INTRODUCTION:

Pregnancy and childbirth are a major life process for women. Childbirth is an outstanding life event for every woman. It is considered as normal to experience concern or anxiety to a certain degree, as it can help women to make ready for childbirth. But, if the fear becomes paralyzing and terrifying, it can turn out to be physically and emotionally disabling and give rise to a specific pathology termed as tocophobia. The aim of the present article is to analyze the tocophobic condition and to give a brief overview of the possible approaches currently available to mitigate the tocophobic condition¹.

History/Terminology:

It is also known as “maieusiophobia” or “parturiphobia.” It was first described in literature by Knauer in 1897.

The term tokophobia was introduced in the medical literature in 2000. The word is from the Greek tokos, meaning childbirth and phobos, meaning fear It is also known as "maleusiophobia" (though this is certainly a variant of "maieusiophobia", from the Greek "maieusis", literally meaning "delivery of a woman in childbirth" but referring generally to midwifery), "parturiphobia" (from Latin parturire, meaning "to be pregnant"), and "lockiophobia"²

Definition

Tokophobia (also known as maieusiophobia or parturiphobia) is insignificant to extreme fear of childbirth and/or pregnancy which can lead to avoidance of childbirth.³

Prevalence of tocophobia:

Around 5-15% pregnant females are affected by this phenomenon.

Tokophobia can be of two types, primary and secondary,³

Primary tokophobia – intense, disabling fear of childbirth which predates the first birth experience: approximately 1 per 1000 Secondary tokophobia – as above, but as a result of/postdates the first birth experience: approximately 1-3% of postnatal women⁴

Factors associated with tokophobia.

1. Anxiety

2. Depression

3. Pre-existing psychiatric disorder

4. Interpersonal Relationships

5. History of abuse

6. History of previous traumatic obstetric event

7. First Pregnancy

8. Low Self-esteem³

Effect of tokophobia on pregnancy:

1. Intrauterine growth retardation

2. Low birth weight

3. Prematurity or Post-datism

4. Changes in the fetal heart rate

5. Uterine Artery dysfunction³

Type of Tokophobia:

There are four types of tokophobia.

1. Fear of the unknown: Mothers may feel terrified during labour because they fear

not knowing and desire to influence what will happen. Mothers could feel ineffective and uncertain about their abilities to give birth, for instance.

2. Dislike of pain: Although there are several ways to reduce labour pain, first-time

Mothers frequently fear it. Meditation, breathing techniques, and prenatal classes can all be helpful. Women who can relax and feel in control experience less pain.

3. Fear of procedures during childbirth:

Controlling your fear of childbirth requires that you have a thorough understanding of what labour entails and some technical information to help you relax while you are pregnant. Some cures include feeling in control and aware of what is happening. By attending childbirth classes, doing prenatal yoga, reading literature about childbirth, and interacting with the medical team, women can achieve this.

4. Fear of slipping out of control: It’s important for women to have emotional and familial support and to convey their needs to their doctors as the pregnancy progresses because uncertain, they may get worse. Depending on the woman’s experience level, normal childbirth can last anywhere from 8 hours on average to12 to 24hours for a primipara. There is plenty of time to get to the hospital as result. Doctors will reassure the woman that competent and knowledgeable medical professionals will be on hand.⁵

Causes:

Some factors that may contribute to its development of tokophobia can include:

· Fear of the unknown, loss of control and privacy.

· Having a history of anxiety, depression, or childhood sexual abuse (Bhatia, M. S., and Jhanjee, A., 2012).

· Fear of pain. Fear for the life of the infant and/or a lack of trust in medical practitioners.

· Hormonal changes that make it harder to manage anxiety.

· Psychosocial factors like getting pregnant at a young age, being impoverished, or lack of social support.

· Hearing traumatic birth stories from friends or on social media.

· Fear of birth-related complications, such as preeclampsia and death (Bhatia, M. S., and Jhanjee, A., 2012).

· Uncertainty over the labor and birth process.⁶

Diagnosis approaches used to determine childbirth anxiety:

1. W-DEQ A and W-DEQ B: A set of questionnaires or clinical interviews can be used to measure pregnancy fearW-DEQ A and W-DEQ B are the most widely used instruments for determining how tough a situation is. The 33 questions on the surveys are evaluated on a Likert scale (from 0 to 6) to gauge how women feel about giving birth. Future (W-DEQ A) and postnatal period evaluation of postnatal experiences (WDEQB). High fear of labour is indicated by a score above 66, and severe fear is indicated by a score above 85

2. Fear of Birth Scale (FOBS): The Fear of Birth Scale (FOBS) is a therapeutic assessment used to assess high levels of birth anxiety. The FOBS gauges how much anxiety women are feeling about their imminent birth using a visual analogue scale.

3. Oxford Worries about Labour Scale (OWLS): The OWLS measures women's worries about labour and delivery as wells their experiences with maternity care in England as part of an extensive study 4. Slade-Pais Expectations of Childbirth Scale SPECS): The Slade-Pais Expectations of Childbirth Scale measures women’s expectations for childbirth (SPECS).⁷

Management the fear of childbirth (FOC):

There are few therapies or classes to manage or overcome the tokophobia patient.

