2002 International International Biennial Scientific Meeting

TOKOPHOBIA: A PROFOUND DREAD AND AVOIDANCE OF CHILDBIRTH. A REVIEW

Kristina Hofberg

Psychiatrist, South Staffordshire Healthcare NHS Trust, UK

kristina.hofberg@virgin.net

Tokophobia is not a modern day phenomenon. Fear of parturition was described by Marce in 1858. Women still suffer the fear of pain and death during childbirth. When this precedes pregnancy and is so intense that childbirth is avoided, it is a phobic state called tokophobia.

Proposed aetiology of tokophobia

• Social culture - the nature of childbirth as pain and punishment in religion.
• Kitchen culture - learning as children from a mother's experiences.
• Theories of anxiety - expectations of delivery are relevant to a woman's experience of and behaviour during delivery.
• Childhood sexual abuse - the trauma of vaginal delivery or even the contemplation of it, may cause a resurgence of distressing memories.

Classification and nature of the disorder

• Primary tokophobia - dread of childbirth pre-dates the first conception.
• Secondary tokophobia - occurs after a previous delivery.
• Tokophobia may present as a symptom of depression.

Prevalence of tokophobia: Fear of childbirth is common in pregnant women but may be disabling in up to 6%. Up to 13% of non gravid women report fear sufficient to postpone or avoid pregnancy.

Treatment studies: Hypnosis, psychoprophylaxis, counselling, short term psychotherapy and extra obstetric support have all been investigated in pregnant women dreading childbirth. Investigations of nulliparous, non gravid women terrified of childbirth are not available.

Conclusion: Tokophobia is a harrowing condition. Women may present to an obstetrician demanding Caesarean Section without obvious medical indication. They may request TOP or sterilisation when the fear is parturition not parenting. Refusal of delivery of choice may cause further psychological trauma. They may be more vulnerable to PTSD and PND.

Further research utilising intervention studies is urgently needed. Until then, tokophobia needs recognition and close liaison between the obstetrician and the psychiatrist to assess the balance between surgical and psychological morbidity.