Concealed Pregnancy Research Articles

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Can Historical Infanticide Investigations Help Us Understand Embodied Experiences of the Past?

ABSTRACT This article explores the usefulness of historian Barbara Duden’s ‘somatic epochs’ for re-examining nineteenth century cases of infanticide, neonaticide and concealment of birth. By re-reading legal documentation in light of Duden’s contention that embodied experience is not fixed through time but figured according to the gendered, social and synesthetic contexts of different epochs, I seek to add complexity to legal and medical discussions of infanticide in this era by exploring the felt bodies of both the women accused of these practices and their communities. Taking three child murder investigations conducted in Western Australia, I use rare reports of mother’s felt bodily experiences around concealed pregnancy to argue that a mind/body dichotomy was not yet in evidence. Instead, there are indications that these women and their communities still thought of bodies as a system of Galenic humoral temperaments, and this has implications for the denial behaviours that manifested around infanticide practices. Claims by women that they were not pregnant but rather had other medical complaints and the hesitation of community members to accuse mothers despite a suspected pregnancy are bathed in fresh light. These nuanced additions to understanding the felt body have useful implications for other corporeal explorations of the past.

Self-assessment

A 19-year-old mother presents in established labour to a labour ward in a large teaching hospital following a concealed pregnancy. It is her first pregnancy. At delivery, the baby gives a cry but is noted to have significantly increased work-of-breathing and remains deeply cyanosed. The midwifery team provide PEEP via a face mask and place a crash-call for medical assistance. At the time of the neonatal crash team's arrival at 4 minutes of life the baby boy is receiving facemask PEEP 5 cm H2O in FiO2 0.45. He has deep subcostal and intercostal recessions with grunting and intermittent apnoea. Pre-ductal saturations are 49%. At a glance he appears of a good birth weight with features typical of a term infant. He is noted to have a scaphoid abdomen.

Concealed Pregnancy in Adolescent Women – A Reflection on Practice

Using fictionalised case studies of two concealed pregnancies in adolescent women, both of whom wish to conceal their birth and relinquish their baby for adoption, this article discusses the literature around concealed pregnancy, adolescent brain development, legal framework for practice and woman-centred care. It is an exploration of whether I achieved the balance needed, when respecting a woman’s right to autonomy feels like a barrier to providing care that is in her best interests. The conclusion of the article is that respecting a woman’s autonomy (and therefore her right to conceal her birth) is central to the mother-midwife relationship and therefore woman-centred care, even when the woman is a teenager.

Concealed pregnancy among school-going adolescents in South Africa: A qualitative study on risks for maternal and child health

Objective: Concealed pregnancy is a public health concern with risks to girl-education as well as maternal and child health. This paper focuses on concealed pregnancy amongst adolescents attending schools in Limpopo province of South Africa. It defines concealed pregnancy, some reasons for concealment, methods used, partners in crime and implications for girl-education as well as maternal and child health.
 Materials and methods: A qualitative and exploratory study using in-depth interviews with 10 pregnant adolescents attending school, five parents and 10 educators on their experiences of caring for pregnant adolescents attending school was conducted.
 Results and Discussion: Results show that pregnant adolescents attending school conceal their pregnancies using various methods of keeping a secret, telling a lie, wearing baggy clothing, isolating and hiding among other students in overcrowded teaching spaces. They participate passively in learning activities to evade attention to themselves. Some authority figures such as educators and parents as well as other students are accomplices.
 Conclusion: To conceal pregnancies, pregnant adolescents attending schools flout antenatal care, thus increasing risks to women and children’s health. They also show lack of attentiveness to learning activities at school, thus losing chances to achieve an education.
 Bangladesh Journal of Medical Science Vol.19(4) 2020 p.620-624

Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya

ObjectivesTo investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP. Study designThis was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7–10 days and by 472 women at 3 months. Main outcome measuresDescriptive statistics and a binary logistic regression model with odds ratios (OR) and 95% confidence intervals (CI) were used. ResultsOf the 807 women, 375 (46.3%) reported UP, and 432 (53.3%) PP. Most women, regardless of reported pregnancy intention, agreed to start using contraceptive methods: UP 273 (72.8%) and PP 338 (78.2%), respectively, P = 0.072. Independent factors associated with UP were young age (14–20 years; OR 1.177; 95% CI, 1.045–2.818; P = 0.033), unmarried status (OR 9.149; 95% CI, 5.719–14.638; P < 0.001), nulliparity (OR 1.968; 95% CI, 1.287–3.008; P = 0.002), concealed pregnancy (OR 7.708; 95% CI, 3.299–18.012; P < 0.001) and absence of a partner at the clinic visit (OR 3.174; 95% CI, 2.214–4.552; P < 0.001). At 3-month follow-up, there was no difference in contraceptive use between the UP group (161; 77.4%) and the PP group (193; 73.7%), P = 0.350. ConclusionContraceptive counselling should be systematically offered to all PAC-seeking women, regardless of their stated pregnancy intention. Adolescents, unmarried women, nulliparous, women with concealed pregnancy and attending the PAC clinic without a partner should be given extra attention by PAC providers offering contraceptive counselling.

Spontaneous rupture of incisional hernia in a 7 month concealed pregnancy: a rare case report

Incisional hernias have been reported in up to 20% of patients undergoing laparotomy. The incidence of incisional hernia following Caesarean section by vertical incision is 3.1%. Spontaneous rupture of abdominal hernia is very rare and usually occurs in incisional and recurrent groin hernias. Conservative management such as manual reduction and use of abdominal binder until term has been applied with unreliable success. Additionally, surgical intervention such as antepartum hernial repair has also been undertaken in few women while allowing for normal vaginal delivery at term. The rarity of this condition prompted us to report a case of spontaneous rupture of incisional hernia in a 35 years old pregnant lady who had developed incisional hernia following caesarean section.

Regaining agency and autonomy: A grounded typology of concealed pregnancy.

To explore and understand the experience of concealed pregnancy and develop a framework for practitioners. Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence. A Glaserian grounded theory study was undertaken. Thirty women were interviewed, between 2014 - 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data. The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology. Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many women's relationships were characterized by emotional, mental, sexual, or physical violence. Fear for one's survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone. This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.

Concealed pregnancy: a concept analysis.

A concept analysis of concealed pregnancy was undertaken using Walker and Avant's framework to examine the attributes, characteristics and uses of the concept in maternity care. Understanding the concept of concealed pregnancy is critical as failing to do so adds the risk of maternal and neonatal morbidity and mortality. Reviewing the literature and selected empirical referents indicated that concealed pregnancy has been predominantly viewed through a biomedical lens. Confusion exists around the definitions of denied and concealed pregnancy. A systematic search of five bibliographic databases using keywords from the years 1960-2014. Walker and Avant's framework was used to guide the concept analysis. A thematic analysis of reviewed papers identified the main characteristics of concealed pregnancy. Concealed pregnancy was conceptualized as a process and the critical attributes are secrecy, hiding, daytime story, staying away and avoidance. This process involves avoidance and if this includes failing to access healthcare can lead to catastrophic outcomes such as maternal and neonatal death. Antecedents, attributes and consequences of concealed pregnancy are also identified. Understanding the concept of concealed pregnancy and its antecedents, attributes and consequences may assist in risk identification of women who conceal a pregnancy. This concept analysis has identified a need for further exploration of the coping styles and psychosocial processes involved in women concealing and revealing a pregnancy.

BJOG Editor's Choice

BJOG Editor's Choice

Manifestations of Birth Trauma at the Forensic Pediatric Autopsy

Despite a greatly decreasing incidence of birth injuries over the past several decades with birth trauma currently accounting for less than 2% of neonatal deaths, birth trauma continues to be a significant cause of morbidity and mortality. Birth trauma is usually recognized by obstetricians and pediatricians, particularly when associated with a difficult delivery; therefore many birth injuries are diagnosed and documented in the neonatal period. Other delivery-related trauma may remain clinically silent without premortem identification. The challenge for the pathologist at autopsy is to correlate a history of birth trauma with injuries seen at autopsy, and to interpret injuries existing at death to accurately include or exclude birth trauma as a potential cause. Recognition of the spectrum of birth trauma is important when considering other accidental and nonaccidental mechanisms of injury, particularly in cases of unwitnessed perinatal death following delivery of a concealed pregnancy or in cases of alleged nonaccidental trauma. Discussed here is a general review of birth trauma that may be seen in a forensic setting to aid in interpretation of injuries that can be encountered.

