As if an unplanned pregnancy isn't scary enough.

By Susan Brickell
July 30, 2018

As much as we hate our periods (cue bloating and painful cramps), I’m ecstatic when I get that little confirmation from my body that I am, in fact, not pregnant. Unplanned pregnancy is not at the top of my agenda at the moment, and it honestly scares me to death.

What frightens me even more, though, is being pregnant for nine months and not knowing it until I go into labor. You've heard the stories: A woman is hit with a terrible stomachache, rushes to the hospital, and then hears from doctors that she's about to become a mom. Lifetime movie, right? "But I had my period." Nope, that was just spotting. "But I took a pregnancy test at home!" Ever heard of a false negative? 

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We know that rigorous exercise, being overweight or underweight, stress, and even your birth control can mess with your cycle and make your period lay low for a while. Finding yourself crazy-busy at work, traveling, or taking care of family can also distract you from realizing that your menstrual cup is growing a chia pet layer of dust over it. And if you do notice, you might think eh, it’s just a little late. But maybe there's more going on.

Believe it or not, there's a long list of reasons a woman can be pregnant and be totally clueless. We talked to doctors about what they are and found out that the situation is more common than you think.

Early symptoms of pregnancy

The most common early symptoms of pregnancy are fatigue, nausea, vomiting, and weight gain. As soon as a woman is hit with one of these, you'd think she'd consider the hint. But it's not quite so simple. The signs manifest differently in everyone, Bat-Sheva Lerner Maslow, MD, reproductive endocrinologist at Extend Fertility, tells Health. For some women, they're severe, but they attribute them to other issues, like a stomach bug. For others, the come on so mild, they don't even register. 

The next pregnancy clue is a missed period—at which point most women will realize something could be up and subsequently get a pregnancy test. Many of us have taken one of those before, either in a doctor’s office or in the privacy of our own bathrooms. We’re familiar with those white and purple plastic sticks that leave us staring at somewhat confusing faint lines that might as well be hieroglyphics. They tend to be the first thing we turn to when our period ghosts us.

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Yet even though home pregnancy kits boast a 99% accuracy rate, there's still a chance the test wasn't sensitive enough to detect the pregnancy. That may be because a woman took it too soon after she realized she skipped her period (the ideal window of time is one week after your missed period), checked the results too soon, or did the test with diluted urine—which is why the instructions advise taking the test first thing in the morning, when urine is most concentrated. 

More signs a pregnant woman might miss

Women with irregular periods may not realize that they've conceived because they are accustomed to having their period go MIA. An overweight woman might not detect pregnancy weight gain. Women who have never been pregnant may not recognize early fetal movement—or they dismiss it as something else.

If a woman does finally take a urine pregnancy test at this point, it can come back negative because of something called the “hook effect,” says Dr. Lerner Maslow. This happens after the first trimester, when levels of a pregnancy hormone can be so high, they essentially overwhelm the test, she explains.

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As the pregnancy continues, it's possible to not notice your abdomen growing, or to have abdominal growth that's very hard to detect or barely presents itself. (Not every mom-to-be sports an obvious bump.) The pregnancy fatigue that many women deal with can easily be confused with other conditions, such as an autoimmune disorder, anemia, or insomnia, Orlando-based ob-gyn Christine Greves, MD, tells Health

On top of physical signs that can go unnoticed, there could also be underlying psychological reasons for not recognizing pregnancy, like denial. Maybe a woman understands that she's pregnant on some level, but she doesn't know how to deal with it or she feels embarrassed or ashamed. Some women fear finally going to a doctor when they're very far along, afraid that they'll be judged for not knowing their own bodies.

Not knowing can put mother and baby at risk

If a woman is unaware of her pregnancy, she not only misses out on taking the prenatal vitamins that are super beneficial to her child's growth and development, but she might also continue to drink alcohol or take drugs—both of which can be harmful to the developing baby. And if she has a medical condition like diabetes or high blood pressure, her pregnancy could be in jeopardy without medical intervention, says Dr. Greves.

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What may actually be the most difficult part to swallow is the shock of delivering a baby you didn’t know existed. Not only can it be psychologically traumatizing, but it also gives you zero time to prepare for taking on such a huge responsibility.

The human body is a weird, weird thing, and with all the ways a woman can not realize she has a baby on board, we're not going to judge. If you've skipped a period, or you're feeling unusually nauseous or exhausted, we suggest seeing your doctor to find out why—so you won't be facing a major surprise month down the line.

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