Ashley is 29-year-old woman who is brought to the Emergency Department of her local hospital by co-workers who found her in the restroom in agony from abdominal cramping. On finding her, after hearing her screams, they noted that she was bleeding heavily from the vagina, and she had told them that she was suffering from a very bad period. During the ride to the hospital, one of her friends said that it looked as though Ashley was having a miscarriage. But how could that be, Ashley had moaned back. She had broken up with her boyfriend five months earlier, had not slept with any man since that time, and in between she could recall having a few periods, though the periods had been lighter than usual and her periods had always come on an irregular, unpredictable schedule. But then again, the bleeding had become regular when she had started taking oral contraceptives, birth control pills, even though she had not always taken the pills on the proper schedule. Occasionally, she had needed catch up after missing a day or two.
A few months, upon visiting her family doctor for what she, and the doctor, had assumed to be gastroenteritis, an intestinal flu, the doctor had merely recommended fluids and rest. He had not suggested a pregnancy test, as she had checked off on her patient questionnaire that she was taking oral contraceptives, and within a few days she had felt better. Since that time, she had not noticed any symptoms typical of pregnancy. She had not felt nauseous, nor breast tenderness. As for her abdomen, she hadn’t noticed it growing. If anything, her waistline had shrunk slightly over the past few months. She had always been slightly overweight and now was exercising and cutting calories, so why would pregnancy even have crossed her mind.
All of this sounded puzzling to Ashley’s coworkers, but ten minutes after arriving at the Emergency Department, as the nurse was starting an intravenous line, preparing to give Ashley some fluids, Ashley’s water broke. She was indeed pregnant. Very pregnant. A fetal monitor registered a strong fetal heartbeat, and very definite uterine contractions. Ashley was in labor, and within three hours became the mother of a newborn girl, who was moderately underweight and estimated to be about four weeks premature, but otherwise healthy. There was no jaundice (yellow skin coloring), not breathing difficulty. The infant had an Apgar score of 9 at one minute after birth, and 10 at five minutes. How did this happen?
Well, if you are in the process of starting a family, most likely you do know something about how it happened. You know the mechanics of what leads to pregnancy, but you may not know that an estimated 1 in 400-500 pregnancies goes unnoticed until 20 weeks gestation, meaning five months into the pregnancy. Furthermore, 1 in 2,500 mothers-to-be do not remain unaware that they are pregnant all the way up to labor.
There are multiple reasons for this. One is that the mother can be under enormous stress, or have some underlying fear, leading to extreme denial of what’s happening to her body, as symptoms of pregnancy develop, symptoms, such as breast tenderness and swelling, abdominal pain, nausea, fatigue, and an intolerance and elevated sensitivity for tastes and smells. She might dismiss a sensation of movement in her abdomen as gas, or indigestion. Denial can be in play in certain situations. A teenager who doesn’t want her parents to know that she got pregnant, for example, might convince herself that she is not pregnant. If she doesn’t believe it herself, it makes it easier to prevent others from suspecting it. Similarly, a married woman who is pregnant, but not by her husband, might also be inclined to fall into this type of mindset. Then, of course, mental health issues can be a factor.
Short of stress, denial, and other personal issues, it’s also quite possible for a pregnant woman not feel any symptoms. She may not gain weight gain, have morning sickness, fatigue, or heartburn. Or, the symptoms may be infrequent, or very mild. As for the abdomen, the most obvious sign of pregnancy as it progresses, different women show to varying degrees based on a variety of factors. If the placenta is forward and the fetus more toward the back, the abdomen may not protrude until very late in pregnancy. If a woman has a large frame, or is obese, the growing uterus may not be so obvious. Additionally, a far back fetus’ movements are often harder to perceive.
As for menstrual bleeding, certain conditions, such as polycystic ovary syndrome (PCOS), eating disorders, or diabetes, can cause a woman’s cycles to be unpredictable. Her periods may be irregular, and very light when they happen, so she may not think much of their disappearance. While this happens, some very light bleeding related to the pregnancy, but that does not result in a spontaneous abortion, could be mistaken for a light period.
All in all, thought it’s a rare occurrence, there are phenomena that in combination can hide a pregnancy, both from the mother, and those around her. To keep this from happening to you, see your doctor on scheduled visits, take care in your birth control, and if something looks amiss take a pregnancy test.