Déni de grossesse et accouchement sous X à l’adolescence : quels liens ?

Abstract

Epidemiologic data identify that adolescents represent a significant proportion of women who give birth anonymously in France. In most cases, these births follow denials of pregnancies. Denial of pregnancy presents specific clinical characteristics during adolescence, period of psychological process rearrangements, and finalization of the separation–individuation process. We present three cases of adolescent mothers who gave birth anonymously, followed in psychiatric consultations during perinatal period. Two of them were followed during pregnancy, after the non-awareness period. The third adolescent was followed during the postnatal period, after an almost total denial of pregnancy. In these three cases, when denial turns off, defense mechanisms specific to adolescence persists until the birth or afterwards. These pregnancies are experienced as a difficulty for these adolescents and their parents also, in familial contexts of former psychological suffering or troubled relationships. We discuss the effects of denial on psychic process of pregnancy. We suggest that the long duration of denial would modify object relation from mother to fetus. When denial turns out, the adolescent experiment new thoughts, in line with the reality of her pregnancy or parental reactions, fostering the emergence of other defense mechanisms. This raises the issue of free will compared with these defensive processes. In terms of separation–individuation process, unlike planned teenage pregnancies generally perceived as likely to cause as family breakdowns, anonymous childbirth would appear as a way to keep intact family relationships and prevent separation between the adolescent and her parents. The practitioner may face rigid individual and family functioning, challenged by the discovery of the pregnancy after denial, which make impossible acceptance of the child. These consultations then engage in ethical reflection.