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Booster Shots

She's Not in a Family Way, but Has a Delicate Condition

October 07, 2002|ROSIE MESTEL

The power of the mind is impressive--but there are limits. The mind, for instance, cannot spontaneously cause a woman to become pregnant and cause her to give birth to a child.

Yet sometimes the mind gets a definite A for effort.

Women, extremely rarely, can show up in doctors' offices looking very, very pregnant and so utterly convinced that they're expecting--maternity frocks and all--that in bygone eras many a doctor was fooled.

Who can blame them?

These women's periods become irregular, even halt. Their bellies distend.

Their breasts grow tender--sometimes exude clear fluid or milk.

Sometimes they experience morning sickness, feel the fetus move--even get as far as to be admitted to hospital with labor pains.

The technical term for such a "phantom pregnancy" is pseudocyesis, from the Greek words pseudes (meaning fake) and kyesis (meaning pregnancy). The Greek physician Hippocrates described it more than 2,000 years ago, noting that some women "imagine that they are pregnant seeing that their menses are suppressed and their matrices swollen."

Queen Mary Tudor of England suffered from two episodes of pseudocyesis after her marriage to Philip of Spain in 1554. The pressure to produce an heir was intense. She was sure she was pregnant, but both times the day of delivery came and went with no result.

In 1814, Joanna Southscott, a New England religious leader, similarly claimed she was pregnant--less convincingly, you'd think, since she was over 60 years old and also claimed the fetus was the Messiah. But her large abdomen and swollen breasts convinced several doctors. When she died soon afterward, more than a dozen physicians were present at the autopsy. It revealed no pregnancy but a distended bowel and a lot of abdominal fat.

Usually, episodes of pseudocyesis last nine months. But one woman in 18th century Paris reportedly sustained the belief in her pregnancy for an impressive 18 years.

"I think, madam," said her physician, "that the best thing you could do would be to swallow a private tutor for your son, or his education will be sadly neglected."

All in all, more than 500 reports of pseudocyesis exist in the medical literature, in females age 5 to 79. Its causes are still a mystery.

You'd think some clues might come from other animals. After all, chickens, rabbits, mice and dogs can develop false pregnancies. Dogs, for instance, will gain weight, develop swollen mammary glands and start nesting. Sigmund Freud's dog reportedly suffered from this. (Wonder what Freud made of it.)

But false pregnancies in such species have a different underlying cause, stemming primarily from physiology. In rabbits, for instance, pregnancy is pretty much assured with each episode of intercourse (no wonder the creatures are so prolific). Intercourse with an infertile male is enough to trigger hormones that make a female bunny act pregnant.

But in human beings, pregnancy and intercourse aren't so tightly linked--and it is the mind that seems to set the condition rolling.

It goes something like this: A woman may very much desire a baby. Then maybe her periods become irregular or stop. (Stress can actually cause this to happen, via release of the hormone cortisol.) She believes that she is pregnant.

Congratulated and fussed over by family and friends, the woman starts dressing pregnant, unconsciously distending her abdomen and carrying her body in a pregnant way.

Accumulations of gas in the abdomen--and movements of that gas--can mimic pregnancy and fetal movements. Weight gain, nausea and fatigue--all can be induced by the mind, behavior changes or hormonal fluxes.

Other hormones can come out of kilter too, causing changes in breast physiology.

"This is truly, if you will, mind over matter--it's perhaps the most graphic expression in humans of a situation where the psychology of what's going on drives hormonal changes," says Dr. John O'Grady, director of obstetrical services at Baystate Medical Center in Springfield, Mass.

These days, pseudocyesis is rare indeed, says Dr. Alan DeCherney, professor of obstetrics and gynecology at UCLA. The pressure to have kids is less intense. Doctors' exams are more thorough.

And these days, of course, there are early, reliable pregnancy tests--and ultrasound to directly view the fetus.

"It used to be that when a patient had symptoms of pregnancy we'd say, 'We can't really tell whether you're pregnant or not' and we'd have to wait till she was 12 weeks along for physical signs," DeCherney says.

"Now we can tell four days after her period, or even sooner. There's no time to get wrapped up in the fantasy."

This is the last Booster Shots column. Many thanks to all who have read and corresponded--it's been fun. You can still reach Rosie Mestel at

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