Tokophobia
Other namesTocophobia, maieusiophobia, parturiphobia
TreatmentCounselling[1]
Frequency~14% of women[2]

Tokophobia is a significant fear of childbirth.[1] It is a common reason why some women request an elective cesarean section.[1] The fear often includes fear of injury to the baby, genital tract, or death.[1] Treatment may occur via counselling.[1]

It is a type of specific phobia. In 2000, an article published in the British Journal of Psychiatry described the fear of childbirth as a psychological disorder that has received little attention and may be overlooked.[3]

Signs and symptoms

Phobia of childbirth, as with any phobia, can manifest through a number of symptoms including nightmares, difficulty in concentrating on work or family activities, panic attacks and psychosomatic complaints. Often the fear of childbirth motivates a request for an elective caesarean section.[4] Fear of labor pain is strongly associated with the fear of pain in general; a previous complicated childbirth, or inadequate pain relief, may cause the phobia to develop. A fear of pregnancy itself can result in an avoidance of pregnancy or even, as birth control methods are never 100% effective, an avoidance of sexual intercourse or asking for sterilization, e.g. via hysterectomy.

Tokophobia is a distressing psychological disorder which may be overlooked by medical professionals; as well as specific phobia and anxiety disorders, tokophobia may be associated with depression and post-traumatic stress disorder.[5] Recognition of tokophobia and close liaison with obstetricians or other medical specialists can help to reduce its severity and ensure efficient treatment.[6][7]

The causes of tokophobia are complex and unique for every woman. Ways of treating tokophobia need to be investigated further but a number of psychological interventions including psychoeducation [18], cognitive behavioural therapy, enhanced midwifery care [19], psychodynamic therapy and eye movement desensitisation and reprocessing therapy [20], have been found to reduce FOC in pregnant women. More tailored support needs to be developed since not all women have the same type of symtoms and fears.

Cause

Reasons for tokophobia can be complex. Women may fear for the infant's life, fear the unknown and fear the uncertainty of the labour and birth process. Women may develop tokophobia based on previous traumatic birth and delivery processes. Women may lack trust in obstetric services, or fear being left alone while in labour. Tokophobia incorporates fear and anxiety on a continuum, where the fear ranges from mild to severe and disabling. Tokophobia can lead to avoidance of pregnancy, e.g., preconception fear of childbirth and not to prefer giving birth vaginally [12-14]. If the fear during pregnancy is left untreated, there is an increased risk for developing pregnancy-specific anxiety, which is associated with impaired neuro-emotional development in newborns [15-16]. With increased distress and anxiety during pregnancy there is a risk that it will also interfere with the woman’s ability to cope with everyday life and preparation to become a mother [17].

Primary tokophobia

Primary tokophobia is the fear and deep-seated dread of childbirth in women who have never experienced birth. It may pre-date pregnancy and can start in adolescence or begin in pregnancy. This may relate back to their own mother's experience or be triggered by exposure to childbirth without adequate explanation at a young age. It may also be experienced by women who have been sexually abused or raped; childbirth could trigger flashbacks in women who are traumatised.

Secondary tokophobia

For parous women, a previous negative birth experience is often the underlying cause of fear of childbirth (tokophobia). Sometimes the negative birth experience is strongly correlated to having experienced imminent danger to the health of the child, such as having an emergency caesarean section [10-11].

Terminology

The term tokophobia was introduced in the medical literature in 2000.[3] The word is from the Greek tokos, meaning childbirth and phobos, meaning fear.[3]

It is also known as "maleusiophobia" (though this is certainly a variant of "maieusiophobia", from the Greek "maieusis", literally meaning "delivery of a woman in childbirth"[8] but referring generally to midwifery), "parturiphobia" (from Latin parturire, meaning "to be pregnant"), and "lockiophobia".[9]

