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Tokophobia | |
---|---|
Other names | Tocophobia, maieusiophobia, parturiphobia |
Treatment | Counselling [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. [3] Factors often include a fear of pain, death, unexpected problems, injury to the baby, sexual problems and a lack of self-belief of the capacity to birth a child. [4] 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. [5]
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. [6] Often the fear of childbirth motivates a request for an elective caesarean section. [7] 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. [8] Recognition of tokophobia and close liaison with obstetricians or other medical specialists can help to reduce its severity and ensure efficient treatment. [9] [10]
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 symptoms and fears.
Reasons for tokophobia can be complex, and are associated with a lack of social support, and with stress, depression and anxiety. [11]
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.
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].
Unaddressed tokophobia may lead to termination of pregnancy, a prolonged labour, epidural use and complications during childbirth. Tokophobia is also associated with postpartum depression and post-traumatic stress disorder (PTSD). [6]
The term tokophobia was introduced in the medical literature in 2000. [5] The word is from the Greek tokos, meaning childbirth and phobos, meaning fear. [5]
It is also known as "maieusiophobia" (though this is certainly a variant of "maieusiophobia", from the Greek "maieusis", literally meaning "delivery of a woman in childbirth" [12] but referring generally to midwifery), "parturiphobia" (from Latin parturire , meaning "to be pregnant"), and "lockiophobia". [13]
Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.
Hypnotherapy, also known as hypnotic medicine, is the use of hypnosis in psychotherapy. The efficacy of hypnotherapy is not well supported by scientific evidence, and, due to the lack of evidence indicating any level of efficacy, it is regarded as a type of alternative medicine by reputable medical organisations such as the National Health Service.
A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.
Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.
Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.
Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.
Postpartum depression (PPD), also called postnatal depression, is a mood disorder experienced after childbirth, which can affect men and women. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.
Ergophobia is described as an extreme and debilitating fear associated with work, a fear of finding or losing employment, or fear of specific tasks in the workplace. The term ergophobia comes from the Greek "ergon" (work) and "phobos" (fear).
Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.
A maternal bond is the relationship between a biological mother/caregiver and her child or baby. While typically associated with pregnancy and childbirth, a maternal bond may also develop in cases later on in life where the child is unrelated, such as in the case of an adoptee or a case of blended family.
Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.
Psychiatric disorders of childbirth, as opposed to those of pregnancy or the postpartum period, are psychiatric complications that develop during or immediately following childbirth. Despite modern obstetrics and pain control, these disorders are still observed. Most often, psychiatric disorders of childbirth present as delirium, stupor, rage, acts of desperation, or neonaticide. These psychiatric complications are rarely seen in patients under modern medical supervision. However, care disparities between Europe, North America, Australia, Japan, and other countries with advanced medical care and the rest of the world persist. The wealthiest nations represent 10 million births each year out of the world's total of 135 million. These nations have a maternal mortality rate (MMR) of 6–20/100,000. Poorer nations with high birth rates can have an MMR more than 100 times higher. In Africa, India & South East Asia, as well as Latin America, these complications of parturition may still be as prevalent as they have been throughout human history.
Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).
Antenatal depression, also known as prenatal or perinatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed or stressed mother feels the affects. The child is less active and can also experience emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, but at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.
Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.
Pregnancy-related anxiety is a distinct anxiety contextualized by pregnancy specific fears, worries, and concerns. Pregnancy-related anxiety is characterized by increased concerns or excessive fears and worries about their unborn baby, childbirth, body image, and impending motherhood. This anxiety is also known as pregnancy-specific anxiety, pregnancy anxiety, pregnancy distress, or pregnancy concerns and was first identified in 1956 when women were observed to be anxious about different aspects of their pregnancy. However, it was not until conventional measures of anxiety and depression were shown to not adequately capture this anxiety that the first empirical evidence was provided. Subsequent studies have provided further support for the distinctiveness of pregnancy-related anxiety from state and trait anxiety, depression and anxiety disorder symptomology.
Birthing classes are classes to help parents to prepare for the birth of a baby and the first cares of a newborn, and a birth plan is a document created by a pregnant woman detailing her decisions and expectations regarding her labor and childbirth.