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Mental health issues
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
Secondary tokophobia is severe fear of childbirth that arises subsequent to a previous traumatic birth. This can include a miscarriage, a stillbirth and any other version of childbirth trauma, such as a difficult instrumental delivery, an emergency CS or a serious postpartum haemorrhage. It is important to remember that what is perceived as a traumatic birth will vary hugely from one person to another. It is more common in women who are naturally anxious and the prevalence is approximately 14% of women, although there is a variation from one country to another (O’Connell 2017). Secondary tokophobia may not necessarily manifest in pregnancy because women may avoid getting pregnant after their previous experience.
The context of birth
Published in Helen Baston, Midwifery, 2020
Not all women can anticipate birth positively. Some women experience a severe fear of childbirth or tokophobia (Aksoy et al. 2015). According to a systematic review and meta-analysis (O’Connell et al. 2017), approximately 14 per cent of pregnant women worldwide have tokophobia, which is a phenomenon that is increasing. Symptoms include avoidance thoughts and behaviours to the extent that woman may put off becoming pregnant for many years or remain childless. It is more common in women expecting their first baby and those who have low self-esteem, anxiety and low partner and social support (Calderani et al. 2019). Tokophobia can be primary in women who do not have children, or secondary in response to a previous traumatic event. It is difficult to quantify how much tokophobia contributes to a request for caesarean birth for non-medical reasons, as some fear may relate specifically to fear of vaginal birth. A systematic review (Olieman et al. 2017) reports a rate of 1–9 per cent although the subsequent impact on maternal health is unclear.
Education and support for women with fear of childbirth
Published in Mary L. Nolan, Parent Education for the Critical 1000 Days, 2020
Abnormal fear of childbirth is given the clinical designation of tokophobia. Some women are so frightened of labour that they choose never to have children, or delay pregnancy until the biological clock is ticking towards the twelfth hour and their own strong desire to have a child, or their partner’s, persuades them to try to overcome their fear and embark on a pregnancy.
Trans and non-binary pregnancy, traumatic birth, and perinatal mental health: a scoping review
Published in International Journal of Transgender Health, 2020
Perinatal mental health (PMH) difficulties impact one in five birthing cisgender (cis) women (NICE, 2014). In addition, 5–15% of cis fathers experience perinatal depression and anxiety (Cameron et al., 2016; Leach et al., 2016). Relevant too are severe fear of childbirth (tokophobia) and traumatic birth. Up to 30% of birthing parents in the UK experience childbirth as a traumatic event, with many subsequently experiencing anxiety, depression, or post-traumatic stress disorder (PTSD) (Slade, 2006). Figures are comparable across countries with similar healthcare systems, 24% in Australia (Toohill et al., 2014) and 34% in the United States (Soet et al., 2003). If left untreated, traumatic birth poses long-term effects, including enduring mental health difficulties, depression in partners, compromised parent-infant and inter-parent relationships, and challenging future reproductive decisions (Greenfield et al., 2016). Partners may themselves experience birth as traumatic (Leach et al., 2016).
Art Therapy and Counseling for Fear of Childbirth: A Randomized Controlled Trial
Published in Art Therapy, 2020
Helén Wahlbeck, Linda J. Kvist, Kajsa Landgren
Fear of childbirth (FOC), also referred to as tokophobia, is related to feelings of limited capability in the face of childbirth and affects the pregnant woman’s quality of life. It is more common in nulliparous women but can also be related to earlier traumatic birth experiences (O’Connell, Leahy-Warren, Khashan, Kenny, & O’Neill, 2017). The prevalence of FOC varies between 5.5 and 26.2%, depending on definition and cutoff points in different studies using the Wijma Delivery Expectancy Questionnaire (W-DEQ) instrument (Wijma, Wijma, & Zar, 1998). A meta-analysis has estimated the global pooled prevalence rate of FOC as 14% (O’Connell et al., 2017).
Investigating fear of childbirth in pregnant women and its relationship between anxiety sensitivity and somatosensory amplification
Published in Journal of Obstetrics and Gynaecology, 2021
Asli Enzel Koc, Sabri Colak, Gamze Vesile Colak, Meltem Pusuroglu, Cicek Hocaoglu
Fear of childbirth was first described by Marce in 1859 as the excessive focus of mothers on pain (Richens et al. 2018). The mother is very much focussed on pain, an uncertain condition for herself. If she gave birth earlier, she is in extreme fear of what should be waiting for her. Most typically, this fear occurs after a traumatic birth. However, it may occur after a normal birth, miscarriage, stillbirth, and termination of pregnancy and is called secondary fear of childbirth (Hofberg and Brockington 2000; Hofberg and Ward 2004; Bhatia and Jhanjee 2012). Women who have not previously given birth may be overwhelmed by fear of what might happen during childbirth. It usually begins in adolescence or early adulthood and is called fear of primary birth. Sometimes prenatal depression may present itself with fear of birth. 5–25% of pregnant women have a fear of birth, and 6% of them experience a decline in this level of functionality. This may have severe consequences for mother and newborn health (Di Renzo 2003; Hofberg and Ward 2004). Severe fears exist that the mother will not be able to give birth or that she or her baby will be harmed. The belief that she will be harmed can be shaped by the impact of the social environment and the past traumatic life events (Hofberg and Ward 2004; Billert 2007). The content of the fear of childbirth has expanded over time. It is no longer just a pregnancy-specific definition. Today, fear of childbirth (tocophobia) is generally defined as a fear of severe birth and fear of pathological birth (Richens et al. 2018). It was reported in the studies that fear of childbirth may lead to the use of contraceptives in the long term, complications of pregnancy and birth, increased use of analgesia at birth, increased birth interventions, urgent and optional caesarean section, postpartum depression, posttraumatic stress disorder, delay in maternal-infant attachment, and problems in the relationship with spouse (Hofberg and Brockington 2000; Hofberg and Ward 2004; Billert 2007; Bakshi et al. 2008; Spice et al. 2009; Mortazavi and Agah 2018). The causes of fear of childbirth are stated as biological reasons (pain), psychological reasons (individual, traumatic events in the past, fear of being a parent) and lack of social support (Richens et al. 2018; Striebich et al. 2018). However, it is not possible to explain the causes of the fear of childbirth in pregnant women and the risk factors affecting them. Therefore, the study of the relationship between fear of childbirth and especially mental symptoms will help to understand this issue.