Neonatal Freshwater Drowning After Birth in the Bathroom

The macroscopic and microscopic findings in neonatal freshwater drowning are demonstrated on the basis of 3 exemplary cases of birth in the bathroom after concealed pregnancy. If the newborn is expelled under water and remains there until death, the lungs cannot be ventilated with air. In case of incomplete or only temporary submersion, aeration of the lungs may develop in the immediate postpartum period. The morphologic criteria of separate existence are critically discussed with respect to the presented findings.

Unknown pregnancy: Presentation of the case

There are two kinds of unknown pregnancies. A denied, unknown pregnancy, graviditatas ignota, when the pregnant woman unconsciously denies the existence of the pregnancy. Contrary to the denied pregnancy there is a hidden pregnancy, a concealed pregnancy in women who know they are pregnant but actively hide their pregnancy from the family, partner, friends, teachers, colleagues, etc. The prevalence of an unknown pregnancy during the first 20 gestation weeks is 1 in 475 pregnancies, in the second half of pregnancy it is 1 in 2455 pregnancies and at the moment of delivery it is 1 in 7225. A 40-year-old woman was transported by an ambulance and admitted to Gynecology and Obstetrics Clinic in Kragujevac after the delivery in home conditions and this patient found out about her pregnancy at the moment of delivery. This case presents a classical example of a denied pregnancy. The reasons are probably at all levels, physiological, psychological and social. The patient was 40 years old, with two children aged 17 and 15 and irregular periods. Denied pregnancies present a multidisciplinary problem, which requires work of different specialties and services and this interferes with family and social life. The denied pregnancy should always be taken into consideration in case of irregular periods, especially in perimenopause. Patients in perimenopause should have regular medical examination by their gyneocolgists, at least once in six months and the delivery outside hospital conditions that bears a great risk should be avoided at any rate.

An exploration of the undetected or concealed pregnancy

This article explores the literature on the phenomenon of the ‘concealed’ or ‘undetected’ pregnancy. It proposes a useful working definition and categorization predominantly based on the work of Conlon (2006). Women's unawareness of pregnancy up to giving birth is explored. Evidence from Confidential Enquiries highlights the risks to both mother and child associated with concealment. By raising awareness among care providers and suggesting remedial action such as making maternity services more accessible it may be possible to reduce the consequences of this problem. Included in this article are four case studies which illustrate the phenomenon. Details have been altered to protect confidentiality. Other accounts where tragedy has resulted are not included, as these might be more easily identifiable.

Characteristics of Women Who Do Not Seek Prenatal Care and Implications for Prevention

To describe characteristics of women without prenatal care and their reasons for not seeking prenatal care. Retrospective record review. Urban, academic medical center. Women without prenatal care whose pregnancies reached the third trimester, who presented to the hospital for delivery or immediately postpartum for a 7 year period. Records were reviewed for factors including socio-demographic factors, history of pregnancy/miscarriage/abortion, social supports, abuse history, history of substance use, toxicology results, history of mental illness or mental retardation, and the reason for lack of prenatal care. Among 211 women with no prenatal care, the primary reasons were noted: 30% had problems with substance use; 29% experienced denial of pregnancy; 18% had financial reasons; 9% concealed pregnancy; and 6% believed they did not need prenatal care due to multiparity. Women with substance use disorders were significantly more likely to be older, unemployed multigravidas. Nurses should target specific groups of women for education and intervention based on their rationale for not seeking prenatal care.

Characteristics of Women Who Deny or Conceal Pregnancy

In order to assess characteristics of women with denial or concealment of pregnancy until delivery, the authors conducted a retrospective study of women with no history of prenatal care who presented to their institution for delivery or immediately postpartum. Among these women, 29% had denied pregnancy, and 9% had concealed pregnancy. Authors constructed models predicting denial or concealment of pregnancy and further elucidated subtypes of denial and concealment of pregnancy. Strikingly, psychiatric consultation was rare for women who had denied or concealed their pregnancies, and yet they would often subsequently take responsibility for their infants.

