Tokophobia: An unreasoning dread of childbirth

Abstract

Four women achieved their ideal delivery, Four women achieved their ideal delivery, bonded well with their babies and enjoyed bonded well with their babies and enjoyed excellent psychological health. Three excellent psychological health. Three women endured vaginal deliveries against women endured vaginal deliveries against their will; all three suffered postnatal de-their will; all three suffered postnatal depression , two suffered symptoms of PTSD pression, two suffered symptoms of PTSD and two had delayed bonding with their in-and two had delayed bonding with their infants. One woman chose to deliver vagin-fants. One woman chose to deliver vagin-ally despite her intense fears (she was also ally despite her intense fears (she was also terrified of needles, hospitals and doctors). terrified of needles, hospitals and doctors). She had an emergency LSCS, and suffered She had an emergency LSCS, and suffered postnatal depression. postnatal depression. Secondary tokophobia Secondary tokophobia Secondary tokophobia occurs after a trau-Secondary tokophobia occurs after a traumatic or distressing delivery. Fourteen matic or distressing delivery. Fourteen women in the sample had developed a women in the sample had developed a dread of childbirth after a previous deliv-dread of childbirth after a previous delivery. Ten had experienced instrumental or ery. Ten had experienced instrumental or operative deliveries for foetal distress; two operative deliveries for foetal distress; two others had suffered severe pain and perineal others had suffered severe pain and perineal tearing. Twelve stated that during the deliv-tearing. Twelve stated that during the delivery they believed that they would die or ery they believed that they would die or that the baby had already died. Maternal that the baby had already died. Maternal morbidity was evident and undetected for morbidity was evident and undetected for many months in ten women (see Table 2). many months in ten women (see Table 2). One woman who accidentally conceived One woman who accidentally conceived again organised a termination of pregnancy again organised a termination of pregnancy rather than face another delivery. The di-rather than face another delivery. The dilemma for these women was that the family lemma for these women was that the family felt incomplete but the women were terri-felt incomplete but the women were terrified of a further delivery. fied of a further delivery. Nevertheless, 13 of these women pro-Nevertheless, 13 of these women proceeded with further pregnancies. Eight were ceeded with further pregnancies. Eight were planned where a sibling was wanted for the planned where a sibling was wanted for the first baby. Two women suffered miscar-first baby. Two women suffered miscarriages (before going on to complete a preg-riages (before going on to complete a pregnancy to term) and one had an ectopic nancy to term) and one had an ectopic pregnancy; all three felt enormous relief pregnancy; all three felt enormous relief when these pregnancies did not result in when these pregnancies did not result in delivery. All 13 women were extremely delivery. All 13 women were extremely anxious during their pregnancies with the anxious during their pregnancies with the recurrent, intrusive belief that they were recurrent, intrusive belief that they were unable to deliver their babies (see Table 3). unable to deliver their babies (see Table 3). Eleven women were seen in the post-Eleven women were seen in the post-natal period; two were still pregnant but natal period; two were still pregnant but had arranged an LSCS (see Table 4). Nine had arranged an LSCS (see Table 4). Nine of the postnatal women arranged an LSCS, of the postnatal women arranged an LSCS, all felt that they had avoided the fearful all felt that they had avoided the fearful situation of situation of tokos tokos. Two women had not. Two women had not obtained an operative delivery: one had obtained an operative delivery: one had had a successful vaginal delivery and good had a successful vaginal delivery and good psychological outcome, although she psychological outcome, although she retained residual symptoms of PTSD from retained residual symptoms of PTSD from her first delivery; the other suffered post-her first delivery; the other suffered post-natal depression, PTSD and a bonding dis-natal depression, PTSD and a bonding disorder with her baby. One woman was order with her baby. One woman was separated at birth from her baby, who separated at birth from her baby, who was ill. She suffered bonding delay. was ill. She suffered bonding delay. Tokophobia as a symptom of Tokophobia as a symptom of depression depression Four women developed a phobic dread and Four women developed a phobic dread and avoidance of avoidance of tokos tokos as a symptom of depres-as a symptom of depression in the prenatal period. In each woman sion in the prenatal period. In each woman this was characterised by a recurrent intru-this was characterised by a recurrent intrusive belief that she was unable to deliver her sive belief that she was unable to deliver her baby and, if made to, would die. Of these baby and, if made to, would die. Of these four women, the first two were primipar-four women, the first two were primipar-ous; both felt shocked at the realisation of ous; both felt shocked at the realisation of pregnancy and both became depressed. pregnancy and both became depressed. One sought a termination of pregnancy One sought a termination of pregnancy even though the pregnancy was planned. even though the pregnancy was planned. The other began to exercise strenuously in The other began to exercise strenuously in the hope of inducing a miscarriage rather the hope of inducing a miscarriage rather than endure a vaginal delivery. Both were than endure a vaginal delivery. Both were treated psychologically and recovered spon-treated psychologically and recovered spontaneously in the middle trimester of preg-taneously in the middle trimester of pregnancy. The second two women already nancy. The second two women already had children; both had experienced vaginal had children; both had experienced vaginal deliveries that they perceived as untrau-deliveries that they perceived as untrau-matic. Both of these subsequent pregnan-matic. Both of these subsequent pregnancies were planned. In the context of cies were planned.