Pregnancy and the birth of a child are commonly seen as one of the most beautiful and intense moments of one’s life. However, especially for women, these require considerable physical, psychological and social adaptation.
Becoming a mother requires learning new skills and increasing responsibility. It represents one of the most significant transition phases of adult life.
During the first trimester many physical symptoms often occur (nausea, fatigue, pain) and thoughts are focused mainly on oneself. The fear of childbirth (also called tocophobia) takes over .
In the second trimester, awareness of the baby’s movements and emotions arising from the realization of the fetus as an independent individual begins to emerge. The woman begins to savor the concept of motherhood and adapts to the internalized conceptions of parenthood. L ‘ anxiety is often lived in unconscious level in the first quarter. Then it is replaced by more specific concerns about the baby and the practical preparation of things that will be needed after birth. This phase is usually full of positive energy (Rouhe, 2015).
The last trimester of pregnancy is a time of preparation for childbirth in which interest in the surrounding situations is reduced. There is a greater focus on birth. Thus also the anxieties and fears for the birth itself arise . With the birth, the woman prepares to “loosen” the symbiotic relationship formed in pregnancy with the fetus and to give her partner the space to create the relationship with the child (Rouhe, 2015).
Symptoms of the fear of childbirth
The fear of childbirth or tocofobia causes intense anxiety, pain or fear that develops during pregnancy and is characterized by “avoidance” of childbirth. According to studies, 5% to 16% of pregnant women suffer from this specific phobic state (Adams et al., 2012).
In clinical practice, the phobia of childbirth is mainly self-reported and there are no guidelines or diagnostic criteria to evaluate it. In some cases this phobic state is severe, causing anxiety, physical ailments and nightmares during pregnancy. The tocofobia leads to avoid facing the dreaded event, namely the natural childbirth. Those with this fear often want to give birth by caesarean section or ask for help to alleviate this specific fear.
Each birth carries a risk for both the mother and the baby, although the risk is very small in Western countries. In fact, morbidity is much higher in caesarean sections than in natural ones (Rouhe 2011).
The fear of pain during labor appears to be strongly associated with the fear of the pain in general. It is one of the most common reasons behind the request for a caesarean section in those who are afraid of childbirth . This can therefore be viewed in this sense as pain avoidance behavior.
Fear of primary and secondary childbirth
In the literature, tocophobia can be distinguished into primary and secondary tocophobia. The first is characterized by a terror and intense suffering for childbirth before conception. The second condition is found mainly as a consequence of previous traumatic experiences related to childbirth.
For example, conditions such as having complex and prolonged labor, the need for invasive obstetric maneuvers, or an emergency caesarean section performed in critical conditions. The perception by the parturient that she has suffered violence against her own body can represent a risk factor. This is also the case in which the birth has had a regular course. In some cases it can lead to post-traumatic stress disorder or postpartum depression .
Who suffers from tocophobia
The fear of childbirth seems to be associated with personalities prone to anxiety, the most vulnerable, with low self-esteem and a history of traumatic events. But there are also contradictory findings on mental health problems in women with this fear (Jokic-Begic N. et al. 2014). Studies have shown the connection between tocophobia and mental health problems, such as depression , anxiety disorders and eating disorders . However, there are also findings that suggest that only a small fraction of fear is related to anxiety and depression.
The fear of childbirth seems to be related to factors such as:
- the fear and mistrust about the skills and competences of the obstetric staff
- the fear of pain and the fear of losing control associated with the event
- fear of dying in childbirth or that one’s child will die (Sjögren, 1997).
Obstetric complications and fear of dying are significantly related to tocophobia . In the literature it is documented how some women come to resort to voluntary termination of pregnancy for fear of childbirth. This especially following a traumatic birth event.
The social and cultural background related to the fear of childbirth often includes terrifying stories or negative experiences related to childbirth, told by friends, relatives or read on forums or contacts found on the Internet.
Sometimes women with tocophobia have been traumatized in childhood from childbirth experiences reported by their mothers or acquaintances.
Sexual, physical and emotional abuse suffered by women in childhood or adolescence also appears to be common in those with fears of childbirth . Abused women seem to require more caesarean section than the general population and often symptoms of tocophobia resulting in avoidance.
Prevention and treatment of the fear of childbirth
Numerous studies have shown that social support and support, in addition to emotional support, are protective factors for pregnant women and for tocophobia .
Good partner support is significant during pregnancy and childbirth. If the partner is depressed, the woman is also more likely to have depressive symptoms. Additionally, marital problems or being a single mother are risk factors for postnatal depression .
From a treatment point of view it is possible first of all to think about the importance of primary and secondary prevention interventions. Psycho-education interventions, relaxation training and individual cognitive behavioral psychotherapy are also useful .
The training of operators who work with women in the various stages of accompaniment to motherhood allows to identify those who could develop the fear of childbirth and to intervene early on the symptoms. Furthermore, an effective and clear communication from the medical staff allows to help the woman to be more aware and increase her perception of control.
