Imagine the horror of admitting a woman for an emergency cesarean surgery—only to discover that she was never pregnant. Imagine telling that woman that you needlessly opened her up only to find that her uterus was empty. Imagine the horror of being that woman, believing you were going to give birth to a child only to learn you were never actually carrying a child in the first place. This is exactly what happened at Cape Fear Valley Medical Center, a hospital in Fayetteville, North Carolina. When a woman went to the hospital in 2008, she was admitted in preparation for delivery of a child, according to the local ABC affiliate. The woman was seen by resident doctors, and they attempted to to induce labor multiple times over the course of two days. After no success, she was scheduled for the ill-fated emergency c-section. It’s difficult to imagine. It’s one thing to want to be pregnant so badly that you have a hard time accepting a negative pregnancy test; it’s another story entirely when even your body seems to believe you’re carrying a child, too. But that is exactly what happened in the North Carolina case, and it’s exactly what happens other cases of false pregnancy, referred to clinically as pseudocyesis. Women with the condition present symptoms that point to pregnancy but never deliver a baby, according to The New York Times. Pseudocyesis is extremely rare—available estimates give a rate of less than one percent of pregnancies—and it is difficult to explain. We visited with three fellows of the American Congress of Obstetricians and Gynecologists—Linda D. Green, MD, Nisseth Urribarri, MD, and Jose E. Berthe, MD—of Green & Urribarri Obstetrics and Gynecology to learn more about this diagnosis.
What is pseudocyesis?
Pseudocyesis was first documented by Greek physician Hippocrates, who wrote of twelve different women who experienced false pregnancies, according to a paper in the Canadian Medical Association Journal. “Many women experience the same exact symptoms that a pregnancy would experience,” according to the doctors at Green & Urribarri, who answered as a team. “Like mind over matter, your brain can fool your body into thinking that you are pregnant, and therefore, the same exact hormones are released.” It’s normal for women of childbearing age to become fixated on the idea of pregnancy and misinterpret symptoms as clues that they’re expecting, but false pregnancies are different: They display actual physical symptoms of pregnancy even when there is no fetus to speak of. “Every sign and symptom of pregnancy has been recorded in these patients except for three: You don’t hear heart tones from the fetus, you don’t see the fetus on ultrasound, and you don’t get a delivery,” said family practitioner Paul Paulman, MD, in an interview with The New York Times. The symptoms of pseudocyesis may vary from patient to patient, but they all mimic those of an actual pregnancy. Women may experience missed periods, morning sickness, food cravings, weight gain, a swollen belly, and even sensations of fetal movement and contractions. In some cases, Paulman said, they’ll even test positive for pregnancy because of their changing hormones. This is different from delusions of pregnancy, which “can be described as a false and fixed belief of being pregnant despite factual evidence to the contrary,” according to research in the Indian Journal of Psychological Medicine.
What causes pseudocyesis?
The cause of this unusual condition isn’t clear. In most cases, there typically isn’t a physiological explanation for pseudocyesis. Many women do exhibit a hormonal imbalance, according to the doctors at Green & Urribarri, but it isn’t clear if the hormonal balance causes the false pregnancy or if the false pregnancy causes the hormonal imbalance. On that hormonal imbalance: Though the condition’s rarity prevents large-scale studies, individual case studies have shown women with pseudocyesis to have elevated levels of the hormones estrogen and prolactin, according to The New York Times story. These hormones cause both physical and psychological pregnancy symptoms. In many cases, the cause seems psychological, and a close look at the woman’s personal circumstances and history may reveal clues as to why she is experiencing a false pregnancy. “More often than not, it is due to psychological reasons, such as trauma or just wanting it bad enough,” explain the doctors at Green & Urribarri. Included in The New York Times story is psychiatrist Biju Basil’s recountance of a woman’s false pregnancy concurring with her son’s girlfriend’s pregnancy—”[Basil] speculated that the woman’s condition arose from a deep-rooted desire to participate more fully in the birth of her first grandchild.” Traumas that can lead to pseudocyesis include multiple miscarriages, severe mental illnesses, and abuse, according to the American Pregnancy Association. Women who have experienced infertility may also be at more risk for experience a false pregnancy, as can women who have lived in extreme poverty. In very rare cases, doctors actually find a physical explanation for the symptoms of false pregnancies, such as cancer or tumors.
