DOMINIQUE COTTREZ, Véronique Courjault, Céline Lesage: three seemingly ordinary women who share a grim alliance.

In cases that have horrified people in their native France, and across the world, each woman has admitted to the killing of her newborn babies.

The latest case, that of 45-year-old Dominique Cottrez, was uncovered this week. The new owners of Cottrez’s previous home made a gruesome discovery when digging in the back garden to make a pool: the remains of two tiny bodies.

When police searched the home in which Cottrez now lives with her husband, Pierre-Marie, they found six more sets of remains wrapped in plastic bags.

Cottrez, who has two adult daughters, has admitted to smothering eight newborns between 1989 and 2006.

In a similar case last March, also in France, 38-year-old Céline Lesage was found guilty of killing six of her newborn babies. Last year, 42-year-old Véronique Courjault was found guilty of murdering three of her newborns.

But the cases are not confined to France, and neither is the psychological condition – pregnancy denial – that experts say led these women to committing infanticide.

What is pregnancy denial?

According to experts, pregnancy denial is a complex mental condition which results in a woman having a lack of awareness of being pregnant.

“Denial” is a more serious condition than may first be understood. It is not a simple, dismissive attitude to the news of a pregnancy, but has been described as an “unconscious defence mechanism characterized by refusal to acknowledge painful realities, thoughts, or feelings.”

A women suffering from this condition can experience it in a range of forms and to different degrees of severity, according to experts.

What are the forms of pregnancy denial?

According to the American Psychiatric Association, there are three forms of pregnancy denial:

1.  Pervasive denial

Pervasive denial “occurs when not only the emotional significance but the very existence of the pregnancy is kept from awareness.”

It can mean that bodily changes and even labour pains can be misinterpreted, meaning the woman can be first consciously aware of having been pregnant only after giving birth. However the trauma involved can mean that a woman can fail to recognise the newborn as a “real” baby.

Speaking to FRANCE 24, president of the French Association for the Recognition of Pregnancy Denial, Felix Navarro said:

One must understand the circumstances under which these situations arise. A woman who has total pregnancy denial suffers terribly painful symptoms that she doesn’t understand. Her water breaks and she sees something coming out of her body: something she can’t fully discern, something that is sometimes inanimate and that the woman doesn’t necessarily identify as a baby.

2. Affective denial

In cases of “affective denial” women are aware of their pregnancy but they make little emotional or physical preparation for it and “continue to think, feel, and behave as though they were not pregnant.”

This is commonly displayed in women who have substance abuse  problems and who may continue drinking or taking drugs during their pregnancy.

3. Psychotic denial

This form of denial occurs in women who suffer from psychosis and have previously lost custody of other children.

How common is it?

According to the British Medical Journal (BMJ); “The common view that denied pregnancies are exotic and rare events is not valid.”

The BMJ concludes that the ratio of pregnancy denial is about one to every 475 births, according to a study based in Berlin over a one year period.

Based on that study, the BMJ calculated that:

In about 1600 births the mother would not have been aware of her pregnancy at 20 weeks of gestation, or later—and each year 300 women would not have realised they were pregnant until going into labour.

What causes it?

The causes seem to be wide and varied, but often appear to be rooted in an early trauma or a mental illness.

Speaking to Time magazine, Michel Delcroix, a former gynecologist who served as a court expert in the Véronique Courjault trial, said the condition can be caused by a woman having experienced physical abuse or rape.

A French study of 22 women with the condition found that the phenomenon was common among young women who are experiencing their first pregnancy. The study noted that one-fifth had been abused.

A German study that included 65 women with the condition found that some of the women had schizophrenia, personality disorders, diminished intelligence, or substance-abuse disorders.

Various studies into the disorder have concluded that women from a range of socio-economic backgrounds experienced pregnancy denial.

Is there treatment?

Experts warn that many women who have experienced pregnancy denial are never referred for psychological screening.

Many women in denial of their pregnancies present themselves at hospital before giving birth (because of intense pain) and, while drug test are sometimes performed, few ever receive psychiatric evaluations.

Nada Stotland, vice president of the APA, told Medscape that women – and sometimes their partners – need to be referred to psychiatrists after experiencing pregnancy denial, something which rarely happens.

She explained: “It takes some psychic effort not to notice that you are pregnant – or that a family member or loved one is pregnant.”

She appealed to medical staff to refer patients to psychiatrists when they display pregnancy denial.