Tokophobia Explained

Tokophobia
Synonyms:	Tocophobia, maieusiophobia, parturiphobia
Treatment:	Counselling
Frequency:	~14% of women^[1]

Tokophobia is a significant fear of childbirth.^[2] 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.^[2]

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]

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.

Cause

Reasons for tokophobia can be complex, and are associated with a lack of social support, and with stress, depression and anxiety.^[10]

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).

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 "maieusiophobia" (though this is certainly a variant of "maieusiophobia", from the Greek "maieusis", literally meaning "delivery of a woman in childbirth"^[11] but referring generally to midwifery), "parturiphobia" (from Latin parturire, meaning "to be pregnant"), and "lockiophobia".^[12]

See also

• Anxiety disorder
• List of phobias
• Blood-injection-injury type phobia
• Psychiatric disorders of childbirth

References

• 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.
• 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
• 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.
• Nilsson C, Lundgren I, Karlström A, Hildingsson I. Self-reported fear of childbirth and its association with women's birth experience and mode of delivery: a longitudial population-based study. Women and Birth 2012;25:114-121
• 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.
• Rondung E, Thomtén J & Sundin Ö. Psychological perspectives on fear of childbirth. Journal of Anxiety Disorders. 2016;44:80–91.
• 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 Gynaecology 2011; 118:1104-1111.
• 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, pp. 97-115
• SFOG. (Svensk förening för Obstetrik och Gynekologi [Swedish Society of Obstetrics & Gynecology]. Förlossningsrädsla [Childbirth fear]. Report No: 77. Stockholm: 2017.
• 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), pp. 237-258
• 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.

External links

• Tokophobia: scared of giving birth?
• Tokophobia: what it’s like to have a phobia of pregnancy and childbirth

Notes and References

1. O'Connell. Maeve A.. Leahy-Warren. Patricia. Khashan. Ali S.. Kenny. Louise C.. Louise Kenny. O'Neill. Sinéad M.. Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica. 96. 8. 2017. 907–920. 0001-6349. 10.1111/aogs.13138. 28369672. free. 10468/4050. free.
2. Wax. JR. Cartin. A. Pinette. MG. Blackstone. J. Patient choice cesarean: an evidence-based review.. Obstetrical & Gynecological Survey. August 2004. 59. 8. 601–16. 15277895. 10.1097/01.ogx.0000133942.76239.57. 21956472.
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 . 10.1016/j.wombi.2018.07.004 . 30115515 . 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 . 10.1111/j.1600-0412.2011.01242.x . 21787365 . 0001-6349.
5. Tokophobia: an unreasoning dread of childbirth. Kristina. Hofberg. I. F.. Brockington. British Journal of Psychiatry. 1 January 2000. 176. 1. 83–85. 4 February 2017. bjp.rcpsych.org. 10.1192/bjp.176.1.83. 10789333. free.
6. 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 . 10.1111/j.1471-0528.2006.00950.x . 16709206 . 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 . 10.1016/j.wombi.2018.07.004 . 30115515 . 1871-5192.
8. Web site: Hilpern. Kate. Hard labour. theguardian.com. 13 December 2015. 28 May 2003.
9. Book: Roland-Price. Anna. Chamberlain. Zara. Karoshi. Mahantesh. Newbold. Sandra. B-Lynch. Christopher. 3 . Keith. Louis G.. A Textbook of Preconceptional Medicine and Management. 2012. Sapiens Publishing Ltd. UK. 978-0-9552282-4-7. 281–288. 13 December 2015. Management of tocophobic women.
10. 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 . 10.1016/j.wombi.2018.07.004 . 30115515 . 1871-5192.
11. Web site: maieusis. www.perseus.tufts.edu. 13 December 2015.
12. Book: Bainbridge. David. Making Babies: The Science of Pregnancy. 2001. Harvard University Press. Cambridge. 0674006534. 214.