Who is at risk for pseudocyesis?
As mentioned above, women who have had traumatic experiences are at an increased risk for experiencing false pregnancies. The doctors at Green & Urribarri explain that deep emotional pain may trigger the symptoms, especially if women have a history of abuse or have been told at some point that they will never have a child. Women in less-developed countries have the highest risk for experiencing false pregnancies, according to research in Reproductive Biology and Endocrinology. For these women, maternal care is not readily available, and many will not seek medical care until they believe they are ready to give birth. In some African cultures, there is a high value placed on fertility, which may also influence the higher occurrence of pseudocyesis. And although women of childbearing age are most likely to experience pseudocyesis, there are reports of elderly women experiencing delusions of pregnancy initiated by physical symptoms. These cases are linked to other mental health conditions, like dementia, according to a study in Age and Aging. Still, pseudocyesis is incredibly rare. While statistics are hard to come by, it occurred at the rate of one-to-six in every 22,000 births as of 1990, according to research in the Journal of Family Practice.
Notable Cases of Pseudocyesis
One of the most tragic cases of pseudocyesis occurred in a 6-year-old girl. Her story, published in The Journal of the American Academy of Child and Adolescent Psychiatry in 1985. A victim of parental abuse and neglect, the young girl yearned “for food, material things and attention as well as feelings of defectiveness, of something missing, and sadness.” By ages 6 and 7, she longed for “her baby,” and was eventually admitted to the hospital “because of abdominal pain, enlarged abdomen for several weeks, along with morning nausea and vomiting and swollen ankles.” Only after after a year of intensive therapy did she accept that she wasn’t pregnant. Mary Tudor, the Queen of England also known as Bloody Mary, is believed to have experienced pseudocyesis. In fact, it is speculated that the violence that earned her the nickname may have been instigated by learning that she wouldn’t give birth to a child, according to The New York Times. Twenty cases of false pregnancies in men have been formally recorded, according research in the journal Psychopathology. In one case, a man with schizophrenia appeared to experience pregnancy on multiple occasions.
How is pseudocyesis treated?
Treating pseudocyesis is more complicated than you might imagine. Although it may seem as simple as telling a woman she is not expecting a child, that is not the case. Once it is confirmed that there is no baby, doctor’s must tread lightly to protect the mental health of the mother involved. “Learning that you are not experiencing a real pregnancy can be emotionally scarring for women,” explain the doctors at Green & Urribarri. “It is vital to have a psychologist present during the meeting.” Once the news has been broken to the patient, they are encouraged to begin any practices that can address the trauma, and they’re also encouraged to treat whatever underlying emotional trauma may have caused the disorder. Most doctors will encourage women to begin attending therapy. The doctors at Green & Urribarri also suggest involvement in support groups. In rare cases, when a physical explanation for the false pregnancy exists, such as cancer or a tumor, doctors treat that right away. And if doctors do find that a hormonal balance is being experienced, they offer medical treatment to correct that. One mom spoke to HealthyWay—let’s call her Hannah—about a pseudocyesis-like experience. She was experiencing a variety of symptoms, all of which seemed to point to pregnancy: She gained weight, experienced nausea that was strangely similar morning sickness, and even started lactating. “It was actually from a brain tumor,” she explains. The tumor was near the pituitary gland, which lead to a condition called prolactinoma—the same condition that Mary Tudor may suffered from, V.C. Medvei suspects in The History of Clinical Endocrinology. Prolactinoma is characterized by an overproduction of the hormone prolactin, mentioned before—symptoms for females include irregular menstrual periods and a milky discharge from the breasts. No matter the course of treatment chosen by a woman and her doctors, recovery from false pregnancies is not easy. For Hannah, treating her false pregnancy meant treating her tumor. For moms who are dealing with past trauma or infertility, treatment of pseudocyesis can be a long road, requiring therapy to address the underlying issues that lead to the pseudocyesis.