Generality
Tocophobia is the pathological fear of childbirth . In some cases, this phobic disorder is a consequence of the psychological and social implications related to the birth of a child . At other times, tocophobia may depend on the idea of not being able to bear the pain of labor .
Fear of childbirth can be influenced by past traumatic experiences (invasive obstetric maneuvers, placental detachment, emergency cesarean section, abortions or extra-uterine pregnancies, etc.) and by listening to testimonies of difficult or complicated births .
Tocophobia can have serious consequences, for example, prolonging labor or predisposing to postpartum depression. For this reason, the doctors and midwives who assist the pregnant woman must be aware of the presentation, the symptoms and the situations that favor the problem. This allows us to put in place a therapeutic plan suitable for guaranteeing a good state of psycho-physical health of the future mother and the unborn child. Some women who suffer from tocophobia find it useful to recount experiences they have experienced or may need to be reassured by gathering information on childbirth (for example, talking to midwives during pregnancy). Other patients may need more targeted treatment, such as some psychotherapy sessions.
If it is not treated and overcome, tocophobia can lead some women to important avoidance strategies, such as deciding not to have children, in order not to face the moment of birth.
What's this
What is Tocophobia?
Tocophobia is the morbid fear of getting pregnant or giving birth .
More specifically, the woman suffering from tocophobia can be terrified:
- From labor and the pain associated with it : in some cases, the fear of childbirth is influenced by the idea of suffering or causing injury to the genital tract ; at other times, this form of phobia is triggered by the thought of hurting the child or even causing death ;
- From the event a real birth : some women are terrified of the coming into the world of a child, up to the point of avoiding it, despite having the desire to become mothers. In this case, tocophobia can be emphasized by the psychological and social implications that follow from the birth of a child.
The recognition of tocophobia and the close collaboration between the figures who assist the pregnant woman during the nine months of pregnancy (obstetricians, gynecologists and other medical specialists) contribute to reducing their severity and guaranteeing effective treatment.
Terminology and synonyms
The term " tocofobia " comes from the union of two Greek words: "tocòs" (childbirth) and "phóbos" (fear, fear), that is " fear of childbirth ".
Tocophobia is also known as parturifobia, locquiofobia and maieusifobia.
Causes and Risk Factors
Tocophobia is a psychological disorder in which the phobic stimulus is represented by pregnancy and / or childbirth . In women who experience this pathological fear, the idea of becoming pregnant or suffering complications during labor are situations experienced with a high level of suffering .
Did you know that…
The disorder has been identified as a phobia in recent times, in 2000, by Dr. Kristina Hofberg. Tocophobia is often an under-diagnosed problem and may not reach the attention of the doctor; in reality, this condition is surprisingly common and it is estimated that it affects 1 in 10 women.
The reasons behind tocophobia can be complex. In many cases, the fear of childbirth is related to the fear of incurring difficult and prolonged labor, injuring the child, suffering injuries to the genital tract or even dying .
Some women who suffer from tocophobia, on the other hand, are terrified of the birth process, understood as something that cannot be predicted with certainty or controlled, especially when one is in the first pregnancy and the experience is completely new. At other times, pregnant women do not trust medical / obstetric services and fear being abused ( obstetric violence ) or left alone at the time of delivery.
Tocophobia can be favored by negative and traumatic experiences experienced in the past: from sexual abuse to exposure to graphic images without adequate communication, from complications incurred in a previous pregnancy to negative health care experience.
Currently, this form of phobia is one of the most frequent indications for elective caesarean section : the programmed birth, in fact, supports, by extension, the woman's request to avoid the labor and birth of the child vaginally, allowing her to face the moment with less risk.
Tocophobia can be distinguished in primary (prior to a pregnancy) or secondary (triggered by a traumatic or complicated delivery).
Primary tocophobia
Primary tocophobia is the fear of childbirth present even before conception and can lead to the renunciation of becoming a parent . This form of the disorder often develops from adolescence and can refer to the experience of one's mother or be triggered by exposure to childbirth, without an adequate explanation at a young age.
Primary tocophobia can be:
- Symptom of an ongoing depression ;
- Consequence of sexual abuse suffered during childhood (note: tocophobia can also be experienced in women who have been raped; in this case, the birth event can trigger flashbacks).
Some women who present primary tocophobia have terminated their pregnancy, while wishing for the arrival of a child.
Secondary tocophobia
Secondary tocophobia is characteristic of nulliparas, that is of women who have never given birth naturally through the vagina. However, the disorder may occur during pregnancies following the first and in pregnant women who have had an unplanned cesarean.
The patients most at risk of tocophobia are those who have had negative and traumatic birth experiences, especially in the case of:
- Invasive obstetric maneuvers (eg manual retraining or curettage without anesthesia);
- Particularly prolonged and difficult labor ;
- Emergency cesarean section, in dramatic conditions (eg placental abruption).
In other cases of tocophobia, the birth was regular, but it is perceived by the woman as a violence to her body, so much to lead to a post-traumatic stress disorder, with consequences of postpartum depression .
Secondary tocophobia can also occur following the refusal to be able to choose the method of performing the delivery (eg by caesarean section or, if natural, with epidural anesthesia).
Tocophobia-related disorders
- The fear of facing painful labor is strongly associated with fear of pain in general.
- Tocophobia can be associated with other mental disorders, such as anxiety disorders, postpartum depression and post-traumatic stress disorder. At the moment, however, there is still little scientific evidence to support these reports.
Symptoms and Complications
Difference with normal childbirth anxiety
Tocophobia should be distinguished from the simple and physiological concern at the thought of childbirth that accompanies the expectant mother during the nine months of pregnancy and the birth of the child. This form of anxiety is very common, especially in the third quarter, and can be considered completely normal. What differentiates the phobic disorder from the usual anxieties experienced by future mothers is the entity with which the fear of childbirth is manifested: some women think that they will die, others imagine an unbearable pain. Tocophobia is therefore an extreme fear .
