "relatively insensitive" to seeing these unusual pregnancies as a possible trigger for psychiatric evaluations.

The small number of referrals may "indicate an important missed opportunity for psychiatric intervention," she said.

Friedman said that in extreme cases, denial or concealment could be a risk factor in neonaticide, where children are killed shortly after birth by their parents.

Dr. Marcia Herman-Giddens, Dr.P.H., of the University of North Carolina School of Public Health, has compiled one of the more extensive neonaticide databases in her study of infant deaths in North Carolina from 1985 to 2000. Although her research team had no way of verifying whether denial was a factor in these deaths, "my impression from reading the literature is that a portion, probably more than a minority of cases involve denial," she said.

Although they are often lumped together, pregnancy denial and concealment are separate conditions. Women who conceal their pregnancies know they are pregnant but actively hide the fact from others. Women who deny their pregnancies convince themselves that the pregnancy does not exist.

When they began their study, Friedman and colleagues suspected that the women most likely to deny or hide pregnancies would be young, pregnant for the first time, less educated and likely to have been victims of abuse.

They did find that the women were on average in their early 20s and more likely to be living with their own mothers. But two-thirds of those who had denied their pregnancies and nearly half of those who concealed them had finished high school.

Women who denied their pregnancies were more likely to be employed than women " mostly students " who hid their pregnancies. For most of the women, the pregnancy was not their first, and the researchers uncovered few reports of abuse.