Abstract
Denying a pregnancy can result in consequences as tragic as neonaticide-the killing of an infant in the first 24 hours of life. Between 150 and 300 neonaticides are committed each year but the actual prevalence of pregnancy denial is unknown. Adolescents are especially vulnerable to pregnancy denial because the unexpected event creates such enormous anxiety and fear for them. Pregnancy denial often eludes parents, teachers, and health care providers. Nurses can advocate for resources and pregnancy screening in primary care settings, and help educate parents and teachers about the problem.
It was the middle of a busy evening shift, when the call came through-the maternal-newborn unit would be getting a patient who delivered her baby at home. When the 17-year-old patient arrived, she was eerily silent. Her mother, who accompanied her, was clearly distraught and provided the details to the obstetrical nurse. "I honestly had no idea she was pregnant. She did not look pregnant. She did not tell me. How could this happen?"
Emergency personnel took the son she delivered directly to the neonatal nursery. He had mild tachypnea and was hypothermic, but his condition was stable.
Kelly was a senior at the local Catholic high school. A high achiever, she was active in the foreign language club and was inducted into the National Honor Society as a junior. She had stayed home from school the day the baby arrived. Her parents had gone to work, knowing that Kelly was not feeling well. She told them she had severe menstrual cramps. Kelly's mother reported that she called Kelly around lunchtime to suggest she take some ibuprofen. When she returned home, she found her daughter in the bathroom, bleeding profusely and huddled beside the commode.
"She was dazed and I could see her pulling the umbilical cord so it would come out of her-there was blood everywhere. It must have just happened. The baby wasn't moving and was still in the toilet, but as I picked him up he began to cry. I wrapped him with bath towels and just screamed. That's when I yelled out to my 12-year-old to call 911. I still don't believe it," recounted Kelly's mother.
Kelly's story did not make the news. Her baby survived and, while distraught and traumatized, she would go on with her life. But what of those teens whose babies did not survive? Two similar cases made national headlines in the past 5 years: Melissa Drexler, the "prom mom" who delivered a baby in the ladies room, placed it in the trash, and then returned to the prom; and Amy Grossberg who, along with her boyfriend, Brian Peterson, deposited their newborn son in a dumpster outside of a hotel. 1 Both infants were found dead. Such acts are known as neonaticide, meaning the death of an infant occurring within the first 24 hours of birth. 2 The consequences resulting from these cases were tragic; however, the girls' responses to their pregnancies were the same as Kelly's-to fully deny that it existed.
An estimated 150 to 300 cases of neonaticide occur in the United States each year. 3 Reliable statistics relating to pregnancy denial with "surprise" deliveries are unavailable because such cases are not reportable. This article explores some of the complexities of adolescent pregnancy that predispose to pregnancy denial, reviews the phenomenon of pregnancy denial and its relationship to neonaticide, and suggests some helpful strategies for nurses who work with adolescents.