Since the dark case of "frozen babies" (2006), the denial of pregnancy is on the front of the media scene and worried.

We often only talk about extreme cases that go as far as infanticide , but the question of denial of pregnancy arises more often than we think.

The point with Gaëlle Guernalec-Levy, author of "I am not pregnant: investigation on the denial of pregnancy ." *

Can you define pregnancy denial in a few words?

Gaëlle Guernalec-Levy: In psychiatry, denial is an unconscious defense mechanism that allows a subject to avoid the perception of a reality experienced as traumatic. The denial of pregnancy is the fact, for a woman, of not being aware of her pregnancy status sometimes until delivery.

One of the main manifestations of denial is ... The invisibility of pregnancy.

How can a woman not realize she is pregnant?

To understand this phenomenon, we must try to consider that what we think we know about pregnancy often corresponds to accepted ideas, physiologically and psychologically.

For example: a pregnant woman no longer has her period, so she knows she is pregnant. No. A large number of women are very irregularly regulated and a lack of menstruation is not a symptom. 10% of pregnant women bleed regularly during pregnancy, so-called "birthday rules". And women who become pregnant while taking the pill (it exists) may continue to have regular bleeding. Under pill, the rules are artificial.

Another example: a pregnant woman gets fat . Yes, but not necessarily right now, for sure a lot. In the case of denial, the baby feels that he is not necessarily welcome, he positions himself differently, very high in the uterine cavity, or he lies down along the spine. The woman does not have a prominent belly . Besides it is very impressive to see how a woman with a flat stomach can end up in a few hours with a huge belly because the denial has just been lifted at 7 months of pregnancy.

Finally: the movements of the fetus. This perception of movement is quite subjective and also depends on how the baby is positioned. Women who have a denial have symptoms. They simply interpret them differently because for a lot of reasons they do not think they are pregnant. When the baby moves, they imagine they have bloating.

Are there women who may be more affected by denial of pregnancy than others?

Even though the population affected by denial is very heterogeneous, in terms of age or social origin, some psychiatrists think that we can find common personality traits, a certain immaturity, difficulties of communication, a troubled relationship to the mother (it could almost concern half of the female population). It remains very vague.

There is no typical profile.

Are there any signs that can help detect pregnancy denial?

If the denial is really strong and the pregnancy remains invisible, it is difficult to detect it.

Even the closest circle sees nothing, perceives nothing, and sometimes doctors sometimes miss out on a very advanced pregnancy.

Is it possible to avoid a denial of pregnancy?

Unless you do pregnancy tests every month, no. But do not fall into psychosis, there is still a lot more risk of wanting a baby and not to get there than not to blame and make a denial ...

A woman who is listening to her body, her sensations, who is clear with her sexuality and desires for maternity (which is not necessarily obvious) a priori, will not make denial.

Why is denial of pregnancy not considered a pathology?

Why would it be? It is a punctual psychic disorder . To make it a pathology would be to lock up these women in psychiatric illness. But they are not sick, let alone crazy.

Women who make a denial of pregnancy simply put in place, unconsciously, a very powerful defense mechanism.

No, what would seem to me more judicious would be, when the denial ends with the murder of the child (a minority of cases fortunately, the neonaticide concerns less than 10% of the denials of pregnancy) to recognize the specificity of these crimes on a judicial plan. To prosecute them for intentional homicide on a 15-year-old, the most serious crime, with aggravating circumstances and punishable by life imprisonment, seems to me to be disproportionate and irrelevant.

When the experts pronounce themselves for the denial of pregnancy leading to infanticide (which could very well be established very quickly during the investigation), it would be necessary to find another incrimination with extenuating circumstances. Because in these cases (and I'm not talking about the case of Veronique Courjault's "frozen babies" but many cases for which there is no doubt about denial), the experts generally agree: there is no intentionality, no premeditation in killing the child.

It is childbirth that turns the woman into murder.

What is the impact on children born of a denial of pregnancy?

This question is fundamental but it is difficult to answer today. There are few studies on the fate of these children and on the construction of the mother-child bond.

For a long time this subject has not interested anyone and mothers tend, once the baby is born and accepted to positve the event, to perceive this baby as a "gift fallen from the sky" and not to want to undergo the look of a psychologist that they will perceive as inquisitor.

It seems that roughly these children are well, from a physiological and psychological point of view. At birth they are more normal size babies, without malformation. And I do not feel that there are more abusive mothers among those who have made a denial.

The important thing seems to me is that the circumstances of the pregnancy are not obscured, that this family history is not a taboo and that the child understands that his parents were confronted with a very disturbing event but that they had the strength to overcome it and to face it.

Obviously, we can only advise these mothers to try to understand with the help of a specialist the occurrence of this denial but we must also reassure them: once they have become mothers, they will do like the others, as best they can and it will be fine.

Denial of pregnancy and denial of parenthood

To better understand the denial of pregnancy, it is important to distinguish the different types:

• Denial of partial pregnancy , when the woman discovers that she is pregnant very shortly before the end of her pregnancy.

• The denial of total pregnancy is determined when the woman gives birth to a baby without even knowing that she was pregnant and that the childbirth is accompanied by a state of stupefaction. It is not uncommon in these cases that it results in the death of the baby, either accidentally or for lack of care.
  
  
• Denial of parenthood occurs when the couple, or one of them, is not ready to become a parent and manifests itself when the baby is already born. In extreme cases (rare), it can lead to infanticide, but more generally, it involves systematically entrusting a baby to third persons (family, babysitter), or leaving the children delivered to themselves by giving them a lot of pocket money for example. These parents do not realize that their children need their presence. We have also seen cases where fathers forgot their child in the car. Unconsciously, such an act may denote a denial of parenthood on the part of a father who, if he desired the child, feels overwhelmed by his presence.

* Thanks to Gaëlle Guernalec-Levy, author of I'm not pregnant: Investigation into denial of pregnancy (Editions Stock).