Thinking about Denial

So I was lying on my back today, watching my belly take on weird, sculptural shapes as my unborn baby decided that she preferred my right side—no, my left side, before she finally settled somewhere in the middle under my belly button. Like most pregnant women, I really like these unmistakable physical signs. The wooshing heartbeat, the fluttering and more ferocious kicks, the smooth proof of the ultrasound screen, the shifting topography of my belly as she flops around—all help me know that I didn’t just imagine her. Maybe it’s because I like my truths nice and literal, or that I have an unlimited imagination and might otherwise wonder if I’d made the whole thing up, but I do like the basic reassurance of these cumulative symptoms.

Weirdly, as I’ve been consumed with tracking the physical evidence of pregnancy, I’m also finding myself really drawn to accounts of women who are pregnant without knowing it. I keep thinking of stories I’ve heard of women going to the hospital complaining of strange abdominal pains only to find out, surprise, it’s labor time. This is the stuff TV writers fall all over themselves for. Think of Peggy’s little surprise in the second season of Mad Men. Her only proof (and grasped only retrospectively, at that) seemed to be her mysterious fatness, a symptom that seemed almost preposterous in both its theatrical execution and its uniqueness. Really, Pegs? Nothing else going on in your body to clue you in? And if there were other clues, why didn’t the writers let us in on them?

Then there are those true, sad stories of real women shocked by the discovery--often under the florescent lights of the ER--that they’re mothers. And what in the world does it mean to be a mother in the biological sense only-- before the awareness kicks in?

I find it astonishing that someone could go month after month and not perceive the wild factory of person-making happening just below her skin. But I also can guess how it’s possible. These symptoms, so factual and convincing to me, seem so not just because they are real, but because I’m paying attention. If I weren’t paying attention—if I decided to explain them away out of fear, distress, or ignorance—I could probably make them all but disappear. Denial is a powerful thing. It’s not the case that my symptoms mystically Summon me to Motherhood. They don’t command my attention and thereby make me a better, more conscious person than I already am. My attention is already there, and these bodily clues are just meeting me half way.

I also know that in a very basic way class plays a role in my feelings about pregnancy. The luxury of paying attention, of exulting in physical symptoms rather than fearing or repressing them, is related to my security about bringing this kid into the world. Because I’m not terrified about how I’m going to feed her and because she’s arriving as a very wanted little person, I can cherish the weird changes she’s putting me through and all the traces of her existence I have already. I can meditate on her for hours, and in so doing, make her more real than she otherwise would be.

“Pregnancy denier” is the oddly political-sounding term that medical researchers use for women and girls who remain unaware of being pregnant throughout the period of gestation. Deniers are different from concealers—those women who know they are pregnant but hide the fact from others. Sometimes this lack of awareness has basic physical roots. A young girl who has just entered puberty might misinterpret pregnancy for something else. A woman who experiences irregular or non-existent periods could understandably go nine months not knowing she’s pregnant, especially if she has other medical conditions that make her body seem opaque to her or her. In one study of pregnancy denial, an obese 32-year-old woman showed up at the ER complaining of urinary problems. A sonogram revealed a live term fetus. She had an emergency c-section and delivered a live 9-lb male baby. The study described the infant, with troubling vagueness, as being “in poor condition” and closed with the recommendation that physicians screen for pregnancy all adolescent girls and women who present in ERs with abdominal complaints.

Unsurprisingly, pregnancy denial can also be associated with psychological disorders. According to some research I looked at, many women who deny pregnancy suffer from dissociative psychopathology (though having this disorder doesn’t necessarily mean a woman will deny her pregnancy). Other illnesses that can lead to denial are schizophrenia and Cotard’s syndrome, a frightening neurological condition in which patients doubt their very existence. But researchers who have tried to pinpoint a single pregnancy denier profile have come up empty. One study that set out to seek a “type” concluded that the group of women involved was “heterogeneous, and a clear-cut typology of a 'pregnancy denier' could not be established.”

A sad and rather obvious fact is that women who don’t know (or accept) that they're pregnant tend not to receive prenatal care. One study of two hundred women who didn’t seek care found that the main reasons were, in order of frequency, substance use, denial of pregnancy, financial reasons, and concealed pregnancy. It's also no surprise to learn that women who don’t know they are pregnant deliver babies that are smaller and less healthy than average.

Interesting, women who showed up at hospitals just in time to deliver or shortly afterward tended to take responsibility for their infants once they were born. This is very good news, but I doubt that “taking responsibility” and bonding always go hand-in-hand.

All this leaves me with the feeling that I’m lucky to be in a place of awareness and readiness. It’s sad to think that for whatever reason (financial, medical, psychological) all pregnant women don’t have this luxury.

There's a lot more to say on this topic, of course, but there are other things I also want to research. I’m really interested, for one, in how very young teenage girls process the experience of being pregnant. Guess I need to start watching more reality TV?