Repressed pregnancy
A suppressed pregnancy ( Latin gravitas suppressalis ) is understood to mean the phenomenon that an existing pregnancy is not consciously perceived as such by the woman. The pregnancy is only known or diagnosed by a doctor at an advanced stage of gestation. In extreme cases, pregnancy is only diagnosed at birth .
Definition of terms
Various terms are used for suppressed pregnancy, including the terms "negated pregnancy", "unperceived pregnancy" and "gravitas suppressalis". In general, a distinction must be made between suppressed and concealed pregnancy. A concealed pregnancy is when the pregnant woman knows about her pregnancy but hides it from her surroundings.
Incidence
The displaced pregnancy that is diagnosed by the 20th week of pregnancy has an incidence of 1: 475. The incidence of displaced pregnancy, which becomes apparent only at birth, is 1 in 2455. The frequency of women giving birth unplanned at home in such a case is 1 in 9821 cases.
to form
In the case of suppressed pregnancy, a distinction is made between three types of repression .
- Profound repression: With this type of repression, on the one hand, the emotional meaning, on the other hand, the mere existence of pregnancy is suppressed from consciousness. This means that typical signs of pregnancy (weight gain, mastodynia , amenorrhea etc.) either do not occur at all or are misinterpreted.
- Affective repression: Here the pregnant woman changes neither physically nor emotionally, although she is aware of her pregnancy. These women continue to think, feel, and act as they did before pregnancy.
- Psychotic repression: This form of repression occurs primarily in women with a psychiatric history. Psychotic repression can also occur in women who have previously had a child stolen from them.
Characteristic
Studies have shown that the women concerned are a heterogeneous group with no particular accumulation in terms of age, education, integration into the social environment and socio-economic status. Contrary to popular belief, primiparae are just as often affected as pluriparous . Furthermore, it can be stated that most women are neither psychotic nor lie.
Risk factors
Various risk factors for the development of a suppressed pregnancy are described. Although the following risk factors cannot be regarded as typical characteristics of the women concerned, they indicate a certain tendency.
- decreased intelligence
- acute separation experiences
- chronic family or interpersonal conflicts
- chronic eating disorders
- severe mental disorder
- Aspirations for autonomy
- indifferent or listless relationship to sexuality
- Misinterpretation of signs of pregnancy
causes
Rationalization of pregnancy symptoms
In the literature, the rationalization of pregnancy symptoms is indicated as a possible cause of suppressed pregnancy. This means that affected women are looking for alternative explanations for typical signs of pregnancy. For example, weight gain is reinterpreted as an unsuccessful diet and child movements as flatulence . Many affected women also describe having menstrual bleeding during pregnancy. In extreme cases, the beginning of labor is even reinterpreted so that women suspected of having an acute abdomen are admitted to hospital , where the pregnancy is then diagnosed using sonography .
| Pregnancy signs and symptoms | Alternative reinterpretations |
|---|---|
| Nausea and vomiting |
|
| Amenorrhea | |
| Signs of fatigue |
|
| Weight gain |
|
| Child movements |
|
| Breast changes |
|
Iatrogenic participation
In connection with suppressed pregnancy, iatrogenic involvement is a frequently described phenomenon. This is understood to mean that an affected woman visits a doctor during her repressed pregnancy with typical pregnancy symptoms, whereby the pregnancy is not diagnosed. Incompetence on the part of doctors is not a sufficient explanation for this phenomenon. A possible cause is described as the fact that affected women often visit a general medical practice because they do not expect pregnancy. It is therefore advisable to always consider pregnancy in women of fertile age, especially if the symptoms are unclear.
One explanation for the iatrogenic participation is projective identification . With this doctor-patient relationship, everyone involved has a mutual perception deficit. In a first step of projective identification in the case of the repressed pregnancy, the pregnant woman wants to free herself from the possibility of pregnancy, as this would pose a threat to her. In a second step, the pregnant woman exerts pressure on the doctor through interpersonal interactions ( paraverbal and non-verbal signals). He feels compelled to think, act and feel as the pregnant woman would. In return, a misdiagnosis is made. These interpersonal signals are usually not consciously perceived.
A psychodynamic attempt to explain it says that the pregnant woman's environment is included in her subjective attitude of not being pregnant. In the literature, cases are described in which the suppressed pregnancy was not noticed by the immediate environment, even when they went swimming together. It is possible for the pregnant woman to influence the doctor in a similar way, so that a certain diagnosis is not carried out and the existence of the pregnancy is not recognized.
