Further Confessions of a GP

Pseudocyesis

‘I think I’m losing my baby,’ wailed the lady sitting in front of me.

Karen was not one of my regular patients and had only registered with our surgery that week. She explained to me that she was 25 weeks pregnant and that up until now her pregnancy had been completely normal.

‘Every day for the last six weeks I’ve felt my baby move, but I’ve felt nothing since last night,’ she anxiously told me.

‘I’m sure he’s fine in there, he’s probably just having a lie-in,’ I chirped optimistically. ‘We’ll have a little listen.’

I was fairly convinced Karen was just having first-time pregnancy jitters and I was looking forward to reassuring her with that lovely sound of a baby’s heartbeat. With Karen up on the couch, I squeezed some gel onto her tummy and moved my Doppler probe around listening for the baby’s heartbeat.

We both remained silent as we listened for the trace of life. Every so often, between the white noise of interference I could make out a pulse, but it was the slow whooshing sound of Karen’s own arteries pulsating rather than the much faster clicking sound of a baby’s heartbeat. We endured an awful 10 minutes of searching, but however much I tweaked and moved the probe, I couldn’t hear the reassuring beat that would let us know her baby was alive. I finally gave up and Karen got off the couch.

‘Look, Karen, it might just be my Doppler machine or perhaps your baby’s lying at a funny angle or something. I’m going to call the obstetric doctor at the hospital and ask them to see you this afternoon. They’ll do a proper scan and find out what’s going on.’

Just as I picked up my phone to call the hospital, I heard a wail from Karen.

‘Oh my god, Doctor, I think I’m going into labour!’

Karen started screaming in pain and I dialled 999.

The paramedics were with us within minutes.

As she panted and groaned, I helped Karen into the ambulance, tears of fear and pain running down her face. As soon as she was safely on her way to hospital, I called the obstetric registrar to warn him of Karen’s imminent arrival.

I carried on with my surgery that afternoon, but all the while I was thinking about Karen and wondering what was happening to her. Going into labour at 25 weeks is much too early and although I’ve heard of the odd baby surviving when born that premature, the odds really aren’t great. The fact that I couldn’t hear the baby’s heartbeat on my probe made me feel even more despairing of the poor little mite’s chances. Miscarriages before 12 weeks are common and heartbreaking, but losing a pregnancy after 25 long weeks must be absolutely horrendous.

As I was sorting out the last of my paperwork at the end of surgery, I decided to call the obstetric registrar at the hospital to find out what was happening.

‘Are you the GP that sent that woman in with the premature labour?’

‘Yes, that was me. How is she?’

‘Well, you didn’t quite get the diagnosis right.’

‘What do you mean?’

‘She had pseudocyesis.’

‘Oh… could you just remind me what that is?’

The obstetric registrar paused for effect and then gave a sigh. ‘It was a pretend pregnancy. As her GP we thought you might have managed to at least do a pregnancy test before getting all excited and sending the nee-naws screaming round with the flashing blue lights.’ With that the obstetric doctor put the phone down, no doubt greatly amused by his successful belittling of me.

Normally I would be irritated at such an unpleasant dressing down by some smug little upstart, but I was absolutely dumbstruck that Karen hadn’t been pregnant. Why had she lied to me? Why had she put herself through such a bizarre and ultimately humiliating experience? My patients fib to me all the time. Mostly they lie about how much they drink or try to con me into believing that their valium prescription had been stolen and they needed some more. It’s been a long time since I routinely took all my patients’ declarations to be wholly truthful, but when Karen told me she was 25 weeks pregnant, I took it completely at face value.

Shocked and upset, I turned to the internet for support and was amazed by how common and powerful false pregnancies can be. For some women the overwhelming desire to believe they are pregnant can even cause their brain to produce the release of hormones that can lead to real pregnancy symptoms such as nausea and bloating. The hormones can stop periods like a real pregnancy would, often fooling everyone around them. Admittedly, the obstetric registrar was right, a pregnancy test would have given the game away, but I have a sneaky suspicion that they only realised that Karen wasn’t really pregnant once they got out the ultrasound scanner.

As a doctor it is never nice to know that you’ve got something completely wrong, but there is an odd reassurance in knowing you are not the only one to have made that mistake. Apparently an obstetrician in the US had been fooled into taking things one step further when a woman with a false pregnancy came in to see her claiming to be nine months pregnant. When the doctor couldn’t find the baby’s heartbeat, the woman was rushed straight to surgery and given an emergency caesarean section in a desperate attempt to save the imaginary baby. It was only when they cut her open and dug around in her abdomen for a bit that they discovered there was in fact no baby to save. Makes my mistake seem relatively trivial in comparison.

I would love to have spoken to Karen again. I wasn’t angry, just confused. Did she really think that she was pregnant? Was it part of some sort of odd delusional belief that was part of a wider mental health problem? Was it just some peculiar form of attention-seeking behaviour? Sadly, I’ve never found out, because Karen never came back to see me.