Unexpectedly expecting

Why some women do not realise they are pregnant

One day, as she was bustling around in the kitchen, Nusrat Jahangir felt an unfamiliar tug in her belly. “It felt like something was kicking me from within,” recalls the 31-year-old homemaker. “Naturally, I got a little worried but not once did I suspect that I might be pregnant!” As fate would have it, however, a quick check-up with her doctor confirmed that Nusrat was indeed, with child.

“Strangely enough, I completely bypassed the obvious symptoms of pregnancy, such as morning sickness, fatigue and vomiting. There was a sporadic flu but that was about it,” shares Nusrat. Coincidentally, Nusrat also had a history of irregular menstruation which made it all the harder for her to figure things out. “I experienced some irregularities in my cycle following the birth of my second child and simply attributed all skipped periods to that. How could I have ever known?” she says, exasperated.

Fortunately for Nusrat, her condition is not out of the ordinary —  she is amongst the thousands of women across the world who fail to realise they might be pregnant. In fact, according to Dr Rubina Hassan, chairperson of Obstetrics and Gyneacology at Ziauddin University and Hospital Karachi, about 20% of expecting mothers have no inkling that they are expecting until late into the pregnancy. “Each pregnancy varies and so, it is highly likely that a woman skips all key symptoms completely,” explains Dr Rubina. “Regardless of whether it was planned or not, 80% of women can tell as the developing foetus starts moving and kicking. Sometimes though, the baby is less active or rests in a way that the mother cannot feel its presence.” In such cases, it is generally after the first trimester that it begins to sink in. “Most baby movements begin in the fifth month and are common in 90% of pregnancies,” adds Dr Rubina.

Inefficient pregnancy testing

For most doctors, the ideal and most reliable method of detecting a pregnancy is via a blood test. “These days, women resort to over-the-counter pregnancy tests which do not always beget accurate results,” claims Dr Rubina. “Not to mention, it is necessary to wait for one week after a missed period to take these home pregnancy tests. False readings will obviously lead to undetected pregnancies.”



The case for irregular menstruation

Much like Nusrat, 32-year-old Asma Alam also had a case of intermittent periods and actually visited the doctor to have her condition checked. “Instead, I was told that there was nothing wrong with me —  I was simply four months pregnant!” shares Asma, who welcomed her third child —  a beautiful baby boy —  just two weeks ago.

“I am one of four sisters, two of whom were diagnosed with ovarian cysts. So I assumed I might have developed a cyst too,” admits Asma. “This pregnancy was completely out of the blue as I had had a baby girl just six months earlier and that too, via a caesarian section.”

According to Dr Rubina, it is natural for women with conditions similar to Asma’s to overlook the possibility of a pregnancy. “Patients with a history of ovarian complications like cysts simply assume the discomfort and pain they feel is because of their condition, not a baby,” she explains. Polycystic Ovarian Syndrome (PCOS) —  a condition wherein tiny cysts develop on the ovaries, thereby impeding regular periods —  is one of the most common causes of infertility as well as unsuspected pregnancies in women. Dr Rubina also adds that some expecting mothers continue to experience bleeding well into their pregnancy which deceives them into thinking they are without child.

Lactation amenorrhea

Although few women are aware of this, breastfeeding actually delays the process by which your menstruation cycle resumes after childbirth. In fact, many women resort to natural birth control via the Lactation Amenorrhea Method (LAM) which inhibits menstruation whilst the mother is lactating. According to Dr Nusrat Shah Kamal, gyneacologist at Civil Hospital in Karachi, “Women who breastfeed their babies round-the-clock and have not started menstruating as per normal are highly unlikely to conceive during that time.” In general, this period lasts up to about six to eight months following delivery, while breast milk remains the main source of feed for the baby. “Once the six months are over, the mother’s milk is accompanied by solids and formulas like Cerelac. It is very much possible for women to conceive from then on.”

The weight issue

One would assume that a pregnancy would eventually manifest itself at least in terms of body weight if nothing else. But in some rare cases, even that does not hold true. Asma, for instance, did not gain any weight even four months into her pregnancy. “I have always been skinny and rather weak,” she shares. “But even while pregnant, I hardly put any extra pounds on.”

Interestingly enough, one of the side-effects of PCOS includes the accumulation of excess fat around the belly which makes one appear bigger than they might be. “This would make it even harder for one to detect a pregnancy,” says Dr Rubina. “A few extra pounds are inconspicuous on a person who is already overweight. Extra flab around a belly that is already swollen is likely to go unnoticed.” In such circumstances, a woman may go up to her third trimester before her condition becomes evident.

Infertility and general carelessness

“This is a very painful reality for married couples,” says Dr Rubina. “When one or both the partners are told they are infertile, they give up on the idea of conceiving psychologically. Such couples have a delayed response to the first signs of pregnancy.” Dr Nusrat further elaborates on this by hinting at the lack of attention paid by women to biological changes. “It is not careless but some women just do nothing about irregular menstruation,” she complains. “Others are careless, regardless of whether they want children or not. They assume it is impossible to conceive while breastfeeding but it is not.”

The solution

In a country where the greater half of the population shies away from topics like childbirth and family planning, it is imperative that we spread awareness regarding the matter. An undiscovered pregnancy can potentially be fatal to the unassuming mother as she goes about her daily business, conducting tasks that can perpetrate physical harm to her or the baby. Such instances may be rare but there is still a dire need for us to educate the masses and encourage dialogue to curtail unwanted and unexpected pregnancies.

How can you not know you are pregnant, especially after the first trimester?

There may not be a definite reason as to why women don’t realise it but over the years, experts have come up with the following reasons to credit surprise pregnancies:

Obesity:

Overweight or obese women are more likely to have irregular menstruation, making them accustomed to missing a period here and there. Moreover, their body shape may cause them to overlook the obvious physical change that arises due to pregnancy.

Placenta:

If a woman’s placenta is positioned near the front of her uterus, she may not feel the baby move as much. When and if movement is felt, it is easy to confuse it with gas, even in women who are very far along in their pregnancy.

Morning sickness:

Surprisingly, some women do not experience morning sickness at all and if they do, it is very mild. Nonetheless, morning sickness can also be explained as a stomach bug or just a side effect of feeling stressed out.

Denial:

Women who do not wish for a child may subconsciously deny the fact that they are indeed having one. It can happen to mature mothers, especially those in their 40s with children already.

What is PCOS?

It has been estimated that about one in every 450 pregnant women are unaware of their pregnancy until the 20th week or later. One in 2,500 remains oblivious until she actually goes into labour. The most common reason for this is that they suffer from Polycystic Ovary Syndrome or PCOS, as it is referred to by the medical fraternity.

According to The Mayo Clinic, PCOS is a very common endocrine system disorder among women of reproductive age. Those with PCOS may have enlarged ovaries containing small collections of fluid called follicles, located on each ovary. Although the real cause it yet to be determined, a large number of women are diagnosed with the syndrome across the world. Owing to its symptoms, which include infrequent or prolonged menstrual periods, excessive hair growth, acne and obesity, many patients confuse pregnancy with PCOS. Consequently, they fail to realise that they are expecting.

Ishrat Ansari works on the Karachi desk at The Express Tribune

Published in The Express Tribune, Ms T, August 23^rd, 2015.