Psychoanalytic explanatory approaches
Various possible psychoanalytic explanations are described in the literature. Some of them are listed below. However, the phenomenon has not been conclusively researched.
- In psychoanalysis it is described that a certain drive can generate pleasure or displeasure. In order for repression to take place, the motive of displeasure must be stronger than the desire for satisfaction. In a first phase of repression, the drive is suppressed from consciousness. The second level of repression describes the so-called pushing back. Thoughts that are related to the repressed drive are also repressed. The motive of repression is therefore to avoid displeasure.
- The oldest described type of defense is repression. Defense is an unconscious process. In psychoanalysis, defense is understood to mean all intrapsychic processes that aim to prevent unpleasant feelings and perceptions from becoming conscious. In the case of suppressed pregnancy, pregnancy would be this unpleasant event. The repression is one of the mature defense mechanisms .
- Depending on the individual situation of the pregnant woman, pregnancy is experienced as a more or less crisis-prone and ambivalent life situation. Every pregnancy is also a complex body and soul process. Every crisis carries the risk of being displaced. In general, it can be said that in a suppressed pregnancy a specific individual psychodynamics of the woman concerned must be assumed.
- The woman's personality structure is decisive for her ability to cope with psychological conflicts. Since pregnancy can trigger ambivalent feelings, the person affected reacts with coping strategies and defense mechanisms to resolve the conflict. Things that a person does not notice cannot trigger negative feelings such as fear. Under displacement is meant to make a conflict unconsciously and keep unconsciously. The suppression of a pregnancy means that it is no longer perceived as threatening. As a result, a suppressed pregnancy could be interpreted as an adjustment disorder or an anxiety disorder .
Functions of repression
A repression of pregnancy can have different functions for the affected woman:
- Protection against abortion
- Avoiding dealing with reality
- External protection: The fear of being pressured into having an abortion.
- Internal protection: Often there is a highly ambivalent desire to have children. If the pregnancy is diagnosed late, the women can have their child. With an earlier diagnosis, an interruption might have occurred .
Individual evidence
- ↑ G. Rau, J. Wessel: On the displacement of pregnancy - presentation of a phenomenon based on some results from 28 cases and presentation of a prospective regional joint study for Berlin . 1997.
- ^ B. Bass, B. von Castelberg, M. Fleischli: Concealed and negated pregnancies - a challenge for the clinic. Ed .: Speculum - Journal of Gynecology and Obstetrics. tape 22 . Krause and Pachernegg - Verlag für Medizin und Wirtschaft, Gablitz March 2004, p. 19-22 .
- ↑ J. Wessel, J. Endikrat, U. Büscher: Frequency of denial of pregnancy; results and epidemiological significance of a 1-year prospective study in Berlin . Ed .: Acta Obstetrica et Gynecologica Scandinavica. tape 81 , 2002, pp. 1021-1027 .
- ↑ a b c d G. Michel: Repressed pregnancy: three times more likely than triplet births . In: Swiss Midwives Association (Ed.): Hebamme.ch . tape 9 . Switzerland September 2008, p. 4-6 .
- ↑ a b c d e P. Rott (editor): As the virgin to the child , German medical weekly . tape 141 , 2016, p. 1-5 , doi : 10.1055 / s-0042-120519 .
- ↑ a b J. Wessel, J. Endikrat, A. Gauruder-Burmester, R. Kästner: Displaced pregnancy . In: The midwife . tape 17 , 2004, p. 7-11 .
- ↑ a b F. Kinzl: Like the virgin to the child. (No longer available online.) 2009, archived from the original on July 31, 2014 ; accessed on August 21, 2017 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ J. Wessel: Which factors in the suppression of pregnancy can promote the non-awareness of an existing pregnancy? In: Gynecology and Obstetrics . Springer Verlag, Luxemburg 1992, p. 1193-1194 .
- ↑ a b c d J. Wessel, J. Endikrat, R. Kästner: Projective identification and repression of pregnancy - considerations on causes and backgrounds of pregnancy, which was not recognized by doctors . In: Z Obstetrics Neonatol . tape 207 , 2003, ISSN 0948-2393 , p. 48-53 .
- ↑ S. Freud: The displacement (1915) . In: Collected Works . 1915 ( psychanalysis.lu [PDF; accessed on January 22, 2018]).
- ↑ M. Berger, H. Hecht: Mental Illness Clinic and Therapy . 2nd Edition. Urban & Fischer , Munich 2004, p. 200-203 .
