Denial of pregnancy and neonaticide: A historical overview and case report

Abstract

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child.

Pregnancy Denial: Toward a New Understanding of the Underlying Mechanisms

“…The concept of “somatic denial” may shed some light on this phenomenon. The so-called silhouette effect, characterizing the absence of abdominal swelling [ 33 ], suggests a possible somatic denial of pregnancy, the absence of a typical pregnant belly hiding the fact of pregnancy from consciousness [ 18 , 26 ]. Also, menstruation-like bleeding is frequently reported in denied pregnancy [ 15 , 18 , 21 , 25 , 27 , 28 ].…”

“…The so-called silhouette effect, characterizing the absence of abdominal swelling [ 33 ], suggests a possible somatic denial of pregnancy, the absence of a typical pregnant belly hiding the fact of pregnancy from consciousness [ 18 , 26 ]. Also, menstruation-like bleeding is frequently reported in denied pregnancy [ 15 , 18 , 21 , 25 , 27 , 28 ]. Nausea is found to be suffered most rarely by women who are unaware of pregnancy until delivery [ 2 ].…”

“…In the past decade, five case reports were published describing women with pregnancy denial likely due to a preexisting mental disorder (see Table 1 ) [ 9 , 15 – 18 ]. Of these, three cases involved psychotic denial, each one of which had a diagnosis of schizophrenia before the onset of pregnancy [ 16 , 17 ], or a novel psychotic episode in the context of a pre-existing mental disorder [ 9 ].…”

“…Of interest is the case of one of these women who had a history of pseudocyesis (false pregnancy) [ 17 ], a condition characterized by her belief that she was pregnant despite evidence to the contrary [ 19 ]. Two women denied their pregnancy twice: one with an unspecified mental disorder (aged 26 and 29 years) [ 15 ] and the other with an intellectual disability and additional borderline personality (aged 17 and 22 years) [ 18 ].…”

Social and Medical Characteristics of Neonates Who Were Abandoned in a Tertiary Maternity Hospital in Turkey

“…Leaving the infant in dangerous areas is an example of excessive neglect and is punishable by law, 3 whereas the term neonaticide refers to the killing of a newborn within 24 hours following delivery. 4 …”