Understanding Later Discovery of Pregnancy
On average, most people discover they are pregnant around 5 1/2 weeks after their last menstrual period.¹ Some people discover their pregnancy later– at 8 weeks, 12 weeks, or even 20 weeks and beyond. And it can happen to anyone who can become pregnant.
Later discovery of pregnancy leads to delays in seeking prenatal care,² delays in changing lifestyle habits including drug and alcohol use,³ and for some, delays in seeking abortion care.⁴
How common is later discovery of pregnancy?
Thanks to period-tracking apps, early-detection pregnancy tests, and a limited understanding of reproductive biology, people assume almost all pregnancies are discovered early. In fact, later discovery is fairly common:
Rose (25) is a American Indian woman who survived two physical assaults. When she got pregnant, she was receiving treatment for major depression and bipolar disorder. She used recreational drugs once a week. Rose found out she was pregnant at 19 weeks GA. She was “shocked and not happy about it.” She had been taking birth control pills, she said, and had trusted their efficacy.⁴
Claire contracted Hepatitis A during the coronavirus pandemic. Because the symptoms of Hepatitis A can mask pregnancy symptoms, even her medical team didn’t realize that she was pregnant. By the time her pregnancy was discovered, via abdominal sonogram, her healthcare providers were unwilling to perform an abortion. She describes that moment as “shocking, scary, and frustrating.”⁵
Why do people discover pregnancies later?
People who experience later discovery aren’t denying their pregnancies; they’re simply not aware of them.⁶ This can happen for many different reasons, and sometimes factors that contribute to later discovery intersect and compound each other.
Common reasons for not recognizing pregnancy include:
Absent and/or ambiguous pregnancy symptoms
Close to half of pregnancies in the US are unintended, which means many people may not attribute pregnancy symptoms.⁷
People have different physiological responses to pregnancy and may lack symptoms that would lead to suspicion of a pregnancy or misinterpret them.⁸
Not recognizing a pregnancy is associated with significant delays in presenting for abortion care⁹ and prenatal care.¹⁰
Contraceptive use
18 in every 100 women who use male condoms become pregnant each year¹²
9 in every 100 women who take birth control pills become pregnant each year¹¹
9 in every 100 women who use the vaginal ring become pregnant each year¹³
1 in every 100 women who have an IUD becomes pregnant each year¹¹
Absent or Irregular periods
Changes in menstrual cycle are not only associated with pregnancy and many people experience irregular menstruation.¹¹ Irregular periods are normal, particularly for teenage girls and perimenopausal women
A number of factors can affect menstrual cycles including certain medications,¹⁴ stress, weight changes, obesity, exercise,and use of birth control as well as medical conditions like heart disease, diabetes, hyperthyroidism, polycystic ovary syndrome (PCOS),¹⁵ and eating disorders¹⁶
Being Very Young
Adolescents and preadolescents do not have regular periods and may not realize the significance of missing periods. It may take 6 years or more after someone’s period starts for their cycle to become regular
Preadolescents may experience sexual abuse and/or become sexually active before they are psychosocially mature enough to understand and recognize a pregnancy
Teens in less favorable socioeconomic circumstances (low education, low income) and teens in child welfare systems are at higher risk of teen pregnancy and birth¹⁷
Previous births
Spotting after pregnancy is common, and can be mistaken for menstruation¹¹
No two bodies are the same and no two pregnancies in the same body are the same. When a pregnancy looks or feels different than a previous one, it can be easy to miss the signs
Outside Stressors
Factors like an abusive relationship, economic hardship, housing instability, illness, and other disruptive events can make it harder for someone to psychologically process a pregnancy⁶
Angel (24) didn’t realize she was pregnant until 22 weeks. She had a husband in jail and a ten-month-old daughter at home. It was that recent birth, and the stress of full-time single parenting, that made her pregnancy difficult for Angel to detect. Her daughter, she said, was her “top priority,” and she was certain that having another child would diminish the care she could provide to both.⁴
Understanding later discovery of pregnancy and abortion access
Most people who seek abortion care later in pregnancy, particularly after 20 weeks, did not know they were pregnant until later. Once a pregnancy is discovered, abortion seekers try to access care as soon as they can. However, as a pregnancy progresses, the cost of abortion care goes up, the number of providers goes down, and more and more restrictions go into effect.⁴
Nicola (18) was used to irregular periods, so she didn’t consider that she might be pregnant. As she was getting ready to go on vacation, “she became dehydrated and started vomiting.” She was advised to go to the hospital, where the doctors confirmed her pregnancy. She and her partner had already broken up. Nicola’s mother was supportive of her, and accompanied her to a women’s health clinic. Both were “upset and in disbelief.” Nicola felt “too young to care for a child,” and worried about finishing her education.¹⁰
This Later Discovery section of WhoNotWhen and the related Later Discovery Fact Sheet was developed and researched by Jenn Chalifoux
References:
¹ Branum AM, Ahrens KA. Trends in Timing of Pregnancy Awareness Among US Women. Matern Child Health J 2017;21:715–26.
² Ayoola AB, Nettleman MD, Stommel M, Canady RB. Time of pregnancy recognition and prenatal care use: a population-based study in the United States. Birth 2010;37:37–43.
³ Cheyne H. How Women Can Go the Full Nine Months. The Conversation. 2020.
⁴ Foster DG, Kimport K. Who seeks abortions at or after 20 weeks? Perspect Sex Reprod Health 2013;45:210–8.
⁵ S. C. Why I Traveled to Colorado for an Abortion During COVID-19. Colorado Times Recorder. 2020. URL: https://coloradotimesrecorder.com/2020/10/why-i-traveled-to-colorado-for-an-abortion-during-covid-19/31697/ (Accessed 30 October 2020).
⁶ Del Giudice M. The evolutionary biology of cryptic pregnancy: A re-appraisal of the ‘denied pregnancy’ phenomenon. Med Hypotheses 2007;68:250–8.
⁷ Unintended Pregnancy in the United States. Guttmacher Institute; 2019.
⁸ Foxcroft KF, Callaway LK, Byrne NM, Webster J. Development and validation of a pregnancy symptoms inventory. BMC Pregnancy Childbirth. 2013;13:3. Published 2013 Jan 16.
⁹ Drey EA et al., Risk factors associated with presenting for abortion in the second trimester, Obstetrics & Gynecology, 2006, 107(1):128–135.
¹⁰ Ayoola AB, Nettleman MD, Stommel M, Canady RB. Time of pregnancy recognition and prenatal care use: a population-based study in the United States. Birth. 2010;37(1):37-43
¹¹ Why women present for abortions after 20 weeks. British Pregnancy Advisory Service ; 2017.
¹² How effective is contraception at preventing pregnancy?. NHS. 2020. URL: https://www.nhs.uk/conditions/contraception/how-effective-contraception/ (Accessed 20 October 2020).
¹³ Birth Control Ring. Planned Parenthood. 2020. URL: https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring (Accessed 20 October 2020).
¹⁴ Roth E. Secondary Amenorrhea. Healthline. 2018. URL: https://www.healthline.com/health/secondary-amenorrhea (Accessed 20 October 2020).
¹⁵ Stopped or missed periods. NHS. 2019. URL: https://www.nhs.uk/conditions/stopped-or-missed-periods/ (Accessed 20 October 2020).
¹⁶ Katz MG, Vollenhoven B. The reproductive endocrine consequences of anorexia nervosa. BJOG 2000;107:707–13.
¹⁷ About Teen Pregnancy. Center for Disease Control. 2020. URL: https://www.cdc.gov/teenpregnancy/about/index.htm (Accessed 1 December 2020)