Denial of pregnancy as a reproductive dysfunction: A proposal for international classification systems

Objective To propose a new Diagnostic and Statistical Manual ( DSM) and International Classification of Diseases (ICD) category concerning reproductive dysfunctions not caused by organic disorder. Methods Forensic ( n=93) and obstetrical cases ( n=78) of denied and concealed pregnancies are compared and discussed. Results Denied pregnancies occur with a ratio of 1:475 births. An overwhelming phenomenological agreement is demonstrated between obstetrical and forensic cases. The findings were similar for denial and concealment of pregnancy, probably representing two different types of reproductive dysfunction that can be classified psychosocially together under the heading “negated pregnancy”. Conclusions Analogous to the phenomenology of “sexual dysfunctions”, “reproductive dysfunctions” could be distinguished by the extraordinariness of both reproductive experience and behavior (as part of human sexuality) and psycho-physiological changes, which characterize the reproductive course of events and cause obvious suffering and interpersonal complications. It is therefore suggested to include these entities as categories in their own right under the appropriate existing headings in DSM and ICD.

The incidence and outcome of concealed pregnancies among hospital deliveries: An 11-year population-based study in South Glamorgan

SummaryDenial of pregnancy has been implicated in potentially jeopardising prenatal care and subsequent safe planned deliveries. This population-based study of hospital deliveries over an 11-year period, reveals that concealed pregnancies have an incidence of one in 2,500 deliveries. Among this cohort, 12% were married and 58% were multiparous with 8% having had a previous caesarean section. Some 20% of women had a medical disorder complicating the antenatal period. There was a preponderance of concealed pregnancies in the winter months compared with booked deliveries (p = 0.02). Mode of delivery was similar between the booked and concealed pregnancies with a low incidence of maternal morbidity in the latter. Prematurity rates (p = 0.0002) were significantly higher in the concealed pregnancy cohort. A total of 20% of infants had depressed Apgar scores at 1 min and 8% at 5 min. There was no documentation of counselling or follow-up in this group. Despite the low incidence of maternal morbidity, these women should be regarded as high-risk labour due to the increased perinatal morbidity. Greater effort needs to be made towards ensuring these women have adequate counselling and follow-up during the postnatal period.

Maternal and fetal death due to placenta previa/accreta ina concealed pregnancy - a case report

This is a case report of maternal and fetal death due to major hemorrhage of a patients with placenta previa/accreta in a concealed pregnancy. Bleeding is the leading cause of maternal mortality in obstetrics. Postpartum hemorrhage is the most important cause of maternal death. Placenta accreta is a severe complication involving an abnormal attachment to the uterine wall so that it cannot be easily separated from the uterus. Due to the fact that one part of the placenta is partially detached, while the other part has grown into the uterus, postpartum hemorrhage may occur with lethal outcome, unless the mother is hospitalized. Fetal death was caused by severe meconium aspiration. One way to prevent such complications is to support legal abortions.

Abortion Disclosure and the Association With Domestic Violence

To estimate the rate at which women disclose abortion to their partners and examine the association between domestic violence and partner disclosure. A cross-sectional cohort study was performed on women presenting for elective termination of pregnancy to a single clinic in Houston, Texas. Subjects were offered an anonymous, self-administered questionnaire. The 15-question survey addressed disclosure of abortion to the partner, reasons for nondisclosure if applicable, and physical and sexual abuse using a modified Abuse Assessment Screen. Of 960 patients, 85.2% completed the survey, for a final sample size of 818. Overall, 139 (17.2%) of subjects chose not to disclose the abortions to their partners, and 14% of patients reported abuse within the past year. Physical or sexual abuse or both was twice as common among nondisclosers (23.7% compared with 12.0%, P = .001). Among nondisclosers, 63 (45.3%) said the relationship with the partner had no future, 52 (37.4%) did not feel obliged to notify their partners, 29 (20.9%) said the partner would oppose the abortion, and 11 (7.9%) said disclosure would result in physical harm. In this urban, racially and socioeconomically diverse population, 17.2% of women concealed pregnancy terminations from their partners. Although relationship instability and personal choice were cited as the most frequent reasons for nondisclosure, the rate of domestic abuse was twice as high in this group and may have adversely affected open communication. Of greatest concern, a subset of nondisclosers reported the direct fear of personal harm as the primary reason for nondisclosure.