It was early in the morning when Kimberlie Bunch woke up with excruciating stomach cramps and nausea. As the aching in her right side got worse, she worried that her appendix might burst. When Bunch’s boyfriend came home from work, he found her writhing in agony, surrounded by unexplained blood splatters. They rushed to the ER, where the nurse asked if Bunch was pregnant. The answer was an unequivocal no: Bunch was using birth control, had irregular periods, and hadn’t gained weight.
But within minutes, a doctor told Bunch that she was in labour. “At that point I thought I was dreaming,” recalled Bunch on an episode of I Didn’t Know I Was Pregnant, a paranoia-inducing TV show documenting women who experience a condition called “denial of pregnancy.” Unlike concealment of pregnancy, which occurs when a woman hides the fact that she’s expecting, denial of pregnancy happens when she is unaware of being pregnant. After Bunch gave birth, she was dumbfounded. “You’re taught all these things that you should expect when you’re pregnant, like morning sickness and weird cravings,” she said, “but I never had any of that.”
Bunch’s story is shocking, but not unique. Although no Canadian statistics exist, a German study showed that for every 2,455 pregnancies, one woman won’t know she’s expecting until she delivers the baby. (A Welsh study found a similar ratio, one in 2,500.) In fact, denial of pregnancy is three times more likely than having triplets. “The common view that denied pregnancies are exotic and rare events is not valid,” concluded pioneer Jens Wessel at University Clinic Charité in Berlin in the 2002 study.
Of the 65 Berlin women with denial of pregnancy, 42 weren’t diagnosed until they were in labour or their third trimester. Many had been pregnant before, and their median age was 27. Nearly all the mothers kept the baby, and carried to full-term. Astoundingly, four sets of twins were delivered. Most of the women were employed, had a relationship with the baby’s father and lived with their partner.
Stunned moms abound. Last month, April Dawn Halkett of Prince Albert, Sask., was acquitted of abandoning her baby after she unexpectedly gave birth in a Walmart washroom and then fled. In the U.K., two days before last Christmas, Tina Cook didn’t know she was having a baby “until I got to the hospital and felt the head.” Labour pains have been mistaken for the flu, cancer, cysts and kidney stones. Jamie-Lynn Spears apparently had liposuction while she was unknowingly pregnant. And a new memoir called What I Thought I Knew by New York playwright Alice Eve Cohen describes how her pregnancy, at age 44, was misdiagnosed as menopause.
These women face one question: “ ‘How did you not know for nine months?’ ” as a mom said on the TV show. When she didn’t get her period, she took pregnancy tests for two months, and all were negative. (Halkett testified that she took three tests and none indicated she was pregnant.) Researchers suspect that some women possess a chemical that obscures the test’s ability to detect pregnancy, but that’s rare, says Charles W. Simpson, a professor at the University of Saskatchewan and a gynecologist-obstetrician who testified at the Halkett trial.
Similarly confusing is the irregular bleeding these women mistake for a period. In the Berlin study, 46 per cent of the women had their periods during pregnancy, some for eight months or longer; 12 per cent had irregular cycles. The authors called this a “mystery.” Another 15 per cent had been on birth control pills.
What’s more, some women pack on so few pounds that they assume their tightening waistbands are due to overindulgence. Others carry so much excess weight that manifestations such as a growing belly or a baby kicking go undetected. Simpson, who has delivered babies in two cases of denied pregnancy, says that one patient was massively obese. “There would be no way we would know she was pregnant based just on looking at her,” he recalls.
There is also the question of clarity of mind. Simpson says that half of these women have a psychiatric disorder such as a delusional syndrome. But in the Berlin study, mental illness was present in only three of 65 participants. “The majority of the recruited women were ‘normal,’ ” wrote the authors.
Tremendous risks are associated with denial of pregnancy. Drinking can cause fetal alcohol syndrome, says Simpson, and smoking leads to low birth weights. Without prenatal care, maternal problems such as high blood pressure, pre-eclampsia and gestational diabetes may go undiagnosed. Where the mother delivers unexpectedly and alone, the baby may not progress through labour properly, says Simpson, or receive enough oxygen.
That’s why researchers such as Wessel have called for greater awareness of denial of pregnancy. “There seems to be,” Wessel has written, “no other condition as dangerous and potentially lethal to mother and child that is being ignored.” Not for long.
Monday, July 20, 2009