This article needs additional citations for verification .(August 2020)
|Other names||Tocophobia, maieusiophobia, parturiphobia|
|Frequency||~14% of women|
Tokophobia is a significant fear of childbirth.It is a common reason why some women request an elective cesarean section. The fear often includes fear of injury to the baby, genital tract, or death. Treatment may occur via counselling.
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.
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.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.Recognition of tokophobia and close liaison with obstetricians or other medical specialists can help to reduce its severity and ensure efficient treatment.
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 , cognitive behavioural therapy, enhanced midwifery care , psychodynamic therapy and eye movement desensitisation and reprocessing therapy , 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.
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 .
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].
The term tokophobia was introduced in the medical literature in 2000.The word is from the Greek tokos, meaning childbirth and phobos, meaning fear.
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"but referring generally to midwifery), "parturiphobia" (from Latin parturire , meaning "to be pregnant"), and "lockiophobia".
Hypnotherapy is a type of mind–body intervention in which hypnosis is used to create a state of focused attention and increased suggestibility in the treatment of a medical or psychological disorder or concern.
A phobia is an anxiety disorder, defined by a 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 or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother 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 cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, 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.
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 type of mood disorder experienced after childbirth, which can affect both sexes. 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.
A doula is a trained professional who provides expert guidance for the service of others and who supports another person through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such as dying. A doula may also provide support to the client's partner, family, and friends.
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while they are pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.
A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term have a breech baby. Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. Breech births also occur in many other mammals such as dogs and horses, see veterinary obstetrics.
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.
Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.
Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium. Three grades of abnormal placental attachment are defined according to the depth of attachment and invasion into the muscular layers of the uterus:
Caesarean delivery on maternal request (CDMR) is a caesarean section birth requested by the pregnant woman without a medical reason.
A vaginal delivery is the birth of offspring in mammals through the vagina. It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower morbidity and mortality than Caesarean sections (C-sections).
Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.
Sex after pregnancy is often delayed for several weeks or months, and may be difficult and painful for women. Painful intercourse is the most common sexual activity-related complication after childbirth. Since there are no guidelines on resuming sexual intercourse after childbirth, the postpartum patients are generally advised to resume sex when they feel comfortable to do so. Injury to the perineum or surgical cuts (episiotomy) to the vagina during childbirth can cause sexual dysfunction. Sexual activity in the postpartum period other than sexual intercourse is possible sooner, but some women experience a prolonged loss of sexual desire after giving birth, which may be associated with postnatal depression. Common issues that may last more than a year after birth are greater desire by the man than the woman, and a worsening of the woman's body image.
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)
A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.
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.