An Irish midwife recently shared a tragic story on Twitter of two women who had concealed their pregnancies right up until labour, telling no one and giving birth alone.

One woman's baby was dead upon birth and the other woman passed out from the pain, waking to find her baby dead beside her. Neither woman ever told anyone until contacting the midwife on Twitter. Sylvia Murphy-Tighe, a midwifery lecturer at the University of Limerick, along with Joan Lalor from TCD have spent years studying women who concealed their pregnancies. Their findings are that this is very much a contemporary issue happening in Ireland right now. Sadly, the adverse outcomes of concealing a pregnancy can be maternal death, neonatal death, newborn abandonment, and occasionally neonaticide. In 2013, a newborn infant was found dead in Cork after being born in a toilet. The following year a newborn infant's body was found in a bin. Another baby's body was found in Wicklow. Baby Maria found by the roadside in Dublin in 2015 and Baby Allannah found in 2016. It is very possible there are others we don't know about. [caption id="" align="aligncenter" width="960"] Authorities looking for the mother of 'Baby Maria' in 2015[/caption] Sylvia says most pregnant women keep it quiet until they themselves have become comfortable with the idea - with many waiting until 12 weeks before telling others. "It's a healthy thing to keep it a secret until you come to terms with it," she explains. Sylvia adds that concealed pregnancy is, "a complex phenomenon, where a woman is aware of her pregnancy and copes by keeping it secret and hidden." One participant in the study explained "to this day, the official story I tell my family is that I did not know I was pregnant." Plenty of the women interviewed for the Keeping It Secret Study had experienced some form of early life trauma, like sexual assault or child sexual abuse. The early trauma had never been disclosed to anyone and when they found themselves with an unexpected and often unwanted pregnancy they did not feel in control of their bodies or lives.

"It's commonly thought that women who conceal pregnancies have mental health issues but the women say they're not mentally unwell - they all knew they were pregnant, they were just trying to manage their situation by regaining agency over their lives and bodies."

Many of the women interviewed said they did not feel they would be supported socially, or by their family or State, if they disclosed the pregnancy. Sylvia says the bio-medical model of maternal healthcare in Ireland is foetal-centred rather than woman-centred and this can lead to women not wanting to engage at all with the maternity system.

"These women sometimes felt that health professionals and social workers are focused on the infant to the detriment of the care of the woman. They feel that professionals don't have the understanding of concealed pregnancy and adverse early trauma."

One participant in the study said: "The hospital is not set up for vulnerable women, I was clearly vulnerable. I have never experienced such a lack of empathy in my life." In light of the new information provided by the KISS study the HSE guidelines for professionals supporting women who have concealed pregnancies urgently require updating. And there is no social demographic marker of someone more likely to conceal a pregnancy: the KISS study interviewed women who were between 15 and 35 at the time of their pregnancies.

"The notion that only teenagers conceal their pregnancies is a fallacy. "In reality concealed pregnancy crosses many boundaries, and women who conceal their pregnancy are not a homogenous group."

The women in the study were from all social strata and levels of education. Some were married, some had other children and some had Masters degrees. The study found that pregnancies concealed up to five months occur in one in 403 pregnancies in rural areas and one in 625 in urban areas. One in 2,500 conceals up to birth. Four of the women interviewed were experiencing domestic abuse from a controlling partner. Sylvia says of there were a range of outcomes for the women in the KISS study,

"Some women proceeded to mother their babies, some chose adoption, some women described forced adoption, some described forced mothering and there was one infanticide case in the study. "Some women wanted abortions but did not have the finances to get an abortion. Two of the women went to clinics in the UK and then changed their minds. "I interviewed women who were absolutely traumatised by their babies being taken from them, in a forced adoption. And women who were mothers already who felt they just couldn't afford another child."

Concealing a pregnancy can have tragic consequences for both mother and baby. In six of the KISS cases the baby died. "Those women never got help, they never told anyone and they grieved that loss. They blamed themselves, they suffered from Post Traumatic Stress Syndrome and depression, mourning the loss of their baby." In one of the cases the midwife on Twitter described the woman was badly torn as a result of birthing alone and she was too scared to seek any medical help for her injuries. Midwife Pauline describes what happened to one of the women in the 1990s "sitting on the toilet, screaming silently into the bath towel she delivered her baby, she fainted immediately. When she woke on the floor she was confused and didn’t know where she was for a moment and then she remembered and jumped up and lifted her baby out of the toilet.

"The baby was not breathing. She sat and held her baby for a long time. She had to wrap her baby girl's body in newspaper along with the placenta, she never cut the cord. She cleaned the bathroom, cleaned herself, knew she was dreadfully torn, but she had to pretend she was fine. She kept the body hidden for a week, until she thought of what to do. "She took a train and left her home county and had to leave her baby's remains in a random bin, she said she couldn’t bury it in case anyone or any animal found it. "To this day she lives in fear every time someone knocks at her door, scared that her secret will have been uncovered, terrified of being in trouble with the guards. She has lived with this for years."

Sylvia says that we need to re-think the way we talk about and view women who conceal. Women in such situations need accessible, confidential and non-judgemental support and care. Women who experienced a concealed pregnancy and accessed counselling described how it was vital to their wellbeing and helped them make sense of a very difficult experience.

If you have been affected by any of the issues raised please contact:

Irish Family Planning Association on 1850 49 50 51 Samaritans on 116 123 or text 087 2 60 90 90 or email jo@samaritans.ie(01) 671 0071 Pieta House and Women's Aid can also provide support.