The evaluation of psychiatrist Ibone Olza has been key in the process of understanding this mental disorder.This case in Costa Rica is a clear example of restorative justice in recognizing that both judicial and healthcare systems failed the woman.
On June 8th, the Court of Justice of San José (Costa Rica) acquitted 35 year-old A.C.B. of all offences and responsibility for the crime of attempted manslaughter homicide of her son, who has just turned seven years of age. The judges have acknowledged, after the analysis of evidence and witnesses, that the woman not only suffered dissociative disorder during childbirth in the context of pregnancy denial, but she was also the victim of obstetric violence due to lack of diagnosis and care in the hospital, which endangered her life and that of her son´s. The expert reports of Ibone Olza, a perinatal psychiatrist and researcher as well as head of the European Institute of Perinatal Mental Health, and her statement as an expert witness before the Court via video conference from the headquarters of the Consulate of Costa Rica in Madrid, have been key in the whole process.
The events occurred on May 5th, 2016. A.C.B. began to feel severe pain in the abdominal area, so she went to the Emergency Department of the Hospital of Alajuela.
There she was told that she had a viral infection and an undetermined intra-abdominal mass and was discharged without any prescribed treatment. Greatly desperate due to increasing pain, the woman asked a friend to help her reach another medical center. During the transfer she felt the urge to defecate and asked to stop somewhere to use a bathroom. They did so at a bank office where A.C.B. gave birth to a baby whom she left in the wastepaper bin. Her lawyer, Vanessa Cascante Alfaro, says “one may certainly think that A.C.B. is a monstrous being, who did not act as she was expected to according to the woman-mother binomial. However, this woman’s conduct could not be judged in a hasty manner, but required an expert to analyse her behaviour and explain why she acted the way she did”.
The previous sentence, issued on September 8th 2021, declared A.C.B. the author of the crime of attempted slaughter to the detriment of her son, imposing an imprisonment of six years, with the possibility of substituting the imposed sentence with house arrest under electronic monitoring. The acquittal, after appealing against this sentence, can be understood as a clear example of restorative justice, recognizing that the woman was a victim of obstetric violence and also suffered from pregnancy denial disorder, a pathology which is still very unknown despite being quite frequent.
Pregnancy Denial Disorder
The first recorded case of pregnancy denial dates back to 1681 in France. It is a psychopathology that is estimated to occur in one out of every 475 pregnancies and in which both women and their family members are unaware of her condition because no physical changes or pregnancy symptoms are observed. In fact, any possible discomfort or pain is usually attributed to intestinal discomfort. Many women, including the case of the Costa Rican woman, continue to use contraceptive methods and present discharges that they confuse with the menstrual cycle, which in many cases are threatened miscarriages.
Pregnancy denial disorder occurs in one out of every 475 pregnancies. In this case, both women and family members are unaware of the condition because no physical changes are observed and no pregnancy symptoms arise; any possible discomfort or pain is usually attributed to intestinal issues.
When childbirth occurs, the woman usually goes into a state of shock and dissociation due to the lack of knowledge of her state; therefore, the person acts automatically in a state of total unconsciousness. Delivery in these cases is usually unassisted, becoming a high-risk situation for the lives of both the baby and mother.
“At the time of delivery the mother displays the symptomatology of the dissociation: she gets rid of the newborn leaving it without thinking about the possible consequences and she acts mechanically. After childbirth, the woman sleeps and subsequently presents retrograde amnesia. The woman suffering from pregnancy denial disorder manifests perplexity during a long time after learning what has happened and also great sadness and guilt for having been able to unintentionally harm her child. Subjecting a woman to a judicial process of such characteristics is not only unfair but also harms the bond between mother and child”, explains Ibone Olza.
Currently, A.C.B.’s son is a healthy and beloved child, deeply attached to his mother, and cared for by her and his maternal grandparents.