See also

References

  1. 1 2 3 4 5 Wax, JR; Cartin, A; Pinette, MG; Blackstone, J (August 2004). "Patient choice cesarean: an evidence-based review". Obstetrical & Gynecological Survey. 59 (8): 601–16. doi:10.1097/01.ogx.0000133942.76239.57. PMID 15277895. S2CID 21956472.
  2. ↑ O'Connell, Maeve A.; Leahy-Warren, Patricia; Khashan, Ali S.; Kenny, Louise C.; O'Neill, Sinéad M. (2017). "Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis". Acta Obstetricia et Gynecologica Scandinavica. 96 (8): 907–920. doi:10.1111/aogs.13138. hdl:10468/4050. ISSN 0001-6349. PMID 28369672.
  3. 1 2 3 Hofberg, Kristina; Brockington, I. F. (1 January 2000). "Tokophobia: an unreasoning dread of childbirth". British Journal of Psychiatry. 176 (1): 83–85. doi:10.1192/bjp.176.1.83. PMID 10789333. Retrieved 4 February 2017 – via bjp.rcpsych.org.
  4. ↑ Garrod, Debbie (December 2011). "Rebuilding confidence in women's abilities in birth". British Journal of Midwifery. 19 (12): 830. doi:10.12968/bjom.2011.19.12.830.
  5. ↑ Hilpern, Kate (28 May 2003). "Hard labour". theguardian.com. Retrieved 13 December 2015.
  6. ↑ Roland-Price, Anna; Chamberlain, Zara (2012). "Management of tocophobic women". In Karoshi, Mahantesh; Newbold, Sandra; B-Lynch, Christopher; et al. (eds.). A Textbook of Preconceptional Medicine and Management (PDF). UK: Sapiens Publishing Ltd. pp. 281–288. ISBN 978-0-9552282-4-7. Retrieved 13 December 2015.
  7. ↑ "Fear of Childbirth, Lecture by Astrid Osbourne, Consultant Midwife" on YouTube
  8. ↑ "maieusis". www.perseus.tufts.edu. Retrieved 13 December 2015.
  9. ↑ Bainbridge, David (2001). Making Babies: The Science of Pregnancy. Cambridge: Harvard University Press. p. 214. ISBN 0674006534.

10. Lyberg A, Dahl B, Haruna M, Takegata M, Severinsson E. Links between patient safety and fear of childbirth - A meta-study of qualitative research. Nursing Open 2019;6:18-29

11. Nilsson C, Lundgren I, Karlström A, Hildingsson I. Self-reported fear of childbirth and its association with women´s birth exerience and mode of delivery: a longitudial population-based study. Women and Birth 2012;25:114-121

12. Rondung E, Thomtén J & Sundin Ö. Psychological perspectives on fear of childbirth. Journal of Anxiety Disorders. 2016;44:80–91.

13. Rouhe H, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. British Journal of Obstetrics and Gyneacology 2011; 118:1104-1111.

14. SFOG. (Svensk förening för Obstetrik och Gynekologi [Swedish Society of Obstetrics & Gynecology]. Förlossningsrädsla [Childbirth fear]. Report No: 77. Stockholm: 2017.

15. Erickson NL, Gartstein MA, Dotson JAW. Review of Prenatal Maternal Mental Health and the Development of Infant Temperament. J Obstet Gynecol Neonatal Nurs. 2017 Jul-Aug;46(4):588-600.

16. Van den Bergh B R H, Mulder E J H, Mennes M, Glover V. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and the child: links and possible mechanisms. A review. Neuroscience and biobehavioral reviews, 2005, Vol.29 (2), p.237-258

17. O´ Connell M A, Leahy-Warren P, Khashan A S, Kenny L C, O´Neill SM. Worldwide prevalence of tochophobia in pregnant women: systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017;96:907-920.

18. Striebich S, Mattern E, Ayerle G M. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia – A systematic review of approaches and interventions. Midwifery, 2018, Vol.61, p.97-115

19. Webb R, Bond R, Romero-Gonzalez B, Mycroft R, Ayers S. Interventions to treat fear of childbirth in pregnancy: a systematic review and meta-analysis. Psychological medicine. 2021;51(12):1964-1977.

20. Moghaddam Hosseini V, Nazarzadeh M, Jahanfar S. Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials. Women and Birth 2017;31(4):254–62.

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