Tokophobia

Last updated
Tokophobia
Other namesTocophobia, 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]

Contents

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]

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. [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 symtoms and fears.

Cause

Reasons for tokophobia can be complex, and are associated with a lack of social support, and with stress, depression and anxiety. [11]

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].

Risks

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]

Terminology

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 "maleusiophobia" (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]

See also

Related Research Articles

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<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

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.

<span class="mw-page-title-main">Caesarean section</span> Surgical procedure in which a baby is delivered through an incision in the mothers abdomen

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. 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.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

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 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.

<span class="mw-page-title-main">Childbirth</span> Expulsion of a fetus from the pregnant mothers uterus

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.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression has been known to be called many different names such as the following: Postpartum blues, baby blues, and maternity blues. This is all 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.

<span class="mw-page-title-main">Doula</span> Non-medical companion who supports a person through significant health-related experiences

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 might also provide support to the client's partner, family, and friends.

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.

<span class="mw-page-title-main">Pregnancy</span> Time of offspring development in mothers body

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.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

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.

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.

The visual analogue scale (VAS) is a psychometric response scale that can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end points.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

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.

Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.

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.

References

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  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. ↑ Dencker, Anna; Nilsson, Christina; Begley, Cecily; Jangsten, Elisabeth; Mollberg, Margareta; Patel, Harshida; Wigert, Helena; Hessman, Eva; Sjöblom, Helen; Sparud-Lundin, Carina (2019). "Causes and outcomes in studies of fear of childbirth: A systematic review". Women and Birth. 32 (2): 99–111. doi:10.1016/j.wombi.2018.07.004. ISSN   1871-5192.
  4. ↑ SYDSJÖ, GUNILLA; SYDSJÖ, ADAM; GUNNERVIK, CHRISTINA; BLADH, MARIE; JOSEFSSON, ANN (2011-10-10). "Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy". Acta Obstetricia et Gynecologica Scandinavica. 91 (1): 44–49. doi:10.1111/j.1600-0412.2011.01242.x. ISSN   0001-6349.
  5. 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.
  6. 1 2 Waldenström, U; Hildingsson, I; Ryding, EL (2006-05-18). "Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth". BJOG: An International Journal of Obstetrics & Gynaecology. 113 (6): 638–646. doi:10.1111/j.1471-0528.2006.00950.x. ISSN   1470-0328.
  7. ↑ Dencker, Anna; Nilsson, Christina; Begley, Cecily; Jangsten, Elisabeth; Mollberg, Margareta; Patel, Harshida; Wigert, Helena; Hessman, Eva; Sjöblom, Helen; Sparud-Lundin, Carina (2019). "Causes and outcomes in studies of fear of childbirth: A systematic review". Women and Birth. 32 (2): 99–111. doi:10.1016/j.wombi.2018.07.004. ISSN   1871-5192.
  8. ↑ Hilpern, Kate (28 May 2003). "Hard labour". theguardian.com. Retrieved 13 December 2015.
  9. ↑ 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.
  10. ↑ "Fear of Childbirth, Lecture by Astrid Osbourne, Consultant Midwife" on YouTube
  11. ↑ Dencker, Anna; Nilsson, Christina; Begley, Cecily; Jangsten, Elisabeth; Mollberg, Margareta; Patel, Harshida; Wigert, Helena; Hessman, Eva; Sjöblom, Helen; Sparud-Lundin, Carina (2019). "Causes and outcomes in studies of fear of childbirth: A systematic review". Women and Birth. 32 (2): 99–111. doi:10.1016/j.wombi.2018.07.004. ISSN   1871-5192.
  12. ↑ "maieusis". www.perseus.tufts.edu. Retrieved 13 December 2015.
  13. ↑ Bainbridge, David (2001). Making Babies: The Science of Pregnancy. Cambridge: Harvard University Press. p. 214. ISBN   0674006534.

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