Can denial of pregnancy be a denial of fertility? A case discussion.

BACKGROUND For many years, several cases of neonaticide resulting from a denial of pregnancy were reported in the press. Recently, a case of neonaticide made headlines in Belgium: a woman realised that she was pregnant during childbirth. A few minutes after the delivery, the baby was asphyxiated to death. In the obstetric history of the patient, we note six pregnancies, of which three births were given to anonymous adoption. Mrs D. was not able to explain why she was not using any method of contraception despite all of her pregnancies. Many questions need to be asked in order to further understand denial of pregnancy. Do these women understand the link between sexual intercourse and the potential of pregnancy? Which women are more at risk of denying their pregnancy? Is there a certain personality profile at risk? METHODS In the following article, we report the case of Mrs D. who presented to the consultation of the clinic of CHU Mont-Godinne (Belgium). We will also discuss the literature available on the online databases (PubMed, PsycArticles, PsycInfo and Cairn.info) using the following keywords: denial of pregnancy, neonaticide, contraception. RESULTS In the results of retrospective studies, we notice that indeed most women who have had a denial of pregnancy were not using any method of contraception. This observation suggests the hypothesis of a denial of fertility in these women. In addition, it appears that a specific personality profile is very difficult to establish, due to the lack of sufficient data and due to the discrepancy of the results concerning these women, especially in the matters of age and socio-economic status. However we can note that some psychological characteristics are similar. CONCLUSIONS The denial of pregnancy is a complex mechanism, which still raises many questions in the clinical setting and in matters of etiopathogenesis. In these patients, we note that denial is a defense mechanism regularly used, even in other aspects of their lives. Moreover, the frequent non-use of contraceptive method might therefore be more in favor of a denial of fertility than of a denial of pregnancy.