Hidden pregnancy hasn’t gone away, it just has another face

Agnes always assumed that her mother would be supportive if she got pregnant, but just as she was working up the courage to break the news, her father was diagnosed with terminal cancer. Now there is so much stress at home that she knows there will never be a good time to drop the bombshell and so she refuses even to think about it.

Eileen sometimes wishes that people would stop talking about the mother and babies scandal because she is in a black hole and the constant handwringing and recrimination on the radio is making her feel overwhelmed.

Her recently laid-off husband has stopped opening the bills, her teenage son has stopped asking if he can go to college, and she can’t face the prospect of another baby at 42.

Every so often, Ireland is transfixed by revelations and reminders of the mothers and babies so cruelly treated by a society with no place for women who got pregnant outside marriage.

But amid all the tut-tutting, hundreds of Irish women continue to hide pregnancies. “Concealed pregnancy has not gone away: it just has another face,” according to Sylvia Murphy Tighe, a former midwife and public health nurse who has been told stories similar to those of Agnes and Eileen.

Research project

A few months ago she and Prof Joan Lalor of the school of nursing and midwifery at Trinity College Dublin appealed for women who had, or who are, concealing pregnancies to participate in a research project where the focus is on hearing the women's own voices.

Already 36 women, three of them pregnant, have made contact. Just over half of them gave birth a generation or more ago, but almost as many have recently concealed a pregnancy, even as the nation recoiled from yet more revelations about Magdalene laundries and unmarked graves in mother and baby homes.

Murphy Tighe says the stereotype of the terrified teenager with nowhere to turn still applies in some cases, but the issue of concealed pregnancy is much more complex and widespread than many people think.

“Yes, it could be a teenager, trying to protect her parents. It could be someone who is not in a conventional relationship and just can’t find a way of going home and saying, ‘I had a one-night stand and I am pregnant’,” says Murphy Tighe.

All ages

She has spoken to women of all ages: some in violent relationships; some not in a relationship; some worn down by financial worries; and others battling depression and feeling emotionally unprepared for a baby.

“It could be a woman in a violent relationship that she wants to leave. It could be the mother you meet every day at the school gates who is married with two kids but who may not feel financially or emotionally capable of dealing with another pregnancy.”

Charlotte Keery, the spokeswoman for Cura, a support group for women facing a crisis pregnancy, agrees that financial pressure is increasingly a factor among those turning to the agency.

“For some people a pregnancy might not have been a crisis 10 years ago but it is now,” she says.

While Cura still gets calls from teenagers terrified to tell their parents, the agency is also contacted by women in their 20s and 30s, and by some in their 40s who find themselves having a ‘menopause’ baby. “That can be as big as a crisis,” says Keery.

While many might expect that as attitudes change, agencies such as Cura have become obsolete, more than 1,600 people contacted the service in 2012.

Keery warns of the serious medical risks for those who don’t engage with antenatal services as problems may go undiagnosed, and, in the worst-case scenario, a woman may give birth alone.

Paula Barry, assistant director of midwifery at the Coombe Women and Infants University Hospital, agrees. “The concealment of a pregnancy is a real challenge for hospital staff,” she says. “It can lead to the wrong advice being given or potentially harmful medication being taken.”

She said that concealment can be a form of denial which, if it persists for the duration of the pregnancy, may mean that the birth will be unassisted. “There are cases of conscious or unconscious denial [of pregnancy] but there is also concealment when women, perhaps for social or psychological reasons, hide their pregnancy,” says Keery. “It could be illness in the family where a young woman thinks, my mum is too ill , I can’t tell her now.”

A report by the Crisis Pregnancy Agency in 2006 estimated that one in every 403 births in a rural hospital was concealed, compared with one in every 625 births at a Dublin maternity hospital.

The study of 51 women who were at least 20 weeks pregnant before engaging with antenatal services found that eight of them arrived at the hospital in labour without having revealed the pregnancy to anyone.

While one-third of the 51 were either unaware or in denial about their pregnancy, two-thirds had deliberately concealed their condition.

The majority (47) were single while three were married and one was separated. Almost half of the women were not in a relationship (24) while 20 were in a long-term relationship, four in a “casual” relationship and three did not say.

Disappointing

Fear of upsetting or disappointing parents was a factor for more than half who concealed a pregnancy for at least 20 weeks.

Three feared being “rejected” by their parents. Ten wanted to protect their family from stigma, 16 wanted to conceal the fact that they were sexually active, nine wanted to avoid others being involved in the decision about their baby’s future and 11 hid the pregnancy to facilitate adoption. One feared rejection by the father and three feared the impact on their relationship with the father.

Murphy Tighe's research project is called Keeping it Secret – The KISS Study – Your Story of Concealed Pregnancy. She says listening to the women's stories is vital if the complex needs of women who conceal pregnancy are to be met.

Ireland may congratulate itself that it is no longer a harsh environment for women who become pregnant outside marriage, but the researcher isn’t so sure and says women who become pregnant in “unconventional” circumstances can still feel that stigma.

Even family support isn’t always enough to make a woman feel she is not being judged.

“One woman has told me that because her mother supported her, she kept her baby but she felt like an oddity for her whole life,” says Murphy Tighe.

Single teenagers aren’t the only ones banging on the hospital door in the middle of the night, alone and in labour. “The reality is that in 2014, women are under increasing pressure. They may be breadwinners, worried about whether a contract will be renewed; they may be in a difficult relationship or have become pregnant in unconventional circumstances,” she says.

Studies undertaken in Ireland, Wales, Berlin and in Ohio in the US have found that one in 2,500 conceals their pregnancy until birth. A prevalence rate of concealed pregnancy until 20 weeks of one in 148 cases was found by an NUIG team in a case-control study in 2012.

Murphy Tighe wants the country to start talking about the issue and how to support those with a crisis pregnancy. “Women in 2014 share the same fate as women of the 1950s, 1960s and 1970s. Many are grieving in silence.” Any woman who would like to participate in the KISS study or to find out more about it can call or text Sylvia Murphy Tighe at 087-9817340 or email smurphyt@tcd.ie