Understanding tokophobia phenomenon as a key to proper management

Abstract: Tokophobia also known as fear of childbirth (FOC) becomes a frequent psychiatric indication to Caesarean section which makes it a rising problem of current obstetrics. Patients with FOC may suffer from additional psychiatric conditions such as depression. Women with higher risk of developing tokophobia are those with immense levels of fear of pain, young, with low educational level, poor socio-economic status, low self-esteem and lack of proper knowledge concerning peripartum period. History of unfortunate events during previous deliveries or illness of the older child are also associated with more frequent occurrence of FOC. Adequate management of FOC focuses on implementing psychotherapy. Symptoms of FOC can be decreased by means of qualified and trustworthy medical staff during labor or support from a closely related person. Secondary tokophobia can be prevented by minimalisation of negative experience during the first birth. If tokophobia is the symptom of depression, the underlying illness should be treated. Tokophobic patients are more prone to experience higher levels of pain during labor, which makes peripartum pain management harder for clinicians. FOC is one of the main reasons for performing caesarean delivery on maternal request (CDMR), which may lead to post-operative complications. Research shows that FOC is related to anxiety concerned with lower self-esteem due to changes occurring in women’s body during pregnancy and delivery. Learning and understanding the reasons behind tokophobia might lead to reducing the number of patients suffering from this condition and in consequence minimalizing the number of performed CDMR.

Authors:

Aleksandra Symonides,Izabella Mogilnicka, Katarzyna Krulak, Joanna Kacperczyk, Agnieszka Dobrowolska-Redo, Ewa Romejko-Wolniewicz

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