1. Psychological or emotional preparation during pregnancy:

One of the most important elements in conquering the fear of child birth is psychological lor emotional preparation during pregnancy, especially in the final trimester. Most women have negative opinions of childbirth, which typically include that it isquite painful. In order to learn to control their thoughts and emotions, which get more intense as the time for delivery approaches, pregnant women are recommended to learn about birth, how contractions function, and how they will feel at various stages of pregnancy. Developing self-control over one's body and realising that pain felt during labour is distinct from pain felt elsewhere are further recommendations.

2. Classes on childbirth education/childbirth education classes:

These classes are served psycho educational resource for women who are expecting to become a mother. Inthesecourses, womengainusefulknowledgeaboutlabour, managingcontractions, positionsofacilitate labour, types of anesthesia, types of medical birth procedures, and the justifications forwhy they might be required, as well as about breathing, relaxation, and massage techniques to manage labour as effectively as possible. Additionally, these courses cover perineal massagetechniques to improve tissue elasticity and muscle tone as well as practical exercises for strengthening the perineal muscles.

3. Haptonomy:

Another strategy for conquering birth fear is haptonomy. Emotional touch is emphasized in this strategy. According to studies, these emotional encounters promote a sense of fulfillment and wellbeing.

4. By touching the womb:

The mother establishes conscious touch, recognizes the fetus, and creates a secure relationship by placing her hands on the womb. Using this technique, the mother’s and/or father's hands must be put on the baby’s belly in order to observe the baby’s responses to their touches. The parents often touch the tummy with more than just their fingertips, moving their handover it. The movements of the fetus must be attended to concurrently by the parents. It is recommended that parents talk to their kids. The voices of the mother and father are also a part of this method. The fetus will benefit from feeling more at ease, supported, and in control as well as from being led and having a reduced heart rate during birth, which will help the baby be placed correctly for labour and eventual delivery.

5. Prenatal psychological counseling:

This counseling aims to make pregnant women more comfortable in their own skin, lessen emotional pregnancy symptoms like prenatal anxiety, stress, and depression, activate maternal coping mechanisms, make the fetus mentally and emotionally available, and enhance mother-fetal attachment. Some of the techniques used in prenatal psychological therapies include breathing exercises, relaxation techniques, guided meditations, art therapy, and the letter technique (writing a message to the baby or another woman who is scared of giving birth).

6. Psychoeducation:

The purpose of behavioral techniques is to help the person explore other approaches to the issue and change how they see the world. These strategies and processes to produce desired behavioral change include systematic, psychological, educational, and other methods and techniques. Behavioral strategies can include making an action plan for the current situation while using problem-solving approaches. Psychoeducation provides opportunities for learning as well as for establishing a safe environment, expressing emotions, sowing seeds of hope, developing self recognition, and developing new learning strategies.⁸

Medical management:

Antidepressants:

These medications balance brain chemicals responsible for regulating mood⁹

Role of nurse in Tokophobia:

Types of interventions:

We will consider any non‐pharmacological antenatal intervention affecting levels of FOC in women. Non‐pharmacological approaches consist of psychosocial and psychological interventions (e.g., behavioural and educational strategies), physical exercise interventions (e.g., mind‐body interventions like mindfulness, relaxation, yoga and Pilates) and therapeutic interventions (e.g., music and art therapy). Psychosocial interventions include diverse supportive interactions, examples of psychological interventions include CBT and psychotherapy. Psychosocial and psychological interventions may be delivered in group or individual sessions, face‐to‐face, or by telephone, or via the Internet. The intervention may be delivered by a trained professional (e.g., psychiatrist, psychologist, social worker, midwives or obstetricians) or by a trained lay person or a trained therapist (art or music therapist), Any type, frequency and duration of intervention will be considered in both clinical and non‐clinical settings.¹⁰

REFERENCE:

1. https://www.ijrcog.org › ijrcog › article › view

2. https://en.wikipedia.org › wiki › Tokophobia

3. https://www.researchgate.net publication 36238854...

4. https://www.gvhealth.org.au uploads 2023/08

5. https://ijip.in › uploads › 18.01.299.20231104.pdf

6. https://ijip.in › uploads › 18.01.299.20231104.pdf

7. https://www.researchgate.net publication 36521617...

8. https://www.researchgate.net publication 36521617...)

9. https://my.clevelandclinic.org health diseases 227...

10. https://www.ncbi.nlm.nih.gov articles PMC6496976

Received on 19.03.2024 Modified on 25.04.2024

A and V Pub Int. J. of Nursing and Medical Res. 2024; 3(3):135-137.

DOI: 10.52711/ijnmr.2024.31

Tocophobia: Mind-Boggling Fear of Pregnancy and Childbirth

Role of nurse in Tokophobia:

Types of interventions: