Behind the fear of childbirth, a real phobia can be hidden, capable of deeply conditioning the life of those who suffer from it. The expert tells us about the causes, consequences and therapies available
Tocophobia is a disorder characterized by an intense and disabling fear of childbirth, which can profoundly influence the pregnancy and the choices of future mothers. To find out more, we interviewed Domenico de Donatispsychiatrist specialized at the School of Psychiatry of the University of Bologna and Serenis Health Director.
To start, could you explain what tocophobia is and what are its main features?
Tocophobia is a specific phobia of the perinatal period which is defined as a serious fear of pregnancy and childbirth. This intense state of anxiety can lead some women to survey of childbirth and pregnancy despite being able to desire a child. Two forms of tocophobia are mainly distinguished: primary tocophobia and secondary tocophobia. There primary tocophobia It concerns women who have not given birth and can already manifest themselves in adolescence or at a young adulthood. It can often derive from the family story by the maternal figure of traumatic parts with the consequent development of fears relating to pregnancy and childbirth. Other times, however, it can unfortunately be conditioned by episodes of sexual abuse suffered in childhood and/or adolescent age.
Primary tocophobia can determine different consequences such as the avoidance of intimate and sexual relationships, an exaggerated attention to contraceptive methods and difficulties in the sexual field (experimenting with conditions such as vaginism).
There secondary tocophobia Instead, it is found in women who have experienced traumatic parts or abortions or even traumatic non -perinatal events. Traumatic aspects concerning previous parts can determine in the woman a marked fear that her life or that of the unborn child may be in danger. It can be characterized by all the symptoms of a classic post-traumatic stress disorder such as amnesia, intrusive thoughts or intrusive memories of the event, sudden crying crisis. Finally, secondary tocophobia can determine the avoidance of further pregnancies or the decision to interrupt the ongoing pregnancy.
As for the content of tocophobia this is very multifaceted and can concern the fear of medical interventions (such as episiotomy), the fear of not having control of the situation, the fear of feeling pain, fear of possible complications for the Unborn child and also the fear of the consequences of childbirth on the sexual sphere.
How widespread is this fear among pregnant women? Are there particularly at risk groups?
In research studies, a very variable prevalence of this condition was found due to the different diagnostic tools used to identify it, but it is estimated that the prevalence may vary from 6% to 14% depending on the type of gravity of the clinical picture.
Several risk factors are identified that can encourage the onset of tocophobia and which are first represented by the presence of previous anxiety and depression disorders. Further risk factors are characterized by the presence of sexual abuse, previous traumatic parts, basic anxious temperament, poor social support, Axogenous family context. In these cases it is good to pay particular attention to the presence of any fears concerning pregnancy and childbirth to investigate the reasons and the degree of suffering that generate and possibly intervene by requesting a psychological and/or psychiatric support.
Is Tocophobia a recent phenomenon has always existed? How can the cultural or social context influence this fear?
Tocophobia is not a recently born phenomenon. Already at the end of the 1700s there are the first medical writings concerning the pathological fear of childbirth. Despite the progress of modern medicine, this disorder is still frequent and for this reason in the last 20 years Research has increased in order to better understand this problem.
The cultural and social context can affect this type of disorder primarily through the risk factors already described such as poor social support and family contexts particularly anxious or characterized by stories of abuse. Also the transgenerational story of traumatic experiences of childbirth can have an important impact on the development of pathological anxiety states concerning pregnancy and childbirth itself.
We are now talking about the emotional, social impact and the health of people. What are the effects of tocophobia on the mental and emotional health of the woman during pregnancy?
Tocophobia can have an important impact on mental health of the woman who is affected and determine important consequences during pregnancy. The patient can experience symptoms such as constant anxiety, panic attacks, insomnia, nervousness, lowering of the mood. In extreme cases these symptoms can lead to the decision of the interruption of pregnancy itself.
On other occasions this condition can induce persistent anxious states or important major depressive reactions in the woman with potential negative repercussions also on the fetus (through the activation of hormonal and inflammatory mechanisms) and on the mother-child relationship in the post-partum.
Can it influence the choices relating to childbirth, such as preference for an elective cesarean? What are the medical implications of these choices?
Tocophobia can influence the choice relating to childbirth. It can in fact lead to the request of a Caesarean birth And in such situations a psychological or psychiatric certification is often required to certify the need for this procedure in order to allow the woman to face childbirth with lower risks for their mental and physical health.
How can close people – partners, family members, health professionals – contribute to improving the experience of a woman who suffers from tocophobia?
The most correct approach by people who are close to those suffering from tocophobia is obviously to understand and welcome the discomfort reported by the woman who suffers from a problem of this type and not to underestimate or neglect this form of disorder of anxiety. The goal is to ensure that the woman who suffers from tocophobia can receive a adequate help of psychological type that can effectively treat this type of fear.
Also by the health personnel There is often ignorance compared to this issue with the risk of the impossibility of the woman to take advantage of the appropriate psychological or psychiatric care. Sometimes for the same reason, the choice of cesarean delivery is also precluded with negative consequences for the mental health of the woman.
What therapeutic strategies are more effective in the treatment of tocophobia? Are there paths that combine psychological support and obstetric accompaniment?
In literature, studies concerning interventions for tocophobia are still limited, but in any case, different treatment possibilities are available. There are types of types psychoeducative concerning the birth process that can also be paid by obstetric staff and that allow to offer reassurance to future mothers and provide them with the information necessary to face birth with greater awareness and tranquility.
Then there are psychotherapeutic paths mainly of address cognitive-behavioral (CBT) which can be short -lived and which generally provide for a cognitive renovation of thoughts and consequent negative emotions relating to childbirth with the description of the expectations of childbirth and remodeling of the same with the aim of achieving greater control and serenity compared to the event itself .
The learning, moreover, of relaxation techniques such as deep breathing, meditation or perinatal yoga allow patients to reduce general anxiety levels and the stress related to labor.
Finally, there is the possibility of more specific interventions such as theEMDR (Eye Movement Desensitization Reprocessing) Above all if traumatic aspects associated with the fear of childbirth were present.
What message would you feel like giving women who face pregnancy with fear of childbirth?
We must not feel ashamed for any negative emotions regarding pregnancy and childbirth. As we have seen, they are rather frequent conditions in the general population and that can be addressed and resolved. To do this, the first fundamental step is that of ask for help to mental health professionals such as psychologists or therapists with specific skills on the Perinatal. When the fear of childbirth goes beyond a physiological fear associated with pregnancy and manifests itself as a deeper discomfort, it is important to face it without fear and through the help of expert professional figures.
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