Lynne we love you fowarding articles - you are awesome. would you mind putting the title in subject of the email so i can find it later. love suzi ----- Original Message ----- From: Leanne Wynne To: ozmidwifery@acegraphics.com.au Sent: Wednesday, November 22, 2006 10:00 AM Subject: [ozmidwifery] article FYI
Denied and concealed pregnancies Issue 24: 20 Nov 2006 Source: Journal of Psychosomatic Research 2006; 61: 723-30 Researchers have proposed that disease classification systems should be modified to include denied and concealed pregnancies as forms of reproductive dysfunction. The case is made by specialists from centers in Berlin and Kiel, Germany, in a paper published in the latest issue of the Journal of Psychosomatic Research. They define denial of pregnancy as a woman's subjective lack of awareness of being pregnant. Their own previously published research (see the ORGYN Online Magazine article Surprise births not uncommon, from the issue dated 25 March 2002) suggested that in 1 in 475 deliveries the woman was not aware of being pregnant and did not receive a diagnosis of pregnancy during the first 20 weeks or more of gestation. In 1 in 2,455 deliveries the woman did not realize that she was pregnant until going into labor. The researchers say these figures show that denial of pregnancy is not a rare event, and is only slightly less frequent that HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count), which occurs in 1 in 280 pregnancies. The prevalence of denial until labor (1 in 2,455) is itself about three times higher than the prevalence of triplets (1 in 7,225). In their new paper, the researchers present the results from two studies (including the 2002 study mentioned above), with breakdown by factors such as age, living arrangements, marital status, employment/training, and number of previous pregnancies. As well as denied pregnancies, both studies looked at concealed pregnancies - in which the woman is aware of her pregnancy, usually at a very early stage, but attempts to hide it so that no-one else becomes aware of it. The researchers report that the findings demonstrate the heterogeneity of women with denied pregnancies, showing that there is not a specific type of woman who ignores the symptoms and signs of pregnancy. They say fertile women of all ages, social backgrounds, and educational, employment and marital status are affected. "Importantly, risk factors that have previously been stated, including social isolation, low intelligence, low socioeconomic status, young age, premarital conception, and naivete of bodily functions, appear to be invalid," the researchers write. Contrary to popular belief, women experiencing their first pregnancy are not the only women affected, they add. In addition, the prevalence of mental illness among affected women was low (in one study only 5 percent of women had a positive anamnesis for schizophrenia, and the overwhelming majority of women demonstrated "normal" mental behavior). The researchers suggest that it is justified to consider denial or concealment of pregnancy "as the final path of various etiologies that can ultimately result in the negation of pregnancy (internally: denial; externally: concealment). Thus, the term 'negated pregnancy' may serve as the main category, for classification purposes." This could come under the general heading of "reproductive dysfunctions," the researchers propose, in systems such as the DSM-IV and International Classifications of Diseases. They add that such a new category could include other reproductive dysfunctions such as an obsessive desire to have children, pseudocyesis (false pregnancy, which can be considered the opposite of a denied pregnancy), high rates of pregnancy terminations, and pathological behavior of a mother towards her child. The researchers say the new classification suggestions would help raise awareness of the conditions, and could also stimulate more research to help understand denial of pregnancy. They conclude: "There seems to be no other condition as dangerous and potentially lethal to mother and fetus that is being ignored across the board of literature on obstetric complications and emergencies." Midwife in charge of "Women's Business" Mildura Aboriginal Health Service
