Understanding Pregnancy Denial: Causes, Risks, and Treatment.

Pregnancy is a life-changing experience, but for some women, the reality of pregnancy may seem too overwhelming to accept. In rare cases, women may experience pregnancy denial, a psychological condition where they fail to acknowledge or refuse to accept that they are pregnant. This condition can have serious consequences for both the mother and the baby.

In this article, we’ll explore the causes, risk factors, symptoms, and potential complications of pregnancy denial, as well as the importance of early diagnosis and management.

What is Pregnancy Denial?

Pregnancy denial is a psychological condition where a woman either denies or is unaware that she is pregnant. Although it’s rare, it occurs in about 1 in 475 women at 20 weeks of pregnancy, but the incidence decreases to 1 in 2500 by the time of delivery. Pregnancy denial can present itself in various forms and may occur alongside other psychiatric conditions, or in otherwise healthy women under significant stress.

Dr. Laura Berman, a licensed clinical psychologist in the state of Illinois who earned her Ph.D. in Clinical Psychology and has worked extensively in the field of sex therapy, relationship counseling, and sexual health, as well as appearing  on the Oprah Winfrey Show and The Dr. Oz Show has said:

"Pregnancy denial is a psychological defense mechanism, and it can happen when a woman is unable or unwilling to process the reality of being pregnant."

Types of Pregnancy Denial

Pregnancy denial can be classified into two major categories:

1. Psychotic Denial
   This form of denial is typically found in women with long-term mental health issues such as schizophrenia. These women may fluctuate between accepting and denying their pregnancy and often refuse to acknowledge that the physical changes they are experiencing are related to pregnancy.

2. Non-Psychotic Denial
   This type occurs in women without a pre-existing psychiatric condition. There are three subtypes of non-psychotic pregnancy denial:

   • Pervasive Denial: The woman completely rejects the idea of pregnancy. She may not even consciously acknowledge the existence of the pregnancy (36% of cases).
   • Affective Denial: The woman knows she is pregnant but avoids acknowledging the emotional significance or making any necessary preparations (52% of cases).
   • Persistent Denial: The woman remains in denial even during the third trimester. She may experience dissociation during delivery (11% of cases).

Causes and Risk Factors

The reasons behind pregnancy denial vary and are often linked to psychological factors, emotional stress, and personal circumstances. Some common causes include:

• Unwanted pregnancy or unexpected pregnancies can trigger overwhelming fear and avoidance.
• External stressors like career pressures, social isolation, or concerns about lifestyle changes due to pregnancy.
• Psychological difficulties, including fears of not being able to care for the baby or negative past experiences with pregnancy.

Risk factors that may increase the likelihood of pregnancy denial include:

• Young age
• First-time pregnancy
• Lack of social support
• A history of substance abuse or mental health conditions
• Low self-esteem or learning difficulties

However, recent research shows that women who experience pregnancy denial may not always fit into these stereotypical categories. Many are well-adjusted, have had children before, and enjoy adequate support systems.

In February 2025, US student Mia McQuillin was traveling through Europe with a group of young people and was charged with Child Homicide after allegedly throwing her newborn baby from a Paris hotel window still attached to its umbilical cord and wrapped in a sheet.

Consequences of Pregnancy Denial

The effects of pregnancy denial can be devastating for both the mother and the baby. Women who deny their pregnancy may avoid essential prenatal care, putting themselves at risk of complications. Some of the most severe consequences include:

• Lack of antenatal care: Without routine checkups, complications such as preterm labor or fetal distress may go unnoticed.
• Precipitous delivery: Women may give birth unexpectedly, sometimes without assistance and in inappropriate locations (such as bathrooms).
• Neonaticide: In the most tragic cases, the newborn may die due to neglect or deliberate harm. This is more likely in women with psychotic denial.

Additionally, women with pregnancy denial may experience emotional distress, difficulty bonding with their baby, and struggle with the demands of motherhood.

