Concealed Pregnancies

NSCB has recently undertaken a serious case review where concealed pregnancy was a feature. The review found that:

• Guidance in relation to concealed pregnancy was not always followed.
• The potential significance of concealed pregnancy was not well understood.

This briefing is intended for all professionals working with women of childbearing age (which can include children and young people under 18).

It will help practitioners understand the issues and the need to follow NSCB procedures.

What is a concealed or denied pregnancy?

In a concealed pregnancy, a woman is aware of the pregnancy but does not tell professionals, or may hide the fact that she is not accessing antenatal care. In a denied pregnancy, the woman is unaware of or unable to accept the reality of the pregnancy. The term concealed pregnancy is used to cover both situations in the NSCB guidance.

When concealed pregnancy is suspected, it is of course difficult to know the stage or gestational date of the pregnancy. A concealed pregnancy is defined as one where the pregnancy is first confirmed at more than 24 weeks gestation – this may be in late pregnancy, in labour, or after the birth of the baby.

A woman who presents at, for example, 22 weeks, is not considered to have concealed her pregnancy but may have additional needs or vulnerabilities, and should be offered appropriate assessment and support.

Risks linked to concealed pregnancy

There are occasional cases – often well publicised – where women appear to have been unaware of their pregnancy until the unexpected arrival of a baby, but adjust quickly to the arrival of a new baby and can parent safely and effectively.

However, in general the risks and issues are very similar for concealed and denied pregnancies, which cannot always be distinguished, and comprehensive assessment and support must be offered in all cases.

• Where a woman has not accessed antenatal care, the risk of pregnancy complications, illness and even death for mum and baby are increased – maternal deaths are rare, but when they do occur, a significant proportion are associated with concealed pregnancy.
• Pregnancy may be concealed deliberately because agencies already have concerns about the safety of the new-born in the care of parents, and concealment is part of a deliberate effort to prevent removal of the baby.
• Teenagers may conceal or deny a pregnancy because of fear of parental and wider social responses. For some women, pregnancy outside marriage may carry stigma or even risk and is concealed. Very vulnerable women, particularly those who have been trafficked or exploited, may not be able to access antenatal care
• Concealment and denial of pregnancy may be linked to mental health difficulties or learning difficulties, and more broadly may reflect ambivalence to the pregnancy, and potential future difficulties in prioritising the baby’s needs, or in bonding with the baby. Careful assessment of family history and functioning is required to establish whether the baby can be safely cared for by parents
• Nationally, there have been a number of serious case reviews where the baby has been killed following birth. There have been other cases where babies have later been significantly neglected or physically harmed following concealed pregnancy.
   

What to do when a concealed pregnancy is suspected:

• Familiarise yourself with NSCB's Concealed Pregnancy Practice Guidance (PDF) 
• Be aware of possible indicators of a concealed pregnancy
• Be aware of the potential for repeated concealed pregnancies
• If you have concerns, seek advice from safeguarding leads
• Encourage the woman to visit her midwife or GP
• When concealed or denied pregnancy is strongly suspected, a referral must be made to Northamptonshire MASH

Last updated: 06 March 2019