Many Irish women still conceal their pregnancies. Kitty Hollandlooks at why this is still happening in this day and age
ONE OF the statistics which stood out from last week's annual report from the Crisis Pregnancy Agency (CPA) was the number of pregnancies that are still being concealed.
According to the agency, one in every 403 births in rural hospitals, and one in every 625 births in Dublin hospitals, is concealed.
When one considers 70,000 babies were born in the Republic in 2007, that's about 140 women a year who either consciously or otherwise did not present for natal care until 20 weeks or more into their pregnancy.
"We are internationally consistent," says Catherine Conlon, who carried out research on the issue in 2006. "In Germany, for example, one in 475 pregnancies is concealed."
A pregnancy is considered concealed when the mother-to-be has neither told anyone in her social or professional network about the pregnancy nor sought ante-natal care for at least 20 weeks. Conlon's study, Concealed Pregnancy: A case-study approach from an Irish setting conducted in-depth interviews with 13 women as well as with professionals, and included a literature review.
Conlon identified three "types" of concealed pregnancies. These were "unconscious denial", where the mother has no subjective awareness that she is pregnant throughout most of the pregnancy, or may even be totally unaware until a sudden delivery.
The second type is "conscious denial" where the woman is aware of the pregnancy but denies it to herself and to others, and the third is "concealment", where the woman acknowledges the pregnancy but hides it from others and does not present for ante-natal care until at least 20 weeks, or halfway, into the pregnancy.
Ann Doherty, a pregnancy support counsellor at Mayo General Hospital, says the average age of the women referred to her with a concealed pregnancy is mid-20s.
"Often people assume it's a teen issue, but that is very rare. Sometimes they are in third level. We get referrals from GPs, ante-natal clinics or even maternity wards if the woman has presented in labour. Or she might self-refer.
"The reasons for concealment vary. It could be a lot of things, like the kinds of supports she has or hasn't, the circumstances of conception such as whether it has been the result of domestic violence or rape, feeling lonely and on her own, or fearful of the implications. They may have a perception of how people will react."
She says that in a rural area such as Mayo there may be a perception that if they tell their partner or family, they will be forced into a marriage they don't want. Others conceal as they are afraid they will be forced to put the baby into care.
"These are usually perceived perceptions and once the concealment is out in the open they can find these fears are not the case at all."
In her interviews Conlon spoke to women who fitted the three "types". One who was in unconscious denial was "Lisa", whose doctor told her she just had cystitis when she felt unwell. She had had the contraceptive injection and when she went back to her GP, saying she still felt ill and was also bloated, she was given anti-inflammatory tablets.
When she went to a hospital, dissatisfied with her GP, she was told she was "heavily pregnant". A friend had said to her a few times that she looked pregnant.
"And I said: 'Yeah! I do look it. I look pregnant for most of my life.' That's what I said to her, joking about it. Sure, it was only a while after I had [the baby]. But there was no way I knew I was pregnant. No way."
Another, "Eileen", was in "conscious denial" and tells how she knew really as soon as she missed a period. She said to herself there "was no unearthly way now I'm worrying" and made a plan to have the baby on her own, and then to leave it at a hospital reception. In the end she was confronted by a family member who forced her to acknowledge the pregnancy.
"Grainne" says she "knew nearly straight away" and concealed it. She says she couldn't even tell her partner of four-and-a-half years. "I had said I would tell . So I said I'd wait until I was about three months [pregnant], and then I'd tell them. But three months made it coincide with my father getting seriously ill so I thought 'Jesus I can't tell them now'."
And the longer it went on the more impossible it became to tell anyone. She worked right up to the day of delivery, decided she would wait until her family went to mass that Sunday and then drove herself, in labour, to hospital.
For others, the pregnancy represented a real crisis and so they concealed. In Conlon's words, concealing for most of the women puts "an enormous strain" on them.
There are also implications for the healthy management of the pregnancy, particularly if the mother has conditions such as anaemia or diabetes. Concealment can also impact on the mother's capacity to bond with her baby after birth.
The main thing that changes for those women who get counselling is that they are no longer carrying the burden on their own, says Doherty.
"Once it has been disclosed to us we are non-directive and we are a listening service. We explore the emotional impact of the pregnancy and they may then disclose it to partners, family.
"We link them in then to supports and that may be ante-natal groups for young mothers, or community groups, and we stay in touch with them after the birth and again link them in with supports."
Mayo General Hospital also offers a weekly outreach ante-natal clinic in Ballina which includes a pregnancy counselling service.
Among the recommendations in Conlon's report were that national guidelines be drawn up for health professionals on how to deal with a concealed pregnancy.
These now have been drawn up and involved the pregnancy support and counselling services at Mayo General and Portiuncula Hospitals and the medical social worker in maternity at University College Hospital, Galway. They are now being finalised by the CPA, and will then be implemented nationally.