The most common trait of phobic disorder is the fear of vaginal delivery, without a corresponding fear of completing the pregnancy by caesarean section. However, both perspectives can be equally terrifying.
In other patients, it is the idea of a child growing within them that is profoundly disturbing. At other times, tocophobia can cause the woman to feel dissociated from her body during the birth experience.
Tocophobia: how does it manifest itself?
Women who are afraid of giving birth naturally are convinced that they cannot cope with the pains of labor and / or die during childbirth.
Like other phobias, faced with the feared situation, namely labor and / or childbirth, or at the thought of the same, tocophobia can manifest itself through a series of symptoms including:
- Difficulty concentrating on work or daily activities;
- Nightmares;
- Panic attacks;
- Anguish and nervousness;
- Cry;
- Devaluation or reduction of self-esteem;
- Agitation.
Tocophobia can also induce a series of physiological-somatic disorders, including:
- Increased heart rate;
- Breathless breathing;
- Sense of fainting or dizziness;
- Nausea;
- Feeling of "empty head";
- Dry mouth;
- Excessive sweating;
- Tremors;
- Numbness.
Possible consequences
Tocophobia is a highly debilitating phobic disorder, as it can have serious short and long term adverse effects (during the months of pregnancy and after birth), both on the future mother and on the baby.
The anxious state of the mother can affect, for example, at the time of labor, prolonging it.
After childbirth, on the other hand, the woman can perceive her body as a failure for having made an episiotomy necessary or having consequences such as fecal incontinence or the prolapse exacerbated by an instrumental birth.
Furthermore, in the absence of a therapeutic path that allows to overcome the disorder, tocophobia could:
- Present yourself with worse characteristics in subsequent gestations;
- Condition women to the point of pushing them to avoid a pregnancy, thus renouncing having a desired child, through:
- The adoption of a rigid contraception;
- Abstention from sexual relations;
- The request for permanent sterilization, such as hysterectomy.
Therefore, tocophobia can have a negative impact on the marital and family relationship .
Diagnosis
Fear of childbirth is a specific type of phobia, which must be addressed with the support of the family doctor or gynecologist and the help of psychologists / psychotherapists experienced in the areas of perinatality.
Early diagnosis is essential to understand the reasons behind one's own discomfort and to frame the problem within the patient's life history, identifying its meaning and quantifying its extent, thus offering an opportunity for appropriate intervention.
The correct recognition and management of tocophobia with a psychotherapy path allows us to give the patient the opportunity to face and overcome the problem; the lack of treatment predisposes, on the other hand, those who suffer from this phobia to the risk of continuing the strategy of avoidance (in the form of refusal to undertake other pregnancies, need a planned caesarean section, etc.).
To know
Early diagnosis of tocophobia and referral to a psychotherapist could avoid resorting to a caesarean section.
Treatment and Remedies
The treatment of tocophobia depends on the triggering cause, taking into consideration that the ways in which the problem is managed can vary from woman to woman.
Introduction to the treatment of Tocophobia
It must be considered that, in the psychiatric field, the chosen therapy for phobias is the cognitive-behavioral approach. This path teaches the subject to face and manage the negative and limiting thoughts associated with his fear, through gradual exposure to phobic stimuli. In this way, the person affected by the disorder is exposed to the feared situations with the possibility of learning self-control techniques capable of reducing anxiety and fear.
Clearly, cognitive-behavioral therapy cannot be applied to tocophobia, since the anxiety-inducing stimulus is childbirth and gradual exposure to this is not possible.
The associated negative beliefs can be addressed with other psychotherapy pathways aimed at overcoming this phobia. Depending on the severity of the clinical picture, other different therapeutic options and relaxation techniques (such as autogenic training, breathing exercises, yoga, progressive relaxation, etc.) may also be indicated, even in combination with each other.
When caesarean section is needed
For some women, an elective cesarean section may be necessary. It must be remembered, however, that this is an abdominal surgery and, as such, is far more invasive than vaginal delivery, in addition to requiring a longer stay.
To learn more: Parto Cesareo - Methods, Directions and Risks »In the presence of tocophobia, therefore, the future mother should be offered the possibility of resorting to birth with analgesia, in a welcoming environment. This could be a valid reason to reassure to face the birth with greater serenity.
Prevention: prepared courses
The lack of proper preparation for childbirth can help to accentuate the severity of tocophobia. When there are factors that can predispose to the onset of the problem, therefore, it is important to act at the level of prevention, devoting time to communication, especially with regard to the experience of the birth of one's child. In this sense, attending a birth preparation course can be useful in reducing anxiety, as well as adopting relaxation techniques or practicing yoga, to focus concentration on breathing.
How to deal with Tocophobia
Initial psychological support is of fundamental importance, as tocophobia can have serious consequences on childbirth (prolonging, for example, labor).
For this reason, doctors, midwives and other specialists who assist the future mother during pregnancy should be aware of the presentation, symptoms and situations predisposing the problem. This allows the staff assisting the woman to involve her in planning an appropriate treatment plan, with the aim of facing and overcoming the time of birth with less risk and guaranteeing a good state of health for mother and child.
The recognition of the disorder in the first trimester of pregnancy is sufficient, in most cases, to intervene with a brief period of psychotherapy, to dissolve the inner conflicts related to the experience. This path aims to induce the patient to rationalize her phobia, trying to focus on the possibility of reacting to anxious thoughts and to face the negative beliefs associated with the idea of childbirth and the birth of her child.