Diagnosis: How to Spot Pregnancy Denial

Pregnancy denial is often hard to diagnose because the symptoms may resemble other conditions. For instance, women with pregnancy denial may experience nausea, abdominal pain, and weight gain, yet refuse to acknowledge they are pregnant. A recent study found that nearly 40% of women with pregnancy denial had visited their doctor with symptoms like nausea or pain but had not been diagnosed as pregnant.

Doctors should be alert to the possibility of pregnancy denial, especially in women of reproductive age presenting with pregnancy-like symptoms. Early detection and diagnosis are key to ensuring the health and safety of both mother and baby.

Treatment and Management of Pregnancy Denial

Once pregnancy denial is identified, immediate intervention is crucial. Treatment often involves a combination of psychiatric care and obstetric support, ensuring that both the mental health and physical well-being of the mother are addressed. Here’s a breakdown of the management process:

1. Psychiatric Support
   Women with pregnancy denial may need psychiatric evaluation to explore the underlying causes of their denial and address any mental health concerns, such as anxiety, depression, or psychosis. Therapy can help them confront their fears and accept the reality of their pregnancy.

2. Medical Supervision
   Regular medical monitoring is essential to ensure that the pregnancy progresses safely, even if the woman is reluctant to seek care. In some cases, medication may be prescribed to manage psychiatric symptoms.

3. Family and Social Support
   It's essential for women experiencing pregnancy denial to have a strong support system. Social workers, family members, and friends can help guide the woman through the process of accepting the pregnancy and preparing for childbirth.

4. Follow-Up Care
   Follow-up visits after delivery are important to ensure that the woman is adjusting to motherhood and that the baby is well cared for. Continued psychiatric support may also be necessary.

Is Cryptic pregnancy the same as pregnancy denial?

Cryptic pregnancy and pregnancy denial are related concepts but are not exactly the same.

• Cryptic Pregnancy: This refers to a situation where a woman is unaware that she is pregnant until very late in the pregnancy, sometimes until labor begins. It is sometimes called a "stealth pregnancy" because symptoms like weight gain or morning sickness may be minimal or mistaken for other conditions. Cryptic pregnancies can occur without overt psychological denial, and the woman may not be in denial about the pregnancy in the traditional sense.

• Pregnancy Denial: This involves a psychological condition where a woman actively denies being pregnant despite clear physical signs. In some cases, this can be linked to mental health issues, such as anxiety, fear, or a desire to avoid an unplanned pregnancy. Pregnancy denial is more focused on the psychological refusal to accept the pregnancy, even when physical signs are present.

While both conditions involve a lack of recognition of pregnancy, cryptic pregnancy is often about the woman being unaware due to a lack of typical symptoms, while pregnancy denial is a psychological refusal to accept the pregnancy even when symptoms are present. Both can lead to serious complications if not addressed early.

Ethical and Legal Considerations

Pregnancy denial presents significant ethical and legal challenges, particularly in cases where the woman’s mental capacity to make decisions about her care is in question. Clinicians must balance the woman’s right to make decisions about her own body with the need to protect the fetus and ensure its well-being.

In some situations, it may be necessary to involve legal professionals to determine whether a woman has the capacity to consent to medical procedures during labor or delivery. Hospitals and health professionals must act in the best interests of both the mother and the fetus, while respecting the woman’s autonomy.

Pregnancy denial, though rare, is an important and complex condition that requires careful attention. By understanding the signs, causes, and risks, healthcare providers can better support women experiencing this difficult psychological state.

Early detection, appropriate treatment, and ongoing care are essential to minimizing the potential risks for both mother and baby. Additionally, societal support, awareness, and comprehensive care are critical to helping women navigate the challenges that come with accepting and adjusting to pregnancy.

If you suspect pregnancy denial in a woman, don’t hesitate to seek help from a healthcare provider. The sooner it is recognized and addressed, the better the outcomes for both mother and child.